| 1. |
- Sjöström, Lars, et al.
(author)
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Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish Obese Subjects Study): a prospective, controlled intervention trial.
- 2009
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In: The lancet oncology. - 1474-5488. ; 10:7, s. 653-62
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Journal article (peer-reviewed)abstract
- BACKGROUND: Obesity is a risk factor for cancer. Intentional weight loss in the obese might protect against malignancy, but evidence is limited. To our knowledge, the Swedish Obese Subjects (SOS) study is the first intervention trial in the obese population to provide prospective, controlled cancer-incidence data. METHODS: The SOS study started in 1987 and involved 2010 obese patients (body-mass index [BMI] >or=34 kg/m(2) in men, and >or=38 kg/m(2) in women) who underwent bariatric surgery and 2037 contemporaneously matched obese controls, who received conventional treatment. While the main endpoint of SOS was overall mortality, the main outcome of this exploratory report was cancer incidence until Dec 31, 2005. Cancer follow-up rate was 99.9% and the median follow-up time was 10.9 years (range 0-18.1 years). FINDINGS: Bariatric surgery resulted in a sustained mean weight reduction of 19.9 kg (SD 15.6 kg) over 10 years, whereas the mean weight change in controls was a gain of 1.3 kg (SD 13.7 kg). The number of first-time cancers after inclusion was lower in the surgery group (n=117) than in the control group (n=169; HR 0.67, 95% CI 0.53-0.85, p=0.0009). The sex-treatment interaction p value was 0.054. In women, the number of first-time cancers after inclusion was lower in the surgery group (n=79) than in the control group (n=130; HR 0.58, 0.44-0.77; p=0.0001), whereas there was no effect of surgery in men (38 in the surgery group vs 39 in the control group; HR 0.97, 0.62-1.52; p=0.90). Similar results were obtained after exclusion of all cancer cases during the first 3 years of the intervention. INTERPRETATION: Bariatric surgery was associated with reduced cancer incidence in obese women but not in obese men. FUNDING: Swedish Research Council, Swedish Foundation for Strategic Research, Swedish Federal Government under the LUA/ALF agreement, Hoffmann La Roche, Cederoths, AstraZeneca, Sanofi-Aventis, Ethicon Endosurgery.
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| 2. |
- Sjöström, Lars, et al.
(author)
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Effects of bariatric surgery on mortality in Swedish obese subjects.
- 2007
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In: The New England journal of medicine. - 1533-4406. ; 357:8, s. 741-52
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Journal article (peer-reviewed)abstract
- BACKGROUND: Obesity is associated with increased mortality. Weight loss improves cardiovascular risk factors, but no prospective interventional studies have reported whether weight loss decreases overall mortality. In fact, many observational studies suggest that weight reduction is associated with increased mortality. METHODS: The prospective, controlled Swedish Obese Subjects study involved 4047 obese subjects. Of these subjects, 2010 underwent bariatric surgery (surgery group) and 2037 received conventional treatment (matched control group). We report on overall mortality during an average of 10.9 years of follow-up. At the time of the analysis (November 1, 2005), vital status was known for all but three subjects (follow-up rate, 99.9%). RESULTS: The average weight change in control subjects was less than +/-2% during the period of up to 15 years during which weights were recorded. Maximum weight losses in the surgical subgroups were observed after 1 to 2 years: gastric bypass, 32%; vertical-banded gastroplasty, 25%; and banding, 20%. After 10 years, the weight losses from baseline were stabilized at 25%, 16%, and 14%, respectively. There were 129 deaths in the control group and 101 deaths in the surgery group. The unadjusted overall hazard ratio was 0.76 in the surgery group (P=0.04), as compared with the control group, and the hazard ratio adjusted for sex, age, and risk factors was 0.71 (P=0.01). The most common causes of death were myocardial infarction (control group, 25 subjects; surgery group, 13 subjects) and cancer (control group, 47; surgery group, 29). CONCLUSIONS: Bariatric surgery for severe obesity is associated with long-term weight loss and decreased overall mortality.
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| 3. |
- Vågstrand, Karin, et al.
(author)
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Associations between salivary bacteria and reported sugar intake and their relationship with body mass index in women and their adolescent children.
- 2008
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In: Public Health Nutrition. - 1368-9800. ; 11:4, s. 341-8
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To study associations between reported sugar intake and salivary bacteria (mutans streptococci, MS and lactobacilli, LB), and sugar intake in relation to body mass index (BMI), in women and adolescents. DESIGN: Cross-sectional study. Habitual dietary intake was reported in a questionnaire and whole saliva samples were collected and cultivated. SETTING: Stockholm, Sweden. SUBJECTS: Four hundred and fourteen mothers and their 16-year-old children (57% girls). RESULTS: Reported total sugar intake was significantly associated with LB in mothers (P = 0.001), but not in daughters and sons (P = 0.03 for mother-son interaction). When excluding lactose, the associations with LB and MS were significant in daughters (P = 0.032 and 0.005, respectively). High BMI and sugar intake from milk were independently associated with MS counts in mothers in a multiple regression model (R2 = 0.053). In daughters, sugar from beverages, candies/chocolates and fruits were all independently associated with MS counts (R2 = 0.074), whereas in sons, only mothers' MS counts were associated (R2 = 0.084). High BMI, low intake from cooked meals and high intake of candies/chocolates were all independently associated with LB in mothers (R2 = 0.076), while, except for candies/chocolates in daughters, no significant associations were found in children. BMI was significantly associated with bacteria counts in both mothers and children, whereas reported sugar intake was not.ConclusionThe associations between reported sugar intake and bacteria were generally weak. In mothers and daughters, some significant associations were found, but not in sons. Bacteria counts, but not reported sugar intake, were positively associated with BMI.
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| 4. |
- Berteus Forslund, Helene, 1952, et al.
(author)
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Should snacks be recommended in obesity treatment? a 1-year randomized clinical trial
- 2008
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In: European Journal of Clinical Nutrition. - : Springer Science and Business Media LLC. - 0954-3007 .- 1476-5640. ; 62:11, s. 1308-1317
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Journal article (peer-reviewed)abstract
- Objective:To study the effect to recommend no snacks vs three snacks per day on 1-year weight loss. The hypothesis was that it is easier to control energy intake and lose weight if snacks in between meals are omitted.Subjects/Method:In total 140 patients (36 men, 104 women), aged 18-60 years and body mass index>30 kg/m(2) were randomized and 93 patients (27 men, 66 women) completed the study. A 1-year randomized intervention trial was conducted with two treatment arms with different eating frequencies; 3 meals/day (3M) or 3 meals and 3 snacks/day (3+3M). The patients received regular and individualized counseling by dieticians. Information on eating patterns, dietary intake, weight and metabolic variables was collected at baseline and after 1 year.Results:Over 1 year the 3M group reported a decrease in the number of snacks whereas the 3+3M group reported an increase (-1.1 vs +0.4 snacks/day, respectively, P<0.0001). Both groups decreased energy intake and E% (energy percent) fat and increased E% protein and fiber intake but there was no differences between the groups. Both groups lost weight, but there was no significant difference in weight loss after 1 year of treatment (3M vs 3+3M=-4.1+/-6.1 vs -5.9+/-9.4 kg; P=0.31). Changes in metabolic variables did not differ between the groups, except for high-density lipoprotein that increased in the 3M group but not in 3+3M group (P<0.033 for group difference).Conclusion:Recommending snacks or not between meals does not influence 1-year weight loss.European Journal of Clinical Nutrition advance online publication, 15 August 2007; doi:10.1038/sj.ejcn.1602860.
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| 5. |
- Berteus Forslund, Helene, 1952, et al.
(author)
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Snacking frequency in relation to energy intake and food choices in obese men and women compared to a reference population.
- 2005
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In: International journal of obesity (2005). - : Springer Science and Business Media LLC. - 0307-0565 .- 1476-5497. ; 29:6, s. 711-9
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To investigate snacking frequency in relation to energy intake and food choices, taking physical activity into account, in obese vs reference men and women. DESIGN: Cross-sectional, descriptive study. SUBJECTS: In total, 4259 obese, middle-aged subjects (1891 men and 2368 women) from the baseline examination of the XENDOS study and 1092 subjects (505 men and 587 women) from the SOS reference study were included. MEASUREMENTS: A meal pattern questionnaire describing habitual intake occasions (main meals, light meals/breakfast, snacks, drink-only), a dietary questionnaire describing habitual energy and macronutrient intake and a questionnaire assessing physical activity at work and during leisure time were used. RESULTS: The obese group consumed snacks more frequently compared to the reference group (P<0.001) and women more frequently than men (P<0.001). Energy intake increased with increasing snacking frequency, irrespective of physical activity. Statistically significant differences in trends were found for cakes/cookies, candies/chocolate and desserts for the relation between energy intake and snacking frequency, where energy intake increased more by snacking frequency in obese subjects than in reference subjects. CONCLUSION: Obese subjects were more frequent snackers than reference subjects and women were more frequent snackers than men. Snacks were positively related to energy intake, irrespective of physical activity. Sweet, fatty food groups were associated with snacking and contributed considerably to energy intake. Snacking needs to be considered in obesity treatment, prevention and general dietary recommendations.
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| 6. |
- Karason, Kristjan, 1962, et al.
(author)
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Effort-related calf pain in the obese and long-term changes after surgical obesity treatment.
- 2005
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In: Obesity research. - 1071-7323. ; 13:1, s. 137-45
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To compare the prevalence of effort-related calf pain in an obese and a general population and to analyze the incidence of and recovery from such pain after surgical and conventional obesity treatment. RESEARCH METHODS AND PROCEDURES: A random sample of 1135 subjects from a general population was compared with 6328 obese subjects in the Swedish Obese Subjects study. Obese subjects were followed longitudinally, and information about calf pain was obtained from surgically and conventionally treated patients for up to 6 years. RESULTS: In both sexes, self-reported calf pain was more common in the obese than in the general population [odds ratios (ORs) 5.0 and 4.0 in men and women, respectively, p<0.001]. Obese patients undergoing surgery had a lower 6-year incidence of calf pain compared with the conventionally treated control group (ORs 0.39 and 0.61, p<0.05). Among subjects reporting symptoms at baseline, the 6-year recovery rate was higher in the surgical group compared with the control group (ORs 15.3 and 5.9, p<0.001). DISCUSSION: Obese subjects have markedly more problems with effort-related calf pain than the general population. Surgical obesity treatment reduces the long-term risk of developing claudication symptoms and increases the likelihood of recovering from such symptoms.
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| 7. |
- Larsson, Ingrid, 1963, et al.
(author)
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Optimized predictions of absolute and relative amounts of body fat from weight, height, other anthropometric predictors, and age 1.
- 2006
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In: The American journal of clinical nutrition. - 0002-9165. ; 83:2, s. 252-9
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Journal article (peer-reviewed)abstract
- BACKGROUND: Body mass index (BMI) is the dominating weight-for-height index, but its validity as a body fat (BF) index has not been properly examined. OBJECTIVES: Our aims were to establish and validate optimal weight-for-height indexes for predicting absolute and relative (percentage) amounts of BF, to examine whether other commonly available anthropometric variables or age could add to the predictive power, and to explore the upper limit for percentage BF. DESIGN: One thousand one hundred twelve randomly selected subjects, and an additional 149 obese subjects, were included in the study. The subjects were randomly allocated to either a primary study group or a validation group. BF was measured with dual-energy X-ray absorptiometry. The relations between weight/heightx (W/Hx) and BF (absolute or percentage) were examined for values of the exponent x that ranged from 0.0 to 3.0. The predictive power of equations that were based on optimal weight-for-height indexes was compared with equations based on weight, height, other anthropometric variables, and age. RESULTS: Absolute BF was optimally and linearly predicted by W/H1, whereas the percentage BF was optimally and nonlinearly predicted by W/H2. The percentage BF asymptotically approached 52% in women and 56% in men. The percentage BF increased only marginally from BMI (in kg/m2) values of >35 in women and >60 in men. Predictions of absolute BF were associated with smaller errors (8.5% for men and 5.7% for women) than were predictions of percentage BF (8.7% for men and 7.9% for women). The addition of other anthropometric measurements for both men and women, and the addition of age for women only, in the regression analyses moderately reduced these errors. CONCLUSION: Our data suggest that W/H may be a more optimal weight-for-height index than is BMI, particularly at high body weights.
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| 8. |
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| 9. |
- Olbers, Torsten, 1964, et al.
(author)
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Body composition, dietary intake, and energy expenditure after laparoscopic Roux-en-Y gastric bypass and laparoscopic vertical banded gastroplasty: a randomized clinical trial.
- 2006
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In: Annals of surgery. - : Ovid Technologies (Wolters Kluwer Health). - 0003-4932. ; 244:5, s. 715-22
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To assess body composition, eating pattern, and basal metabolic rate in patients undergoing obesity surgery in a randomized trial. INTRODUCTION: There is limited knowledge regarding how different bariatric surgical techniques function in terms of altering body composition, dietary intake, and basic metabolic rate. METHODS: Non-superobese patients were randomized to laparoscopic Roux-en-Y gastric bypass (LGBP, n = 37) or laparoscopic vertical banded gastroplasty (LVBG, n = 46). Anthropometry, dual-energy x-ray absorptiometry (DEXA), computed tomography (CT), indirect calorimetry, and reported dietary intake were registered prior to and 1 year after surgery. RESULTS: Follow-up rate was 97.6%. LGBP patients had significantly greater reduction of waist circumference and sagittal diameter compared with LVBG. DEXA demonstrated a larger reduction of body fat in all compartments after LGBP, especially at the trunk (P<0.001). CT demonstrated more reduction of the visceral fat (P=0.016). Patients were able to eat all types of food after LGBP, although about 30% claimed they avoided fats. LGBP patients decreased their proportion of dietary fat significantly more than those operated on with LVBG (P = 0.005), who consumed more sweet foods and avoided whole meat and vegetables. Lean tissue mass (LTM) was proportionally less reduced, especially in men, after LGBP. The decreases in BMR postoperatively reflected the lower body mass in a pattern that did not differ among the groups. CONCLUSION: LGBP patients demonstrated better outcomes compared with LVBG patients in terms of body composition. Energy expenditure developed as expected postoperatively. A "steering" away from fatty foods after LGBP may be an important mechanism of action in gastric bypass.
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| 10. |
- Vagstrand, K., et al.
(author)
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Eating habits in relation to body fatness and gender in adolescents--results from the 'SWEDES' study
- 2007
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In: Eur J Clin Nutr. - : Springer Science and Business Media LLC. - 0954-3007 .- 1476-5640. ; 61:4, s. 517-25
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To investigate if eating habits among adolescents are related to body fatness and gender. DESIGN: Cross-sectional study. SETTING: Obesity Unit, Huddinge University Hospital, Sweden, 2001-2002. SUBJECTS: Two hundred and seventy-five girls and 199 boys, aged 16-17 years. METHOD: Questionnaires were used for dietary intake and meal frequency, BodPod for measuring body fatness (BF%). In all, 169 girls and 128 boys were classified as adequate reporters (AR) of energy intake, and were used in the dietary analyses. The whole sample was used in the meal frequency analyses. RESULTS: The correlation between reported energy intake and weight in the AR group was 0.23 (P<0.01) for girls and 0.36 for boys (P<0.001). The correlations were inverse or not significant in the whole sample. The following variables correlated significantly with a high BF% (r (s)=+/-0.2): a low intake of milk in both girls and boys, a high intake of fibre and alcohol and a low intake of sugar in girls and a low intake of breakfast cereals in boys. Those with regular breakfast habits had healthier food choices than others, but this was not related to BF%. Boys had more meals per day (4.9 vs 4.6, P=0.02), especially early in the morning and late at night, whereas girls reported a higher relative intake of light meals and fruit and a lower intake of milk than boys. CONCLUSIONS: A few associations between eating habits and body fatness were found, but without any obvious patterns. The true differences in eating habits between lean and overweight adolescents are probably very small.
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