Prevalence and predictors of weight loss maintenance: a retrospective population-based survey of European adults with overweight and obesity.

BACKGROUND: The prevalence of weight loss attempts has increased worldwide, although the extent to which sustained weight loss is achieved is unknown. There is insufficient research into weight loss maintenance (WLM) in individuals with overweight or obesity who have recently lost clinically significant amounts of weight (≥5%), particularly in the European general population. The present study aimed to determine the prevalence and retrospective predictors of WLM in population-based samples of European adults with overweight or obesity who had made a recently completed weight loss attempt. METHODS: Participants (N = 2000) in UK, Denmark and Portugal completed an online survey about loss and regain in their most recent completed weight loss attempt, features of their attempt (duration, self-weighing, lapses, strategies), as well as loss of control and binge eating. Multiple regression analysis was used to determine factors retrospectively associated with WLM in those who achieved clinically significant weight loss (n = 1272). RESULTS: Mean (SD) self-reported weight loss was 9% (8%) and mean (SD) regain was 96.3% (9%) of participants' start weight. Twenty-three percent of the total sample had maintained weight loss of ≥5% for at least 1 month. Controlling for weight loss and time since attempt, predictors of better WLM were avoidance of a temporary lapse, infrequent/absent loss of control and binge eating, and use of a greater number of dietary strategies for WLM (r2  = 0.338, P < 0.001). PRINCIPAL CONCLUSIONS: Factors associated with recent successful WLM indicate the importance of the continued use of dietary and other strategies for WLM, particularly in the face of a lapse, as well as the need to manage dysfunctional eating behaviours.

Short- and long-term theory-based predictors of physical activity in women who participated in a weight-management program.

This study analyzed psychosocial predictors of the Theory of Planned Behavior (TPB) and Self-Determination Theory (SDT) and evaluated their associations with short- and long-term moderate plus vigorous physical activity (MVPA) and lifestyle physical activity (PA) outcomes in women who underwent a weight-management program. 221 participants (age 37.6 ± 7.02 years) completed a 12-month SDT-based lifestyle intervention and were followed-up for 24 months. Multiple linear regression analyses tested associations between psychosocial variables and self-reported short- and long-term PA outcomes. Regression analyses showed that control constructs of both theories were significant determinants of short- and long-term MVPA, whereas affective and self-determination variables were strong predictors of short- and long-term lifestyle PA. Regarding short-term prediction models, TPB constructs were stronger in predicting MVPA, whereas SDT was more effective in predicting lifestyle PA. For long-term models, both forms of PA were better predicted by SDT in comparison to TPB. These results highlight the importance of comparing health behavior theories to identify the mechanisms involved in the behavior change process. Control and competence constructs are crucial during early adoption of structured PA behaviors, whereas affective and intrinsic sources of motivation are more involved in incidental types of PA, particularly in relation to behavioral maintenance.

Matrix metalloproteinase gene polymorphisms: lack of association with chronic obstructive pulmonary disease in a Brazilian population.

There are many candidate genes for chronic obstructive pulmonary disease (COPD). One such candidate is the group of genes that code for matrix metalloproteinases (MMPs), which play an essential role in tissue remodeling and repair associated with COPD. We tested the hypothesis that polymorphic variation in MMP genes influences the risk of developing COPD by examining functional polymorphisms in the promoters of MMP-3, MMP-9 and MMP-12 genes in 111 COPD patients and 101 controls. The -1171 5A/6A MMP-3, -1562 C/T MMP-9 and -82 A/G MMP-12 polymorphisms were analyzed by polymerase chain reaction, followed by restriction digestion. No significant differences were observed in allele and genotype frequencies between COPD patients and controls. Haplotype analysis also did not reveal differences between COPD patients and controls. We found that MMP polymorphisms had no significant impact on the risk of developing COPD in this Brazilian sample.

The NoHoW protocol: a multicentre 2×2 factorial randomised controlled trial investigating an evidence-based digital toolkit for weight loss maintenance in European adults.

INTRODUCTION: Obesity and associated diseases place a severe burden on healthcare systems. Behavioural interventions for weight loss (WL) are successful in the short term but often result in weight regain over time. Self-regulation of eating and activity behaviours may significantly enhance weight loss maintenance (WLM) and may be effectively augmented by contextual behavioural approaches to emotion regulation. The NoHoW trial tests the efficacy of a theoretically informed, evidence-based digital toolkit using a mobile-enabled website, activity trackers and Wi-Fi scales for WLM aiming to target (1) self-regulation and motivation, and (2) emotion regulation in adults who achieved clinically significant (≥5%) WL in the previous 12 months (initial body mass index (BMI) ≥25 kg/m2). METHODS AND ANALYSIS: The study is an 18-month, 3-centre, 2×2 factorial single-blind, randomised controlled trial, which recruited 1627 participants achieving ≥5% WL between March 2017 and March 2018. Participants are randomly allocated to one of four arms: (1) self-monitoring only (self-weighing and activity tracker), (2) self-regulation and motivation, (3) emotion regulation or (4) combined self-regulation, motivation and emotion regulation. Participants attend four clinical investigation days at 0, 6, 12 and 18 months and are instructed to use the digital toolkit for 18 weeks during the first 6 months and at their discretion for the remaining 12 months. The primary outcome is change in weight (kg) at 12 months from baseline. Secondary outcomes are body composition (eg, bioimpedance analysis), health biomarkers (glycated haemoglobin, lipids, blood pressure, hair cortisol), dietary intake, physical activity, sleep, motivational, self-regulatory, emotion regulatory moderators/mediators of WLM, engagement, user experience, acceptability and cost-effectiveness of the interventions. ETHICS AND DISSEMINATION: Ethical approval was granted by Institutional Ethics Committees at the Universities of Leeds (17-0082; 27 February 2017), Lisbon (17/2016; 20 February 2017) and Capital Region of Denmark (H-16030495, 8 March 2017). Results will be published in scientific journals. TRIAL REGISTRATION NUMBER: ISRCTN88405328.

The effect of control group selection in the analysis of risk factors for extended spectrum beta-lactamase-producing Klebsiella pneumoniae infections. A prospective controlled study.

The aim was to evaluate the effect of control selection on risk factor analysis for extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBL-KP) infections. Four contemporaneous case-control studies were conducted prospectively with 372 patients: Study 1 (ESBL-KP-infected vs non-infected); Study 2 (ESBL-KP-infected vs non-ESBL-KP-infected); Study 3 (all KP-infected vs non-infected); Study 4 (non-ESBL-KP-infected vs non-infected). Time at risk (TAR, i.e. duration of hospital stay) was the most significant risk factor [Study 1: odds ratio (OR): 5.74 (95% CI: 2.26-14.59; P<0.001); Study 2: 3.52 (1.47-8.43; P=0.005); Study 3: 2.68 (1.57-4.58; P<0.001)]; central venous catheterisation (CVC) was a risk factor in Study 1: 5.31 (1.67-16.82; P=0.005) and Study 3: 2.10 (1.04-4.27; P=0.04). Prior use of cephalosporins (PUC) was a risk factor only in studies with non-infected patients as controls [Study 1: 5.64 (1.90-16.72; P=0.002) and Study 3: 4.60 (2.09-10.13; P<0.001)]. The ORs were uniformly lower with 'non-ESBL-KP-infected' (TAR: 3.52; CVC: 2.07; PUC: 1.97) compared with 'non-infected' patients (TAR: 5.74; CVC: 5.31; PUC: 5.64) as control groups. Selection of control patients has a crucial role in the evaluation of risk factors for ESBL-KP infections. A consistent underestimation of the magnitude of the risk factors is observed when the control group is defined by the non-ESBL-KP-infected patients.

Changes in thoracic gas volume with air-displacement plethysmography after a weight loss program in overweight and obese women.

OBJECTIVE: This study was designed to compare measured and predicted thoracic gas volume (V (TG)) after weight loss and to analyze the effect of body composition confounders such as waist circumference (WC) on measured V (TG) changes. DESIGN: Prospective intervention study. SETTING: Outpatient University Laboratory, Lisbon, Portugal. SUBJECTS: Eighty-five overweight and obese women (body mass index = 30.0+/-3.5 kg/m(2); age = 39.0+/-5.7 years) participating in a 16-month university-based weight control program designed to increase physical activity and improve diet. METHODS: Body weight (Wb), body volume (Vb), body density (Db), fat mass (FM), percent fat mass (%FM) and fat-free mass (FFM) were assessed by air-displacement plethysmography (ADP) at baseline and at post-intervention (16 months). The ADP assessment included a protocol to measure V (TG) and a software-based predicted V (TG). Dual-energy X-ray absorptiometry (DXA) (Hologic QDR 1500) was also used to estimate FM, %FM and FFM. Maximal oxygen uptake (VO(2) max) was assessed with a modified Balke cardiopulmonary exercise testing protocol with a breath-by-breath gas analysis. RESULTS: Significant differences between the baseline and post-weight loss intervention were observed for body weight and composition (Vb, Db, %FM, FM and FFM), and measures of V (TG) (measured: Delta=0.2 l, P<0.001; predicted: Delta=0.01 l, P<0.010) variables. Measured V (TG) change was negatively associated with the change in the WC (P=0.008), controlling for VO(2) max and age (P=0.007, P=0.511 and P=0.331). Linear regression analysis results indicated that %FM and FM using the measured and predicted V (TG) explained 72 and 76%, and 86 and 90% respectively, of the variance in %FM and FM changes using dual-energy x-ray absorptiometry. CONCLUSIONS: After weight loss, measured V (TG) increased significantly, which was partially attributed to changes is an indicator of body fat distribution such as WC. Consequently, measured and predicted V (TG) should not be used interchangeably when tracking changes in body composition. The mechanisms relating the reduction of an upper body fat distribution with an increase measured V (TG) are worthy of future investigation.

Inadequate treatment of ventilator-associated pneumonia: risk factors and impact on outcomes.

Initial antibiotic therapy is an important determinant of clinical outcomes in ventilator-associated pneumonia (VAP). Several studies have investigated this issue, with conflicting results. This study investigated risk factors of inadequate empirical antimicrobial therapy and its impact on outcomes for patients with a clinical diagnosis of VAP. The primary outcome was adequacy of antimicrobial therapy. Secondary outcomes were duration of mechanical ventilation, hospital and intensive care unit (ICU) lengths of stay, and mortality due to VAP. Mean age was 62.9+/-15.2 years, mean APACHE (Acute Physiological Assessment and Chronic Health Evaluation) II score was 20.1+/-8.1 and mean MODS (Multiple Organ Dysfunction Score) was 3.7+/-2.5. Sixty-nine (45.7%) of 151 patients with a clinical diagnosis of VAP received inadequate antimicrobial treatment for VAP initially. There were 100 (66.2%) episodes of VAP caused by multidrug-resistant pathogens, of which 56% were inadequately treated, whereas the rate of inadequate antimicrobial therapy for VAP caused by susceptible-drug pathogens was 25.5% (P<0.001). Multiple logistic regression analysis revealed that the risk of inadequate antimicrobial treatment was more than twice as great for patients with late-onset VAP [odds ratio (OR), 2.93; 95% confidence interval (CI), 1.30-6.64; P=0.01], and more than three times for patients with VAP caused by multidrug-resistant pathogens (OR, 3.07; 95% CI, 1.29-7.30; P=0.01) or with polymicrobial VAP (OR, 3.67; 95% CI, 1.21-11.12; P=0.02). Inadequate antimicrobial treatment was associated with higher mortality for patients with VAP. Two of three independent risk factors for treatment inadequacy were associated with the isolation and identification of micro-organisms.

Prevalence of personal weight control attempts in adults: a systematic review and meta-analysis.

The purpose of this systematic review and meta-analysis was to estimate the prevalence of personal weight control attempts (weight loss and/or maintenance) worldwide and to identify correlates, personal strategies used and the underlying motives. We included epidemiological/observational studies of adults (≥18 years) reporting prevalence of weight control attempts in the past-year. Seventy-two studies (n = 1,184,942) met eligibility criteria. Results from high quality studies showed that 42% of adults from general populations and 44% of adults from ethnic-minority populations reported trying to lose weight, and 23% of adults from general populations reported trying to maintain weight annually. In general population studies, higher prevalence of weight loss attempts was observed in the decade of 2000-2009 (48.2%), in Europe/Central Asia (61.3%) and in overweight/obese individuals and in women (p < 0.01). Of the 37 strategies (grouped in 10 domains of the Oxford Food and Activity Behaviours Taxonomy) and 12 motives reported for trying to control weight, exercising and dieting (within the energy compensation and restraint domains, respectively) and wellbeing and long-term health were the most prevalent. To our knowledge, this is the first systematic review to investigate weight control attempts worldwide. Key strategies and motives were identified which have implications for future public health initiatives on weight control.

Sedentary behavior and compensatory mechanisms in response to different doses of exercise-a randomized controlled trial in overweight and obese adults.

BACKGROUND/OBJECTIVES: To examine compensatory changes in sedentary behavior (SB) and light-intensity physical activities (LIPA) in response to a 22-week exercise training program in overweight/obese adults; and to determine if different forms of exercise training and physical activity recommendations interact with these compensatory changes. SUBJECTS/METHODS: Eighty-nine overweight and obese individuals (body mass index (BMI): 25-34.9 kg/m2, 48% males), aged 18-50 years, were randomized into four intervention groups (strength, endurance, combined strength + endurance and physical activity recommendations) with a 25-30% caloric restriction of total daily energy expenditure for 22 weeks. Energy expenditure was measured by accelerometry before, during and after the program. RESULTS: LIPA increased significantly (P<0.001) after three months and at the end of intervention compared to baseline (pre: 281±9 min; 3 months: 303±9 min; post: 312±8 min). SB percentage decreased by 5.3 at the end of the intervention (P=0.002). No interactions were observed between groups or sexes. Significant correlations were found between SB and body weight, fat mass, android fat mass and lean body mass before and after the intervention (P<0.05). LIPA was also significantly correlated with all these body composition variables in the pre-intervention, but only correlated with body weight at the end of intervention. CONCLUSIONS: There were no compensatory changes after a combined exercise and diet program; where minutes in LIPA increased and %SB decreased after the program, without differences among exercise modes. Greater physical activity levels can contribute to a better percentage and distribution of body tissues.

Body fat measurement in adolescent athletes: multicompartment molecular model comparison.

OBJECTIVE: To assess the accuracy of air displacement plethysmography (ADP) and dual energy X-ray absorptiometry (DXA) per cent body fat (%BF) estimations in comparison with a reference five-compartment (5C) model used as the reference method. DESIGN: Cross-sectional study. SETTING: Outpatient University Laboratory, Lisbon, Portugal. METHODS: A total of 32 girls (age: 15.1+/-0.3 years) and 46 boys (age: 15.3+/-1.2 years) athletes were measured. Body volume was assessed by ADP; bone mineral content was assessed by DXA; and total-body water was assessed by deuterium dilution. Statistical analyses included examination of the coefficient of correlation (r), standard error of estimation (s.e.e.), slope, intercept, and pure error (p.e.) and the agreement between models. RESULTS: For boys and girls, differences between the 5C model and ADP %BF were 0.2 and 1.7% (r = 0.86 and 0.98, s.e.e.= 2.50 and 1.55%, p.e.=2.77 and 2.23%), respectively. Differences between the 5C model and DXA %BF were -1.0 and -3.7% (r = 0.85 and 0.91, s.e.e.= 2.60 and 2.91%, p.e.= 2.90 and 4.66%), for boys and girls, respectively. For girls, regression between ADP and DXA against the reference method did not differ from the line of identity (P > 0.05) while for boys differences were found (P < 0.05). Dual energy X-ray absorptiometry overestimated %BF, particularly in girls. For both genders, large limits of agreement were found between the reference method and both techniques, with the exception of ADP in female athletes. CONCLUSION: We conclude that the two techniques were not precise for individual %BF prediction, though ADP revealed better agreement for girls. However, considering all performance criteria for the mean group, our analysis highlights ADP as a valid and nonbiased tool for the evaluation of body composition in adolescent athletes.

Interactions of individual perceived barriers and neighbourhood destinations with obesity-related behaviours in Europe.

Perceived barriers towards physical activity and healthy eating as well as local availability of opportunities (destinations in the neighbourhood) are important determinants of obesity-related behaviours in adults. Little is known, however, about how these factors interact with the behaviours. Data were analysed from 5,205 participants of the SPOTLIGHT survey, conducted in 60 neighbourhoods in urban regions of five different countries across Europe. A virtual audit was conducted to collect data on the presence of destinations in each neighbourhood. Direct associations of, and interactions between, the number of individual perceived barriers and presence of destinations with obesity-related behaviours (physical activity and dietary behaviours) were analysed using multilevel regression analyses, adjusted for key covariates. Perceiving more individual barriers towards physical activity and healthy eating was associated with lower odds of physical activity and healthy eating. The presence of destinations such as bicycle lanes, parks and supermarkets was associated with higher levels of physical activity and healthier dietary behaviours. Analyses of additive interaction terms suggested that the interaction of destinations and barriers was competitive, such that the presence of destinations influenced obesity-related behaviours most among those perceiving more barriers. These explorative findings emphasize the interest and importance of combining objective (e.g. virtual neighbourhood audit) methods and subjective (e.g. individual perceived barriers collected in a survey) to better understand how the characteristics of the residential built environment can shape obesity-related behaviours depending on individual characteristics.

A review of psychosocial pre-treatment predictors of weight control.

Prompted by the large heterogeneity of individual results in obesity treatment, many studies have attempted to predict weight outcomes from information collected from participants before they start the programme. Identifying significant predictors of weight loss outcomes is central to improving treatments for obesity, as it could help professionals focus efforts on those most likely to benefit, suggest supplementary or alternative treatments for those less likely to succeed, and help in matching individuals to different treatments. To date, however, research efforts have resulted in weak predictive models with limited practical usefulness. The two primary goals of this article are to review the best individual-level psychosocial pre-treatment predictors of short- and long-term (1 year or more) weight loss and to identify research needs and propose directions for further work in this area. Results from original studies published since 1995 show that few previous weight loss attempts and an autonomous, self-motivated cognitive style are the best prospective predictors of successful weight management. In the more obese samples, higher initial body mass index (BMI) may also be correlated with larger absolute weight losses. Several variables, including binge eating, eating disinhibition and restraint, and depression/mood clearly do not predict treatment outcomes, when assessed before treatment. Importantly, for a considerable number of psychosocial constructs (e.g. eating self-efficacy, body image, self-esteem, outcome expectancies, weight-specific quality of life and several variables related to exercise), evidence is suggestive but inconsistent or too scant for an informed conclusion to be drawn. Results are discussed in the context of past and present conceptual and methodological limitations, and several future research directions are described.

Comparison of air displacement plethysmography with dual-energy X-ray absorptiometry and 3 field methods for estimating body composition in middle-aged men.

This study was designed to compare air displacement plethysmography with dual-energy X-ray absorptiometry (DXA) and 3 other field methods for estimation of body composition. Subjects were 62 healthy, white men aged 37.6+/-2.9 y (weight: 81.8+/-11.3 kg; height: 171.5+/-4.9 cm). Body composition was also assessed by using body mass index, single-frequency bioelectrical impedance analysis, multi-frequency bioelectrical impedance spectroscopy, and the skinfold-thickness equations of Jackson and Pollock and Durnin and Womersley. Percentage body fat (%BF) with the plethysmograph was 23.4+/-7.0 and with DXA was 26.0+/-7.4. The 2.6% mean difference was significant (P< 0.05). Total error was 3.7%BF. As assessed by multiple regression analysis, %BF with the plethysmograph, age, weight, and height yielded a DXA-adjusted R2 value of 89.5% fat and an SEE of 2.4% fat. All other models had higher SEEs and lower adjusted R2 values: 4.3% and 66.5% for body mass index, 3.3% and 79.8% for bioelectrical impedance analysis, 3.6% and 76.2% for bioelectrical impedance spectroscopy, 3.7% and 74.55% for the equations of Jackson and Pollock, and 3.9% and 71.6% for the equations of Durnin and Womersley, respectively. The plethysmograph also predicted fat mass and fat-free mass more accurately than all other models, with a lower SEE and higher adjusted R2 value. In conclusion, although %BF was systematically underestimated, body composition was closely estimated with air displacement plethysmography in middle-aged men.

Receiver operating characteristic analysis of body mass index, triceps skinfold thickness, and arm girth for obesity screening in children and adolescents.

BACKGROUND: Valid and practical methods based on health-related criteria for obesity screening in children and adolescents are not available. Arbitrarily defined body mass index (BMI) cutoffs have been proposed to select adolescents at high risk of developing obesity in adulthood. OBJECTIVE: We assessed the usefulness of BMI, triceps skinfold thickness, and upper arm girth for screening for obesity by using a health-related definition of obesity (> or = 25% body fat in boys and > or = 30% body fat in girls) and a criterion method (dual-energy X-ray absorptiometry) that estimates percentage fat without the potential bias associated with other methods in adolescents. DESIGN: This was a cross-sectional study of Portuguese boys (n = 165) and girls (n = 163) aged 10-15 y. Nonparametric receiver operating characteristic (ROC) analysis was used to define the best tradeoff between true-positive and false-positive rates. RESULTS: True-positive rates ranged from 67% to 87% and from 50% to 100% in girls and boys, respectively, and false-positive rates ranged from 0% to 19% and from 5% to 26%, respectively. For children aged 10-11 y, the areas under the curves (AUCs) for ROCs, an index of diagnostic accuracy, were close to 1.0, suggesting very good accuracy. For older boys and girls, AUCs for triceps skinfold thickness were similar to or greater than AUCs for BMI and upper arm girth. CONCLUSIONS: The results suggest that triceps skinfold thickness gives the best results for obesity screening in adolescents aged 10-15 y. BMI and upper arm girth were reasonable alternatives, except in 14-15-y-old boys, in whom both indexes were only marginally able to discriminate obesity.

Assessing body composition and changes in body composition. Another look at dual-energy X-ray absorptiometry.

Dual-energy X-ray absorptiometry (DXA) is selected with increasing frequency as a method for both assessing body composition and measuring the changes in body composition. Issues have been raised about hydration, software version, hardware (fan beam vs. pencil beam), and the subject population in relation to the validity of DXA-derived estimates of body composition. This paper reviews validation studies of DXA to assess the impact of recent developments in its technology. Studies by Prior et al., Kohrt et al., Salamone et al., Going et al., and Pietrobelli et al. demonstrate the effectiveness of DXA estimates of changes in body composition. By contrast, Clasey et al., Nelson et al., and Friedl et al. found limitations in DXA estimates of body composition and its changes. These contradictory conclusions were explored for threats to internal validity in each research study. From this analysis, two validation guidelines are recommended for use when evaluating estimates of body composition. When multicomponent models are used, it is essential that estimates of body water as a fraction of fat-free mass fall in the expected range (71 to 75%) and have a relatively small standard deviation (2 to 3%). For measuring changes in body composition, DXA estimates of total body mass must accurately reflect both baseline and posttreatment scale body weight estimates. Failure to meet these guidelines threatens the internal validity of the study and raises the likelihood of methodological discrepancies. Applying these criteria to DXA studies of body composition under review accounts for much of the contradictory conclusions among investigations.

Subcutaneous central fat is associated with cardiovascular risk factors in men independently of total fatness and fitness.

The purpose of this study was to analyze the single and independent associations of whole body composition and fat distribution with cardiovascular disease (CVD) risk factors and fitness in middle-aged men. Sixty-two healthy Caucasian men (37.6 +/- 2.9 yr, 81.8 +/- 11.3 kg, 171.5 +/- 4.9 cm) participated in the study. Dual-energy x-ray absorptiometry (DXA) was used to assess total and regional body composition. The triceps, biceps, midthigh, calf, subscapular, chest, abdominal and suprailiac skinfolds, and the waist, hip and midthigh circumferences, and sagittal diameter were estimated. Cardiovascular fitness was estimated with a submaximal test. Bivariate and partial correlation analysis were used to study the association of total body percent fat (%fat), DXA trunk fat and trunk skinfolds (sum of subscapular, chest, abdominal, and suprailiac) and fitness with insulin, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), TC/HDL-C, low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), apolipoprotein AI (apo AI), apolipoprotein B (apo B), lipoprotein(a) [Lp(a)], and diastolic and systolic blood pressure. All anthropometric and DXA body composition variables were significantly correlated with TC/HDL-C (from .26 to .50, P < .05). Similar relationships were found for insulin, HDL-C, and systolic blood pressure (r from .26 to .47, P < .05). Cardiovascular fitness was significantly (P < .05) associated with insulin (r = -.36), HDL-C (r = .27), TC/HDL (r = -.27), and with systolic blood pressure (r = -.37). After controlling for trunk skinfolds, none of the anthropometric and DXA body composition variables were correlated with any of the CVD risk factors. Similarly, when controlling for trunk skinfolds, cardiovascular fitness was not related to any of the metabolic variables. After adjusting for %fat, DXA trunk fat, and cardiovascular fitness, trunk skinfolds remained significantly (P < .05) related to insulin (r = .35), HDL-C (r = -.40), TC/HDL-C (r = .43), and apo AI (r = -.39). In conclusion, this study suggests that subcutaneous truncal fat, as estimated by skinfolds, is an independent predictor of CVD risk factors, and that the association between cardiovascular fitness and these risk factors may be mediated by the levels of abdominal subcutaneous fat in Caucasian middle-aged men.

Usefulness of age-adjusted equations to estimate body fat with air displacement plethysmography in male adolescent athletes.

This study was designed to examine the accuracy of air-displacement plethysmography (ADP) using Lohman's age-adjusted equations (Leq) and Siri's equation (Seq) in estimating body fat (BF) in male adolescent athletes, with the four-compartment (4C) model as reference. Subjects were 51 Caucasian boys (age, 15.5+/-1.2 years; weight, 71.0+/-11.9 kg; stature, 1.79+/-0.12 m). Comparison of means with the Wilcoxon test showed that BF estimates with Seq to be different from those with Leq and 4C model, (8.8+/-4.4 vs. 7.9+/-4.5 and 8.1+/-4.0 kg, respectively) ( p<0.001), suggesting an overestimation of BF. However, BF estimates with the Leq and with the 4C model were identical ( p>0.05). Estimates using Seq and Leq with the 4C model were similar, as shown by the 95% confidence intervals (-4.7-2.4 and -4.0-3.7, respectively). These findings suggest that in male adolescent athletes, the use of Leq improves estimates of BF by densitometry using ADP.

Relationship between absorptiometry and ultrasound measurements of abdominal subcutaneous fat tissue in postmenopausal women.

The purpose of this study was to describe the association of abdominal subcutaneous adipose tissue (SAT) as assessed by ultrasound with fat tissue in the abdomen, trunk, and other areas as measured by DXA in 101 postmenopausal Caucasian women (62.5 years; 27.3 kg/m(2); 43.0% body fat). Ultrasound SAT thickness was calculated with electronic calipers positioned at the skin-fat and fat-muscle computer screen interface, at the suprailiac (SUPT) and abdominal (ABDT) sites. Pearson correlation showed significant ( p<0.001) coefficients between SAT by DXA at both ABDT ( r=0.644) and SUPT ( r=0.537). Other DXA measurements were also associated ( p<0.001) with SAT assessed by DXA and ultrasound. In postmenopausal women, DXA estimates of subcutaneous and total adiposity are moderately associated with ultrasound measures of fat in the abdomen. Future research at our and other laboratories should clarify the clinical and practical significance of these findings.

Body surface area estimation and its impact on predicting appendicular skeletal muscle mass with a mechanistic model based on the Reference Man.

The purpose of this study was to analyze the difference between the equations presented by Du Bois and Du Bois (1916) and Livingston and Lee (2001), used to estimate body surface area (BSA) and its impact on predicting appendicular skeletal muscle mass (ASMM) in adults, using a model based on the Reference Man (Fuller et al. 1992). Subjects were 666 Caucasian women (44.3+/-15.2 years, 63.7+/-10.5 kg, 1.57+/-0.07 m, 26.0+/-4.3 kg/m(2)) and 316 Caucasian men (42.8+/-15.4 years, 79.8+/-12.5 kg, 1.72+/-0.07 m, 26.8+/-3.8 kg/m(2)). Dual-energy X-ray absorptiometry was used to assess fat mass and fat-free mass. Du Bois's and Livingston's BSA equations were used to calculate ASMM according to Fuller's method. As compared to the new Livingston equation, Du Bois's equation underestimated ( p<0.05) BSA in women (-0.08 m(2)) and in men (-0.06 m(2)). On the other hand, ASMM was overestimated in the arms, legs, and total body with Du Bois's equation. This effect was of greater magnitude in obese subjects.

Effect of a Pulmonary Rehabilitation Program on the levels of anxiety and depression and on the quality of life of patients with chronic obstructive pulmonary disease.

OBJECTIVE: To analyze the effect of a Pulmonary Rehabilitation Program (PRP) on the levels of anxiety and depression and the quality of life of patients with chronic obstructive pulmonary disease. METHOD: Patients with chronic obstructive pulmonary disease (COPD) who completed the PRP of 3 weekly sessions of 60 min duration for 12 weeks, a total of 36 sessions, were assessed using Beck Inventory (BAI and BDI) and Saint George's Respiratory Questionnaire (SGRQ). RESULTS: A total of 125 individuals, with an average age of 63.7 ± 8.8 years, FEV1: 1.17 ± 0.57L (43.18 ± 18.79% predicted), 61.6% male and 38.4% female, were analyzed. The BAI and BDI before and after PRP were, respectively, 10.15 ± 6.32 vs. 7.67 ± 7.21; p=0.0041 and 12.60 ± 7.99 vs. 8.96 ± 7.29; p=0.00016. The results of the SGRQ domains were, respectively, Before and After symptoms (48.53 ± 20.41 vs. 32.58 ± 18.95), Activity (69.15 ± 20.79 vs. 52.42 ± 23.70), Impact (32.92 ± 18.29 vs. 20.27 ± 16.70), Total (46.69 ± 16.90 vs. 32.07 ± 16.96). When correlating the BDI to the domains of the SGRQ, weak correlations were observed (Symptoms r=0.22; p=0.01; Activity r=0.28; p=0.001; Impact r=0.52; p=2.72; Total r=0.44; p=0.17). In the same way, weak correlations were observed when correlating the BAI to the SGRQ (Symptoms r=0.28; p=0.0009; Activity r=0.32; p=0.0005; Impact r=0.42; p=7.33; Total r=0.43; p=0.74). CONCLUSION: Although the PRP improves levels of depression and anxiety as well as the quality of life in patients with COPD, no significant correlation of these analyzed variables was observed.