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Objective: The authors assessed the efficacy of sertraline in the treatment of night eating syndrome. Method: Thirty-four outpatients diagnosed with night eating syndrome were randomly assigned to receive either sertraline (N=17) or placebo (N=17) in an 8-week, double-blind, flexible-dose (50-200 mg/day) study. A mixed effects linear regression model was used to analyze change in the primary outcome measure, Clinical Global Impression (CGI) improvement rating. Secondary outcomes included changes in night eating symptoms, the number of nocturnal awakenings and ingestions, total daily caloric intake after the evening meal, CGI severity ratings, quality of life ratings, and weight. Results: Sertraline was associated with significantly greater improvement than placebo. Twelve subjects in the sertraline group (71%) were classified as having responded (CGI improvement rating [less than or equal to] 2, indicating much or very much improved) versus only three (18%) in the placebo group. There were also significant improvements in night eating symptoms, CGI severity ratings, quality of life ratings, frequency of nocturnal ingestions and awakenings, and caloric intake after the evening meal. Overweight and obese subjects in the sertraline group (N=14) lost a significant amount of weight by week 8 (mean=-2.9 kg, SD=3.8) compared with overweight and obese subjects receiving placebo (N=14) (mean=-0.3 kg, SD=2.7). Conclusions: In this 8-week trial, sertraline was effective in the treatment of night eating syndrome and was well tolerated.

Background: Although depressive conditions in later life are a major public health problem, the outcomes of minor and subsyndromal depression are largely unknown. Objective: To compare outcomes among patients with minor and subsyndromal depression, major depression, and no depression, and to examine putative outcome predictors. Design: Cohort study. Setting: Patients from primary care practices in greater New York City, and Philadelphia and Pittsburgh, Pennsylvania. Patients: 622 patients who were at least 60 years of age and presented for treatment in primary care practices that provided usual care in a randomized, controlled trial of suicide prevention. Of the 441 (70.9%) patients who completed 1 year of follow-up, 122 had major depression, 205 had minor or subsyndromal depression, and 114 did not have depression at baseline. Measurements: One year after a baseline evaluation, data were collected by using the following tools: Hamilton Depression Rating Scale, the depressive disorders section of the Structured Clinical Interview for DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition), Charlson Comorbidity Index, Multilevel Assessment Instrument for measuring instrumental activities of daily living, Physical Component Summary of the Medical Outcomes Study Short Form-36, and Duke Social Support Index. Results: Patients with minor or subsyndromal depression had intermediate depressive and functional outcomes. Mean adjusted 1-year Hamilton depression score was 10.9 (95% CI, 9.6 to 12.2) for those with initial major depression, 7.0 (CI, 5.9 to 8.1) for those with minor or subsyndromal depression, and 2.9 (CI, 1.6 to 4.2) for those without depression (P < 0.001 for each paired comparison). Compared with patients who were not depressed, those who had minor or subsyndromal depression had a 5.5-fold risk (CI, 3.1-fold to 10.0-fold) for major depression at 1 year after controlling for demographic characteristics (P < 0.001). Cerebrovascular risk factors were not associated with a diagnosis of depression at 1 year after controlling for overall medical burden. Initial medical burden, self-rated health, and subjective social support were significant independent predictors of depression outcome. Limitations: Participants received care at practices that had personnel who had been given enhanced education about depression treatment; 29.1% of participants withdrew from the study before completing 1 year of follow-up. Conclusions: The intermediate outcomes of minor and subsyndromai depression demonstrate the clinical significance of these conditions and suggest that they are part of a spectrum of depressive illness. Greater medical burden, poor subjective health status, and poorer subjective social support confer a higher risk for poor outcome.

Objective: This study compared time to first remission for elderly depressed patients in primary care for practices that implemented a care management model versus those providing usual care. In addition, it sought to identify risk factors for nonremission that could guide treatment planning and referral to care managers or specialists. Method: Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT) data were analyzed. Participants were older patients ([greater than or equal to] 60 years) selected following screening of 9,072 randomly identified primary care patients. The present analysis examined patients with major depression and a 24-item Hamilton Depression Rating Scale score of 18 or greater who were followed for at least 4 months (N=215). Primary care practices were randomly assigned to offer the PROSPECT intervention or usual care. The intervention consisted of services of trained care managers, who offered algorithm-based recommendations to physicians and helped patients with treatment adherence over 18 months. Results: First remission occurred earlier and was more common among patients receiving the intervention than among those receiving usual care. For all patients, limitations in physical and emotional functions predicted poor remission rate. Patients experiencing hopelessness were more likely to achieve remission if treated in intervention practices. Similarly, the intervention was more effective in patients with low baseline anxiety. Conclusions: Longitudinal assessment of depression, hopelessness, anxiety, and physical and emotional functional limitations in depressed older primary care patients is critical. Patients with prominent symptoms or impairment in these areas may be candidates for care management or mental health care, since they are at risk for remaining depressed and disabled.

Background: Total body potassium (TBK) is an index of fat-free mass. Data describing changes in TBK in African American, Asian, or Hispanic populations have not been reported. Objective: The aim was to investigate possible sex and racial differences in TBK in adults over an age range of 70 y. Design: The study used longitudinal and cross-sectional data collected in a body-composition unit from 973 men and 1368 women of African American, Asian, white, and Hispanic race-ethnicity. Random coefficient models in which baseline weight and height were taken into account were applied to estimate sex-specific changes in TBK among the 4 racial-ethnic groups. Results: The ages of 30 and 31 y were identified for women and men, respectively, as the cutoffs after which TBK began to decline. Both sexes had similar racial-ethnic patterns for expected mean TBK at the age cutoffs: African Americans had the highest value, followed by whites, Hispanics, and Asians. After the age cutoffs, the decline in TBK differed by race and sex. In women, African Americans showed the most rapid decline, whereas Asians had the lowest. In men, Hispanics had the most rapid decline in TBK, followed by African Americans, whites, and Asians. Conclusion: Significant sex and racial differences exist in the rate of change in TBK with age. Further studies are needed to explore the associations of declining TBK with health risks. KEY WORDS Total body potassium, race, sex, age, skeletal muscle mass, African Americans, Asians, whites, Hispanics

Background: Limited research has been done to explore differences between ethnic groups, including Hispanic Americans (HAs), in the association between percentage body fat (PBF) and body mass index (BMI; in kg/[m.sup.2]); the numbers of HAs are increasing in the US population. Objective: We investigated whether the relation between PBF and BMI in adult HAs differed from that of African Americans (AAs) and European Americans (EAs). Design: We used a multiple regression model in which PBF measured with dual energy X-ray absorptiometry was predicted by the reciprocal of BMI (1/BMI; in [m.sup.2]/kg) in a sample of 487 men ([n.sub.EA] = 192, [n.sub.AA] = 148, and [n.sub.HA] = 147) and 933 women ([n.sub.EA] = 448, [n.sub.AA] = 304, and [n.sub.HA] = 181). Results: For men, our results showed no significant differences between HAs and EAs, AAs and EAs, or HAs and AAs in the slope of the line relating 1/BMI to PBF. In women, there were significant differences in PBF as predicted by BMI between HAs and EAs (P < 0.002) and AAs and HAs (P = 0.020), but not between AAs and EAs. When PBF was estimated on the basis of predicting equations, the trend of the predicted PBF value in women differed according to ethnic group and BMI category. At a BMI < 30, HAs tended to have more body fat than did EAs and AAs, and at a BMI > 35, EAs tended to have more body fat than did the other groups. Conclusions: Our results show that the relation between PBF and BMI in HA women differs from that of EA and AA women. KEY WORDS Body composition, ethnicity, percentage body fat, body mass index, Hispanic Americans, Hispanics, dual-energy X-ray absorptiometry, DXA

Background: Waist circumference (WC) is strongly linked to obesity-associated risks. However, currently proposed WC risk thresholds are not based on associations with obesity-related risk factors but rather with body mass index (BMI; in kg/[m.sup.2]). Objective: The objective was to determine the relations of WC to obesity-associated risk factors in a representative sample of US whites and to derive comparable risk thresholds for WC and BMI. Design: Data on 9019 white participants of the third National Health and Nutrition Examination Survey were divided into 2 groups according to the presence of [greater than or equal to] 1 of 4 obesity-associated risk factors: low HDL cholesterol, high LDL cholesterol, high blood pressure, and high glucose. Odds ratio (OR) equations were derived from logistic regression models for WC and BMI with the use of the 25th percentile in the study population as the reference. Receiver operating characteristic curves for identifying risk factors were computed for WC and BMI. Results: At BMIs of 25 and 30, ORs were 1.19 (95% CI: 1.06, 1.35) and 2.37 (95% CI: 1.33, 4.22) for men and 1.56 (95% CI: 1.29, 1.91) and 3.16 (95% CI: 1.94, 5.28) for women, respectively. The corresponding ORs for WC were at 90 and 100 cm for men and at 83 and 93 cm for women. Minima on the receiver operating characteristic curves for men were at 96 cm for WC and at 26 for BMI and for women were at 86 cm for WC and 25 for BMI. Conclusion: WC is more closely linked to cardiovascular disease risk factors than is BMI. KEY WORDS Body mass index, BMI, cardiovascular disease risk factors, obesity, waist circumference, third National Health and Nutrition Examination Survey, NHANES III

Objective: The purpose of this study was to estimate and compare the effects of antipsychotics--both the newer ones and the conventional ones--on body weight. Method: A comprehensive literature search identified 81 English- and non-English-language articles that included data on weight change in antipsychotic-treated patients. For each agent, a meta-analysis and random effects metaregression estimated the weight change after 10 weeks of treatment at a standard dose. A comprehensive narrative review was also conducted on all articles that did not yield quantitative information but did yield important qualitative information. Results: Placebo was associated with a mean weight reduction of 0.74 kg. Among conventional agents, mean weight change ranged from a reduction of 0.39 kg with molindone to an increase of 3.19 kg with thioridazine. Among newer antipsychotic agents, mean increases were as follows: clozapine, 4.45 kg; olanzapine, 4.15 kg; sertindole, 2.92 kg; risperidone, 2.10 kg; and ziprasidone, 0.04 kg. Insufficient data were available to evaluate quetiapine at 10 weeks. Conclusions: Both conventional and newer antipsychotics are associated with weight gain. Among newer agents, clozapine appears to have the greatest potential to induce weight gain, and ziprasidone the least. The differences among newer agents may affect compliance with medication and health risk.

To assess the accuracy of 2-dimensional echocardiography versus transesophageal echocardiography (TEE) in predicting aortic annulus diameter, and to datermine which part of the cardiac cycle should be used for measuring the size of the aortic valve prosthesis in patients undergoing aortic valve replacement, the aortic annulus was measured retrospectively in a blinded fashion in a group of 94 patients who had undergone aortic valve replacement: 66 had preoperative transthoracic echocardiography (TTE), 69 had intraoperative TEE, and 41 had both. Accuracy of measurements was calculated by the mean biases (differences between annular size by echo and actual valve size chosen by intraoperative mechanical sizing of the aortic annulus). TTE was compared with TEE and end-diastolic (ED) measurements with end-systolic (ES) measurements. The mean biases [+ or -] SD were -1.7 [+ or -] 3.4 mm by TRE-ES versus -0.9 [+ or -] 3.S mm by TEE-ES measurements (p = NS), and +0.03 [+ or -] 3 mm by TRE-ED versus +O.5 [+ or -] 2.8 mm by TEE-ED (p = NS). Examination of the magnitudes of the biases gave the same result. ED measurements were found to have a smaller amount of bias than ES measurements, both by TTE and by TEE: -1.7 [+ or -] 3.4 mm by TTE-ES versus +0.03 [+ or -] 3 mm by TRE-ED (p = 0.0001) and -0.9 [+ or -] 3.S mm by TEE-ES versus +0.5 [+ or -] 2.8 mm by TEE-ED (p = 0.0001). Examination of the magnitudes of the biases also gave the same result. Thus, TTE (as well as TEE) can predict valve size in patients undergoing aortic valve replacement. ED annular sizing better predicts valve size than ES sizing. These results can be used clinically in the assessment of patients undergoing aortic valve replacement.

Background: Skeletal muscle (SM) is a large body compartment of biological importance, but it remains difficult to quantify SM with affordable and practical methods that can be applied in clinical and field settings. Objective: The objective of this study was to develop and cross-validate anthropometric SM mass prediction models in healthy adults. Design: SM mass, measured by using whole-body multislice magnetic resonance imaging, was set as the dependent variable in prediction models. Independent variables were organized into 2 separate formulas. One formula included mainly limb circumferences and skinfold thicknesses [model 1: height (in m) and skinfold-corrected upperarm, thigh, and calf girths (CAG, CTG, and CCG, respectively; in cm)]. The other formula included mainly body weight (in kg) and height (model 2). The models were developed and cross-validated in nonobese adults [body mass index (in kg/[m.sup.2]) [is less than] 30]. Results: Two SM (in kg) models for nonobese subjects (n = 244) were developed as follows: SM = Ht x (0.00744 x [CAG.sup.2] + 0.00088 x [CTG.sup.2] + 0.00441 x [CCG.sup.2]) + 2.4 x sex - 0.048 x age + race + 7.8, where [R.sup.2] = 0.91, P [is less than] 0.0001, and SEE = 2.2 kg; sex = 0 for female and 1 for male, race = -2.0 for Asian, 1.1 for African American, and 0 for white and Hispanic, and SM = 0.244 x BW + 7.80 x Ht + 6.6 x sex - 0.098 x age + race - 3.3, where [R.sup.2] = 0.86, P [is less than] 0.0001, and SEE = 2.8 kg; sex = 0 for female and 1 for male, race = - 1.2 for Asian, 1.4 for African American, and 0 for white and Hispanic. Conclusion: These 2 anthropometric prediction models, the first developed in vivo by using state-of-the-art body-composition methods, are likely to prove useful in clinical evaluations and field studies of SM mass in nonobese adults. Am J Clin Nutr 2000;72:796-803. KEY WORDS Limb circumference, skinfold thickness, body composition, skeletal muscle, nonobese adults

Background: Although international interest in classifying subject health status according to adiposity is increasing, no accepted published ranges of percentage body fat currently exist. Empirically identified limits, population percentiles, and z scores have all been suggested as means of setting percentage body fat guidelines, although each has major limitations. Objective: The aim of this study was to examine a potential new approach for developing percentage body fat ranges. The approach taken was to link healthy body mass index (BMI; in kg/[m.sup.2]) guidelines established by the National Institutes of Health and the World Health Organization with predicted percentage body fat. Design: Body fat was measured in subjects from 3 ethnic groups (white, African American, and Asian) who were screened and evaluated at 3 universities [Cambridge (United Kingdom), Columbia (United States), and Jikei (Japan)] with use of reference body-composition methods [4-compartment model (4C) at 2 laboratories and dual-energy X-ray absorptiometry (DXA) at all 3 laboratories]. Percentage body fat prediction equations were developed based on BMI and other independent variables. Results: A convenient sample of 1626 adults with BMIs [is less than or equal to] 35 was evaluated. Independent percentage body fat predictor variables in multiple regression models included 1/BMI, sex, age, and ethnic group (R values from 0.74 to 0.92 and SEEs from 2.8 to 5.4% fat). The prediction formulas were then used to prepare provisional healthy percentage body fat ranges based on published BMI limits for underweight ([is less than] 18.5), overweight ([is greater than] 25), and obesity ([is greater than or equal to] 30). Conclusion: This proposed approach and initial findings provide the groundwork and stimulus for establishing international healthy body fat ranges. Am J Clin Nutr 2000;72:694-701. KEY WORDS Obesity, percentage body fat, malnutrition, nutritional assessment, body fat guidelines, body composition, prediction equations

By virtue of its potential effects on rates of energy expenditure, uncoupling protein 3 (UCP3) is an obesity candidate gene. We identified nine sequence variants in UCP3, including Val9Met, Vall0211e, [...]

Background: The factors that control body composition in disease are uncertain. Objective: We planned to compare the relative influences of HIV infection, sex, race, and environment on body composition. Methods: We analyzed results of body composition studies performed by bioelectrical impedance analysis in 1415 adults from 2 cohorts: white and African American men and women from the United States, and African men and women (279 HIV-infected and 1136 control). The effects of sex and HIV infection on weight, body cell mass, and fat-free mass were analyzed by using both unadjusted and age-, weight-, and height-adjusted data. Results: Control men weighed more and had more body cell mass and fat-free mass than did control women, although control women had more fat. The strongest correlates with body composition were height and weight, followed by sex, HIV infection, age, environment, and race. Control men and women weighed more and had more body cell mass, fat-free mass, and fat than did HIV-infected men. However, differences in body composition between HIV-infected and control groups were strongly influenced by sex. Of the differences in weight between HIV-infected and uninfected subjects, fat-free mass accounted for 51% in men but only 18% in women, in whom the remainder was fat. Sex effects were similar in African and American groups. Conclusions: Sex has a marked effect on the changes in body composition during HIV infection, with women losing disproportionately more fat than men. Sex-related differences in body composition were narrower in the HIV-infected groups. Race and environment had smaller effects than sex and HIV infection. Am J Clin Nutr 1999;69:432-9. KEY WORDS Nutritional assessment, body composition, bioelectrical impedance analysis, BIA, HIV infection, malnutrition, African Americans, Africans, men, women, whites