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Aims: Type 2 diabetes (T2D) is known to be associated with high BMI and waist circumference (WC). These measures do not discriminate well between skeletal muscle (SM) and body fat (BF), which may have opposite influences. Methods: We conducted a secondary analysis of population-based data from 58,128 aged 18–85 yrs from Scottish Health Surveys (2003, 2008–2011) and Health Surveys for England (2003–2006, 2008–2013), excluding pregnant women and insulin-treated diabetes. Logistic regression was used to assess associations of known T2D, and of screened HbA1c > 48 mmol/mol (> 6.5%), with sex-specific quintiles of BMI, WC, and BF% and SM% estimated by validated anthropometric equations, adjusted for age, sex, smoking, ethnicity, country, and survey year. Results: As expected, ORs for having known T2D rose with quintiles of BMI (1, 1.5, 2.3, 3.1, and 6.5) and WC (1, 1.8, 2.5, 3.5, and 8.7). Compared to the lowest BF% quintile, OR for having T2D in highest BF% quintile was 11.1 (95% CI = 8.4–14.6). Compared to the highest SM% quintile, OR for having T2D in lowest SM% quintile was 2.0 (1.7–2.4). Of 72 adults with T2D/HbA1c > 6.5% in the lowest quintile of BF%, 27 (37.5%) were in quintile 1 of SM%. Similar patterns of OR were observed for having HbA1c > 6.5% in those without known T2D. Conclusions: Estimated BF% associates strongly with T2D. Low SM% also has a significant association, suggesting a neglected aspect of aetiology within T2D. These two simple measures with biological relevance, available from data collected in most health surveys, may be more useful than the purely statistical terms BMI. [ABSTRACT FROM AUTHOR]

We show that a double Lie algebroid, together with a chosen decomposition, is equivalent to a pair of 2-term representations up to homotopy satisfying compatibility conditions which extend the notion of matched pair of Lie algebroids. We discuss in detail the double Lie algebroids arising from the tangent bundle of a Lie algebroid and the cotangent bundle of a Lie bialgebroid. [ABSTRACT FROM AUTHOR]

Summary: We examined cross-sectional associations of metabolic syndrome and its components with male bone turnover, density and structure. Greater bone mass in men with metabolic syndrome was related to their greater body mass, whereas hyperglycaemia, hypertriglyceridaemia or impaired insulin sensitivity were associated with lower bone turnover and relative bone mass deficits. Introduction: Metabolic syndrome (MetS) has been associated with lower bone turnover and relative bone mass or strength deficits (i.e. not proportionate to body mass index, BMI), but the relative contributions of MetS components related to insulin sensitivity or obesity to male bone health remain unclear. Methods: We determined cross-sectional associations of MetS, its components and insulin sensitivity (by homeostatic model assessment-insulin sensitivity (HOMA-S)) using linear regression models adjusted for age, centre, smoking, alcohol, and BMI. Bone turnover markers and heel broadband ultrasound attenuation (BUA) were measured in 3129 men aged 40-79. Two centres measured total hip, femoral neck, and lumbar spine areal bone mineral density (BMD, n = 527) and performed radius peripheral quantitative computed tomography (pQCT, n = 595). Results: MetS was present in 975 men (31.2 %). Men with MetS had lower β C-terminal cross-linked telopeptide (β-CTX), N-terminal propeptide of type I procollagen (PINP) and osteocalcin ( P < 0.0001) and higher total hip, femoral neck, and lumbar spine BMD ( P ≤ 0.03). Among MetS components, only hypertriglyceridaemia and hyperglycaemia were independently associated with PINP and β-CTX. Hyperglycaemia was negatively associated with BUA, hypertriglyceridaemia with hip BMD and radius cross-sectional area (CSA) and stress-strain index. HOMA-S was similarly associated with PINP and β-CTX, BUA, and radius CSA in BMI-adjusted models. Conclusions: Men with MetS have higher BMD in association with their greater body mass, while their lower bone turnover and relative deficits in heel BUA and radius CSA are mainly related to correlates of insulin sensitivity. Our findings support the hypothesis that underlying metabolic complications may be involved in the bone's failure to adapt to increasing bodily loads in men with MetS. [ABSTRACT FROM AUTHOR]

Background/objectives: There is limited evidence that prominent calorie labelling on out-of-home meals helps consumers reduce calorie intakes and avoid weight gain, but no evidence on its effects on macro- and micro-nutrients. The objective of this study was to assess the impact of prominent calorie labelling on energy, macro- and micro-nutrients.Subjects/methods: Young adults in a catered residential setting were observed when choosing main meals over three study periods in fixed order in this observational study. Period 1: with calorie labels (20 weeks); period 2: without calorie labels (10 weeks); period 3: with calorie labels plus information on estimated energy requirements (10 weeks). Nutrient contents of meal choices were analysed from food composition tables.Results: Energy, 4 macronutrients and 19 micronutrients levels were derived from 4200 meals chosen by 120 subjects over 40 weeks. Means (s.d. or Median) for key macro- and micro-nutrients were for period 1: energy=658 (94) kcal, fat=31 (8.6) g, saturated fat=10.5 (2.7) g, B12=2.5 (1.7) μg, folate=119 (46.8) μg, vitamin C=80.0 (42) mg, Ca=278 (129) mg, Na=1230 (119) mg, Fe=22 (10) g, Se=19 (10.1) μg, I=34 (10.1) μg, period 2: energy=723 (87) kcal, fat=35 (7.6) g, saturated fat=12 (2.7) g, B12=3.4 (1.7) μg, Folate=182 (13.3) μg, vitamin C=87.0 (49.7) mg, Ca=379 (149) mg, Na=1352 (114) mg, Fe=41.6 (14) g, Se=26 (10.3) μg, I=38.0 (18.4) μg, period 3: energy=578 (109) kcal, fat=27.3 (9.1) g, saturated fat=8.5 (2.7) g, B12=2.2 (0.5) μg, Folate=90 (50.8) μg, vitamin C=75.0 (34) mg, Ca=277 (119) mg, Na=1205 (99) mg, Fe=14.5 (10.9) g, Se=15.0 (10) μg, I=32.0 (18.4) μg. All macro- and micro-nutrients, except for B1, vitamin C, vitamin E and Ca were significantly different between the three periods (P<0.001), but all mean intakes remained above recommended levels.Conclusions: Calorie labelling resulted in reductions in calories, fat and saturated fat contents of the meals chosen, without compromising micronutrient consumptions. [ABSTRACT FROM AUTHOR]

Objective:In both the United States and United Kingdom, countries with high prevalence of obesity, weight gain is particularly rapid in young adulthood and especially identified among first-year students.Design:A triangulation protocol was used, incorporating quantitative and qualitative research methods. A 27-question online survey was sent to all first-year undergraduates twice, with a 9-month interval. An online focus group was conducted at the end of the year, analysed by content and thematically. Self-reported weights and heights were validated against objectively measured data.Results:From a total of 3010 first-year students, 1440 (female=734) responded at baseline mean (s.d.) age 20 (3.6) years, body mass index 22.3 (4.6) kg m−2, 17% smokers and 80% alcohol drinkers. At follow-up, 1275 students reported a mean weight change of 1.8 (s.d. 2.6) kg over the 9-month period. Self-reported data correlated strongly with measured weights (r=0.999, P<0.001) and heights (r=0.998, P<0.001). Predictors of weight gain were baseline weight (P<0.001). Dairy products consumption was associated with less weight gain (P<0.001). Fruit and vegetable consumption, and time spent on physical activity or sleeping were associated with neither weight gain nor weight loss. Focus group content analysis revealed weight gain as a major concern, reported by half the participants, and increased alcohol consumption was considered the most common lifestyle change behind weight gain. Thematic analysis identified three main themes as barriers to or facilitators of healthy lifestyles and weight; budget, peer influence and time management.Conclusions:Rapid weight gain is of concern to young adults. Students living away from home are at particular risk, owing to specific obesogenic behaviours. Consumption of fruit and vegetables, and physical activity, despite popular beliefs, were not associated with protection against weight gain. [ABSTRACT FROM AUTHOR]

Calorie-labelling of meals has been suggested as an antiobesity measure, but evidence for impact is scarce. It might have a particular value for young adults, when weight gain is most rapid. A systematic literature review and a meta-analysis was performed to assess the effect of calorie-labelling on calories purchased. Seven studies met the inclusion and quality criteria of which six provided data allowing a meta-analysis. Three reported significant changes, all reductions in calories purchased (−38.1 to −12.4 kcal). Meta-analysis showed no overall effect, −5.8 kcal (95% confidence interval (CI)=−19.4 to 7.8 kcal) but a reduction of −124.5 kcal (95% CI=−150.7 to 113.8 kcal) among those who noticed the calorie-labelling (30-60% of customers). A questionnaire, to gauge views on calorie-labelling, was devised and sent to young adults in higher education: 1440 young adults (mean age 20.3 (s.d.=2.9) years) completed the survey. Nearly half (46%) said they would welcome calorie information in catering settings and on alcoholic drinks. Females opposing to calorie-labelling were heavier to those who did not (64.3 kg vs 61.9 kg, P=0.03; BMI=22.4 kg m−2 vs 21.7 kg m−2, P=0.02). In conclusion, the limited evidence supports a valuable effect from clearly visible calorie-labelling for obesity prevention, and it appears an attractive strategy to many young adults. [ABSTRACT FROM AUTHOR]

Background:Adiposity and health risks are better indicated by waist circumference than body mass index (BMI). Patterns of change with age are incompletely documented.Methods:Adults aged 18-92 years in the Scottish and English Health Surveys of 1994-96 and 2008-10 were divided into fifteen 5-year age bands. Sex-specific prevalences of overweight/obesity and of increased/high waist circumference against age were compared using analysis of covariance.Results:Data available for 7932 Scottish and 55 925 English subjects in 1994-96, and for 27 391 Scottish and 30 929 English in 2008-10, showed generally similar patterns of change in the two countries. Prevalences of both elevated BMI and waist circumference rose with age for longer in 2008-10 than in 1994-96, reaching higher peaks at greater ages, particularly among men. Between 1994-96 and 2008-10, maximum prevalences of BMI>30 increased from 25 to 38% (larger increases in men than women), reaching a peak at age 60-70 years in both sexes. This peak prevalence was 5-10 years later than in 1994-96 for men and remained unchanged for women. Between 1994-96 and 2008-10, maximum prevalences of high waist circumference (men>102 cm, women>88 cm) increased from 30 to -70% in both sexes, peaking in 2008-10 at ages 80-85 years (men) and 65-70 years (women). In 2008-10, proportions of adults with 'normal' BMI (18.5-25) fell with age to 15-20% at age 60-70 years (men) and 75 years (women). Among all those with BMI=18.5-25, aged>65 years, the proportions with unhealthily elevated waist circumference were 30 (men>94 cm) and 55% (women>80 cm).Conclusions:Almost 40% of men and women are now becoming obese. People are growing fatter later in life, with waist circumference rising more persistently than BMI, which may indicate increased loss of muscle mass and sarcopenia in old age. Among older people, few now have 'normal' BMI, and of these up to half have elevated waist circumference, raising questions for the suitability of BMI as a measure of adiposity in this age group. [ABSTRACT FROM AUTHOR]

Background:Liraglutide 3.0 mg, with diet and exercise, produced substantial weight loss over 1 year that was sustained over 2 years in obese non-diabetic adults. Nausea was the most frequent side effect.Objective:To evaluate routinely collected data on nausea and vomiting among individuals on liraglutide and their influence on tolerability and body weight.Design:A randomized, placebo-controlled, double-blind 20-week study with an 84-week extension (sponsor unblinded at 20 weeks, open-label after 1 year) in eight European countries (Clinicaltrials.gov: NCT00422058).Subjects:After commencing a 500-kcal/day deficit diet plus exercise, 564 participants (18-65 years, body mass index (BMI) 30-40 kg m−2) were randomly assigned (after a 2-week run-in period) to once-daily subcutaneous liraglutide (1.2, 1.8, 2.4 or 3.0 mg), placebo or open-label orlistat (120 mg × 3 per day). After 1 year, participants on liraglutide/placebo switched to liraglutide 2.4 mg, and subsequently, to liraglutide 3.0 mg (based on 20-week and 1-year results, respectively).Results:The intention-to-treat population comprised 561 participants (n=90-98 per arm, age 45.9±10.3 years, BMI 34.8±2.7 kg m−2 (mean±s.d.)). In year 1, more participants reported ⩾1 episode of nausea/vomiting on treatment with liraglutide 1.2-3.0 mg (17-38%) than with placebo or orlistat (both 4%, P⩽0.001). Most episodes occurred during dose escalation (weeks 1-6), with 'mild' or 'moderate' symptoms. Among participants on liraglutide 3.0 mg, 48% reported some nausea and 13% some vomiting, with considerable variation between countries, but only 4 out of 93 (4%) reported withdrawals. The mean 1-year weight loss on treatment with liraglutide 3.0 mg from randomization was 9.2 kg for participants reporting nausea/vomiting episodes, versus 6.3 kg for those with none (a treatment difference of 2.9 kg (95% confidence interval 0.5-5.3); P=0.02). Both weight losses were significantly greater than the respective weight losses for participants on placebo (P<0.001) or orlistat (P<0.05). Quality-of-life scores at 20 weeks improved similarly with or without nausea/vomiting on treatment with liraglutide 3.0 mg.Conclusion:Transient nausea and vomiting on treatment with liraglutide 3.0 mg was associated with greater weight loss, although symptoms appeared tolerable and did not attenuate quality-of-life improvements. Improved data collection methods on nausea are warranted. [ABSTRACT FROM AUTHOR]

Background:Previous studies, based on relative risks for certain secondary diseases, have shown greater healthcare costs in higher body mass index (BMI) categories. The present study quantifies the relationship between BMI and total healthcare expenditure, with the patient as the unit of analysis.Methods:Analyses of cross-sectional data, collected over 18-months in 2002-2003, from 3324 randomly selected patients, in 65 general practices across UK. Healthcare costs estimated from primary care, outpatient, accident/emergency and hospitalisation attendances, weighted by unit costs taken from standard sources.Results:In univariate analyses, significant associations (P<0.05) were found between total healthcare expenditure and all dependent variables (women>men, drinkernon-smokers, and increasing with greater physical activity, age and BMI. In multivariate analysis, age, sex, BMI, smoking and alcohol consumption remained significantly associated with healthcare cost, and together explained just 9% of the variance in healthcare expenditure. Adjusted total annual healthcare cost was £16 (95% CI £11-£21) higher per unit BMI. All cost categories were significantly (P<0.003) higher for those with BMI >40 compared with BMI <20 kg m−2: prescription drugs (men: £390 versus £16; women: £211 versus £73), hospitalisation (men: £72 versus £0; women: £243 versus £107), primary care (men: £191 versus £69; women: £268 versus £153) and outpatient care (£234 versus £107 women only).Conclusions:Annual healthcare expenditure rose a mean of £16 per unit greater BMI, doubling between BMI 20-40 kg m−2. This gradient may be an underestimate if the lower-BMI patients with heights and weights recorded had other costly diseases. [ABSTRACT FROM AUTHOR]

Objective:To document changes in body mass index (BMI) and waist circumference (WC) over a 10-year period 1998-2008, in representative surveys of adults.Subjects:Adults aged 18-72 in the Scottish Health Surveys conducted in 1998, 2003 and 2008 were divided, separately for men and women, into eleven 5-year age bands. 'Synthetic birth-cohorts' were created by dividing participants into thirteen 5-years-of-birth bands (n=20 423). Weight, height and WC were objectively measured by trained observers.Results:Subjects with data available on BMI/WC were 7743/6894 in 1998, 5838/4437 in 2003 and 4688/925 in 2008 with approximately equal gender distributions. Mean BMI and waist were both greater in successive surveys in both men and women. At most specific ages, people were consistently heavier in 2008 than in 1998 by about 1-1.5 BMI units, and WCs were greater by about 2-6 cm in men and 5-7 cm in women. Greater increases were seen at younger ages between 1998 and 2003 than between 2003 and 2008, however increases continued at older ages, particularly in waist. All birth-cohorts observed over the 10 years 1998-2008 showed increases in both BMI and waist, most marked in the younger groups. The 10-year increases in waist within birth-cohorts (mean 7.4 cm (8.1%) in men and 8.6 cm (10.9%) in women) were more striking than in BMI (mean 1.8 kg m−2 (6.6%) in men and 1.5 kg m−2 (6.4%) in women) were particularly steep in older women.Conclusion:People were heavier and fatter in 2003 than those of the same age in 1998, with less marked increases in WC between 2003 and 2008 than between 1998 and 2003. There were proportionally greater increases in WC than in BMI, especially in older women. This suggests a disproportionate increase in body fat, compared with muscle, particularly among older women. [ABSTRACT FROM AUTHOR]

Objective:Having demonstrated short-term weight loss with liraglutide in this group of obese adults, we now evaluate safety/tolerability (primary outcome) and long-term efficacy for sustaining weight loss (secondary outcome) over 2 years.Design:A randomized, double-blind, placebo-controlled 20-week study with 2-year extension (sponsor unblinded at 20 weeks, participants/investigators at 1 year) in 19 European clinical research centers.Subjects:A total of 564 adults (n=90-98 per group; body mass index 30-40 kg m−2) enrolled, 398 entered the extension and 268 completed the 2-year trial. Participants received diet (500 kcal deficit per day) and exercise counseling during 2-week run-in, before being randomly assigned (with a telephone or web-based system) to once-daily subcutaneous liraglutide (1.2, 1.8, 2.4 or 3.0 mg, n=90-95), placebo (n=98) or open-label orlistat (120 mg × 3, n=95). After 1 year, liraglutide/placebo recipients switched to liraglutide 2.4 mg, then 3.0 mg (based on 20-week and 1-year results, respectively). The trial ran from January 2007-April 2009 and is registered with Clinicaltrials.gov, number NCT00480909.Results:From randomization to year 1, liraglutide 3.0 mg recipients lost 5.8 kg (95% confidence interval 3.7-8.0) more weight than those on placebo and 3.8 kg (1.6-6.0) more than those on orlistat (P0.0001; intention-to-treat, last-observation-carried-forward). At year 2, participants on liraglutide 2.4/3.0 mg for the full 2 years (pooled group, n=184) lost 3.0 kg (1.3-4.7) more weight than those on orlistat (n=95; P<0.001). Completers on liraglutide 2.4/3.0 mg (n=92) maintained a 2-year weight loss of 7.8 kg from screening. With liraglutide 3.0 mg, 20-week body fat decreased by 15.4% and lean tissue by 2.0%. The most frequent drug-related side effects were mild to moderate, transient nausea and vomiting. With liraglutide 2.4/3.0 mg, the 2-year prevalence of prediabetes and metabolic syndrome decreased by 52 and 59%, with improvements in blood pressure and lipids.Conclusion:Liraglutide is well tolerated, sustains weight loss over 2 years and improves cardiovascular risk factors. [ABSTRACT FROM AUTHOR]

Summary: The influence of age and sex steroids on bone density and geometry of the radius was examined in two European Caucasian populations. Age-related change in bone density and geometry was observed. In older men, bioavailable oestradiol may play a role in the maintenance of cortical and trabecular bone mineral density (BMD). Introduction: To examine the effect of age and sex steroids on bone density and geometry of the radius in two European Caucasian populations. Methods: European Caucasian men aged 40-79 years were recruited from population registers in two centres: Manchester (UK) and Leuven (Belgium), for participation in the European Male Ageing Study. Total testosterone (T) and oestradiol (E) were measured by mass spectrometry and the free and bioavailable fractions calculated. Peripheral quantitative computed tomography was used to scan the radius at distal (4%) and midshaft (50%) sites. Results: Three hundred thirty-nine men from Manchester and 389 from Leuven, mean ages 60.2 and 60.0 years, respectively, participated. At the 50% radius site, there was a significant decrease with age in cortical BMD, bone mineral content (BMC), cortical thickness, and muscle area, whilst medullary area increased. At the 4% radius site, trabecular and total volumetric BMD declined with age. Increasing bioavailable E (bioE) was associated with increased cortical BMD (50% radius site) and trabecular BMD (4% radius site) in Leuven, but not Manchester, men. This effect was predominantly in those aged 60 years and over. In older Leuven men, bioavailable testosterone (Bio T) was linked with increased cortical BMC, muscle area and SSI (50% radius site) and total area (4% radius site). Conclusions: There is age-related change in bone density and geometry at the midshaft radius in middle-aged and elderly European men. In older men bioE may maintain cortical and trabecular BMD. BioT may influence bone health through associations with muscle mass and bone area. [ABSTRACT FROM AUTHOR]

The influence of sex steroids on calcaneal quantitative ultrasound (QUS) parameters was assessed in a population sample of middle-aged and elderly European men. Higher free and total E2 though not testosterone, were independently associated with higher QUS parameters. The aim of this study was to investigate the association between QUS parameters and sex steroids in middle-aged and elderly European men. Three thousand one hundred forty-one men aged between 40 and 79 years were recruited from eight European centres for participation in a study of male ageing: the European Male Ageing Study. Subjects were invited by letter to attend for an interviewer-administered questionnaire, blood sample and QUS of the calcaneus (Hologic-SAHARA). Blood was assessed for sex steroids including oestradiol (E2), testosterone (T), free and bio-available E2 and T and sex hormone binding globulin (SHBG). Serum total T was not associated with any of the QUS parameters. Free T and both free and total E2 were positively related to all QUS readings, while SHBG concentrations were negatively associated. These relationships were observed in both older and younger (<60 years) men. In a multivariate model, after adjustment for age, centre, height, weight, physical activity levels and smoking, free E2 and SHBG, though not free T, remained independently associated with the QUS parameters. After further adjustment for IGF-1, however, the association with SHBG became non-significant. Higher free and total E2 are associated with bone health not only among the elderly but also middle-aged European men. [ABSTRACT FROM AUTHOR]

Objectives:This paper discusses the benefits that a ‘realist’ approach can bring to an outcome study using the example of a nutritional intervention offered as an adjunct to the existing smoking cessation programmes to limit post-cessation weight gain.Subjects and setting:Participants of a smoking cessation programme in areas of deprivation in the north, south and west of Glasgow.Results:A realist approach enabled the development of a framework able to investigate both implementation and outcomes of the intervention. Drawing on theoretical and experiential knowledge, context–mechanism–outcome hypotheses were developed for further testing at later stages of evaluation. This will focus the further stages of evaluation on testing these specific hypotheses using outcome data collected at the end of the intervention.Conclusion:Adopting such an evaluation approach enables integration of process and outcome data that will refine our understanding of contexts and mechanisms, which are associated with these behavioural changes. It can aid further policy decisions by identifying the type of participant and circumstances that are associated with positive outcomes and those subgroups of participants that can be targeted more effectively using other approaches. [ABSTRACT FROM AUTHOR]

Objective:To document patterns of measured weight and waist circumference (WC) change and the increase in overweight and obesity over a 9-year period.Subjects/Methods:A total of 1044 subjects from two age-defined cohorts aged 39 and 59 in 1991. Height, weight and WC were measured in 1991, 1995 and 2000 and body mass index (BMI) was calculated. Pattern of weight and WC change was studied over approximately 9 years.Results:The prevalence of overweight and obesity increased markedly and the younger cohort showed greater increases in weight and WC than the older cohort. There was no significant difference in mean BMI and/or mean 9-year weight change between men and women in either age cohort, and mean weight gain was similar for all occupational groups. Only 20% of subjects maintained a stable weight (±2 kg), while 42.2 and 17.6% gained greater than 5 and 10 kg over the 9-year period, respectively. The rate of weight gain appeared to be relatively steady over the 9 years among younger subjects but declined in the older subjects in the second half of the observation period.Conclusions:Health promotion strategies to prevent weight gain need to be population-based, targeting all social and age groups, but particularly those in their early middle-age.European Journal of Clinical Nutrition (2008) 62, 1208–1214; doi:10.1038/sj.ejcn.1602839; published online 11 July 2007 [ABSTRACT FROM AUTHOR]

Objective:To examine associations between current recommended physical activity levels and body mass index (BMI) with some cardiovascular disease (CVD) risk factors (total cholesterol, high-density lipoprotein cholesterol (HDL-C), non-HDL-cholesterol (non-HDL-C), C-reactive protein (CRP), fibrinogen, and blood pressure), general health score (GHQ12) and predicted coronary heart disease (CHD) risk.Design:Further analysis of the cross-sectional Scottish Health Survey 1998 data.Subjects:Five thousand four hundred and sixty adults 16–74 years of age.Results:After controlling for some confounding factors, obesity was significantly associated with higher odds ratio (OR) for elevated cholesterol, CRP, systolic blood pressure, non-HDL-C and lower HDL-C (P<0.001), and with greater predicted CHD risk compared to BMI <25 kg/m2. Regular self-reported physical activity was associated with smaller OR of lower HDL-C and higher CRP, and average predicted 10-year CHD risk in obese subjects, but did not eliminate the higher risk of the measured CVD risk factors in this group. The OR of these two risk factors were still high 4.39 and 2.67, respectively, when compared with those who were inactive with BMI <25 kg/m2 (P<0.001). Those who reported being physically active had better GHQ scores in all BMI categories (P<0.001).Conclusion:Reporting achievement of recommended physical activity levels may reduce some CVD risk factors, predicted CHD risk and improve psychosocial health, but may not eliminate the extra risk imposed by overweight/obesity. Therefore, increasing physical activity and reducing body weight should be considered to tackle CVD risk factors.European Journal of Clinical Nutrition (2008) 62, 1–9; doi:10.1038/sj.ejcn.1602693; published online 7 March 2007 [ABSTRACT FROM AUTHOR]

OBJECTIVE:: To define relationships between smoking status, body mass index (BMI), waist and hip circumferences (WC, HC) and waist to hip ratio (WHR). DESIGN:: Further analysis of the cross-sectional Scottish Health Survey 1998 data. SUBJECTS:: Nationally representative sample of 9047 adults aged 16-74?y. RESULTS:: Body mass index (BMI) was lower in current smokers and higher in exsmokers (P<0.001) when compared with nonsmokers in the survey population as a whole. After adjustment for confounding factors (age, social class, physical activity and alcohol intake), these differences still remained. However, examination of age categories showed no such differences in BMI between current smokers and nonsmokers in men aged 16-24?y or women aged below 55?y. In the age category 16-24?y, prevalence of cigarette smoking was highest at 51%(men) and 43%(women) in obese subjects and lowest at 35%(men) and 33%(women) in people with BMI of 25-30?kg/m2. For women current smokers, mean WC and WHR were higher and HC was lower compared with nonsmokers (P<0.001). In men, only HC was lower in current smokers compared with nonsmokers for the entire sample (P<0.001). CONCLUSION:: Cigarette smoking is associated with a lower BMI in adults over 24?y particularly in men, but not in younger people. In women, smoking is linked to the development of central adiposity. The gender-related central adiposity of men is not further increased by smoking, but a lower HC could suggest a reduction in muscle mass.International Journal of Obesity (2005) 29, 236-243. doi:10.1038/sj.ijo.0802827 Published online 26 October 2004 [ABSTRACT FROM AUTHOR]

To evaluate the response to simple innovative dietary counselling in post myocardial infarction patients. Randomised controlled trial. Cardiac rehabilitation programmes of two acute hospitals in Lanarkshire, Scotland. A total of 69 men and 29 women aged 35–75 y who survived acute myocardial infarction and participated in the cardiac rehabilitation programmes of the study hospitals between 1st September 1997 and 1st August 1998. At 12 weeks follow-up, diet composition had improved significantly in intervention subjects, but no such change was evident in the control group. The target of five portions of fruit and vegetables per day was achieved by 65% of intervention subjects but only 31% of control subjects (P=0.004). Between-group differences in food intakes were no longer evident at 1 y. Diet composition did however remain in line with current dietary targets in intervention subjects. Compared to conventional cardiac rehabilitation, this intervention, focused on targets known to improve mortality, improved diet in post myocardial infarction patients. However, a more sustained programme is required to maintain improvements. Delivery of the intervention was expensive and further research is required to determine the feasibility of a group approach using the same package. The study was supported by Chief Scientist Office of the Scottish Executive Department of Health. [ABSTRACT FROM AUTHOR]

Objective: To evaluate a two-page food frequency list for use as a Dietary Targets Monitor in large scale surveys to quantify consumptions of the key foods groups targeted in health promotion. Design: Intakes of fruit and vegetables, starchy foods and fish estimated from a validated food frequency questionnaire (FFQ) were compared with a short food frequency list (the Dietary Targets Monitor) specifically designed to assess habitual frequency of consumption of foods in relation to dietary targets which form the basis of a National (Scottish) Food and Health Policy. Subjects: A total of 1085 adults aged 25-64 y from the Glasgow MONICA Study. Results: The two questionnaires both collected data on frequencies of food consumption for fruit and vegetables, starchy foods and fish. Comparing the two questionnaires, there were consistent biases, best expressed as ratios (FFQ:Dietary Targets Monitor) between the methods for fruit and vegetables (1.33, 95% CI 1.29, 1.38) and 'starchy foods' (1.08, 95% CI 1.05, 1.12), the DTM showing systematic under-reporting by men. For fish consumption, there was essentially no bias between the methods (0.99, 95% CI 0.94, 1.03). Using calibration factors to adjust for biases, the Dietary Targets Monitor indicated that 16% of the subjects were achieving the Scottish Diet food target (400 g/day) for fruit and vegetable consumption. Nearly one-third (32%) of the subjects were eating the recommended intakes of fish (three portions per week). The Dietary Targets Monitor measure of starchy foods consumption was calibrated using FFQ data to be able to make quantitative estimates: 20% of subjects were eating six or more portions of starchy food daily. A similar estimation of total fat intake and saturated fat intake (g/day) allowed the categorization of subjects as low, moderate or high fat consumers, with broad agreement between the methods. The levels of agreement demonstrated by Bland-Altman analysis, were insufficient to permit use of the... [ABSTRACT FROM AUTHOR]

OBJECTIVE: To assess the clinical usefulness of published guidelines for the use of orlistat, by studying whether weight loss ≥ 2.5 kg during a 4 week dietary lead-in period, and weight losses of ≥ 5% after 12 weeks and ≥ 10% after 6 months of drug therapy predict weight loss and risk factor changes after 2 years. DESIGN: A retrospective analysis of pooled data from 2 multicentre, randomised, placebo-controlled clinical trials with similar design. SETTING: Twenty-nine centres throughout Europe. PARTICIPANTS: Two hundred and twenty men and women (BMI 28 - 43 kg/m[SUP2]) who completed 2 years of treatment. INTERVENTION: After a 4 week hypocaloric diet plus placebo, 2 years of treatment with orlistat 120 mg tid, plus a hypocaloric diet for the first year and a weight maintenance diet in year two. MAIN OUTCOME MEASURES: Weight loss and obesity-related risk factor changes. RESULTS: Weight loss ≥ 5% body weight after 12 weeks of diet plus orlistat therapy was a good indicator of 2 year weight loss, whereas weight loss of ≥ 2.5 kg during the 4 week lead-in and ≥ 10% after 6 months did not add significantly to the prediction of 2 year outcomes. Patients who lost ≥ 5% of their weight at 12 weeks (n = 104, 47.3%) lost significantly more weight after 2 years than others: -11.9% (95% confidence interval (CI) -13.4% to -10.3%) vs -4.7% (-5.7% to -3.7%) (P = 0.0001), and had significantly greater reductions in total cholesterol, LDL-cholesterol, triglycerides, glucose, insulin, and blood pressure. Among those who achieved ≥ 5% weight loss at 12 weeks, the overall health benefits were not significantly greater in patients who went on to lose ≥ 10% body weight at 6 months compared with those who did not achieve ≥ 10% weight loss by month 6. CONCLUSIONS: Of the criteria currently suggested for assessing response to orlistat treatment, weight loss of ≥ 5% at 12 weeks accurately predicts sustained improvements in weight and major risk factors at 2... [ABSTRACT FROM AUTHOR]

OBJECTIVES:: (1) To compare the effectiveness a 2512 kJ (600 kcal) daily energy deficit diet (ED) with a 6279 kJ (1500 kcal) generalized low-calorie diet (GLC) over a 24 week period (12 weeks weight loss plus 12 weeks weight maintenance). (2) To determine if the inclusion of lean red meat at least five times per week as part of a slimming diet is compatible with weight loss in comparison with a diet that excludes lean red meat. DESIGN:: Randomized controlled trial. SETTING:: Large petrochemical work-site. PARTICIPANTS:: One-hundred and twenty-two men aged between 18 and 55 y. MAIN OUTCOME MEASURES:: Weight loss and maintenance of weight loss. INTERVENTION:: Eligible volunteers were randomized to one of the four diet/meat combinations (ED meat, ED no meat, GLC meat, GLC no meat). One-third of subjects in each diet/meat combination were randomized to an initial control period prior to receiving dietary advice. All subjects attended for review every 2 weeks during the weight loss period. For the 12 week structured weight maintenance phase, individualized energy prescriptions were re-calculated for the ED group as 1.4 (activity factor) × basal metabolic rate. Healthy eating advice was reviewed with subjects in the GLC group. All subjects were contacted by electronic mail at 2 week intervals and anthropometric and dietary information requested. RESULTS:: No difference was evident between diet groups in mean weight loss at 12 weeks (4.3 (s.d. 3.4) kg ED group vs 5.0 (s.d. 3.5) kg GLC group, P=0.34). Mean weight loss was closer to the intended weight loss in the 2512 kJ (600 kcal) ED group. The dropout rate was also lower than the GLC group. The inclusion of lean red meat in the diet on at least five occasions per week did not impair weight loss. Mean weight gain following 12 weeks weight maintenance was +1.1 (s.d. 1.8) kg, P<0.0001. No differences were found between groups. CONCLUSIONS:: This study has shown that the individualized 2512 kJ (600 kcal) ED approach... [ABSTRACT FROM AUTHOR]

AIMS: To compare anthropometric measurements and to define their behavioural associations in migrant and British-born South Asians (who have increased cardiovascular risk) or Italians (who have reduced cardiovascular risk), and in the general population of British women living in the west of Scotland. STUDY DESIGN: Cross-sectional survey of women aged 20-42y, selected mainly from birth registration data, which included 63 migrant South Asians, 56 British-born South Asians, 39 migrant Italians, 51 British-born Italians, and 50 subjects representative of the general population of women, all resident in the west of Scotland. MEASUREMENTS: Height, weight, body mass index (BMI), and waist and hip circumferences. RESULTS: With age adjustment, migrant South Asians (0.88) had greater waist-to-hip ratio than British-born South Asians (0.84; P < 0.05), while there was no difference between migrant (0.81) and British-born (0.79) Italian groups. Both migrant (P < 0.001 ) and British-born South Asian (P < 0.05) groups had higher waist-to-hip ratio and were about 3 cm shorter than Italian groups and the general population. Neither weight nor BMI were different between ethnic groups. Waist and hip circumferences were not different between migrant and British-born ethnic minority groups. Migrant South Asians (86.8cm) had significantly (P < 0.05) larger waist circumference than the general population (78.6 cm). British-born Italian women (103.0 cm) had larger hip circumference than the general population of women (96.4cm), while other groups had similar hip circumferences. Additional adjustments for physical activity, smoking, alcohol consumption and parity reduced the differences in anthropometric measurements: only waist-to-hip ratio of migrant South Asians remained significantly (P < 0.01 ) higher than that of the general population women. CONCLUSIONS: The adverse anthropometric indicators of cardiovascular risk in migrant South Asian women are substantially explained by... [ABSTRACT FROM AUTHOR]

In a single blind crossover study, ciclazindol, 10-(m-chlorophenyl)-2, 3, 4, 10-tetrahydropyrimide (1, 2α) indol-10-ol hydrochloride (Fig. 1), has been found to have hypoglycaemic action, and to produce reduction in appetite and weight. The mode of action appears to be different from either biguanides or sulphonylureas. Side-effects were few and mild. Metformin 500 mg b.d. had comparable hypoglycaemic effect but did not suppress appetite. Ciclazindol may be useful as a mild oral hypoglycaemic agent for obese patients, and would be suitable for once daily administration. [ABSTRACT FROM AUTHOR]

In this article the author reflects on the causes of childhood obesity and risks associated with it. It is stated that obesity is the leading cause of Coronary Heart Disease (CHD) and committing most of the current generations to chronic ill health and disability. Studies have found that childhood obesity depends on the body weight of parents.

This paper reformulates Li-Bland's definition for LA-Courant algebroids, or Poisson Lie 2-algebroids, in terms of split Lie 2-algebroids and self-dual 2-representations. This definition generalises in a precise sense the characterisation of (decomposed) double Lie algebroids via matched pairs of 2-representations. We use the known geometric examples of LA-Courant algebroids in order to provide new examples of Poisson Lie 2-algebroids, and we explain in this general context Roytenberg's equivalence of Courant algebroids with symplectic Lie 2-algebroids. We study further the core of an LA-Courant algebroid and we prove that it carries an induced degenerate Courant algebroid structure. In the nondegenerate case, this gives a new construction of a Courant algebroid from the corresponding symplectic Lie 2-algebroid. Finally we completely characterise VB-Dirac and LA-Dirac structures via simpler objects, that we compare to Li-Bland's pseudo-Dirac structures. [ABSTRACT FROM AUTHOR]

A correction to the article "Safety, tolerability and sustained weight loss over 2 years with the once-daily human GLP-1 analog, liraglutide," that was published in the 2012 issue is presented.

Objective: To improve the management of obese adults (18-75 y) in primary care. Design: Cohort study. Settings: UK primary care. Subjects: Obese patients (body mass index > or =30 kg/m(2)) or BMI> or =28 kg/m(2) with obesity-related comorbidities in 80 general practices. Intervention: The model consists of four phases: (1) audit and project development, (2) practice training and support, (3) nurse-led patient intervention, and (4) evaluation. The intervention programme used evidence-based pathways, which included strategies to empower clinicians and patients. Weight Management Advisers who are specialist obesity dietitians facilitated programme implementation. Main Outcome Measures: Proportion of practices trained and recruiting patients, and weight change at 12 months. Results: By March 2004, 58 of the 62 (93.5%) intervention practices had been trained, 47 (75.8%) practices were active in implementing the model and 1549 patients had been recruited. At 12 months, 33% of patients achieved a clinically meaningful weight loss of 5% or more. A total of 49% of patients were classed as 'completers' in that they attended the requisite number of appointments in 3, 6 and 12 months. 'Completers' achieved more successful weight loss with 40% achieving a weight loss of 5% or more at 12 months. Conclusion: The Counterweight programme provides a promising model to improve the management of obesity in primary care. [ABSTRACT FROM AUTHOR]