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Universal prenatal daily iron-folic acid (IFA) and multiple micronutrient (MM) supplements are recommended to reduce the risk of low birth weight, maternal anemia, and iron deficiency (ID) during pregnancy, but the evidence of their effect on iron status among women with mild or no anemia is limited. The aim of this study was to describe the iron status [serum ferritin (SF), serum soluble transferrin receptor (sTfR), and body iron (BI)] before and after micronutrient supplementation during pregnancy. We examined 834 pregnant women with hemoglobin > 100 g/L at enrollment before 20 wk of gestation and with iron measurement data from a subset of a randomized, double-blind trial in China. Women were randomly assigned to take daily 400 µg of folic acid (FA) (control), FA plus 30 mg of iron, or FA, iron, plus 13 additional MMs provided before 20 wk of gestation to delivery. Venous blood was collected in this subset during study enrollment (before 20 wk of gestation) and 28-32 wk of gestation. We found that, at 28-32 wk of gestation, compared with the FA group, both the IFA and MM groups had significantly lower prevalence of ID regardless of which indicator (SF, sTfR, or BI) was used for defining ID. The prevalence of ID at 28-32 wk of gestation for IFA, MM, and FA were 35.3%, 42.7%, and 59.6% by using low SF, 53.6%, 59.9%, and 69.9% by using high sTfR, and 34.5%, 41.2%, and 59.6% by using low BI, respectively. However, there was no difference in anemia prevalence (hemoglobin < 110 g/L) between FA and IFA or MM groups. We concluded that, compared with FA alone, prenatal IFA and MM supplements provided to women with no or mild anemia improved iron status later during pregnancy but did not affect perinatal anemia. This trial was registered at clinicaltrials.gov as NCT00137744. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Dietary supplements are not recommended as part of a weight-loss program due to concerns about efficacy and safety. This study sought to assess prevalence and duration of nonprescription weight-loss supplement use, associated weight-control behaviors, discussion of use with a health care professional, and specific ingredient use. Participants and Design: Adults aged ≥18 years (n=9,403) completed a cross-sectional population-based telephone survey of health behaviors from September 2002 through December 2002. Statistical Analyses Performed: Both χ2 and t tests were conducted for categorical and mean comparisons and multiple variable logistic regression was used to determine significant predictors. Results: An estimated 15.2% of adults (women 20.6%, men 9.7%) had ever used a weight-loss supplement and 8.7% had past year use (women 11.3%, men 6.0%); highest use was among women aged 18 to 34 years (16.7%). In regression models, use was equally prevalent among race/ethnic groups and education levels. One in 10 (10.2%) of users reported ≥12 month use, with less frequent long-term use in women (7.7%) than men (15.0%), P=0.01. Almost one third (30.2%) of users discussed use during the past year; 73.8% used a supplement containing a stimulant including ephedra, caffeine, and/or bitter orange. Conclusions: Use of supplements for losing weight seems to be common among many segments of the US adult population. Many adults are long-term users and most do not discuss this practice with their physician. Most of the weight-loss supplements taken contain stimulants. Qualified professionals should inquire about use of supplements for weight loss to facilitate discussion about the lack of efficacy data, possible adverse effects, as well as to dispel misinformation that may interfere with sound weight-management practices. [Copyright &y& Elsevier]

Background: Although walking is a popular leisure-time activity, a substantial amount of total daily walking occurs in nonleisure contexts (i.e., occupation, transportation, and household work). Because nonleisure walking is not assessed by traditional leisure-time activity surveys, total walking among U.S. adults may be underestimated. This study describes walking estimates obtained from a measure of leisure-time activity and a specific measure of total walking in all contexts. Methods: A national sample of adults (n=6626), selected by random-digit dialing, was surveyed between May 1999 and November 2000. Estimates of walking prevalence and of weekly time spent walking were examined from two separate modules: (1) an assessment restricted to leisure-time activity, and (2) an assessment of total walking. Results: Walking prevalence based on the total walking module was nearly double that based on the leisure-time module (81% vs 43%, respectively). The median weekly minutes of walking also nearly doubled using the total walking module (239 vs 130 minutes, respectively). Among those with jobs involving substantial walking, median weekly walking minutes were more than three times greater with the total walking module (476 vs 130 minutes, respectively). Conclusions: U.S. adults, particularly those with jobs involving walking, do a substantial amount of walking not captured by traditional leisure-time activity surveys. This may affect the appropriate targeting of physical activity interventions, as well as the evaluation of the effectiveness of physical activity promotions and policies. However, further characterization of nonleisure walking is needed to determine its contribution to health and meeting physical activity guidelines. [Copyright &y& Elsevier]

Objectives. We examined trends in fruit and vegetable consumption in the United States. Methods. A 6-item food frequency questionnaire was used to assess consumption among 434 121 adults in 49 states and the District of Columbia who were sampled in random-digit-dialed telephone surveys administered in 1994, 1996, 1998, and 2000. Results. Although the geometric mean frequency of fruit and vegetable consumption declined slightly, the proportion of respondents consuming fruits and vegetables 5 or more times per day did not change. With the exception of the group aged 18 to 24 years, which experienced a 3-percentage-point increase, little change was seen among sociodemographic subgroups. Conclusions. Frequency of fruit and vegetable consumption changed little from 1994 to 2000. If increases are to be achieved, additional efforts and new strategies will be needed. (Am J Public Health. 2004;94:1014-1018). [ABSTRACT FROM AUTHOR]

: BackgroundAlcohol abuse is a major public health problem in the United States. Binge drinking and drinking among youth are of special concern. The purpose of this study is to examine trends in alcohol use and binge drinking and correlates of the behaviors with a focus on drinking among persons 18 to 20 years of age.: MethodsData are from telephone interviews of 449,110 adults aged ≥18 years residing in the 19 states that participated in the Behavioral Risk Factor Surveillance System (BRFSS) from 1985 to 1999. The percentages reporting current alcohol use and binge use (≥5 drinks per occasion) were calculated by year, age, gender, race, and level of education. Data were analyzed in 2003.: ResultsFrom 1985 to 1999, the prevalence of current alcohol use dropped 7.3%, and binge drinking dropped 3.3%. Among all age groups, most of the decline occurred before 1990. The greatest decline in both current (12.6%) and binge use (7.3%) occurred in the 18- to 20-year-old group. Between 1997 and 1999, however, respondents in this age group reported increases in these behaviors. Throughout the survey period, the proportion of current users who binge changed very little and remained highest among persons aged 18–20 years (52.1%).: ConclusionsAlcohol use leveled off in the 1990s, but may be increasing, especially among persons 18–20 years of age. Those who drink are about as likely to report binge drinking as were drinkers 15 years ago. [Copyright &y& Elsevier]

Discusses the need for obesity to be recognized as a chronic condition for which no cure can reasonably be expected without physician assistance. Use of the smoking cessation model and adapting it to obesity; Assessing patients' risk of obesity-related conditions; Patient's receptivity to counseling.

: BackgroundPopulation-based estimates for the prevalence of smokers receiving advice from a health professional to quit smoking and the prevalence of binge drinkers being talked to about alcohol use are lacking for U.S. adults. This information is useful for clinicians and public health professionals.: MethodsData are from the Behavioral Risk Factor Surveillance System, a continuous random-digit-dial telephone survey of U.S. adults. In 1997, 10 states collected data on these health interventions for tobacco and alcohol use. The prevalence of professional advice to quit smoking and about alcohol use was calculated and examined by demographic characteristics. The number of at-risk adults who had a routine checkup in the last year and had not received these interventions was also estimated.: ResultsBy self-report, 70% of smokers were advised to quit, and 23% of binge drinkers were talked to about their alcohol use. Using multivariate logistic regression analyses, we found among smokers that women and older persons were more likely to receive advice; among binge drinkers, health intervention was more likely to occur for men and non-Hispanic blacks. Across the 10 states, approximately 2 million smokers and 2 million binge drinkers with a routine checkup in the past 12 months were not advised to quit smoking or talked to about their alcohol use.: ConclusionsMany opportunities to intervene with smokers and binge drinkers are lost. Efforts to increase physician education and to identify and reduce other barriers may help. [Copyright &y& Elsevier]

Reviews the methods used to measure dietary intake of preschool-aged children and examines the challenges of using such methods. Methodology; Validity of food recalls and food records; Validity of food frequency questionnaires.

Presents several medical-related letters to the editor as of June 20, 2001. Intensity of physical activity and the risk of coronary heart disease; Brassica vegetables and breast cancer risk; Histamine poisoning from seafood; Others.

Background: Pharmacotherapy is recommended for the treatment of obese persons with a body mass index of 30 kg/m(2) or higher or a body mass index of at least 27 kg/m(2) plus an obesity-related comorbid condition.Objective: To estimate the prevalence of use of prescription weight loss pills in the United States in 1996-1998.Design: 1998 Behavioral Risk Factor Surveillance System, a nationally representative telephone survey.Setting: United States.Participants: 139 779 adults 18 years of age and older.Measurements: Self-reported pill use for 1996-1998, body mass index (current and before pill use), age, sex, and race or ethnicity.Results: The 2-year prevalence of pill use was 2.5% (95% CI, 2.1% to 2.9%), or 4.6 million U.S. adults. Use was higher in women than in men (4.0% vs. 0.9%, respectively) and highest among Hispanic respondents (3.2%). Of pill users, 25% were not overweight (body mass index < 27 kg/m(2) before using pills.Conclusions: Nearly 5 million U.S. adults used prescription weight loss pills in 1996-1998. However, one quarter of users were not overweight, suggesting that weight loss pills may be inappropriately used, especially among women, white persons, and Hispanic persons. [ABSTRACT FROM AUTHOR]

Investigates the effects of asking beverage-specific versus grouped questions about alcohol intake. Common use of the quantity-frequency method to measure alcohol intake in large surveys; Observation of a higher mean number of drinks per month among drinkers who were asked beverage-specific questions than for those who were asked group-beverage questions.

Offers the results of a study on the spread of the obesity epidemic in the United States from 1991-1998. How obesity can lead to several chronic diseases such as cardiovascular diseases and diabetes; Context; Objective; Design; Setting; Main outcome measures; Results; Conclusions.

Presents a study to examine the prevalence of attempting to lose or to maintain weight and to describe weight control strategies among adults in the United States. Context; Design; Setting; Participants; Main outcome measures; Results; Conclusions.

A brief food frequency questionnaire was used to assess daily fruit and vegetable consumption among 23 699 adults in 16 US states sampled in a random-digit dialing telephone survey. Men consumed fewer servings per day (3.3) than did women (3.7). Only 20% of the population consumed the recommended 5 or more daily servings. Intakes varied somewhat by state and were lower among the young and the less educated. Efforts are needed to improve fruit and vegetable consumption among all Americans, especially younger adults and those with lower levels of education. [ABSTRACT FROM AUTHOR]

In this study, data collected in 1989 in a random-digit dialing telephone survey of 60 590 adults in 38 states and the District of Columbia were analyzed. Approximately 38% of women and 24% of men reported that they were currently trying to lose weight. Methods reported were counting calories (24% of women, 14% of Men), participating in organized weight loss programs (10%, 3%), taking special supplements (10%, 7%), taking diet pills (4%, 2%), and fasting for 24 hours or longer (5%, 5%). Among both sexes, only half of those trying to lose weight reported using the recommended method of caloric restriction combined with physical activity. [ABSTRACT FROM AUTHOR]

Objectives: Although attempted weight loss is common, little is known about the goals and durations of weight loss attempts and the rates of achieved weight loss in the general population. Methods. Data were collected by telephone in 1989 from adults aged 18 years and older in 39 states and the District of Columbia. Analyses were carried out separately for the 6758 men and 14,915 women who reported currently trying to lose weight. Results. Approximately 25% of the men respondents and 40% of the women respondents reported that they were currently trying to lose weight. Among men, a higher percentage of Hispanics (31%) than of Whites (25%) or Blacks (23%) reported trying to lose weight. Among women, however, there were no ethnic differences in prevalence. The average man wanted to lose 30 pounds and to weigh 178 pounds; the average woman wanted to lose 31 pounds and to weigh 133 pounds. Black women wanted to lose an average of 8 pounds more than did White women, but Black women's goal weight was 10 pounds heavier. The average rate of achieved weight loss was 1.4 pounds per week for men and 1.1 pounds per week for women; these averages, however, may reflect only the experience of those most successful at losing weight. Conclusions. Attempted weight loss is a common behavior, regardless of age, gender, or ethnicity, and weight loss goals are substantial; however, obesity remains a major public health problem in the United States. [ABSTRACT FROM AUTHOR]

Examines the distribution and interrelationships of overweight, cigarette smoking, blood pressure and plasma levels of lipids and glucose among 160 Navajo Indians adolescents between the ages of 12-19. Weight of adolescents compared with the general United States population; Percentage of adolescents who had impaired glucose tolerance or diabetes mellitus.

Reports on a survey conducted in the United States, which made use of a thirteen-item, telephone-administered food frequency questionnaire. Dietary fat intake in the United States.

Summarizes the results of studies which compared infant growth by different method of feeding in developing countries. Discussion on the effects of infant feeding on growth during and after the first six months of life; Review of the factors associated with growth faltering in the weaning period; Findings on the effect of prolonged breast feeding.

Discusses the factors that play important roles in assessing the adequacy of breast milk for infant growth. Issues with growth references; Discussion on theoretical calculations; Problems and issues associated with the measurement of breast milk output; Summary of findings about growth performance of breast fed infants in developed and developing countries.

Examines studies on the effects of feeding method on infant growth and nutritional status in developing countries. Discussion on the adequacy of breast milk for infant growth and the need for food supplements; Comparison of infant growth by method of feeding; Discussion and recommendations.

Discusses the factors associated with the relationship between breast feeding and infant nutrition. Information on physical growth and development; Results of studies on obesity; Cases of undernutrition and anemia.

Discusses whether breast feeding is associated with lower infectious disease-specific infant morbidity than alternative forms of feeding. Background on theoretical views about breast feeding; Review of studies about infection.

Features an assessment of epidemiologic and clinical studies on the impact of breast feeding on infant health or its substitutes in the United States and other industrialized countries based on studies of human populations since 1970. Questions on breast feeding that were addressed; Limitations of the research; Sources of studies; Discussion on methodologic considerations and research recommendations.

Provides interim estimates of the difference in the prevalence of smoking between pregnant and nonpregnant women in the U.S. overall and by age, race and education. Smoking behavior of unmarried pregnant women; Use of cross-sectional data collected from 1985 through 1986 from 25 states and the District of Columbia, in which pregnant and nonpregnant women were included in the same sampling frame.

In 1977. a large rubella outbreak occurred in Hawaii. Because attack rates were high among women of childbearing age, we conducted extensive surveillance efforts to detect both pregnancies complicated by rubella and cases of congenital rubella syndrome (CRS). Initial surveillance included a survey of physicians and hospitals, review of fetal death and birth certificates, and cord blood screening for rubella-specific IgM of infants born following the epidemic, Two years after the outbreak, the medical community was again surveyed In identify affected children who were missed initially, No case of CRS was identified either shortly after the outbreak or in the ensuing two years. In addition, none of the 5.605 cord serum samples obtained was found to contain rubella-specific IgM antibody. Through active surveillance, we received 12 reports of rubella m pregnant women, o[ whom I I elected to terminate their pregnancies. The extensive use of therapeutic abortion by exposed women may have prevented the birth of infants with CRS. Surveillance for rubella-related abort ions is an important component in assessing the health impact of rubella in a community. (Am J Public Health 1984: 74:1249-1251.) [ABSTRACT FROM AUTHOR]

Discusses the factors that need to be considered in the study of infant feeding practices and growth. Issues in the interpretation of growth performance; Birth weight and gestational age as determinants of attained weight for age; Problems with interpreting data on breast milk volume and composition; Discussion on theoretical calculations; Summary of findings on infant growth in relation to breast feeding.

Discusses studies which deal with the psychological factors associated with infant breast feeding. Effect of breast feeding on the mother and infant bonding; Impact on a child's psychological development; Discussion on the intellectual functioning of children.

Discusses the results of several studies which tested the possibility that breast feeding protects infants against allergic diseases. Data on eczema; Research on asthma; Discussion on allergic rhinitis and food allergy.

Discusses whether breast feeding is associated with lower infant mortality than alternative forms of feeding. Results of estimation based on death rates; Discussion on several possible causes of deaths; Overview of findings about sudden infant death syndrome; Trends in infant mortality.

Discusses several methodological considerations in a review of epidemiologic and clinical studies on the impact of breast feeding on infant health in industrialized countries. Advice about interpretation; Information on several methodologic problems; Discussion on the use of data from national surveys in the United States; Problem with the statistical methodology used for data analysis.

Objective To examine the concentration of C-reactive protein (CRP) in relation to gestational weeks during pregnancy among Chinese women. Methods From a randomized control trial of prenatal supplementation with folic acid, iron-folic acid, and multiple micronutrients in China, we examined 834 pregnant women with CRP measured initially between 5 and 20 weeks and at follow-up between 28 and 32 weeks gestation. We calculated and plotted CRP geometric means by gestational weeks. The same analysis was repeated for women who had normal pregnancies (624 women) by excluding women with stillbirth, preterm, small for gestational age, body mass index <18.5 kg/m2 or >30 kg/m2 at enrollment, and hypertension or anemia during pregnancy. Results We observed a significant positive trend between log-transformed CRP and gestational age from 5 to 20 weeks and from 28 to 32 weeks both in the full sample and in the subset of women who had normal pregnancies. CRP geometric mean was 0.81 mg/l at 5-7 weeks of gestation, 2.85 mg/l at 19-20 weeks of gestation, and 3.89 mg/l at 32 weeks of gestation. A similar increasing trend in the CRP median or percentage of elevated CRP were also observed. Conclusion We concluded that CRP increased with gestational age among healthy Chinese women who delivered healthy infants. Am. J. Hum. Biol. 28:574-579, 2016. © 2016 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Enumerates several recommendations for the study of infant growth in relation to infant feeding practices. Discussion on growth references; Importance of longitudinal studies on mortality and morbidity in relation to feeding practices; Role of inadequate food and infection to growth faltering.

Presents several recommendations for research about the impact of breast feeding on infant health in industrialized countries. Issue on research priority and study design; Areas of population research that should be considered; Discussion on the lack of studies on the relationship between infant mortality and method of infant feeding in the United States.

Presents information on the sources of epidemiologic and clinical studies about the impact of breast feeding on infant health in industrialized countries.

Discusses the factors that were not considered in a review of the epidemiologic and clinical studies on the impact of breast feeding on infant health in industrialized countries.

Lists several questions considered in a review of epidemiologic and clinical studies on the impact of breast feeding on infant health in industrialized countries.

Consuming an adequate amount of iodine during pregnancy is critical for fetal neurologic development. Even a mild deficiency can impair cognitive ability. Important sources of iodine in the United States include dairy products and iodized salt. Although the U.S. population has traditionally been considered iodine sufficient, median urinary iodine concentrations (UIC) have decreased 50% since the 1970s. We analyzed 2001-2006 NHANES data from urine iodine spot tests for pregnant (n = 326), lactating (n = 53), and nonpregnant, nonlactating (n = 1437) women of reproductive age (15-44 y). We used WHO criteria to define iodine sufficiency (median UIC: 150-249 μg/L among pregnant women; ≥100 μg/L among lactating women; and 100-199 μg/L among nonpregnant, nonlactating women). The iodine status of pregnant women was borderline sufficient (median UIC = 153 μg/L; 95% CI = 105-196), while lactating (115 μg/L; 95% CI = 62-162) and nonpregnant, nonlactating (130 μg/L; 95% CI = 117-140) women were iodine sufficient. Dairy product consumption was an important contributor to iodine status among both pregnant and nonpregnant, nonlactating women, and those who do not consume dairy products may be at risk for iodine deficiency. Although larger samples are needed to confirm these findings, these results raise concerns about the iodine status of pregnant women and women of reproductive age who are not consuming dairy products. Iodine levels among U.S. women should be monitored, particularly among subgroups at risk for iodine deficiency. [ABSTRACT FROM AUTHOR]

In large epidemiologic studies, information on breastfeeding practice is often collected from maternal recall through interviews, but there is concern about the accuracy of the data, especially when mothers are asked to recall their practices from many years earlier. This review examines the validity and reliability of maternal recall of breastfeeding history using 11 studies published between 1966 and 2003 in English with a sample of 10 or more. Validity is the degree to which recall compares with a validation standard or reference, and reliability refers to the degree to which the breastfeeding practices obtained by recall are repeatable over time. The existing studies suggest that maternal recall is a valid and reliable estimate of breastfeeding initiation and duration, especially when the duration of breastfeeding is recalled after a short period (&les;3 years). Validity and reliability of maternal recall for the age at introduction of food and fluids other than breast milk are less satisfactory. Further and more extensive studies on maternal recall of breastfeeding history and ways to improve such recall are warranted. [ABSTRACT FROM AUTHOR]

Objective. Although many studies have found that childhood levels of body mass index (BMI; kg/m 2 ) are associated with adult levels, it has been reported that childhood BMI is not associated with adult adiposity. We further examined these longitudinal associations. Design. Cohort study based on examinations between 1973 and 1996. Setting. Bogalusa, Louisiana. Participants. Children (2610; ages 2-17 years old) who were followed to ages 18 to 37 years; the mean follow-up was 17.6 years. Main Outcome Measures. BMI-for-age and triceps skinfold thickness (SF) were measured in childhood. Subscapular and triceps SFs were measured among adults, and the mean SF was used as an adiposity index. Adult obesity was defined as a BMI ≥30 kg/m² and adult overfat as a mean SF in the upper (gender-specific) quartile. Results. Childhood levels of both BMI and triceps SF were associated with adult levels of BMI and adiposity. The magnitude of these longitudinal associations increased with childhood age, but the BMI levels of even the youngest (ages 2-5 years) children were moderately associated (r = 0.33-0.41) with adult adiposity. Overweight (BMI-for-age ≥ 95th centile) 2- to 5-year-olds were >4 times as likely to become overfat adults (15 of 23 [65%]), as were children with a BMI < 50th centile (30 of 201 [15%]). Even after accounting for the triceps SF of children, BMI-for-age provided additional information on adult adiposity. Conclusions. Childhood BMI is associated with adult adiposity, but it is possible that the magnitude of this association depends on the relative fatness of children. [ABSTRACT FROM AUTHOR]

Background: Despite the popularity of antiobesity medications, there is a lack of population-based data on their use. In addition, response (termination of pill use and receipt of an echocardiogram) to the fenfluramine and dexfenfluramine market withdrawal among the public has not been described. Lessons learned from this event have implications for future withdrawals.Methods: We used data from the Behavioral Risk Factor Surveillance System (BRFSS) a random-digit telephone survey. In 1998, six states included detailed questions about the use of prescription weight loss pills in the previous 2 years, n = 16,460 noninstitutionalized adults aged 18 years or older.Results: Almost one third of prescription weight loss pills users were not obese before taking pills. Family and friends and other nonphysicians were reported as sources of medication by one in ten users. One third of users also reported taking nonprescription diet products. Among fenfluramine or dexfenfluramine users, one third continued pill use after the market withdrawal and only one quarter received echocardiograms.Conclusions: Despite enormous publicity, many persons continued to use fen-phen after the market withdrawal and most did not receive follow-up echocardiograms. Our study raises issues regarding the effectiveness of withdrawal warnings in a small but significant subset. Additional means of communicating risk to individuals are needed for future product withdrawals including special strategies for those lacking healthcare coverage. [Copyright &y& Elsevier]

Background: Americans spend over $33 billion annually on weight-loss products and services. Although weight-control methods are of considerable public health interest, few national data on weight-loss practices are available. This paper examines the prevalence of specific weight-loss practices among U.S. adults trying to lose weight.Methods: Data from the 1998 National Health Interview Survey, which was conducted through face-to-face interviews of a nationally representative sample of U.S. adults (n =32,440), were analyzed in 2003.Results: Twenty-four percent of men and 38% of women were trying to lose weight. Attempting weight loss was less common among normal weight (body mass index [BMI]<25 kg/m2) people (6% men, 24% women) than overweight (BMI≥25 to 30 kg/m2) people (28%, 49%) or obese (BMI≥30 kg/m2) people (50%, 58%). Among those trying to lose weight, the most common strategies were eating fewer calories (58% men, 63% women); eating less fat (49%, 56%); and exercising more (54%, 52%). Less frequent strategies were skipping meals (11% men, 9% women); eating food supplements (5%, 6%); joining a weight-loss program (3%, 5%); taking diet pills (2%, 3%); taking water pills or diuretics (1%, 2%); or fasting for ≥24 hours (0.6%, 0.7%). Only one third of all those trying to lose weight reported eating fewer calories and exercising more.Conclusions: Increased efforts are needed among all those trying to lose weight to promote effective strategies for weight loss, including the use of calorie reduction and increased physical activity. [Copyright &y& Elsevier]

Background: There is limited population-based data on diet and physical activity behaviors and weight loss among users of prescription weight loss medications. Most findings are from clinical settings or from research that includes organized behavioral programs. Methods: We analyzed data from the 1998 Behavioral Risk Factor Surveillance System, an annual telephone survey conducted in all fifty states, the District of Columbia and Puerto Rico. The sample consisted of 135,435 noninstitutionalized adults aged 18 years old and older. We determined the prevalence and odds of prescription weight loss medication use, odds of 10% weight loss, and among current weight loss medication users, the prevalence and odds for diet and physical activity behaviors. Results: 10.2% of obese women and 3.1% of obese men reported using prescription weight loss medications in the past 2 years. Of users, 28.2% had lost at least 10% of their pretreatment body weight. The odds of losing at least this much weight were higher among women, those who usually consumed ≥ 5 fruits and vegetables daily and those who met physical activity recommendations. Among current prescription weight loss medication users, 26.7% reported both eating fewer calories and meeting recommended leisure-time physical activity levels (<40% of any group met both). Of those meeting both recommendations, almost half (47.2%) had lost 10% of their pretreatment body weight. Of current users, 9% reported using the medications for weight maintenance. Conclusions: Only 26.7% of prescription weight loss medication users reported following recommended diet and physical activity behaviors. Further research is needed to assess whether behavioral changes are associated with greater weight loss and maintenance among prescription weight loss medication users. [ABSTRACT FROM AUTHOR]

Context: Although the prevalence of obesity has markedly increased among US adults, health risks vary according to the severity of obesity. Persons with class 3 obesity (body mass index [BMI] ≥40) are at greatest risk, but there is little information about this subgroup. Objective: To examine correlates of class 3 obesity and secular trends. Design, Setting, and Participants: Adults (aged ≥18 years) in the United States who participated in the Behavioral Risk Factor Surveillance System telephone survey between 1990 (75 600 persons) and 2000 (164 250 persons). Main Outcome Measure: Body mass index calculated from self-reported weight and height. Results: The prevalence of class 3 obesity increased from 0.78% (1990) to 2.2% (2000). In 2000, class 3 obesity was highest among black women (6.0%), persons who had not completed high school (3.4%), and persons who are short. During the 11-year period, the median BMI level increased by 1.2 units and the 95th percentile increased by 3.2 units. Conclusion: The prevalence of class 3 obesity is increasing rapidly among adults. Because these extreme BMI levels are associated with the most severe health complications, the incidence of various diseases will increase substantially in the future. [ABSTRACT FROM AUTHOR]

Accurate assessment of infant feeding is needed for clinical practice and research. We identified 32 studies that evaluated the validity of direct observation, test weighing, or doubly labeled water methods. Correlations with validation standards were highest for doubly labeled water and test weighing, and lowest for observation. Cost and availability of isotope may limit the doubly labeled water method to research studies, whereas observation may be useful for clinical practice. Test weighing could be applied to either setting, but it may be practical to sample less frequently over 24 hours. Validity results and intended use of the measurement should be considered when selecting a method. [ABSTRACT FROM AUTHOR]

Presents a study to estimate the prevalence of overall and specific nonprescription weight loss product use by demographic characteristics, prescription diet pill use, diabetic status, and lifestyle choices in the United States. Design and setting; Participants; Main outcome measures; Results; Conclusion that with increasing rates of obesity, nonprescription product use is likely to increase.

In this secondary analysis of data from a double‐blind randomized controlled trial (clinicaltrials.gov identifier: NCT00133744) of micronutrient supplementation (multiple micronutrients [MMN], iron–folic acid [IFA] and folic acid [FA] alone), we examined the potential modifying effect of gestational age at enrolment on the association of antenatal supplementation and pregnancy‐induced hypertension (PIH). We included 18,775 nulliparous pregnant women with mild or no anaemia who were enrolled at 20 weeks of gestation or earlier from five counties of northern China. Women were randomly assigned to receive daily FA, IFA or MMN from enrolment until delivery. We used logistic regression to evaluate the association between PIH and timing of micronutrient supplementation. The incidence of PIH was statistically significantly lower among women who began MMN supplementation before 12 gestational weeks compared with women who began MMN supplementation at 12 weeks or later (RR = 0.74, 95% CI: 0.60–0.91). A similar protective effect was observed for both early‐onset (<28 weeks, RR 0.45, 0.21–0.96) and late‐onset of PIH (≥28 weeks, RR 0.77, 0.63–0.96). No statistically significant association was observed between PIH occurrence and timing of supplementation for FA or IFA. Maternal MMN supplementation and antenatal enrolment during the first trimester of pregnancy appeared to be of importance in preventing both early‐ and late‐onset of PIH. [ABSTRACT FROM AUTHOR]

ABSTRACT. Breast-feeding is an important determinant of the health and nutritional status of children, particularly in lower socioeconomic populations. A major goal of the Georgia Special Supplemental Food Program for Women, Infants, and Children (WIC) is to increase the practice of breast-feeding among the women it serves. Breast-feeding practices were determined among a random sample of 404 women from a cohort of 2010 who attended WIC prenatal clinics in Georgia in 1986 and were expected to deliver in February 1987. Respondents were interviewed 6 months postpartum. Of these women, 24% initially breast-fed, but only 6% continued for 6 months or longer. The initiation of breast-feeding was associated with greater maternal education and with being roamed. The adjusted odds of breast-feeding for mothers who were married or living as married were 3.0 (95% confidence interval, 1.7 to 5.3) times greater than for mothers who were not married or living as married. Mothers with more than 12 years, 12 years, or 10 to 11 years of education were 5.2 (1.8 to 15.3), 2.7 (1.0 to 6.9), and 2.5 (0.9 to 6.9) times more likely, respectively, to breast-feed than mothers with 9 or fewer years of education. After adjustment was made for marital status and education, the remaining variables (ethnicity, parity, age, and employment status) did not influence the initiation of breast-feeding in this low-income population. The need for vigorous promotion of breast-feeding by the Georgia WIC program is emphasized by the low rate of initiation and short duration of breast-feeding in this low-income population. [ABSTRACT FROM AUTHOR]

Presents a study which determined whether inadequate control for pre-existing illness or cigarette smoking contributed to the association between weight loss and increased risk for death in a cohort of U.S. adults. Discussion on previous analysis of weight loss and death; Effect of weight loss on mortality risks for the aged; Results and discussion.

Context: Implementation of the National Institutes of Health's 1998 guidelines, which recommended that health care professionals advise obese patients to lose weight, required baseline data for evaluation.Objectives: To describe the proportion and characteristics of obese persons advised to lose weight by their health care professional during the previous 12 months and to determine whether the advice was associated with reported attempts to lose weight.Design: The Behavioral Risk Factor Surveillance System, a random-digit telephone survey conducted in 1996 by state health departments.Setting: Population-based sample from 50 states and the District of Columbia.Participants: A total of 12835 adults, 18 years and older, classified as obese (body mass index > or =30 kg/m2), who had visited their physician for a routine checkup during the previous 12 months.Main Outcome Measures: Reported advice from a health care professional to lose weight, and reported attempts to lose weight.Results: Forty-two percent of participants reported that their health care professional advised them to lose weight. Using multivariate logistic regression analysis, we found that the persons who were more likely to receive advice were female, middle aged, had higher levels of education, lived in the northeast, reported poorer perceived health, were more obese, and had diabetes mellitus. Persons who reported receiving advice to lose weight were significantly more likely to report trying to lose weight than those who did not (OR, 2.79; 95% CI, 2.53-3.08).Conclusions: Less than half of obese adults report being advised to lose weight by health care professionals. Barriers to counseling need to be identified and addressed. [ABSTRACT FROM AUTHOR]