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OBJECTIVE--To examine whether the duration of abdominal obesity determined prospectively using measured waist circumference (WC) is associated with the development of new-onset diabetes independent of the degree of abdominal adiposity. [...]

OBJECTIVE--To investigate the long-term associations of magnesium intake with incidence of diabetes, systemic inflammation, and insulin resistance among young American adults. RESEARCH DESIGN AND METHODS--A total of 4,497 Americans, aged [...]

Background: Consumption of liquid calories from beverages has increased in parallel with the obesity epidemic in the US population, but their causal relation remains unclear. Objective: The objective of this study was to examine how changes in beverage consumption affect weight change among adults. Design: This was a prospective study of 810 adults participating in the PREMIER trial, an 18-mo randomized, controlled, behavioral intervention trial. Measurements (weight, height, and 24-h dietary recall) were made at baseline, 6 mo, and 18 mo. Results: Baseline mean intake of liquid calories was 356 kcal/d (19% of total energy intake). After potential confounders and intervention assignment were controlled for, a reduction in liquid calorie intake of 100 kcal/d was associated with a weight loss of 0.25 kg (95% CI: 0.11, 0.39; P < 0.001) at 6 mo and of 0.24 kg (95% CI: 0.06, 0.41; P = 0.008) at 18 mo. A reduction in liquid calorie intake had a stronger effect than did a reduction in solid calorie intake on weight loss. Of the individual beverages, only intake of sugar-sweetened beverages (SSBs) was significantly associated with weight change. A reduction in SSB intake of 1 serving/d was associated with a weight loss of 0.49 kg (95% CI: 0.11, 0.82; P = 0.006) at 6 mo and of 0.65 kg (95% CI: 0.22, 1.09; P = 0.003) at 18 mo. Conclusions: These data support recommendations to limit liquid calorie intake among adults and to reduce SSB consumption as a means to accomplish weight loss or avoid excess weight gain. This trial was registered at clinicaltrials.gov as NCT00000616. Am J Clin Nutr 2009;89:1299-306.

Background: Little research has explored the association of macronutrient intake and glycated hemoglobin (Hb[A.sub.1c]) in adults with diabetes. Objective: The objective of the study was to examine the cross-sectional association between macronutrient intake and Hb[A.sub.lc] in diabetic American Indians. Design: A total of 1284 participants aged 47- 80 y who had diabetes for [greater than or equal to] 1 y at the second examination (1993-1995) of the Strong Heart Study were included in this study. Dietary intake was assessed by using a 24-h recall. Logistic regression models were used to evaluate the odds of poor glycemic control (Hb[A.sub.1c] [greater than or equal to] 7%) among sex-specific quintiles of macronutrient intake, after adjustment for the possible confounders age, sex, study center, body mass index, duration of diabetes, diabetes treatment, smoking, alcohol drinking, total energy intake, and physical activity. Results: Higher total fat (>25-30% of energy), saturated fatty acids (> 13% of energy), and monounsaturated fatty acids (> 10% of energy) and lower carbohydrate intake ( KEY WORDS Macronutrient intake, glycated hemoglobin, Hb[A.sub.lc], cross-sectional association, diabetes

Background: The results of previous studies on the association between dietary fat intake and coronary heart disease (CHD) incidence are inconsistent. Objective: The aim of this study was to examine the association between dietary fat intake and CHD incidence in American Indians in the Strong Heart Study. Design: A total of 2938 participants aged 47-79 y and free of CHD at the second examination (1993-1995) were examined and followed for CHD, nonfatal CHD, and fatal CHD events to 31 December 2002. Dietary intake was assessed by using a 24-h diet recall and was calculated as percentages of energy. Results: Participants were followed for a mean ([+ or -]SD) of 7.2 [+ or -] 2.3 y. During follow-up, 436 incident CHD cases (298 nonfatal CHD and 138 fatal CHD events) were ascertained. Participants aged 47-59 y in the highest quartile of intake of total fat, saturated fatty acids, or monounsaturated fatty acids had higher CHD mortality than did those in the lowest quartile [hazard ratio (95% CI): 3.57 (1.21, 10.49), 5.17 (1.64, 16.36), and 3.43 (1.17, 10.04), respectively] after confounders were controlled for. These associations were not observed for those aged 60-79 y. Conclusions: Total fat, saturated fatty acid, and monounsaturated fatty acid intake were strong predictors of CHD mortality in American Indians aged 47-59 y, independent of other established CHD risk factors. It may be prudent for American Indians to reduce their fat intake early in life to reduce the risk of dying from CHD. KEY WORDS Dietary fat intake, fatty acids, cholesterol, coronary heart disease, mortality, American Indians

OBJECTIVE--The aim of this study was to describe the association of the metabolic syndrome with demographic characteristics and to identify modifiable risk factors for development of the metabolic syndrome. RESEARCH [...]

Background: Cross-sectional epidemiologic studies suggest that a higher intake of dietary sodium is associated with an increased risk of left ventricular hypertrophy. We studied the relationship between dietary sodium intake and incidence of congestive heart failure (CHF) in the first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study participants. Participants and Methods: The study sample consisted of 5233 nonoverweight and 5129 overweight men and women without a history of CHF at their baseline examination. Dietary sodium and other nutrient intake estimates were obtained by a 24-hour dietary recall method at the baseline examination, conducted from 1971 to 1975. The incidence of CHF was assessed using medical records and death certificates obtained in 1982 to 1984, 1986, 1987, and 1992. Results: During an average of 19 years of follow-up, we documented 413 cases of CHF in nonoverweight and 679 cases of CHF in overweight participants. After adjustment for known CHF risk factors, the relative risk of CHF among overweight participants was 1.43 (95% confidence interval, 1.07-1.91) for those whose sodium intake was greater than 113.6 mmol/d compared with those whose intake was less than 50.2 mmol/d. The relative risks of CHF for a 100-mmol/d higher intake of sodium or per 1743 kcal (average energy intake in the study population) were 1.26 (95% confidence interval, 1.03-1.53) and 1.21 (95% confidence interval, 1.04-1.40), respectively. Conclusions: A higher intake of dietary sodium is a strong independent risk factor for CHF in overweight persons. A reduction in sodium intake may play an important role in the prevention of CHF in overweight individuals and populations.

Background: Epidemiologic studies report inconsistent findings on the association of fruit and vegetable intake with the risk of cardiovascular disease. Objective: The objective was to examine the relation between fruit and vegetable intake and the risk of cardiovascular disease. Design: We studied 9608 adults aged 25-74 y participating in the first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study and free of cardiovascular disease at the time of their baseline examination between 1971 and 1975. Fruit and vegetable intake at baseline was measured with a food-frequency questionnaire. The incidence of and mortality from cardiovascular disease were obtained from medical records and death certificates. Results: Over an average of 19 y, 888 strokes (218 fatal), 1786 ischemic heart disease events (639 fatal), 1145 cardiovascular disease deaths, and 2530 all-cause deaths were documented. Consuming fruit and vegetables [greater than or equal to] 3 times/d compared with < 1 time/d was associated with a 27% lower stroke incidence [relative risk (RR): 0.73; 95% CI: 0.57, 0.95; P for trend = 0.01), a 42% lower stroke mortality (0.58; 0.33, 1.02; P for trend = 0.05), a 24% lower ischemic heart disease mortality (0.76; 0.56, 1.03; P for trend = 0.07), a 27% lower cardiovascular disease mortality (0.73; 0.58, 0.92; P for trend = 0.008), and a 15% lower all-cause mortality (0.85; 0.72, 1.00; P for trend = 0.02) after adjustment for established cardiovascular disease risk factors. Conclusion: We showed an inverse association of fruit and vegetable intake with the risk of cardiovascular disease and all-cause mortality in the general US population. KEY WORDS Fruit, vegetables, ischemic heart disease, cerebrovascular disorders, mortality, cohort studies, NHANES I, National Health and Nutrition Examination Survey, cardiovascular disease

Background: Soybean protein and dietary fiber supplementation reduce serum cholesterol in randomized controlled trials. Consumption of legumes, which are high in bean protein and water-soluble fiber, may be associated with a reduced risk of coronary heart disease (CHD). Methods: A total of 9632 men and women who participated in the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study (NHEFS) and were free of cardiovascular disease (CVD) at their baseline examination were included in this prospective cohort study. Frequency of legume intake was estimated using a 3-month food frequency questionnaire, and incidence of CHD and CVD was obtained from medical records and death certificates. Results: Over an average of 19 years of follow-up, 1802 incident cases of CHD and 3680 incident cases of CVD were documented. Legume consumption was significantly and inversely associated with risk of CHD (P=.002 for trend) and CVD (P=.02 for trend) after adjustment for established CVD risk factors. Legume consumption 4 times or more per week compared with less than once a week was associated with a 22% lower risk of CHD (relative risk, 0.78; 95% confidence interval, 0.68-0.90) and an 11% lower risk of CVD (relative risk, 0.89; 95% confidence interval, 0.80-0.98). Conclusions: Our study indicates a significant inverse relationship between legume intake and risk of CHD and suggests that increasing legume intake may be an important part of a dietary approach to the primary prevention of CHD in the general population. Arch Intern Med. 2001;161:2573-2578

Background: The incidence of congestive heart failure (CHF) has been increasing steadily in the United States during the past 2 decades. We studied risk factors for CHF and their corresponding attributable risk in the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. Participants and Methods: A total of 13 643 men and women without a history of CHF at baseline examination were included in this prospective cohort study. Risk factors were measured using standard methods between 1971 and 1975. Incidence of CHF was assessed using medical records and death certificates obtained between 1982 and 1984 and in 1986, 1987, and 1992. Results: During average follow-up of 19 years, 1382 CHF cases were documented. Incidence of CHF was positively and significantly associated with male sex (relative risk [RR], 1.24; 95% confidence interval [CI], 1.10-1.39; P [is less than] .001; population attributable risk [PAR], 8.9%), less than a high school education (RR, 1.22; 95% CI, 1.04-1.42; P=.01; PAR, 8.9%), low physical activity (RR, 1.23; 95% CI, 1.09-1.38; P [is less than] .001; PAR, 9.2%), cigarette smoking (RR, 1.59; 95% CI, 1.39-1.83; P [is less than] .001; PAR, 17.1%), overweight (RR, 1.30; 95% CI, 1.12-1.52; P=.001; PAR, 8.0%), hypertension (RR, 1.40; 95% CI, 1.24-1.59; P [is less than] .001; PAR, 10.1%), diabetes (RR, 1.85; 95% CI, 1.51-2.28; P [is less than] .001; PAR, 3.1%), valvular heart disease (RR, 1.46; 95% CI, 1.17-1.82; P=.001; PAR, 2.2%), and coronary heart disease (RR, 8.11; 95% CI, 6.95-9.46; P [is less than] .001; PAR, 61.6%). Conclusions: Male sex, less education, physical inactivity, cigarette smoking, overweight, diabetes, hypertension, valvular heart disease, and coronary heart disease are all independent risk factors for CHF. More than 60% of the CHF that occurs in the US general population might be attributable to coronary heart disease. Arch Intern Med. 2001;161:996-1002

SHARON H. SAYDAH, MHS [1] CATHERINE M. LORIA, PHD [2] MARK S. EBERHARDT, PHD [3] FREDERICK L. BRANCATI, MD, MHS [1,4,5] OBJECTIVE -- Although clinically evident type 2 diabetes is [...]

Background: Folate has been linked to cardiovascular disease (CVD) through its role in homocysteine metabolism. Objective: To assess the relationship between serum folate and CVD mortality. Design: In this prospective study, serum folate concentrations were measured on a subset of adults during the Second National Health and Nutrition Examination Survey (1976-1980) and vital status ascertained after 12 to 16 years. Setting and Patients: A national probability sample consisting of 689 adults who were 30 to 75 years of age and did not have a history of CVD at baseline. Main Outcome Measure: Vital status was determined by searching national databases that contained information about US decedents. Results: The associations between serum folate and CVD and all-cause mortality differed by diabetes status (P=.04 and P=.03, respectively). Participants without diabetes in the lowest compared with the highest serum folate tertile had more than twice the risk of CVD mortality after adjustment for age and sex (relative risk [RR], 2.64; 95% confidence interval [CI], 1.15-6.09). This increased risk for participants in the lowest tertile was attenuated after adjustment for CVD risk factors (RR, 2.28; 95% CI, 0.96-5.40). Serum folate tertiles were not significantly associated with total mortality, although the age- and sex-adjusted risk was increased for participants in the lowest compared with highest tertile (RR, 1.74; 95% CI, 0.96-3.15). Risk estimates for participants with diabetes were unstable because of the small sample size (n=52). Conclusion: These data suggest that low serum folate concentrations are associated with an increased risk of CVD mortality among adults who do not have diabetes.

Background: Low vitamin C status may increase the risk of mortality from cancer and cardiovascular disease. Objective: The objective was to test whether an association existed between serum ascorbate concentrations and mortality and whether the association was modified by cigarette smoking status or sex. Design: Serum ascorbate concentrations were measured in adults as part of the second National Health and Nutrition Examination Survey (1976-1980). Vital status was ascertained 12-16 y later. Results: The relative risk (RR) of death, adjusted for potential confounders, was estimated by using Cox proportional hazards models. Men in the lowest ([is less than] 28.4 [micro]mol/L) compared with the highest ([is greater than or equal to] 73.8 [micro]mol/L) serum ascorbate quartile had a 57% higher risk of dying from any cause (RR: 1.57; 95% CI: 1.21, 2.03) and a 62% higher risk of dying from cancer (RR: 1.62; 95% CI: 1.01, 2.59). In contrast, there was no increased risk among men in the middle 2 quartiles for these outcomes and no increased risk of cardiovascular disease mortality in any quartile. There was no association between serum ascorbate quartile and mortality among women. These findings were consistent when analyses were limited to nonsmokers or further to adults who never smoked, suggesting that the observed relations were not due to cigarette smoking. Conclusions: These data suggest that men with low serum ascorbate concentrations may have an increased risk of mortality, probably because of an increased risk of dying from cancer. In contrast, serum ascorbate concentrations were not related to mortality among women. Am J Clin Nutr 2000;72:139-45. KEY WORDS Ascorbic acid, antioxidants, mortality, cancer, cardiovascular disease, smoking, NHANES II, second National Health and Nutrition Examination Survey, adults

Although diabetes is a well-established cause of mortality, the burden of death attributable to diabetes in the U.S. is not well quantified. We therefore performed a prospective cohort study using [...]

Although clinically evident diabetes is a well-established cause of mortality, less is known about the subclinical states of glucose intolerance. We therefore performed a prospective cohort study using data from [...]

Supplemental Digital Content is available in the text.

Supplemental Digital Content is available in the text.

Deconstructing interventions into the specific techniques that are used to change behavior represents a new frontier in behavioral intervention research. This paper considers opportunities and challenges in employing the Behavior Change Techniques Taxonomy (BCTTv1) developed by Michie and colleagues, to code the behavior change techniques (BCTs) across multiple interventions addressing obesity and capture dose received at the technique level. Numerous advantages were recognized for using a shared framework for intervention description. Coding interventions at levels of the social ecological framework beyond the individual level, separate coding for behavior change initiation vs. maintenance, fidelity of BCT delivery, accounting for BCTs mode of delivery, and tailoring BCTs, present both challenges and opportunities. Deconstructing interventions and identifying the dose required to positively impact health-related outcomes could enable important gains in intervention science.

The National Heart, Lung, and Blood Institute and the National Institutes of Health Office of Disease Prevention convened a meeting on August 29-30, 2013 entitled "Obesity Intervention Taxonomy and Pooled Analysis." The overarching goals of the meeting were to understand how to decompose interventions targeting behavior change, and in particular, those that focus on obesity and to combine data from groups of related intervention studies to supplement what can be learned from the individual studies. This paper summarizes the workshop recommendations and provides an overview of the two other papers that originated from the workshop and that address decomposition of behavioral change interventions and pooling of data across diverse studies within a consortium.

Young adulthood has been identified as a high-risk period for the development of obesity but few interventions have been tested in this population. One way to escalate our learning about effective interventions is to test a number of interventions simultaneously as a consortium of research trials. This paper describes the Early Adult Reduction of weight through LifestYle intervention (EARLY) trials. Seven research sites were funded to conduct intervention trials, agreeing to test similar primary outcomes and cooperating to use a set of common measurement tools. The EARLY consortium was able to work cooperatively using an executive committee, a steering committee, workgroups and subcommittees to help direct the common work and implement a set of common protocol and measurement tools for seven independent but coordinated weight-related intervention trials. Using a consortium of studies to help young adults reach or maintain a healthy weight will result in increased efficiency and speed in understanding the most effective intervention strategies.

Supplemental Digital Content is available in the text.

Supplemental Digital Content is available in the text.

Longitudinal studies are very useful for studying diet/disease relationships. The fundamental components of a longitudinal study are that 1) data are collected for two or more distinct time periods; 2) the subjects are the same or comparable from one time period to the next; and 3) data are compared between or among time periods in the analysis. A longitudinal study is often assumed to be synonymous with a cohort study, but there are at least four possible definitions for a longitudinal study. While focusing on cohort studies, the paper describes the nature of longitudinal studies, including a discussion of how the different definitions differ from a cohort study and a set of important assumptions necessary to cohort studies. It also highlights some of the major issues associated with such studies, including the selection of a dietary survey methodology; data collection issues in multicultural, multilingual societies; the importance of nutrient databases; measurement error and misclassification in nutrient intake and energy adjustment.

Sodium intake is related to blood pressure, an established risk factor for heart disease and stroke. Reducing intake may save billions in United States health care dollars annually. Efforts targeting sodium reductions make accurate monitoring vital, yet limited information exists on the accuracy of the current data to assess sodium intake in the United States population. In this symposium, new findings were presented on the accuracy of estimating population 24-h urinary excretion of sodium from spot urine specimens or sodium intake from 24-h dietary recalls. Differences in accuracy by sex, BMI, and race were apparent as well as by timing of spot urine collections. Although some published equations appear promising for estimating group means, others are biased. Individual estimates of sodium intake were highly variable and adjustment for within-individual variation in intake is required for estimating population prevalence or percentiles. Estimates indicated United States sodium intake remains high.

Types of diet used for treating overweight people include those that emphasize protein, those that emphasize carbohydrates, or those that emphasize fat. There is considerable controversy about which is most effective. This randomized clinical trial compared the effects on the body weight of overweight individuals of 4 energy-reduced diets that differed in their targeted percentage of macronutrients. A total of 811 overweight adults aged 50 to 52 years were randomized to receive to 1 of 4 diets containing fat, protein, and carbohydrates in the following proportions: 20%, 15%, and 65% (group 1, n 204); 20%, 25%, and 55% (group 2, n 202); 40%, 15%, and 45% (group 3, n 204); and 40%, 25%, and 35% (group 4, n 201). Each diet contained similar foods. Individual and group instructional sessions were offered to the participants.

Dietary sodium intake predicts the amount of fluid consumed (1), likely through increasing thirst. In UK (2) and Australian children (3), dietary sodium was shown to predict consumption of sugar-sweetened beverages (SSBs), which in turn may increase obesity risk. The aim of this study was to examine the cross-sectional association between dietary sodium, total fluid, and SSB consumption in a nationally representative sample of US children and adolescents aged 2–18 years within the National Health and Nutrition Examination Survey (NHANES) 2005-2008.

Background. The study examined the association of obesity with acculturation in a large and diverse sample of US Hispanic/Latino adults. Methods. The Hispanic Community Health Study (HCHS)/Study of Latinos (SOL) is a community-based cohort study of Hispanic/Latino adults aged 18–74 years (N=16,415) from four urban areas. Height and weight were directly measured using a standardized protocol. Acculturation was assessed by the Short Acculturation Scale for Hispanics (SASH). Other immigration related variables included place of birth, length of residency in the US, and age at immigration. Odds ratios were calculated to assess the association of overweight, moderate obesity, and extreme obesity (≥40 kg/m2) with acculturation and sociodemographic variables. Results. The prevalence of obesity was 42.4% for women and 36.5% for men and varied by field center and Hispanic/Latino background. The strongest predictor of moderate and extreme obesity was length of residency in mainland US. This association was consistent across Hispanic/Latino backgrounds. Acculturation was not significantly associated with obesity. Discussion. The burden of obesity is high among Hispanic/Latino adults. The study findings suggest that prolonged exposure to the environments in these communities, rather than acculturation, is an important risk factor for obesity in this population.

Background. Weight is typically measured on a single day in research studies. This practice assumes negligible day-to-day weight variability, although little evidence exists to support this assumption. We compared the precision of measuring weight on one versus two days among control participants in the Weight Loss Maintenance trial. Methods. Trained staff measured weight on two separate days at baseline, 12 months, and 30 months (2004–2007). We calculated the standard deviation (SD) of mean weight change from baseline to the 12- and 30-month visits using (a) the first and (b) both daily weights from each visit and conducted a variance components analysis (2009). Results. Of the 316 participants with follow-up measurements, mean (SD) age was 55.8 (8.5) years, BMI was 30.8 (4.5) kg/m2, 64% were women, 36% were black, and 50% were obese. At 12 months, the SD of mean weight change was 5.1 versus 5.0 kg using one versus two days of weight measurements (P=.76), while at 30 months the corresponding SDs were 6.3 and 6.3 kg (P=.98). We observed similar findings within subgroups of BMI, sex, and race. Day-to-day variability within individuals accounted for <1% of variability in weight. Conclusions. Measurement of weight on two separate days has no advantage over measurement on a single day in studies with well-standardized weight measurement protocols.