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Background: Latinx adults are disproportionately impacted by the interrelated challenges of food insecurity and nutrition sensitive chronic diseases. Food and nutrition insecurity can exacerbate the development and progression of chronic diseases, such as diabetes. Sustainable, effective interventions aimed at improving food insecurity and diabetes management for Latinx populations are needed., Methods: This hybrid type 1 trial evaluates the effectiveness of a multi-level intervention that includes a medically supportive food and behavioral lifestyle program on the primary outcome of Hemoglobin A1c (HbA1c) at 6 months. Latinx adults (n = 355) with type 2 diabetes (HbA1c of 6.0-12.0 %), overweight/obesity (BMI > 25 kg/m 2 ), and self-reported risk of food insecurity will be randomized 1:1 to intervention (12 weekly deliveries of vegetables, fruits, and whole-grain foods + culturally-modified behavioral lifestyle program) versus control (food deliveries after a 6-month delay). Outcome asessments will occur at 0, 6 and 12 months, and include HbA1c, dietary intake, psychosocial health outcomes, and diabetes-related stressors. In addition, food insecurity and the impact of the intervention on up to two household members will be measured. Qualitative interviews with patients, healthcare providers, and community partners will be conducted in accordance with Reach, Effectivenes, Adoption, Implementation, and Maintenence (RE-AIM) framework to identify barriers and best practices for future dissemination., Conclusions: The ADELANTE trial will provide novel insight to the effectiveness of a multi-level intervention on diabetes-related outcomes in Latinx adults. The mixed-method approach will also identity the reach of this 'Food is Medicine' intervention on additional household members to inform diabetes prevention efforts., Clinical Trial Registration: NCT05228860., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: While the individual impacts of long-term residence and food insecurity on overweight/obesity are well-documented, their combined effect on immigrants' weight status is less understood. This study examines the interaction between length of residence and food insecurity in predicting overweight/obesity among immigrants and investigates whether this relationship is gender-specific., Design: A national cross-sectional survey., Setting: The 2017-2018 Canadian Community Health Survey., Subjects: Immigrants aged 18 and older (N = 13 680)., Measures: All focal variables were self-reported., Analysis: Logistic regression models were employed., Results: Long-term immigrants were more likely to report overweight/obesity than their short-term counterparts (OR = 1.39; P < .001). Moreover, immigrants from food-insecure households were at a higher risk of reporting overweight/obesity (OR = 1.27; P < .05) compared to those from food-secure households. The analysis further revealed that food insecurity exacerbated the detrimental association between length of residence and overweight/obesity in men (OR = 2.63; P < .01) but not in women (OR = .66; P > .05)., Conclusion: The findings suggest that long-term immigrant men may be especially susceptible to the compounded chronic stressors of extended residence and food insecurity. Health professionals and policymakers should advocate for psychosocial resources to help mitigate these adverse effects and support the well-being of immigrant populations., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: To estimate and compare the association between metabolically healthy overweight/obesity (MHO) and the risk of type 2 diabetes (T2DM) among different ethnic groups in southwest China, while also exploring possible ethnic differences., Methods: This is a prospective cohort study of 6,820 participants in Southwest China. MHO was defined as body mass index (BMI) ≥ 24 kg/m 2 and the presence of ≤ 1 component of metabolic syndrome. Cox proportional risk models were utilized to analyze the association between MHO and the risk of T2DM., Results: The median follow-up time was 6.58 years, during which 708 new cases of T2DM were diagnosed. In the total population, after adjusting for confounding factors, MHO was found to increase the risk of T2DM compared to metabolically healthy normal weight (MHNW) individuals (HR = 1.49, 95% CI: 1.15-1.93). Subgroup analysis by ethnicity revealed that, MHO increased the risk of T2DM in the Han population (HR = 1.64, 95% CI: 1.21-2.23), however, the difference was not statistically significant in the ethnic minority population.The results of sensitivity analysis further supported the robustness of these findings. Meanwhile, stratified by sex, age, and urban/rural, it was found that ethnic differences in the association between MHO and T2DM still existed, however, it is important to note that the association between MHO and T2DM was not statistically significant in the Han population subgroup aged ≥ 45 years (p > 0.05)., Conclusion: MHO was associated with an increased risk of T2DM compared to MHNW, and there are ethnic differences. Future interventions need to be strengthened for Han Chinese key populations to reduce the risk of T2DM., (© 2024. The Author(s).)

Introduction: Maternal overweight or obesity has been associated with metabolic syndrome through 1 year postpartum, but it remains unknown whether a culturally-modified, motivationally-targeted, and individually-tailored Lifestyle Intervention could improve postpartum cardiometabolic health among Hispanic women with overweight or obesity., Methods: Proyecto Mamá was a randomized controlled trial conducted in Western Massachusetts from 2014 to 2020 in which Hispanic women with overweight/obesity were randomized to a Lifestyle Intervention (LI) involving diet and exercise or to a comparison Health and Wellness Intervention (HW). Biomarkers of cardiovascular risk (i.e., lipids, C-reactive protein) and insulin resistance (fasting insulin, glucose, HbA1c, homeostasis model assessment [HOMA-IR], leptin, adiponectin) were measured at baseline (early pregnancy), mid-pregnancy, and 6 weeks, 6 months, and 12 months postpartum. Generalized linear mixed effect models were used to evaluate differences in the change in biomarkers over the course of postpartum follow-up time., Results: In intent-to-treat analyses among eligible women (LI; n=51, HW; n=58) there were no significant differences in changes in biomarkers of CVD risk or insulin resistance over the postpartum year; for example, the intervention effect for total cholesterol was 6.98 (SE: 6.36, p=0.27) and for HbA1c was -0.01 (SE: 0.4, p=0.85). In pooled analyses, regardless of intervention arm, women who participated in any vigorous activity had less of an increase in HbA1c (intervention effect = -0.17, SE: 0.05, p=0.002) compared to those with no vigorous activity, and similarly beneficial associations with other cardiovascular risk biomarkers (p<0.05)., Discussion: Women who participated in vigorous activity, regardless of their assigned intervention arm, had more favorable changes in biomarkers of insulin resistance., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Black African-Caribbean (BAC) populations are at greater risk of cardiometabolic disease than White Europeans (WE), despite exhibiting lower fasting triacylglycerol (TAG) concentrations. However, limited data exist regarding postprandial fatty acid metabolism in BAC populations. This study determined the ethnic differences in postprandial fatty acid metabolism between overweight and obese WE and BAC men. WE [ n = 10, age 33.3 ± 1.7 yr; body mass index (BMI) = 26.8 (25.8-31.0) kg/m 2 ] and BAC [ n = 9, age 27.9 ± 1.0 yr; BMI = 27.5 (26.0-28.6) kg/m 2 ] men consumed two consecutive (at 0 and 300 min) moderate-to-high-fat meals-the first labeled with [U- 13 C]palmitate. The plasma concentration and appearance of meal-derived fatty acids in very-low-density lipoprotein (VLDL)-TAG, chylomicron-TAG, and nonesterified fatty acid (NEFA) were determined over an 8-h postprandial period. Indirect calorimetry with 13 CO 2 enrichment determined total and meal-derived fatty acid oxidation rates, and plasma β-hydroxybutyrate (3-OHB) concentration was measured to assess ketogenesis. BAC exhibited lower postprandial TAG [area under the curve (AUC 0-480 ) = 671 (563-802) vs. 469 (354-623) mmol/L/min, P = 0.022] and VLDL-TAG [AUC 0-480 = 288 ± 30 vs. 145 ± 27 mmol/L/min, P = 0.003] concentrations than WE. The appearance of meal-derived fatty acids in VLDL-TAG was lower in BAC than in WE (AUC 0-480 = 133 ± 12 vs. 78 ± 13 mmol/L/min, P = 0.007). Following the second meal, BAC showed a trend for lower chylomicron-TAG concentration [AUC 300-480 = 69 (51-93) vs. 43 (28-67) mmol/L/min, P = 0.057]. There were no ethnic differences in the appearance of chylomicron-TAG, cumulative fatty acid oxidation, and the NEFA:3-OHB ratio ( P > 0.05). In conclusion, BAC exhibit lower postprandial TAG concentrations compared with WE men, driven by lower VLDL-TAG concentrations and possibly lower chylomicron-TAG in the late postprandial period. These findings suggest that postprandial fatty acid trafficking may be a less important determinant of cardiometabolic risk in BAC than in WE men. NEW & NOTEWORTHY Postprandial TAG is lower in Black African-Caribbean men than in White European men, and this is likely driven by lower meal-derived VLDL-TAG in Black African-Caribbean men. This observation could suggest that fatty acid trafficking may be a less important determinant of cardiometabolic risk in Black Africans than in White European men.

Double burden of malnutrition (DBM) is a global public health concern. This study determined the prevalence of DBM and its associated factors among 451 indigenous households in an urbanized state of Malaysia. Mothers and children were measured for weight and height/length. Mothers were interviewed for socio-demographics and diets of mothers and children. Prevalence of DBM (overweight/obese mother and underweight/stunted child) was 28.8%. Food insecurity, maternal height (<150 cm) and energy intake (>recommendation), child's age (≥24 months) and energy intake (

Objective: The objective of this study was to evaluate the efficacy of a mobile health (mHealth)-delivered behavioral intervention on changes in postpartum weight and cardiometabolic risk factors (blood pressure [BP], lipids, and hemoglobin A1c) over 12 months., Methods: A randomized controlled trial of 300 African American postpartum people with overweight and obesity enrolled in Philadelphia Women, Infants, and Children (WIC) clinics was conducted. Participants were randomized to usual WIC care (n = 151) or a 12-month mHealth-delivered intervention (n = 149) comprising behavior change goals, interactive self-monitoring text messages, and counseling support., Results: Intervention and usual-care participants did not significantly differ in 12-month mean postpartum weight change (1.1 vs. 1.6 kg, p = 0.5; difference -0.6 kg, 95% CI: -2.3 to 1.2). However, high intervention engagement led to weight loss compared with weight gain among those who were less engaged (-0.6 vs. 2.4 kg, p = 0.01; difference -3.0 kg, 95% CI: -5.4 to -0.6). The intervention reduced systolic BP relative to usual care (-1.6 vs. 2.4 mm Hg, p = 0.02; difference -4.0 mm Hg, 95% CI: -7.5 to -0.5), but this effect did not extend to other cardiometabolic risk factors., Conclusions: Among African American postpartum people enrolled in WIC, an mHealth-delivered intervention reduced systolic BP but not additional cardiometabolic risk factors or weight. Intervention participants with high engagement had significantly better postpartum weight outcomes, and thus, next steps include addressing barriers to engagement., (© 2024 The Obesity Society.)

Exercise and diet are beneficial for pain, yet many patients do not receive such recommendations from providers. This may be due to biases related to gender, race, and weight. We recruited medical students (N = 90) to view videos of women with chronic back pain performing a functional task; patients varied by weight (overweight/obese) and race (Black/White). For each woman patient, providers rated their likelihood of recommending exercises or dietary changes. Ratings significantly differed across recommendations (F(2.75, 244.72) = 6.19, P < .01) in that providers were more likely to recommend flexibility exercises than aerobic exercises and dietary changes and were more likely to recommend strength exercises than dietary changes. Results also indicated that women with obesity were more likely to receive aerobic (F(1,89) = 17.20, P < .01), strength (F(1,89) = 6.08, P = .02), and dietary recommendations (F(1,89) = 37.56, P < .01) than were women with overweight. Additionally, White women were more likely to receive a recommendation for flexibility exercises (F(1,89) = 4.92, P = .03) than Black women. Collectively, these findings suggest that providers' exercise and dietary recommendations for women with chronic pain are influenced by the weight status and racial identity of the patient. Future studies are needed to identify the reasons underlying these systematic differences, including the stereotypes and attitudes that may be driving these effects. PERSPECTIVE: This article presents results on how patient weight and race impact providers' exercise and diet recommendations for women with chronic back pain. Provider recommendations for these modalities may be systematically biased in a way that impedes care and impacts patient functioning., (Copyright © 2024 United States Association for the Study of Pain, Inc. All rights reserved.)

The purpose of the study was to conduct in-depth qualitative interviews to understand the lived experiences of African American parents of overweight adolescents who had previously participated in a family-based weight loss program and to utilize these insights to inform the essential elements of the LEADS trial, an integrated resilience stress management and health promotion intervention. Participants (N = 30) were African American parents and/or caregivers (96.7% female; M age  = 49.73, SD = 10.88; M BMI  = 37.63, SD = 8.21) of adolescents with overweight and/or obesity. Interviews were transcribed and coded using inductive and deductive approaches for themes by two independent coders. Inter-rater reliability was acceptable (r = 0.70-0.80) and discrepancies were resolved to 100% agreement. Prominent stress themes included caregiver responsibilities, work, interpersonal family conflict, and physical and emotional consequences of chronic stress. Participants also noted decreases in physical activity and poor food choices due to stress. Coping mechanisms included prayer/meditation, church social support, and talking with family/partner. Results highlight the importance of mitigating stress among African American parents through stress management and cultural/familial resilience approaches to increase the likelihood of engagement in behavioral strategies in health promotion programs. Future studies should assess the utility of incorporating stress management components and health promotion techniques to improve health outcomes among African American families., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objectives: Overweight and obesity (OWOB) starts in childhood, influences adult cardiovascular risk, and is not equally distributed across ethnic groups. It is unclear which effects can be expected from reductions in OWOB across the life course on inequalities in cardio-metabolic diseases in a multi-ethnic population. This study aims to estimate the effects of three scenarios of changes in OWOB (the Normal-Weight-for-All scenario, the No-Ethnic-Difference-over-the-Life-Course scenario, the and No-Ethnic-Differences-in-Childhood scenario)., Study Design: A simulation study., Methods: We combine data from multiple data sources and use the Dynamic Modeling for Health Impact Assessment (DYNAMO-HIA) model to estimate the effects of three scenarios on the cumulative incidence of diabetes mellitus, ischaemic heart disease (IHD) and stroke between 18 and 70 years in the five largest ethnic groups in the Netherlands., Results: In the scenario where all individuals have normal weight, the cumulative incidence decreased in all ethnic minority groups for all diseases, with largest decreases among South-Asian Surinamese, where the reduction of diabetes incidence exceeded 50%. In the scenario where the prevalence of OWOB in each ethnic-minority group was reduced to the current level among the Dutch-origin population, ethnic inequalities in cardio-metabolic diseases were substantially reduced, particularly when lowered prevalence of OWOB persisted across the lifespan. Reductions were the largest for diabetes and for the Asian Surinamese population., Conclusions: A substantial part of the well-known ethnic inequalities in incidence of diabetes, IHD, and stroke can be attributed to OWOB. Interventions aimed at reducing OWOB have clear potential to reduce the health inequalities in these outcomes, especially for diabetes, in particular when they have an impact across the lifespan., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To understand the nutritional status and physical fitness of the Uygur, Kazak and Han ethnic college students, and to investigate the nonlinear relationship between BMI and physical fitness indexes in different ethnic groups., Methods: A total of 3 600 Uygur, Kazakh and Han students majoring in non-sports in a university in Xinjiang Uygur Autonomous Region in 2021 were selected by stratified random cluster sampling method. Height, weight, vital capacity, 50 m running, standing long jump, sit-and-reach, sit-up/pull-up and endurance running were measured. Body mass index (BMI), standardized Z score of each test score and physical fitness index (PFI) were calculated. The data were analyzed by Chi-square test, single factor analysis of variance, and nonlinear quadratic regression., Results: Prevalences of overweight (16.00%) and obesity (8.08%) of the Han college students were significantly higher than those of the Uygur (11.83% and 4.08%) and Kazakh (13.58% and 4.58%). Prevalence of low weight in the Uygur (11.92%) was the highest, and the lowest was the Kazakh (9.75%). There were significant differences in the prevalence of BMI classification among the three ethnic groups boys and girls (all P < 0.05). There were significant differences in PFI among college students of different BMI levels in the Uygur, Kazakh and Han ethnic college students (all P < 0.05), and the PFI of normal weight group was higher than the other weight groups in general, and the overweight group was higher than the obese group, but some ethnics showed the highest PFI in the low weight group. The non-linear quadratic regression results showed that the curves of the Uygur boys and girls and the Kazakh boys were inverted "J" shaped, and the PFI increased and then decreased with the increase of BMI, while the rest of the curves were arc-shaped, and the PFI decreased with the increase of BMI., Conclusion: Overweight obesity in the Uygur, Kazakh and Han ethnic college students brings about a decrease in physical fitness, but Kazakh low weight male and female and Han low weight grils have better physical fitness than the normal weight groups. Focusing on improving the physical fitness of Uygur low-weight and high-weight boys and Han high-weight girls could effectively reduce the differences in physical fitness of college students in different weight levels and ethnic groups.

Mexican Americans are among the highest risk groups for obesity and its associated health consequences, including diabetes, heart disease, and cancer. 154 overweight/obese Mexican Americans recruited from the Mexican Consulate in New York City were enrolled in COMIDA (Consumo de Opciones Más Ideales De Alimentos) (Eating More Ideal Food Options), a 12-week Spanish-language lifestyle intervention that included a dietary counseling session, weight-loss resources, and thrice-weekly text messages. Participants' weight (primary outcome); dietary intake, physical activity, and nutrition knowledge (secondary outcomes) were assessed pre- and post-intervention. Of the 109 who completed follow-up, 28% lost ≥ 5% of their baseline body weight. Post-intervention, participants consumed more fruit and less soda, sweet pastries, fried foods and red meat; increased physical activity; and evidenced greater nutrition knowledge. A community-based lifestyle intervention with automated components such as text messaging may be a scalable, cost-effective approach to address overweight/obesity among underserved populations., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Limited research on alanine aminotransferase (ALT) screening for metabolic dysfunction-associated steatotic liver disease (MASLD) among US Asian/Pacific Islander (PI) children necessitates investigation in this heterogeneous population., Objective: Examine ALT elevation among Asian/PI children with overweight or obesity., Methods: Elevated ALT prevalence (clinical threshold) and association with body mass index ≥85th percentile were compared among 18 402 Asian/PI and 25 376 non-Hispanic White (NHW) children aged 9-17 years using logistic regression., Results: ALT elevation was more prevalent among Asian/PI (vs. NHW) males with overweight (4.0% vs. 2.7%), moderate (7.8% vs. 5.3%) and severe obesity (16.6% vs. 11.5%), and females with moderate (5.1% vs. 3.0%) and severe obesity (10.2% vs. 5.2%). Adjusted odds of elevated ALT were 1.6-fold and ~2-fold higher for Asian/PI (vs. NHW) males and females (with obesity), respectively. Filipino, Chinese and Southeast Asian males had 1.7-2.1-fold higher odds, but Native Hawaiian/PI (NHPI) and South Asian males did not significantly differ (vs. NHW). Filipina and Chinese females with obesity had >2-fold higher odds, Southeast and South Asian females did not differ and NHPI findings were mixed (vs. NHW)., Conclusion: High elevated ALT prevalence among Asian/PI children with overweight and obesity emphasizes the need for MASLD risk assessment and examination of ethnic subgroups., (© 2024 World Obesity Federation.)

Background: Available data show that the epidemiological profile of most indigenous Brazilian populations is characterized by the coexistence of long-standing health problems (high prevalence of infectious and parasitic diseases, malnutrition, and deficiency diseases, such as anemia in children and women of reproductive age), associated with new health problems, especially those related to obesity (hypertension, type 2 diabetes mellitus and dyslipidemia). Based on this scenario, this study analyzed the nutritional profile of the adult population of seven indigenous peoples from the Brazilian Amazon in the years 2007 and 2021., Methods: A total of 598 adults individuals were analyzed in 2007 (319 women and 279 men) and 924 in 2021 (483 women and 441 men), from seven indigenous peoples located in the state of Pará, who were assisted during health actions carried out in 2007 and in 2021. Body mass index classification used the World Health Organization criteria for adults: low weight, < 18.5 kg/m 2 ; normal weight, ≥ 18.5 and < 25 kg/m 2 ); overweight, ≥ 25 and < 30 kg/m 2 , and obesity, ≥ 30 kg/m 2 . A waist circumference (WC) < 90 cm in men and < 80 cm in women was considered normal., Results: The data revealed heterogeneous anthropometric profiles, with a low prevalence of nutritional changes in the Araweté, Arara and Parakanã peoples, and high proportions of excess weight and abdominal obesity in the Kararaô, Xikrin do Bacajá, Asurini do Xingu and Gavião peoples, similar to or even higher than the national averages., Conclusion: Different stages of nutritional transition were identified in the indigenous peoples analyzed, despite apparently having been subjected to the same environmental pressures that shaped their nutritional profile in recent decades, which may indicate different genetic susceptibilities to nutritional changes. The evidence shown in this study strongly suggests the need to investigate in greater depth the genetic and environmental factors associated with the nutritional profile of Brazilian indigenous peoples, with assessment of diet, physical activity and sociodemographic and socioeconomic variables that enable the development of appropriate prevention and monitoring measures., (© 2024. The Author(s).)

Despite well-documented global declines in physical activity (PA) during the COVID-19 pandemic, little is known regarding the specific impact among underserved, rural Alabama counties. This is concerning as this region was already disproportionately burdened by inactivity and related chronic diseases and was among the hardest hit by COVID-19. Thus, the current study examined the effect of COVID-19 on PA in four rural Alabama counties. An ancillary survey was administered between March 2020 and August 2021 to the first cohort (N = 171) of participants enrolled in a larger PA trial. Main outcomes of this survey included the perceived impact of COVID-19 on PA, leisure-time PA, and social cognitive theory (SCT) constructs at 3 months. Almost half of the participants reported being less active during the pandemic (49.7%) and endorsed that COVID-19 made PA more difficult (47.4%), citing concerns such as getting sick from exercising outside of the home (70.4%) and discomfort wearing a face mask while exercising (58%). Perceived COVID-19 impact on PA was significantly associated with education, household dependents, and gender ( p 's < 0.05). More women, parents, and college graduates reported that the COVID-19 pandemic made PA more difficult. Overall, there were no significant associations between PA, SCT constructs, or perceived COVID-19 impact on PA scores at 3 months. While the pandemic made PA difficult for many participants, these barriers were not associated with leisure-time PA levels or related theoretical mechanisms of action, which bodes well for the success of our ongoing intervention efforts and the resiliency of these communities.

Objective: To understand early-life growth in the Middle East and North Africa (MENA) region, and how it has changed over time, we estimated the prevalence of wasting and overweight at ages under 5 years., Design: Cross-sectional data from twenty-nine Demographic and Health Surveys with direct anthropometric data and parent-reported demographic information were examined. The study utilised the WHO Child Growth Standards to classify overweight (weight-for-height z-score ≥ 2 sd above the median), wasting (weight-for-height z-score ≤ 2 sd below the median) and unhealthy weight defined as either wasting or overweight., Setting: Nationally representative for nine of the MENA countries (Armenia, Azerbaijan, Egypt, Jordan, Mauritania, Morocco, Tunisia, Turkey and Yemen)., Participants: Children under age 5 from nine MENA countries between 1987 and 2016 ( n 155 961)., Results: Across the region, at the most recent time point, between 7·3 and 23·6 % of children experienced unhealthy weight (Jordan - 7·3 %, Egypt -23·6 %); 1·7 and 16·6 % had wasting (Turkey, Yemen) and 2·0 and 15·0 % had overweight (Yemen, Egypt). Overweight was more common than wasting in all countries except Yemen and Mauritania. Between 1987 and 2016, the prevalence of unhealthy weight in the region increased (10·0-18·4 %) due to increases in both wasting and overweight. Boys had a higher prevalence of unhealthy weight than girls., Conclusion: Undernutrition continues to be a problem in some countries in the MENA region, and overnutrition is emerging as a health concern in many countries in the region. Countries in the region must advance programmes that reduce undernutrition while not overlooking or inadvertently promoting overnutrition.

Rates of non-alcoholic fatty liver disease (NAFLD) vary dramatically among Hispanic subpopulations, with Mexican-origin (MO) Hispanics experiencing a disproportionate burden. This study examined dietary fatty acid (FA) intake among overweight and obese MO Hispanic adults in the United States (US) and evaluated its association with liver steatosis and fibrosis. Participants (N = 285, MO Hispanic adults) completed 24-h dietary recalls to assess dietary FA exposure. Liver steatosis and fibrosis were estimated using transient elastography (FibroScan ® ). Multiple regression analysis tested relationships between FA intakes and liver steatosis or fibrosis, adjusting for age, sex, body mass index (BMI) and total energy. A total of 51% (n = 145) of participants were suspected to have NAFLD and 20% self-reported a type 2 diabetes diagnosis. No significant association was observed between Linoleic Acid and α-Linolenic Acid (LA:ALA) ratio, or omega-6 to omega-3 (n-6:n-3) ratio and liver steatosis. However, a one-point increase in the LA:ALA ratio resulted in a 1.01% increase in the liver fibrosis scores (95% CI: [1.00, 1.03]; p = 0.03), and a one-point increase in the n-6:n-3 ratio resulted in a 1.02% increase in liver fibrosis score (95% CI: [1.01, 1.03]; p = 0.01). Further research is needed to determine if modulation of FA intake could reduce NAFLD risk in this high-risk population.

Background: In the United States, the prevalence of obesity among adults has increased 3-fold since the 1980s, but patterns of incidence of new cases of obesity are not known., Objectives: To examine the incidence of new cases of obesity: overall, by demographic and educational subgroups, by weight status, and changes during this century., Methods: We analyzed adult (≥20 y) anthropometric records from the US nationally representative Panel Study of Income Dynamics from 2001 to 2017. Among those not having obesity (body mass index, BMI, ≥30 kg/m 2 ) at first observation, we used Poisson models to estimate the incidence of obesity [cases/1000 person-years (PYs)] and incidence rate ratio (IRR)., Results: Among 13,888 adults followed for 115,797 PYs, the incidence of obesity in 2001-2017 was 28.1/1000 PYs (95% CI: 26.7, 29.7). Over the periods 2001-2005, 2005-2009, and 2009-2013, the incidence of obesity was stable, but in 2013-2017 the incidence increased by 18% compared to 2009-2013 [IRR: 1.18 (95% CI: 1.06, 1.30)]. Blacks had higher obesity incidence [47.9/1000 PYs (95% CI: 42.7, 53.1)] than Whites [26.2/1000 PYs (95% CI: 24.6, 27.9)]. Risk was particularly high among Black females [57.9/1000 PYs (95% CI: 49.1, 66.8)] and Black young adults (20-29 y) [65.5/1000 PYs (95% CI: 54.2, 76.7)]. Across race, obesity incidence was highest in young adults (20-29 y) [34.1/1000 PYs (95% CI: 31.5, 36.7)] and declined with age [age 70+ y: 18.9/1000 PYs (95% CI: 16.6, 21.8)]. Those with overweight had an obesity risk 7 times higher than those with normal weight [62.1/1000 PYs (95% CI: 58.8, 65.3) vs. 8.8/1000 PYs (95% CI: 8.1, 9.6)]. Those with less than high-school education had higher obesity incidence than those with education beyond high-school [39.4/1000 PYs (95% CI: 34.4, 44.4) vs. 24.7/1000 PYs (95% CI: 23.1, 26.3)]., Conclusions: Incidence of obesity was stable over the first 13 y of the last 2 decades but increased by 18% in 2013-2017. Blacks and younger adults were at highest risk, and those with overweight were also at high risk for developing obesity., (Copyright © 2022 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)

Introduction: British South Asians have a higher prevalence of overweight and obesity than the wider population. Bradford (UK), with its high Pakistani presence and levels of economic deprivation, has exceptionally high instances, especially in deprived areas where many Pakistanis reside. British Pakistani women in Bradford are more likely to be overweight and obese. There is uncertainty on how these women can be aided to manage their weight. Therefore, the objective of this study was to explore the obesity concerns of Pakistani women living in deprived inner-city areas of Bradford., Methods: Three focus groups interviews were carried out with 23 Pakistani women living in deprived areas of Bradford. Data were analysed thematically., Results: This exploratory study identified a wide range of concerns that women had around managing their weight. Participants disclosed distrust in information given around medication, conflicting dietary information and reported low levels of trust in women-only organized physical activities. Cultural barriers were identified, which included the gender role of the woman, the lack of culturally appropriate dietary advice, cultural misunderstandings of what constitutes a healthy diet and healthy weight, the lack of culturally suitable exercise facilities and conforming to family and community expectations. Other concerns were language barriers around a lack of understanding, the inability to read Urdu and reliance on others to translate information., Conclusion: These findings have implications for researchers, local authorities, policy makers and others with an interest in reducing the rates of obesity in this population. Recommendations include training health practitioners to be culturally aware of the diet and eating practices of this community, exploring different ways to support socially isolated women to be more physically active at home, addressing physical activity and diet misconceptions and designing obesity management information materials appropriate for a range of literacy levels., Patient or Public Contribution: Public contributors were involved in the development of the interview guide and design of the research. A pilot focus group with participants not included in the present paper was used to help test and refine the focus group questions. Interview transcripts were member checked by participants, and participants assisted with data analysis., (© 2022 The Authors. Health Expectations published by John Wiley & Sons Ltd.)

Background: Obesity and overweight affect a large proportion of the world's population. Increasingly, this problem can be observed among young adults. The aim of the study was to identify the motivations and barriers to healthy eating habits among young Poles, the relationship between physical activity and healthy eating and the impact of healthy eating on the body composition of the young., Methods: The method used in the research was a diagnostic survey using direct personal interviews. The research was conducted in the years 2016-2019 on a group of 399 young Poles aged 18-26. Their body composition was analyzed by determining resistance and reactance using the biological impedance method, with a TANITA SC-330ST Body Composition Analyzer., Results and Conclusion: The main reasons for healthy eating among young Poles are the intent to follow a doctor's recommendations, to lose weight and to live a healthy lifestyle and to follow a trend. On the other hand, the largest barriers to proper nutrition are: lack of time to prepare healthy meals and of financial resources, inability to prepare meals and limited knowledge of the principles of healthy eating. The eating behavior varied significantly in relation to the physical activity of the respondents. Active people's eating habits were the best, and those of sedentary people the worst. Healthy eaters also had normal body composition indicators (adipose tissue level, BMI, body type). Young adults should be educated on the principles of healthy eating and have access to healthy food in canteens and vending machines, both at work and at university.

The present study aimed to document the prevalence of and identify factors associated with excessive gestational weight gain (GWG) in early pregnancy among women with pre-pregnancy overweight or obesity. Women with pre-pregnancy overweight or obesity ( n  = 247) were recruited between 12 and 20 weeks of gestation and completed questionnaires and were weighed to estimate early GWG. Nearly one-third of women met (17%, n  = 42) or exceeded (13%, n  = 33) guidelines for total GWG in early pregnancy. Univariate analyses showed race, income, and pre-pregnancy weight status to be significantly related to GWG category in early pregnancy ( p  < .009). Only race and pre-pregnancy weight status remained significant in a multivariate model, with Black women and women with pre-pregnancy obesity having higher odds of having met or exceeded guidelines for total GWG in early pregnancy compared with White women and women with pre-pregnancy overweight ( p  < .04). These findings highlight the need for early intervention to reduce weight-related complications among pregnant women.Impact statement What is already known on this subject? Women with pre-pregnancy overweight or obesity who gain excessive gestational weight early in pregnancy are at unique risk for pregnancy complications and adverse birth outcomes. What do the results of this study add? The present study adds to a growing body of literature documenting that a notable amount of women are gaining excessive gestational weight early in pregnancy. The present study further documents that Black women and women with pre-pregnancy obesity are at particular risk of gaining excessive gestational weight early in pregnancy. What are the implications of these findings for clinical practice and/or further research? Additional work examining modifiable risk factors, particularly among Black women and women with pre-pregnancy obesity, that contribute to excessive gestational weight gain (GWG) in the first half of pregnancy is warranted and will be necessary to inform interventions aimed at promoting weight loss during the preconception and interconception periods or encouraging appropriate GWG across the entire course of pregnancy.

The double burden of malnutrition (DBM) affects many low- and middle-income countries. However, few studies have examined DBM at the individual level, or undernutrition and overnutrition co-occurring within the same person. This study aims to investigate the prevalence and determinants of DBM among adults in the Philippines. Data from the 2013 National Nutrition Survey were used. The sample size in the analysis was 17,010 adults aged ≥20 years old, after excluding pregnant and lactating women. DBM was defined as the co-occurrence of overweight/obesity and anemia (definition #1), overweight/obesity and anemia or vitamin A deficiency (definition #2), and overweight/obesity and anemia or vitamin A deficiency or iodine insufficiency (definition #3). Anthropometric measurements and biochemical markers were used for DBM assessment. Data were analyzed using descriptive statistics, the chi-square test, and logistic regression by R software. Results showed that definition #3 is the predominant type of DBM (7.0%) in the general population, whereas the prevalence of DBM has increased to 23.7% in overweight/obese persons. Sex, age, educational attainment, marital status, household size, wealth quintile, and smoking status were the determinants of DBM. This study revealed that Filipino adults experience malnutrition critically and must be addressed through food and nutrition interventions.

Background: There are few long-term studies of interventions to reduce in low socioeconomic status children with overweight or obesity. The Stanford GOALS trial evaluated a 3-year, community-based, multi-level, multi-setting, multi-component (MMM) systems intervention, to reduce weight gain among low socioeconomic status, Latinx children with overweight or obesity., Methods: We did a two-arm, parallel group, randomised, open-label, active placebo-controlled trial with masked assessment over 3 years. Families from low-income, primarily Latinx communities in Northern California, CA, USA, with 7-11-year-old children with overweight or obesity were randomly assigned to a MMM intervention or a Health Education (HE) comparison intervention. The MMM intervention included home environment changes and behavioural counselling, community after school team sports, and reports to primary health-care providers. The primary outcome was child BMI trajectory over three years. Secondary outcomes included one- and two-year changes in BMI. This trial is registered with ClinicalTrials.govNCT01642836., Findings: Between July 13, 2012, and Oct 3, 2013, 241 families were recruited and randomly assigned to MMM (n=120) or HE (n=121). Children's mean age was 9·5 (SD 1·4) years, 134 (56%) were female and 107 (44%) were male, and 236 (98%) were Latinx. 238 (99%) children participated in year 1, 233 (97%) in year 2, and 227 (94%) in year 3 of follow-up assessments. In intention-to-treat analysis, over 3 years, the difference between intervention groups in BMI trajectory was not significant (mean adjusted difference -0·25 [95% CI -0·90 to 0·40] kg/m 2 ; Cohen's d=0.10; p=0·45). Children in the MMM intervention group gained less BMI over 1 year than did children in the HE intervention group (-0·73 [-1·07 to -0·39] kg/m 2 , d=0.55); the same was true over 2 years (-0·63 [-1·13 to -0·14] kg/m 2 ; d =0.33). No differential adverse events were observed., Interpretation: The MMM intervention did not reduce BMI gain versus HE over 3 years but the effects over 1 and 2 years in this rigorous trial show the promise of this systems intervention approach for reducing weight gain and cardiometabolic risk factors in low socioeconomic status communities., Funding: US National Institutes of Health., Competing Interests: Declaration of interests TNR serves on scientific advisory boards for WW International. DMW has received grant funding and serves on a scientific advisory board for Tolerion, on an advisory board for the California Institute for Regenerative Medicine, and on a data and safety monitoring board for Intrexon T1D Partners. JS has received funding from Weight Watchers. All other authors declare no competing interests., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Interleukin 6 (IL-6) and its receptors are expressed in approximately half of breast cancer (BC) tissues, and high serum IL-6 levels are associated with poor prognosis. African American (AA) patients with BC have higher serum IL-6 levels compared to Caucasians, suggesting additional risk of disease-related complications in AAs. The purpose of this study was to compare IL-6 complex biomarkers in AA women with and without a history of BC. We conducted a secondary analysis of phenotypic data from two studies of weight loss in AA women with and without a history of BC who had similar age and adiposity. Biomarkers analyzed included tumor necrosis factor alpha (TNF-α), IL-6, IL-6 soluble receptor (IL6sr), and soluble glycoprotein 130 (GP130); IL6sr and GP130 were newly analyzed for this study. TNF-α levels were 1.86 times higher in the BC group (N = 7) compared to those without BC (N = 10; p < 0.001) despite similar age, weight, and body mass index. GP130 levels tended to be higher in women with BC; IL-6 and Il-6 sr were not different between groups. There was a strong correlation between GP130 and TNF-α (r = .638; p = .006) in the group overall. High TNF-α levels in the BC group and a strong correlation between GP130 and TNF-α in the overall group suggest the presence of IL-6 complex initiated TNF-α production. Further study is needed to evaluate IL-6 reduction through a variety of approaches, including weight loss and anti-IL-6 therapies, which may ultimately implicate the reduction of IL-6 complex associated BC-specific recurrence and mortality.

Hispanic women are at high risk for type 2 diabetes (T2D), with obesity and unhealthy eating being important contributing factors. A cross-sectional design was used in this study to identify dietary patterns and their associations with diabetes risk factors. Participants completed a culturally adapted Food Frequency Questionnaire capturing intake over the prior 3 months. Overweight/obese Hispanic women (n = 191) with or at risk for T2D were recruited from a community clinic into a weight loss intervention. Only baseline data was used for this analysis. Dietary patterns and their association with diabetes risk factors (age, body mass index, abdominal obesity, elevated fasting blood glucose [FBG], and hemoglobin A1c). An exploratory factor analysis of dietary data adjusted for energy intake was used to identify eating patterns, and Pearson correlation coefficient (r) to assess the association of the eating patterns with the diabetes risk factors. Six meaningful patterns with healthful and unhealthful traits emerged: (1) sugar and fat-laden, (2) plant foods and fish, (3) soups and starchy dishes, (4) meats and snacks, (5) beans and grains, and (6) eggs and dairy. Scores for the "sugar and fat-laden" and "meats and snacks" patterns were negatively associated with age (r = - 0.230, p = 0.001 and r = - 0.298, p < 0.001, respectively). Scores for "plant foods and fish" were positively associated with FBG (r = 0.152, p = 0.037). Being younger may be an important risk factor for a diet rich in sugar and fat; this highlights the need to assess dietary patterns among younger Hispanic women to identify traits potentially detrimental for their health.

Ethnopharmacological Relevance: The seed of Senna obtusifolia (L.) H. S. Irwin & Barneby (Cassiae semen, CS) also known as Jue ming zi in China, has been traditionally used for weight management by purging the liver and improving the liver functions to support digestion. In the past decades, it has been used for hepatoprotection and treatment of overweight and other metabolic disorders such as hyperlipidaemia and diabetes., Aim of the Review: This review aimed at providing comprehensive information on the traditional usages, pharmacology, phytochemistry and toxicology of CS and critically exploring its potential usage for clinical weight management from both traditional and modern application perspectives., Materials and Methods: In order to fully understand the properties, actions and indications of CS, two sets of Chinese classical texts were searched, namely: Zhong Hua Yi Dian (Encyclopedia of Traditional Chinese Medicine) and Zhong Guo Ben Cao Quan Shu (Complete Collection of Traditional Texts on Chinese Materia Medica). The purpose of studying these classical texts was to determine the traditional use of CS in weight management. Comprehensive searches were also performed on seven databases for publications on original randomised clinical trials (RCT), in vivo, in vitro or in silico studies related to pharmacological effects of CS. Detailed information about the phytochemistry of CS was collected from books, encyclopedia, online databases and journal literature., Findings: In classical literature review, 89 classic texts provided information of properties, actions and indications of CS. In modern literature review, 44 studies were included for analysis, including 5 RCTs, 7 in vivo studies, 14 in vitro studies, 2 in silico studies and 16 studies of mixed types. Chinese classic literature has provided traditional evidence of the usage of CS for weight management. Contemporary studies have revealed that CS has weight loss effects and possesses some other pharmacological activities supporting weight management. Some chemical compounds of CS have been hypothesised to have a direct or indirect contribution to weight control., Conclusions: The relationships between chemical compounds and the corresponding weight-loss target proteins are not fully understood. Therefore, CS constituents should be further explored for the development of novel therapeutic or preventive agents for the treatment of overweight and obesity., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Obesity is an increasing public health concern both in the developed and developing countries. Previous studies have demonstrated that considerable alterations in lipid metabolism and consequently marked changes in lipid profile are associated with the onset and progression of obesity-related complications. To characterize the full spectrum of obesity-induced changes in lipid metabolism, direct infusion tandem mass spectrometry analysis is the most promising approach. To better understand which of the many lipid species are the most strongly associated with obesity, the aim of our work was to measure and profile plasma lipids in normal ( n = 57), overweight ( n = 31), and obese ( n = 48) individuals randomly selected from samples of Hungarian general and Roma populations by using the targeted quantitative lipidomics platform, the Lipidyzer. Principal component and stepwise regression analyses were used to identify the most significant clusters and species of lipids by increasing body mass index (BMI). From the 18 clusters identified four key lipid species (PE P-16:0/20:3, TG 20:4&#95;33:1, TG 22:6&#95;36:4, TG 18:3&#95;33:0) showed a strong significant positive and three others (Hex-Cer 18:1;O2/22:0, LPC 18:2, PC 18:1&#95;18:1) significant negative association with BMI. Compared to individual lipid species alone, the lipid species ratio (LSR) we introduced showed an extremely strong, at least 9 orders of magnitude stronger, association with BMI. The LSR can be used as a sensitive and predictive indicator to monitor obesity-related alterations in human plasma and control the effectiveness of treatment of obesity associated non-communicable diseases.

Background: Weight reduction is effective in preventing T2D however, weight reduction and maintenance is difficult to achieve on a population scale. Serum insulin-like growth factor II (IGF-II) and IGF-II receptor (IGF2R) have been associated with diabetic status and body weight in prior studies and, in addition, IGF-II has been indicated as predictive of future weight change. We measured these serum markers in participants with obesity/overweight and prediabetes from the New Zealand arm of the PREVIEW lifestyle intervention randomised trial before and after an 8-week low energy diet (LED)., Methods: Total IGF-II (n = 223) and soluble IGF2R (n = 151) were measured using commercial ELISA kits on fasted serum samples taken prior to an 8-week LED and also from participants completing the LED., Results: IGF-II levels were not correlated with baseline body weight although mean levels did significantly decrease following the LED. Change in IGF-II serum level was correlated to fasting glucose change (p = 0.04) but not to weight change. Baseline serum IGF2R was correlated with BMI (p = 0.007) and was significantly higher in Māori compared to European Caucasian participants independent of body weight (p = 0.0016). Following LED, IGF2R change was positively associated with weight change (p = 0.02) when corrected for ethnicity. Pre-LED levels of these serum markers were not predictive of the magnitude of weight loss over the 8 weeks., Conclusion: Neither marker was useful in predicting magnitude of short-term weight loss. IGF2R is positively associated with BMI and is higher in Māori compared to European Caucasian individuals., (Copyright © 2021 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.)

Leptin levels and oxidative stress are implicated in obesity risk. Reports of association of leptin gene (LEP) and leptin receptor gene (LEPR) polymorphisms with leptin elevation are contradictory in a diverse population. Only a few studies report the linkage of obesity with biochemical markers and genetic factors., Objective: The aim of this study was to examine whether plasma lipid peroxidation, antioxidant capability, leptin levels are associate selected LEP -2548 A/G and LEPR Q223R polymorphisms in mestizo and indigenous obesity Mexican population., Methods: We identified and characterized 50 overweight or obese subjects and 50 healthy, normal- weight volunteers with indigenous Tepehuana or Mexican mestizo ethnicity from Durango, Mexico. LEP -2548 A/G and LEPR Q223R polymorphisms were determined by genotyping. Concentrations of leptin, antioxidant capacity (CA) and lipoperoxidation (LIPX) were determined in fast conditions on plasma with Enzyme-Linked ImmunoSorbent Assay (ELISA) in all participants., Results: The highest genotype frequency was the heterozygous LEPR, which was associated with lipid peroxidation levels in normal-weight Tepehuan populations. A positive correlation was observed (r = 0.5; p <0.01) between LEP polymorphism and lipoperoxidation in normal weight Tepehuan subjects. On the other hand, the LEPR polymorphism was associated with the level of lipoperoxidation (r = 0.13; P <0.05) in mestizo populations of normal weight., Conclusion: It is probable that there is a synergistic effect for obesity, where the presence of oxidative stress and single nucleotide polymorphisms (SNP) of leptin and its receptor contributes to the generation of pathological subcutaneous fat of obesity, together with the environmental conditions of the populations., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Objectives: This study aimed to investigate the sex- and age-specific trends of stunting and combined overweight with stunting among schoolchildren over a 13-year period in Kuwait., Subjects and Methods: The Kuwait Nutrition Surveillance System objectively measured the height of 172,573 schoolchildren (5-19 years) over a 13-year period (2007-2019). Data on gender and date of birth were extracted from school records. Stunting was defined as height 2 standard deviations (SD) below the World Health Organization growth reference median. Logistic regression models were used to examine the trends of stunting over the study period while stratifying by gender., Results: In males, the prevalence of stunting increased from 2.46% in 2007 to 4.18% in 2019 (p for trend <0.001). In females, the prevalence of stunting fluctuated but remained around 3.80% in both 2007 and 2019. The odds of stunting significantly increased in the period 2017-2019 compared to the period 2007-2010 among males, adjusted odds ratio (AOR) 1.04 (95% confidence interval [CI]: 1.14-1.76); p = 0.009, but not females, AOR 0.89 (95% CI: 0.73-1.07); p = 0.176. Although not statistically significant, there was a tendency for the odds of combined overweight with stunting to increase in males, AOR 1.65 (95% CI: 0.90-3.04); p = 0.087, but not females, AOR 1.13 (95% CI: 0.88-1.45); p = 0.248., Conclusion: Although the prevalence of stunting and combined stunting with overweight is low, there is an emerging upward trend in schoolboys that warrants further investigation and monitoring. This highlights the need for gender-specific interventions to reduce nutritional abnormalities in high-income countries in the Middle East countries like Kuwait., (© 2021 The Author(s). Published by S. Karger AG, Basel.)

We estimated 2011-2015 Alaska mortality from modifiable behavioural risk factors using relative risks, hazard ratios, and population attributable fraction estimates from a comprehensive review of peer-reviewed literature; prevalence estimates from government reports; as well as data from the Alaska Department of Environmental Conservation for 2011-2015. To identify the number of deaths attributable to specified risk factors, we used mortality data from the Alaska Division of Public Health, Health Analytics & Vital Records Section. Data included actual reported deaths of Alaska residents for 2011-2015 that matched relevant underlying International Classification of Diseases and Related Health Problems 10th Revision codes. The actual causes of death in Alaska in 2011-2015 were estimated to be overweight/physical inactivity (20% of all deaths, 26% of Alaska Native deaths), smoking (18%/18%), alcohol consumption (9%/13%), firearms (4%/4%), and drug use (3%/3%). Other actual causes of death included microbial agents (3%/4%), motor vehicles (2%/2%), and environmental pollution (1%/1%). This updated methodology reveals that overweight/physical inactivity was the leading cause of death in Alaska, followed closely by smoking. Just three preventable causes made up almost 60% of all deaths, and almost 70% of deaths among Alaska Native people, both highlighting disparities and underscoring prevention needs.

Importance: Identifying effective weight loss interventions for Latino adults at risk of diabetes is of critical public health importance., Objective: To determine whether a culturally adapted behavioral intervention for Latino adults was more effective than usual care for weight loss over 24 months., Design, Setting, and Participants: In this randomized clinical trial, Latino adults with a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 24 or greater and a high risk for type 2 diabetes were recruited in primary care practices in the San Francisco, California, area, randomized to receive the Vida Sana intervention or usual care, and followed up for 24 months. The study was conducted from November 2015 to May 2019, and data were analyzed from July 2019 to Septmeber 2020., Interventions: The treatment group received Vida Sana, a culturally adapted lifestyle intervention that included a family-based orientation session and 22 group sessions over 12 months. Participants were encouraged to use a wearable activity tracker and mobile applications to track their physical activity and dietary intake. Participants received monthly email messages for an additional 12 months. The control group received usual care., Main Outcomes and Measures: The primary outcome was weight loss at 24 months. Secondary outcomes included weight loss at 12 months and achieving at least 5% weight loss at 12 and 24 months. Associations of baseline characteristics and intervention adherence with weight loss outcomes were also examined., Results: Among 191 participants (mean [SD] age, 50.2 [12.2] years; 118 [61.8%] women; 107 participants [57.2%] of Mexican origin; mean [SD] baseline BMI, 32.4 [5.7]) randomized, 92 participants were randomized to the intervention and 99 participants were randomized to usual care. Of these, 185 participants (96.9%) completed 24-month follow-up. Mean (SD) weight loss did not differ significantly by group at 24 months (intervention: -1.1 [5.7] kg; control: -1.1 [7.1] kg; P = .93). However, mean (SD) weight loss was significantly greater in the intervention group (-2.6 [6.0] kg) than the control group (-0.3 [4.2] kg) at 12 months (mean difference, -2.1 [95% CI, -3.6 to -0.7] kg; P = .005). Intervention participants were more likely to achieve at least 5% weight loss than control participants at 12 months (22 participants [25.9%] vs 9 participants [9.2%]; P = .003), and participants who achieved at least 5% weight loss attended more intervention sessions than those who did not (mean [SD], 16.6 [7.6] sessions vs 12.4 [7.5] sessions; P = .03)., Conclusions and Relevance: These findings suggest that among Latino adults with high diabetes risk, a culturally adapted behavioral lifestyle intervention was effective for weight loss over 12 months but not 24 months., Trial Registration: ClinicalTrials.gov Identifier: NCT02459691.

We aimed to estimate the effect of age at menarche on the risk of excess body weight in Brazilian women two and four years after delivery. This was a cohort study that used data from adult women of the Predictors of Maternal and Child Excess Body Weight (PREDI) Study obtained at baseline (2012) and at 1 st (2014) and 2 nd (2016) follow-up. A total of 435 women attending a public maternity hospital in Joinville-Brazil were initially included in the study (baseline) and 215 of them continued to participate in the 2 nd follow-up carried out in the homes of the participants. Regression analysis was used to estimate the association between age at menarche (<12; ≥12 years) and excess body weight (≥25 kg/m 2 ) trajectory during the follow-ups. Unadjusted analysis showed that mothers with age at menarche <12 years were 1.29 times ( p = .018) more likely to be overweight/obese than those with age at menarche ≥12 years. After adjustment, age at menarche continued to exert an independent effect on the mother's body mass index (RR = 1.23; p = .037) four years after delivery. Strategies designed to attenuate the rising prevalence of maternal overweight and obesity, especially after pregnancy, could help improve the mother's health status in the future.

In Portugal, the majority of immigrants come from Portuguese-speaking countries. Among children, overweight and obesity are serious public health concerns, but a few studies include children with immigrant background. This study aimed to estimate the prevalence of overweight and obesity and risk of abdominal obesity in school-age children and to explore potential determinants, considering the origin of the children's parents (both mother and father are non-Portuguese, only one Portuguese, and both are Portuguese). A cross-sectional study included a random sample of 789 children (5-11 years old, 49.2% of males and 50.8% female) attending public primary schools in Barreiro, district of Setubal, Portugal. Fieldwork occurred from 20th April to 3rd July 2009. Data concerning socioeconomic, eating habits, and sports outside school were obtained through a questionnaire applied to the children's person in charge. Anthropometric measures were collected by certified technicians. One-third of the children presented overweight and obesity (33.7%, 95% CI [30.0; 37.7]) and risk of abdominal obesity (16.4%, 95% CI [13.6; 19.7]) without differences according to parents' origin. Children with immigrant background presented higher consumption of low-priced, high-sugar, and high-fat foods, with a worse situation for girls. Females from both non-Portuguese parents also practiced less sports outside school than those where one or two parents are Portuguese. Thus, promoting and monitoring a healthy diet and physical activity in this group should be prioritized in this local setting.

Individuals' perceptions of their food environments are a mediator between exposure to the environment and people's interaction with it. The Nutrition Environment Measures Surveys (NEMS) are valid and reliable measures to assess food environments. In Spain, there is no adapted instrument to measure the perceived obesogenic environment. This article aims to adapt and evaluate the Perceived Nutrition Environment Measures Survey for a Spanish context (NEMS-P-MED). The Spanish version has 32 questions to measure the perception about availability, accessibility and marketing of 3 types of environment: home, shops and restaurants. We assess feasibility, construct validity and internal consistency reliability through a sample of 95 individuals. The internal consistency was acceptable for most items (Cronbach's alpha coefficients range from 0.6 to 0.9), similar to that of the original scale. The NEMS-P-MED has been shown to be valid and, on certain items reliable, and was useful to assess the population's perceptions of the food environment in the home, restaurants and food stores in a Spanish context. Adapting standardized measurement tools to specific contexts to assess the perceived and observed characteristics of food environments may facilitate the development of effective policy interventions to reduce excess weight.

Objective: To examine the prevalence of overweight and obesity in urban adolescents with asthma and to investigate the relationships between anthropometric measures and asthma outcomes including quality of life, asthma control and lung function. Methods: Adolescents with an asthma diagnosis, 12-20 years-old, were recruited from three urban communities in the United States. Spirometry and anthropometric data including height, weight and waist circumferences were collected along with questionnaire data measuring quality of life, asthma control, and medication adherence. Body mass index (BMI) and waist-height ratio (WHtR) were computed. Results: The sample ( N  = 294) included 48% female and 80% African American. About 50% of the sample were either overweight or obese, and 41% had central obesity. No significant gender interactions with either BMI or WHtR on asthma outcomes were found. Neither BMI nor WHtR predicted quality of life, asthma control or medication adherence, while females had poorer quality of life and asthma control regardless of weight status ( p  < 0.001). Higher BMI or WHtR predicted higher spirometry values. Regardless of weight status, females had greater percent predicted spirometry values, while raw values ( L ) were significantly greater in males. Conclusions: High BMI is a common comorbidity among poor, primarily African American, urban adolescents with asthma. The negative impact of being overweight or obese on quality of life or asthma control is yet to be manifested in adolescents. The findings underscore adolescence as an ideal period to safely intervene to reduce excessive body weight, which can prevent the potentially harmful effects of obesity on future asthma outcomes.

Objective: To examine sex and racial/ethnic differences in sleep quality and the association between sleep quality and body weight status among US college students. Participants: A nationally representative sample ( N  = 324,767) of college students from 2011 to 2015. Methods: A secondary data analysis of cross-sectional data. Results: Women showed poorer sleep quality (nights per week getting enough sleep to feel rested) than men (4.00 versus 4.34 days; p < .001). In both men and women, compared with non-Hispanic whites, racial/ethnic minorities showed lower sleep quality ( p < .001). Compared with normal weight participants, overweight participants had poorer sleep quality ( p = .007) among men, and both overweight ( p = .004) and obese participants ( p < .001) had lower sleep quality among women. Conclusions: Understanding sex and racial/ethnic sleep differences and the association between sleep and body weight status is important for colleges to promote college students' healthy sleep.

Obesity rates increase as household income increases among Black men, yet only a few studies have sought to understand this unique association. Scholars have posited that gendered stressors like role strain that are work-related could play a role in obesity among Black men. Work-life interference is a concept that captures the conflict between work life and family/personal life. Work-life interference is associated with obesity-related behaviors but has been understudied in Black men. The aim of this study was to determine the interrelationship between work-life interference, income, and obesity among Black men. Using data from the 2015 National Health Interview Survey, the associations between household income and odds of overweight and obesity (measured by body mass index) were assessed using ordinal logit regressions. Multiplicative interaction terms were used to assess the potential moderation of the association between income and log-odds of overweight/obesity by work-life interference. The results of our study demonstrate that work-life interference interacts with income ≥400% federal poverty level (FPL) on the log-odds of overweight/obesity (beta=2.10, standard error [se]=.87). Among those who reported work-life interference, Black men who had household income ≥400% FPL had higher log-odds of overweight/obesity (beta=1.51, se=.74) compared with those with income <100% FPL. There was no association between income and obesity among Black men who did not report work-life interference. The results suggest that work-life interference plays an important role in the positive association between income and obesity in Black men. Future studies should explicate the obesogenic ways in which work and family/personal life combine among high-income Black men., Competing Interests: Competing Interests: None declared., (Copyright © 2020, Ethnicity & Disease, Inc.)

Background: Associations between high BMI and sleep duration and chronic illness are recognised. Short sleep is an accepted predictor of high BMI for children, including Indigenous Australian children. Short sleep has also been associated with high BMI in Australian adults, although not specifically in Indigenous Australian adults. This study aims to determine whether the relationship between sleep duration and BMI observed in non-Indigenous adults holds for Indigenous adults., Methods: Data collected from 5204 non-Indigenous and 646 Indigenous participants aged over 18 years in a nationally representative Australian Health Survey 2011-2013 were analysed. Sleep duration was self-reported as the time between going to bed and time waking up; BMI was derived from measurement and categorised into normal weight (BMI = 18.5-24.9) and overweight/obese (BMI ≥ 25). Logistic regression was performed for the non-Indigenous and Indigenous groups separately to examine the association between sleep duration and BMI in each group., Results: Proportionally more Indigenous people were classified as overweight/obese than non-Indigenous (χ 2  = 21.81, p < 0.001). Short sleep was reported by similar proportions in both groups (Indigenous 15% vs non-Indigenous 17%) whereas long sleep of > 9 h was reported by proportionally more Indigenous than non-Indigenous people (41% vs 26%). Without accounting for possible confounders, the association between sleep duration and BMI for the Indigenous group was not significant but a possible dose-response relationship was evident, with the odds of overweight/obesity being greatest for those who typically slept < 7 h (OR = 1.77, 95% CI 0.38-3.94) and < 6 h (OR = 1.55, 95%CI = 0.58-4.14). The same model for the non-Indigenous group was significant, with the odds of overweight/obesity being greatest for those who typically slept < 6 h (OR = 1.67, 95%CI 1.25-2.25). The risk of overweight/obesity diminished for both groups with sleep > 7 h. Accounting for a range of socioeconomic and personal confounders attenuated the strength of these relationships marginally., Conclusion: Adding to reports relating sleep duration and BMI for Australian adults, this study provides evidence for an inverse relationship in non-Indigenous adults and suggests a similar trend for Indigenous adults. This trend was non-significant but is consistent with previous results for Indigenous children.

Background: Establishment of an unbiased association between gestational weight gain (GWG) and perinatal health is urgently needed in China, which has the largest population in the world. Our study aimed to create weight-gain-for-gestational-age charts using early pregnancy body mass index (BMI) to present selected percentiles of GWG in China., Methods: A population-based follow-up study was conducted based on the Maternal and Newborn Health Monitoring System, which recruited 132,835 pregnant women between October 2013 and September 2016 in 12 districts/counties of 6 provinces in China. Multilevel analyses and restricted cubic splines were performed to model the longitudinal repeated maternal weight gain measurements and obtain smoothed curves for GWG. The internal and external validation of each model was also assessed., Results: To develop models of GWG, 34,288 women were included. Smoothed percentiles of GWG in the 3rd, 10th, 50th, 90th, and 97th percentiles were estimated for each week of gestation. The median figures for GWG were 15.0 kg, 14.4 kg, 13.5 kg, and 12.1 kg in underweight, normal weight, overweight, and obese women, respectively, at 40 weeks. Of all the weight measurements, more than 70% and 95% fell within the expected 1 to 2 standard deviations, respectively. To accomplish external validation of the models, 20,458 women were included. The specificities of measurements in the 5th, 10th, 15th, 25th, 75th, 85th, 90th, and 95th percentiles in four BMI categories were between 90% and 100%., Conclusions: The population-based gestational weight gain Z-score charts performed well in providing guidance regarding expected gestational weight gain in Chinese women.

Children in the child welfare system have greater rates of obesity and are more prone to overweight/obesity as adults compared to other children. There is limited research on how ecological, biological and developmental factors impact the trajectory of overweight/obesity in this group. This retrospective study examined these factors among children entering the child welfare system. Overweight/obesity was highest among children 12-18 years. Children with diagnoses indicative of poor nutrition, and limiting exercise, were more likely to be overweight/obese. Ecological risks often were not disclosed. Barriers to obtaining information to address overweight/obesity reflect challenges to addressing chronic disease more broadly.

This study sought to examine racial/ethnic variations in receipt of provider recommendations on weight loss, patient adherence, perception of weight, attempts at weight loss and actual weight loss among patients with overweight/obesity status at Health Resources and Services Administration-funded health centres (HC). We used a 2014 nationally representative survey of adult HC patients with overweight/obesity status (PwOW/OB) last year and reported the HC was their usual source of care (n = 3517). We used logistic regression models to assess the interaction of race/ethnicity and having obesity in (1) provider recommendations of diet or (2) exercise, (3) patient adherence to diet or (4) exercise, (5) perceptions of weight and (6) weight loss attempts. We used a multinomial regression model to examine (7) weight loss or gain vs no change and a linear regression model to evaluate (8) percent weight change. We found Black PwOW/OB (OR = 1.65) experienced greater odds of receiving diet recommendations than Whites. We found limited racial/ethnic disparities in adherence. Black (OR = 0.41), Hispanic/Latino (OR = 0.45), and American Indian/Alaska Native (OR = 0.41) PwOW/OB had lower odds of perceiving themselves as overweight. Black (OR = 1.68) and Hispanic (OR = 1.98) PwOW/OB had a greater odds of reporting weight gain, and Asian PwOW/OB (OR = 0.42) had lower odds of reporting weight loss than Whites. Disparities in provider diet recommendations among Blacks and Hispanics indicated the importance of personalized weight management recommendations. Understanding underlying reasons for discordance between self-perception and observed weight among different groups is needed. Overall increase in weight, despite current interventions, should be addressed through targeted racially/ethnically appropriate approaches., (© 2020 World Obesity Federation.)

Introduction: Population-specific obesity in different age groups and in the Roma population as well as the presence of noncommunicable diseases that are linked to obesity necessitate the development of ethnical-specific prevention and intervention programmes., Aim: Our goal is to model the effects on nutritional status of interventional programmes of different intensities carried out in various age groups of the Roma population., Method: We defined the effect of different public health interventions on the state of health of the Roma population by use of the Dynamic Modeling for Health Impact Assessment software. Two models of interventions were studied throughout our research: one that focuses on only one aspect of lifestyle changes; and one that includes radical prevention programmes that aim to change lifestyles as a whole and have an impact on nutritional status., Results: Nearly 20% of Roma men and women are obese, and by 2070, one third of the Roma population will be overweight or obese without any public health intervention. Not even when the most efficient proceedings of the scientific literature are applied do prevention-intervention programmes of moderate-intensity offer a perceptible result about the incidence and prevalence of diseases linked to obesity. In the case of application of these programs, not more than a ten-person order of magnitude decrease can be achieved. This is not enough to prove a statistical detectability on the population level. Whereas, complex intervention programmes, based on a comprehensive transformation of lifestyle and food consumption patterns can present perceptible outcome primarily among the middle-aged and the elderly., Conclusion: The survey results direct attention to the fact that reducing the burden of disease in the Roma population caused by obesity is only to be achieved as a complex, all-councils act that requires resources much greater than what is available now. Orv Hetil. 2020; 161(27): 1137-1145.

Background: Information regarding circulating fatty acids (FA) in association with metabolic health in black Africans is scarce, while the usefulness of circulating FAs as biomarkers of dietary fat intake and predictors for medical conditions is increasing., Objective: We compared eleven dietary and the levels of 26 plasma phospholipid FAs in metabolically healthy and unhealthy phenotypes in black South African adults., Methods: Adults from the South African arm of the Prospective Urban and Rural Epidemiology study baseline (n = 711) were categorised into four groups, namely normal weight without metabolic syndrome (MetS) (MHNW), normal weight with MetS (MUNW), metabolically healthy overweight/obese (MHO) and metabolically unhealthy overweight/obese (MUO). Dietary and plasma phospholipid FAs were measured by a quantitative food frequency questionnaire and gas chromatography-tandem mass spectrometry, respectively. We compared dietary FAs, plasma phospholipid FAs, and estimated desaturase activity between the metabolic status groups using ANCOVA adjusted for age and energy intake., Results: MetS was diagnosed in 35% of the participants. After adjustment for age and total energy intake, in comparison to the MHNW reference group, saturated dietary FAs (C14:0 to C18:0) and alpha-linolenic acid intakes were higher in both overweight/obese groups (MHO and MUO), while linoleic acid intakes were higher in the MUO group only. Plasma levels of most saturated FAs (C18:0 to C22:0) and PUFAs were higher, whereas selected MUFAs, palmitic acid, and estimated desaturase activities were lower in the overweight/obese groups., Conclusions: The overweight groups generally had higher fat intakes than normal-weight groups, but lower plasma levels of palmitic, palmitoleic, oleic, cis-vaccenic and estimated desaturase activities. Therefore, in this population, lower plasma levels of palmitic, palmitoleic, oleic, and cis-vaccenic acids and decreased estimated desaturase activities may be biomarkers of abnormal metabolic health in overweight/obese study participants., Competing Interests: Declaration of Competing Interest Authors declare no competing interests., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Weight stigma and binge eating have been found to be associated in Western populations; however, this relationship is understudied among Asian Americans. The aims of the study were to (1) investigate the prevalence of binge eating and its relationship with experienced weight stigma in higher-weight Asian Americans, and (2) examine whether the level of acculturation moderates this relationship. Data were collected from a cross-sectional study with 166 higher-weight Asian American adults living in North Carolina, United States. Demographic data, the frequency of experiencing weight stigma, the severity of binge eating, the levels of acculturation, the perceived racism against Asians, and perceived stress were assessed via self-reported questionnaires. The results indicated that experienced weight stigma was a significant independent predictor over and above the effects of other stressors, such as racism and general stress. The level of acculturation did not influence the relationship between the experienced weight stigma and binge eating after adjusting for relevant covariates. Our findings contribute to the limited literature examining weight stigma and binge eating among Asian American populations, highlighting that higher levels of experienced weight stigma are associated with a greater degree of binge eating.

Background: The prevalence of overweight and obesity among women of childbearing age is considered a public health concern. Few studies have been conducted in the Gaza Strip to determine the magnitude of overweight and obesity. This study aimed to determine the prevalence of overweight and obesity along with their associated factors among women in the Gaza Strip., Methods: A cross-sectional study was conducted to recruit a total of 357 mothers aged 18-50 years. Interviews were carried out among mothers to collect sociodemographic information, nutritional information, and physical activity. Anthropometric measurements [height, weight and waist circumference (WC)] were conducted with the mothers. Body Mass Index (BMI) was computed to determine the prevalence of overweight and obesity. Multinomial logistic regression was used to examine the associated factors of overweight and obesity., Results: The combined prevalence of overweight and obesity among mothers was (64.1%). The results of multinomial logistic regression showed the risk of overweight and obesity increased with age, the highest risk being in mothers aged > 33.0 years (OR = 2.7, 95% CI: (1.06,6.86)), and (OR = 5.72, 95% CI: (2.07,15.78)), respectively, compared to mothers aged < 33.0 years. Moreover, mothers with medium and high educational levels had a slightly higher risk of obesity (OR = 0.31, 95% CI: (0.15,0.64)), and (OR = 0.32, 95% CI: (0.12,0.82)) respectively than mothers with low educational level. Household income was positively associated with overweight and obesity. Mothers exposed to higher monthly income were more likely to be overweight or obese (OR = 2.64, 95% CI: (1.20, 5.83)), and (OR = 3.06, 95% CI: (1.28,7.29)), respectively. Nutrition knowledge was significantly associated with a high prevalence of obesity (OR = 1.20, 95% CI: (1.03,1.38))., Conclusions: This study showed a higher prevalence of overweight and obesity among Palestinian women than previous studies. Age, educational level, monthly income, and nutrition knowledge were associated with the prevalence of overweight and obesity, compared to other variables that were not associated with overweight and obesity such as location, work status, physical activity, and sitting hours. Urgent action is needed to tackle overweight and obesity among women. Effective intervention is required to increase nutrition knowledge among women to improve their eating behaviors.

Introduction: Middle-aged Hispanic women have the highest prevalence of overweight and lifetime risk for diabetes of all gender/racial groups. This study examines use of alternative medicine for weight loss and diabetes management among overweight and obese Mexican American women with or at risk for diabetes., Method: As part of a diabetes risk-reduction intervention targeting overweight and obese Hispanic women at a federally qualified health center in Hillsboro, Oregon, we administered a survey of different treatment modalities, including alternative medicine, traditional Mexican medicine, and home remedies to 85 Hispanic women. We also asked participants how often they disclosed their use of alternative methods to their providers., Results: Nearly all participants with diabetes (97%) reported using at least one alternative strategy for diabetes control, with home remedies, commercial weight-loss products, and herbal teas being the most endorsed. Most participants with diabetes and half of those without diabetes reported never telling their provider., Conclusion: This group of women reported a high prevalence of use of alternative methods for weight control and diabetes management. Yet most participants with diabetes never reported this use to a health care provider. To ensure patient safety, providers treating Hispanic women need to probe for complementary and alternative medicine practices.

Background: Weight gain is common following migration to a new country. Mexican immigrants have a disparate prevalence of overweight/obesity and food insecurity. Social stressors, such as unemployment, discrimination, and the threat of deportation, may fuel both food insecurity and weight gain in this population., Objectives: We sought to (1) examine community-defined causes and correlates of obesity among Mexican-Americans; (2) determine how current social stressors, policies, and programs impact food insecurity and obesity; and (3) identify community-defined priorities for preventive interventions., Methods: Group concept mapping (GCM) was used in a community-academic partnership (CAP) to describe the factors contributing to weight gain and obesity among Mexican immigrant families. Activities included community brainstorming, sorting and rating, multivariate statistical analysis, and community interpretation of results., Results: Eighty statements were generated in the brainstorming sessions. These statements were sorted into nine clusters, which were organized into three regions: (1) intrapersonal factors; (2) community-level factors; and (3) social policy-related barriers. Statements reflecting the impact of immigration-related stressors were found in all three regions, addressing participants' fears of deportation, and the prioritization of resources away from healthy eating, resulting in food insecurity. Community members identified five priority areas for intervention planning: (1) lack of exercise; (2) lack of knowledge of a healthy diet; (3) expense of healthy foods; (4) "junk" food; and (5) stress management., Conclusions: Results suggest high levels of social stress are contributing to food insecurity and obesity among Mexican immigrant families. Areas identified for intervention planning reflect the need for a multifaceted approach toward obesity prevention.

Purpose: To estimate racial/ethnic-stratified effects of maternal prepregnancy BMI on size for gestational age at birth, by comparing siblings within families., Methods: This study examined linked vital statistics and patient discharge data from 580,960 infants born to 278,770 women in the State of California (2007-2012). To control for family-level confounding, we used fixed effects multinomial regression, modeling size for gestational age (small [SGA], appropriate, large [LGA]) as a function of maternal BMI (underweight, normal weight, overweight, obesity class I, II, III) and time-varying covariates. We conducted overall and race/ethnicity-stratified (non-Hispanic white, black, Asian; Hispanic) analyses. For comparison, we fit analogous random effects models, which do not control for family-level confounding., Results: In fixed effects models, maternal BMI was most strongly associated with LGA in non-Hispanic white women, reaching 6.7 times greater for class III obesity (OR [95% CI]: 6.7 [5.1, 8.7]); and weakest in black women (OR [95% CI]: 3.0 [1.5, 5.7]). Associations with SGA were similar across race/ethnicity. Compared with random effects estimates, fixed effects were most attenuated for LGA associations among racial/ethnic minority women., Conclusions: Maternal prepregnancy BMI was differentially associated with size for gestational age across racial/ethnic groups, with the strongest family-level confounding in racial/ethnic minority women., (Copyright © 2020 Elsevier Inc. All rights reserved.)