| 1. |
- Ekelund, Ulf, et al.
(författare)
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Association of weight gain in infancy and early childhood with metabolic risk in young adults
- 2007
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Ingår i: Journal of Clinical Endocrinology and Metabolism. - : The Endocrine Society. - 0021-972X .- 1945-7197. ; 92:1, s. 98-103
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Tidskriftsartikel (refereegranskat)abstract
- CONTEXT: Early postnatal life has been suggested as an important window during which risks for long-term health may be influenced. OBJECTIVE: The aim of this study was to examine the independent associations between weight gain during infancy (0-6 months) and early childhood (3-6 yr) with components of the metabolic syndrome in young adults. DESIGN: This was a prospective cohort study (The Stockholm Weight Development Study). SETTING: The study was conducted in a general community. PARTICIPANTS: Subjects included 128 (54 males) singletons, followed from birth to 17 yr. MAIN OUTCOME MEASURE: None of these young adults met the full criteria for the metabolic syndrome. We therefore calculated a continuous clustered metabolic risk score by averaging the standardized values of the following components: waist circumference, blood pressure, fasting triglycerides, high-density lipoprotein cholesterol, glucose, and insulin level. RESULTS: Clustered metabolic risk at age 17 yr was predicted by weight gain during infancy (standardized beta = 0.16; P < 0.0001) but not during early childhood (standardized beta = 0.10; P = 0.23), adjusted for birth weight, gestational age, current height, maternal fat mass, and socioeconomic status at age 17 yr. Further adjustment for current fat mass and weight gain during childhood did not alter the significant association between infancy weight gain with the metabolic risk score (standardized beta = 0.20; P = 0.007). CONCLUSIONS: Rapid weight gain during infancy (0-6 months) but not during early childhood (3-6 yr) predicted clustered metabolic risk at age 17 yr. Early interventions to moderate rapid weight gain even at very young ages may help to reduce adult cardiovascular disease risks.
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| 2. |
- Eklund, Fredrik, et al.
(författare)
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Variation in fracture rates by country may not be explained by differences in bone mass
- 2009
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Ingår i: Calcified Tissue International. - : Springer Science and Business Media LLC. - 0171-967X .- 1432-0827. ; 85:1, s. 10-16
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Tidskriftsartikel (refereegranskat)abstract
- It is unclear whether the high fracture incidence in Sweden compared with other countries is related to low bone mass. We present and compare bone mineral density (BMD, g/cm(2)) at the femoral neck in a mainly osteoporotic referral population consisting of 2,031 men and 6,932 women with that of previous population-based cohorts. BMD measurements were collected at a single study center in Sweden, and data on validated hip fractures were collected from the corresponding health-care district and the cohort investigated. The BMD values of our cohort were similar to those of population-based cohorts from other countries. In contrast, the total incidence of hip fractures in 80-year-old women and men in the health-care district where our BMD measurements were performed was high (1.8% and 0.9%, respectively). The correlation between age and BMD was more negative in men aged 20-49 years than in women of the same age group (-0.011 vs. -0.006 g/cm(2) yearly, P < 0.001). In contrast, at 50-80 years of age, more negative regression coefficients were seen in women (-0.007 vs. -0.004 g/cm(2) yearly, P < 0.001 for comparison). In conclusion, a low BMD may not be the key factor explaining Sweden's comparatively high fracture incidence. In our cross-sectional data, age trends in BMD at the femoral neck differ between men and women. It would be highly interesting to further study the underlying causes of the global variations in fracture incidence rates.
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| 3. |
- Hemmingsson, Erik, et al.
(författare)
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No apparent progress in bioelectrical impedance accuracy : validation against metabolic risk and DXA.
- 2009
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Ingår i: Obesity. - : Wiley. - 1930-7381 .- 1930-739X. ; 17:1, s. 183-7
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Tidskriftsartikel (refereegranskat)abstract
- Bioelectrical impedance (BIA) is quick, easy, and safe when quantifying fat and lean tissue. New BIA models (Tanita BC-418 MA, abbreviated BIA(8)) can perform segmental body composition analysis, e.g., estimate %trunkal fatness (%TF). It is not known, however, whether new BIA models can detect metabolic risk factors (MRFs) better than older models (Tanita TBF-300, abbreviated BIA(4)). We therefore tested the correlation between MRF and percentage whole-body fat (%BF) from BIA(4) and BIA(8) and compared these with the correlation between MRF and dual-energy X-ray absorptiometry (DXA, used as gold standard), BMI and waist circumference (WC). The sample consisted of 136 abdominally obese (WC >or= 88 cm), middle-aged (30-60 years) women. MRF included fasting blood glucose and insulin; high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides; high sensitive C-reactive protein, plasminogen activator inhibitor-1 (PAI-1), and fibrinogen; and alanine transaminase (ALT) liver enzyme. We found that similar to DXA, but in contrast to BMI, neither %BF BIA(4) nor %BF BIA(8) correlated with blood lipids or ALT. In the segmental analysis of %TF, BIA(8) only correlated with inflammatory markers, but not insulin, blood lipids, or ALT liver enzyme (in contrast to WC and %TF DXA). %TF DXA was associated with homeostatic model assessment insulin resistance (HOMA-IR) independently of WC (P = 0.03), whereas %TF BIA(8) was not (P = 0.53). Receiver-operating characteristic (ROC) curves confirmed that %TF BIA(8) did not differ from chance in the detection of insulin resistance (P = 0.26). BIA estimates of fatness were, at best, weakly correlated with obesity-related risk factors in abdominally obese women, even the new eight-electrode model. Our data support the continued use of WC and BMI.
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| 4. |
- Johansson, Kari, et al.
(författare)
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Effect of a very low energy diet on moderate and severe obstructive sleep apnoea in obese men : a randomised controlled trial.
- 2009
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Ingår i: The BMJ. - : BMJ. - 1756-1833 .- 0959-8138 .- 1468-5833. ; 339
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To assess the effect of weight loss induced by a very low energy diet on moderate and severe obstructive sleep apnoea in obese men. Design Single centre, two arm, parallel, randomised, controlled, open label trial. Blocked randomisation procedure used for treatment allocation. Setting Outpatient obesity clinic in a university hospital in Stockholm, Sweden. Participants 63 obese men (body mass index 30-40, age 30-65 years) with moderate to severe obstructive sleep apnoea (apnoea-hypopnoea index (AHI) >or=15), treated with continuous positive airway pressure.INTERVENTIONS: The intervention group received a liquid very low energy diet (2.3 MJ/day) for seven weeks to promote weight loss, followed by two weeks of gradual introduction of normal food, reaching 6.3 MJ/day at week 9. The control group adhered to their usual diet during the nine weeks of follow-up.MAIN OUTCOME MEASURE: AHI, the major disease severity index for obstructive sleep apnoea. Data from all randomised patients were included in an intention to treat analysis (baseline carried forward for missing data). Results Of the 63 eligible patients, 30 were randomised to intervention and 33 to control. Two patients in the control group were dissatisfied with allocation and immediately discontinued. All other patients completed the trial. Both groups had a mean AHI of 37 events/h (SD 15) at baseline. At week 9, the intervention group's mean body weight was 20 kg (95% confidence interval 18 to 21) lower than that of the control group, while its mean AHI was 23 events/h (15 to 30) lower. In the intervention group, five of 30 (17%) were disease free after the energy restricted diet (AHI <5), with 15 of 30 (50%) having mild disease (AHI 5-14.9), whereas the AHI of all patients in the control group except one remained at 15 or higher. In a subgroup analysis of the intervention group, baseline AHI significantly modified the effectiveness of treatment, with a greater improvement in AHI in patients with severe obstructive sleep apnoea (AHI >30) at baseline compared with those with moderate (AHI 15-30) sleep apnoea (AHI -38 v -12, P<0.001), despite similar weight loss (-19.2 v -18.2 kg, P=0.55). Conclusion Treatment with a low energy diet improved obstructive sleep apnoea in obese men, with the greatest effect in patients with severe disease. Long term treatment studies are needed to validate weight loss as a primary treatment strategy for obstructive sleep apnoea.TRIAL REGISTRATION: Current Controlled Trials ISRCTN70090382.
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| 5. |
- Neovius, Martin, et al.
(författare)
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Adiposity measures as indicators of metabolic risk factors in adolescents
- 2009
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Ingår i: Obesity Facts. - : S. Karger AG. - 1662-4025 .- 1662-4033. ; 2:5, s. 294-301
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To examine the relation between adiposity assessment methods (percentage body fat (%BF), BMI, and waist circumference (WC)) and individual metabolic risk factors (f-insulin, HDL cholesterol, triglycerides) and a combined measure of metabolic risk. Methods: Cross-sectional study of 300 males (BMI 20.8 +/- 3.0 kg/m(2)) and females (BMI 21.3 +/- 2.9 kg/m(2)) 17 years of age. F-insulin and components of the metabolic syndrome defined by the International Diabetes Federation (IDF) were used as metabolic risk indicators, with samples stratified into BMI, %BF, and WC groups, respectively. Diagnostic accuracy was expressed as the area under the ROC curve (AUC). Results: In males, diagnostic accuracy for HDL and f-insulin was poor to fair for BMI (AUC 0.70, p = 0.001; 0.60, p = 0.22), WC (0.68, p = 0.003; 0.63, p = 0.11), and %BF (0.65, p = 0.009; 0.66, p = 0.04). The diagnostic accuracy for triglycerides was greater for all three measures (BMI 0.92, WC 0.95, %BF 0.87; all p < 0.001). For females, neither test performed better than chance for f-insulin and HDL, and only %BF performed better than chance for triglycerides (0.65, p = 0.08). All three measures exhibited higher accuracy for presence of >= 2 metabolic risk factors (AUCs 0.76-0.91, p < 0.001) in both sexes. Conclusion: %BF was not superior to BMI and WC for detecting metabolic risk in the general adolescent population.
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| 6. |
- Neovius, Martin, et al.
(författare)
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Assessment of change in body fat percentage with DXA and eight-electrode BIA in centrally obese women.
- 2007
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Ingår i: Medicine & Science in Sports & Exercise. - : Ovid Technologies (Wolters Kluwer Health). - 0195-9131 .- 1530-0315. ; 39:12, s. 2199-203
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To compare estimates of change in percent body fat (Delta%BF) between DXA and BIA8 in abdominally obese women.METHODS: Six-month longitudinal study of 106 women (baseline: age 48.2 +/- 7.6 yr; BMI 30.4 +/- 2.9 kg.m; %BFDXA 45.8 +/- 3.6%) participating in an exercise-oriented behavior-change program (walking and bicycling). Fatness was measured by DXA and Tanita BC-418 (BIA8). Agreement between methods was assessed, and regression analysis was used to find predictors of the deviation between methods for estimating changes in fat mass percentage.RESULTS: The methods differed significantly, both at baseline and follow-up (-5.0 and -4.4%BF, respectively; both P < 0.001). The mean Delta%BF was -1.1 +/- 2.5%BFDXA and -0.5 +/- 2.2%BFBIA8 (mean difference between methods 0.6 +/- 1.8%BF; P < 0.001; 95% limits of agreement -3.0 to 4.2%BF), with a range of -14.8 to 3.3%BFDXA and -9.4 to 3.5%BFBIA8. Approximately 49% of the variation in the difference between methods was explained by variations in age (beta = -0.05; P = 0.006), DeltaBMI (beta = 0.98; P < 0.001), and Delta%BFDXA (beta = -0.71; P < 0.001), indicating that the larger the change, the greater the discrepancy between methods.CONCLUSION: The difference between methods regarding Delta%BF was statistically significant, but it was of small magnitude. However, with increasing Delta%BF, increasing discrepancies were observed, implying that the BIA equipment may have limited validity for detecting larger fat losses. Both clinicians and researchers may benefit from awareness of this potential limitation.
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| 7. |
- Neovius, Martin, et al.
(författare)
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Bioelectrical impedance underestimates total and truncal fatness in abdominally obese women.
- 2006
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Ingår i: Obesity. - : Wiley. - 1930-7381 .- 1930-739X. ; 14:10, s. 1731-8
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To compare estimates of total and truncal fatness from eight-electrode bioelectrical impedance analysis equipment (BIA(8)) with those from DXA in centrally obese women. The secondary aim was to examine BMI and waist circumference (WC) as proxy measures for percentage total body fat (%TBF) and truncal body fat percentage (tr%BF).RESEARCH METHODS AND PROCEDURES: This was a cross-sectional study of 136 women (age, 48.1 +/- 7.7 years; BMI, 30.4 +/- 2.9 kg/m(2); %TBF(DXA), 46.0 +/- 3.7%; WC, 104 +/- 8 cm). Fatness was measured by DXA and Tanita BC-418 equipment (Tanita Corp., Tokyo, Japan). Agreement among methods was assessed by Bland-Altman plots, and regression analysis was used to evaluate anthropometric measures as proxies for total and abdominal fatness.RESULTS: The percentage of overweight subjects was 41.9%, whereas 55.9% of the subjects were obese, as defined by BMI, and all subjects had a WC exceeding the World Health Organization cut-off point for abdominal obesity. Compared with DXA, the BIA(8) equipment significantly underestimated total %BF (-5.0; -3.6 to -8.5 [mean; 95% confidence interval]), fat mass (-3.6; -3.9 to -3.2), and tr%BF (-8.5; -9.1 to -7.9). The discrepancies between the methods increased with increasing adiposity for both %TBF and tr%BF (both p < 0.001). Variation in BMI explained 28% of the variation in %TBF(DXA) and 51% of %TBF(BIA8). Using WC as a proxy for truncal adiposity, it explained only 18% of tr%BF(DXA) variance and 27% of tr%BF(BIA8) variance. The corresponding figures for truncal fat mass were 49% and 35%, respectively. No significant age effects were observed in any of the regressions.DISCUSSION: BIA(8) underestimated both total and truncal fatness, compared with DXA, with higher dispersion for tr%BF than %TBF. The discrepancies increased with degree of adiposity, suggesting that the accuracy of BIA is negatively affected by obesity.
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| 8. |
- Neovius, Martin, et al.
(författare)
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Combined effects of overweight and smoking in late adolescence on subsequent mortality : nationwide cohort study
- 2009
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Ingår i: BMJ. British Medical Journal. - : BMJ. - 0959-8146 .- 0959-535X. ; 338, s. b496-
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate the combined effects on adult mortality of overweight and smoking in late adolescence. DESIGN: Record linkage study with Cox proportional hazard ratios adjusted for muscle strength, socioeconomic position, and age. SETTING: Swedish military service conscription register, cause of death register, and census data. PARTICIPANTS: 45 920 Swedish men (mean age 18.7, SD 0.5) followed for 38 years. MAIN OUTCOME MEASURES: Body mass index (underweight (BMI <18.5), normal weight (18.5-24.9), overweight (25-29.9), and obesity (>or=30)), muscle strength, and self reported smoking (non-smoker, light smoker (1-10 cigarettes/day), heavy smoker (>10/day)) at mandatory military conscription tests in 1969-70. All cause mortality. RESULTS: Over 1.7 million person years, 2897 men died. Compared with normal weight men (incidence rate 17/10 000 person years, 95% confidence interval 16 to 18), risk of mortality was increased in overweight (hazard ratio 1.33, 1.15 to 1.53; incidence rate 23, 20 to 26) and obese men (hazard ratio 2.14, 1.61 to 2.85; incidence rate 38, 27 to 48), with similar relative estimates in separate analyses of smokers and non-smokers. No increased risk was detected in underweight men (hazard ratio 0.97, 0.86 to 1.08; incidence rate 18, 16 to 19), though extreme underweight (BMI <17) was associated with increased mortality (hazard ratio 1.33, 1.07 to 1.64; incidence rate 24, 19 to 29). The relative excess risk due to interaction between BMI and smoking status was not significant in any stratum. Furthermore, all estimates of interaction were of small magnitude, except for the combination of obesity and heavy smoking (relative excess risk 1.5, -0.7 to 3.7). Compared with non-smokers (incidence rate 14, 13 to 15), risk was increased in both light (hazard ratio 1.54, 1.41 to 1.70; incidence rate 15, 14 to 16) and heavy smokers (hazard ratio 2.11, 1.92 to 2.31; incidence rate 26, 24 to 27). CONCLUSIONS: Regardless of smoking status, overweight and obesity in late adolescence increases the risk of adult mortality. Obesity and overweight were as hazardous as heavy and light smoking, respectively, but there was no interaction between BMI and smoking status. The global obesity epidemic and smoking among adolescents remain important targets for intensified public health initiatives.
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| 9. |
- Neovius, Martin
(författare)
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Diagnostic tests for adiposity and metabolic risk factors in adolescence : results from the Stockholm weight development study (SWEDES)
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Despite growing concern about the development of pediatric obesity, there is still controversy about its classification. International classification systems have been proposed and national systems are in use in many countries, often in parallel. Most proposed classification systems are distribution-based and not anchored to either fatness, metabolic risk or risk of adult obesity. Aims: To assess the diagnostic accuracy of BMI, WC and W-ER for fatness, the characteristics of commonly used classification systems, and to estimate the relationship between diagnostic tests for overweight, insulin resistance and cholesterol profile. Design: SWEDES is a prospective cohort study of 481 children followed from birth until age 17y, and their mothers. BMIdevelopment was assessed retrospectively from healthcare records, and clinical measurements at age 17y were performed. Measurements included height, weight, WC, HC, body composition (FM, FFM), and blood samples. Proposed classification systems for childhood and adolescent obesity were evaluated by use of ROC analyses. Through regression analyses, the association between different screening measures and insulin resistance (HOMA-IR) was also investigated. Results: The IOTF/Cole classification system was found to be highly specific (0.95-1.00), but insensitive for fatness, especially in females (0.22-0.25). The outcome was shown to be fairly insensitive to the choice of gold standard to define fatness. The same characteristics remained in longitudinal analyses when using BMI at different ages as diagnostic tests for both BMI-based and FMIbased overweight in late adolescence. Using alternative measures as indicators of total fatness revealed that WC and BMI display similar diagnostic accuracy, while WHR performs significantly worse, also when evaluated against blood variables. In boys, the associations between simple anthropometric measures and insulin resistance were weaker than for detailed body composition measures, while in girls no significant associations were observed. The associations between BMI in childhood and adolescence and blood variables were non-existent or weak, implying that anchorage of classification against such outcomes may be complicated. Conclusion: Currently proposed BMI-based classification systems for adolescent overweight are highly specific, but less sensitive for fatness as well as for metabolic risk. The awareness about the trade-offs involved in applying such classification systems should be raised, since it may affect efficiency in the usage of healthcare and public health resources. A classification system designed for international monitoring cannot be optimal for the different needs of risk group stratification in such different settings as specialized care, public health and targeted prevention. Misuse is likely to result in wasted resources as well as foregone health improvements.
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| 10. |
- Nordström, Anna, et al.
(författare)
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Postpubertal development of total and abdominal percentage body fat : an 8-year longitudinal study.
- 2008
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Ingår i: Obesity. - : Wiley. - 1930-7381. ; 16:10, s. 2342-2347
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the present study was to describe postpubertal changes in total and abdominal adiposity in young men and the relation to changes in physical activity (PA). The study included 107 white men with a mean age of 17.1 +/- 1.7 years at baseline. Total percentage body fat (%BF) and abdominal percentage body fat (abd%BF) were measured at baseline and after a mean time of 28, 68, and 92 months using dual-energy X-ray absorptiometry (DXA). PA (h/week) was assessed at each visit by questionnaire. Over the study period, significant increases of 7.8 +/- 5.5%BF and 9.0 +/- 5.6 abd%BF were observed. Subjects who were active athletes throughout the study (n = 24), or nonathletes not changing their level of PA during follow-up (n = 27) increased 5.7 +/- 3.2 and 8.1 +/- 6.7%BF, respectively. Athletes who quit organized training during follow-up period (n = 56) increased by 8.7 +/- 4.9%BF. In the total cohort, the average annual gains in BMI, %BF, and abd%BF were 0.4 kg/m(2), 0.9%BF, and 1.1abd%BF (all P < 0.0001), respectively. Adjustment for changes in PA altered the coefficient magnitudes only marginally. Changes in PA were, however, significantly and inversely associated with changes in %BF and abd%BF (P = 0.005 and P = 0.02, respectively), but were not significantly associated with BMI development (P = 0.15). In summary, our results indicate that the natural course of adiposity development in postpubertal men is characterized by adiposity gains. The influence of PA on especially abd%BF may influence the future risk of cardiovascular disease.
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