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Background Many healthcare professionals (HCPs) feel uncomfortable and incompetent talking about weight with children with overweight and obesity and their parents. To optimally target interventions that can improve obesity care for children, we assessed the self-efficacy (SE) and perceived barriers (PBs) of Dutch HCPs with regard to talking about weight and lifestyle when treating children with overweight or obesity. We also analyzed interdisciplinary differences. Methods A newly developed, practice- and literature-based questionnaire was completed by 578 HCPs from seven disciplines. ANOVA and chi-square tests were used to analyze interdisciplinary differences on SE, PBs, and the effort to discuss weight and lifestyle despite barriers. Regression analyses were used to check whether age, sex or work experience influenced interdisciplinary differences. Results On average, the reported score on SE was 7.2 (SD 1.2; scale 1–10) and the mean number of PBs was 4.0 (SD 2.3). The majority of HCPs (94.6%) reported perceiving one or more barriers (range 0–12 out of 17). HCPs who in most cases perceived too many barriers to discuss weight and lifestyle of the child (9.6%, n = 55) reported a lower SE (mean 6.3) than professionals who were likely to discuss these topics (mean SE 7.3, p p > 0.05). In total, 14.2% (n = 82) of HCPs either felt incapable (SE ≤ 5) or reported that in most cases they did not address weight and lifestyle due to PBs. Conclusions Although on average Dutch HCPs rated their self-efficacy as fairly good, for a subgroup major improvements are necessary to lower perceived barriers and improve self-efficacy, in order to improve the quality of care for Dutch children with obesity.

The relationship between BMI and relative mortality risk is J- or U-shaped; both a low and a high BMI are related to increased risk of mortality.- When analyses are restricted to healthy individuals who are non-smokers and are followed up for a long time, the relative mortality risk is already increased at a BMI of 25 kg/m² and increases further with increasing BMI.- There are people with obesity who do not have significant cardiovascular risk factors, but even so they are at increased risk of cardiovascular disease compared to people who are not overweight and lack risk factors.- People with severe illnesses often experience weight loss and - at the same time - are at increased risk of premature death, and therefore it appears that overweightness is associated with a favourable prognosis.- The observation that overweight and obese people are not linked to increased mortality can largely be explained by methodological sources of bias.

To investigate the association between home environmental determinants of fruit and vegetable consumption with childhood overweight separately for low, medium and high social economic status (SES) families.A cross-sectional study was carried out in 2006 among 4072 children aged 4-13 years in the city of Zwolle, the Netherlands. Of these children, data were available on measured height and weight, and from a parental questionnaire, on sociodemographic characteristics and children's fruit and vegetables intake. Associations were studied using logistic regression analyses.Not eating the recommended amounts of vegetables daily was associated with overweight for children with a low SES background (odds ratio [OR]: 1.17; 95% confidence interval [CI]: 0.66-2.07) and medium SES background (OR: 1.73; 95% CI: 1.20-2.49). Eating 2 pieces of fruit daily was associated with a lower OR for overweight among children with a high SES background (OR: 0.66; 95% CI: 0.50-0.88). Determinants of eating vegetables 7 d were: permission to take candy without asking, eating at the table 7 d per week, eating a takeaway meal ≥ 1 d per week, eating a home cooked meal 6 d per week and cooking together with caregiver less than 5 d per week.Interventions regarding vegetable consumption should be tailored to families with low and medium SES background. The most promising avenues for intervention seem to be (i) to prevent eating takeaway meals on a weekly basis and, (ii) to promote eating a home cooked meal at the table and (iii) to involve children in the cooking process. Interventions should support parents in making these home environmental changes.

To evaluate the effects of a counselling intervention on excessive weight gain during pregnancy and postpartum weight retention.The New Life(style) study was a randomised trial with a control group (n = 113) and an intervention group (n = 106).Midwife practices in the Netherlands.Women with a healthy pregnancy, expecting their first baby.The intervention consisted of four face-to-face counselling sessions about weight, physical activity and diet during pregnancy, and one session by telephone after delivery.Weight was objectively assessed at 15, 25 and 35 weeks of gestation, and again at 8, 26 and 52 weeks postpartum. In regression models, the intervention effect on gestational weight gain and postpartum weight retention was assessed.Women gained on average 11.3 kg (SD 3.7 kg) from early to late pregnancy. Women were 1.0 kg (SD 5.3 kg) lighter at 52 weeks postpartum compared with early pregnancy. The intervention had no effect on gestational weight gain (B = -0.05; 95% CI -1.10 to 1.00) or postpartum weight (B = 0.94; 95% CI -2.41 to 0.53) in the total study group. In a subgroup of overweight and obese women (n = 47), a favourable trend on all outcomes was observed, but none of the differences were statistically significant.The lifestyle counselling intervention evaluated in this study did not have an effect on excessive weight gain or postpartum weight retention. Our findings for overweight and obese women need to be confirmed in a larger, well-designed randomised trial.

In a previous study, the effectiveness of introducing a small meal in addition to the existing size and a proportional pricing strategy have been assessed in Dutch worksite cafeterias. To assess the degree of implementation and to inform the design of future interventions, the present study aimed to describe the process evaluation of both interventions. Process evaluation components from Baranowski and Stables, and Rogers (i.e. Recruitment, Maintenance, Context, Resources, Implementation, Exposure, Contamination, and Continued use) were chosen as a theoretical basis. The process evaluation involved qualitative (e.g. structured observations, semi-structured interviews) and quantitative data (e.g. consumer questionnaires) collected from 17 intervention and eight control worksite cafeterias. In all intervention cafeterias, two portion sizes were offered. The pricing instructions were followed in 13 intervention cafeterias. The cafeterias managers indicated that they did not consider offering large and small meals as being complex, risky or time-consuming to implement. Some managers perceived the consumer demand as high, others as (too) low. One year after the study had ended, nine of the intervention cafeterias had continued (at least partly) to follow the protocol. Offering a smaller portion size in addition to the existing size, as well as proportional pricing, was generally implemented as prescribed by the protocol and can be considered promising in terms of continued use. However, additional efforts are needed to make the intervention more effective in motivating consumers to replace their large portion with a small portion.

This study aims to improve comparability of available data within the World Health Organization (WHO) European Region taking into account differences related to the aging of the population. Surveys were included if they were conducted on adults aged 25-64 years between 1985 and 2010 in the WHO European Region. Overweight/obesity prevalences were adjusted to the European standard population aged 25-64. Data were entered for each of the 5-year categories between 1981 and 2010. Measured height and weight data were available for males in 16 and females in 24 of the 53 countries. The 50-64-year-olds had higher prevalence of overweight and obesity as compared to the 25-49-year-olds. This pattern occurs in every country, by male and female, in almost all surveys. Age-standardized overweight prevalence was higher among males than females in all countries. Trend data showed increases in most countries. Age-standardized maps were based on self-reported data because of insufficient availability of measured data. Results showed more countries with available data as well as the higher category of obesity in the later surveys. Measured values are needed and age adjustment is important in documenting emerging overweight and obesity trends, independent of demographic changes, in the WHO European Region.

Migrants from Turkey and Morocco are among the largest ethnic minority groups in several European countries. In this review, we aimed to systematically search, assess and describe the available literature on cardiovascular disease (CVD), obesity and other endogenous cardiovascular risk factors among these groups. Although the number of publications covering this topic among Turkish and Moroccan migrants has increased in the past decades, studies among these groups, especially the Moroccan, are still limited. There is a particular lack of information on CVD mortality and morbidity rates. Furthermore, studies are often hampered by low participation rates, small sample sizes and self-reported data. This further complicates drawing sound conclusions on CVD and risk factors among these migrant groups. The results with regard to CVD morbidity and mortality rates are inconclusive. With regard to CVD risk factors, we tentatively conclude that obesity and diabetes are more common among Turkish and Moroccan migrant groups in Europe than the western European population. In the Turkish population there is also a fair amount of evidence for unfavourable high-density lipoprotein cholesterol levels. However, more research on this topic among these major ethnic minorities is of high importance.

Excess weight in early life is believed to increase susceptibility to obesity, and in support of such theory, excess weight and fast weight gain in early childhood have been related to overweight later in life. The aim of this study was to review the literature on body size and growth in 0- to 4-year-old children and the association with body size at age 5-13 years. In total, 43 observational studies on body size and/or growth were included, of which 24 studies had been published in 2005 or later. Twenty-one studies considered body size at baseline, and 31 studies considered growth which all included assessment of weight gain. Eight (38%) studies on body size, and 15 (48%) on weight gain were evaluated as high-quality studies. Our results support conclusions in previous reviews of a positive association between body size and weight gain in early childhood, and subsequent body size. Body size at 5-6 months of age and later and weight gain at 0-2 years of age were consistently positively associated with high subsequent body size. Results in this review were mainly based on studies from developed Western countries, but seven studies from developing countries showed similar results to those from developed countries.

Chin A Paw M, Slootmaker S, Schuit A, Seidell J, Van Mechelen W. Haalbaarheid en effectiviteit van een online beweegadvies. Huisarts Wet 2010;53(11):595-600.

The combination of a masculine type of fat distribution, hypertension, atherosclerosis, and type 2 diabetes mellitus occurs more often in individuals than on the basis of chance alone. Two reasons to call a clustering of clinical signs and symptoms a syndrome are that this leads to improved diagnosis and prognosis in individuals and that the syndrome provides insight into the underlying pathophysiological mechanisms. However, individuals with the metabolic syndrome have no appreciably higher risk of coronary disease than would be expected from the presence of the individual risk factors. In addition, individuals with the syndrome may manifest many different subsets of risk factors, a sign of obscure pathophysiology. Finally, there is no treatment for the metabolic syndrome other than treatment for each of its components. Therefore, the metabolic syndrome does not exist.

To evaluate the relation between common variants in the ATP-sensitive K+ channel genes and glucose intolerance.We conducted a meta-analysis of reported association studies in Caucasian populations for common variants in the ABCC8 (exons 16 and 18) and the KCNJ11 (E23K) gene and examined sources of heterogeneity in the results. The meta-analysis was based on 7768-10216 subjects (depending on the gene variant), and included two new population-based studies in the Netherlands with 725 cases and 742 controls.For the KCNJ11 variant, the summary odds ratio (OR) for glucose intolerance was 1.12 (1.01-1.23, P=0.03) for the EK genotype and 1.44 (1.17-1.78, P=0.0007) for the KK genotype, as compared with the EE genotype. For the ABCC8 exon 16 variant, the OR was 1.06 (0.94-1.19, P=0.34) for ct and 0.93 (0.71-1.20, P=0.56) for tt, as compared with the cc genotype. For ABCC8 exon 18, the OR was 1.20 (0.97-1.49, P=0.10) for CT/TT, as compared with the CC genotype. Studies of the ABCC8 variants that were published first or had smaller sample sizes (for the exon 18 variant) showed stronger associations, which may indicate publication bias. For the ABCC8 exon 18 and the KCNJ11 variant, associations were stronger for studies of clinical diabetes than newly detected glucose intolerance. The population attributable risk for clinical Type 2 diabetes was 6.2% for the KCNJ11 KK genotype and 10.1% for the KCNJ11 EK and KK genotype combined.The common KCNJ11 E23K gene variant, but not the ABCC8 exon 16 or exon 18 variant, was consistently associated with Type 2 diabetes.

The Body Mass Index (BMI) is used as a measure of overweight and obesity. In epidemiological studies age, sex and ethnic background all have to be taken into consideration, particularly when determining the health risk caused by the amount of body fat. --Caution should be observed when using the BMI as a measure for interpreting overweight and obesity as body composition can be highly variable yet have the same BMI. Therefore, BMI is not a reliable measurement of body composition in individuals particularly in older and younger people. --Excess body fat in the visceral depot poses a separate health risk. The BMI does not give any insight into regional body fat distribution. Waist circumference is a valid index of visceral fat accumulation and can therefore be used as an indicator of health risks associated with visceral obesity.

The prevalence of overweight and obesity in children is increasing rapidly. This is alarming because obesity is associated with severe chronic diseases, such as type 2 diabetes mellitus. Obesity at young age is related to obesity at adult age. Consequently, the prevention of overweight from childhood onwards is an important issue. Apart from diabetes mellitus type 2 there is an increased risk of orthopaedic complications, respiratory problems, fertility problems, cardiovascular diseases and psychosocial consequences in the form of a negative self-image, emotional and behavioural problems and depression. Environmental and behavioural factors are regarded as the most important causes of the rapid increase in the prevalence of overweight and as the most important starting points for prevention. Most prevention programmes are still in the initial stages. Prevention programmes aimed at stimulating breast feeding and daily physical activity (playing outside) and the restriction of sweetened drinks and watching TV are very promising. With such preventive measures the involvement of both the school and the parents is important.

The insulin receptor substrate-1 (IRS-1) gene is among the most frequently studied candidate genes for Type 2 diabetes, but findings have been inconsistent. This may have been due to generally small study sizes, or to interaction with body fatness as suggested by studies of insulin sensitivity. The aim of this study was to test the hypothesis that the IRS-1 Gly972Arg variant increases risk of Type 2 diabetes.We conducted two large population-based studies including a total of 725 cases and 742 control subjects, who were Caucasian Dutch men and women aged 40-70 years. We calculated odds ratios adjusted for body mass index, study centre, sex and age.Carriers of the Arg allele did not have a higher prevalence of newly detected (OR 0.49, 95% CI 0.24-1.01) or treated (OR 0.71, 0.37-1.35) Type 2 diabetes in the first study, or a higher prevalence of glucose intolerance (OR 1.07, 0.71-1.59) in the second study. The summary odds ratio was 0.86 (0.62-1.17) for carrying the Arg allele as compared with the Gly/Gly genotype. Associations did not differ appreciably by degree of obesity. Also, the Arg variant was not associated with detrimental values for body mass index, waist circumference, plasma HDL-and total cholesterol or hypertension.Our findings indicate that the IRS-1 Gly972Arg variant does not substantially increase risk of common Type 2 diabetes, or Type 2 diabetes in obese persons.

About 12% of the adult Dutch population is obese (Quetelet Indexor = 30 kg/m2). The prevalence has roughly doubled over the past 20 years. Obesity is strongly associated with a number of chronic diseases, such as type 2 diabetes mellitus, increased healthcare costs and a loss of productivity. Obesity is always the result of a mismatch between energy intake and energy expenditure. Foods with a high percentage of energy derived from fat are associated with weight gain, particularly when the rest of the energy is obtained from products containing little dietary fibre. Foods with a high content of refined added sugars or starch might be unfavourable with respect to the energy balance and the risk for type 2 diabetes mellitus and cardiovascular diseases. Slimming diets should aim for a gradual and sustained weight loss of about 10% of the initial weight over a period of six months, followed by weight maintenance over the next two years. Physical activity is an essential component of a weight loss strategy. Moderate sustained weight loss is associated with a strong reduction in the risk of type 2 diabetes mellitus in people with impaired glucose tolerance.

The objective of this study was to explore explanations for the preference of physicians to prescribe beta-blockers to hypertensive men and diuretics to hypertensive women. A qualitative study among 12 family physicians was conducted with a combination of written case simulations, semi-structured interviews and statements on attitudes of physicians towards antihypertensive drug choice. Among the male hypertensive cases the most frequently prescribed drugs were beta-blockers, whereas among the female hypertensive cases diuretics were more often prescribed. Physician characteristics associated with a preferred prescribing of beta-blockers to hypertensive men and diuretics to hypertensive women were: older age (no residency in family medicine), the believe that beta-blockers are more effective in men with regard to lowering blood pressure and that diuretics are more effective in women, a non-evidence based attitude and a sex-related attitude towards the choice of beta-blockers and diuretics in general, and in particular towards the prescribing of beta-blockers to hypertensive men because men have a higher absolute risk of coronary heart disease than women. An additional explanation for these findings may be the higher prevalence of ankle oedema among women. Patient characteristics associated with more prescribing of beta-blockers to hypertensive men and diuretics to hypertensive women were: current employment and a "high-risk" profile in terms of blood pressure level and additional cardiovascular risk factors. Although, most considerations underlying a preferred prescribing of beta-blockers to hypertensive men and diuretics to hypertensive women were not evidence-based, the actual choice of antihypertensive drug (diuretic or beta-blocker) was evidence-based. These considerations may also play a role in the sex difference in the choice of calcium antagonists and angiotensin converting enzyme inhibitors and require further investigation.

The benefit of pharmacological treatment of hypertension in the prevention of cardiovascular diseases has been established mainly in subjects younger than 80 years of age. The consequences of undertreatment of hypertension with regard to the occurrence of stroke was studied in the Netherlands. About 33% of the hypertensives younger than 80 years and 55% of the hypertensives older than 80 years were not pharmacologically treated, although they were 'candidates' for pharmacological treatment of hypertension. About 19% (n = 1350) of all strokes that occurred in the Netherlands in 1994 among hypertensives younger than 80 years may be attributable to untreated hypertension. Among hypertensives older than 80 years this percentage was 32% (n = 1345). Although the benefit of pharmacological treatment of hypertension in persons older than 80 years has not been established experimentally, the results suggest that a considerable proportion of the strokes among this group of hypertensives may be prevented.

The food industry is a critical factor in any potentially successful long-term strategy to prevent obesity. By producing new products low in energy density and improving the nutritional quality (and reducing the energy content) of existing products, as well as through advances in responsible marketing and labeling, the food industry can provide foods that enable consumers to achieve lower energy intakes without going short of essential nutrients. The food industry is not the sole factor and government policies regarding agriculture, prices and subsidies are equally essential. Caterers and retailers are yet another important cog in the wheel for progress in obesity prevention. Intensive collaboration between all these players will only be attained if obesity prevention is given the priority it deserves in future public health planning.

From 1987 to 1991, over 36,000 men and women aged 20-59 years have been examined in the Monitoring Project on Cardiovascular Disease Risk Factors in The Netherlands. Classification of the treatment status of hypertensives in this population-based study was based on self-administered questionnaires. In order to assess the accuracy of self-reported antihypertensive drug use we compared the questionnaire information with computerized pharmacy records from a sample of 372 hypertensive subjects. Most antihypertensive drugs that were mentioned in the questionnaire were present in the pharmacy medication history (93%). However, this percentage was less (76%) when a comparison was made with the calculated duration of use based on the number of units prescribed and the directions for use in the pharmacy records. About 94% of the hypertensive subjects who were using an antihypertensive drug according to the pharmacy records, also mentioned at least one antihypertensive drug in the questionnaire. Agreement between self-reported antihypertensive drug use and pharmacy records was consistently high for all classes of antihypertensive drugs. Among 321 (86%) subjects, the number and types of self-reported antihypertensive drugs were exactly the same as in the pharmacy records. In conclusion, the agreement between self-reported antihypertensive drug use and pharmacy records was high, and the self-reported questionnaire information on antihypertensive drug use can be reliably used for the classification of treatment status of hypertensive subjects in this population-based study.

We investigated the impact of family history of myocardial infarction on 12-year coronary heart disease mortality. Men and women with a family history had an increased risk for coronary heart disease death, irrespective of other risk factors (RR = 1.58; 95% CI = 1.17-2.13 and RR = 2.12; 95% CI = 1.11-4.05, respectively). Women with a family history seemed to be more susceptible to the detrimental effects of smoking; not to the effects of other risk factors. We found no effect modification by family history in men.

We investigated interactions between a mutation (D9N) in the lipoprotein lipase (LPL) gene and physical activity, as well as other lifestyle factors, on lipid traits in a population-based sample of Dutch men and women (n = 379). We used questionnaire information to classify physical activity, alcohol consumption, and smoking habits, while overweight was defined as a body mass index (BMI)25 kg/m2. Non-fasting blood samples were used for the determination of lipid traits and the D9N genotype. Fifteen subjects (4%) carried the mutation. They presented with higher levels of total cholesterol, apolipoprotein (apo) B and triglycerides compared to non-carriers. While no interactions with overweight, alcohol consumption, and smoking were found, a strong interaction between the D9N mutation and physical activity became apparent. Physically inactive D9N carriers (n = 5) had considerably higher total cholesterol (+2 mmol/l, por = 0.0001) and apo B levels (+63 mg/dl, por = 0.0001) compared to non-carriers of this mutation, whereas their high-density lipoprotein (HDL)-cholesterol concentrations were lower (-0.22 mmol/l, p0.05). This was not the case for physically active D9N carriers (n = 10). In conclusion, a common variant of the LPL gene (D9N) adversely affects plasma lipid and lipoprotein profiles. However, the unfavorable consequences may be counteracted by physical activity.

To gain insight into the physical activity level of a sample of the Dutch population, to identify groups with an increased prevalence of physical inactivity and to investigate if increased moderate activity is associated with a more favourable cardiovascular risk profile and a higher self-rated health.Descriptive.In 1993-1997 a monitoring project on risk factors and health has been carried out in a random sample of inhabitants of Doetinchem, Amsterdam and Maastricht. Using a questionnaire, information was obtained from the participants about physical activity, demographic characteristics, smoking behaviour and self-rated health. Also, height, weight and blood pressure were measured and a blood sample was taken. In this sample, the serum concentrations of total and high density lipoproteins were determined. This article concerns the activity in 1997 and the trend in activity in the period 1994-1997. In 1997, 4,029 persons, aged 20-64 years, took part.In 1997 46% (n = 1864) of the study population were, on average, active in moderate activities for less than half an hour per day, and 21% (n = 831) for less than half an hour per week ('inactives'). Inactivity was most common in subjects aged 50-59 years (28%), subjects with a low educational level (38%), widowed subjects (34%) and unemployed (36%) or disabled (42%) subjects. Since 1994, the proportion of inactive subjects increased among individuals with a low level of education. Regular physical activity, whether moderate or strenuous, was associated with a more favourable risk profile and a better self-rated health.Almost half of the persons examined were little active, which was associated with a less favourable cardiovascular risk profile and a less good self-rated health.

In order to determine whether screening of thyroid function is justified in patients with hypercholesterolaemia, we determined the prevalence of subclinical hypothyroidism at different levels of total plasma cholesterol in middle-aged men and women.1200 participants were selected from a population based cross sectional study on risk factors for cardiovascular diseases. The participants were divided into three groups: total plasma cholesterol5 mmol/l, total plasma cholesterol 5-8 mmol/l, total plasma cholesterol8 mmol/l. Each group was comparable in size and sex distribution. Subclinical hypothyroidism was defined as plasma TSH levels higher than 4 mU/l, in the presence of normal free thyroxine (FT4(4)) concentration.Plasma samples of a total of 1191 participants were analyzed. The overall prevalence of subclinical hypothyroidism was 1.9% in men and 7.6% in women of middle age. In women the prevalence of subclinical hypothyroidism increased from 4.0 percent in the lowest, to 10.3 percent in the highest cholesterol stratum (P = 0.02). In men, the mean prevalence was 1.8 percent and roughly similar in the various strata. After age correction, an increase of 1 mU/l TSH in women was associated with an increase of 0.09 mmol/l total plasma cholesterol (95% confidence interval (CI) 0.02-0.16 mmol/l). A similar trend was found in men (0.16 mmol/l, 95% CI -0.02-0.34 mmol/l).In the population, the prevalence of subclinical hypothyroidism is up to 10 percent in middle aged women with high levels of total plasma cholesterol and may justify case-finding. In these women approximately 0.5 mmol/l of total plasma cholesterol can be attributed to the subclinical thyroid dysfunction. In men a similar correlation between thyroid dysfunction and total plasma cholesterol is seen, but the prevalence of thyroid dysfunction is considerably lower.

Two mutations in the lipoprotein lipase (LPL) gene, a T to G transition at position -93 of the proximal promoter region and an Asp9Asn substitution in exon 2, were examined in 762 Dutch males with angiographically-diagnosed coronary artery disease (CAD) and 296 healthy normolipidemic Dutch males. The two mutations exhibited strong linkage disequilibrium (D' = 0.975). A significantly higher proportion of cases (4.86%) than controls (1.37%) carried the -93G/Asn9 allele (p = 0.008). In the combined sample of cases and controls, adjusted mean plasma total cholesterol (TC) levels were significantly higher in -93G/Asn9 carriers (6.20+/-0.13 mmol/l) than in non-carriers (5.93+/-0.03 mmol/l; p = 0.048), while mean high-density lipoprotein cholesterol (HDL-C) levels were lower in carriers (0.88+/-0.03 mmol/l) than in non-carriers (0.98+/-0.01 mmol/l; p = 0.002). There was a trend towards higher triglyceride (TG) levels in carriers (1.96+/-0.14 mmol/l) compared with non-carriers (1.73+/-0.03 mmol/l) (p = 0.08). Additionally, carrier frequencies in tertiles of TC, HDL-C, TG, and LPL activity, suggested an association of the -93G/Asn9 variant with higher TC and TG levels, and with lower HDL-C and LPL activity levels. Logistic regression revealed a significant odds ratio (OR) for the combined -93G/Asn9 genotype in CAD cases relative to controls (OR: 5.36; 95% CI: 1.57-18.24), with age, body mass index (BMI), smoking, and plasma total- and HDL-cholesterol levels included in the model. In conclusion, we show that the LPL Asp9Asn mutation is in non-random association with a T G substitution at position -93 of the proximal promoter region and that the combined -93G/Asn9 genotype predisposes to decreased HDL-C levels and an increased risk of CAD.

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 (p0.01) 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.

The amount of intraabdominal (visceral) fat is an important determinant of disturbances in lipid and glucose metabolism. Cross-sectional studies in women have found associations between high androgen levels and visceral fat accumulation. The causal relation between these phenomena is unknown. We, therefore, studied prospectively the effect of testosterone administration on body fat distribution in 10 young, nonobese, female to male transsexuals undergoing sex reassignment. Before, after 1 yr, and after 3 yr of testosterone administration, magnetic resonance images were obtained at the level of the abdomen, hip, and thigh to quantify both sc and visceral fat depots. After 1 yr of testosterone administration, sc fat depots at all levels showed significant reductions compared to baseline measurements. The mean visceral fat area did not change significantly, but subjects who gained weight in the first year after testosterone administration showed an increase in visceral fat. After 3 yr of testosterone administration, sc fat depots were no longer significantly lower compared to pretreatment measurements, but the mean visceral fat depot had increased significantly by 13 cm2 (95% confidence interval, 4-22 cm2), a relative increase of 47% (95% confidence interval, 8-91%) from baseline. The increase in visceral fat was most pronounced in those subjects who had gained weight. We conclude that long term testosterone administration in young, nonobese, female subjects increases the amount of visceral fat. In addition, an increase in weight in this hyperandrogenic state leads to a preferential storage of fat in the visceral depot.

To study the relation between changes in body weight and subsequent mortality.Prospective follow-up study.Population study.6441 men aged 40-59 y at baseline participating in the European cohorts of the Seven Countries Study. The men were divided into groups depending on their weight pattern ascertained from three weight measurements with intervals of 5 years. They were also divided in quartiles according to the degree of weight variability.All-cause and cause-specific mortality during 15 years following the last weight measurement. Deaths occurring during the first 5 years of follow-up were excluded.Significantly elevated hazard ratios (RR) for death from all causes (RR = 1.3; 95% confidence interval (CI): 1.2-1.5), all cardiovascular diseases (RR = 1.2; 95% CI: 1.0-1.5) and other causes (RR = 1.6; 95% CI: 1.2-2.2) were found for men with a decreasing weight compared with men with a constant weight. A fluctuating weight was associated with an increased risk of all cause mortality (RR = 1.2; 95% CI: 1.0-1.4), coronary heart disease (RR = 1.5; 95% CI: 1.0-1.9) and myocardial infarction (RR = 1.5; 95% CI: 1.0-2.2). The group of men with an increasing body weight also had elevated hazard ratios for dying from coronary heart disease and myocardial infarction, but these were only significant when the total 15-year follow-up was analyzed. The risks of dying from all-causes, cardiovascular disease, cancer and other causes were increased in the upper quartile versus the lower quartile of weight variability.The results of the present study show that a decreasing and a fluctuating body weight are associated with increased mortality. An average increase of 7 kg body weight was associated with an elevated risk of dying from coronary heart disease and myocardial infarction. Lowest mortality in these middle-aged men was found in those who maintained a constant body weight.

To study the prevalence and trends in obesity in the period 1987-1991.Linear regression of average body mass index (BMI in kg/m2) and prevalence of obesity (BMIor = 30 kg/m2) in a continuous monitoring project in three towns in The Netherlands.It was estimated that over the whole period the prevalence of obesity was 7% in men and 9% in women. After adjustment for age and educational level the prevalence of obesity increased significantly in both men with about 1.7 percentage points (+/- standard error: 0.8) and in women with 1.9 +/- 0.8 percentage points between 1987 and 1991. When stratified by 10-year age category the increase was strongest in those aged 20-29 and 50-59 years. When stratified by educational level, the increase was only significant in the lowest category (primary education and lower secondary education) and was not significant in other categories.Obesity is relatively common in The Netherlands and, at least among responders to the yearly surveys, the prevalence of obesity has increased in the period 1987-1991 particularly in those with a relatively low educational level.

Obesity (defined as a body mass index30 kg/m2) is common in middle-aged Europeans. The prevalence is notably high in women from Mediterranean and Eastern European countries. In most European countries the prevalence of obesity has been shown to be increasing. When the impact of obesity on health status is assessed this should be done at many levels. Not only should be looked at mortality or diseases and disorders associated with obesity. Physical functioning and quality of life are also of great importance although they may not be bound to any specific diagnosis. Mobility disability has been shown to be more strongly related to obesity than the association between obesity and mortality. Estimation of direct health care costs attributable to obesity vary between 1-5% of the total health care expenditure depending on the definition of obesity and the methods for calculating these costs. This ranks obesity among the major determinants of health care costs.

Obesity, defined as a body mass index30 kg/m2 is relatively common in Europe especially among women and especially in Southern and Eastern European countries. Among men the distribution of body mass index values is surprisingly similar in most countries of Europe despite a large variability among women. Available data from European countries (Germany, Finland, Sweden, The Netherlands, England) suggest that the prevalence of obesity has been stable or (most often) increasing during the ninety-eighties. Publications from affluent countries outside Europe suggest similar trends. These trends suggest that public health policies recommending avoidance of overweight and the common practice of dieting fail to prevent an increase in the prevalence of obesity, let alone to reduce the prevalence. It is unclear which factors are responsible for weight gains in Europe. Continuing high fat intakes in combination with low physical activity and widespread cessation of smoking may contribute to the increasing prevalence although some studies suggest that increased prevalences are also found in smokers and non-smokers. Obesity as well as weight gain are both important and independent contributors to cardiovascular disease and diabetes mellitus. More research is needed to elucidate the reasons for the large variation in the prevalence of obesity among European women and to the health risks associated with obesity in different European countries.

To determine whether breast size as reflected in cup size is independently associated with Wolfe's mammographic patterns.Univariate and multivariate associations between the waist/hip ratio (WHR), body mass index (BMI), cup size, age, parity, age at menarche menopausal status and Wolfe's mammographic parenchymal patterns were determined by (multiple) linear logistic regression.Population based mammographic breast cancer screening project.7819 women between 39 to 52 years of age.The univariate analysis demonstrated that women in the lowest tertile with respect to BMI and WHR when compared to women in the upper tertile were significantly more likely to display the high risk P2, Dy breast patterns. Cup size showed a similar inverse relation with the P2, Dy patterns. When age, WHR and BMI are entered together in the multivariate model the relation between cup size and the P2 Dy patterns is no longer significant in the upper tertile.Breast size is not a major independent determinant of the high risk P2, Dy parenchymal breast patterns when the WHR and BMI are taken into account.

Levels and trends in blood pressure (BP), as well as prevalence and treatment of hypertension, were studied in The Netherlands between 1987 and 1991. BP was measured continuously using a standardized method in 36,273 men and women 20-59 years of age. The data were weighted for the age distribution of the general Dutch population in 1990 and adjusted for each technician who measured BP. In summer in both men and women, systolic blood pressure (SBP) was about 1.5-2.0 mm Hg lower than in the other seasons, and diastolic blood pressure (DBP) was 0.5-1.0 mm Hg lower. In 1987 SBP was 124 mm Hg in men and 117 mm Hg in women. DBP was 78 mm Hg in men and 75 mm Hg in women. The prevalence of hypertension was 8% in both men and women. Between 1987 and 1991, SBP decreased slightly while DBP increased slightly. The prevalence of hypertension did not change in this period. The percentage of treated hypertensive men decreased significantly from 44% in 1987 to 34% in 1991 and from 60% to 49%, in women. We conclude that the prevalence of hypertension did not change between 1987 and 1991, yet the treatment of hypertension decreased, possibly because of a change in the pattern of treatment by Dutch physicians.

The study objective was to determine the relationship between the abdominal sagittal diameter (waist depth) and subsequent mortality. This was a prospective study carried out in 981 male participants of the Baltimore Longitudinal Study on Aging which is a prospective study at the National Institute on Aging in Baltimore. The main outcome measures of the study were total and cause-specific mortality occurring during 17,529 person-years. The men were divided by age (cut-off point 55 years) at the start of follow-up. All-cause and coronary heart disease mortality rates (adjusted for age, height and body mass index) increased with increasing sagittal diameter in the younger group but not in the older group. No significant relationship was observed between the sagittal diameter and cancer mortality. Body mass index, skinfolds and waist/hip ratio were not significantly related to any of the endpoints studied. The increased risk of mortality with increasing sagittal diameter was somewhat stronger when the first ten years of follow-up were excluded and was more pronounced at lower levels of risk factors such as serum cholesterol, serum triglycerides, plasma glucose and diastolic blood pressure and in never plus ex-smokers compared to smokers. The study indicates that the abdominal sagittal diameter is a strong predictor of mortality in younger adult men independently of age, height, body mass index and conventional risk factors for mortality such as smoking, serum lipids and blood pressure. Regional adiposity may be a less strong risk factor for mortality in older men.

In this study the effect of fluoxetine versus placebo treatment on body weight, body composition and abdominal fat areas, assessed from three magnetic resonance imaging scans at umbilicus level, was investigated. Thirty-eight abdominal overweight men aged 41 +/- 7 years (mean +/- s.d.), BMI 27.9 +/- 1.2 kg/m2 and WHR 0.97 +/- 0.03 were given dietary advice and a placebo (n = 20) or fluoxetine treatment (n = 18, 60 mg/day) for 12 weeks after a placebo run-in of two weeks. Measurements were carried out during run-in and at week 12 of treatment. The treatment groups did not differ at the start of the study. After treatment, weight loss (on average) was observed in both groups: -2.4 +/- 0.6 kg and -5.9 +/- 0.7 kg for the placebo and fluoxetine groups, respectively. Weight loss was significantly larger in the fluoxetine group (P = 0.0004). The reduction of fat mass tended to be larger (P = 0.08), and the reduction of fat-free mass was considerably larger in the fluoxetine group (P = 0.0005). Absolute (and proportional) changes in visceral and subcutaneous fat areas (cm2) were +2 +/- 26 (+1%) and -9 +/- 26 (-4%) in the placebo group, and -9 +/- 30 (-3%) and -30 +/- 27 (-13%) in the fluoxetine group. In both groups the proportional change in subcutaneous fat area was larger than the change in visceral fat (P0.02). Only in the fluoxetine group was the decrease in subcutaneous fat area significant, and larger compared to the placebo group (P = 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

The measurement of fat distribution has become an important issue in obesity research. Numerous techniques have been developed to assess visceral fat because this fat seems to be most strongly associated with metabolic disorders. This review focuses on methods for the direct and indirect assessment of visceral fat ranging from multiple-scan computerized tomography to anthropometric measurements. The principles of techniques, their accuracy and reproducibility as well as aspects of costs and safety are discussed. Comparison of the different methods shows that imaging techniques, such as computerized tomography and magnetic resonance imaging, are the optimal techniques available for accurate assessment of visceral fat. Methods other than imaging techniques have limited potential in the measurement of changes in visceral fat deposition. Anthropometric measurements can be useful to classify subjects into different types of fat distribution for diagnosis of abdominal obesity, and for general application in epidemiological studies. The choice of a particular technique should be based on a balance of practical and financial considerations and the aim of the study. Involvement of ionizing radiation exposure may be an important element in the decision-making process.

A new index of abdominal adiposity, the conicity index, and the waist-to-hip ratio (WHR) were compared as health indicators in seven European populations and two USA populations. The total sample included 1280 men and 960 women. Abdominal adiposity as detected by these indices is significantly associated with more cardiovascular risk indicators among women than it is among men. Both indices are equivalent as health indicators. However, the conicity index has several advantages over the WHR: (i) it has a theoretical (expected) range; (ii) it includes a built-in adjustment of waist circumference for height and weight, allowing direct comparisons of abdominal adiposity between individuals or even between populations; and (iii) it does not require the hip circumference to assess fat distribution.

The authors followed 775 men (aged 18-98 years) participating in the Baltimore Longitudinal Study in Aging for an average of ten years. Resting metabolic rate and fasting respiratory exchange ratio (RER) were measured by indirect calorimetry on their first visit and related to subsequent weight change. Deviations from the predicted value of resting metabolic rates (predicted from their estimated fat-free mass) were calculated. Average weight change was 0.07 kg (s.d. 6.4 kg); 122 men (15.3%) gained more than 5 kg and 40 (5.2%) more than 10 kg during the follow-up. After adjustment for initial age, body mass index, fat-free mass, and duration of follow-up, RER, but not RMR or deviations from predicted RMR, was positively related to weight change (P less than 0.001). Major weight gain (from at least 5 kg to at least 15 kg) was related to initial RER in non-obese men only (initial body mass index less than 25 kg/m2). From Cox proportional hazard regression analyses the adjusted relative risk of gaining 5 kg or more in initially non-obese men with a fasting RER of 0.85 or more was calculated to be 2.42 (95% confidence interval: 1.10-5.32) compared to men with a fasting RER less than 0.76. It was concluded that a relatively high fasting RER is a weak but significant predictor of substantial weight gain in non-obese white men.

We examined body fat distribution in relation to anthropometrically derived variables in 24 girls in early and late stages of puberty. The amounts of subcutaneous and intra-abdominal body fat were derived from transverse slices at the levels of the waist, hip and trochanter using magnetic resonance imaging (MRI), and were compared to the related circumferences, the circumference ratios and the trunk-to-extremity skinfold ratios. Waist, hip and trochanter circumferences were highly correlated to the respective related MRI total fat surface area both in early and late pubertal girls (r = 0.79-0.97), while waist circumference, and waist-hip, waist-thigh or skinfold ratios were not significantly correlated to intra-abdominal fat areas. Late pubertal girls (n = 11) were significantly taller, heavier and fatter compared to early pubertal girls (n = 13), yet their anthropometric waist-to-hip or waist-to-trochanter circumference ratios were significantly lower. The intra-abdominal fat area measured in a transverse MRI section at the level of the waist was 24.1 +/- 4.1 cm2 in early pubertal girls and 25.7 +/- 4.1 cm2 in late pubertal girls (mean +/- s.e.m.). As compared to early pubertal girls, the MRI derived amount of subcutaneous fat in late pubertal girls was significantly higher at the trochanter level (142.1 +/- 12.7 vs. 201.3 +/- 26.3 cm2; P less than 0.05). We conclude that circumferences at the trunk are good measures for the related amounts of fat in pubertal girls. In contrast conventional anthropometric measurements, such as trunk-to-extremity skinfold ratio or waist-to-hip circumference ratio, cannot be used to predict the amount of intra-abdominal fat in pubertal girls.(ABSTRACT TRUNCATED AT 250 WORDS)

Development of overweight and physical activity during life was studied retrospectively in a group of physically active and a group of sedentary elderly women. The two groups of elderly women were selected based on a validated physical activity questionnaire. A previous study on their current dietary intake and nutritional status showed a 12 kg higher body weight in the sedentary group compared to the physically active group, whereas body height did not differ. In order to study the relationship between development of overweight and physical activity in these elderly women, a retrospective study was carried out in 45 subjects. Information about former physical activity was collected by means of a detailed structured interview. Information about body shape and fatness, expressed as 'weight index', was obtained using silhouettes and subjective rating of obesity of subjects compared with peers. Classification of obesity was checked by old photographs rated by interviewers, sizes of clothing and recalled body weight and height. Information was collected about the situation at age 12, 25, 40 and 55 years whereas the mean current age is 71. Weight index was statistically significantly different between the active and sedentary group from age 25 onwards (P less than 0.05). Photographs proved to be useful for a valid and objective categorization. No differences were found in physical activity scores between the groups at age 12, 25, 40 and 55 years. It is concluded that the current difference in body shape and fatness between physically active and inactive elderly women was already present at age 25 and persisted throughout their adult life.(ABSTRACT TRUNCATED AT 250 WORDS)

It has been proposed that subcutaneous fat patterning assessed by skinfolds is measuring different aspects of fat distribution compared to circumferences and circumference ratios. In this study in 510 men born in 1950 selected from six European towns we compared the associations between five skinfolds, eight circumferences and several skinfold and circumference ratios and metabolic risk factors after adjustment for body mass index (BMI). All skinfolds were independently of BMI positively related to diastolic blood pressure. Waist circumferences at most levels were independently of BMI positively related to blood pressure and triglycerides and negatively to HDL-cholesterol. Circumferences at the levels of chest, hips, thigh and arm were not related to any of the risk factors studied. Waist/thigh ratios were generally more strongly and more consistently related to risk factors than waist/hip ratios. The partial correlations of anthropometric variables with risk factors were relatively weak and never exceeded r = 0.20. The results give an indication, however, that subcutaneous fat patterning is related to different risk factors compared to waist/hip ratios. Moreover, waist/thigh and waist circumference alone (measured either as the minimal circumference or midway between the lower rib margin and the iliac crest) were stronger correlates of cardiovascular risk factors compared to waist/hip ratio.