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Background: Individuals respond differently to dietary intake leading to different associations between diet and traits. Most studies have investigated large cohorts without subgrouping them., Objective: The purpose was to identify non-uniform associations between diets and anthropometric traits that appeared to be in conflict with one another across subgroups., Design: We used a cohort comprising 43,790 women and men, the Danish Diet, Cancer and Health study, which includes a baseline examination at age 50-64 years and a follow-up about 5 years later. The baseline examination involved anthropometrics, body fat percentage, a food frequency questionnaire and information on lifestyle. From the questionnaire data we computed association rules between the intake of food groups and changes in waist circumference and body weight. Using association rule mining on subgroups and gender-specific cohorts, we identified non-uniform associations. The two gender-specific cohorts were stratified into subgroups using a non-linear, self-organizing map based method., Results: We found 22 and 7 cases of conflicting rules in 8 participant subgroups for different anthropometric traits in women and men, respectively. For example, in a subgroup of women moderate waist loss was associated with a dietary pattern characterized by low intake in both cabbages and wine, in conflict with the association trends of both dietary factors in the female cohort. The finding of more conflicting rules in women suggests that inter-individual differences in response to dietary intake are stronger in women than in men., Conclusions: This combined stratification and association discovery approach revealed epidemiological relationships between dietary factors and changes in anthropometric traits in subgroups that take food group interactions into account. Conflicting rules adds an additional layer of complexity that should be integrated into the study of these relationships, for example in relation to genotypes., (Copyright © 2019 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Body fat distribution is a marker of metabolic health independent of body size. Visceral fat accumulation has been suggested to result from a decreased expandability of the subcutaneous fat depots. Furthermore, the visceral fat may be easier to mobilize than the peripheral fat. We examined whether differences in abdominal obesity at baseline influenced prospective body-weight changes., Objective: In this study we examined whether body-fat distribution at baseline was associated with long-term and short-term weight changes., Design: We included 3 observational studies (ntotal = 7271) with mean follow-up times of 5-9 y and two 8-10-wk weight loss intervention studies (ntotal = 1091). We examined the association between baseline waist circumference and weight changes in a substitution regression model, where body weight, height, and fat-free mass were fixed so that a difference in waist circumference would reflect a difference in body fat distribution alone. The results were summarized in meta-analyses., Results: In the observational studies, we found no associations between baseline waist circumference and subsequent weight change in men (β: 0.03 kg; 95% CI: -0.01, 0.08 kg; P = 0.19), but a negligible inverse association in women (β: -0.05 kg; 95% CI: -0.08, -0.01 kg; P = 0.01). There was no association between baseline waist circumference and weight loss in the intervention studies (men: β: -0.05 kg; 95% CI: -0.13, 0.03 kg; P = 0.25; women: β: -0.00 kg; 95% CI: -0.03, 0.03 kg; P = 0.84). However, in all studies, the SDs of the weight change residuals were greater, the greater the waist circumference at baseline. This trend was statistically significant in women in most studies as well as in men in 1 of the studies., Conclusions: With narrow CIs in 3 observational studies and 2 weight loss interventions, we did not find any clinically or epidemiologically relevant association between baseline abdominal obesity and weight change. However, the present study suggests that a greater baseline abdominal obesity is a marker for greater weight fluctuations. The CCHS trial was registered at www.clinicaltrials.gov as NCT02993172. The Health2006 trial was registered at www.clinicaltrials.gov as NCT00316667. The ORG study was conducted before trial registration was required. The NUGENOB trial was registered at www.isrctn.com as ISRCTN25867281. The DiOGenes trial was registered atwww.clinicaltrials.gov as NCT00390637.

Background: There is evidence that birth size is positively associated with height in later life, but it remains unclear whether this is explained by genetic factors or the intrauterine environment., Aim: To analyze the associations of birth weight, length and ponderal index with height from infancy through adulthood within mono- and dizygotic twin pairs, which provides insights into the role of genetic and environmental individual-specific factors., Methods: This study is based on the data from 28 twin cohorts in 17 countries. The pooled data included 41,852 complete twin pairs (55% monozygotic and 45% same-sex dizygotic) with information on birth weight and a total of 112,409 paired height measurements at ages ranging from 1 to 69 years. Birth length was available for 19,881 complete twin pairs, with a total of 72,692 paired height measurements. The association between birth size and later height was analyzed at both the individual and within-pair level by linear regression analyses., Results: Within twin pairs, regression coefficients showed that a 1-kg increase in birth weight and a 1-cm increase in birth length were associated with 1.14-4.25 cm and 0.18-0.90 cm taller height, respectively. The magnitude of the associations was generally greater within dizygotic than within monozygotic twin pairs, and this difference between zygosities was more pronounced for birth length., Conclusion: Both genetic and individual-specific environmental factors play a role in the association between birth size and later height from infancy to adulthood, with a larger role for genetics in the association with birth length than with birth weight., (Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Infant feeding may play an important role in the development of childhood overweight and obesity., Objective: The objective of this study was to examine whether duration of breastfeeding (BF), timing of introduction of complementary food, and protein intake at age 18 mo are associated with body mass index [BMI (measured in kg/m2)] and overweight at ages 7 and 11 y, independent of BMI during infancy., Design: Children participating in the Danish National Birth Cohort were followed up at ages 7 and 11 y. Information on infant feeding, protein intake at age 18 mo, Ponderal Index at birth, child BMI (at ages 5 mo, 12 mo, 7 y, and 11 y), and several parental factors was available. Path analysis was used to assess the direct and indirect effects of infant feeding on BMI z scores (BMIz) at ages 7 (n = 36,481) and 11 y (n = 22,047). Logistic regression analyses were used to examine associations with overweight., Results: Duration of BF was not associated with childhood BMIz at ages 7 and 11 y. Earlier introduction of complementary food (<4 mo old) was not associated with BMIz at age 7 y, but with a 0.069 (95% CI: 0.021, 0.117, P = 0.005) higher BMIz at age 11 y and increased risk of overweight at age 11 y (OR 1.44; 95% CI: 1.04, 2.00; P = 0.03). Protein intake from dairy products (per 5 g/d) was associated with higher BMIz only at age 7 y (OR: 0.012; 95% CI: 0.003, 0.021; P = 0.007). Protein intake from meat and fish (per 2 g/d) was associated with a 0.010 (95% CI: 0.004, 0.017; P = 0.003) higher BMIz at age 7 y, a 0.013 (95% CI: 0.005, 0.020; P = 0.002) higher BMIz at age 11 y and increased odds of overweight at age 7 y (OR: 1.07; 95% CI: 1.03, 1.10; P < 0.001), but not at age 11 y., Conclusions: Intake of protein from meat and fish at age 18 mo was associated with higher BMIz and risk of overweight in childhood. However, the effect sizes were small. Early introduction of complementary food may be associated with child BMIz and child overweight. This study was registered at www.clinicaltrials.gov as NCT03334760.

Seasonal variation in birth weight was found in a previous Danish study. In the present study we investigated if the seasonality in birth weight tracked into BMI at 7years of age, but found no seasonality of birth in either BMI, overweight, or obesity., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Purpose: This study evaluates the relationship between body mass index (BMI), fat mass index (FMI) and fat-free mass index (FFMI) changes and mortality in persons ≥65 years., Methods: Adults ≥65 years with at least two body composition measurements (BCM) between 1990 and 2011 were included. We excluded persons who died within one month of the second BCM and who had two single BCM in a one-month timeframe. Mortality data was retrieved until December 2012. For each person, we calculated the regression slopes for BMI, FMI and FFMI changes. Significant positive slopes were categorized as "gain", negative slopes as "loss" and the others as "maintenance". The impact of body composition changes was evaluated by Cox regression models while adjusting for sex, age, co-morbidities and body composition at the last measurement., Results: We included 791 persons with 3049 BCM. After adjustment for sex, and age and co-morbidities, a loss of FFMI, but not of FMI or BMI, increased the risk of mortality (HR 2.02, 95%CI 1.28-3.19). The prediction of mortality with FFMI loss remained significant when further adjusting for FMI loss and the last available body composition (HR 1.68, 95%CI 1.04-2.70)., Conclusions: FFMI loss is related to increased mortality in older persons., (Copyright © 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background: Birth weight has inconsistent associations with colorectal cancer, possibly due to different anatomic features of the colon versus the rectum. The aim of this study was to investigate the association between birth weight and colon and rectal cancers separately., Methods: 193,306 children, born from 1936 to 1972, from the Copenhagen School Health Record Register were followed prospectively in Danish health registers. Colon and rectal cancer cases were defined using the International Classification of Disease version 10 (colon: C18.0-18.9, rectal: 19.9 and 20.9). Only cancers classified as adenocarcinomas were included in the analyses. Cox regressions were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Analyses were stratified by birth cohort and sex., Results: During 3.8 million person-years of follow-up, 1465 colon and 961 rectal adenocarcinomas were identified. No significant sex differences were observed; therefore combined results are presented. Birth weight was positively associated with colon cancers with a HR of 1.14 (95% CI, 1.04-1.26) per kilogram of birth weight. For rectal cancer a significant association was not observed for birth weights below 3.5kg. Above 3.5kg an inverse association was observed (at 4.5kg, HR=0.77 [95% CI, 0.61-0.96]). Further, the associations between birth weight and colon and rectal cancer differed significantly from each other (p=0.006)., Conclusions: Birth weight is positively associated with the risk of adult colon cancer, whereas the results for rectal cancer were inverse only above values of 3.5kg. The results underline the importance of investigating colon and rectal cancer as two different entities., (Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Although the peroxisome proliferator-activated receptor γ (PPARγ) pathway is central in adipogenesis, it remains unknown whether it influences change in body weight (BW) and whether dietary fat has a modifying effect on the association., Objectives: We examined whether 27 single nucleotide polymorphisms (SNPs) within 4 genes in the PPARγ pathway are associated with the OR of being a BW gainer or with annual changes in anthropometry and whether intake of total fat, monounsaturated fat, polyunsaturated fat, or saturated fat has a modifying effect on these associations., Methods: A case-noncase study included 11,048 men and women from cohorts in the European Diet, Obesity and Genes study; 5552 were cases, defined as individuals with the greatest BW gain during follow-up, and 6548 were randomly selected, including 5496 noncases. We selected 4 genes [CCAAT/enhancer binding protein β (CEBPB), phosphoenolpyruvate carboxykinase 2, PPARγ gene (PPARG), and sterol regulatory element binding transcription factor 1] according to evidence about biologic plausibility for interactions with dietary fat in weight regulation. Diet was assessed at baseline, and anthropometry was followed for 7 y., Results: The ORs for being a BW gainer for the 27 genetic variants ranged from 0.87 (95% CI: 0.79, 1.03) to 1.12 (95% CI: 0.96, 1.22) per additional minor allele. Uncorrected, CEBPB rs4253449 had a significant interaction with the intake of total fat and subgroups of fat. The OR for being a BW gainer for each additional rs4253449 minor allele per 100 kcal higher total fat intake was 1.07 (95% CI: 1.02, 1.12; P = 0.008), and similar associations were found for subgroups of fat., Conclusions: Among European men and women, the influence of dietary fat on associations between SNPs in the PPARγ pathway and anthropometry is likely to be absent or marginal. The observed interaction between rs4253449 and dietary fat needs confirmation., (© 2016 American Society for Nutrition.)

Background: Traffic noise can act as a stressor and disturb sleep, and has been associated with cardiovascular disease. Recent studies suggest a possible association to metabolic outcomes and adiposity through biological mechanisms related to physiological stress and sleep disturbance., Objectives: We aimed to investigate the association between long-term residential traffic noise and changes in adiposity., Materials and Methods: The study was based on 39,720 middle-aged Danish men and women from a cohort, with information on weight and waist circumference at two points in time. Residential exposure to traffic noise was calculated for all participants' present and historical addresses using the Nordic prediction method. The associations between traffic noise and changes in adiposity measures after a mean follow-up of 5.3 years were analyzed by linear and logistic regression with adjustments for age, sex, socioeconomic position and lifestyle factors in three models with increasing adjustment., Results: In linear models adjusted for sex, age, socioeconomic position and competing noise sources we found road traffic noise to be significantly associated with small gains in both weight and waist circumference. For example, time-weighted mean exposure 5-years preceding follow-up was associated with a yearly weight gain of 15.4 g (95% confidence interval (CI): 2.14; 28.7) and a yearly increase in waist circumference of 0.22 mm (95% CI: 0.018; 0.43) per 10dB. Similarly, in Poisson regression models we found an 10% increased risk for gaining more than 5 kg body weight during follow-up (95% CI: 1.04; 1.15) per 10 dB higher 5 years exposure preceding follow-up. Exposure to railway noise above 55 dB was associated with weight gain (39.9 g/year (95% CI: 10.2; 69.6)), but not with a significant change in waist circumference. We found baseline BMI (p<0.001) and waist circumference (p=0.001) to be significant effect modifiers for the association between road traffic noise and waist circumference, with gain in waist circumference only among the obese (BMI≥30) participants (1.20 mm/year (95% CI: 0.68; 1.72)) and participants with a large waist circumference (0.83 mm/year (95% CI: 0.42; 1.23))., Conclusion: The findings supports previous studies suggesting that traffic noise may be associated with development of adiposity. However, the potential effects are small and suggest an effect mainly among obese participants., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Studies suggest that gestational weight gain (GWG) and breastfeeding behavior may influence long-term maternal abdominal fat mass. However, this could be confounded by abdominal fat mass before pregnancy because it is unknown whether abdominal fat mass, independently of body size, affects GWG and breastfeeding behavior., Objective: We investigated how maternal prepregnancy fat distribution, described by waist circumference (WC) and body mass index (BMI), is associated with GWG and breastfeeding behavior., Design: We analyzed 1371 live births to 1024 women after enrollment in the Coronary Artery Risk Development in Young Adults study (1985-1996). For each birth, maternal prepregnancy BMI and WC were measured at year 0 (baseline), 2, 5, or 7 examinations. Recalled GWG and breastfeeding behavior were collected at years 7 and 10. GWG was analyzed by using linear regression and breastfeeding behavior by using logistic regression and discrete-time logistic regression., Results: Adjusted for potential confounders, a 1-cm larger WC adjusted for BMI was associated with a 0.19-kg (95% CI: -0.29-, -0.10-kg) lower GWG. In contrast, a 1-unit higher BMI adjusted for WC was associated with a 0.27-kg (95% CI: 0.06-, 0.47-kg) higher GWG. The OR for ever breastfeeding compared with never breastfeeding was 0.93 (95% CI: 0.90, 0.97) per 1-cm larger WC after adjustment for BMI, whereas it was 1.10 (95% CI: 1.02, 1.19) per 1-unit higher BMI adjusted for WC., Conclusions: Maternal prepregnancy body size was differently associated with GWG and breastfeeding behavior depending on the location of the fat mass. Thus, maternal fat distribution may be a more important determinant of GWG and breastfeeding behavior than BMI alone., (© 2015 American Society for Nutrition.)

Background: Many environmental factors have been shown to influence birth weight (BW) and one of these are season of birth., Aim: The aim of the present study was to investigate the seasonal variation in BW in Denmark during 1936-1989, and to see if the variation could be explained by sunshine exposure during pregnancy., Methods: The study population was selected from the Copenhagen School Health Records Register and included 276 339 children born between 1936 and 1989. Seasonal variation was modeled using a non-stationary sinusoidal model that allowed the underlying trend in BW and the amplitude and phase of the yearly cycles to change., Results: There was a clear seasonal pattern in BW which, however, changed gradually across the study period. The highest BWs were seen during fall (September - October) from 1936 to 1963, but a new peak gradually grew from the early 1940s during early summer (May - June) and became the highest from 1964 to 1989. The amplitude of the fall peak started at 25.5 (95%CI 24.6; 25.9) grams and gradually disappeared. The amplitude of the early summer peak gradually arose from nothing to a peak of 18.6 (95%CI 17.7; 19.6) grams in the mid 1980s where it started to decrease again. Sunshine did not explain the seasonal variation in BW., Conclusion: There was a clear seasonal pattern in BW in Denmark 1936-1989, which however changed across the study period. Throughout the study period we observed a peak in BW during the fall, but gradually, starting in the early 1940s, an additional early summer peak emerged and became the highest from 1964 and onwards., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Background: Several studies have shown that adherence to the Mediterranean Diet measured by using the Mediterranean diet score (MDS) is associated with lower obesity risk. The newly proposed Nordic Diet could hold similar beneficial effects. Because of the increasing focus on the interaction between diet and genetic predisposition to adiposity, studies should consider both diet and genetics., Objective: We investigated whether FTO rs9939609 and TCF7L2 rs7903146 modified the association between the MDS and Nordic diet score (NDS) and changes in weight (Δweight), waist circumference (ΔWC), and waist circumference adjusted for body mass index (BMI) (ΔWCBMI)., Design: We conducted a case-cohort study with a median follow-up of 6.8 y that included 11,048 participants from 5 European countries; 5552 of these subjects were cases defined as individuals with the greatest degree of unexplained weight gain during follow-up. A randomly selected subcohort included 6548 participants, including 5496 noncases. Cases and noncases were compared in analyses by using logistic regression. Continuous traits (ie, Δweight, ΔWC, and ΔWCBMI) were analyzed by using linear regression models in the random subcohort. Interactions were tested by including interaction terms in models., Results: A higher MDS was significantly inversely associated with case status (OR: 0.98; 95% CI: 0.96, 1.00), ΔWC (β = -0.010 cm/y; 95% CI: -0.020, -0.001 cm/y), and ΔWCBMI (β = -0.008; 95% CI:-0.015, -0.001) per 1-point increment but not Δweight (P = 0.53). The NDS was not significantly associated with any outcome. There was a borderline significant interaction between the MDS and TCF7L2 rs7903146 on weight gain (P = 0.05), which suggested a beneficial effect of the MDS only in subjects who carried 1 or 2 risk alleles. FTO did not modify observed associations., Conclusions: A high MDS is associated with a lower ΔWC and ΔWCBMI, regardless of FTO and TCF7L2 risk alleles. For Δweight, findings were less clear, but the effect may depend on the TCF7L2 rs7903146 variant. The NDS was not associated with anthropometric changes during follow-up., (© 2014 American Society for Nutrition.)

Background & Aims: Childhood overweight increases the risk of early development of non-alcoholic fatty liver disease, which may predispose to carcinogenesis. We investigated if childhood body size during school ages was associated with the risk of primary liver cancer in adults., Methods: A cohort of 285,884 boys and girls, born 1930 through 1980, who attended school in Copenhagen, were followed from 1977 to 31 December 2010. Their heights and weights were measured by school doctors or nurses at ages 7 through 13 years. Body mass index (BMI) z-scores were calculated from an internal age- and sex-specific reference. Information on liver cancer was obtained from the National Cancer Registry. Hazard ratios and 95% confidence intervals (95% CI) of liver cancer were estimated by Cox regression., Results: During 6,963,105 person-years of follow-up, 438 cases of primary liver cancer were recorded. The hazard ratio (95% CI) of adult liver cancer was 1.20 (1.07-1.33) and 1.30 (1.16-1.46) per 1-unit BMI z-score at 7 years and 13 years of age, respectively. Similar associations were found in boys and girls, for hepatocellular carcinoma only, across years of birth, and after accounting for diagnoses of viral hepatitis, alcohol-related disorders, and biliary cirrhosis., Conclusions: Higher BMI in childhood increases the risk of primary liver cancer in adults. In view of the high case fatality of primary liver cancer, this result adds to the future negative health outcomes of the epidemic of childhood overweight, reinforcing the need for its prevention., (Copyright © 2013 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.)

Background: Reproduction has been related to long-term maternal weight gain, and changes in fat mass, with gestational weight gain, have been identified as an important contributor. However, the influence of weight changes during the whole reproductive cycle and the modifying effect of breastfeeding are unknown., Objective: The objective was to examine how prepregnancy weight, gestational weight gain, postpartum weight changes, and breastfeeding influence maternal weight and body mass index-adjusted waist circumference (WCBMI) 7 y after delivery., Design: This was a prospective cohort study of 23,701 women participating in the Danish National Birth Cohort with singleton births and no births during follow-up. Path analysis was used to assess the total, direct, and indirect effects; the latter was mediated through weight changes on the pathways., Results: Postpartum weight retention at 6 mo and weight gain from 6 to 18 mo postpartum were highly positively associated with both outcomes. A 1-kg increase in weight retention at 6 mo postpartum corresponded to an average increase of 0.5 kg at 7 y. Gestational weight gain was not associated with WCBMI but was positively associated with weight at 7 y; 87% of this effect was mediated through later weight changes. For both outcomes, a small inverse association was observed for breastfeeding duration. This was strongest for WCBMI, for which 97% of the effect was direct, ie, not mediated through postpartum weight., Conclusions: These findings show that postpartum weight retention at 6 mo and weight gain from 6 to 18 mo postpartum contribute equally to adverse maternal anthropometric measures 7 y after delivery. Breastfeeding duration may have a beneficial effect.

Purpose: To investigate a possible association between prenatal selective serotonin reuptake inhibitor (SSRI) exposure and childhood overweight at 7 years of age., Methods: Information on pregnancy exposures and prevalence of childhood overweight at 7 years of age was obtained from the Danish National Birth Cohort. Overweight was classified as body mass index >85th percentile, based on age and sex. Based on an a priori hypothesis, we conducted analyses stratified by child sex to examine sex-specific differences., Results: Of eligible pregnant women, 127 reported using an SSRI, 490 reported having a psychiatric illness but no psychotropic medication use, and 35,568 reported no psychiatric illness and no psychotropic medication use. In comparison to children of mothers with a psychiatric illness but no SSRI use during pregnancy, prenatal SSRI exposure overall was not associated with an increased risk of childhood overweight (adjusted prevalence ratio [aPR] 1.12; 95% confidence interval 0.71 to 1.77). However, when stratified according to child sex, an increased risk was observed among males (aPR 1.78; 95% CI, 1.01 to 3.12) but not females (aPR 0.86; 95% CI, 0.37 to 1.99). In contrast, female children of mothers with a psychiatric illness but no SSRI use during pregnancy were more likely to be overweight than female children of unexposed mothers (aPR 1.45; 95% CI, 1.05 to 2.02). This association was not mirrored among males (aPR 1.06; 95% CI, 0.76 to 1.50)., Conclusions: We observed the potential for opposing sex-specific differences in the long-term effects of prenatal exposure to SSRI use and/or maternal psychiatric illness on childhood overweight. Limitations of the present study suggest that further research in this area may be warranted with larger sample sizes and longer follow-up., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background & Aims: Non-alcoholic fatty liver disease (NAFLD) is a major hepatic consequence of obesity. It has been suggested that the high sensitivity C-reactive protein (hs-CRP) is an obesity-independent surrogate marker of severity of NAFLD, especially development of non-alcoholic steato-hepatitis (NASH), but this remains controversial. We aimed to investigate whether associations between various features of NAFLD and hs-CRP are independent of body mass index (BMI) in its broad range among obese patients., Methods: A total of 627 obese adults (80% females), representing three cohorts from France and Belgium, had information on liver histology obtained from liver biopsies and measures of hs-CRP and BMI. We investigated whether the different features of NAFLD and BMI were associated with hs-CRP, with and without mutual adjustments using linear regression., Results: BMI and hs-CRP were strongly associated. Per every 10% increase in BMI the hs-CRP level increased by 19-20% (p<0.001), and adjustment for NAFLD-stage (including no-NAFLD) did not influence the association. We found no BMI-independent association between NASH and hs-CRP. However, a positive association between degree of steatosis and hs-CRP was observed (p<0.05) and this effect remained significant after adjusting for BMI, lobular inflammation, hepatocyte ballooning, and fibrosis. We found no significant associations between the other features of NAFLD and hs-CRP., Conclusions: This study indicates that it is the accumulation of fat -both in the adipose tissue and in liver steatosis- that leads to increased hs-CRP levels among obese patients. Thus, hs-CRP may be a marker of steatosis, but not of severity of NAFLD, in obese patients., (Copyright © 2011 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.)

We investigated the role of the fat mass and obesity associated gene (FTO) and variants near the melanocortin-4 receptor gene (MC4R) in modulating habitual intake of total energy and macronutrients, glycemic index, glycemic load, dietary energy density, and energy from 20 food groups in adults. In a population-based sample of 756 healthy adult twin pairs, we studied associations between FTO rs9939609, near-MC4R rs12970134, rs17700633, and rs17782313 single nucleotide polymorphisms (SNP) and habitual dietary intake. Habitual dietary intake was assessed by a 247-question FFQ. Nontransformed variables and variables transformed by natural logarithm were analyzed by linear regression and dichotomized variables were analyzed by logistic regression. FTO SNP rs9939609 was not associated with habitual dietary intake. For the near-MC4R SNP rs12970134 and rs17700633, we found significant positive associations with intake of energy from whole grains (P >or= 0.04). These associations did not remain significant after controlling for multiple testing. The outcome of this study indicates that polymorphisms in the FTO gene and near the MC4R gene do not have a role in regulating food intake and preference for specific food items.

Background: Transcription factor 7-like 2 (TCF7L2) rs7903146 associates with type 2 diabetes and may operate via impaired glucagon-like peptide 1 secretion, which is stimulated more by fat than by carbohydrate ingestion., Objective: The objective was to examine the interaction between TCF7L2 rs7903146 and dietary fat and carbohydrate [high-fat, low-carbohydrate: 40-45% of energy as fat (HF); compared with low-fat, high-carbohydrate: 20-25% of energy as fat (LF)] in obese individuals' responses to a 10-wk hypoenergetic diet (-600 kcal/d)., Design: European, obese participants (n = 771) were randomly assigned to receive an HF or an LF diet. Body weight, fat mass (FM), fat-free mass (FFM), waist circumference (WC), resting energy expenditure (REE), fasting fat oxidation in percentage of REE (FatOx), homeostasis model assessed insulin release (HOMA-beta), and HOMA-insulin resistance (HOMA-IR) were determined at baseline and after the intervention; 739 individuals were genotyped for rs7903146., Results: Average weight loss was 6.9 kg with the LF and 6.6 kg with the HF (difference between diets, NS) diet. Among individuals who were homozygous for the T-risk allele, those in the HF diet group experienced smaller weight losses (Deltaweight) (2.6 kg; P = 0.009; n = 622), smaller DeltaFFM (1.6 kg; P = 0.027; n = 609), smaller DeltaWC (3.3 cm; P = 0.010; n = 608), and a smaller DeltaHOMA-IR (1.3 units; P = 0.004; n = 615) than did the LF diet group. For C allele carriers, there were no differences between the HF and LF diet groups. For the HF diet group, each additional T allele was associated with a reduced loss of FM (0.67 kg; P = 0.019; n = 609). TCF7L2 rs7903146 was not associated with DeltaREE, DeltaFatOx, DeltaHOMA-beta, or dropout., Conclusion: Our results suggest that obese individuals who are homozygous for the TCF7L2 rs7903146 T-risk allele are more sensitive to LF than to HF weight-loss diets.

Background: Dietary fiber may play a role in obesity prevention. Until now, the role that fiber from different sources plays in weight change had rarely been studied., Objective: Our aim was to investigate the association of total dietary fiber, cereal fiber, and fruit and vegetable fiber with changes in weight and waist circumference., Design: We conducted a prospective cohort study with 89,432 European participants, aged 20-78 y, who were free of cancer, cardiovascular disease, and diabetes at baseline and who were followed for an average of 6.5 y. Dietary information was collected by using validated country-specific food-frequency questionnaires. Multiple linear regression analysis was performed in each center studied, and estimates were combined by using random-effects meta-analyses. Adjustments were made for follow-up duration, other dietary variables, and baseline anthropometric, demographic, and lifestyle factors., Results: Total fiber was inversely associated with subsequent weight and waist circumference change. For a 10-g/d higher total fiber intake, the pooled estimate was -39 g/y (95% CI: -71, -7 g/y) for weight change and -0.08 cm/y (95% CI: -0.11, -0.05 cm/y) for waist circumference change. A 10-g/d higher fiber intake from cereals was associated with -77 g/y (95% CI: -127, -26 g/y) weight change and -0.10 cm/y (95% CI: -0.18, -0.02 cm/y) waist circumference change. Fruit and vegetable fiber was not associated with weight change but had a similar association with waist circumference change when compared with intake of total dietary fiber and cereal fiber., Conclusion: Our finding may support a beneficial role of higher intake of dietary fiber, especially cereal fiber, in prevention of body-weight and waist circumference gain.

Our objectives were to estimate the degree of misreporting energy intake (EI) and analyze associations with previous BMI, current BMI, or both. The study was part of the Adiposity and Genetics Study follow-up study including 309 Danish men (age 40-65 y) originally sampled from the obligatory draft board examination. Height and weight were measured at the mean ages of 20 (draft board), 33, 44, and 49 y (current age). Obesity was categorized as BMI >or= 31 kg/m(2). Dietary intake for 7 d and physical activity (PA) level (PAL) were self-reported. Resting metabolic rate (RMR) was measured in a ventilated hood system. By comparing EI with energy expenditure and assuming energy balance, reporting accuracy (RA) was estimated as EI/(RMR.PAL). A plausibility interval was calculated to encompass specific variation components of EI, RMR, and PAL; the specific 95% plausibility interval was 1.00 +/- 0.35. Participants were categorized as underreporters (RA 1.35) of EI. The relation between RA and BMI was studied through linear regression analysis. Overall, the RA was (mean +/- SE) 0.76 +/- 0.01. Of 309 participants, 35% underreported and 7% overreported. Whether stratified for current BMI or draft board BMI, the obese men were more likely to underreport than those who were not obese. Among those currently not obese, underreporting was more prevalent among those who were obese at the draft board examination (44%) than among those who were not (21%). Regression analysis showed that both previous and current BMI and their combination were significantly associated with RA. Thus, underreporting of dietary intake seems to be associated with not only current BMI but also with current BMI in combination with previous BMI.

Background: It is unclear from the inconsistent epidemiologic evidence whether dietary fat intake is associated with future weight change., Objective: The objective was to assess the association between the amount and type of dietary fat and subsequent weight change (follow-up weight minus baseline weight divided by duration of follow-up)., Design: We analyzed data from 89,432 men and women from 6 cohorts of the EPIC (European Prospective Investigation into Cancer and Nutrition) study. Using country-specific food-frequency questionnaires, we examined the association between baseline fat intake (amount and type of total, saturated, polyunsaturated, and monounsaturated fats) and annual weight change by using the residual, nutrient density, and energy-partition methods. We used random-effects meta-analyses to obtain pooled estimates across centers., Results: Mean total fat intake as a percentage of energy intake ranged between 31.5% and 36.5% across the 6 cohorts (58% women; mean +/- SD age: 53.2 +/- 8.6 y). The mean (+/-SD) annual weight change was 109 +/- 817 g/y in men and 119 +/- 823 g/y in women. In pooled analyses adjusted for anthropometric, dietary, and lifestyle factors and follow-up period, no significant association was observed between fat intake (amount or type) and weight change. The difference in mean annual weight change was 0.90 g/y (95% CI: -0.54, 2.34 g/y) for men and -1.30 g/y (95% CI: -3.70, 1.11 g/y) for women per 1 g/d energy-adjusted fat intake (residual method)., Conclusions: We found no significant association between the amount or type of dietary fat and subsequent weight change in this large prospective study. These findings do not support the use of low-fat diets to prevent weight gain.

Background: Recommendations for gestational weight gain (GWG) account for a woman's prepregnancy body mass index (BMI), but other factors may be important., Objectives: The objectives were to investigate whether, within BMI categories, the GWG with the lowest risks to mother and infant varied with parity and to describe these risks in short (<160 cm), young (<20 y), and smoking women., Design: Of 27,030 primiparous and 31,407 multiparous women with term births within the Danish National Birth Cohort, self-reported GWG was divided into 6 categories (<5, 5-9, 10-15, 16-19, 20-24, and > or =25 kg). Population-based registers provided information about birth outcomes. GWG-specific absolute adjusted risks for emergency cesarean delivery, birth of a small-for-gestational-age (SGA) or large-for-gestational-age (LGA) infant, and postpartum (6 mo) weight retention (PPWR) were compared across different types of women., Results: The risk of SGA decreased with increasing GWG in both parity groups, but SGA risk <10% was reached at 2-3 GWG categories lower in multiparae than in primiparae. An excess risk of LGA was present only in obese primiparae and multiparae, but the PPWR risk increased with increasing GWG irrespective of BMI and parity. Young primiparae had better outcomes than other primiparae. Short women had a higher risk of emergency cesarean delivery that varied minimally with GWG. Smokers had a higher SGA risk and had a PPWR risk similar to that of nonsmokers., Conclusions: The tradeoff in risk between mother and infant is reached at lower GWG in multiparae than in primiparae; therefore, a lower GWG may be needed among multiparae. Differential guidelines seem unnecessary for short or young women or smokers.

Background: The development of obesity is still a poorly understood process that is dependent on both genetic and environmental factors., Objective: The objective was to examine how physical activity and the proportion of energy as protein in the diet modify the genetic variation of body mass index (BMI), waist circumference, and percentage body fat., Design: Twins from Denmark (756 complete pairs) and Finland (278 complete pairs) aged 18-67 and 21-24 y, respectively, participated. The proportion of energy as protein in the diet was estimated by using food-frequency questionnaires. The participants reported the frequency and intensity of their leisure time physical activity. Waist circumference and BMI were measured. Percentage body fat was assessed in Denmark by using a bioelectrical impedance method. The data were analyzed by using gene-environment interaction models for twin data with the Mx statistical package (Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA)., Results: High physical activity was associated with lower mean values, and a high proportion of protein in the diet was associated with higher mean BMI, waist circumference, and percentage body fat and a reduction in genetic and environmental variances. Genetic modification by physical activity was statistically significant for BMI (-0.18; 95% CI: -0.31, -0.05) and waist circumference (-0.14; 95% CI: -0.22, -0.05) in the merged data. A high proportion of protein in the diet reduced genetic and environmental variances in BMI and waist circumference in Danish men but not in women or in Finnish men., Conclusions: Our results suggest that, in physically active individuals, the genetic variation in weight is reduced, which possibly suggests that physical activity is able to modify the action of the genes responsible for predisposition to obesity, whereas the protein content of the diet has no appreciable effect.

Background: Previous studies on the association between macronutrient intake and the development of abdominal obesity, which carries an increased health risk, have not shown a consistent pattern, possibly due to mixed effects of other aspects of the food intake., Objective: This study investigated the association between intake from 21 food and beverage groups and the subsequent 5-year difference in waist circumference., Methods: The study population consisted of 22,570 women and 20,126 men, aged 50 to 64 years at baseline, with complete data on baseline and follow-up waist circumference, baseline diet (192 items food frequency questionnaire), body mass index, and selected potential confounders (eg, smoking status, sport activities, and intake of alcoholic beverages). Multiple linear regression analyses were performed., Results: For women, 5-year difference in waist circumference was inversely related to intake from red meat, vegetables, fruit, butter, and high-fat dairy products, whereas intake from potatoes, processed meat, poultry, and snack foods was positively associated. For men, red meat and fruit intakes were inversely associated with 5-year difference in waist circumference, whereas snack foods intake was positively associated. Sex differences occurred for vegetables, high-fat dairy products, and processed meat., Conclusions: The results suggest that a diet low in fruits and red meat and high in snack foods was associated with larger waist circumference gains in both sexes. Furthermore, in women a diet low in vegetables, butter, and high-fat dairy products, and high in poultry, potatoes, and processed meat were likely determinants of subsequent gain at the waist.

Background: High fruit and vegetable intakes may limit weight gain, particularly in susceptible persons, such as those who stop smoking., Objective: The objective was to assess the association of fruit and vegetable intake with subsequent weight change in a large-scale prospective study., Design: The data used were from 89,432 men and women from 5 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). The association between fruit and vegetable intake and weight change after a mean follow-up of 6.5 y was assessed by linear regression. Polytomous logistic regression was used to evaluate whether fruit and vegetable intake relates to weight gain, weight loss, or both., Results: Per 100-g intake of fruit and vegetables, weight change was -14 g/y (95% CI: -19, -9 g/y). In those who stopped smoking during follow-up, this value was -37 g/y (95% CI: -58, -15 g/y; P for interaction < 0.0001). When weight gain and loss were analyzed separately per 100-g intake of fruit and vegetables in a combined model, the odds ratios (95% CIs) were 0.97 (0.95, 0.98) for weight gain > or =0.5 and <1 kg/y, 0.94 (0.92, 0.96) for weight gain > or =1 kg/y, and 0.97 (0.95, 0.99) for weight loss > or =0.5 kg/y. In those who stopped smoking during follow-up, the odds ratios (95% CIs) were 0.93 (0.88, 0.99), 0.87 (0.81, 0.92), and 0.97 (0.88, 1.07), respectively (P for interaction < 0.0001)., Conclusions: Fruit and vegetable intake relates significantly, albeit weakly inversely, to weight change. For persons who stop smoking, high fruit and vegetable intakes may be recommended to reduce the risk of weight gain.

Habitual dietary intake is a complex behavior that may have both biological and nonbiological bases. We estimated the contribution of genetic and environmental influences on dietary intake in a large population-based sample of healthy twins. Data originated from a cross-sectional study of 600 male and female healthy twin pairs with self-reported food consumption frequency using a validated questionnaire with 247 foods and recipes. Estimates of relative proportion of additive genetic, nonadditive genetic, shared environmental, and unshared environmental effects on various aspects of dietary intake were obtained by quantitative genetic modeling of twin data based on linear structural equations. The analyses demonstrated genetic influence on total energy, macronutrient energy, and dietary fiber intakes, the glycemic index and the glycemic load of the foods consumed, and the dietary energy density, with significant heritability estimates ranging from 0.25 (0.11-0.38) to 0.47 (0.31-0.60) in men and 0.32 (0.12-0.48) to 0.49 (0.35-0.61) in women. When analyzing dietary intake as the intake of energy from 20 food groups, the genetic and environmental influences differed among food groups and between gender. For some food groups (fruit for both genders, poultry and eggs for men), no genetic influence was found, whereas nonadditive genetic effects were demonstrated for other food groups (juices and eggs for women). A number of food groups had shared environmental influences (potatoes, vegetables, fruits, poultry, fish, margarine, and candy). These results provide evidence for both genetic and shared environmental effects on dietary intake. Although the remaining nonshared environmental effects include measurement errors, there appears to be considerable potential for individually modifiable effects.

Elevated plasma concentrations of remnant-like particle cholesterol (RLP-C) are atherogenic. However, factors that determine RLP-C are not fully understood. This study evaluates which factors affect RLP-C in the fasting and postprandial state, using multiple regression analyses in a large cohort of lean and obese participants. All participants (n = 740) underwent a test meal challenge containing 95 energy % (en%) fat (energy content 50% of predicted daily resting metabolic rate). Fasting and postprandial concentrations of circulating metabolites were measured over a 3-h period. Obese participants (n = 613) also participated in a 10-wk weight loss program (-2510 kJ/d), being randomized to either a low-fat or a high-fat diet (20-25 vs. 40-45en% fat). Postprandial RLP-C was associated with fasting RLP-C, waist:hip ratio (WHR), HOMA(IR) (homeostasis model assessment index for insulin resistance) (P < 0.001), and age, independently of BMI and gender [adjusted R(2) (adj. R(2)) = 0.70). These factors were also related to fasting RLP-C (P < 0.010), along with gender and physical activity (adj. R(2) = 0.23). The dietary intervention resulted in significantly lower fasting RLP-C concentrations, independently mediated by weight loss, improvements in HOMA(IR), and the fat content of the prescribed diet. However, after inclusion of plasma triglyceride (TG), HDL-cholesterol, and FFA concentrations in the models, HOMA(IR) and WHR no longer significantly predicted fasting RLP-C, although WHR remained a predictor of postprandial RLP-C (P = 0.002). Plasma TG was strongly associated with both fasting and postprandial RLP-C (P < 0.001). In conclusion, plasma RLP-C concentrations are mainly associated with plasma TG concentrations. Interestingly, the high-fat diet was more effective at decreasing fasting RLP-C concentrations in obese participants than the low-fat diet.

Background: Weight gained during pregnancy and not lost postpartum may contribute to obesity in women of childbearing age., Objective: We aimed to determine whether breastfeeding reduces postpartum weight retention (PPWR) in a population among which full breastfeeding is common and breastfeeding duration is long., Design: We selected women from the Danish National Birth Cohort who ever breastfed (>98%), and we conducted the interviews at 6 (n = 36 030) and 18 (n = 26 846) mo postpartum. We used regression analyses to investigate whether breastfeeding (scored to account for duration and intensity) reduced PPWR at 6 and 18 mo after adjustment for maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG)., Results: GWG was positively (P < 0.0001) associated with PPWR at both 6 and 18 mo postpartum. Breastfeeding was negatively associated with PPWR in all women but those in the heaviest category of prepregnancy BMI at 6 (P < 0.0001) and 18 (P < 0.05) mo postpartum. When modeled together with adjustment for possible confounding, these associations were marginally attenuated. We calculated that, if women exclusively breastfed for 6 mo as recommended, PPWR could be eliminated by that time in women with GWG values of approximately 12 kg, and that the possibility of major weight gain (>or=5 kg) could be reduced in all but the heaviest women., Conclusion: Breastfeeding was associated with lower PPWR in all categories of prepregnancy BMI. These results suggest that, when combined with GWG values of approximately 12 kg, breastfeeding as recommended could eliminate weight retention by 6 mo postpartum in many women.

Objective: Most people maintain almost constant body weight over long time with varying physical activity and food intake. This indicates the existence of a regulation that works well for most individuals. Yet some people develop obesity, indicating that this regulation sometimes fails. The difference between the two situations is typically an energy imbalance of about 1% over a long period of time., Theory: Weight gain increases basal metabolic rate. Weight gain is often associated with a decrease in physical activity, although not to such an extent that it prevents an increase in total energy expenditure and energy intake. Dependent on the precise balance between these effects of weight gain, they may make the body weight unstable and tend to further promote weight gain. With the aim of identifying the thresholds beyond which such self-promoting weight gain may take place, we develop a simple mathematical model of the body as an energy-consuming machine in which the changes in physical activity and food intake are described as feedback effects in addition to the effect of the weight gain on basal metabolic rate. The feedback parameters of the model may differ between individuals and only in some cases do they take values that make weight gain self-promoting., Results: We determine the quantitative conditions under which body weight gain becomes self-promoting. We find that these conditions can easily be met, and that they are so small that they are not observable with currently available techniques. This phenomenon encourages emphasis on even minor changes in food intake and physical activity to abate or stop weight gain.

Background: Cross-sectional studies have reported a lower prevalence of abdominal obese persons among frequent drinkers than among nonfrequent drinkers., Objective: We tested the hypothesis that drinking frequency is associated with subsequent changes in waist circumference., Design: Data come from a prospective cohort study conducted in 1993-1997 (baseline) and 1999-2002 (follow-up) and included 43 543 men and women. Baseline information on alcohol drinking frequency was related to 1) change in waist circumference by linear regression and 2) major gain and major loss in waist circumference (defined as waist change in the lowest or highest quintile of waist changes) by polytomous logistic regression, also taking into account amount of alcohol intake., Results: Drinking frequency was inversely associated with changes in waist circumference in women and was unassociated with changes in waist circumference in men. Drinking frequency was unassociated with major waist loss but was inversely associated with major waist gain: odds ratios among men were 0.97 (95% CI: 0.73, 1.28), 0.95 (95% CI: 0.81, 1.12), 0.88 (95% CI: 0.77, 0.99), 0.82 (95% CI: 0.71, -0.95), and 0.79 (95% CI: 0.69, 0.9) for never drinking, drinking on 1, 2-4, 5-6, and 7 d/wk, respectively, compared with men who drank alcohol on <1 d/wk (P for trend < 0.0001). Results for women were similar. Adjustment for the amount of alcohol intake or total energy intake did not affect results considerably., Conclusions: Drinking pattern may be associated with development of abdominal obesity; in this prospective study, drinking frequency was inversely associated with major waist gain and was unassociated with major waist loss.

Background: An association between high prepregnant body mass index (BMI) and early termination of breastfeeding has been observed, but this finding may have depended on the sociocultural context., Objective: The objective was to determine whether this association was stronger with increasing maternal obesity, was modified by gestational weight gain, and still existed when there was greater social support for breastfeeding., Design: Study participants (37 459 women) were drawn from the Danish National Birth Cohort. The association of prepregnant BMI and gestational weight gain with the termination of full or any breastfeeding by 1, 16, or 20 wk postpartum was assessed with logistic regression analyses, and the risk of early termination of full and any breastfeeding during the first 18 mo postpartum was assessed with Poisson regression analyses., Results: The risk of early termination of any (with similar results for full) breastfeeding rose progressively with increasing prepregnant BMI values (in kg/m(2)), from 1.12 (95% CI: 1.09, 1.16) for overweight (BMI = 25.0-29.9) women to 1.39 (95% CI: 1.19, 1.63) for obese class III women (BMI >or= 40) compared with normal-BMI women. Gestational weight gain did not add to or modify the association between prepregnant BMI and breastfeeding., Conclusions: These findings extend the observation to a broader range of BMIs that the greater the prepregnant BMI, the earlier the termination of breastfeeding. Together with the fact that this association was evident in a more supportive social context for breastfeeding, these findings suggest a biological basis for the association.

Objective: Twin studies are used extensively to decompose the variance of a trait, mainly to estimate the heritability of the trait. A second purpose of such studies is to estimate to what extent the non-genetic variance is shared or specific to individuals. To a lesser extent the twin studies have been used in bivariate or multivariate analysis to elucidate common genetic factors to two or more traits., Methods and Results: In the present study the variances of traits related to lipid metabolism is decomposed in a relatively large Danish twin population, including bivariate analysis to detect possible common genetic factors of the traits., Conclusions: The heritabilities of apolipoprotein B and E, cholesterol, LDL, and high density lipoprotein (HDL) were significant in the general population, although gender-specific levels and significance were detected. Heritabilities of apolipoprotein A1, triglycerides, and very low density protein (VLDL) were only significant when the population was stratified according to gender.

Background: The diet may influence the development of abdominal obesity, but the few studies that have prospectively examined the relations between diet and changes in waist circumference (WC) have given inconsistent results., Objective: Associations between total energy intake, energy intake from macronutrients, and energy intake from macronutrient subgroups based on different food sources and 5-y differences in WC (DWC) were investigated., Design: A Danish cohort of 22 570 women and 20 126 men aged 50-64 y with baseline data on WC, diet, BMI, and potential confounders reported their WC 5 y later. Associations of baseline diet with DWC were assessed by multiple linear regression analysis., Results: Neither total energy intake nor energy intake from each of the macronutrients was associated with DWC, except for an inverse association with protein, especially animal protein. In women, positive associations with DWC were seen for carbohydrate from refined grains and potatoes and from foods with simple sugars, whereas carbohydrate from fruit and vegetables was inversely associated and significantly different from any other carbohydrate subgroup. The results for men resembled those for women, although none were significant. Vegetable fat was positively associated with DWC for both men and women in a combined analysis. A U-shaped association between alcohol from wine and DWC was present for both sexes, and alcohol from spirits was positively associated with DWC in women., Conclusions: Although no significant associations with total energy or energy from fat, carbohydrate, or alcohol were observed, protein intake was inversely related to DWC, and some macronutrient subgroups were significantly associated with DWC.

Background: The effect of energy restriction and macronutrient composition on gene expression in adipose tissue is not well defined., Objective: The aim of the study was to investigate the effect of different low-energy diets on gene expression in human adipose tissue., Design: Forty obese women were randomly assigned to a moderate-fat, moderate-carbohydrate diet or a low-fat, high-carbohydrate hypoenergetic (-600 kcal/d) diet for 10 wk. Subcutaneous adipose tissue samples were obtained before and after the diet period. High-quality RNA samples were obtained from 23 women at both time points, and these samples were hybridized to microarrays containing the 8500 most extensively described human genes. The results were confirmed by separate messenger RNA measurements., Results: Both diets resulted in weight losses of approximately 7.5% of baseline body weight. A total of 52 genes were significantly up-regulated and 44 were down-regulated as a result of the intervention, and no diet-specific effect was observed. No major effect on lipid-specific transcription factors or genes regulating signal transduction, lipolysis, or synthesis of acylglycerols was observed. Most changes were modest (<25% of baseline), but all genes regulating the formation of polyunsaturated fatty acids from acetyl-CoA and malonyl-CoA were markedly down-regulated (35-60% decrease)., Conclusions: Macronutrients have a secondary role in changes in adipocyte gene expression after energy-restricted diets. The most striking alteration after energy restriction is a coordinated reduction in the expression of genes regulating the production of polyunsaturated fatty acids.

Objective: Obesity is typically developed over long time and reflected in an energy imbalance, which is too small to be measured and controlled. Our objective is to formulate a mathematical model for the relation between the change in body mass and the values of the energy intake and the energy expenditure, controlled by the physical activity factor PAF. DATA AND THEORY: The uncontrolled components of energy expenditure increases as result of body mass increase: expenditure of a larger mass and expenditure to convert matter in intake into tissue. Both contributions depend on the fraction of fat in the added tissue. Based on data from the literature, the fraction of fat in added tissue and the energy required to convert energy into tissue are estimated and included in the model., Results: Application of the theory shows that an increase in body mass of 1 kg/year corresponds to an energy imbalance of 71 kJ/d for men. Of this imbalance, 82% are stored as new tissue, while 18% are used for energy conversion. If a man in steady state changes energy intake by 0.1 MJ/d, keeping the physical activity factor constant, then the corresponding increase in steady-state body mass is 1.77 kg/PAF, and it will take 320/PAF days before half the change of body mass has taken place. A typical value for PAF is 1.8., Conclusion: Energy-based theoretical relations between the various factors involved in energy balance help identifying and quantifying the components of the energy balance and understanding their relations during development of obesity. The inclusion of increased energy expenditure to convert food energy to tissue changes previous estimates of the energy imbalance by about 20 percent.

Background: Women who are overweight or obese before pregnancy breastfeed for shorter durations than do normal-weight women. These shorter durations may place infants of overweight and obese women at risk of not receiving the benefits of breastfeeding, which may include a reduced risk of overweight later in life., Objective: We examined how maternal prepregnant body mass index (BMI; in kg/m2) and infant feeding pattern are associated with infant weight gain., Design: In this prospective, observational study, we used multiple regression analyses adjusted for potential confounding factors to examine these associations among 3768 mother-infant dyads from the Danish National Birth Cohort., Results: In multiple regression analyses, increasing maternal prepregnant BMI, decreasing durations of breastfeeding, and earlier complementary food introduction were associated with increased infant weight gain. An interaction was identified for short durations of breastfeeding (<20 wk). Earlier complementary food introduction (<16 wk) was associated with greater infant weight gain; however, the timing of complementary food introduction did not increase infant weight gain at longer durations of breastfeeding (> or =20 wk). In this sample, prepregnant obesity (BMI > or = 30.0), short durations of breastfeeding, and earlier introduction of complementary food were associated with 0.7 kg of additional weight gain during infancy., Conclusions: Infant weight gain is associated with maternal prepregnant BMI and with an interaction between the duration of breastfeeding and the timing of complementary food introduction. Future investigations of the effects of breastfeeding on infant weight gain should account for all of these factors.

Objective: To address the role of alcohol intake and tobacco smoking and the combination of the two on subsequent risk of Dupuytren's disease., Study Design and Setting: Cohort study of 7,254 subjects enrolled in the Copenhagen City Heart Study (1981-1983). Both self-reported information on lifestyle and objective measures at the baseline examination were linked to presence of Dupuytren's disease at a subsequent examination (1991-1994) using multivariate logistic regression analysis., Results: A total of 772 subjects had signs of Dupuytren's disease at follow-up. After adjustment for age, sex, educational level, diabetes, and either alcohol or tobacco consumption, respectively, odds ratios for having the disease increased in a dose-dependent manner with increasing levels of alcohol or tobacco intake; however, there was no statistical interaction between heavy smoking and heavy drinking., Conclusion: Alcohol intake and tobacco smoking are independently associated with increased risk of Dupuytren's disease, and the combination of the two conveys a very large risk.