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BACKGROUND:: There is a continuing need to examine the relationship between diet quality and health in the population. The Healthy Eating Index (HEI) has been developed as a composite measure of diet quality by the US Department of Agriculture. OBJECTIVES:: The first objective was to use the HEI to assess the diet quality of a representative sample of the US population and population groups. The second objective was to examine the association between HEI and obesity. DESIGN:: Cross-sectional analysis of data from 10?930 adults who participated in the Third National Health and Nutrition Examination Survey. Sociodemographic, physical activity, dietary, and health data were used in the analysis. Diet quality was assessed with the HEI score, ranging from 0 to 100, based on 10 dietary criteria. A low HEI score indicates poor diet. RESULTS:: A majority of survey participants had a low HEI score. The percentage of individuals classified as having a poor diet varied by age, gender, race/ethnicity, income, and education. A low HEI score was associated with overweight and obesity. There was a graded increase in the odds ratio of obesity across the HEI category after adjusting for age, gender, race/ethnicity, physical activity, smoking, alcohol use, income, and education. CONCLUSIONS:: An index of diet quality, such as HEI, may provide a comprehensive assessment of diet in the population. Since the HEI is based on the US Dietary Guidelines, the use of these guidelines as a way to improve health should be emphasized. However, the overall effectiveness of these guidelines in disease prevention needs to be studied further. SPONSORSHIP:: None.European Journal of Clinical Nutrition (2004) 58, 1580-1586. doi:10.1038/sj.ejcn.1601989 Published online 19 May 2004 [ABSTRACT FROM AUTHOR]

Objective: In addition to slowing diabetes development among participants in the Diabetes Prevention Program (DPP), intensive lifestyle change and metformin raised HDL-cholesterol (HDL-C) compared to placebo treatment. We investigated the lifestyle and metabolic determinants as well as effects of biomarkers of inflammation, endothelial dysfunction and coagulation and their changes resulting from lifestyle and metformin interventions on the increase in HDL-C in the DPP., Methods: The effects of a 1year period of intensive lifestyle change aimed at achieving 7% weight loss or metformin 850mg twice daily versus placebo on HDL-C were assessed in 3070 participants with impaired glucose tolerance, and on HDL particle concentration (HDL-P) and size in a subgroup of 1645 individuals. Treatment-associated changes in lifestyle and metabolic factors as well as in novel biomarkers were investigated for their associations with change in HDL-C using multiple regression analysis., Results: After adjusting for BMI, insulin resistance, glycemia, dietary saturated fat, alcohol intake, physical activity and nine different biomarkers, only adiponectin accounted for the effect of intensive lifestyle change on HDL-C via an increase in large HDL-P. By contrast baseline and change in BMI and tissue plasminogen activator levels attenuated the effect of metformin on HDL-C, with adiponectin having no specific effect., Conclusion: While both lifestyle and metformin interventions used to prevent diabetes increase HDL-C, the mechanisms involved differ between the two treatments and may have consequences for future risk of cardiovascular disease., Competing Interests: none, (Copyright © 2016. Published by Elsevier Inc.)

MK-0493 is a novel, potent, and selective agonist of the melanocortin receptor 4 (MC4R), one of the best-validated genetic targets and considered one of the most promising for the development of antiobesity therapeutics. An ad libitum energy-intake model was qualified with excellent reproducibility: the geometric mean ratio (GMR) with 95% confidence interval (CI) for total energy intake over a period of 24 h for 30 mg sibutramine/placebo was 0.82 (0.76, 0.88), and for 10 mg sibutramine/placebo it was 0.98 (0.91, 1.05). MK-0493 showed a small and marginally significant effect on 24-h energy intake, whereas 30 mg of sibutramine caused a significant reduction in total 24-h energy intake; specifically, the GMR (95% CI) for 30 mg sibutramine/placebo was 0.79 (0.74, 0.85). MK-0493 was associated with modest weight reduction from baseline but had only small, statistically insignificant effects relative to placebo after 12 weeks in a fixed-dose study and also after 18 weeks of stepped-titration dosing. We conclude that agonism of MC4R is not likely to represent a viable approach to the development of antiobesity therapeutics.

Objective: The Look AHEAD (Action for Health in Diabetes) study is a 16-centre randomised clinical trial in overweight and obese individuals with type 2 diabetes, designed to evaluate the long-term effects (up to 11.5 years) of intensive weight loss intervention on the time to incidence of major cardiovascular events., Research Design and Methods: Eligibility requirements are diagnosis of type 2 diabetes (determined by self-report and verification) in individuals aged 4574 years and body mass index (BMI) > 25 kg/m2 (> 27 kg/m2 if currently taking insulin). The intensive lifestyle intervention is designed to achieve and maintain weight loss through decreased caloric intake and increased physical activity. The study is designed to provide 90% probability of detecting an 18% difference in major cardiovascular disease event rates in patients randomised to the intensive lifestyle intervention compared to the control group receiving standard diabetes support and education., Results: The 5,145 participants who were randomised between 2001 and 2004 were 63.3% white, 15.6% African-American, 13.2% Hispanic, 5.0% American Indian and 1.0% Asian-American, which closely paralleled the ethnic distribution of diabetes in the National Health and Nutrition Examination Survey (NHANES) 1999-2000 survey. Their average age at entry was 59+/-6.8 years (mean+/-SD), and 60% were women. There were 31.5% between 4555 years of age, 51.5% were 5665, and 17.0% were 6676 years of age. Some 15.4% of participants were taking insulin at the time of randomisation and 14.0% had a history of cardiovascular disease. More men (21.3%) than women (9.2%) had a history of cardiovascular disease. Few participants (4.4%) were current cigarette smokers, compared to 16.2% in the NHANES 1999-2000 survey. Furthermore, 65.0% of participants had a first-degree relative with diabetes. Overall, BMI averaged 36+/-5.9 kg/m2 at baseline, with 83.6% of the men and 86.1% of women having a BMI > 30 kg/m2 and 17.9% of men and 25.4% of women having a BMI > 40 kg/m2., Conclusions: The Look AHEAD study has successfully randomised a large cohort of participants who have type 2 diabetes with a wide distribution of age, obesity, ethnicity and racial background and will examine the effects of lifestyle intervention on the incidence of major cardiovascular events.

Objective: To examine the obesity-related chronic diseases in the US adult population according to gender, race and socioeconomic status., Methods: Data from the 1994-1996 Continuing Survey of Food Intakes by Individuals (1994-1996 CSFII) conducted by the US Department of Agriculture/Agricultural Research Service (USDA/ARS) were used in the analysis. Relevant data included self-reported weight and height, self-reported physician-diagnosed diabetes mellitus, hypertension, heart disease and high serum cholesterol. Analysis was conducted according to gender, race, income level and education level., Results: There was a graded increase in diabetes, hypertension and high serum cholesterol with increasing body weight in nearly all gender, racial and socioeconomic groups. Among the obese individuals, the prevalence of hypertension was higher in black subjects and the prevalence of diabetes, hypertension and heart disease was higher in individuals with lower education compared to their counterparts. The odds of having diabetes, hypertension, heart disease and high serum cholesterol increased with increasing body weight after adjusting for age, gender, race, income, education and smoking., Conclusion: Although cross-sectional in nature, our results suggest that the disease burden associated with obesity in the population may be substantial. This burden increases with increasing severity of obesity. Our findings support the current opinion that, although the nature of obesity-related health risks is similar in all populations, the specific level of risk associated with a given level of obesity may be different depending on gender, race and socioeconomic condition.

Underwater weighing has been the gold standard for the measurement of body composition in humans; however, the two formulas widely used, the Siri and Bronze, were developed using young adult white males. The development of newer techniques in the past 20 years has greatly expanded the accuracy and ease of measuring body composition. These methods have improved the ability to model relationships between body compartments. This article reviews the compartmental models and then critiques the methods available to measure body composition.

In 224 twin pairs (132 monozygotic, 86 dizygotic, and 6 of uncertain zygosity) in whom the index twin had developed IDDM before 30 yr of age, 51 of the co-twins (38 monozygotic, 10 dizygotic, and 3 of uncertain zygosity) subsequently became diabetic. On the basis of concordance ratios, which were significantly discrepant (P < 0.01) between monozygotic and dizygotic twins, the substantial genetic role in IDDM etiology is confirmed. For the monozygotic co-twin of an IDDM case, the relative risk is significantly related to an early age at proband diagnosis (P < 0.01 for 0-4 vs. 5-9 yr of age). However, among monozygotic co-twins at any age, IDDM risk decreases as time passes after the proband diagnosis (P < 0.01 for 0-23 vs. > or = 24 mo after a proband diagnosis at 5-9 yr of age). Moreover, a structural-equation analysis suggests a profound contribution to liability (as much as 79%) from the twins' shared environment. Risk to like-sex male dizygotic co-twins is as high as that to monozygotic co-twins, significantly higher than that to like-sex female dizygotic co-twins (P < 0.005), and even higher than that to male co-twins in unlike-sex dizygotic pairs (P < 0.05). Overall, the risk to the dizygotic co-twin of a case is significantly higher (P < 0.001) than that to a non-twin sibling, as reported in the literature. The observed male excess is consistent with reported patterns of IDDM in experimental animals, and in certain circumstances in humans. Taken together, these observations suggest an important early acquired determinant of IDDM, independent of genetic determinants. On the basis of Kaplan-Meier IDDM-free survival curves, if the proband is diagnosed before 15 yr of age, the long-term risk to the co-twin is estimated at 44% (monozygotic) and 19% (dizygotic); it reaches 65% for the co-twin of a monozygotic proband diagnosed before 5 yr of age. An IDDM discordant period of no more than 3 yr was observed in 60% of the pairs destined to become concordant, offering a very brief window for intervention following the recognition of high risk.

This is only a partial overview of some of the activities within DHEW related to nutrition, with a particular focus on the Nutrition Coordinating Committee. Although the activities are already broad, they will expand as we identify additional problems and decide on appropriate solutions. Let me call on the members of The American Dietetic Association to assist us in our efforts to assign priorities to our activity. My discussion began with nutrition education, because this is a priority for both The American Dietetic Association and DHEW. We would welcome your help now and in the future as we attempt to make our programs in nutrition education and information more effective, more available, and more responsive to the needs of the American people. Nutrition in the Humphrey tradition is alive and well in DHEW.

In this paper I have defined obesity and indicated its prevalence, as well as its risks. Body fat and its relation to other body components can be quantitated in many ways. From a practical point of view, the use of body mass or Quetelet index, defined as the ratio of weight (kg) divided by the square of the height (m2) is the most useful. Overweight is defined as a BMI of 25 to 30 kg/m2 and obesity as a BMI above 30 kg/m2. The WHR can provide additional information about the risk of obesity. Using BMI, the prevalence of overweight in the English-speaking countries of Australia, Great Britain, and the United States is almost identical at 24% of women and 31 to 34% of men. In the obese category, there are more Americans (12%) than in the other two countries (6-8%). There is a U-shaped relationship between weight and risk of death. When body weight is increased 20% above average, the extra mortality rises to 20% for men and 10% for women. This extra mortality is associated with an increased death rate from heart disease, hypertension, diabetes mellitus, digestive diseases, and cancer. In addition to an increased risk of death, overweight individuals demand more from their heart, lungs, and musculoskeletal and digestive systems.