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IntroductionResearch showing Place of Birth (POB) predicts excess weight gain and obesity risk among Latino adults has not prompted similar research in Latino children, although childhood is a critical period for preventing obesity.MethodsLongitudinal cohort observational study on public school children self-identified by parent/guardian as Latino in grades K-12 for school years 2006-07 through 2016-17 with measured weight and height (n= 570,172students; 3,10,3642observations). POB reported by parent/guardian was categorized as continental US (not NYC) (n=295,693), NYC (n=166,361), South America (n=19,452), Central America (n=10,241), Dominican Republic (n=57,0880), Puerto Rico (n=9,687) and Mexico (n=9,647). Age- and sex-specific BMI percentiles were estimated based on established growth charts. Data were analyzed in 2020.ResultsPrevalence of obesity was highest among US (non-NYC)-born girls (21%) and boys (27%), followed by NYC-born girls (19%) and boys (25%). Among girls, South Americans (9%) had the lowest prevalence of all levels of obesity, while Puerto Ricans (19%) and Dominicans (15%) had the highest prevalence. Among boys, South Americans also had the lowest prevalence of all levels of obesity (15%), while Puerto Ricans (22%) and Mexicans (21%) had the highest. In adjusted models, obesity risk was highest in US (non-NYC)-born children, followed by children born in NYC (pConclusionsThe heterogeneity of obesity risk among Latino children highlights the importance of POB.

Studying the impact of built-environment changes on human behavior and health is empirically challenging. To overcome this challenge, there has been increasing recognition of the usefulness of systems’ approaches for scenario testing to understand and prioritize such public health interventions. Limited research has shown a potential effect on the positive energy expenditure as a result of the use of dynamic furniture that promotes micromovement among school children. In this article, we aim to determine, via experiments in simulated populations of elementary school students, whether the use of dynamic furniture in the school environment has an impact on the childhood obesity over time. An agent-based model is developed to simulate three physical activity (PA) profiles over a period of six years with and without the dynamic furniture. Based on the prevalence trends from the experiments, there is no apparent impact of dynamic furniture use among boys, regardless of activity profile category. However, there are some pieces of evidence of differing trends among girls with a low PA profile. Although the intervention produces a marginal change in obesity prevalence in one population, the dynamic furniture is not a sole solution to the obesity epidemic. However, the use of dynamic furniture in schools may be a worthwhile component of prevention interventions.

Introduction Latinos in the United States represent a heterogeneous population disproportionally impacted by obesity. Yet, the prevalence of obesity by specific Latino group is unclear. Using the New York City Community Health Survey (2013–2017), this study compared self‐reported obesity in the city's largest Latino adult populations (Puerto Ricans, Mexicans, Dominicans, Ecuadorians, and Colombians). Methods Age‐standardized prevalence using the 2000 Census and prevalence ratios (PRs) for self‐reported obesity (BMI ≥30 kg/m2) by country of origin were estimated using weighted multivariable logistic regression adjusting for socio‐demographic characteristics, health status, and behaviors. Results Obesity prevalence among Mexicans (36.8%; 95% CI [31.5, 42.4]) and Puerto Ricans (36.3%; 95% CI [31.7, 41.3]) was significantly higher than that among Colombians (23.8%; 95% CI [18.8, 29.5]), Ecuadorians (24.2%; 95% CI [20.7, 28.1]), and Dominicans (27.0%; 95% CI [25.0, 29.1]). After adjusting for covariates, compared to Mexicans, the PRs of obesity remained significantly lower for Colombians (PR = 0.80; 95% CI [0.64, 1.00]), Ecuadorians (PR = 0.72; 95% CI [0.61, 0.86]) and Dominicans (PR = 0.75; 95% CI [0.65, 0.85]). There was no significant difference between Mexicans and Puerto Ricans. Conclusion Obesity prevalence differs by country of origin, suggesting that clustering of Latinos in public health research may obscure unique risks among specific groups. Despite group differences, all Latino groups exhibit high prevalence of obesity and warrant renewed efforts tailored to the specific context and culture of each group to prevent and reduce obesity.

Digital, Non-alcoholic fatty liver disease (NAFLD) is a potentially serious liver disease that affects approximately one-quarter of the global adult population, causing a substantial burden of ill health with wide-ranging social and economic implications. It is a multisystem disease and is considered the hepatic component of metabolic syndrome. Unlike other highly prevalent conditions, NAFLD has received little attention from the global public health community. Health system and public health responses to NAFLD have been weak and fragmented, and, despite its pervasiveness, NAFLD is largely unknown outside hepatology and gastroenterology. There is only a nascent global public health movement addressing NAFLD, and the disease is absent from nearly all national and international strategies and policies for non-communicable diseases, including obesity. In this global Delphi study, a multidisciplinary group of experts developed consensus statements and recommendations, which a larger group of collaborators reviewed over three rounds until consensus was achieved. The resulting consensus statements and recommendations address a broad range of topics — from epidemiology, awareness, care and treatment to public health policies and leadership — that have general relevance for policy-makers, health-care practitioners, civil society groups, research institutions and affected populations. These recommendations should provide a strong foundation for a comprehensive public health response to NAFLD., Ciencias Médicas y de la Salud

OBJECTIVE This study aimed to estimate population-level prevalence of obesity and severe obesity for New York City youth and examine the most recent trends over time. METHODS All public school youth in grades kindergarten through eighth (K-8) (2011-2012 through 2016-2017) with valid weight and height measures were included (N = 1,137,782 unique students; 3,720,297 observations). Age- and sex-specific BMI percentiles for obesity and severe obesity were estimated using Centers for Disease Control and Prevention growth charts. Repeated cross-sectional analyses were conducted using logistic regression, weighting for missing or invalid responses and accounting for clustering by students and schools to examine trends over time and by sociodemographics. RESULTS Among youth in K-8 (aged 5-15 years, 48.8% girls), the prevalence of obesity and severe obesity in 2011-2012 was 21.5% and 6.4%, respectively, compared with 20.2% and 6.0%, respectively, in 2016-2017. Since 2011-2012, decreasing trends in obesity and severe obesity (relative declines: 6.0% and 6.3%, respectively, P

Objective This study aimed to (1) identify mechanistic model structures that produced quality fit to historic obesity prevalence trends and (2) evaluate the sensitivity of future obesity prevalence to social transmission and nonsocial parameters. Methods An age- and gender-structured compartmental model was used to describe transitions between weight status groups. Four model structures with different combinations of social transmission and nonsocial mechanisms were calibrated to match historic time series and assessed for quality of fit. Projections of overall obesity prevalence to 2052 were simulated, and sensitivity analyses were conducted. Results The model structure that included only nonsocial mechanisms indicated that the overall obesity prevalence in the United States has already stabilized and will increase little more; however, it underestimated observed obesity prevalence since 2013. If social transmission mechanisms influence obesity, the model estimated continued increases in obesity prevalence, reaching 48.0% to 55.1% by 2050. Obesity prevalence was most sensitive to changes in the adult social transmission parameters, especially among women. Conclusions The model projected that US obesity prevalence in the overall population will likely continue to increase for decades. The findings that obesity prevalence was most sensitive to adult parameters can be used to inform conversations about priorities for public health and health care programs and policies.

This study examined the longitudinal persistence behavior of first-time, nontraditionally aged students at four-year institutions by leveraging the 2004 to 2009 Beginning Postsecondary Student data set. A human capital theory framework was employed to assess how student background characteristics, enrollment characteristics, and financial factors influence first-time, nontraditional student retention across multiple years of enrollment. The findings indicated that the highest risk of departure occurred during the first year of enrollment for nontraditional students who were first generation, enrolled full time, and from a low-income background. During the second year, students from a middle-income background were most at risk. Female students were most likely to depart in the third year, and minority students had the greatest risk of departure during the fourth year.

Background In 2012, the central government of Spain enacted Royal Decree-Law (RDL) 16/2012 and Royal Decree (RD) 1192/2012, which abolished universal healthcare coverage, thus limiting access to care for undocumented immigrants. Free health care was also no longer granted to anyone who has never been employed. In this context, this study investigated the prevalence of late HIV diagnoses (LHDs) among immigrants living in Spain vs. native-born Spaniards. Methods Data (n = 5943) from the 2010 to 2015 Cohort of the Spanish AIDs Research Network were used, including HIV-positive and antiretroviral therapy (ART)-naïve patients throughout Spain. Multivariate logistic models were fitted to compare the prevalence of LHD among the groups, adjusting for covariates. Results The prevalence of LHD in the total sample was 39.5%. Compared with native-born Spaniards (n = 4445), immigrants (n = 1488) were more likely to have LHD (37.4% vs. 45.7%, respectively; P < 0.001). Multivariate analysis showed that the prevalence ratio of LHD among immigrants vs. native-born Spaniards was 1.15 [95% confidence interval (CI), 1.02–1.28], after adjusting for covariates. This disparity widened from 2010 to 2011 (APR = 1.14, 95% CI, 1.02–1.29) to 2012–15 (APR = 1.28, 95% CI, 1.17–1.39), although the change was not statistically significant. Conclusions Immigrants in Spain had a higher risk of LHD compared with native-born counterparts. LHD is an important healthcare marker due to the positive benefits of early HIV diagnosis, including prevention, improvements in health outcomes and decreases in overall cost of treatment. More research is needed on the causes of the disparity and potential social and policy interventions to reduce the prevalence of LHD among immigrants.

BackgroundIn 2012, the Government of Spain enacted Royal Decree-Law (RDL) 16/2012 and Royal Decree (RD) 1192/2012 excluding undocumented immigrants from publicly funded healthcare services. We conducted a policy implementation analysis to describe and evaluate the legal and regulatory actions taken at the autonomous community (AC) level after enactment of 2012 RDL and RD and their impact on access to general healthcare and HIV services among undocumented immigrants.MethodsWe reviewed documents published by the governments of seven ACs (Andalucía, Aragón, Euskadi (Basque Country), Castilla-La Mancha, Galicia, Madrid, Valencia) from April 2012 to July 2018, describing circumstances under which undocumented immigrants would be able to access free healthcare services. We developed indicators according to the main systemic barriers presented in official documents to analyse access to free healthcare across the participating ACs. ACs were grouped under five access categories: high, medium-high, medium, medium-low and low.ResultsAndalucía provided the highest access to free healthcare for undocumented immigrants in both general care and HIV treatment. Medium-high access was provided by Euskadi and medium access by Aragón, Madrid and Valencia. Castilla-La Mancha provided medium-low access. Galicia had low access. Only Madrid and Galicia provided different and higher level of access to undocumented migrants in HIV care compared with general healthcare.ConclusionsImplementation of 2012 RDL and RD across the ACs varied significantly, in part due to the decentralisation of the Spanish healthcare system. The challenge of healthcare access among undocumented immigrants included persistent systemic restrictions, frequent and unclear rule changes, and the need to navigate differences across ACs of Spain.

Community-driven responses are essential to ensure the adoption, reach and sustainability of evidence-based practices (EBPs) to prevent new cases of opioid use disorder (OUD) and reduce fatal and non-fatal overdoses. Most organizational approaches for selecting and implementing EBPs remain top-down and individually oriented without community engagement (CE). Moreover, few CE approaches have leveraged systems science to integrate community resources, values and priorities. This paper provides a novel CE paradigm that utilizes a data-driven and systems science approach; describes the composition, functions, and roles of researchers in CE; discusses unique ethical considerations that are particularly salient to CE research; and provides a description of how systems science and data-driven approaches to CE may be employed to select a range of EBPs that collectively address community needs. Finally, we conclude with scientific recommendations for the use of CE in research. Greater investment in CE research is needed to ensure contextual, equitable, and sustainable access to EBPs, such as medications for OUD (MOUD) in communities heavily impacted by the opioid epidemic. A data-driven approach to CE research guided by systems science has the potential to ensure adequate saturation and sustainability of EBPs that could significantly reduce opioid overdose and health inequities across the US.

Highlights • HEALing Communities Study is a parallel-group cluster randomized controlled trial. • Communities That HEAL intervention’s goal is to reduce opioid overdose deaths. • Structured consensus decision-making strategy guided study measure development. • More than 80 study measure specifications and a common data model were developed. • The study will provide methodology and longitudinal community data for research., Background Opioid overdose deaths remain high in the U.S. Despite having effective interventions to prevent overdose deaths, there are numerous barriers that impede their adoption. The primary aim of the HEALing Communities Study (HCS) is to determine the impact of an intervention consisting of community-engaged, data-driven selection, and implementation of an integrated set of evidence-based practices (EBPs) on reducing opioid overdose deaths. Methods The HCS is a four year multi-site, parallel-group, cluster randomized wait-list controlled trial. Communities (n = 67) in Kentucky, Massachusetts, New York and Ohio are randomized to active intervention (Wave 1), which starts the intervention in Year 1 or the wait-list control (Wave 2), which starts the intervention in Year 3. The HCS will test a conceptually driven framework to assist communities in selecting and adopting EBPs with three components: 1) A community engagement strategy with local coalitions to guide and implement the intervention; 2) A compendium of EBPs coupled with technical assistance; and 3) A series of communication campaigns to increase awareness and demand for EBPs and reduce stigma. An implementation science framework guides the intervention and allows for examination of the multilevel contexts that promote or impede adoption and expansion of EBPs. The primary outcome, number of opioid overdose deaths, will be compared between Wave 1 and Wave 2 communities during Year 2 of the intervention for Wave 1. Numerous secondary outcomes will be examined. Discussion The HCS is the largest community-based implementation study in the field of addiction with an ambitious goal of significantly reducing fatal opioid overdoses.

Background There is no established effective treatment for patients with t(1;22)(p13;q13) acute megakaryoblastic leukemia (AMKL) and hepatic fibrosis. Observation Here we report the outcomes of 2 t(1;22)(p13;q13) AMKL patients with hepatic fibrosis. One patient died from liver failure despite the control of leukemia. The other patient was successfully treated with reduced-intensity chemotherapy and antifibrosis therapy with tretinoin and α-tocopheryl acetate, the hepatic fibrosis resolved and leukemia was in remission for 3 years. Conclusions Reduced-intensity chemotherapy plus antifibrosis therapy with tretinoin and α-tocopheryl acetate could be a treatment option for these patients with t(1;22)(p13;q13) AMKL and hepatic fibrosis.

On ‘International NASH Day’, we launch a call for the global health community to collaboratively shape and deliver a comprehensive, long-term public health agenda for NAFLD. A global multidisciplinary coalition is needed to guide our response to this increasingly prevalent, yet underaddressed disease.

Obesity is a complex system problem involving a broad spectrum of policy, social, economic, cultural, environmental, behavioural, and biological factors and the complex interrelated, cross-sector, non-linear, dynamic relationships among them. Systems modelling is an innovative approach with the potential for advancing obesity research. This study examined the applications of systems modelling in obesity research published between 2000 and 2017, examined how the systems models were developed and used in obesity studies and discussed related gaps in current research. We focused on the applications of two main systems modelling approaches: system dynamics modelling and agent-based modelling. The past two decades have seen a growing body of systems modelling in obesity research. The research topics ranged from micro-level to macro-level energy-balance-related behaviours and policies (19 studies), population dynamics (five studies), policy effect simulations (eight studies), environmental (10 studies) and social influences (15 studies) and their effects on obesity rates. Overall, systems analysis in public health research is still in its early stages, with limitations linked to model validity, mixed findings and its actual use in guiding interventions. Challenges in theory and modelling practices need to be addressed to realize the full potential of systems modelling in future obesity research and interventions.

Objective This randomized controlled trial was conducted to determine comparative efficacy of a 12-month community-centered weight management program (MEND2-5 for ages 2-5 or MEND/CATCH6-12 for ages 6-12) against a primary care-centered program (Next Steps) in low-income children. Methods Five hundred forty-nine Hispanic and black children (BMI ≥ 85th percentile), stratified by age groups (2-5, 6-8, and 9-12 years), were randomly assigned to MEND2-5 (27 contact hours)/MEND/CATCH6-12 (121.5 contact hours) or Next Steps (8 contact hours). Primary (BMI value at the 95th percentile [%BMIp95]) and secondary outcomes were measured at baseline, 3 months (Intensive Phase), and 12 months (Transition Phase). Results For age group 6-8, MEND/CATCH6-12 resulted in greater improvement in %BMIp95 than Next Steps during the Intensive Phase. Effect size (95% CI) was −1.94 (−3.88, −0.01) percentage points (P = 0.05). For age group 9-12, effect size was −1.38 (−2.87, 0.16) percentage points for %BMIp95 (P = 0.07). MEND2-5 did not differentially affect %BMIp95. Attendance averaged 52% and 22% during the Intensive and Transition Phases. Intervention compliance was inversely correlated to change in %BMIp95 during the Intensive Phase (P

Maternal obesity and excessive gestational weight gain (GWG) are significant contributors to the global obesity epidemic. However, isolated lifestyle interventions to address this in pregnancy appear to have only modest benefit and responses can be variable. This paper aims to address the question of why the success of lifestyle interventions to prevent excessive GWG is suboptimal and variable. We suggest that there are inherent barriers to lifestyle change within pregnancy as a life stage, including the short window available for habit formation; the choice for women not to prioritise their weight; competing demands including physiological, financial, relationship, and social situations; and lack of self-efficacy among healthcare professionals on this topic. In order to address this problem, we propose that just like all successful public health approaches seeking to change behaviour, individual lifestyle interventions must be provided in the context of a supportive environment that enables, incentivises and rewards healthy changes. Future research should focus on a systems approach that integrates the needs of individuals with the context within which they exist. Borrowing from the social marketing principle of 'audience segmentation', we also need to truly understand the needs of individuals to design appropriately tailored interventions. This approach should also be applied to the preconception period for comprehensive prevention approaches. Additionally, relevant policy needs to reflect the changing evidence-based climate. Interventions in the clinical setting need to be integrally linked to multipronged obesity prevention efforts in the community, so that healthy weight goals are reinforced throughout the system.

The purpose of this study was to develop a qualitative and socioculturally tailored systems model of childhood obesity in the Chinese American community in Manhattan’s Chinatown. We utilized group model building (GMB) methodology as a form of participatory systems modeling. The study was conducted in Manhattan’s Chinatown community. We recruited 16 Chinese American adults from the community. GMB workshops engendered a causal loop diagram (CLD), the visualization of a complex systems model illustrating the structures, feedbacks, and interdependencies among socioculturally specific pathways underlying childhood obesity, in Manhattan’s Chinatown community. The analysis of CLD revealed that participants considered the following factors to influence childhood obesity: (1) traditional social norms affecting body image, how children are raised, parental pressure to study, and trust in health of traditional foods; (2) grandparents’ responsibility for children; (3) limited time availability of parents at home; and (4) a significant amount of children’s time spent indoors. GMB represents a novel method to understand the complexity of childhood obesity in culturally specific populations and contexts. The study identified sociocultural subsystems that may underlie the development and perpetuation of childhood obesity among Chinese American children. Insights from the study can be useful in the design of future empirical studies and interventions.

Preschool children’s interest in popular culture is linked to many determinants of obesity development including branded energy-dense foods and sedentary play using digital technologies. In addition, highly packaged foods and throwaway toys reinforce unsustainable environmental habits encouraged by immersive marketing systems. Interrupting the effects of these systems demands multiple and diverse solutions. Our solution engages early childhood educators in obesity prevention by doing what they do best – pedagogy, curricula and care. Assisting young children to interact with their interests and developing habits like Healthy eating, Active play and environmentally Sustainable practices (HAS) is unique methodology. We believe that building the capacity of educators to co-create HAS curricula using children’s interests has the potential to develop life-long well-being and sustainability habits. HAS curricula aid in young children’s development of agentic decision-making abilities through the transformation of everyday concepts into higher-order mature concepts.

Background and Purpose Elevated serum uric acid (UA) is a risk factor for the development of kidney disease. Inhibitors of xanthine oxidase (XOi), an enzyme involved in UA synthesis, have protective effects at early stages of experimental diabetic nephropathy (DN). However, long-term effects of XOi in models of DN remain to be determined. Experimental Approach The development of albuminuria, renal structure and molecular markers of DN were studied in type 2 diabetic Zucker obese (ZO) rats treated for 18 weeks with the XOi febuxostat and compared with vehicle-treated ZO rats, ZO rats treated with enalapril or a combination of both agents, and lean Zucker rats without metabolic defects. Results Febuxostat normalized serum UA and attenuated the development of albuminuria, renal structural changes, with no significant effects on BP, metabolic control or systemic markers of oxidative stress (OS). Most of these actions were comparable with those of enalapril. Combination treatment induced marked decreases in BP and was more effective in ameliorating structural changes, expression of profibrotic genes and systemic OS than either monotherapy. Febuxostat attenuated renal protein expression of TGF-s, CTGF, collagen 4, mesenchymal markers (FSP1 and vimentin) and a tissue marker of OS nitrotyrosine. Moreover, febuxostat attenuated TGF-s- and S100B-induced increased expression of fibrogenic molecules in renal tubular cells in vitro in UA-free media in an Akt kinase-dependent manner. Conclusions and Implications Febuxostat is protective and enhances the actions of enalapril in experimental DN. Multiple mechanisms might be involved, such as a reduction of UA, renal OS and inhibition of profibrotic signalling.

Key Points Question What is the county-level prevalence of extreme obesity in the United States? Findings In this cross-sectional study of adults in the United States, county-level prevalence of self-reported extreme obesity ranged from 1.3% to 15.7%. Several prominent clusters of high prevalence were identified, including in the Mississippi Delta and the Southeast. Meaning Prevalence of extreme obesity appears to vary considerably by county; heterogeneity is obscured by available state-level prevalence estimates., Importance The prevalence of extreme obesity continues to increase among adults in the US, yet there is an absence of subnational estimates and geographic description of extreme obesity. This shortcoming prevents a thorough understanding of the geographic distribution of extreme obesity, which in turn limits the ability of public health agencies and policy makers to target areas with a known higher prevalence. Objectives To use small-area estimation to create county-level estimates of extreme obesity in the US and apply spatial methods to identify clusters of high and low prevalence. Design, Setting, and Participants A cross-sectional analysis was conducted using multilevel regression and poststratification with data from the 2012 Behavioral Risk Factor Surveillance System and the US Census Bureau to create prevalence estimates of county-level extreme obesity (body mass index ≥40 [calculated as weight in kilograms divided by height in meters squared]). Data were included on adults (aged ≥18 years) living in the contiguous US. Analysis was performed from June 4 to December 28, 2018. Main Outcomes and Measures Multilevel logistic regression models estimated the probability of extreme obesity based on individual-level and area-level characteristics. Census counts were multiplied by these probabilities and summed by county to create county-level prevalence estimates. Moran index values were calculated to assess spatial autocorrelation and identify spatial clusters of hot and cold spots. Estimates of moderate obesity were obtained for comparison. Results Overall, the weighted prevalence of extreme obesity was 4.0% (95% CI, 3.9%-4.1%) and the prevalence of moderate obesity was 23.7% (95% CI, 23.4%-23.9%). County-level prevalence of extreme obesity ranged from 1.3% (95% CI, 1.3%-1.3%) to 15.7% (95% CI, 15.3%-16.0%). The Pearson correlation coefficient comparing model-predicted estimates with direct estimates was 0.81 (P, This cross-sectional study estimates county-level rates of extreme obesity identifies clusters of high and low prevalence within the US.

This study was designed to determine (a) whether the prevalence and odds of either obesity or diabetes differed in foreign-born black Africans and Caribbeans living in New York City (NYC) and (b) whether time in the United States (US) affected odds of either outcome. Data were obtained from NYC Community Health Survey 2009–13 for 380 African-born blacks and 2689 Caribbean-born blacks. Weighted logistic regression estimated odds of obesity and diabetes, adjusting for age, sex, education, income, marital status, children

Foreign-born blacks from sub-Saharan Africa and the Caribbean represent 4.2% and 19% of the foreign-born population in New York City (NYC). As foreign-born blacks are often grouped with African Americans, data on risk of obesity and diabetes (DM) in Africans and Caribbeans in NYC is scant. Our goal was to determine (a) if the prevalence of either obesity or DM differed in African and Caribbean immigrants; and (b) whether duration of stay in the United States (U.S.) affected odds of either outcome. Working with the New York City Community Health Survey 2009-13 data was obtained for 363 blacks born in sub-Saharan Africa (60% male, age 43 ±24y (mean ±SD), BMI 27.1 ±7.8 kg/m2) and 2,539 blacks born in the Caribbean (39% male, age 46 ±23y, BMI 27.9 ±8.5 kg/m2). Weighted logistic regression examined odds of obesity and DM, adjusting for socioeconomic and demographic variables such as age, gender, education, income, marital status, children Prevalence of obesity in Africans was 16.7% and in Caribbeans was 29.7%. The prevalence of DM was 10.5% in Africans and 14.7% in Caribbeans. Africans had significantly lower odds of obesity [OR=0.60 (95% CI 0.40-0.90) P=0.01], but there was no difference in odds of DM between the two groups. Odds of obesity were higher in African [OR=2.35 (95% CI 1.16-4.78) P=0.02] and Caribbean women [OR=2.20 (95% CI 1.63-2.98) P= Overall Africans living in NYC are less obese than Caribbean blacks, but the odds of DM do not differ. This suggests that the association between BMI and DM risk differs in blacks according to region of origin. In short, combining foreign-born blacks into a single category may mask important differences in health status. Disclosure M.F. Horlyck-Romanovsky: None. A.E. Sumner: None. T. Huang: None.

Purpose The purpose of this study was to inform public policy opportunities to reduce childhood obesity by identifying parents' perceptions of factors contributing to childhood obesity, attribution of responsibility, and the extent of their support for public prevention policies with attention to socio-economic status. Design and Methods In 2015, 2066 parent-child dyads across socio-economic strata from 43 randomly selected schools in Ankara completed surveys and measurements to examine perceptions, attribution, and prevention policies related to childhood obesity. Results Parents across the socio-demographic spectrum recognized obesity as a serious problem. Unhealthy food availability was identified as the leading cause of while industry and media were credited with having the greatest responsibility for childhood obesity. There was strong public support for policy strategies targeting schools, marketing, and the built environment, though support tempered as socio-economic status and parental education decreased. Conclusions This survey provided insight into parents' knowledge and beliefs surrounding childhood obesity as well as their endorsement of related prevention strategies. Educational messages that address variations in SES to describe the causes of childhood obesity and connect those causes to actionable community prevention strategies may improve community support for enhanced policy actions within and beyond school settings.

Obesity in our childbearing population has increased to epidemic proportions in developed countries; efforts to address this issue need to focus on prevention. The Health in Preconception, Pregnancy and Postbirth (HIPPP) Collaborative - a group of researchers, practitioners, policymakers and end-users - was formed to take up the challenge to address this issue as a partnership. Application of systems thinking, participatory systems modelling and group model building was used to establish research questions aiming to optimise periconception lifestyle, weight and health. Our goal was to reduce the burden of maternal obesity through systems change.

Computed tomographic (CT) fluoroscopy-guided percutaneous cryoablation is an effective therapeutic method used to treat focal renal masses. The purpose of this study is to quantify the radiation dose to the patient and interventional radiologist during percutaneous cryoablation of renal masses using CT fluoroscopic guidance. Over a 1-year period, the CT fluoroscopy time during percutaneous cryoablation of renal masses was recorded in 41 patients. The level of complexity of each procedure was designated as simple, intermediate, or complex. Patient organ radiation doses were estimated using an anthropomorphic model. Dose to the interventional radiologist was estimated using ion chamber survey meters. The average CT fluoroscopy time for technically simple cases was 47 s, 126 s for intermediate cases, and 264 s for complex cases. The relative risk of hematologic stomach and liver malignancy in patients undergoing this procedure was 1.003–1.074. The lifetime attributable risk of cancer ranged from 2 to 58, with the highest risk in younger patients for developing leukemia. The estimated radiation dose to the interventionalist without lead shielding was 390 mR (3.9 mGy) per year of cases. The radiation risk to the patient during CT fluoroscopy-guided percutaneous renal mass cryoablation is, as expected, related to procedure complexity. Quantification of patient organ radiation dose was estimated using an anthropomorphic model. This information, along with the associated relative risk of malignancy, may assist in evaluating risks of the procedure, particularly in younger patients. The radiation dose to the interventionist is low regardless of procedure complexity, but highlights the importance of lead shielding.

The purpose of this study is to measure the organ doses and effective dose (ED) for parathyroid 4D CT and scintigraphy and to estimate the lifetime attributable risk of cancer incidence associated with imaging.Organ radiation doses for 4D CT and scintigraphy were measured on the basis of imaging with our institution's protocols. An anthropomorphic phantom with metal oxide semiconductor field effect transistor detectors was scanned to measure CT organ dose. Organ doses from the radionuclide were based on International Commission for Radiological Protection report 80. ED was calculated for 4D CT and scintigraphy and was used to estimate the lifetime attributable risk of cancer incidence for patients differing in age and sex with the approach established by the Biologic Effects of Ionizing Radiation VII report. A 55-year-old woman was selected as the standard patient according to the demographics of patients with primary hyperparathyroidism.Organs receiving the highest radiation dose from 4D CT were the thyroid (150.6 mGy) and salivary glands (137.8 mGy). For scintigraphy, the highest organ doses were to the colon (41.5 mGy), gallbladder (39.8 mGy), and kidneys (32.3 mGy). The ED was 28 mSv for 4D CT, compared with 12 mSv for scintigraphy. In the exposed standard patient, the lifetime attributable risk for cancer incidence was 193 cancers/100,000 patients for 4D CT and 68 cancers/100,000 patients for scintigraphy. Given a baseline lifetime incidence of cancer of 46,300 cancers/100,000 patients, imaging results in an increase in lifetime incidence of cancer over baseline of 0.52% for 4D CT and 0.19% for scintigraphy.The ED of 4D CT is more than double that of scintigraphy, but both studies cause negligible increases in lifetime risk of cancer. Clinicians should not allow concern for radiation-induced cancer to influence decisions regarding workup in older patients.

Research is limited on the health of foreign-born Blacks (FBBs), who are often grouped with African Americans. This study compared obesity and diabetes odds in FBBs and US-born Blacks (USBBs) in NYC. Analyzing the 2009–2013 NYC Community Health Survey (3701 FBBs and 6297 USBBs), weighted multivariate logistic regression examined odds of obesity and diabetes, adjusting for age, gender, education, income, marital status, children

Diet is a major determinant of obesity; however, findings from the studies examining how dieting to lose weight affects weight gain have been inconclusive. Our aim was to examine the longitudinal association of frequency of dieting for weight loss with (a) obesity status and (b) body mass index (BMI) change. We used data from Waves 9 (2009) and 10 (2010) of the Household Income and Labour Dynamics in Australia (HILDA) survey. Binominal logistic regression estimated the association of frequency of dieting in 2009 on probability of obesity in 2010. Multinomial logistic regression estimated the association of frequency of dieting in 2009 on the probability of BMI gain versus BMI maintenance and BMI loss between 2009 and 2010. The analysis sample size was 8824. Compared to those who were never on a diet in the previous year, the odds of obesity were 1.9, 2.9, and 3.2 times higher among those who were on a diet once, more than once, and always, respectively. Similarly, the odds of BMI gain versus BMI maintenance and also versus BMI loss were higher among those who dieted than those who did not. Dieting to lose weight can contribute to the risk of future obesity and weight gain. Losing weight requires a commitment to change one’s lifestyle and a sustained effort to maintain a healthy diet and engage in physical activity.

The cancer-associated protein Anterior Gradient 2 (AGR2) has been described, predominantly in adenocarcinomas. Increased levels of extracellular AGR2 (eAGR2) have been correlated with poor prognosis in cancer patients, making it a potential biomarker. Additionally, neutralizing AGR2 antibodies showed preclinical effectiveness in murine cancer models suggesting eAGR2 may be a therapeutic target. We set out to identify a peptide by mRNA display that would serve as a theranostic tool targeting AGR2. This method enables the selection of peptides from a complex (>1011) library and incorporates a protease incubation step that filters the selection for serum stable peptides. We performed six successive rounds of enrichment using a 10-amino acid mRNA display library and identified several AGR2 binding peptides. One of these peptides (H10), demonstrated high affinity binding to AGR2 with a binding constant (KD) of 6.4 nM. We developed an AGR2 ELISA with the H10 peptide as the capture reagent. Our H10-based ELISA detected eAGR2 from cancer cell spent media with a detection limit of (20-50 ng/ml). Furthermore, we investigated the therapeutic utility of H10 and discovered that it inhibited cell viability at IC50 (9-12 μmoles/L) in cancer cell lines. We also determined that 10 μg/ml of H10 was sufficient to inhibit cancer cell migration in breast and prostate cancer cell lines. A control peptide did not show any appreciable activity in these cells. The H10 peptide showed promise as both a novel diagnostic and a potential therapeutic peptide.

Background Childhood obesity rates have been rising rapidly in developing countries. A better understanding of the risk factors and social context is necessary to inform public health interventions and policies. This paper describes the validation of several measurement scales for use in Turkey, which relate to child and parent perceptions of physical activity (PA) and enablers and barriers of physical activity in the home environment. Method The aim of this study was to assess the validity and reliability of several measurement scales in Turkey using a population sample across three socio-economic strata in the Turkish capital, Ankara. Surveys were conducted in Grade 4 children (mean age = 9.7 years for boys; 9.9 years for girls), and their parents, across 6 randomly selected schools, stratified by SES (n = 641 students, 483 parents). Construct validity of the scales was evaluated through exploratory and confirmatory factor analysis. Internal consistency of scales and test-retest reliability were assessed by Cronbach’s alpha and intra-class correlation. Results The scales as a whole were found to have acceptable-to-good model fit statistics (PA Barriers: RMSEA = 0.076, SRMR = 0.0577, AGFI = 0.901; PA Outcome Expectancies: RMSEA = 0.054, SRMR = 0.0545, AGFI = 0.916, and PA Home Environment: RMSEA = 0.038, SRMR = 0.0233, AGFI = 0.976). The PA Barriers subscales showed good internal consistency and poor to fair test-retest reliability (personal α = 0.79, ICC = 0.29, environmental α = 0.73, ICC = 0.59). The PA Outcome Expectancies subscales showed good internal consistency and test-retest reliability (negative α = 0.77, ICC = 0.56; positive α = 0.74, ICC = 0.49). Only the PA Home Environment subscale on support for PA was validated in the final confirmatory model; it showed moderate internal consistency and test-retest reliability (α = 0.61, ICC = 0.48). Discussion This study is the first to validate measures of perceptions of physical activity and the physical activity home environment in Turkey. Our results support the originally hypothesized two-factor structures for Physical Activity Barriers and Physical Activity Outcome Expectancies. However, we found the one-factor rather than two-factor structure for Physical Activity Home Environment had the best model fit. This study provides general support for the use of these scales in Turkey in terms of validity, but test-retest reliability warrants further research.

Author(s): Cunningham, William E; Ford, Chandra L; Kinsler, Janni J; Seiden, Danielle; Andrews, Laral; Nakazono, Terry; Bell, Douglas S | Abstract: BackgroundAlthough antiretroviral therapy (ART) is available to treat HIV+ persons and prevent transmission, ineffective delivery of care may delay ART use, impede viral suppression (VS), and contribute to racial/ethnic disparities along the continuum of care. This study tested the effects of a bi-directional laboratory health information exchange (LHIE) intervention on each of these outcomes.MethodsWe used a quasi-experimental, interrupted time-series design to examine whether the LHIE intervention improved ART use and VS, and reduced racial/ethnic disparities in these outcomes among HIV+ patients (N = 1181) in a comprehensive HIV/AIDS clinic in Southern California. Main outcome measures were ART pharmacy fill and HIV viral load laboratory data extracted from the medical records over 3 years. Race/ethnicity and an indicator for the intervention (after vs. before) were the main predictors. The analysis involved 3-stage, multivariable logistic regression with generalized estimating equations.ResultsOverall, the intervention predicted greater odds of ART use (odds ratio [OR] = 2.50; 95% confidence interval: 2.29 to 2.73; P l 0.001) and VS (OR = 1.12; 95% confidence interval: 1.04 to 1.21; P l 0.05) in the final models that included sociodemographic, behavioral, and clinical covariates. Before the intervention, there were significant black/white disparities in ART use OR = 0.75 (0.58-0.98; P = 0.04) and VS OR = 0.75 (0.61-0.92; P = 0.001). After the intervention, the black/white disparities decreased after adjusting for sociodemographics and the number of HIV care visits, and Latinos had greater odds than whites of ART use and VS, adjusting for covariates.ConclusionsThe intervention improved overall ART treatment and VS, and reduced black/white disparities. LHIE interventions may hold promise if implemented among similar patients.

Among low- and middle-income nations, the highest prevalence of child overweight and associated metabolic disorders has been found in Middle Eastern and Eastern European countries. Obesity has been on the rise in Turkey and past research has shown regional variations among adults. However, the prevalence of childhood obesity in different socioeconomic groups in the largest metropolitan areas in the country has not been reported.This study aimed to investigate the prevalence of child obesity with a population-representative, SES-stratified random sample with objective measures of body mass index (BMI) in the capital city of Turkey.Weight status was measured by the WHO growth curve and analyzed by socioeconomic status (SES), sex, and parental factors in a population-representative sample of 2066 parent-child dyads. Chi-square and logistic regression were conducted.Rates of overweight and obesity were 21.2% and 14.6% (35.8% combined) but significantly higher in high (24.5% and 18.9%) vs. low SES (20.1% and 13.8%) (P = 0.02). Boys were at higher risk for obesity than girls, especially in high vs. low SES (Odds Ratio [OR] = 3.0 [95% CI: 1.4-6.5] vs. 1.7 [95% CI: 1.2-2.5]). Having both parents being overweight or obese increased the risk for obesity, particularly in medium and high SES (OR = 5.8 [95% CI: 2.3-14.1]) and 6.3 (95% CI: 1.5-26.2).Higher maternal education was a risk factor in low-to-medium but not high SES. In Ankara, child overweight and obesity appears to be 1.5 times more prevalent than national estimates. Higher SES may signify greater exposure to an obesogenic environment and greater obesity risk.معدل انتشار سمنة الأطفال والعوامل المتعلقة بالأبوين في أنقرة، تركيا.محمود يارديم، هلال أوزسيبي، أوزجور أراز ، سارب أونر ، شينج لي، هانده أونلو، أوموت أرسلان، نظمي بيلير، تيري هوانج.من بين الأمم منخفضة ومتوسطة الدخل، وُجِدَ معدل الانتشار المرتفع لزيادة وزن الأطفال واضطرابات التمثيل الغذائي ذات الصلة بها في بلدان شرق المتوسط وأوروبا الشرقية. وشَهِدَ معدل السمنة زيادة في تركيا، حيث أوضحت البحوث السابقة تفاوتات إقليمية بين البالغين. ومع ذلك، لم يتم الإبلاغ عن معدل انتشار سمنة الأطفال في الفئات الاجتماعية الاقتصادية المختلفة في أكبر المناطق الحضرية بالبلد.هدفت هذه الدراسة إلى بحث معدل انتشار سمنة الأطفال في عينة عشوائية مَُثِّلة للسكان ومقسمة إلى شرائح حسب الوضع الاجتماعي والاقتصادي، وذلك باستخدام مقاييس موضوعية لمنسب كتلة الجسم في عاصمة تركيا.تم قياس حالة الوزن باستخدام منحنى النمو الخاص بمنظمة الصحة العالمية، وتحليلها حسب الوضع الاجتماعي والاقتصاد ي ونوع الجنس والعوامل المتعلقة بالأبوين في عينة مَُثِّلة للسكان تضم 2066 من ثنائيات الآباء–الأطفال. وأُجري اختبار مربع كاي والارتباط المنطقي.بلغت معدلات زيادة الوزن والسمنة 21.2% و 14.6% (إجمالاً 35.8%)، ولكن كانت أعلى بكثير في الوضع الاجتماعي والاقتصادي المرتفع (24.5% و 18.9%) مقابل الوضع الاجتماعي والاقتصادي المنخفض (20.1% و 13.8%) (0.02 = P). وكان الفتيان (الذكور) معرضين لخطر الإصابة بالسمنة بشكل أكبر من الفتيات في الوضع الاجتماعي والاقتصادي المرتفع مقابل الوضع الاجتماعي والاقتصادي المنخفض (6.5 – 1.4 = CI% 95 ؛ 3.0 = OR) مقابل (2.5 – 1.2 = CI % 95 ؛ 1.7 = OR). وأدت زيادة الوزن أو السمنة لدى الأبوين إلى تزايد خطر الإصابة بالسمنة، لا سيّما في الوضع الاجتماعي والاقتصادي المتوسط والمرتفع (26.2 – 1.5 = CI % 95 ؛ 6.3 = OR).يعد عدم حصول الأمهات على التعليم العالي أحد عوامل الخطر في الوضع الاجتماعي والاقتصادي المنخفض إلى المتوسط، ولكن ليس في الوضع الاجتماعي والاقتصادي المرتفع. وفي أنقرة، يبدو أن زيادة الوزن والسمنة لدى الأطفال أكثر انتشارًا بمرة ونصف مقارنة بالتقديرات الوطنية. وقد يشير الوضع الاجتماعي والاقتصادي المرتفع إلى تعرض أكبر لبيئة مسببة للسمنة ووجود خطر أكبر للإصابة بالسمنة.Prévalence de l’obésité de l’enfant et facteurs parentaux associés à travers les strates socio-économiques à Ankara (Turquie).Parmi les pays à revenu faible et intermédiaire, c’est dans les pays du Moyen-Orient et de l’Europe de l’est que la plus haute prévalence du surpoids chez l’enfant et de troubles métaboliques associés a été observée. L’obésité est en augmentation en Turquie et les travaux de recherche menés dans le passé ont montré des variations régionales parmi les adultes. Cependant, la prévalence de l’obésité de l’enfant dans différents groupes socio-économiques dans les plus grandes zones métropolitaines du pays n’a pas fait l’objet de rapports.La présente étude avait pour objectif d’étudier la prévalence de l’obésité de l’enfant dans un échantillon de population représentatif aléatoire stratifié sur le statut socio-économique, et à l’aide de mesures objectives de l’indice de masse corporelle (IMC) dans la capitale turque.Le statut pondéral a été mesuré à l’aide la courbe de croissance de l’OMS et analysé en fonction du statut socio-économique, du sexe, et de facteurs parentaux dans un échantillon de population représentatif de 2066 dyades parent-enfant. Le test du khi-carré et la régression logistique ont été utilisés.Les taux de surpoids et d’obésité étaient de 21,2 % et 14,6 % (35,8 % combinés), et étaient significativement plus élevés parmi les statuts socio-économiques élevés (24, 5 % et 18,9 %) et les statuts socio-économiques inférieurs (20,1 % et 13,8 %) (p = 0,02). Les garçons étaient exposés à un risque plus élevé d’obésité que les filles, notamment ceux bénéficiant d’un statut socio-économique plus élevé (Odds ratio [OR] = 3,0 [IC à 95 % : 1.4-6,5] contre 1,7 [IC à 95 % : 1,2-2,5]). Le fait d’avoir les deux parents en surpoids ou obèses augmentait le risque d’obésité, particulièrement pour ceux ayant un statut socio-économique intermédiaire et élevé (OR= 5,8 [IC à 95 % : 2,3-14,1] et 6,3 [IC à 95 % : 1,5-26,2]).Un niveau d’éducation maternel plus élevé était un facteur de risque dans les cas de statut socio-économique faible à intermédiaire, mais pas dans les cas de statut socio-économique élevé. À Ankara, le surpoids et l’obésité de l’enfant semblent être 1,5 fois plus fréquents que les estimations nationales, et un statut socio-économique élevé peut signifier une plus grande exposition à un environnement obésogène et un risque accru d’obésité.

Lipoprotein lipase (LPL) is a candidate gene for obesity based on its role in triglyceride hydrolysis and the partitioning of fatty acids towards storage or oxidation. Whether dietary fatty acids modify LPL associated obesity risk is unknown.We examined five single nucleotide polymorphisms (SNPs) (rs320, rs2083637, rs17411031, rs13702, rs2197089) for potential interaction with dietary fatty acids for obesity traits in 1171 participants (333 men and 838 women, aged 45-75 y) of the Boston Puerto Rican Health Study (BPRHS). In women, SNP rs320 interacted with dietary polyunsaturated fatty acids (PUFA) for body mass index (BMI) (P = 0.002) and waist circumference (WC) (P = 0.001) respectively. Higher intake of PUFA was associated with lower BMI and WC in homozygotes of the major allele (TT) (P = 0.01 and 0.005) but not in minor allele carriers (TG and GG). These interactions were replicated in an independent population, African American women of the Atherosclerosis Risk in Communities (ARIC) study (n = 1334).Dietary PUFA modulated the association of LPL rs320 with obesity traits in two independent populations. These interactions may be relevant to the dietary management of obesity, particularly in women.

Interest in the application of systems science (SS) to obesity and noncommunicable chronic disease (NCD) research has been growing rapidly over the past decade as the epidemic of obesity and NCDs continues to grow globally. This article summarizes the key messages of the presentations made in the special symposium “Applications of Complex Systems Science in Obesity and Noncommunicable Chronic Disease Research,” held during the ASN Scientific Sessions and Annual Meeting at Experimental Biology 2014. Invited leaders from various fields presented cutting-edge aspects of the applications of SS in public health research, with a focus on obesity and NCDs. In addition, the symposium was capped with a discussion on funding opportunities from the NIH. The speakers described the nature of SS, how it could be applied to biomedical and public health research, lessons from SS to inform obesity and NCD interventions, and the promises, challenges, and recommendations going forward.

Objective The aim of this research was to assess the association of prolonged financial stress (FS) with subsequent obesity. Design and Methods Data were from Waves 8 (2008), 9 (2009), and 10 (2010) of Household Income and Labor Dynamics in Australia (HILDA) survey. The outcome was obesity measured in 2010. Prolonged FS was defined as having experienced FS in both 2008 and 2009. FS was measured in each year using seven questionnaire items. Analyses adjusted for health, physical activity, income, education, baseline obesity, and other covariates. Results Prolonged FS was a strong predictor of subsequent obesity. The adjusted risk of being obese in 2010 were 20% higher (RR: 1.20; 95% CI: 1.10-1.30) among individuals who experienced FS in both 2008 and 2009 than those who did not experience FS in either year. The association of FS with obesity was independent of income and constant across income categories. Conclusions Obesity prevention research should pay more attention to FS as an important dimension of economic deprivation, a concept that is distinct from common indicators of socioeconomic status such as income. Future research can examine the effect of financial education and counseling programs that help individuals with such skills as money management, budgeting, and saving on a reduction in FS and obesity.

Improving the design of the built environment to promote health and well-being is an emerging priority within public health, particularly as a component f efforts to address the ongoing epidemic of childhood besity. Research suggests that environmental design at multiple spatial scales, ranging from regional land use and transportation planning, to accessibility of public transit, to building characteristics such as stair placement, and even the design of food trays in contexts such as school cafeterias, can influence dietary choices and physical activity. Moreover, because the built environment is amenable to change, the environmental design process provides a tangible mechanism for influencing health-related social norms at a population level. This advantage is critical, given growing consensus that individual-level interventions will not be sufficient to reverse the growth in the prevalence of childhood obesity.

Type 2 diabetes is a significant and increasing burden in adolescents and young adults. Clear strategies for research, prevention, and treatment of the disease in these vulnerable patients are needed. Evidence suggests that type 2 diabetes in children is different not only from type 1 but also from type 2 diabetes in adults. Understanding the unique pathophysiology of type 2 diabetes in youth, as well as the risk of complications and the psychosocial impact, will enable industry, academia, funding agencies, advocacy groups, and regulators to collectively evaluate both current and future research, treatment, and prevention approaches. This Consensus Report characterizes type 2 diabetes in children, evaluates the fundamental differences between childhood and adult disease, describes the current therapeutic options, and discusses challenges to and approaches for developing new treatments.

Preventing and managing youth-onset type 2 diabetes are a major challenge. This paper reviews the evidence of lifestyle and drug therapies in improving glucose, insulin, and insulin sensitivity. Forty-four interventions were analyzed, of which 11 were drug (mainly metformin) interventions combined with lifestyle while the remainder used lifestyle strategies only. Fewer than a dozen out of 44 interventions reported significant improvements in glucose-related outcomes. Metformin in addition to lifestyle therapy did not necessarily enhance intervention effects. The overall lack of findings can be partially attributed to the heterogeneity of study populations, the lack of intervention intensity, under-powered study design, and the challenging lives of at-risk populations. New treatment options in both drugs and lifestyle strategies are direly needed.

Childhood obesity is a global health issue. To identify research trends and gaps of childhood obesity research, we reviewed MEDLINE publications from January 2011 to May 2012 and qualitatively analyzed the major domains and themes of research focus. Major domains are: measurements, obesity correlates, prevention interventions, treatment interventions, and policy issues. Key advances and innovations are highlighted within each domain. Emerging areas include the advancement of measurement methodologies that simultaneously capture individual and contextual information across time, analysis of policy problems, and the development of multilevel, community interventions. However, few effective and sustainable interventions are exemplified; some strategies are promising. Recommendations for future research includes the adoption of a systems approach that integrates individual, environmental, and policy change, the scale up and diffusion of innovations, studies of intended and unintended policy impacts, and the design and testing of effective social marketing strategies.

Male gender is a risk factor for progression of polycystic kidney disease (PKD). 17β-Estradiol (E2) protects experimentally, but clinical use is limited by adverse effects. Novel E2 metabolites provide many benefits of E2 without stimulating the estrogen receptor, and thus may be safer. We hypothesized that E2 metabolites are protective in a model of PKD. Studies were performed in male control Han:SPRD rats, and in cystic males treated with orchiectomy, 2-methoxyestradiol, 2-hydroxyestradiol (2-OHE), or vehicle, from age 3 to 12 wk. Cystic rats exhibited renal functional impairment (∼50% decrease in glomerular filtration and renal plasma flow rates, P < 0.05) and substantial cyst development (20.5 ± 2.0% of cortex area). 2-OHE was the most effective in limiting cysts (6.0 ± 0.7% of cortex area, P < 0.05 vs. vehicle-treated cystic rats) and preserving function, in association with suppression of proliferation, apoptosis, and angiogenesis markers. Downregulation of p21 expression and increased expression of Akt, the mammalian target of rapamycin (mTOR), and some of its downstream effectors were significantly reversed by 2-OHE. Thus, 2-OHE limits disease progression in a cystic rodent model. Mechanisms include reduced renal cell proliferation, apoptosis, and angiogenesis. These effects may be mediated, at least in part, by preservation of p21 and suppression of Akt and mTOR. Estradiol metabolites may represent a novel, safe intervention to slow progression of PKD.

This article proposes a systems-based framework to examine 3 structural dimensions of childhood obesity interventions that can impact intervention sustainability, scalability, and reach. These 3 dimensions are the locus of intervention drivers (top-down vs. bottom-up), the locus of change effected (policy vs. individual behavior), and the public versus private sector. Interventions focused on individual behavior change often rely on bottom-up approaches and have generally been less sustainable than policy interventions. However, top-down (government or industry) support can lead to better funding and shifts in social norms. In the public sector, top-down efforts targeting individual behavior are generally also more scalable and have wider reach to diverse communities. In the private sector, behavior-change interventions tend to have greater resources and are sustained over longer periods, even when efficacy is in question; they may also be quite scalable. In a systems approach, a combination of approaches...

IL28B genetic polymorphism is related to interferon-sensitivity in chronic hepatitis C, but the significance of grafts carrying different genotypes from recipients is still unclear in liver transplantation. A 51-year-old Japanese male carrying a minor genotype underwent dual liver transplantation for liver cirrhosis due to hepatitis C virus (HCV). The left lobe graft carried a major genotype, and the right a minor genotype. He achieved virological response during the course of pegylated-interferon and ribavirin therapy against recurrent hepatitis C for 2 years, but HCV relapsed immediately at the end of the therapy. Two years after antiviral therapy, liver biopsy was performed from each graft. The specimens showed A1F0 in the left lobe graft and A2F2 in the right. Moreover, quantitative polymerase chain reaction was performed using RNA extracted from each specimen to see there was no HCV RNA in the left lobe whereas there was in the right. This case provides clear evidence that IL28B genetic variants determine interferon sensitivity in recurrent hepatitis C following liver transplantation, which could result in new strategies for donor selection or for posttransplant antiviral therapy to HCV positive recipients.

Nonalcoholic steatohepatitis (NASH) is considered the hepatic manifestation of metabolic syndrome (MetS) among adults. Emerging data suggest that MetS may be associated with nonalcoholic fatty liver disease (NAFLD) in children as well. We sought to determine whether MetS or its component features are associated with specific histological features or severity of NAFLD.Children and adolescents aged 6-17 years enrolled in the Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN) with clinical data obtained within 6 months of liver biopsy were included. MetS was defined as the presence of three or more of the following features as determined by application of age-adjusted normative values: central obesity, dyslipidemia, impaired fasting glucose, and elevated blood pressure. Liver biopsies were evaluated by the Pathology Committee of the NASH CRN.Two hundred fifty four children were included in the analysis, of whom 65 (26%) met specified criteria for MetS. Among children with MetS, there is a higher proportion of females who were on average older in age and pubertal. The risk of MetS was greatest among those with severe steatosis (odds ratio (OR)=2.58 for grade 3 vs. grade 1 steatosis, P=0.001). The presence of hepatocellular ballooning was also significantly associated with MetS (OR=2.10, P=0.03). Those with advanced fibrosis (stage 3/4) had an OR for MetS of 3.21 (P=0.04) vs. those without fibrosis (stage 0). Borderline zone 1 or definite NASH patterns compared with "not NASH" were strongly associated with MetS (OR=4.44, P=0.005 and OR=4.07, P=0.002, respectively). The mean NAFLD Activity Score (NAS) was greater among children with MetS vs. those without (4.8 +/- 1.4 vs. 4.3 +/- 1.4, P=0.01). Central obesity was significantly associated with steatosis, fibrosis, hepatocellular ballooning, and NAFLD pattern. Insulin resistance was significantly associated with steatosis, fibrosis, hepatocellular ballooning, NAS, and NAFLD pattern.MetS is common among children with NAFLD and is associated with severity of steatosis, hepatocellular ballooning, NAS, NAFLD pattern, and the presence of advanced fibrosis. Individual MetS features, particularly central obesity and insulin resistance, were also associated with severity of NAFLD. MetS features should be considered in children with NAFLD as individually and collectively they help identify children with more advanced disease.

To intraindividually compare a low-tube-voltage (80 kVp), high-tube-current (675 mA) computed tomographic (CT) technique with a high-tube-voltage (140 kVp) CT protocol for the detection of pancreatic tumors, image quality, and radiation dose during the pancreatic parenchymal phase.This prospective, single-center, HIPAA-compliant study was approved by the institutional review board, and written informed consent was obtained. Twenty-seven patients (nine men, 18 women; mean age, 64 years) with 23 solitary pancreatic tumors underwent dual-energy CT. Two imaging protocols were used: 140 kVp and 385 mA (protocol A) and 80 kVp and 675 mA (protocol B). For both protocols, the following variables were compared during the pancreatic parenchymal phase: contrast enhancement for the aorta, the pancreas, and the portal vein; pancreas-to-tumor contrast-to-noise ratio (CNR); noise; and effective dose. Two blinded, independent readers qualitatively scored the two data sets for tumor detection and image quality. Random-effect analysis of variance tests were used to compare differences between the two protocols.Compared with protocol A, protocol B yielded significantly higher contrast enhancement for the aorta (508.6 HU vs 221.5 HU, respectively), pancreas (151.2 HU vs 67.0 HU), and portal vein (189.7 HU vs 87.3 HU), along with a greater pancreas-to-tumor CNR (8.1 vs 5.9) (P.001 for all comparisons). No statistically significant difference in tumor detection was observed between the two protocols. Although standard deviation of image noise increased with protocol B (11.5 HU vs 18.6 HU), this protocol significantly reduced the effective dose (from 18.5 to 5.1 mSv; P.001).A low-tube-voltage, high-tube-current CT technique has the potential to improve the enhancement of the pancreas and peripancreatic vasculature, improve tumor conspicuity, and reduce patient radiation dose during the pancreatic parenchymal phase.

Aim: The aim of this study was to determine the associations of telomere length to markers of obesity, insulin resistance and inflammation in Saudi children. Methods: A total of 69 boys and 79 girls, aged 5-12 years, participated in this cross-sectional study. Anthropometrics were measured. Serum glucose and lipid profile were measured using routine laboratory methods. Serum insulin, leptin, adiponectin, resistin, tumour necrosis factor-alpha and active plasminogen activator inhibitor 1 were quantified using customized multiplex assay kits. C-reactive protein and angiotensin II were quantified using ELISA. Leucocyte telomere length was examined by quantitative real time PCR utilizing IQ cycler. Results: Mean telomere length was significantly shorter in obese boys compared with their lean counterparts (p = 0.049), not in girls. It was not associated to insulin resistance, adipocytokines and markers of inflammation. In girls, the significant predictor of telomere length was waist circumference, explaining 24% of variance (p = 0.041) while in boys, systolic blood pressure explained 84% of the variance (p = 0.01). Conclusion: Childhood obesity in boys corresponds to shorter leucocyte telomere length which is not evident in girls. The association of leucocyte telomere length to blood pressure and waist circumference in children suggests clinical implications as to the contribution of these parameters in premature ageing.

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the United States. The association between NAFLD and quality of life (QOL) remains unclear. These data are important to estimate the burden of illness in NAFLD. The aim was to report QOL scores of adults with NAFLD and examine the association between NAFLD severity and QOL. QOL data were collected from adults with NAFLD enrolled in the Nonalcoholic Steatohepatitis Clinical Research Network using the Short Form 36 (SF-36) survey, and scores were compared with normative U.S. population scores. Liver biopsy histology was reviewed by a central pathology committee. A total of 713 subjects with NAFLD (male = 269, female = 444) were included. Mean age of subjects was 48.3 years; 61% had definite nonalcoholic steatohepatitis (NASH), and 28% had bridging fibrosis or cirrhosis. Diabetes was present in 27% of subjects. Subjects with NAFLD had worse physical (mean, 45.2) and mental health scores (mean, 47.6) compared with the U.S. population with (mean, 50) and without (physical, 55.8; mental, 52.5) chronic illness. Subjects with NASH reported lower physical health compared with subjects with fatty liver disease without NASH (44.5 versus 47.1, P = 0.02). Subjects with cirrhosis had significantly (P < 0.001) poorer physical health scores (38.4) than subjects with no (47.6), mild (46.2), moderate (44.6), or bridging fibrosis (44.6). Cirrhosis was associated with poorer physical health after adjusting for potential confounders. Mental health scores did not differ between participants with and without NASH or by degree of fibrosis. Conclusion: Adults with NAFLD have a significant decrement in QOL. Treatment of NAFLD should incorporate strategies to improve QOL, especially physical health. (HEPATOLOGY 2009.)

The purpose of this study was to assess whether radiation dose savings using a lower peak kilovoltage (kVp) setting, bismuth breast shields, and automatic tube current modulation could be achieved while preserving the image quality of MDCT scans obtained to assess for pulmonary embolus (PE).CT angiography (CTA) examinations were performed to assess for the presence or absence of pulmonary artery emboli using a 64-MDCT scanner with automatic tube current modulation (noise level=10 HU), two kVp settings (120 and 140 kVp), and bismuth breast shields. Absorbed organ doses were measured using anthropomorphic phantoms and metal oxide semiconductor field effect transistor (MOSFET) detectors. Image quality was assessed quantitatively as well as qualitatively in various anatomic sites of the thorax.Using a lower kVp (120 vs 140 kVp) and automatic tube current modulation resulted in a dose savings of 27% to the breast and 47% to the lungs. The use of a lower kVp (120 kVp), automatic tube current modulation, and bismuth shields placed directly on the anterior chest wall reduced absorbed breast and lung doses by 55% and 45%, respectively. Qualitative assessment of the images showed no change in image quality of the lungs and mediastinum when using a lower kVp, bismuth shields, or both.The use of bismuth breast shields together with a lower kVp and automatic tube current modulation will reduce the absorbed radiation dose to the breast and lungs without degradation of image quality to the organs of the thorax for CTA detection of PE.