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Regular nut consumption is associated with lower adiposity and reduced weight gain in adulthood. Walnut feeding studies have observed minimal effect on body weight despite potential additional energy intake. Several mechanisms may explain why consuming nuts promotes weight control, including increased early phase satiety, possibly reflected in postprandial response of gastrointestinal and pancreatic peptides hypothesized to affect appetite. The purpose of this study was to compare postprandial insulin, glucagon and gastrointestinal peptide response and satiety following a meal with ∼54% of energy from walnuts or cream cheese, using a within-subject crossover study design in overweight/obese adults (N=28). Sixty minutes after the walnut-containing meal, glucagon-like peptide-1 was lower than after the reference meal (p=0.0433), and peptide YY, cholecystokinin and ghrelin did not differ after the two meals. Sixty and 120min after the walnut-containing meal, pancreatic polypeptide (p=0.0014 and p=0.0002) and glucose-dependent insulinotropic peptide (p&nbsp

BACKGROUND: To improve cancer disparities among underrepresented minority (URM) populations, better representation of URM individuals in cancer research is needed. The San Diego State University and University of California San Diego Moores Cancer Center Partnership is addressing cancer disparities through an educational program targeting undergraduate URM students. METHODS: The Partnership provides a paid intensive summer research internship enriched with year-round activities that include educational sessions, a journal club, mentorship, social activities, and poster sessions and presentations. Program evaluation through follow-up surveys, focus groups and other formal and informal feedback, including advisory and program steering committees are used to improve the program. Long-term follow-up among scholars (minimum of 10 years) provides data to evaluate the program’s long-term impact on scholars’ education and career path. RESULTS: Since 2016, 63 URM undergraduate students participated in the scholar program. At the Year 2 follow-up (2016 cohort; n=12), 50% had completed their Graduate Record Examination (GRE) and/or applied to graduate or medical school. Lessons learned during the course of the program led to implementation of changes to provide a better learning experience and increase overall program satisfaction. Updates were made to recruitment timeline, improvements of the recruitment processes, refinement of the program contracts and onboarding meetings, identification of essential program coordinator skills and responsibilities, adjustments to program components, and establishment of a well-mapped and scheduled evaluation plan. CONCLUSIONS: The Partnership identified best practices and lessons learned for implementing lab-based internship scholar programs in biomedical and public health fields that could be considered in other programs.

BackgroundObesity is a risk factor for postmenopausal breast cancer incidence and premenopausal and postmenopausal breast cancer mortality, which may be explained by several metabolic and hormonal factors (sex hormones, insulin resistance, and inflammation) that are biologically related. Differential effects of dietary composition on weight loss and these metabolic factors may occur in insulin-sensitive vs. insulin-resistant obese women.ObjectiveTo examine the effect of diet composition on weight loss and metabolic, hormonal and inflammatory factors in overweight/obese women stratified by insulin resistance status in a 1-year weight loss intervention.Methods and resultsNondiabetic women who were overweight/obese (n=245) were randomly assigned to a lower fat (20% energy), higher carbohydrate (65% energy) diet; a lower carbohydrate (45% energy), higher fat (35% energy) diet; or a walnut-rich (18% energy), higher fat (35% energy), lower carbohydrate (45% energy) diet. All groups lost weight at follow-up (P

Objective Providing portion-controlled prepackaged foods in a behavioral counseling intervention may promote more weight and fat loss than a standard self-selected diet. Methods The primary aim was to test whether providing portion-controlled prepackaged lunch and dinner entrees within a behavioral weight loss intervention promotes greater weight loss at 12 weeks compared to self-selected foods in adults with overweight/obesity. Other aims were to examine effects on biological factors, fitness, and meal satisfaction. One-half of those assigned to prepackaged entrees were provided items with a higher protein level (>25% energy) as an exploratory aim. Results Participants (N = 183) had a baseline weight of 95.9 (15.6) kg (mean [SD]) and BMI of 33.2 (3.5) kg/m2. Weight data at 12 weeks were available for 180 subjects. Weight loss for regular entree, higher protein entree, and control groups was 8.6 (3.9)%, 7.8 (5.1)%, and 6.0 (4.4)%, respectively (P

Epidemiological studies have linked regular nut consumption with lower body mass index and reduced likelihood of weight gain in adulthood. Nuts can displace other foods in the diet, and thus, promote a healthier dietary pattern. The purpose of this study was to examine the effect of pistachio nut consumption in overweight/obese adults. This randomized controlled study enrolled non-diabetic overweight/obese adults (n = 100) assigned to a 4-month behavioral weight loss intervention only group (controls) or also prescribed 1.5 oz/day (42 g/day) of pistachios (pistachio group). Outcomes were change in body weight, cardiometabolic factors, and dietary intake. Percent weight change was similar in the two groups (&minus, 5.1 [0.5] (mean [SE])% in the control group and &minus, 4.9 [0.6]% in the pistachio group, and body mass index (BMI) and waist circumference were reduced in both groups (time effect p &le, 0.05). The pistachio group (but not the control group) exhibited a significant reduction in both systolic and diastolic blood pressure (time effect p = 0.01). Plasma alpha-carotene, beta-carotene, and lutein concentrations increased significantly in the pistachio group (time effect p &lt, 0.05). Pistachio consumption was associated with increased dietary fiber intake and decreased consumption of sweets. Regular consumption of pistachios was associated with a comparable degree of weight loss, and similar reductions in BMI and waist circumference, in overweight/obese men and women compared to controls, and favorable changes in the diet, in the context of a behavioral weight loss intervention.

Background: To improve cancer disparities among underrepresented minority (URM) populations, better representation of URM individuals in cancer research is needed. The San Diego State University (SDSU) and University of California San Diego (UCSD) Moores Cancer Center Partnership is addressing cancer disparities through an educational program targeting undergraduate URM students. Aims: To increase the proportion of URM individuals participating in cancer research by providing a range of research education opportunities supported by the Partnership Scholar Program Methods: The Partnership provides a paid intensive summer research internship enriched with year-round activities that include educational sessions, a journal club, mentorship, social activities, and poster sessions and presentations. Program evaluation through follow-up surveys, focus groups and other formal and informal feedback, including advisory and program steering committees are used to improve the program. Long-term follow-up among scholars (minimum of 10 years) provides data to evaluate the program’s long-term impact on scholars’ education and career path. Results: Since 2016, 63 URM undergraduate students participated in the scholar program. At the Year 2 follow-up (2016 cohort; n=12), 50% had completed their GRE and/or applied to graduate school or medical school. Lessons learned during the course of the program led to changes that were implemented to provide a better learning experience and increase overall program satisfaction, which include: 1) Lengthening the recruitment timeline to improve reach of eligible students and to provide more time for scholar selection and onboarding. 2) Improving the recruitment processes by collaborating with organizations serving URM students. 3) Refining the program contracts and onboarding meetings to help clarify expectations for scholars and faculty mentors. 4) Program coordinator skills and responsibilities (e.g., communication with scholars and mentors) are key to scholar satisfaction and retention. The coordinator organizes and communicates program activities, holds one-on-one in-person meetings, and provides ongoing mentorship to increase retention and scholar success in their ongoing academic development. 5) Adjustments to program components, such as scheduling and curricula of the summer education sessions, pairing scholars with clinicians, and the addition of social events were implemented to improve scholars’ learning experience. 6) Efficient tracking of the multitude of evaluation metrics requires a well-mapped and scheduled evaluation plan that includes automated publication notification systems and LinkedIn groups to evaluate scholars’ satisfaction and achievements post-program completion. Conclusions: The Partnership identified best practices and lessons learned for implementing lab-based internship scholar programs in biomedical and public health fields that could be considered in other programs. (U54CA132384 & U54CA132379) Citation Format: Elinor Gaida, Elva M Arredondo, Anthony J Barrios, Sanford I Bernstein, Richard M Cripps, Sheila E Crowe, Jill Dumbauld Nery, Maria Elena Martinez, Bilge Pakiz, Mercedes A Quintana Serrano, Roland Wolkowicz, Hala Madanat. Training the next generation of undergraduate URM cancer scientists: Results and lessons learned from a cancer research Partnership Scholar Program [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D037.

Background: Fasting glucose and homeostatic model assessment-insulin resistance (HOMA-IR) are important measures of the risk for metabolic syndrome and diabetes. Weight loss interventions are considered part of the first line of therapy for those who develop disease states associated with insulin resistance, such as pre-diabetes, diabetes, or metabolic syndrome. Sex differences in insulin resistance have been extensively reported, but sex differences in the ability to improve insulin sensitivity are not well-established. This study sought to identify factors that predict change in HOMA-IR in response to weight loss. Methods: Non-diabetic subjects who were overweight/obese (n=100) were randomly assigned to a walnutenriched reduced-energy diet or a standard reduced-energy-density diet in a 6-month weight loss intervention. There were no significant differences in weight change, glucose, insulin, or HOMA-IR between the two diet groups. These subjects were combined into a single cohort and analyzed with multivariate analysis. Results: The combined groups lost an average of 8.7 kg (p

Physical activity is associated with reduced risk and progression of breast cancer, and exercise can improve physical function, quality of life, and fatigue in cancer survivors. Evidence on factors associated with cancer survivors’ adherence to physical activity guidelines from the American Cancer Society and the U.S. Department of Health and Human Services is mixed. This study seeks to help fill this gap in knowledge by examining correlates with physical activity among breast cancer survivors. Overweight or obese breast cancer survivors (N = 692) were examined at enrollment into a weight loss intervention study. Questionnaires and medical record review ascertained data on education, race, ethnicity, menopausal status, physical activity, and medical history. Measures of anthropometrics and fitness level were conducted. Regression analysis examined associations between physical activity and demographic, clinical, and lifestyle factors. Overall, 23 % of women met current guidelines. Multivariate analysis revealed that body mass index (p = 0.03), emergency room visits in the past year (p = 0.04), and number of comorbidities (p = 0.02) were associated with less physical activity. Geographic region also was associated with level of physical activity (p = 0.02), with women in Alabama reporting significantly less activity than those in other participating regions. The majority of overweight/obese breast cancer survivors did not meet physical activity recommendations. Physical activity levels were associated with degree of adiposity, geographic location, and number of comorbidities. The majority of overweight breast cancer survivors should be encouraged to increase their level of physical activity. Individualizing exercise prescriptions according to medical comorbidities may improve adherence.

Objective The purpose of this analysis was to examine the correlates of the physical and psychosocial domains of quality of life (QOL) in a cohort of breast cancer survivors participating in a weight loss intervention trial. Methods Correlates of QOL and psychosocial functioning were examined in 692 overweight or obese breast cancer survivors at entry into a weight loss trial. QOL was explored with three measures: Short-form 36 (SF-36), Impact of Cancer scale (IOC), and the Breast Cancer Prevention Trial (BCPT) symptom scales. Available data included information on weight and physical activity, as well as demographic and medical characteristics. Multivariate analyses were used to identify associations adjusted for other characteristics. Results In multivariate analysis, younger age was associated with higher negative impact scores (p

Background: Visceral adipose tissue is more metabolically active than other fat depots and is more closely associated with obesity-related diseases, such as cardiovascular disease and type 2 diabetes, than indicators of obesity, such as body mass index. Across various strategies to promote weight loss, including energy-reduced diet and exercise, variable effects on VAT compared to loss of total body fat have been reported. Methods: To examine the effect of a behavioral weight loss intervention using portion-controlled prepackaged entrees on VAT, we examined data and measurements from overweight/obese men and women (N=183) who were assigned to a weight loss intervention and prescribed a reduced-energy diet with either portion-controlled prepackaged entrees or self-selected meals in a randomized clinical trial. VAT was estimated with dual-energy X-ray absorptiometry at baseline and study end (12 weeks). Results: VAT loss was greater for the prepackaged entrees group (p=0.02), with an average loss of 29% compared to an average loss of 19% among participants consuming self-selected meals. VAT (mean [SEM]) was 1651 (71) g and 1546 (157) g at baseline and 1234 (59) g and 1278 (118) g at study end in the prepackaged entrees and self-selected meal groups, respectively. Greater VAT loss was associated with higher baseline weight and VAT, and greater weight loss, but not associated with age or physical activity. Conclusion: Prescribing portion-controlled prepackaged entrees in a behavioral weight loss intervention promotes a reduction in VAT, which should promote improved metabolic profile and reduced cardiovascular disease risk.

Background: Understanding how diet composition and personal characteristics relate to eating behaviors of individuals in weight loss programs could better inform the development and expectations of prescribed weight loss regimens. The purpose of this study was to examine whether diet composition has a significant effect on eating behaviors of individuals participating in a weight loss intervention and what characteristics significantly correlate with changes in such behaviors. Methods: The Eating Inventory questionnaire was used to assess eating behaviors of restraint, disinhibition and hunger at baseline and 6 months among individuals participating in a weight loss intervention who were prescribed a standard reduced-energy-density diet or a walnut-enriched reduced-energy diet as one component of a behavioral weight loss intervention. Results: After 6 months of intervention, there were significant improvements in both study arms on all scales and most subscales, with overall restraint increasing, disinhibition decreasing and hunger decreasing. Other correlations were that as restraint increased, weight loss increased; as hunger decreased, disinhibition decreased; and as physical activity increased, disinhibition decreased. Among personal characteristics, restraint was significantly associated with sex, age and education at baseline, with women reporting higher restraint than men, younger participants reporting lower restraint than older individuals, and college graduates reporting lower restraint than noncollege graduates. Over the course of the weight loss program, there were significant correlations between increased restraint and being male as well as decreased hunger and being a college graduate. Conclusion: Our results highlight the significance of restraint among the three eating behaviors as it was the only behavior significantly correlated with weight loss and was also correlated with several personal characteristics. Disinhibition and hunger showed other significant correlations with one another that do not directly correlate with weight loss but may be important in other aspects of weight control such as weight loss maintenance.

Fifty years ago, the causes of cancer were largely unknown. Since then, it has become clear that a strong relationship exists between obesity and many cancers, particularly postmenopausal breast cancer. A major challenge in understanding the link between obesity and cancer risk has been elucidating the biological basis underlying the association. Although this remains unresolved, the main candidate systems linking adiposity and cancer risk are (1) insulin and the insulin-like growth factor-I (IGF-I) axis, (2) endogenous reproductive hormones, and (3) chronic inflammation. The purpose of this paper is to provide a mechanistic overview of the hypothesized relationship between diet, physical activity, and obesity with breast cancer risk and progression. In addition, we will provide examples of recently funded randomized clinical trials examining metabolic risk factors in relation to breast cancer risk and survival. Additional research is warranted to validate the strength and consistency of the relationships among diet, these biomarkers, and breast cancer risk. As these relationships become clearer, future studies will be needed to develop effective intervention programs to prevent breast cancer and improve cancer prognosis by promoting a healthy lifestyle.

PurposeComorbid medical conditions are common among breast cancer survivors, contribute to poorer long-term survival and increased overall mortality, and may be ameliorated by weight loss. This secondary analysis evaluated the impact of a weight loss intervention on comorbid medical conditions immediately following an intervention (12months) and 1-year postintervention (24months) using data from the Exercise and Nutrition to Enhance Recovery and Good health for You (ENERGY) trial-a phase III trial which was aimed at and successfully promoted weight loss.MethodsENERGY randomized 692 overweight/obese women who had completed treatment for early stage breast cancer to either a 1-year group-based behavioral intervention designed to achieve and maintain weight loss or to a less intensive control intervention. Minimal support was provided postintervention. New medical conditions, medical conditions in which non-cancer medications were prescribed, hospitalizations, and emergency room visits, were compared at baseline, year 1, and year 2. Changes over time were analyzed using chi-squared tests, Kaplan-Meier, and logistic regression analyses.ResultsAt 12months, women randomized to the intervention had fewer new medical conditions compared to the control group (19.6 vs. 32.2%, p&nbsp

We appreciate the interest that Hryniuk et al have expressed in our article that described the results of the Exercise and Nutrition to Enhance Recovery and Good Health for You (ENERGY) trial, a behavioral weight-loss intervention in overweight or obese breast cancer survivors. As we noted in our article, we concur that women who have been diagnosed and treated for breast cancer often have special issues, such as treatment-related musculoskeletal problems, enduring psychosocial symptoms (especially fatigue and depression), and changes in body composition associated with cancer treatment, which can complicate weight management efforts. Moreover, breast cancer survivors also may have more foodrelated concerns and body image issues that must be addressed to promote adherence to weight loss efforts. The ENERGY intervention was tailored to breast cancer survivors and, hence, addressed their preferences and the challenges specific to breast cancer-related symptoms, including fatigue, symptoms of estrogen withdrawal, body image concerns, and lymphedema. Details about the screening process and specific medical and psychiatric exclusion criteria for the ENERGYtrial have been previously published. Similar to Hryniuk et al, we excluded women who were bipolar or schizophrenic, but we also screened out individuals with other psychoses, bulimia nervosa, and anorexia nervosa, as well as serious personality disorders and serious depression. Several psychosocial measures were conducted at baseline and regular intervals, including risk for depression, using the Center for Epidemiologic Studies Depression Scale (CES-D). In addition, we queried whether participants were currently being treated for depression. As we have previously reported, 137 of the 692 participants (approximately 20%) were considered at risk for depression (CES-D score $16) at study entry, and 21% reported that they were currently being treated for depression. These two measures were strongly associated (P , .001). In response to the suggestion of Hryniuk et al that depression might be an important determinant of weight loss, we conducted an exploratory analysis of the relationship between depression and subsequent study outcomes in the ENERGY trial. There were no differences in weight loss, drop-out rate, or attendance at group or individual intervention sessions at any follow-up time point by depression status based on the CES-D score or diagnosis and treatment of depression. Thus, our data from a relatively large population of overweight and obese breast cancer survivors are not in agreement with those reported by Hryniuk et al. However, it must be noted that our population could have differed because we screened out individuals with severe depression and other disorders that may have been included in the Hryniuk et al sample. Nonetheless, based on our extensive experience with diet and weight-loss interventions in this population, we believe any weight control interventions in cancer survivors need to also address enduring psychosocial symptoms such as cancer-related fatigue and depression.

Background Optimal macronutrient distribution of weight loss diets has not been established. The distribution of energy from carbohydrate and fat has been observed to promote differential plasma lipid responses in previous weight loss studies, and insulin resistance status may interact with diet composition and affect weight loss and lipid responses. Methods and Results Overweight and obese women (n=245) were enrolled in a 1‐year behavioral weight loss intervention and randomly assigned to 1 of 3 study groups: a lower fat (20% energy), higher carbohydrate (65% energy) diet; a lower carbohydrate (45% energy), higher fat (35% energy) diet; or a walnut‐rich, higher fat (35% energy), lower carbohydrate (45% energy) diet. Blood samples and data available from 213 women at baseline and at 6 months were the focus of this analysis. Triglycerides, total cholesterol, and high‐ and low‐density lipoprotein cholesterol were quantified and compared between and within groups. Triglycerides decreased in all study arms at 6 months ( P P P< 0.05). Insulin sensitivity and C‐reactive protein levels also improved. Conclusions Weight loss was similar across the diet groups, although insulin‐sensitive women lost more weight with a lower fat, higher carbohydrate diet versus a higher fat, lower carbohydrate diet. The walnut‐rich, higher fat diet resulted in the most favorable changes in lipid levels. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 01424007.

Low circulating concentrations of vitamin D metabolites have been associated with increased risk for several diseases and clinical conditions. Large observational studies and surveys have shown that obesity is independently associated with lower serum 25-hydroxyvitamin D (25(OH)D) concentration. Few studies have examined the effect of weight loss on serum 25(OH)D concentration. The purpose of this study was to prospectively examine the effect of weight loss on serum 25(OH)D concentration. Data were collected from 383 overweight or obese women who participated in a 2-year clinical trial of a weight-loss program, in which 51% (N = 195) lost at least 5% of baseline weight by 24 months, 18% (N = 67) lost 5–10%, and 33% (N = 128) lost >10%. Women who did not lose weight at 24 months had an increase in serum 25(OH)D of 1.9 (9.7) ng/ml (mean (SD)); 25(OH)D increased by 2.7 (9.1) ng/ml for those who lost 5–10% of baseline weight; and 25(OH)D increased by 5.0 (9.2) ng/ml for those who lost >10% of baseline weight (P = 0.014). At baseline, 51% (N = 197) of participants met or exceeded the recommended serum concentration of 20 ng/ml. By study end, 64% (N = 230) of overweight or obese women met this goal, as well as 83% (N = 20) of those whose weight loss achieved a normal BMI. These findings suggest that weight loss, presumably associated with a reduction in body fat, is associated with increased serum 25(OH)D concentration in overweight or obese women.

Background Obesity is characterized by chronic mild inflammation and may influence the risk and progression of cancer. Purpose The current study is an exploratory analysis of the effect of a weight loss intervention that emphasized increased physical activity on inflammatory cytokines (tumor necrosis factor-α [TNF-α], interleukin-6 [IL-6], interleukin-8 [IL-8], and vascular endothelial growth factor [VEGF]) at the end of the 16-week intervention period in overweight breast cancer survivors. Methods Study participants averaged 56 years of age (N = 68). Intervention participants (n = 44 vs. 24 controls) participated in a cognitive behavioral therapy-based weight management program as part of an exploratory randomized trial. The intervention incorporated strategies to promote increased physical activity and diet modification. Baseline and 16-week data included height, weight, body composition, physical activity level, and biomarkers IL-6, IL-8, TNF-α, and VEGF. Results Weight loss was significantly greater in the intervention group than controls (−5.7 [3.5] vs. 0.2 [4.1] kg, P

OBJECTIVE. To investigate adolescent eating, activity, and behavioral patterns, and attitudes and their associations with obesity in selected communities in Indonesia. DESIGN. A cross-sectional questionnaire and physical measurement-based study in three communities of varying modernization levels in Indonesia (Yogyakarta, Kuta, and Jakarta). Subjects. 1758 middle school students (aged 12-15 years) recruited at six different schools: one public and one private school in each of the three target communities. MEASUREMENTS. The questionnaire collected data on demographic characteristics (age, gender, ethnicity, estimated household income); fast food eating habits (frequency, types of food/restaurant, general beliefs about fast foods); television, computer, and Play Station usage; physical activity (hrs/wk of participation in physical activity, transportation means for attending school); and eating habits (frequency of consuming selected foods and beverages). Student's height and weights were obtained, body mass index (BMI: weight [kg]/height [m(2)]) was calculated, and obesity was defined as ≥95%, using the BMI-for-age cut-offs from the Centers for Disease Control and Prevention (CDC) charts. RESULTS. Chi-square analysis revealed associations between obesity and community setting, family income, use of a computer or Play Station, type of transportation to school, and beliefs about fast foods (P0.01). According to the logistic regression analysis, adolescents from families with incomes over Rp 2 mil were three times as likely to be obese (95% CI 1.9, 4.9) and boys were 2.6 times more likely to be obese (95% CI 1.5, 4.5). CONCLUSION. Greater likelihood of obesity among Indonesian adolescents who spend greater amounts of time using a computer or Play Station suggests that such sedentary activities may be replacing physical activity, promoting an energy imbalance, and subsequently, an increased risk for obesity.

Purpose Obesity increases risk for all-cause and breast cancer mortality and comorbidities in women who have been diagnosed and treated for breast cancer. The Exercise and Nutrition to Enhance Recovery and Good Health for You (ENERGY) study is the largest weight loss intervention trial among survivors of breast cancer to date. Methods In this multicenter trial, 692 overweight/obese women who were, on average, 2 years since primary treatment for early-stage breast cancer were randomly assigned to either a group-based behavioral intervention, supplemented with telephone counseling and tailored newsletters, to support weight loss or a less intensive control intervention and observed for 2 years. Weight and blood pressure were measured at 6, 12, 18, and 24 months. Longitudinal mixed models were used to analyze change over time. Results At 12 months, mean weight loss was 6.0% of initial weight in the intervention group and 1.5% in the control group (P < .001). At 24 months, mean weight loss in the intervention and control groups was 3.7% and 1.3%, respectively (P < .001). Favorable effects of the intervention on physical activity and blood pressure were observed. The weight loss intervention was more effective among women older than 55 years than among younger women. Conclusion A behavioral weight loss intervention can lead to clinically meaningful weight loss in overweight/obese survivors of breast cancer. These findings support the need to conduct additional studies to test methods that support sustained weight loss and to examine the potential benefit of intentional weight loss on breast cancer recurrence and survival.

Understanding the degree to which eating behaviors, such as disinhibition and restraint, are associated with weight loss and weight loss maintenance could contribute to further refinement of effective weight management intervention strategies. The purpose of this analysis was to examine if these factors mediate weight loss or weight loss maintenance using data from a randomized controlled trial testing a commercial weight loss program that delivered behavioral counseling and structured meal plans including prepackaged foods. Mediation analyses were used to examine whether changes in disinhibition and restraint mediated the relationship between intervention and weight change during initial weight loss (0-6 months), continued weight loss (6-12 months), or weight loss maintenance (12-24 months) phases. Only decreases in disinhibition between baseline and 6 months mediated the intervention effect on initial weight loss. Our results suggest the mediation effects of these eating behaviors are modest and other factors contribute to a larger, more complex long-term weight loss prognosis.

The effect of participation in a diet intervention study on self-reported quality of life (QOL) with subjects at risk of recurrence of colorectal adenomas was explored in 77 men and women, aged 18-80 years, with a history of adenomatous polyps. Participants were randomly assigned to intervention and control groups and followed for one year. Dietary goals for the intervention group included reduced intake of fat and increased intakes of fiber, calcium, and vegetables and fruit. Diet counseling was provided by telephone. Anthropometric measurements were obtained and dietary intakes were assessed at baseline, six and 12 months. The Quality of Life Factors questionnaire (QF), designed to explore the absolute effects of the diet intervention on participants’ perceived QOL, was administered at baseline and study end. Based on repeated 24-hour dietary recalls, the intervention group reported significantly higher consumption of vegetables, fruit, low-fat dairy products, fiber, and calcium at 12 months. There were no significant differences in total QF scores for the two groups at study end, and no significant changes within groups between baseline and study end. Findings suggest that even though the intervention participants made significant modifications in their eating behavior, these changes did not impact their perceived QOL negatively.

Objective To describe the performance characteristics and validate a folate-specific focused recall approach to estimating folate intake. Design In a cross-sectional study, folate-specific recalls were used to estimate subjects' average daily folate intake from seven days of dietary recall over a one-month period. This estimate was compared to an estimate of the average daily folate intake obtained using the Fred Hutchinson Cancer Research Center Food Frequency Questionnaire (FFQ) and to plasma folate and homocysteine concentrations. Subjects Subjects were women aged 21 to 47 years and were recruited from the university community. Thirty-three subjects were recruited, and 28 subjects completed the study. Intervention After an initial clinic visit, during which a baseline blood sample was collected for measurement of plasma folate and total homocysteine concentrations, subjects participated in focused dietary recall interviews by telephone and/or Internet (e-mail). At the end of the month, subjects completed the FFQ. Main outcome measures The main outcome measures were to describe how well the focused recalls were able to describe relative dietary folate intake as compared to the FFQ and if the focused recall method estimate correlated with plasma folate and homocysteine concentrations. Statistical analyses Estimated folate intakes were ranked by tertiles using the two dietary assessment approaches and the rankings were compared. The Spearman correlation test was used to compare the focused recall and the FFQ dietary data to plasma folate and homocysteine concentrations. Results Estimated folate intake inclusive of supplements was 411.4±192.8 (mean±SD) μg/day based on focused recalls and 458.5±221.5 μg/day based on the FFQ. Exclusive of supplements, estimated folate intake from the diet was 327.8±30.2 μg/day based on focused recalls and 373.5±155.6 μg/day based on the FFQ. The ranking comparison of focused recalls vs the FFQ demonstrated a concordance of 44% without supplements and 67% with supplements for the highest tertile, and 56% without supplements and 67% with supplements for the lowest tertile. Estimated folate intake based on focused recalls was correlated significantly with plasma homocysteine ( r =−0.443, P r =0.354; P =.06) concentrations. Applications A focused dietary recall approach is a useful method for collecting information on folate intake in women. Estimated folate intake based on the focused recall approach is reasonably correlated with plasma folate and total homocysteine concentrations even in this small sample of women. Accurate data on folate intake can form the basis of dietary counseling to increase intake of this important micronutrient in the target population of young women. J Am Diet Assoc. 2003;103:991-1000.

OBJECTIVE To test whether a weight loss program promotes greater weight loss, glycemic control, and improved cardiovascular disease risk factors compared with control conditions and whether there is a differential response to higher versus lower carbohydrate intake. RESEARCH DESIGN AND METHODS This randomized controlled trial at two university medical centers enrolled 227 overweight or obese adults with type 2 diabetes and assigned them to parallel in-person diet and exercise counseling, with prepackaged foods in a planned menu during the initial phase, or to usual care (UC; two weight loss counseling sessions and monthly contacts). RESULTS Relative weight loss was 7.4% (95% CI 5.7–9.2%), 9.0% (7.1–10.9%), and 2.5% (1.3–3.8%) for the lower fat, lower carbohydrate, and UC groups (P < 0.001 intervention effect). Glycemic control markers and triglyceride levels were lower in the intervention groups compared with UC group at 1 year (fasting glucose 141 [95% CI 133–149] vs. 159 [144–174] mg/dL, P = 0.023; hemoglobin A1c 6.9% [6.6–7.1%] vs. 7.5% [7.1–7.9%] or 52 [49–54] vs. 58 [54–63] mmol/mol, P = 0.001; triglycerides 148 [134–163] vs. 204 [173–234] mg/dL, P < 0.001). The lower versus higher carbohydrate groups maintained lower hemoglobin A1c (6.6% [95% CI 6.3–6.8%] vs. 7.2% [6.8–7.5%] or 49 [45–51] vs. 55 [51–58] mmol/mol) at 1 year (P = 0.008). CONCLUSIONS The weight loss program resulted in greater weight loss and improved glycemic control in type 2 diabetes.

Objectives.Source case finding in San Diego, California, rarely detects the source for children with tuberculosis (TB) infection or disease. One third of all pediatric TB isolates in San Diego are Mycobacterium bovis, a strain associated with raw dairy products. This study was conducted to determine risk factors for TB infection in San Diego.Design.Case-control study of children ≤5 years old screened for TB as part of routine health care visit. Asymptomatic children with a positive (≥10 mm) Mantoux skin test (TST) were matched by age to 1 to 2 children with negative TST from the same clinic. We assessed risk factors for TB infection through parental interview and chart review.Results.A total of 62 cases and 97 controls were enrolled. Eleven cases and 25 controls were excluded from analysis because of previous positive skin tests. Compared with controls, cases were more likely to have received BCG vaccine (73% vs 7%, odds ratio [OR] 44), to be foreign born (35% vs 11%, OR 4.3), and to have eaten raw milk or cheese (21% vs 8%, OR 3.76). The median time between the most recent previous TST and the current test was 12 months for cases and 25 months for controls. Other factors associated with a positive TST included foreign travel, staying in a home while out of the country, and having a relative with a positive TST. There was no association between contact with a known TB case. In a multivariable model, receipt of BCG, contact with a relative with a positive TST, and having a previous TST within the past year were independently associated with TB infection.Conclusions.We identified several new or reemerging associations with positive TST including cross border travel, staying in a foreign home, and eating raw dairy products. The strong associations with BCG receipt and more recent previous TST may represent falsely positive reactions, booster phenomena, or may be markers for a population that is truly at greater risk for TB infection. Unlike studies conducted in nonborder areas, we found no association between positive TB skin tests and contact with a TB case or a foreign visitor. Efforts to control pediatric TB in San Diego need to address local risk factors including consumption of unpasteurized dairy products and cross-border travel. The interpretation of a positive TST in a young child in San Diego who has received BCG is problematic.

Background Weight loss is associated with improvements in cardiometabolic risk factors, including serum glucose, insulin, C‐reactive protein, and blood lipids. Few studies have evaluated the long‐term (>18 months) effect of weight loss on these risk factors or sought to identify factors associated with sustained improvements in these measures. Methods and Results In 417 overweight/obese women (mean [ SD ] age, 44 [10] years) participating in a weight loss trial, we sought to identify predictors of weight loss–associated cardiometabolic risk factors after 12 and 24 months of intervention. Total cholesterol ( TC ), low‐density lipoprotein (LDL)–cholesterol (LDL‐C), high‐density lipoprotein ( HDL )–cholesterol, non‐ HDL ‐cholesterol, triglycerides (TG), insulin, glucose, C‐reactive protein (CRP), and cardiopulmonary fitness were measured at baseline and at 12 and 24 months. After 24 months, significant reductions in body weight, waist circumference, CRP, TC, HDL ‐cholesterol, and non‐ HDL ‐cholesterol were observed ( P HDL ‐cholesterol were reduced regardless of the amount of weight lost, whereas reductions in LDL–cholesterol, CRP, insulin, and TG were observed only in those who lost ≥10% body weight. Step‐test performance improved only in those who lost ≥10% body weight after 24 months. Change in weight demonstrated a positive predictive value for change in cholesterol, insulin, glucose, and triglycerides. Baseline level of the biomarker showed the greatest predictive value for follow‐up measures for insulin, cholesterol, glucose, and triglycerides. Conclusions Our data extend the results from short‐term weight loss trials and suggest that the magnitude of weight loss and baseline values for risk factors are associated with improvements in cardiometabolic risk factors even after 24 months. Clinical Trials Registration Information URL: http://www.clinicaltrials.gov/ . Unique identifier: NCT00640900.

In a longitudinal study, following a community sample (N = 386) from age 5, early risk factors for depressive symptomatology at age 18 were examined separately for females and males. For females, predictors included low birthweight and death of a parent; for males, they included emotional dependency and internalizing behavior problems. Depressive symptomatology at age 15 emerged as an important risk factor for both genders. Clinical implications are discussed, and areas for further research are proposed.

Objective The prevalence of DSM-III-R traumas and posttraumatic stress disorder (PTSD) and their impact on psychosocial functioning were examined in a community population of older adolescents. Method Subjects were 384 adolescents participating in an ongoing longitudinal study. When subjects were aged 18 years, the NIMH Diagnostic Interview Schedule, Version IIIR, was used to identify lifetime traumatic events and diagnoses of PTSD, major depression, phobias, and substance dependence. Behavioral, emotional, and academic functioning in later adolescence was evaluated through self-report measures and school records. Results More than two fifths of adolescents experienced at least one DSM-III-R trauma by age 18 years; PTSD developed in 14.5% of these affected youths or 6.3% of the total sample. Youths with PTSD demonstrated widespread impairment at age 18, including more overall behavioral-emotional problems, interpersonal problems, academic failure, suicidal behavior, and health problems, as well as an increased risk for additional disorders. An equally striking finding was that youths who experienced traumas but did not develop PTSD also showed deficits in many of these areas when compared with their peers who had not experienced traumas. Conclusions The substantial risk faced by youths in community settings for experiencing traumas and PTSD, along with associated impairments in later adolescence, underscores the need for programs of prompt intervention.

Social, academic, emotional functioning and social support of 99 ninth-grade Asian American students were investigated using standardized measures. When compared to 404 ninth-grade Caucasian adolescents who had attended the same school, Asian American students exhibited less delinquent behavior and performed better academically. However, they were significantly more isolated, more depressed and anxious, less apt to be involved in after school activities or seek help for their problems, and internalized their social problems. Also, they had fewer role models and less social support, underscoring the psychosocial and emotional plight of Asian American adolescents and the dire need to establish proactive outreach programs.

Objective An ongoing, 14-year, longitudinal community study examined psychosocial risks for adolescent suicidal ideation and attempts, as well as the link between earlier suicidal behavior and later functioning. Method Nearly 400 youths were followed between the ages of 5 and 18 years. Suicidal ideation was assessed at age 15 and lifetime suicide attempts were determined at age 18. Risk factors covered developmental periods from birth to age 15, and most were measured prospectively using multiple informants. Late-adolescent functioning (at age 18) was based on both self-reports and school records. Results For both genders, the early onset (by age 14) of psychiatric disorders significantly increased the risk for suicidal ideation at age 15 and suicide attempts by age 18. Early gender-specific risks for suicidal ideation included preschool behaviors that are counter to typical gender norms, such as aggressive behavior in females and dependence in males. Suicidal ideation at age 15 and suicide attempts were both associated with deficits in later adolescence (at age 18) in behavioral and social-emotional functioning. Conclusions Suicidal ideation at age 15 was a marker of distress with long-term implications for later functioning. The early gender-specific risk factors for suicidal behavior identified in this study can aid in developing strategies for prevention and early intervention.

Obesity is associated with an increased risk for recurrence and all-cause mortality in breast cancer survivors. Excess adiposity is associated with increased estrogen, insulin, and leptin, and with decreased sex hormone binding globulin (SHBG) concentrations, which may promote breast cancer progression and recurrence. This study aimed to assess the effects of weight loss on these factors.Breast cancer survivors who were overweight or obese (n = 220) and who were enrolled in a weight loss intervention study provided baseline and follow-up blood samples and weight data. Serum estrogens, SHBG, insulin, and leptin were measured at baseline, 6 months, and 18 months.Weight loss of ≥5% of initial weight decreased leptin and insulin compared with those who did not achieve that amount of weight loss (P.0001). Weight loss also increased SHBG at 6 and 18 months (P.01). Postmenopausal women who lost ≥5% of body weight at 6 months had lower estrone (P = .02), estradiol (P = .002), and bioavailable estradiol (P = .001) concentrations than women who did not lose at least 5% of body weight, and weight loss at 18 months was significantly related to a change in serum bioavailable estradiol concentration (P = .02).Favorable changes in estrogens, SHBG, insulin, and leptin were observed in association with weight loss in these women who were overweight or obese and who had been diagnosed and treated for breast cancer. Weight loss appears to have favorable effects on hormonal and biologic factors associated with increased risk for recurrence and poorer prognosis.

In a community study of 386 Caucasian working-class older adolescents, a sizeable proportion met lifetime criteria for selected DSM-III-R diagnoses. Alcohol abuse/dependence had the highest lifetime prevalence rate (32.4%), followed by phobias (22.8%), drug abuse/dependence (9.8%), major depression (9.4%), and, least commonly, post-traumatic stress disorder (6.3%) and obsessive compulsive disorder (2.1%). Significant gender differences were found for major depression, post-traumatic stress disorder, and alcohol abuse/dependence, whereas socioeconomic differences occurred in major depression, phobias, and drug abuse/dependence. Adolescents with specific psychiatric disorders had significantly poorer functioning on measures of behavioral problems, interpersonal problems, self-esteem, and school performance. Results suggest the importance of identifying psychiatric disorder in adolescence, and the need for preventive strategies and prompt treatment.

In a sample of 404 White adolescents (mean age 14.5 years) from working-class families, striking similarities were found for both genders in levels and correlates of antisocial behavior. Aggressive conduct was most strongly associated with delinquent behavior. Also, both genders reported interpersonal difficulties with intimate relationships and family, including large numbers of breakups with close friends and escalating numbers of arguments with parents. In spite of these interpersonal difficulties, antisocial youth indicated less need for positive feedback. Different, but related, internalizing behaviors were noted for both genders. Antisocial boys had low self-esteem and girls had more depressive symptoms. Additionally, boys perceived their families as lacking cohesion and girls were more affected by parental marital disruption. Only antisocial girls indicated low levels of involvement in school-related activities. Maternal reports also noted girls' unproductivity. Implications of accurate identification of correlates of antisocial behavior are discussed.

In a sample of White working-class adolescents, 21% scored above 12 on the Children's Depression Inventory (CDI), with almost twice as many girls as boys in the high-CDI group. Maternal and adolescent reports indicated deficits in most areas of adolescent functioning in the high-CDI group. Within the high-CDI group, no differences in social class and family structure were found. No gender differences emerged for most correlates of depressive symptoms; both high-CDI boys and girls displayed coexisting internalizing and externalizing behaviors, including sad affect, withdrawal, antisocial behaviors, and substance abuse. Three differences appeared between high-CDI boys and girls. High-CDI boys considered themselves more unpopular, whereas high-CD! girls were seen as more externalizing by their mothers and more smoked than did high-CDI boys. Implications for interventions and research are discussed.

As part of an ongoing ten-year longitudinal research project, 382 15-year-olds from a white, working-class community were studied. Findings indicate that those who experienced parental separation more recently were most likely to be adversely affected, and that girls from recently disrupted families were more likely than boys to experience problems in emotional and behavioral functioning and were likely to express dissatisfaction with available levels of social support.

ROCK, CHERYL L., BILGE PAKIZ, SHIRLEY W. FLATT, AND ELIZABETH L. QUINTANA. Randomized trial of a multifaceted commercial weight loss program. Obesity. 2007;15:939–949. Objective: To test whether a commercial weight loss program promotes greater weight loss in overweight or obese women compared with control conditions and to describe the effect on plasma lipids, carotenoids, hormones, and fitness. Research Methods and Procedures: Overweight or obese women were randomized to commercial weight loss program or control conditions (n 35 each). Results: At randomization, participants were 41.1 (11.4) (mean [standard deviation]) years, BMI 34.0 (3.5) kg/m 2 , and weight 92.0 (11.1) kg. At 6 months, change in weight by intent-to-treat (ITT) analysis was 7.2 (6.7) kg and 7.8% (7.2%) in the intervention group vs. 0.3 (3.9) kg and 0.3% (4.5%) in the control group (n 35 for each; p 0.01). One-year ITT analysis revealed significantly greater change in weight, percent weight, BMI, and waist and hip circumferences in the intervention vs. control group. Completers at 1 year exhibited change in weight of 7.3 (10.4) kg for the intervention group (n 32) vs. 0.7 (5.6) kg for controls (n 33) (p 0.01), and 7.8% (11.1%) weight change for the intervention group vs. 0.7% (6.2%) for controls (p 0.01). High-density lipoprotein (HDL) cholesterol concentration increased significantly in the intervention group. Fasting serum insulin decreased in the intervention but increased in the control group at 6 months (p 0.01), remaining different at 1 year (p 0.05). Discussion: The commercial program successfully facilitated weight loss, which was notably maintained at 1 year, and promoted favorable changes in plasma lipid and hormone concentrations.

Overweight or obesity is an established negative prognostic factor in breast cancer. Co-morbidities associated with obesity, including cardiovascular disease (CVD), may negatively impact quality of life and survival in this population. Our purpose was to determine the effect of a cognitive behavioral therapy (CBT) intervention for weight loss through exercise and diet modification on risk factors for recurrence of breast cancer, and risks for CVD associated with obesity. Eighty-five overweight or obese breast cancer survivors were randomly assigned to a once weekly, 16-week intervention or wait-list control group. The intervention incorporated elements of CBT for obesity, addressing a reduction in energy intake, as well exercise, with a goal of an average of 1 h a day of moderate to vigorous activity. Body weight, total and regional body fat (by dual energy X-ray absorptiometry), waist and hip circumference, and blood lipids were assessed at baseline and following 16 weeks of intervention. Results: Seventy six women (89.4%) completed the intervention. Independent t-test to evaluate group differences at 16 weeks showed significant differences in weight, body mass index, percent fat, trunk fat, leg fat, as well as waist and hip circumference between intervention and control groups (P ≤ 0.05). Furthermore, levels of triglycerides and total cholesterol/high density lipoprotein cholesterol levels were also significantly reduced following the intervention. These results indicate that 16 weeks of a CBT program for weight management may reduce obesity and CVD risk in overweight breast cancer survivors.

Psychosocial problems such as depression are present as long-term sequelae of breast cancer and its treatment in a substantial minority of patients. In general and patient populations, lifestyle factors such as obesity and physical activity have been associated with depression, and these and related characteristics may be associated with depression in breast cancer survivors. The purpose of this cross-sectional study was to examine factors associated with depression in overweight or obese women (n=85) who had been diagnosed and treated for early stage breast cancer. Depressive symptoms were measured with the Beck depression inventory (BDI), eating psychopathology was assessed with the eating disorder examination—questionnaire (EDE-Q), and physical activity was estimated with the seven-day physical activity recall. BDI was directly correlated with global EDE-Q score (r=0.56, P

Data collected over a period of 18 years were analyzed vis-a-vis risk factors for serious antisocial behavior in 375 young adults living in the community. Early aggression and hostility, acting-out behavior, academic difficulties, and negative family environment were identified as precursors of later deviance, and different patterns were found for males and females.

Objective Ages of onset of psychiatric disorders, as well as the link between early onset and later psychosocial functioning, were examined in a community population of older adolescents. Method Subjects were 386 adolescents who were participants in an ongoing 14-year longitudinal study. At age 18, lifetime diagnoses and ages of onset of major depression, phobias, post-traumatic stress disorder, and substance disorders were assessed using the NIMH Diagnostic Interview Schedule, Revised Version. Behavioral, emotional, and academic functioning in later adolescence were evaluated through self-report measures and school records. Results Almost one fourth of the adolescents met criteria for at least one disorder by age 14. Simple phobias emerged earliest (by early childhood), whereas for major depression and substance disorders the peak risk periods for onset were midadolescence. The early onset (by age 14) disorders was associated with continued impairments in behavioral and emotional functioning in late adolescence at age 18). Furthermore, the early onset of disorders, compared to later onset (ages 15 through 18), increased the risk for additional co-occurring disorders. Conclusions The striking levels of early psychopathology and associated long-term deficits in functioning found in this community population underscore the need for programs of early intervention.

Objective An ongoing 14-year longitudinal study examined psychosocial antecedents of major depression in late adolescence in a community population. Method Subjects were 385 adolescents followed between the ages of 5 and 18 years. Early health, familial, behavior, academic, and environmental risks for major depression were identified using data collected at ages 5, 9, 15, and 18 years. At age 18, a lifetime diagnosis of major depression was assessed using the NIMH Diagnostic Interview Schedule (DIS-III-R). Results For males, neonatal health problems, dependence problems at age 5 years, perceived unpopularity and poorer perceptions of their role in the family at age 9 years, remarriage of a parent, early family discord, and anxiety at age 15 years significantly increased the risk of developing major depression. Females with major depression, compared with nondepressed females, had older parents and came from larger families, and at age 9 years had greater perceived unpopularity and anxiety, lower self-esteem, and poorer perceptions of their role in the family. Depressed females also reported, more stressful life events, including death of parent and pregnancy. Conclusions Underscoring the importance of early psychosocial factors in the later development of major depression and pointing to specific risks, our findings can aid in developing strategies for prevention and early intervention. J. Am. Acad. Child Adolesc. Psychiatry , 1993, 32, 6:1155–1163.

Context The prevalence of overweight and obesity in the United States remains high. Commercial weight loss programs may contribute to efforts to reduce the prevalence of overweight and obesity, although few studies have examined their efficacy in controlled trials. Objective To test whether a free prepared meal and incentivized structured weight loss program promotes greater weight loss and weight loss maintenance at 2 years compared with usual care. Design, Setting, and Participants A randomized controlled trial of weight loss and weight loss maintenance in 442 overweight or obese women (body mass index, 25-40) aged 18 to 69 years (mean age, 44 years) conducted at US institutions over 2 years with follow-up between November 2007 and April 2010. Intervention The program, which involves in-person center-based or telephone-based one-to-one weight loss counseling, was available over a 2-year period. Behavioral goals were an energy-reduced, nutritionally adequate diet, facilitated by the inclusion of prepackaged food items in a planned menu during the initial weight loss phase, and increased physical activity. Participants assigned to usual care received 2 individualized weight loss counseling sessions with a dietetics professional and monthly contacts. Main Outcome Measures Weight loss and weight loss maintenance. Results Weight data were available at 24 months for 407 women (92.1% of the study sample). In an intent-to-treat analysis with baseline value substitution, mean weight loss was 7.4 kg (95% confidence interval [CI], 6.1-8.7 kg) or 7.9% (95% CI, 6.5%-9.3%) of initial weight at 24 months for the center-based group, 6.2 kg (95% CI, 4.9-7.6 kg) or 6.8% (95% CI, 5.2%-8.4%) for the telephone-based group, and 2.0 kg (95% CI, 0.6-3.3 kg) or 2.1% (95% CI, 0.7%-3.5%) for the usual care control group after 24 months (P Conclusion Compared with usual care, this structured weight loss program resulted in greater weight loss over 2 years. Trial Registration clinicaltrials.gov Identifier: NCT00640900