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Background and Aim: Acute alcohol withdrawal causes changes in hepatic blood flow and metabolism that may result in liver damage. This study aims to assess liver function tests and markers of hepatic fibrogenesis following alcohol withdrawal in alcoholics with clinically compensated liver disease., Methods: Serial liver function tests and clinical assessments were performed on 22 male alcoholics during alcohol withdrawal. Plasma tissue inhibitor of metalloproteinase 1 (TIMP1), an inhibitor of collagen degradation, and plasma amino-terminal procollagen III peptide (PIIINP), a collagen precursor molecule, were measured in these alcoholics and in 11 control subjects., Results: Transaminase levels did not change significantly over 7 days when all subjects were analyzed together. However, 32% of subjects showed a marked transaminase rise. These subjects did not differ from the others in baseline characteristics or short-term outcome, but had a greater benzodiazepine requirement. Only one subject consumed paracetamol (acetaminophen; 1-2 g/day). He had the largest transaminase rise. By comparing PIIINP assays, intact PIIINP concentration appears to increase following alcohol withdrawal. The TIMP1 levels were elevated in alcoholic subjects, but did not change following withdrawal., Conclusions: Increasing PIIINP suggests that hepatic fibrogenesis increases, or hepatic clearance falls, during acute alcohol withdrawal. The TIMP1 elevation in these alcoholics suggests that the inhibition of collagen degradation occurs while liver disease is still compensated. The period following alcohol withdrawal may be a time of marked increased susceptibility to paracetamol. The biochemical changes we observed were not associated with adverse short-term outcome, but the cumulative effect after repeated episodes of abrupt withdrawal may be of concern.

Background: Alcohol has been an integral part of the diets of many cultures for thousands of years, and formed the basis of early antiseptics. However, many health professionals have been loath to recommend its moderate consumption. Fears of increased risks of cancers, strokes and coronary heart disease (CHD), as well as its role in accidents, violence, psychological and social decline (when consumed in excess) meant that alcohol was viewed as generally detrimental to health. Recent reports have examined some of these fears and suggest that the moderate consumption of alcoholic beverages, particularly red wine, may actually protect against the development of CHD. Evidence for the influence of alcoholic drinks on strokes and cancer is less clear., Objectives: This review discusses the chemical differences between red wine and other alcoholic beverages and their possible effects on the development of CHD, stroke and cancer., Data Synthesis and Conclusions: Both clinical and experimental evidence suggest that red wine does indeed offer a greater protection to health than other alcoholic beverages. This protection has been attributed to grape-derived antioxidant polyphenolic compounds found particularly in red wine.

Tea is rich in antioxidant polyphenols (catechins, flavonols, theaflavins and thearubigins). Epidemiological evidence relating regular consumption of tea or related polyphenols to CHD is equivocal. Catechins are absorbed from tea, but low plasma concentrations are attained. The bioavailability of theaflavins and thearubigins is unknown. Tea does not reduce blood pressure or plasma lipids in well-controlled human trials. Tea polyphenols inhibit LDL lipid peroxidation in vitro, but the effect ex vivo is small. The plasma antioxidant potential increases after drinking green but not black tea. Tea consumption tended to reduce the development of aortic atherosclerosis in rabbits. Tea polyphenols exert marked effects on cells, and inhibit neutrophil migration and inflammatory responses, sometimes at low concentrations. These diverging results suggest potential beneficial effects, but emphasize the need for good human trials of tea using early markers of CHD before firm conclusions can be drawn.

Objective: To assess whether waist circumference at the first antenatal visit predicts risk of developing hypertension later in pregnancy., Methods: Pregnant women with singleton pregnancies (n = 1142, median age 29 years, interquartile range 25-32 years, 387 primigravidas) were recruited at their first antenatal visits. Using standardized methods, midwives determined the weights, heights (for calculation of body mass index [BMI]), and waist circumferences of all women. Eighty-two women developed pregnancy-induced hypertension, and 21 developed preeclampsia (hypertension with proteinuria)., Results: The median waist circumference between 6 and 16 weeks' gestation was 79 cm (interquartile range 72-84 cm), and there was no significant relationship between waist circumference and gestational age. Greater waist circumference was noted in subjects who subsequently developed pregnancy-induced hypertension (median 81 versus 77 cm, Mann-Whitney U test, P =.002) or preeclampsia (median 80 versus 77 cm, P =.02). The conventional, nonpregnant waist circumference action level of 80 cm gave a Mantel-Haenszel odds ratio (OR) for pregnancy-induced hypertension of 1.8 (95% confidence interval [CI] 1.1, 2.9) and for preeclampsia of 2.7 (95% CI 1.1, 6.8), compared with waists of less than 80 cm. Body mass index values were higher in women who developed pregnancy-induced hypertension (median 26 versus 24, P =.001) or preeclampsia (median 26 versus 24, P =.02). The conventional action limit for a BMI of 25 had an OR for pregnancy-induced hypertension of 2.0 (95% CI 1.2, 3.4) and for preeclampsia of 1.9 (95% CI 0.7, 4.8). Results were similar when the analysis was restricted to data from primigravidas., Conclusion: We conclude that waist circumference up to 16 weeks' gestation can predict pregnancy-induced hypertension and preeclampsia. Therefore, waist circumference could form the basis for health promotion involving raising awareness of the importance of or urging weight reduction for women planning pregnancies.

Obesity is a progressive disease of unwanted fat accumulation which has multiple, organ-specific pathological consequences. The manifestations of obesity occur within virtually every subspecialty of medicine or surgery and they interact importantly to accelerate the ageing process in many organs. Many of the hazards of obesity have multiple causes (e.g., diabetes, heart disease, stroke, colonic and breast cancer, urinary incontinence, tiredness, back pain, breathlessness). All of these conditions become more prevalent with age and are also more prevalent among overweight persons, particularly those with a central fat distribution marked by a high waist circumference. Hypertension may be caused or aggravated by weight gain. It is mediated by the physical demands of an expanded circulating volume and increased metabolic rate by metabolic mechanisms related to central fat distribution and the "metabolic syndrome", and to increased sodium consumption by overweight people (because they need more food to maintain a higher metabolic rate). Since body mass index (BMI) and waist circumference increase significantly with age there is an escalation of the burden of ill health from obesity with age. The best simple indicator of disease risk with obesity is the waist circumference since this identifies people who have a high body fat content and also those who have an increased intraabdominal accumulation of fat. The quantitative burden of ill health from overweight and obesity varies within different specialties, but up to 80% of type 2 diabetes or polycystic ovarian syndrome can be attributed to obesity. Obesity is the cause of sleep apnea syndrome in around 50% of cases and heart disease in perhaps 10-20% of cases. In Scotland 80% of people with existing cardiovascular disease are overweight compared with 57% of the general population. The financial burden to health services from overweight and obesity has been incompletely assessed, although it is estimated that around 4% of total health care budgets are attributable to people having BMI > 25 kg/m(2). This is similar to the entire cost of diabetes, epilepsy or major cancers. Obesity is therefore an extremely expensive disease based on these conservative estimates from limited evaluations. More general assessments show how obesity increases the amount of time taken off work, the number of drugs prescribed and the expenditure from social services support. Thus, obesity represents a huge burden not only on the individual patient physically, psychologically, socially and financially but also on families and careers and is a huge drain on health care resources. Overweight affects well over half of all adults worldwide, progressing to BMI > 30 kg/m(2) in around 20% outside subsistence rural communities. Its rapidly increasing prevalence now described as an epidemic demands major preventive measures, as well as better medical treatment for individuals affected.

Aims: To survey dietitians involved in diabetes care regarding the provisions for patients with diabetes., Methods: A national survey of 512 dietitians known to be engaged in provision of diabetes care was conducted in 1997 and 391 (76%) responded., Results: Nationally the median provision of dietetic care for diabetes reported was 10.7 h per 100,000 general population per week, but the provision was uneven ranging from 2.0 to 27.6 h per 100,000. Eighty-five per cent of dietitians worked in areas where the provision was less than 22 h per 100,000 general population per week (the current recommended minimum standard). Dietetic provision was greater in secondary care (median 9.1 h per 100,000 general population per week) than in general practice, residential homes and other locations (median 4.4 h per 100,000 general population per week). Provision was greater in those areas in which a designated dietitian had responsibility for co-ordinating the dietetic service for diabetes than in areas where the co-ordinator was not a dietitian or where there was no co-ordinator. Over 90% of dietitians reported following British Diabetic Association (BDA) recommendations regarding advice on carbohydrate, sugar, fat and fibre consumption, but only one-third routinely advised on salt restriction. Of the 17% of dietitians who continue to use carbohydrate exchanges, all combine this method with other approaches. Of the recommendations made by the Clinical Standards Group, only 69% of dietitians reported seeing more than half of newly diagnosed adult patients within four weeks, and less than 50% reported offering half or more of their patients an annual review. Amongst the literature in current use, 98% of dietitians use BDA literature for teaching patients and 90% use BDA publications in their own education. Seventy-six per cent of dietitians believed that there was a role for commercial slimming organizations in weight management of people with diabetes., Conclusions: Given the proven value of dietetic input in diabetes management, there would be advantages to correcting the regional inequalities in dietetic provision for diabetes care in the UK.

The rapidly rising prevalence of obesity, worldwide, has prompted re-evaluations of the definitions and diagnostic criteria, and of the extent of the burden it contributes to health care services. Although categorized arbitrarily for epidemiological purposes according to BMI > 25 kg/m2 ('overweight') and BMI > 30 kg/m2 ('obese'), the disease itself (ICD code E.66) is the process of excess fat accumulation. It leads to multiple organ-specific pathological consequences, particularly if there is a tendency to intra-abdominal fat accumulation. The simplest field method to identify obesity and risk of medical problems is the waist circumference, and this method has found a special role in health promotion. Risks begin with waist > 80 cm (women) or > 94 cm (men). As a broad generalization, obesity produces few symptoms below the age of 40 years, but then several symptoms often develop; tiredness, breathlessness, back pain, arthritis, sweatiness, poor sleeping, depression and menstrual disorders all being common. The symptoms are often attributed to diseases in other body systems. Metabolic diseases like diabetes, hyperlipidaemia and, hypertension develop later, but the mean BMI at diagnosis of diabetes is 28 kg/m2. Ultimately, obesity increases the likelihood of myocardial infarction, stroke and several major cancers, but its biggest impact on health, especially in the elderly, is probably the multiplicity of effects on other body systems. The greatest challenge for public health is to develop effective preventive measures, recognizing that BMI > 25 kg/m2 before the age of 20 years is a very strong predictor of obesity and ill health in adulthood.

The flavonol contents of 20 varieties of tomato fruit were investigated in relation to variety, size, season, and country of origin. Ten commonly consumed tomato-based food products were also assessed. Free and conjugated flavonols were identified and quantified using reversed-phase HPLC. Ninety-eight percent of flavonols detected in tomatoes were found to occur in the skin. Tomatoes contained, primarily as conjugates, quercetin and kaempferol. The main quercetin conjugate was identified as rutin (quercetin 3-rhamnosylglucoside) by LC-MS. The total flavonol content of the different varieties of tomato that were analyzed varied from 1.3 to 22.2 microgram/g of fresh weight (fw). Smaller cherry tomato fruits originating from warm sunny climates, such as Spain and Israel, were found to contain the highest concentration of flavonols. Among the tomato-based products investigated, tomato juice and tomato purée were rich in flavonols, containing 14-16 microgram/mL and 70 microgram/g fw, respectively. In contrast to fresh tomatoes, most tomato-based products contained significant amounts of free flavonols.

Recent changes to the health services have led to an increased provision of clinical care in family planning clinics. While some women may only require contraceptive services, others may demand advice on a breadth of lifestyle issues, including diet and nutrition. Obesity affects 17% of women of childbearing age in Scotland and being overweight during pregnancy has significant health risks. A postal survey of 227 nurses identified as working in family planning clinics in Scotland was conducted in 1998. After a mail shot and one reminder, a net response rate of 64% (n = 145) was achieved. Overall, it was found that obesity was perceived as the most extensive problem in women of childbearing age. Seventy nurses (48%) reported that, in addition to offering family planning services, they gave dietary advice 'frequently' or 'always' to their clients without being asked. There were differences in nutrition-related activities in consultations between nurses offering family planning services only and those who routinely offered nutritional advice. Over half (61%) of the nurses reported that they would give advice regarding weight management even if the patients were not seeking help, although there was no significant difference between the two comparison groups. In some cases, the nutritional advice offered to clients highlighted a deficit in training. Most nutrition education came from diploma and/or training courses and scientific literature, followed by 'experience'. Those nurses already embracing a nutritional advice and guidance role were more interested in further nutrition training (p = 0.018) than the other nurses. However, overall, 67% of the nurses wished to train further in nutrition and weight management. The findings suggest that family planning nurses should be supported to develop nutritional advice and guidance skills, and that there is a pressing need for training in public health nutrition and weight management for nurses working in family planning services.

Any intervention which causes negative energy balance is guaranteed to be efficacious in producing weight loss, which will continue while there is negative energy balance or be maintained as long as the new energy balance is maintained. In clinical practice compliance is rarely 100% so the efficiency of even the most efficacious treatment is usually low. However, recent evidence-based guidelines have recognized the clinical benefits of moderate (5-10%) weight loss, which is achievable using a variety of interventions. Long-term studies of 'weight loss' are, in reality, combinations of weight loss (usually completed in 1-6 months) followed by variable weight maintenance, set in the context of progressive adult weight gain in an obesogenic environment. Few studies have adopted specific and separate strategies for weight loss and weight maintenance. Meta-analyses conducted by non-expert methodologists have failed to recognize these distinctions, and have criticized the available research without understanding the different needs of studies with weight change as the outcome variable, which require randomized controlled trials (RCT), and those with weight loss as the treatment, intended to improve metabolic or biomedical outcome measures. An RCT design is inapplicable to studies of biomedical end points (e.g. cardiac risk factors) when weight loss is the treatment. Because fixed weight loss cannot be prescribed there is always a range of weight changes in any study, and single-sample studies with regression analysis provide the best design. An RCT study design does not give useful information about clinical value as the control group is always 'treated' to some extent. Placebo- (or control)-subtracted differences are misleading because in an RCT all subjects recruited to active treatment, including non-responders, are continued on treatment for the full duration of the study. In routine clinical practice, treatments are changed in the light of early experience as a therapeutic trial to optimize the results for each individual, and audit is required to evaluate 'long term weight loss'.

Objective: To assess the efficacy and tolerability of orlistat (Xenical) in producing and maintaining weight loss over a 12-month period., Design: Patients were randomized to double-blind treatment with either orlistat 120 mg or placebo three times daily, in conjunction with a low-energy diet, for 12 months., Setting: Five centres in the UK., Subjects: 228 obese adult patients with body mass index between 30 and 43 kg/m2 and mean weight 97 kg (range 74-144 kg)., Interventions: All patients were prescribed a low-energy diet, providing 30% of energy from fat, designed to produce an individually tailored energy deficit of approximately 600 kcal/day, for a run-in period of 4 weeks and then 12 months, plus orlistat 120 mg or placebo three times daily., Main Outcome Measures: Change in body weight (the primary efficacy parameter), waist circumference and adverse events were reviewed regularly, together with serum lipids, insulin, glucose and plasma levels of fat-soluble vitamins and beta carotene., Results: Based on an intent-to-treat analysis, after 1 y of treatment patients receiving orlistat had lost an average of 8.5% of their initial body weight compared with 5.4% for placebo-treated patients; 35% of the orlistat group lost at least 5% of body weight compared with 21% of the placebo group (P < 0.05), and 28% and 17%, respectively (P = 0.04) lost at least 10% of body weight. Orlistat-treated patients showed significant decreases (P < 0.05) in serum levels of total cholesterol, low density lipoprotein cholesterol, and in the low density lipoprotein: high density lipoprotein ratio in comparison with placebo. Both groups had similar adverse-event profiles, except for gastrointestinal events, which were 26% more frequent in the orlistat group but were mostly mild and transient. To maintain normal plasma levels of fat-soluble vitamins, supplements of vitamins A, D and E were given to 1.8%, 8.0% and 3.6%, respectively, of orlistat-treated patients, compared with 0.9% of placebo-treated patients for each vitamin type. After 1 y, the decrease in vitamin E and beta carotene was significantly greater in orlistat-treated patients compared with those receiving placebo (P < 0.001). No significant change was found in the mean vitamin E:total cholesterol ratio in either group after 52 weeks., Conclusions: Orlistat, in conjunction with a low-energy diet, produced greater and more frequent significant weight loss than placebo during 1 y of treatment. One-third of orlistat-treated patients achieved clinically relevant weight loss (> or = 5% initial body weight). There was also an improvement in relevant serum lipid parameters. Fat-soluble vitamin supplements may be required during chronic therapy. Orlistat was well tolerated and offers a promising new approach to the long-term management of obesity.

Objectives: to predict flavonols content of the habitual diets of free-living subjects from urine and plasma concentrations of flavonols., Design: Ten type 2 diabetic patients (five male, five female), mean age 60 (s.e.m. 7) y and BMI 30.2 (s.e.m. 3.5) kg/m2 were treated in a random crossover design for a 2 week period on either a low flavonoid diet or on the same diet supplemented at one of two high flavonols levels (total 77.3 or 110.4 mg/day) provided by supplements of 1500 ml tea daily and 400 g fried white onion in olive oil with and without tomato ketchup and herbs., Setting: Glasgow Royal Infirmary, University of Glasgow, Scotland., Main Outcome Measures: Fasting plasma concentration, urine concentration and 24 h excretion of quercetin, isorhamnetin, kaempferol and myricetin., Results: Plasma flavonol concentration (r=0.750, P=0.001), 24 h urine concentration (r=0.847, P=0.001) and 24 h urine excretion (r=0.728, P=<0.001) were all highly significantly related to dietary intake and gave similar estimates of intakes. Fasting plasma flavonols concentrations on habitual diets ranged from 0 to 43.7 ng/ml mean. Regression equations were constricted: total flavonols intake r=0.74, P<0.001 and quercetin intake r=0.744, P<0. 001. From these equations, flavonol intakes from habitual diets were estimated at 17-50, mean 35 mg/day. Of this, 91% was from quercetin., Conclusions: Dietary flavonols are absorbed and appear in plasma and urine as potential biomarkers in concentrations related quantitatively to intake. Estimation of dietary intake from plasma or urine concentrations appears possible., Sponsorship: Rank Prize Funds and Rank Foundation of the Department of Human Nutrition; Ministry of Health and Medical Education, IR Iran. European Journal of Clinical Nutrition (2000) 54, 143-149

The relationship among antioxidant activity, based on the electron-spin resonance determination of the reduction of Fremy's radical, vasodilation activity, and phenolic content was investigated in 16 red wines. The wines were selected to provide a range of origins, grape varieties, and vinification methods. Sensitive and selective HPLC methods were used for the analysis of the major phenolics in red wine: free and conjugated myricetin, quercetin, kaempferol, and isorhamnetin; (+)-catechin, (-)-epicatechin, gallic acid, p-coumaric acid, caffeic acid, caftaric acid, trans-resveratrol, cis-resveratrol, and trans-resveratrol glucoside. Total anthocyanins were measured using a colorimetric assay. The total phenolic content of the wines was determined according to the Folin-Ciocalteu colorimetric assay and also by the cumulative measurements obtained by HPLC. The 16 wines exhibited a wide range in the values of all parameters investigated. However, the total phenol contents, measured both by HPLC and colorimetrically, correlated very strongly with the antioxidant activity and vasodilation activity. In addition, the antioxidant activity was associated with gallic acid, total resveratrol, and total catechin. In contrast, only the total anthocyanins were correlated with vasodilation activity. The results demonstrate that the different phenolic profiles of wines can produce varying antioxidant and vasodilatant activities, which opens up the possibility that some red wines may provide enhanced health benefits for the consumer.

We assessed the prevalence, methods for recognition and clinical management of malnutrition in acute admissions in a large academic inner-city hospital. Of a total of 337 patients, it was possible to measure both height and weight in 219 patients (65% of admissions). As an alternative for bed-bound patients, mid-upper arm circumference was not very reliable in predicting BMI (sensitivity 98%; specificity 65%), and waist circumference even less so. Of these, 13% were malnourished (body mass index BMI <18.5 kg/m(2) or BMI 18.5-20 kg/m(2) with reported weight loss >3 kg in the last 3 months). Six patients (31% of those with BMI <18.5 kg/m(2)) and one with BMI 18.5-20 kg/m(2) were recognized as suffering from malnutrition and referred to the dietitian. Review of case records could not establish if the diagnosis was missed in the remainder, or if a conscious decision was taken not to manage malnutrition actively. Malnutrition in acute hospital admissions goes apparently unrecognized and unmanaged in 70% of cases. Since there are serious consequences, and effective simple treatment is readily available, increased awareness is required, with routine assessment of nutritional status in all patients.

A model to explain interpersonal trust development, and its consequences for co-operative behaviour in doctor/patient partnerships derived from the context of business relationships is applied to patient/physician relationships. Threshold barriers exist against all human behaviours or actions and trust is the process by which barriers to co-operation and compliance are overcome. Dispositional trust (a psychological trait to be trusting) is dominant in the early stages of a relationship and contributes to the weight of subsequent trust development. Co-operative behaviour or compliance ultimately requires a secure situational trust emerging from consultations, which is carried forward as learnt trust and modified in each subsequent consultation. The model comprises three types of situational trust (calculus-based, knowledge-based, and identification trust) and five co-operation criteria from which to determine an individual's tendency for co- operative behaviour. These model components can be identified and mapped from a range of qualitative data, with the aim of enhancing co-operative behaviour and efficiently achieving optimal patient compliance.

Flavonols are polyphenolic secondary plant metabolites that are present in varying levels in commonly consumed fruits, vegetables and beverages. Flavonols have long held an interest for nutritionists, which has increased following a Dutch study in the early 1990's showing that dietary intake of flavonols was inversely correlated with the incidence of coronary heart disease. The main factors that have hindered workers in the field of flavonol research are (i) the accurate measurement of these compounds in foods and biological samples, and (ii) a dearth of information on their absorption and metabolism. This review aims to highlight the work of the authors in attempting to clarify the situation. The sensitive and selective HPLC procedure to identify and quantify common flavonols and their sugar conjugates is described. In addition, the results of an on-going screening program into the flavonol content of common produce and beverages are presented. The bioavailability of dietary flavonols is discussed with reference to an intervention study with onions, as well as pilot studies with tea, red wine and cherry tomatoes. It is concluded that flavonols are absorbable and accumulate in plasma and that consuming high flavonol-containing varieties of fruits and vegetables and particular types of beverages could increase their circulatory levels.

Objective: A novel system for nutrient analysis has been developed and tested over 5 years. Its key features are a nutrient database of 600 commonly eaten foods (95% of foods eaten in 7-day surveys); a booklet identifying each food with a bar code, bar codes for gram weight and for portion sizes (small, medium, large) and a bar-code reader with dietary analysis software for PCs. In the present study the bar-code system has been evaluated by comparison with a commonly used manual entry nutrient analysis software for dietitians' use., Design: Cross-sectional., Setting: Glasgow city district., Subjects: One hundred and sixty adults aged 18-65 years old., Results: Comparing mean intakes for macro- and micronutrients, using the Bland and Altman method, the bias between the two methods was small, ranging from 0.93 to 1.03. The bar-code system took significantly less professional time in data entry and nutrient analysis than the widely used manual system (29min per 7-day diary vs. 47 min per 7-day diary, P < 0.001)., Conclusions: It is suggested that the bar-code system offers greater speed with a saving of professional time needed for nutrient analysis of dietary surveys. This system is commended for maintaining accuracy while promoting economy.

Background: Sibutramine, an inhibitor of serotonin and noradrenaline uptake, reduces appetite to cause weight loss. This study tested the hypothesis that an increase in energy expenditure also contributes to this weight loss. In addition, the effects of sibutramine on adrenaline induced changes in heart rate and cardiac output were determined, Methods: Nineteen obese females randomly received either sibutramine 15 mg daily or placebo for 12 weeks along with dietary advice. Resting energy expenditure (REE) was measured and then energy expenditure was measured during a 30 min infusion of adrenaline (25 ng/min/kg IBW). Cardiac output and heart rate, measured by Duplex Colour Doppler ultrasonography, were similarly measured in the basal state and post adrenaline. All measurements were recorded at baseline and then after 12 weeks., Results: Ten patients who received sibutramine reduced their weight by 8.1+/-3.8% while 9 placebo treated subjects reduced their weight by 5.1+/-4.4%, P=0.13. In absolute terms, REE decreased in placebo subjects from 1500+/-201 kcal/24 h to 1357+/-231 kcal/24 h (9.4+/-9.9%) and in sibutramine subjects from 1540+/-184 kcal/24 h to 1444+/-128 kcal/24 h (5.3+/-12.0%), P=0.77. The increased weight loss in the sibutramine group was associated with an increase in the FFM adjusted REE (2.2+/-16.1%) unlike the expected decrease (5.8+/-9.5%) in the placebo group (P=0.11). There was some suggestion (P=0.09) that the usual positive correlation between loss of weight and decline in REE was lost in the sibutramine group (r=-0.30) compared with placebo (r=0.35). There was a negative correlation between loss of FFM and decline in REE/kg FFM and (P=0.029) which was not evident in placebo (P=0.83). Adrenaline induced energy expenditure was similar in the two groups at the end of the 12 week period and there were no significant cardiovascular changes between the two groups., Conclusions: Sibutramine limits the decline in REE associated with weight loss, equivalent to about 100 kcal/d. This could allow greater numbers of people to maintain a greater degree of weight loss.

The prevalence of obesity has doubled in the last 10 years and is now reaching epidemic proportions. There is a significant comorbidity and financial cost associated with this disorder. Orlistat is an intestinal lipase inhibitor that is approved for the treatment of obesity. Recent randomized, double-blind, placebo-controlled trials have demonstrated the benefit of orlistat used in conjunction with a hypocaloric (low-fat) diet in facilitating weight reduction and the long-term maintenance of this weight loss. Patients treated with orlistat lost a greater amount of initial body weight compared to those who received placebo. After 24 months of treatment, weight loss of more than 5% was maintained in a greater number of those treated with orlistat. This was associated with significant reductions in cardiovascular risk factors (cholesterol, LDL cholesterol, LDL:HDL cholesterol ratio). The main adverse events are related to fat malabsorption, with potential losses of fat-soluble vitamins and other compounds. Orlistat as a treatment for obesity, when prescribed within present guidelines, can aid modest weight loss in about one-third of patients. More importantly, it can assist in the maintenance of weight loss with major medical benefits for these patients.

Objective: To test the hypothesis that overweight and central fat distribution make people look older and have poorer health., Design: We asked 201 male and 161 female observers aged 28-67 y with body mass index (BMI) 17-45 kg/m2, to estimate the age of eight silhouette photographs of female volunteers with known BMI and waist and hips. Silhouette photographs were presented individually and grouped in three trios for analysis: trio A, each subject had waist to hip ratio = 0.7, BMI for each subject was 22, 24, 29 kg/m2; trio B, each subject had BMI = 22 kg/m2, waist to hip ratio for each subject was 0.66, 0.73, 0.99; and trio C, each subject had BMI = 29 kg/m2, waist to hip ratio for each subject was 0.76, 0.88, 0.99. The observers were then asked to judge the likelihood of developing heart disease, health and longevity of the silhouettes which were presented in four pairs controlling either for BMI or waist to hip ratio., Results: The age of a silhouette with BMI 22 kg/m2 was estimated to be 35 y, 24 kg/m2 to be 45 y, and 30 kg/m2 to be 55 y, when waist to hip ratio was matched at 0.7. When BMI was controlled at either 22 or 29 kg/m2, higher waist to hip ratio led to a greater age estimation. An increase from a 65 cm to 88 cm waist circumference led to an estimate of 25 y older. Narrow hips was also judged as older. The silhouettes judged the more likely to be healthy and live longer were those with the lower waist to hip ratio (by 70% observers), and the lower BMI (by 90% observers). Waist to hip ratio appeared less influential when BMI of the silhouettes was high. The observers' own BMI, age or sex had little influences on their assessments of the age and health status of the silhouette photographs., Conclusions: Using novel sets of silhouette photographs, it was shown that overweight or central fat distribution and narrow hips suggest a person is older and has poorer health: People with BMI 29.7 kg/m2 appear to be 15-18 y older than those with BMI 22.2 kg/m2, each extra cm on the waist makes women appear to look a year older, and progressively less healthy. BMI and age of the observers had little influences on the findings.

Objective: To describe the types and delivery of obesity treatment currently favoured by General Practitioners (GPs) working in Scotland., Design: Representative cross-sectional survey using a postal questionnaire which included case stories as stimuli for questions about the GPs' nutrition guidance to overweight female patients., Subjects: A systematic sample of 1400 general practitioners (GPs) from a total of 3593 GPs working in Scotland in 1997., Results: From 1363 eligible GPs, 609 returned the full questionnaire and a further 132 took part in a telephone mini-interview. Net response was 54.4% (741/1363). Almost half of the GPs (45.6%) reported that they had read the recent national clinical guideline for integrating obesity prevention with weight management (SIGN 1996). The majority of GPs (89.6%) agreed that nutrition has an important role to play in the management of disease and 82.4% agreed that they can offer healthy eating advice to patients. However, only 34.8% of GPs believed that they had been successful in treating overweight patients. Routinely used treatments involve either a dietitian, practice nurse and/or a commercial slimming group and realistic weight loss was considered one criteria of successful treatment by some GPs. Age, year qualified and location of practice were found to have little influence over variations in GP treatment while weak associations between gender of GP and treatment were found., Conclusions: The readership of the clinical guidelines in Scotland has been moderate so far although a multidisciplinary approach to obesity treatment is recognised. Further investigations of any relationships between nutrition education-obesity treatment are needed.

Background: Estimating total burdens of disease associated with overweight and obesity has been hampered by a lack of consistent published data using standardized body mass index (BMI or Quetelet index [calculated as weight in kilograms divided by the square of the height in meters: weight (kg)/[height x (m)2]]) diagnostic criteria, and by poorly standardized reference populations., Subjects and Methods: Symptoms of respiratory insufficiency, low back pain, non-insulin-dependent diabetes mellitus, cardiovascular risk factors, and physical functioning using SF-36 questionnaire were determined in a cross-sectional representative survey of 5887 men and 7018 women aged 20 to 59 years from the Netherlands and analyzed using BMI criteria of the National Institutes of Health and the World Health Organization guidelines., Results: The prevalences of cardiovascular risks were higher in men than women, but the other health outcomes were more frequent in women. Virtually all health outcomes considered were significantly influenced by BMI. A BMI of 25 to 30 kg/m2 had a generally greater impact on odds ratios for health outcomes in women than in men. People with BMI below 25 kg/m2 were considered the reference group, with low prevalence of symptoms of obesity-related diseases and good quality of life. Between 25 to 30 kg/m2, the prevalences of these were all increased, and above 30 kg/m2 greatly increased. After adjustments for age and lifestyle factors, odds ratios (95% confidence intervals [95% CI]) in those with a BMI of 30 kg/m2 or higher were 3.5 (95% CI, 2.8-4.4) in men and 3.3 (95% CI, 2.8-3.9) in women for shortness of breath when walking upstairs, 4.6 (95% CI, 2.4-8.8) in men and 5.4 (95% CI, 2.8-10.5) in women for non-insulin-dependent diabetes mellitus, 5.5 (95% CI, 4.5-6.6) in men and 2.9 (95% CI, 2.4-3.4) in women for having at least 1 major cardiovascular risk factor. Both men and women with BMI of 30 kg/m2 or higher were twice as likely to have difficulties in performing a range of basic daily physical activities. Compared with women with BMI lower than 25 kg/m2, those with BMI of 30 kg/m2 or higher were 1.5 times more likely to have symptoms of intervertebral disk herniation. Significantly more overweight women had problems associated with low back pain, including hindrance to their daily business, absence from work, and medical consultation., Conclusions: Health risks for a range of problems are presented using the standard BMI cutoff points. Overweight and obesity are associated with increased risks of chronic diseases, secondary symptoms, and impairment of quality of life.

Objective: To examine the effects of a thiazolidinedione (600 mg troglitazone) insulin-sensitizing treatment on total body fat measured by underwater weighing, on intra- and extra-abdominal fat mass using magnetic resonance imaging (MRI), and on anthropometric measures., Research Design and Methods: Type 2 diabetic outpatients were studied in a double-blind randomized trial carried out at Glasgow Royal Infirmary, Scotland., Results: Groups who received troglitazone (8 men, 3 women) and placebo (8 men, 2 women) were well matched for age, BMI, total body fat percentage by underwater weighing, and intra-abdominal fat (kilograms) by MRI. After 12 weeks, body weight changes in the troglitazone group (mean +0.66 kg [95% CI -0.71 to 2.04], P = 0.31) and the placebo group (mean +0.25 kg [-0.64 to 1.13], P = 0.55) were not statistically different. Changes in total body fat with troglitazone (mean +1.02% body wt [-1.13 to 3.17], P = 0.32) and placebo (mean -0.54% body wt [-1.68 to 0.59], P = 0.31) were not significantly different. There was, however, a decrease in intra-abdominal fat mass in the troglitazone-treated group (mean -0.47 kg [-0.79 to -0.13], P = 0.01), and this was significantly different (P = 0.03) from placebo treatment (mean -0.41 kg [-0.77 to -0.05])., Conclusions: Treatment with the thiazolidinedione troglitazone in human patients with type 2 diabetes decreases intra-abdominal fat mass but does not affect total body fat or weight. This potentially valuable effect points to a differential action on insulin sensitivity in different adipose tissue depots.

Diabetic patients have reduced antioxidant defenses and suffer from an increased risk of free radical-mediated diseases such as coronary heart disease. Epidemiological evidence has suggested that antioxidant dietary flavonoids may protect against heart disease, but a biological effect has yet to be demonstrated directly in humans. In this study, 10 stable type 2 diabetic patients were treated for 2 weeks on a low-flavonol diet and for 2 weeks on the same diet supplemented with 76-110 mg of flavonols (mostly quercetin) provided by 400 g of onions (and tomato sauce) and six cups of tea daily. Freshly collected lymphocytes were subjected to standard oxidative challenge with hydrogen peroxide, and DNA damage was measured by single-cell gel electrophoresis. Fasting plasma flavonol concentrations (measured by high-performance liquid chromatography) were 5.6 +/- 2.9 ng/ml on the low-flavonol diet and increased 12-fold to 72.1 +/- 15.8 ng/ml on the high-flavonol diet (P < 0.001). Oxidative damage to lymphocyte DNA was 220 +/- 12 on an arbitrary scale of 0-400 U on the low-flavonol diet and 192 +/- 14 on the high-flavonol diet (P = 0.037). This decrease was not accounted for by any change in the measurements of diabetic control (fasting plasma glucose or fructosamine) or by any change in the plasma levels of known antioxidants, including vitamin C, carotenoids, alpha-tocopherol, urate, albumin, and bilirubin. In conclusion, we have shown a biological effect of potential medical importance that appears to be associated with the absorption of dietary flavonols.

Objectives: This study quantified the impairment of quality of life attributable to body fatness by using the standardized SF-36 Health Survey., Methods: Tertiles of waist circumference and body mass index (BMI) in 1885 men and 2156 women aged 20 to 59 years in the Netherlands in 1995 were compared., Results: The odds ratios and 95% confidence intervals of subjects with the largest waist circumferences, compared with those in the lowest tertile, were 1.8 (1.3, 2.4) in men and 2.2 (1.7, 2.9) in women with difficulties in bending, kneeling, or stooping; 2.2 (1.4, 3.7) in men and 1.7 (1.2, 2.6) in women with difficulties in walking 500 m; and 1.3 (1.0, 1.9) in men and 1.5 (1.1, 1.9) in women with difficulties in lifting or carrying groceries. Anthropometric measures were less strongly associated with social functioning, role limitations due to physical or emotional problems, mental health, vitality, pain, or health change in 1 year. The relationship between quality of life measures and BMI were similar to those between quality of life measures and waist circumference., Conclusions: Large waist circumferences and high BMIs are more likely to be associated with impaired quality of life and disability affecting basic activities of daily living.

We tested the hypothesis that people with a natural ability in 'power sports' (a presumed marker for predominance of type 2, glycolytic muscle fibres) might have increased risks of coronary heart disease (CHD) compared to those with a natural ability in 'endurance sports' (as a marker for predominance of type 1, oxidative muscle fibres). We examined subsequent cardiovascular disorders retrospectively in 231 male former soldiers, aged 34-87 years, who had undergone a course in physical training in the Army School of Physical Training, Aldershot, UK, who assessed themselves as having natural ability in either power (n = 107) or endurance (n = 124) sports. The proportion with CHD, defined as angina and/or coronary angioplasty and/or coronary artery bypass graft and/or heart attack was 18.7% in the 'power group' vs. 9.7% in the 'endurance group' (difference: chi 2 = 3.9, p = 0.05). The proportions with CHD and/or risk factors rose to 39.3% in the 'power group' vs. 25.8% in the 'endurance group' (difference: chi 2 = 4.8, p = 0.03). Under logistic regression analysis, compared to the 'endurance group', the 'power group' had 2.2 (95% CI: 1.00-4.63) the risk of developing CHD, and 1.86 (95% confidence interval: 1.06 to 3.25) the risk of developing CHD and/or risk factors. Men with a natural ability in 'power sports' are at increased risk of developing cardiovascular disorders, compared to men with a natural ability in 'endurance sports'. A predominance of type 2, glycolytic muscle fibres, presumably of genetic origin, may predispose to cardiovascular disorders.

Flavonols are polyphenols found ubiquitously in plants and plant-products. Flavonols, particularly quercetin, are potent antioxidants in vitro and their intake has been associated inversely with the incidence of coronary heart disease. The aim of this study was to investigate the accumulation in plasma and excretion in urine of flavonol glucosides following ingestion of lightly fried onions. Five healthy volunteers followed a low-flavonoid diet for 3 days. On day 4, after an overnight fast, subjects were given 300 g of lightly fried yellow onions which contain conjugates of quercetin and isorhamnetin, including quercetin-3,4 '-diO-beta-glucoside, isorhamnetin-4'-O-beta-glucoside and quercetin-4'-O-beta-glucoside. Blood collection was carried out at 0 min, 0.5, 1.0, 1.5, 2, 3, 4, 5 and 24h after the supplement. In addition, subjects collected all their urine for 24h following the onion supplement. Isorhamnetin-4'-O-beta-glucoside and quercetin-4 '-O-beta-glucoside accumulated in plasma with maximum levels, defined as proportion of intake, of 10.7+/-2.6% and 0.13+/-0.03% respectively. The time of the quercetin-4'glucoside peak plasma concentration was 1.3+/-0.2 h after the ingestion of onions while a value of 1.8+/-0.7 h was obtained for isorhamnetin-4'-glucoside. Excretion in urine, as a proportion of intake, was 17.4+/-8.3% for isorhamnetin-4'-O-beta-glucoside and 0.2+/-0.1% for quercetin-4'-O-beta-glucoside. Possible reasons for the accumulation and excretion of isorhamnetin-4'-glucoside in proportionally much higher amounts than quercetin-4'-glucoside are discussed. It is concluded that flavonols are absorbed into the bloodstream as glucosides and minor structural differences affect markedly both the level of accumulation and the extent to which the conjugates are excreted.

The following article is a report from the Chairman of the Professional Advisory Committee of the British Diabetic Association. The committee, with the help of a number of experts currently working in the field, produced a set of guidelines intended for use by health care professionals on the issues around genetic screening for Type 1 diabetes mellitus. The guidelines were approved by the Board of Management of the British Diabetic Association and we publish them here.

To assess the response of low consumers of fruit and vegetables to a nutrition education intervention programme, data were collected from 104 adults on attitudinal variables related to 'eating more fruit, vegetables and vegetable dishes'. Questionnaires (based on the theory of planned behaviour) assessing perceived barriers to increasing fruit and vegetable consumption were administered before an action-orientated intervention programme and at the end of the intervention period (8 weeks). Questionnaire scores for belief-evaluations in the intervention groups pre- and post-study indicated that support of family and friends, food costs, time constraints and shopping practicalities (in order to increase intake of fruit, vegetable and vegetable dishes) were barriers to greater consumption of these foodstuffs. Perceived situational barriers to increasing intakes of fruits and vegetables were: limited availability of vegetables, salads and fruit at work canteens, take-aways, friends' houses and at work generally. Following the intervention the number of visits to the shops was perceived as a greater barrier for increasing intakes of fruit and vegetables. Perceived practical opportunities for increasing intakes high-lighted drinking fruit juice, taking fruit as a dessert, having fruit as a between-meal snack and eating two portions of vegetables with a meal. About two-thirds of intervention subjects achieved the recommended fruit and vegetable target, but it is concluded that practical issues and situational barriers need to be addressed for the success of future public health campaigns.

This study reports results from a randomized controlled intervention trial, focusing on: (1) the identification of successful consumer strategies for increasing fruit and vegetable intakes to the recommended levels of more than five (80 g) portions per day and (2) impact on overall diet and nutrient intakes. Adult men and women (n 170) fulfilling the main recruitment criterion of eating less than five fruit and vegetable portions per day but contemplating increasing intakes were recruited. Complete valid dietary data was provided by 101 intervention (fifty-nine estimated fruit and vegetable intakes, and forty-two simultaneous weighted total dietary and estimated fruit and vegetable intakes) and twenty-four control subjects (weighed total dietary intakes). Intervention advice included the specific association of high fruit and vegetable intake with reduced risk of disease, practicalities, and portion definition with a target intake of greater than five 80 g fruit and vegetable portions per day for 8 weeks. There were significant effects (P < 0.001) on weighed intakes of fruit and vegetables in the intervention group, rising from 324 (SE 25) to 557 (SE 31) g/d and reflected by validated portion measures at 8 weeks intervention. Successful strategies chosen by 'achievers' of the target intake (65% of subjects) were conventional (fruit as a snack, vegetables with main meals etc.) and favoured fruit. There were significant increases in percentage energy from carbohydrate (from sugars not starch), vitamin C, carotenes and NSP and there was a significant decrease in percentage energy from fat for subjects who had high fat intakes (> 35% energy) at baseline. Follow-up self-reported measures at 6 and 12 months indicated mean intakes of 4.5 and 4.6 defined portions/d respectively, suggesting some sustainable effect. In conclusion, the intervention led to significant increases in fruit and vegetable intakes largely via conventional eating habits, with some desirable effects on macro- and micronutrient intakes.

We evaluated the accuracy of self-reported home-assessed and self-measured waist circumference in 101 men and eighty-three women aged 28-67 years. The main outcome measures were subjects' self-reported and self-measured waist circumference, and self-classification according to the previously defined waist action level 1 (940 mm in men, 800 mm in women) and action level 2 (1020 mm in men, 880 mm in women), and waist circumference measured by the investigator using the 'Waist Watcher' tape-measure, as the reference method. The mean errors (95% CI limits of agreement) for subjects' self-reported waist circumference (self-reported minus reference; mm) were -67 (95% CI -210, 77) in men and -43 (95% CI -211, 123) in women, and for self-measured waist circumference (mm) using the 'Waist Watcher' (self-measured minus reference) were -5 (95% CI -62, 52) in men and -4 (95% CI -50, 42) in women. The proportions of subjects classified into waist action level 1 or action level 2 by the investigator were used as the reference method. Self-reported waist circumference of men and women respectively would be classified correctly in different categories based on action level 1 with sensitivities of 58.3 and 78.7%, and specificities of 92.5 and 91.7%, and action level 2 with sensitivities of 35.3 and 44.9%, and specificities of 98.5 and 90.7%. Using the 'Waist Watcher' with different colour bands based on the action levels, male and female subjects respectively classified themselves into correct categories according to action level 1 with sensitivities of 100 and 95.7%, and specificities of 95.1 and 97.2%, and according to action level 2 with sensitivities of 97.1 and 100%, and specificities of 100% for both sexes. Only 2% of the sample misclassified themselves into the wrong categories according to waist circumference action levels. In conclusion, people tend to underestimate their waist circumference, but the 'Waist Watcher' tape-measure offers advantages over self-reported home-assessed measurement, and may be used as a screening tool for self-classifying the risk of ill health through intra-abdominal fat accumulation.

Objective: To study the associations of lifestyle factors with waist circumference 'Action Levels', hip circumference and body mass index., Design: Cross-sectional study in a random sample of 5887 men and 7018 women aged 20-59 years, selected from the civil registries of Amsterdam, Maastricht and Doetinchem, The Netherlands., Results: Results were compared to those in low health risk reference groups: non-smokers, occasional drinkers, highest educated, physically active, employed subjects, women who had no live births, or 20-29-year-olds. In multivariate logistic regression analysis, odds ratios (95% confidence interval) for having a waist above 'Action Level 2' (> or =102 cm in men, > or =88 cm in women) were significantly lower in smokers, and higher in heavy drinkers, inactive subjects, unemployed people, those educated below secondary level, women who had > or =3 live births, and older age. Mean waist-to-hip ratio adjusted for body mass index and age were higher in these groups. Residual analysis showed that the likelihood of having larger waist than expected from their body mass index was 1.2 times (1.1-1.4) in male smokers, 1.4 times (1.2-1.7) in male and 1.7 times (1.3-2.2) in female heavy drinkers, 1.6 times (1.5-1.8) in inactive men, and 1.3 times (1.1-1.5) in unemployed women. The risk of having smaller hips than expected from body mass index was 1.2 times (1.1-1.4) in male and 1.2 times (1.0-1.3) in female smokers, 1.2 times (1.1-1.3) in men and 1.1 times (1.0-1.2) in women who were inactive., Conclusions: Each lifestyle factor influences the size of waist and the hips differently, and understanding these influences is important for health promotion directed at the general public. Lifestyle modifications such as smoking cessation, reduced drinking, and a more physically active lifestyle should all be encouraged, leading to an overall healthier body shape.

Objective: To investigate the associations of indices of adiposity with cardiovascular risk factors., Subjects: 93 men and 98 women aged 18-69 y., Outcome Measures: Body mass index (BMI), waist to hip ratio (WHR), waist circumference, waist to height ratio, blood pressure, fasting concentrations of blood glucose, insulin, plasma lipids and lipoprotein subfractions, apoproteins, lipoprotein(a) and post-heparin lipases., Results: BMI and waist showed similar associations (P < 0.01) with a cluster of major cardiovascular risk factors including total cholesterol, low density lipoprotein-cholesterol and very low density lipoprotein-cholesterol in men, and ratio of low density lipoprotein-/high density lipoprotein-cholesterol for both genders. Large waist circumference was significantly (P < 0.01) associated (controlled for age and smoking) with features of the metabolic syndrome, including raised insulin concentration (men: r=0.37, women: r=0.49), reduced high density lipoprotein2 (men: r=-0.30, women: r=-0.34), increased very low density lipoprotein1 mass (men: r=0.31, women: r=0.42), raised small, dense low density lipoprotein (men: r=0.30, women: r=0.31), elevated blood pressure (men: r=0.27, women: r=0.28), increased triglyceride (men: r=0.43, women: r=0.48) and apolipoprotein-B (men: r=0.32, women: r=0.35). Waist circumference also correlated with hepatic lipase/lipoprotein lipase ratio in women (r=0.52). Height adjustment did not substantially change relationships between waist circumference and risk factors. WHR correlated with fewer risk factors., Conclusion: For the purpose of health promotion to prevent cardiovascular disease associated with overweight and intra-abdominal fat accumulation, the general public should be advised to be aware of the risk associated with large waist circumference.

Background: Symptoms and secondary disorders associated with excess central fat distribution are being increasingly recognised. We aimed to define the symptoms and assess risks of chronic disorders in people with large waist circumferences., Methods: We did a cross-sectional study of 5887 men and 7018 women aged 20-59 years from the general population of Maastricht, Amsterdam, and Doetinchem, Netherlands. We assessed in health centres respiratory insufficiency, low back pain, degree of physical function, presence of non-insulin-dependent diabetes, and cardiovascular risk factors. We measured bodyweight, body-mass index, and waist circumference by action levels (men: less than action level 1 <94.0 cm, action levels 1-2 94.0-101.9 cm, more than action level 2 > or =102.0 cm; women: less than action level 1 <80.0 cm, action levels 1-2 80.0-87.9 cm) more than action level 2 > or =88.0 cm). The reference group were people with waist circumferences lower than action level 1., Findings: All symptoms and risks increased among participants higher than action level 2, after adjustment for age and lifestyle, by 3.1 (95% CI 2.5-3.7) in men and 2.7 (2.3-3.1) in women for shortness of breath when walking upstairs; 4.5 (2.5-7.8) and 3.8 (1.9-7.3) for non-insulin-dependent diabetes; and 4.2 (3.6-5.0) and 2.8 (2.4-3.2) for at least one major cardiovascular risk factor. Above action level 2, compared with the reference group, men and women were at twice the risk of difficulties in everyday activities, women were 1.5 times more likely to have low back pain or symptoms of intervertebral disc herniation, with secondary problems including hindrance to daily activities., Interpretation: People with large waist circumferences have excess burden of ill health. Waist action levels could be useful for health promotion to raise awareness of the need for weight management.

Objectives: To assess attitudes, predictors of intention, and identify perceived barriers to increasing fruit and vegetable (F&V) intakes., Design: UK nationwide postal survey utilizing the theory of planned behaviour., Subjects: Stratified (by social class and region) random sample of 2020 UK adults providing a modest response rate of 37% (n = 741)., Results: Belief measures (e.g. health, cost, taste, etc.) were strongly associated with overall attitudes which were reported as being largely favourable towards fruit, vegetables and, to a lesser extent, vegetable dishes, and were strongly associated with reported intention to increase consumption. Subjects reported they could increase their consumption, but this was only weakly associated with intention to do so. Approximately 50% of respondents reported an intention to increase intakes. Social pressure was strongly associated with reported intention to increase; however, scores indicated low perceived social pressure to change. Evidence of unrealistic optimism concerning perceived intakes and the perceived high cost of fruit may also act as barriers., Conclusions: Results from this study suggest a lack of perceived social pressure to increase F&V intakes and suggests that public health efforts require stronger and broader health messages that incorporate consumer awareness of low present consumption.

Gradient reversed-phase HPLC was used to obtain quantitative estimates of the levels of free and conjugated myricetin and quercetin in 65 red wines from Italy, Chile, France, California, Australia, Bulgaria, Spain, Romania, New Zealand, Brazil, Morocco, and Hungary. The concentrations of total flavonols ranged from 4.6 to 41.6 mg L(-1). High total flavonol levels appear to be associated with the use of thick-skinned grape varieties, such as Cabernet Sauvignon, with a high skin:volume ratio, which were left to ripen fully in sunny conditions before harvest and which were extracted efficiently by modern methods of vinification. Some Chilean Cabernet Sauvignon wines contained up to 40 mg of total flavonols L(-1), which was higher than the levels detected in Cabernet Sauvignon from France, California, and Australia. The flavonol content of 1989 and 1990 Cabernet Sauvignon from Bulgaria was <6 mg L(-1). Chilean Cabernet Sauvignon, Merlot, and Pinot Noir all contained consistently higher concentrations of flavonols than their counterparts from different geographical regions.

The aims of this study were to establish the associations of stature, body mass index, waist to hip ratio, and waist circumference with Type 2 (non-insulin-dependent) diabetes mellitus in a random sample of 5887 men and 7018 women aged 20-59 years in a cross-sectional study set in The Netherlands. The crude prevalence of Type 2 diabetes (overall 1.58% in men, 0.94% in women) was significantly (p < 0.01) higher in shorter subjects and those with high body mass index, high waist to hip ratio, and larger waist circumference. Odds ratios and 95% confidence intervals (95% CI) were adjusted for age, cigarette smoking, alcohol consumption, physical activity, and education. Compared to the tallest tertile of height, odds ratios for Type 2 diabetes were 4.4 (95% CI: 1.3 to 11.5) in men and 1.6 (95% CI: 0.8 to 3.2) in women whose height was in the shortest tertile. Compared to the lowest tertile, odds ratios for Type 2 diabetes were 18.4 (95% CI: 4.3 to 78.5) in men and 5.3 (95% CI: 2.0 to 14.0) in women with waist to hip ratio in the highest tertile, 4.1 (95% CI: 2.0 to 8.4) in men and 2.1 (95% CI: 1.0 to 4.2) in women with body mass index in the highest tertile, and 4.9 (95% CI: 2.1 to 11.7) in men and 2.7 (95% CI: 1.2 to 5.9) in women with waist circumference in the highest tertile. In conclusion, although in longitudinal studies waist is a powerful predictor of diabetes incidence, Type 2 diabetes in a cross-sectional survey is associated with shortness in stature, as well as large waist circumference and high body mass index, and particularly strongly with high waist to hip ratio, suggesting that the development of Type 2 diabetes may modify hip circumference independently of body fat.

1. In order to evaluate factors influencing thermogenesis in obesity, energy expenditure was measured before and during an adrenaline infusion (25 ng min-1 kg-1 ideal body weight for 30 min) in 22 obese females. 2. Thermogenic responses were related to body morphology, age and biochemistry. In addition, thermogenic responses were related to cardiovascular responses by simultaneously measuring blood pressure, pulse rate and cardiac output using Doppler sonography. 3. Resting energy expenditure was predicted by body weight, lean body mass and fat mass. 4. Adrenaline-induced thermogenesis was predicted by fasting insulin, low basal respiratory quotient and body fat. 5. There was a significant relationship between the cardiac output and thermogenic responses to adrenaline (r = 0.63 P < 0.015) but there was no relationship to the heart rate or blood pressure responses. For every 1% increase in energy expenditure, there was a 5% increase in cardiac output. 6. In conclusion, the factors predicting resting energy expenditure and adrenaline-induced thermogenesis are different. Increased lipid oxidation and central fat distribution (with hyperinsulinaemia) are associated with a greater thermogenic response. The proportionately greater cardiac output responses may have implications for thermogenic agents designed to induce weight loss.

Obesity management includes primary weight loss, prevention of weight regain, and the management of associated risk factors, such as smoking, hyperlipidaemia and hypertension. All these require lifestyle modification. The success or failure of management will depend on the characteristics of both the patient and the physician (or therapeutic team). Thus, direct statistical comparisons between methods of management may be misleading. Weight loss of 5-10% (usually 5-10 kg and equivalent to 5-10 cm waist reduction for most patients) is generally achievable within 3-4 months. Attempts to achieve weight loss over longer periods of time are usually unsuccessful. Improved clinical, symptomatic and biochemical benefits are very significant with this degree of weight loss. It is therefore unreasonable to pursue an 'ideal' bodyweight. In reported studies, the weight decrease over the first 3-4 months represents the total weight loss. Data collected after this time reflect both the initial weight loss and the ability of the patient and the programme to maintain weight loss. Many reports and study designs do not make this distinction. The principal goal of weight management, whether in primary prevention or in treatment of the obese, is weight maintenance. This goal has to be viewed in the context of a normal tendency to gain weight through adult life. In good hands, dietary and behavioural techniques can maintain significant weight loss for 1 year or longer in about 40% of patients. This increases to about 70% for patients receiving appetite modifying drugs; professional resource requirements are also lower. Surgical approaches are reserved for those with more serious clinical risks. Weight loss in individuals with non-insulin dependent diabetes mellitus (NIDDM) can be achieved in newly diagnosed patients and non-diabetics with comparable success. The goal of interventions in established NIDDM patients should be improved weight maintenance evaluated over 1-2 years, not acute loss achieved in 3 months.

Objective: The present study investigated the associations of stature, lower leg length (LLL) and demi-arm span (demi-AS) with major predisposing cardiovascular risk factors and coronary heart disease., Study Design and Subjects: Cross-sectional study set at Glasgow Royal Infirmary of a subsample of 543 men and 646 women aged 25-66 y from the random MONICA sample. ASSOCIATED MEASURES: LLL, demi-AS, blood pressure, plasma total cholesterol, diabetes mellitus and coronary heart disease (angina, angioplasty, heart attack, and coronary artery bypass graft)., Results: The numbers (and proportions) of men and women, respectively, with hypertension were 126 (23.6%) and 80 (14.0%), hypercholesterolaemia 155 (29.0%) and 171 (30.1%), coronary heart disease 53 (10.1%) and 47 (8.4%), and diabetes 15 (2.9%) and 9 (1.6%). Results were adjusted for age, social class and smoking. Analysis of variance showed that in men, shortness of height, LLL or demi-AS were all associated significantly (P < 0.05) with hypercholesterolaemia. Long LLL, high ratios of LLL:height or LLL:demi-As were associated significantly (P < 0.05) with diabetes mellitus. In women, shortness of height or LLL were associated with significantly (P < 0.05) with coronary heart disease. High ratio of demi-AS:height or low ratio of LLL:demi-AS was associated significantly (P < 0.05) with coronary heart disease., Conclusions: Short stature and limb lengths, and also altered skeletal proportions, which may reflect interrupted early growth, are associated with several metabolic disorders. Skeletal disproportion associates with diabetes in men and coronary heart disease in women.

Objective: To determine the level of a single transverse scan of intra-abdominal fat between L1 and L5 vertebrae that best predicts intra-abdominal fat volumes., Subjects: Sixteen male and seven female patients with non-insulin-dependent diabetes mellitus, aged 44-74 y., Outcome Measures: Volumes and areas from single scans of intra-abdominal fat measured by magnetic resonance imaging with a 1.5 Tesla magnetic field strength., Results: Intra-abdominal fat volumes and were calculated from fat areas from eight cross-sectional transverse single scans (nine scans in eight men) of 20 mm thickness. Men and women, respectively, had mean body mass index (BMI) of 27.9 (s.d. 3.0) and 31.6 (s.d. 4.7) kg/m2, and intra-abdominal fat of 2.3 (s.d. 0.5) and 2.5 (s.d. 0.6) kg. Intra-abdominal fat area of the fourth scan (in the direction of L1 to L5) gave the highest prediction of total intra-abdominal fat both in men (r = 0.959, P < 0.001) and in women (r = 0.973, P < 0.001). The intra-abdominal fat area of the third scan gave almost as good a prediction. These third and fourth scans corresponded to L2 and L3 vertebrae. The intra-abdominal fat areas from the sixth and seventh scans, corresponded to the frequently used L4-L5 and had lower correlations with intra-abdominal fat. There were no gender differences in the prediction of volumes from areas of intra-abdominal fat. Intra-abdominal fat areas of the fourth scan explained 93% of variance (SEE = 0.14 kg) of total of intra-abdominal fat for both genders: intra-abdominal fat (kg) = 0.0108 x intra-abdominal fat area of the fourth scan (cm2) + 0.244., Conclusions: In large studies of intra-abdominal fat, using magnetic resonance imaging (MRI) or computerised tomography scanning, a single intra-abdominal fat area at the intervertebral disc between L-2 and L-3 vertebrae offers a cheaper, faster and safer method, with high prediction of total intra-abdominal fat volumes and masses.

Objectives: Patients with non-insulin-dependent diabetes mellitus (NIDDM) have been shown to be more obese and have higher waist-to-hips circumference ratios compared to nondiabetics. In this study, we tried to dissociate obesity, waist and hip circumference from NIDDM., Design: A cross-sectional population-based case-control study., Setting: General population., Controls: 5887 men and 7018 women, aged 20-59 years, without known diabetes or hyperglycaemia., Cases: 93 men and 66 women were diagnosed with NIDDM., Main Outcome Measures: We predicted waist and hips' circumference from the body mass index, weight/height2, (BMI) on the basis of linear regression. Differences between observed and expected values (residuals) of waist and hip circumference were categorized into tertiles. The relative odds of having NIDDM in tertiles of waist and hip residuals (middle tertile as reference) were calculated by multiple logistic regression analysis adjusted for each other and for age, smoking, physical activity, alcohol consumption and education., Results: NIDDM was most prevalent in men and women who had larger waists and in those who had smaller hip circumferences than expected from their BMI. Adjusted odds ratios (95% CI) for NIDDM were 2.9 (1.6-5.1) in men and 2.8 (1.5-5.1) in women who had a larger than expected waist, and were 3.7 (2.1-6.5) in men and 2.1 (1.1-3.8) in women who had smaller than expected hips., Conclusions: Our findings suggest that diabetics have larger waists and smaller hips compared to nondiabetics, irrespective of their degree of obesity, age and life-style factors. One possibility is that besides abdominal fatness, peripheral muscle atrophy is one of the factors associated with NIDDM.

Objective: To investigate the effect of a dietary intervention to reduce body weight on red cell aggregation (RCA), factor VII activity, plasminogen activator inhibitor (PAI) activity, tissue plasminogen activator (t-PA) antigen, fibrinogen, whole blood and plasma viscosity, haematocrit and lipids., Design: Open single stranded study of dietary intervention for weight loss in a volunteer sample., Subjects: Forty-five subjects whose BMI exceeded 26 kg/m2 were recruited and received dietetic advice designed to reduce body weight by 0.5 kg per week., Measurements: Body weight and waist and hip circumferences, dietary intake by seven day weighed inventory, RCA, factor VII activity, PAI activity, t-PA antigen, fibrinogen, whole blood and plasma viscosity, haematocrit and lipids., Results: After 12 weeks of dietary intervention there were reductions in body weight and BMI by 5.9 (s.d. 3.3) kg and 1.9 (s.d. 1.0) kg/m2 respectively in males, and 4.1 (s.d. 2.9) kg and 1.6 (s.d. 1.1) kg/m2 in females (P < 0.0001). Factor VII activity (P = 0.0043), RCA (P = 0.01) and t-PA antigen (P = 0.016) were reduced in females after weight reduction but no differences were found in PAI activity, whole blood, plasma viscosity or haematocrit. The changes in factor VII activity and RCA were appropriate for the changes in BMI on the basis of the relationships of the risk factors with BMI in a cross sectional survey of a representative Scottish population. Plasma total cholesterol was reduced (P = 0.016) but HDL cholesterol and triglycerides remained unchanged. There were significant associations between the reductions in factor VII activity and BMI (r = 0.395, P = 0.013) and between the reductions in RCA and waist to hip ratio (r = 0.350, P = 0.04). No relationship was seen between changes in serum cholesterol and changes in factor VII activity or RCA., Conclusions: Modest weight loss, of 5% body weight, with conventional dietary intervention reduces two established risk factors for ischaemic heart disease (factor VII activity and RCA) which are generally elevated in those with increased body weight.

Objectives: To examine the associations of low back pain symptoms with waist circumference, height, waist to hip ratio and body mass index, and to test the interactions between (1) waist circumference and height, and (2) waist to hip ratio and body mass index., Setting: Cross-sectional study set in The Netherlands of a random sample of 5887 men and 7018 women aged 20-60 y., Results: The prevalences of low back pain in men and women in the past 12 months were 46% and 52%, of whom 17% and 21% had low back pain for a total of 12 or more weeks, and 13% and 18% had symptoms suggestive of intervertebral disc herniation. After adjustments for age, smoking and education, more women in the highest tertile of waist circumference reported low back pain in the past 12 months (odds ratio = 1.2, 95% confidence interval: 1.1-1.4), low back pain for a total of 12 or more weeks (odds ratio = 1.5, 95% confidence interval: 1.3-1.8), and intervertebral disc herniation symptoms (odds ratio = 1.3, 95% confidence interval: 1.1-1.6) than women in the lowest waist tertile. Corresponding values of low back pain symptoms for women with high body mass index or high waist to hip ratio were similar to those with high waist. There were no significant differences between men in different tertiles of waist, waist to hip ratio or body mass index reporting low back pain symptoms. Tallest subjects did not report low back pain symptoms more often than shortest subjects. There was no significant interactions between waist and height or between waist to hip ratio and body mass index on low back pain symptoms., Conclusions: Women who are overweight or with a large waist have a significantly increased likelihood of low back pain. There are no significant interactions between waist and height, or waist to hip ratio and body mass index on low back pain symptoms.

Objective: To investigate the influence of height on the relationships between the intra-abdominal fat and anthropometric measures., Subjects: Twenty healthy female volunteers aged 20-51 y from Aberdeen, and 71 men and 34 women aged 19-85 y from Nijmegen, The Netherlands., Outcome Measures: Intra-abdominal fat volumes by magnetic resonance imaging (MRI) in Aberdeen and cross-sectional areas at L4-L5 level by computerised tomography (CT) in Nijmegen, height, body mass index (BMI), waist circumference, waist sagittal and transverse diameters, waist to hip ratio, and skinfolds., Results: In the MRI study the women with BMI 20-33 kg/m2, waist circumference 62-97 cm, height 148-172 cm, and intra-abdominal fat volume 0.07-2.66 kg, waist circumference gave the highest correlation of simple indices with intra-abdominal fat volume, explaining 77.8% of variance. Single cross-sectional MRI cuts predicted volume with r = 0.94-0.99. Height in various levels of index power was not related to waist circumference, waist diameters, BMI, or skinfolds and did not improve prediction of intra-abdominal fat volume or of cross-sectional intra-abdominal fat area at any level. The CT study of men and women with BMI 18-32 kg/m2 and 19-38 kg/m2, waist circumference 71-112 cm and 74-125 cm, height 158-197 cm and 151-182 cm, and intra-abdominal fat area 13-274 cm2 and 19-221 cm2 respectively, height also had little influence on the relationships of intra-abdominal fat area with waist circumference or with any other indices of adiposity in linear or quadratic models. Compared to younger subjects, intra-abdominal fat area was higher in older subjects for a given waist circumference., Conclusions: Height does not importantly influence the differences in measures of adiposity or intra-abdominal fat volume in women, or intra-abdominal fat area in both sexes. Age does influence the prediction of intra-abdominal fat from waist circumference, but waist circumference alone has a predictable simple relationship with intra-abdominal fat volume or area, which is likely to relate to the prediction of health risk for health promotion.