Dietary Saturated Fat and Bone Health in Young Adults: The Young Finns Cohort.

Previous studies suggest that saturated fat (SFA) intake may negatively impact on bone. However, few human studies on the topic exist. Women and men aged 31-46 years from the Cardiovascular Risk in Young Finns study attended the peripheral quantitative computed tomography and ultrasound bone measurements in 2008 (n = 1884-1953, ~ 56% women). In addition, fracture diagnoses in 1980-2018 were searched for the national health care registers and 431 participants had at least one fracture. Food consumption was gathered with the 48-h dietary recall interviews and food frequency questionnaire in 1980-2007. In the present study, radial, tibial, and calcaneal bone traits, and fractures were examined relative to the long-term intake of SFA. No consistent associations were seen between bone outcomes and SFA intake that would have replicated in both women and men. The only evidence for differential distributions was seen in cortical density and cortical-to-total area ratio at the radial shaft, and speed of sound at the calcaneus, which were 0.1-0.4% higher in women in the lowest tertile of SFA intake compared with the highest tertile. In addition, among men, the odds ratio (OR) of fractures was greater in the second (OR 1.86, 95% confidence interval (CI) 1.03-3.33) and third tertile of SFA intake (OR 2.45, 95% CI 1.38-4.36) compared with the lowest tertile, independently of many risk factors of osteoporosis. In this observational study, we found no robust evidence of the associations of dietary long-term SFA intake with bone outcomes. Therefore, additional studies are needed to confirm the association of dietary SFA with bone health in humans.

The association of dietary animal and plant protein with putative risk markers of colorectal cancer in overweight pre-diabetic individuals during a weight-reducing programme: a PREVIEW sub-study.

PURPOSE: Diets with increased protein content are popular strategies for body weight regulation, but the effect of such diets for the colonic luminal environment is unclear. We aimed to investigate the associations between putative colorectal cancer-related markers and total protein intake, plant and animal proteins, and protein from red and processed meat in pre-diabetic adults (> 25 years). METHODS: Analyses were based on clinical and dietary assessments at baseline and after 1 year of intervention. Protein intake was assessed from 4-day dietary records. Putative colorectal cancer-related markers identified from 24-h faecal samples collected over three consecutive days were: concentration of short-chain fatty acids, phenols, ammonia, and pH. RESULTS: In total, 79 participants were included in the analyses. We found a positive association between change in total protein intake (slope: 74.72 ± 28.84 µmol per g faeces/E%, p = 0.01), including animal protein intake (slope: 87.63 ± 32.04 µmol per g faeces/E%, p = 0.009), and change in faecal ammonia concentration. For change in ammonia, there was a dose-response trend from the most negative (lowest tertile) to the most positive (highest tertile) association (p = 0.01): in the high tertile, a change in intake of red meat was positively associated with an increase in ammonia excretion (slope: 2.0 ± 0.5 µmol per g faeces/g/day, p < 0.001), whereas no such association was found in the low and medium tertile groups. CONCLUSION: Increases in total and animal protein intakes were associated with higher excretion of ammonia in faeces after 1 year in overweight pre-diabetic adults undertaking a weight-loss intervention. An increase in total or relative protein intake, or in the ratio of animal to plant protein, was not associated with an increase in faeces of any of the other putative colorectal cancer risk markers. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01777893.

Long-term effects of increased protein intake after weight loss on intrahepatic lipid content and implications for insulin sensitivity: a PREVIEW study.

The aim of this study was to assess the effects of a weight maintenance period comprising two diets differing in protein intake, after weight loss, on intrahepatic lipid content and implications for insulin sensitivity. A total of 25 participants [body mass index (BMI): 31.1 (3.5 kg/m2; intrahepatic lipid (IHL): 8.7 (8.3%; fasting glucose: 6.4 (0.6 mmol/l; homeostatic model assessment for insulin resistance (HOMA-IR): 3.7 (1.6; Matsuda index: 3.4 (2.9] started an 8-wk low-energy diet followed by a 2-yr weight maintenance period with either high protein or medium protein dietary guidelines. At baseline, after 6 mo, and after 2 yr, IHL, visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) were determined by magnetic resonance spectroscopy/imaging. Glucose and insulin concentrations, determined during an oral glucose challenge, were used to assess the HOMA-IR and Matsuda insulin sensitivity index (ISI). Protein intake was measured with 24-h urinary nitrogen excretion. Protein intake, BMI, IHL, VAT, SAT, HOMA-IR, and ISI did not change differently between the groups during the intervention. In the whole group, BMI, IHL, VAT, SAT, HOMA-IR, and ISI were favorably changed at 6 mo and 2 yr compared with baseline ( P < 0.05). Mixed-model analysis showed that independent of BMI, protein intake (g/d) at 6 mo was inversely related to IHL (coefficient: -0.04; P < 0.05) and VAT (coefficient: -0.01; P < 0.05). Overall, IHL was positively related to HOMA-IR (coefficient: 0.10; P < 0.01) and inversely related to ISI (coefficient: -0.17; P < 0.01), independent of BMI. A 2-yr medium- to high-protein energy-restricted diet reduced IHL and VAT. Independently of changes in BMI, IHL was inversely related to insulin sensitivity.

Sources of variability in childhood obesity indicators and related behaviors.

The purpose of this study was to describe sources of variability in obesity-related variables in 6022 children aged 9-11 years from 12 countries. The study design involved recruitment of students, nested within schools, which were nested within study sites. Height, weight and waist circumference (WC) were measured and body mass index (BMI) was calculated; sleep duration and total and in-school moderate-to-vigorous physical activity (MVPA) and sedentary time were measured by accelerometry; and diet scores were obtained by questionnaire. Variance in most variables was largely explained at the student level: BMI (91.9%), WC (93.5%), sleep (75.3%), MVPA (72.5%), sedentary time (76.9%), healthy diet score (88.3%), unhealthy diet score (66.2%), with the exception of in-school MVPA (53.8%) and in-school sedentary time (25.1%). Variance explained at the school level ranged from 3.3% for BMI to 29.8% for in-school MVPA, and variance explained at the site level ranged from 3.2% for WC to 54.2% for in-school sedentary time. In general, more variance was explained at the school and site levels for behaviors than for anthropometric traits. Given the variance in obesity-related behaviors in primary school children explained at school and site levels, interventions that target policy and environmental changes may enhance obesity intervention efforts.

Development of a nutrition knowledge questionnaire for young endurance athletes and their coaches.

Both athletes and coaches should have adequate nutrition knowledge to understand the importance of diet on athletic performance, recovery, and health. Nutrition knowledge can be assessed reliably only by validated knowledge questionnaires. The aim of this study was to develop a reliable and valid questionnaire for assessing the nutrition knowledge of young endurance athletes and their coaches. The questionnaire was developed with an expert panel and pilot tested by athletes, coaches, and students. Content, face, and construct validities both as test-retest reliability and internal consistency reliability were ensured when the current questionnaire was developed. Athletes (n = 16) and coaches (n = 13) pilot tested the 127-item questionnaire. After item analysis and proposals from the expert panel, 41 items were removed. Internal consistency of the 86-item questionnaire in the pilot study was 0.87, measured using Cronbach's α. Construct validity was evaluated by the difference in knowledge between nutrition (n = 20) and humanities students (n = 22). Nutrition students had significantly higher knowledge scores (P < .001). Test-retest reliability for all knowledge sections between those groups was 0.85 measured using Pearson's r. Final adjustments to the questionnaire were made on the grounds of feedback from the respondents and proposals from the experts (n = 6). These adjustments resulted in minor changes in the construct of the items, the layout of the questionnaire, and the removal of 7 items. The final questionnaire had 79 items. The questionnaire can be used to measure the overall nutrition knowledge of endurance athletes and their coaches and to find potential gaps in nutrition knowledge.

Burden of allergy diets in Finnish day care reduced by change in practices.

BACKGROUND: Nonessential allergy diets in children with mild symptoms may harm the development of immunological tolerance and impose a burden on families and day care. We aimed to reduce the high prevalence of allergy diets in day care by reforming the practices for inquiring about need of special diets from parents. METHODS: We developed a new special diet form and an information leaflet based on the new allergy guidelines. The new form was implemented into 40 Finnish day care centres in the capital region in 2013-2015. The questionnaires on practices concerning special diets in day care centres and allergy knowledge were collected from the personnel. RESULTS: After 2 years, the new special diet form was used by 64% of families with food-allergic children, and the prevalence of allergy diets in day care centres decreased by 43% to 4.3% (IQ range 3.05-5.96). A significant decrease was found in the prevalence of all basic (milk, grains, egg) and most other allergy diets (P for trend < 0.01). The new practice was well accepted by day care and kitchen personnel. Lack of updated allergy knowledge was noted among day care personnel. CONCLUSIONS: The burden of allergy diets in day care settings could be decreased by simple pragmatic changes based on current allergy guidelines. Old allergy attitudes persisted among day care personnel, indicating the need for continuous education.

Maximal strength, muscular endurance and inflammatory biomarkers in young adult men.

The aim was to study associations of maximal strength and muscular endurance with inflammatory biomarkers independent of cardiorespiratory fitness in those with and without abdominal obesity. 686 young healthy men participated (25±5 years). Maximal strength was measured via isometric testing using dynamo-meters to determine maximal strength index. Muscular endurance index consisted of push-ups, sit-ups and repeated squats. An indirect cycle ergometer test until exhaustion was used to estimate maximal aerobic capacity (VO2max). Participants were stratified according to those with (>102 cm) and those without abdominal obesity (<102 cm) based on waist circumference. Inflammatory factors (C-reactive protein, interleukin-6 and tumour necrosis factor alpha) were analysed from serum samples. Maximal strength and muscular endurance were inversely associated with IL-6 in those with (ß=-0.49, -0.39, respectively) (p<0.05) and in those without abdominal obesity (ß=-0.08, -0.14, respectively) (p<0.05) adjusted for smoking and cardio-respiratory fitness. After adjusting for smoking and cardiorespiratory fitness, maximal strength and muscular endurance were inversely associated with CRP only in those without abdominal obesity (ß=-0.11, -0.26, respectively) (p<0.05). This cross-sectional study demonstrated that muscular fitness is inversely associated with C-reactive protein and IL-6 concentrations in young adult men independent of cardiorespi-ratory fitness.

Associations of maximal strength and muscular endurance with cardiovascular risk factors.

The aim was to study the associations of maximal strength and muscular endurance with single and clustered cardiovascular risk factors. Muscular endurance, maximal strength, cardiorespiratory fitness and waist circumference were measured in 686 young men (25±5 years). Cardiovascular risk factors (plasma glucose, serum high- and low-density lipoprotein cholesterol, triglycerides, blood pressure) were determined. The risk factors were transformed to z-scores and the mean of values formed clustered cardiovascular risk factor. Muscular endurance was inversely associated with triglycerides, s-LDL-cholesterol, glucose and blood pressure (ß=-0.09 to - 0.23, p<0.05), and positively with s-HDL cholesterol (ß=0.17, p<0.001) independent of cardiorespiratory fitness. Muscular endurance was negatively associated with the clustered cardiovascular risk factor independent of cardiorespiratory fitness (ß=-0.26, p<0.05), whereas maximal strength was not associated with any of the cardiovascular risk factors or the clustered cardiovascular risk factor independent of cardiorespiratory fitness. Furthermore, cardiorespiratory fitness was inversely associated with triglycerides, s-LDL-cholesterol and the clustered cardiovascular risk factor (ß=-0.14 to - 0.24, p<0.005), as well as positively with s-HDL cholesterol (ß=0.11, p<0.05) independent of muscular fitness. This cross-sectional study demonstrated that in young men muscular endurance and cardiorespiratory fitness were independently associated with the clustering of cardiovascular risk factors, whereas maximal strength was not.

Effect of supervised and home exercise training on bone mineral density among breast cancer patients. A 12-month randomised controlled trial.

UNLABELLED: The ability of combined step aerobic- and circuit-training to prevent bone loss after breast cancer treatments was related to skeletal site and patients' menopausal status. Among premenopausal breast cancer survivors, a 12-month exercise intervention completely prevented bone loss at the femoral neck, whereas no exercise effect was seen at lumbar spine or at neither site in postmenopausal women. INTRODUCTION: The primary objective of this randomised clinical trial was to determine the preventive effect of supervised weight-bearing jumping exercises and circuit training on bone loss among breast cancer patients. METHODS: Of 573 breast cancer survivors aged 35-68 years randomly allocated into exercise or control group after adjuvant treatments, 498 (87%) were included in the final analysis. The 12-month exercise intervention comprised weekly supervised step aerobic- and circuit-exercises and similar home training. Bone mineral density (BMD) at lumbar spine and femoral neck were measured by dual-energy X-ray absorptiometry. Physical performance was assessed by 2-km walking and figure-8 running tests, and the amount of physical activity was estimated in metabolic equivalent-hours/week. RESULTS: In premenopausal women, bone loss at the femoral neck was prevented by exercise, the mean BMD changes being -0.2% among the trainees vs. -1.4% among the controls (p = 0.01). Lumbar bone loss could not be prevented (-1.9% vs. -2.2%). In postmenopausal women, no significant exercise-effect on BMD was found either at the lumbar spine (-1.6% vs. -2.1%) or femoral neck (-1.1% vs. -1.1%). CONCLUSIONS: This 12-month aerobic jumping and circuit training intervention completely prevented femoral neck bone loss in premenopausal breast cancer patients, whereas no effect on BMD was seen in postmenopausal women.

Grocery purchase data in the study of alcohol use - A validity study.

BACKGROUND: Alcohol use epidemiology is facing challenges as survey response rates decline. In addition, population surveys fail to capture a large proportion of alcohol consumed and are expensive to conduct. This study aims to aid in complementing traditional epidemiological methods by validate grocery purchase data in the research on population alcohol use. METHODS: The LoCard study subjects were loyalty card holders of a grocery retail co-operative, which possessed more than 45 % market share in Finland. One third of those who consented to the analyses of their grocery purchases were presented a questionnaire including a Food Frequency Questionnaire on the web; N = 11,818 responded. The relationship between beer purchase frequency and self-reported beer drinking frequency was studied for association and agreement in different subgroups using crosstabulations and Poisson regression modeling. RESULTS: The association between beer purchase frequency and self-reported beer drinking frequency was good (Gamma = .556). The agreement between beer purchase frequency and drinking frequency was only fair (Kappa = .189). Limiting the data to those single adult households that reported making at least 61 % of their grocery purchases from this grocery retailer and collapsing the frequency categories to three instead of six increased the agreement to good (Kappa = .463). CONCLUSIONS: Information on beer purchase frequency from the loyalty card database can be used to rank people according to their drinking frequency and to estimate beer drinking frequency with fair to good accuracy, depending on what share of grocery purchases they make from the grocery retailer in question.

Maintenance of exercise-induced benefits in physical functioning and bone among elderly women.

SUMMARY: This study showed that about a half of the exercise-induced gain in dynamic balance and bone strength was maintained one year after cessation of the supervised high-intensity training of home-dwelling elderly women. However, to maintain exercise-induced gains in lower limb muscle force and physical functioning, continued training seems necessary. INTRODUCTION: Maintenance of exercise-induced benefits in physical functioning and bone structure was assessed one year after cessation of 12-month randomized controlled exercise intervention. METHODS: Originally 149 healthy women 70-78 years of age participated in the 12-month exercise RCT and 120 (81%) of them completed the follow-up study. Self-rated physical functioning, dynamic balance, leg extensor force, and bone structure were assessed. RESULTS: During the intervention, exercise increased dynamic balance by 7% in the combination resistance and balance-jumping training group (COMB). At the follow-up, a 4% (95% CI: 1-8%) gain compared with the controls was still seen, while the exercise-induced isometric leg extension force and self-rated physical functioning benefits had disappeared. During the intervention, at least twice a week trained COMB subjects obtained a significant 2% benefit in tibial shaft bone strength index compared to the controls. A half of this benefit seemed to be maintained at the follow-up. CONCLUSIONS: Exercise-induced benefits in dynamic balance and rigidity in the tibial shaft may partly be maintained one year after cessation of a supervised 12-month multi-component training in initially healthy elderly women. However, to maintain the achieved gains in muscle force and physical functioning, continued training seems necessary.

Influence of weight reduction on muscle performance and bone mass, structure and metabolism in obese premenopausal women.

Muscle performance, body composition and bone mass at the lumbar spine and proximal femur with DXA, structural traits at the tibia and radius with pQCT, and biomarkers of bone metabolism were assessed at baseline and after a three-month weight reduction in obese premenopausal women. Associations between changes in weight loss and bone traits were analyzed by linear regression analysis. The mean (SD) weight loss was 4.3 (4.5) kg ranging from 14.8 kg loss to 2.1 kg gain. Muscle performance was well maintained, while no signs of bone loss or structural deterioration were observed. Changes in bone resorption were significantly associated with weight change (for CTX, r=-0.34; p=0.043, and for TRACP5b, r=-0.35; p=0.032). There were borderline (p<0.1) negative correlations between changes in biomarkers and bone traits. Reduced fat mass was associated with slight mean increase in cortical density of the radial shaft. Also total body BMC increased slightly. Changes in both fat and lean mass were associated with a change in BMC. Our findings suggest that mild-to-moderate weight reduction modulated bone turnover slightly, but they do not support the common notion that such a weight reduction would compromise bone rigidity, possibly partly due to well maintained muscle performance.

Twenty-five year socioeconomic trends in leisure-time and commuting physical activity among employed Finns.

The trend of socioeconomic differences in physical activity is largely unknown in Finland. In this study, we examined socioeconomic trends in leisure-time and commuting physical activity among Finns in 1978-2002. Nationwide data were derived from an annually repeated cross-sectional Finnish Adult Health Behavior Survey. People under the age of 25, students, the unemployed, and retirees were excluded from the analysis. The final data set included 25 513 women and 25 302 men. Socioeconomic variables included education, occupation, and household income. Odds ratios for being physically active and 95% confidence intervals were calculated. People with the lowest income were less leisure-time and commuting physically active. Among women, low occupational status was associated with high commuting physical activity whereas among men such an association was not found. No educational differences among men in leisure-time and commuting physical activity over time were found. Some indications were found that educational differences in leisure-time physical activity among women might have been reversed. Our data suggest that socioeconomic differences in leisure-time and commuting physical activity are quite small and have remained similar between 1978 and 2002.

Inequality in physical activity, sedentary behaviour, sleep duration and risk of obesity in children: a 12-country study.

OBJECTIVE: Studies examining associations between movement behaviours (i.e. physical activity, sedentary behaviour and sleep duration) and obesity focus on average values of these movement behaviours, despite important within-country and between-country variability. A better understanding of movement behaviour inequalities is important for developing public health policies and behaviour-change interventions. The objective of this ecologic analysis at the country level was to determine if inequality in movement behaviours is a better correlate of obesity than average movement behaviour volume in children from all inhabited continents of the world. METHODS: This multinational, cross-sectional study included 6,128 children 9-11 years of age. Moderate-to-vigorous physical activity (MVPA), total sedentary time (SED) and sleep period time were monitored over 7 consecutive days using waist-worn accelerometry. Screen time was self-reported. Inequality in movement behaviours was determined using Gini coefficients (ranging from 0 [complete equality] to 1 [complete inequality]). RESULTS: The largest inequality in movement behaviours was observed for screen time (Gini of 0.32; medium inequality), followed by MVPA (Gini of 0.21; low inequality), SED (Gini of 0.07; low inequality) and sleep period time (Gini of 0.05; low inequality). Average MVPA (h d-1) was a better correlate of obesity than MVPA inequality (r = -0.77 vs. r = 0.00, p = 0.03). Average SED (h d-1) was also a better correlate of obesity than SED inequality (r = 0.52 vs. r = -0.32, p = 0.05). Differences in associations for screen time and sleep period time were not statistically significant. MVPA in girls was found to be disproportionally lower in countries with more MVPA inequality. CONCLUSIONS: Findings from this study show that average MVPA and SED should continue to be used in population health studies of children as they are better correlates of obesity than inequality in these behaviours. Moreover, the findings suggest that MVPA inequality could be greatly reduced through increases in girls' MVPA alone.

Thresholds of physical activity associated with obesity by level of sedentary behaviour in children.

BACKGROUND: It is unknown whether moderate-to-vigorous physical activity (MVPA) thresholds for obesity should be adapted depending on level of sedentary behaviour in children. OBJECTIVE: The objective of the study is to determine the MVPA thresholds that best discriminate between obese and non-obese children, by level of screen time and total sedentary time in 12 countries. METHODS: This multinational, cross-sectional study included 6522 children 9-11 years of age. MVPA and sedentary time were assessed using waist-worn accelerometry, while screen time was self-reported. Obesity was defined according to the World Health Organization reference data. RESULTS: Receiver operating characteristic curve analyses showed that the best thresholds of MVPA to predict obesity ranged from 53.8 to 73.9 min d-1 in boys and from 41.7 to 58.7 min d-1 in girls, depending on the level of screen time. The MVPA cut-offs to predict obesity ranged from 37.9 to 75.9 min d-1 in boys and from 32.5 to 62.7 min d-1 in girls, depending on the level of sedentary behaviour. The areas under the curve ranged from 0.57 to 0.73 ('fail' to 'fair' accuracy), and most sensitivity and specificity values were below 85%, similar to MVPA alone. Country-specific analyses provided similar findings. CONCLUSIONS: The addition of sedentary behaviour levels to MVPA did not result in a better predictive ability to classify children as obese/non-obese compared with MVPA alone.

The adiposity of children is associated with their lifestyle behaviours: a cluster analysis of school-aged children from 12 nations.

BACKGROUND: The relationship between children's adiposity and lifestyle behaviour patterns is an area of growing interest. OBJECTIVES: The objectives of this study are to identify clusters of children based on lifestyle behaviours and compare children's adiposity among clusters. METHODS: Cross-sectional data from the International Study of Childhood Obesity, Lifestyle and the Environment were used. PARTICIPANTS: the participants were children (9-11 years) from 12 nations (n = 5710). MEASURES: 24-h accelerometry and self-reported diet and screen time were clustering input variables. Objectively measured adiposity indicators were waist-to-height ratio, percent body fat and body mass index z-scores. ANALYSIS: sex-stratified analyses were performed on the global sample and repeated on a site-wise basis. Cluster analysis (using isometric log ratios for compositional data) was used to identify common lifestyle behaviour patterns. Site representation and adiposity were compared across clusters using linear models. RESULTS: Four clusters emerged: (1) Junk Food Screenies, (2) Actives, (3) Sitters and (4) All-Rounders. Countries were represented differently among clusters. Chinese children were over-represented in Sitters and Colombian children in Actives. Adiposity varied across clusters, being highest in Sitters and lowest in Actives. CONCLUSIONS: Children from different sites clustered into groups of similar lifestyle behaviours. Cluster membership was linked with differing adiposity. Findings support the implementation of activity interventions in all countries, targeting both physical activity and sedentary time.

Stakeholder appraisal of policy options for responding to obesity in Finland.

The aim of the Finnish Policy Options for Responding to the Growing Challenge of Obesity Research Project study was to use a multi-criteria mapping method to assess stakeholder opinions on policies that might have relevance when planning policies targeting obesity prevention. When evaluating policies, criteria relating to 'Positive societal benefits' and 'Additional health benefits' were often considered important, along with the more obvious 'Efficacy in addressing obesity'. Other criteria (like economic factors) were of less importance. All policy options targeting at 'Educational and Research Initiatives' were highly ranked in the analysis by all stakeholders. Policies aimed at improving 'Food-Related Informational Initiatives' were also ranked well on average, although more variation between stakeholders existed. Policies targeting increased physical activity and easier access/provision to healthy foods received also relatively good rankings but with wide variation and doubts in the appraisals. Policies encouraging new technological innovations and institutional reforms were mostly ranked poorly and were not seen as solutions to obesity problem. Irrespective of the stakeholder group, it seems that while traditional educational policies were most highly ranked, several other policies are also viable options in the policy portfolio of obesity prevention.

Preventing excessive weight gain during pregnancy - a controlled trial in primary health care.

OBJECTIVE: To investigate whether individual counselling on diet and physical activity during pregnancy can have positive effects on diet and leisure time physical activity (LTPA) and prevent excessive gestational weight gain. DESIGN: A controlled trial. SETTING: Six maternity clinics in primary health care in Finland. The clinics were selected into three intervention and three control clinics. SUBJECTS: Of the 132 pregnant primiparas, recruited by 15 public health nurses (PHN), 105 completed the study. INTERVENTIONS: The intervention included individual counselling on diet and LTPA during five routine visits to a PHN until 37 weeks' gestation; the controls received the standard maternity care. RESULTS: The counselling did not affect the proportion of primiparas exceeding the weight gain recommendations or total LTPA when adjusted for confounders. The adjusted proportion of high-fibre bread of the total weekly amount of bread decreased more in the control group than in the intervention group (difference 11.8%-units, 95% confidence interval (CI) 0.6-23.1, P=0.04). The adjusted intake of vegetables, fruit and berries increased by 0.8 portions/day (95% CI 0.3-1.4, P=0.004) and dietary fibre by 3.6 g/day (95% CI 1.0-6.1, P=0.007) more in the intervention group than in the control group. There were no high birth weight babies (>or=4000 g) in the intervention group, but eight (15%) of them in the control group (P=0.006). CONCLUSIONS: The counselling helped pregnant women to maintain the proportion of high-fibre bread and to increase vegetable, fruit and fibre intakes, but was unable to prevent excessive gestational weight gain.

Mid-upper arm circumference as a screening tool for identifying children with obesity: a 12-country study.

BACKGROUND: No studies have examined if mid-upper arm circumference (MUAC) can be an alternative screening tool for obesity in an international sample of children differing widely in levels of human development. OBJECTIVE: Our aim is to determine whether MUAC could be used to identify obesity in children from 12 countries in five major geographic regions of the world. METHODS: This observational, multinational cross-sectional study included 7337 children aged 9-11 years. Anthropometric measurements were objectively assessed, and obesity was defined according to the World Health Organization reference data. RESULTS: In the total sample, MUAC was strongly correlated with adiposity indicators in both boys and girls (r > 0.86, p < 0.001). The accuracy level of MUAC for identifying obesity was high in both sexes and across study sites (overall area under the curve of 0.97, sensitivity of 95% and specificity of 90%). The MUAC cut-off value to identify obesity was ~25 cm for both boys and girls. In country-specific analyses, the cut-off value to identify obesity ranged from 23.2 cm (boys in South Africa) to 26.2 cm (girls in the UK). CONCLUSIONS: Results from this 12-country study suggest that MUAC is a simple and accurate measurement that may be used to identify obesity in children aged 9-11 years. MUAC may be a promising screening tool for obesity in resource-limited settings.

Effects of walking training on weight maintenance after a very-low-energy diet in premenopausal obese women: a randomized controlled trial.

BACKGROUND: Maintenance of weight loss is a core problem in the treatment of obesity. Physical activity may improve maintenance and metabolic risk factors associated with obesity. HYPOTHESES: (1) A walking training program of moderate intensity, started after weight reduction by a very-low-energy diet, improves maintenance of weight loss and obesity-related metabolic disorders; and (2) the effect of the training program is related to the prescribed amount of physical activity, ie, a higher amount (energy expenditure) leads to more favorable results. METHODS: The participants were premenopausal women with a mean body mass index of 34.0 kg/m(2). Eighty-two participants were randomized to this study; 74 participated in the follow-up assessment. A 12-week weight reduction by mostly a very-low-energy diet was followed by a 40-week maintenance program randomized in 3 groups: a control group with no increase in habitual exercise and with counseling on diet and relapse prevention; a walk-1 group, with a walking program targeted to expend 4.2 MJ/wk and diet counseling; and a walk-2 group, with a walking program of 8. 4 MJ/wk and diet counseling. Random permuted blocks within strata were used, with weight loss (in 3 classes) as the stratifying factor. After the intervention, the subjects were followed up for 2 years. MAIN OUTCOME MEASURES: Primary outcomes were body weight, fat mass, and waist circumference at the 2-year follow-up. Secondary outcomes were the levels of serum lipoproteins and lipids, plasma glucose, insulin, and blood pressure. RESULTS: The mean weight loss after weight reduction was 13.1 kg. The main outcome variables remained stable during the maintenance program, but increased during the follow-up period. Compared with the end of weight reduction, weight regain at the 2-year follow-up was 3.5 kg less (95% confidence interval, 0.2-6.8) and waist circumference regain 3.8 cm less (95% confidence interval, 0.3-7.3) in the walk-1 group vs controls. The secondary outcomes showed a partial relapse during the maintenance program, and a further regain during the follow-up period. CONCLUSIONS: Inclusion of a walking program of moderate training regimen into a weight maintenance program improved maintenance of losses in weight and waist circumference.