Muscle Mass and Vitamin C

“We know that Vitamin C consumption is linked with skeletal muscle mass. It helps defend the cells and tissues that make up the body from potentially harmful free radical substances. Unopposed these free radicals can contribute to the destruction of muscle, thus speeding up age-related decline.”

#vitaminc #muscle #skeletalmuscle

Lucy N Lewis, Richard P G Hayhoe, Angela A Mulligan, Robert N Luben, Kay-Tee Khaw, Ailsa A Welch. Lower Dietary and Circulating Vitamin C in Middle- and Older-Aged Men and Women Are Associated with Lower Estimated Skeletal Muscle Mass. The Journal of Nutrition, 2020; DOI: 10.1093/jn/nxaa221

https://academic.oup.com/jn/article/150/10/2789/5897318

sarcopenia, skeletal muscle, frailty, vitamin C, ascorbic acid, muscle mass, muscle loss, aging, gain muscle, muscle growth, body mass index, diet ,frailty, skeletal muscles, plasma, ascorbic acid, sarcopenia, calcium ascorbate,

Green tea and Weight Loss

The analysis of 26 randomized controlled trials including 1,344 participants found that body weight and body mass index significantly changed after green tea was consumed for periods longer than 12 weeks and at a dosage of less than 800 mg/day.

Ying Lin et al, The effect of green tea supplementation on obesity: A systematic review and dose–response meta‐analysis of randomized controlled trials, Phytotherapy Research (2020). DOI: 10.1002/ptr.6697

Higher chocolate consumption associated with lower levels of total fat—fat deposits all over the body—and central—abdominal—fat, independently of whether or not subjects are physically active, and of their diet

Scientists at the University of Granada have disproved the old idea that chocolate is fattening, in a study reported this week in Nutrition

The study—possibly the most comprehensive to date—included 1458 European adolescents aged between 12 and 17 years

University of Granada researchers from the Faculty of Medicine and the Faculty of Physical Activity and Sports Sciences have scientifically disproven the old belief that eating chocolate is fattening. In an article published this week in the journal Nutrition, the authors have shown that higher consumption of chocolate is associated with lower levels of total fat (fat deposited all over the body) and central fat (abdominal), independently of whether or not the individual participates in regular physical activity and of diet, among other factors.

The researchers determined whether greater chocolate consumption associated with higher body mass index and other indicators of total and central body fat in adolescents participating in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study. This project, financed by the European Union, studies eating habits and lifestyle in young people in 9 European countries, including Spain.

Independent of diet and physical activity

The study involved 1458 adolescents aged between 12 and 17 years and results showed that a higher level of chocolate consumption associated with lower levels of total and central fat when these were estimated through body mass index, body fat percentage—measured by both skinfolds and bioelectrical impedance analysis—and waist circumference. These results were independent of the participant’s sex, age, sexual maturation, total energy intake, intake of saturated fats, fruit and vegetables, consumption of tea and coffee, and physical activity.

As the principle author Magdalena Cuenca-García explains, although chocolate is considered a high energy content food—it is rich in sugars and saturated fats—“recent studies in adults suggest chocolate consumption is associated with a lower risk of cardiometabolic disorders”.

In fact, chocolate is rich in flavonoids—especially catechins—which have many healthy properties: “they have important antioxidant, antithrombotic, anti-inflammatory and antihypertensive effects and can help prevent ischemic heart disease”.

Recently, another cross-sectional study in adults conducted by University of California researchers found that more frequent chocolate consumption also associated with a lower body mass index. What’s more, these results were confirmed in a longitudinal study in women who followed a catechin-rich diet.

The effect could be partly due to the influence of catechins on cortisol production and on insulin sensitivity, both of which are related with overweight and obesity.

Calorie impact is not the only thing that matters

The University of Granada researchers have sought to go further and analyse the effect of chocolate consumption at a critical age like adolescence by also controlling other factors that could influence the accumulation of fat. The research, which is both novel and, perhaps, the largest and best-controlled study to date, is the first to focus on the adolescent population. It includes a large number of body measures, objective measurement of physical activity, detailed dietary recall with 2 non-consecutive 24-hour registers using image-based software, and controls for the possible effect of a group of key variables.

In Nutrition, the authors stress that the biological impact of foods should not be evaluated solely in terms of calories. “The most recent epidemiologic research focuses on studying the relation between specific foods—both for their calorie content and for their components—and the risk factors for developing chronic illnesses, including overweight and obesity”.

Despite their results, the authors insist that chocolate consumption should always be moderate. “In moderate quantities, chocolate can be good for you, as our study has shown. But, undoubtedly, excessive consumption is prejudicial. As they say: you can have too much of a good thing”.

The University of Granada researchers stress that their findings “are also important from a clinical perspective since they contribute to our understanding of the factors underlying the control and maintenance of optimal weight”.

Reference: Association between chocolate consumption and fatness in European adolescents Magdalena Cuenca-García, Jonatan R. Ruiz, Francisco B. Ortega, Manuel J. Castillo Nutrition (2013). http://dx.doi.org/10.1016/j.nut.2013.07.011

chocolate

In the photo, the University of Granada researchers who have published this article. From left to right, Jonatan R. Ruiz, Magdalena Cuenca-García, Manuel J. Castillo and Francisco B. Ortega. Dr Ruiz and Dr Ortega currently work in the Department of Physical and Sports Education (Faculty of Physical Activity and Sports Sciences), and Dr Cuenca-García and Dr Castillo work in the Department of Physiology (Faculty of Medicine).

Corresponding author: Magdalena Cuenca-García Department of Physiology Faculty of Medicine University of Granada Telephone: +34 958 24 3540 E-mail address: mmcuenca@ugr.es

Could artificial sweetener CAUSE diabetes? Splenda ‘modifies way the body handles sugar’, increasing insulin production by 20%

Study found sugar substitute sucralose had an effect on blood sugar levels
Also discovered that insulin production increased by 20% when consumed
Scientists aren’t sure what implications are, but said that regularly elevated insulin levels could eventually cause insulin resistance and even diabetes

By Rachel Reilly

PUBLISHED: 12:27 EST, 30 May 2013 | UPDATED: 12:27 EST, 30 May 2013

Splenda is made of sucralose, which has been found to affect blood glucose and insulin levels

Splenda can modify how the body handles sugar and could lead to diabetes, according to a new study.

Scientists found that consuming the sugar alternative made of sucralose caused a person’s sugar levels to peak at a higher level and in turn increase the amount of insulin a person produced.

Researchers said that while they did not fully understand the implications of the findings, they might suggest that Splenda could raise the risk of diabetes.

This is because regularly elevated insulin levels can lead to insulin resistance, which is a known path to type 2 diabetes.

‘Our results indicate that this artificial sweetener is not inert – it does have an effect,’ said Yanina Pepino, research assistant professor of medicine at the Washington School of Medicine in St. Louis, who led the study.

‘And we need to do more studies to determine whether this observation means long-term use could be harmful.’

Sucralose is made from sugar, but once processed its chemical make up is very different. Gram for gram it is 600 times sweeter than table sugar.

The scientists analysed the effects of Splenda in 17 severely obese people who did not have diabetes and did not use artificial sweeteners regularly.

Participants had an average body mass index of just over 42. A person is considered obese when their BMI reaches 30.

Scientists gave subjects either water or dissolved sucralose to drink before they consumed glucose (sugar).

More…

They wanted to understand whether the combination of sucralose and glucose would affect insulin and blood sugar levels.

Every participant was tested twice. Those who drank water followed by glucose in one visit drank sucralose followed by glucose in the next. In this way, each person served as his or her own control group.

‘We wanted to study [overweight people] because these sweeteners frequently are recommended to them as a way to make their diets healthier by limiting calorie intake,’ Pepino said.

They found that when study participants drank sucralose, their blood sugar peaked at a higher level than when they drank only water before consuming glucose.

Better off with the real thing?: Artificial sweeteners were once thought to be the holy grail for dieters and diabetics, but recent studies have shown that they could pose dangers to health

Insulin levels also rose about 20 percent higher. So despite no extra sugar being consumed, the artificial sweetener was related to an enhanced blood insulin and glucose response.

Professor Yanina explained that they do not fully understand the implications that these rises could have.

She said: ‘The elevated insulin response could be a good thing because it shows the person is able to make enough insulin to deal with spiking glucose levels.

‘But it also might be bad because when people routinely secrete more insulin, they can become resistant to its effects, a path that leads to type 2 diabetes.’

It has been thought that artificial sweeteners, such as sucralose, don’t have an effect on metabolism.

They are used in such small quantities that they don’t increase calorie intake. Rather, the sweeteners react with receptors on the tongue to give people the sensation of tasting something sweet without the calories associated with natural sweeteners, such as table sugar.

While scientists are not sure what the implications of the study are, they said there could be an increased risk of diabetes

But recent findings in animal studies suggest that some sweeteners may be doing more than just making foods and drinks taste sweeter.

One finding indicates that the gastrointestinal tract and the pancreas can detect sweet foods and drinks with receptors that are virtually identical to those in the mouth.

That causes an increased release of hormones, such as insulin.

Some animal studies also have found that when receptors in the gut are activated by artificial sweeteners, the absorption of glucose also increases.

Professor Pepino added: ‘Most of the studies of artificial sweeteners have been conducted in healthy, lean individuals. In many of these studies, the artificial sweetener is given by itself.

But in real life, people rarely consume a sweetener by itself. They use it in their coffee or on breakfast cereal or when they want to sweeten some other food they are eating or drinking.’

Just how sucralose influences glucose and insulin levels in people who are obese is still somewhat of a mystery.

‘Although we found that sucralose affects the glucose and insulin response to glucose ingestion, we don’t know the mechanism responsible,’ said Pepino.

‘We have shown that sucralose is having an effect. In obese people without diabetes we have shown sucralose is more than just something sweet that you put into your mouth with no other consequences.’

She said further studies are needed to learn more about the mechanism through which sucralose may influence glucose and insulin levels, as well as whether those changes are harmful.

The study was published in the journal Diabetes Care.

In a statement, Splenda said: ‘Numerous clinical studies in people with Type 1 and Type 2 diabetes and non-diabetic people have shown that Splenda Brand Sweetener (sucralose) does not affect blood glucose levels, insulin, or HbA1c.

‘FDA and other important safety and regulatory agencies from around the world have concluded that sucralose does not adversely affect glucose control, including in people with diabetes.

‘Experts from around the world have found that Splenda Brand Sweetener is suitable for everyone, including those with diabetes.’

Study shows drinking one 12oz sugar-sweetened soft drink a day can increase the risk of type 2 diabetes by 22 percent

Contact: Sam Wong Press Office sam.wong@imperial.ac.uk 44-020-759-42198 Diabetologia

Drinking one (or one extra)* 12oz serving size of sugar-sweetened soft drink a day can be enough to increase the risk of developing type 2 diabetes by 22%, a new study suggests. The research is published in Diabetologia (the journal of the European Association for the Study of Diabetes) and comes from data in the InterAct consortium**. The research is by Dr Dora Romaguera, Dr Petra Wark and Dr Teresa Norat, Imperial College London, UK, and colleagues.

Since most research in this area has been conducted in North American populations, the authors wanted to establish if a link between sweet beverage consumption and type 2 diabetes existed in Europe. They used data on consumption of juices and nectars, sugar-sweetened soft drinks and artificially sweetened soft drinks collected across eight European cohorts participating in the European Prospective Investigation into Cancer and Nutrition (EPIC study; UK, Germany, Denmark, Italy, Spain, Sweden, France, Italy, Netherlands)***, covering some 350,000 participants.

As part of the InterAct project, the researchers did a study which included 12,403 type 2 diabetes cases and a random sub-cohort of 16,154 identified within EPIC. The researchers found that, after adjusting for confounding factors, consumption of one 12oz (336ml) serving size of sugar-sweetened soft drink per day increased the risk of type 2 diabetes by 22%. This increased risk fell slightly to 18% when total energy intake and body-mass index (BMI) were accounted for**** (both factors that are thought to mediate the association between sugar-sweetened soft drink consumption and diabetes incidence). This could indicate that the effect of sugar-sweetened soft drink on diabetes goes beyond its effect on body weight.

The authors also observed a statistically significant increase in type 2 diabetes incidence related to artificially sweetened soft drink consumption, however this significant association disappeared after taking into account the BMI of participants; this probably indicates that the association was not causal but driven by the weight of participants (i.e. participants with a higher body weight tend to report higher consumption of artificially sweetened drinks, and are also more likely to develop diabetes). Pure fruit juice and nectar***** consumption was not significantly associated with diabetes incidence, however it was not possible using the data available to study separately the effect of 100% pure juices from those with added sugars.

The authors say the increased risk of diabetes among sugar-sweetened soft drink consumers in Europe is similar to that found in a meta-analysis of previous studies conducted mostly in North America (that found a 25% increased risk of type 2 diabetes associated with one 12 oz daily increment of sugar-sweetened beverage consumption).

Dr Romaguera concludes: “Given the increase in sweet beverage consumption in Europe, clear messages on the unhealthy effect of these drinks should be given to the population.”

###

Notes to editors:

*The increased risk of 22% is for each extra 12oz sugar sweetened drink, so would apply to someone who had 1 drink versus someone who had 0, or someone who had 2 drinks versus someone who had 1, etc.

**The InterACT consortium is investigating, among other things, nutritional factors and physical activity to study the association of nutritional, dietary and physical activity behaviours with incident diabetes in the nested case-cohort study and to contribute to the analysis of gene-lifestyle interaction. It is a sub-division of the EPIC study, which was designed to investigate the relationships between diet, nutritional status, lifestyle and environmental factors and the incidence of cancer and other chronic diseases.

***The centres involved were France, Italy, Spain, Denmark, UK (Oxford, Cambridge), Netherlands (Bilthoven, Utrecht), Germany (Heidelberg, Potsdam), Sweden (Umea, Malmo)

****Extra info from Dr Romaguera: The 22% figure is used as the top line because it is widely accepted by the scientific community that these models should not be adjusted for BMI. In the meta-analysis comparison with other studies from the USA, the risk is those studies is NOT adjusted by BMI. That makes it possible to compare the two sets of results (25% increased risk in North American studies versus 22% in Europe).

*****nectars (UK and USA definition) are fruit juices that have been diluted to some extent and may contain additives (sugar or sweeteners)

First signs of heart disease seen in newborns of overweight/obese mums

Contact: Stephanie Burns sburns@bmjgroup.com 44-020-738-36920 BMJ-British Medical Journal

Artery wall thickening already present at birth

The walls of the body’s major artery – the aorta – are already thickened in babies born to mums who are overweight or obese, finds a small study published online in the Fetal and Neonatal Edition of Archives of Disease of Childhood.

Importantly, this arterial thickening, which is a sign of heart disease, is independent of the child’s weight at birth – a known risk factor for later heart disease and stroke.

And it may explain how overweight/obese mums could boost their children’s subsequent risk of cardiovascular disease, suggest the authors, who point out that more than half of women of childbearing age in developed countries are overweight or obese.

Twenty three women, whose average age was 35, were included in the study when they were 16 weeks pregnant.

A body mass index (BMI) of more than 25 kg/m2 was defined as overweight or obese, and this ranged from 17 to 42 kg/m2 among the women.

Ten of the babies born were boys, and birthweights ranged from 1850g to 4310g.

The abdominal aorta, which is the section of the artery extending down to the belly, was scanned in each newborn within seven days of birth to find out the thickness of the two innermost walls – the intima and media.

Intima-media thickness ranged from 0.65mm to 0.97mm, and was associated with the mother’s weight. The higher a mum’s weight, the greater was the baby’s intima-media thickness, irrespective of how much the baby weighed at birth.

The difference in intima-media thickness between babies of overweight and normal weight mums was 0.06mm.

“The earliest physical signs of atherosclerosis are present in the abdominal aorta, and aortic intima-media thickness is considered the best non-invasive measure of structural health of the vasculature in children,” write the authors.

And this may explain how a mum being overweight might affect her child’s subsequent risk of heart disease and stroke in later life, they conclude.

###

[Maternal adiposity and newborn vascular health Online First doi 10.1136/archdischild-2012-303566]

Childhood obesity linked to more immediate health problems than previously thought

Contact: Amy Albin aalbin@mednet.ucla.edu 310-794-8672 University of California – Los Angeles Health Sciences

While a great deal of research on childhood obesity has spotlighted the long-term health problems that emerge in adulthood, a new UCLA study focuses on the condition’s immediate consequences and shows that obese youngsters are at far greater risk than had been supposed.

Compared to kids who are not overweight, obese children are at nearly twice the risk of having three or more reported medical, mental or developmental conditions, the UCLA researchers found. Overweight children had a 1.3 times higher risk.

“This study paints a comprehensive picture of childhood obesity, and we were surprised to see just how many conditions were associated with childhood obesity,” said lead author Dr. Neal Halfon, a professor of pediatrics, public health and public policy at UCLA, where he directs the Center for Healthier Children, Families and Communities. “The findings should serve as a wake-up call to physicians, parents and teachers, who should be better informed of the risk for other health conditions associated with childhood obesity so that they can target interventions that can result in better health outcomes.”

With the dramatic rise in childhood obesity over the past two decades, there has been a parallel rise in the prevalence of other childhood-onset health conditions, such as attention deficit–hyperactivity disorder, asthma and learning disabilities. But previous studies on the topic have been limited due to a narrow focus on a specific region of the county, a small sample size or a single condition.

The new UCLA research, a large population-based study of children in the United States, provides the first comprehensive national profile of associations between weight status and a broad set of associated health conditions, or co-morbidities, that kids suffer from during childhood.

Overall, the researchers found, obese children were more likely than those who were classified as not overweight to have reported poorer health; more disability; a greater tendency toward emotional and behavioral problems; higher rates of grade repetition, missed school days and other school problems; ADHD; conduct disorder; depression; learning disabilities; developmental delays; bone, joint and muscle problems; asthma; allergies; headaches; and ear infections.

For the study, the researchers used the 2007 National Survey of Children’s Health, analyzing data on nearly 43,300 children between the ages 10 and 17. They assessed associations between weight status and 21 indicators of general health, psychosocial functioning and specific health disorders, adjusting for sociodemographic factors.

Of the children in the study, 15 percent were considered overweight (a body mass index between the 85th and 95th percentiles), and 16 percent were obese (a BMI in the 95th percentile or higher).

The study, which is currently available online, will be published in the January–February print issue of the journal Academic Pediatrics.

The UCLA researchers speculate that the ongoing shift in chronic childhood conditions is likely related to decades of underappreciated changes in the social and physical environments in which children live, learn and play. They propose that obesity-prevention efforts should target these social and environmental influences and that kids should be screened and managed for the co-morbid conditions.

The researchers add that while the strength of the current study lies in its large population base, future studies need to examine better longitudinal data to tease out causal relationships that cannot be inferred from a cross-sectional study.

“Obesity might be causing the co-morbidity, or perhaps the co-morbidity is causing obesity — or both might be caused by some other unmeasured third factor,” Halfon said. “For example, exposure to toxic stress might change the neuroregulatory processes that affect impulse control seen in ADHD, as well as leptin sensitivity, which can contribute to weight gain. An understanding of the association of obesity with other co-morbidities may provide important information about causal pathways to obesity and more effective ways to prevent it.”

###

Halfon’s co-authors on the study included Kandyce Larson and Dr. Wendy Slusser, both of UCLA.

The study was supported by funding from the Maternal and Child Health Bureau of the Health Resource Services Administration.

The authors have no financial ties to disclose.

For more information on the UCLA Center for Healthier Children, Families and Communities, please visit www.healthychild.ucla.edu.

Low muscle strength in adolescence linked to increased risk of early death

Contact: Stephanie Burns
sburns@bmjgroup.com
44-020-738-36920
BMJ-British Medical Journal

Effect similar to classic risk factors such as weight and blood pressure

Research: Muscular strength in male adolescents and premature death: cohort study of one million participants

Low muscle strength in adolescence is strongly associated with a greater risk of early death from several major causes, suggests a large study published on bmj.com today.

The effect is similar to well established risk factors for early death like being overweight or having high blood pressure, leading the authors to call for young people, particularly those with very low strength, to engage in regular physical activity to boost their muscular fitness.

High body mass index (BMI) and high blood pressure at a young age are known risk factors for premature death, but whether muscular strength in childhood or adolescence can predict mortality is unclear.

So a team of researchers, led by Professor Finn Rasmussen at the Karolinska Institutet in Sweden, tracked more than one million Swedish male adolescents aged 16 to 19 years over a period of 24 years.

Participants underwent three reliable muscular strength tests at the start of the study (knee extension strength, handgrip strength and elbow flexion strength). BMI and blood pressure were also measured. Premature death was defined as death before age 55 years.

During the follow-up period, 26,145 participants (2.3% of the group) died. Suicide was the most common cause of death (22.3%) compared with cardiovascular diseases (7.8%) or cancer (14.9%).

High muscular strength was associated with a 20-35% lower risk of early death from any cause and also from cardiovascular diseases, independently of BMI or blood pressure. No association was seen with cancer deaths.

Stronger adolescents also had a 20-30% lower risk of early death from suicide and were up to 65% less likely to have any psychiatric diagnosis, such as schizophrenia and mood disorders. These results suggest that physically weaker individuals might be more mentally vulnerable, say the authors.

In contrast, male adolescents with the lowest level of muscular strength showed the greatest all-cause mortality and also the greatest mortality in cardiovascular disease and suicide before age 55 years.

Death rates from any cause (per 100,000 person years) ranged between 122.3 and 86.9 for weakest and strongest adolescents respectively. Rates for cardiovascular diseases were 9.5 and 5.6 and for suicide were 24.6 and 16.9.

The authors say that low muscular strength in adolescents “is an emerging risk factor for major causes of death in young adulthood, such as suicide and cardiovascular diseases.” The effect sizes of these associations “are similar to classic risk factors such as body mass index and blood pressure,” they add.

They suggest that muscular strength tests, in particular handgrip strength, could be assessed with good reliability in almost any place, including clinical settings, schools and workplaces.

They also support the need for regular physical activity in childhood and adolescence, saying: “People at increased risk of long term mortality, because of lower muscular strength, should be encouraged to engage in exercise programmes and other forms of physical activity.”

Super-sizing the soldier: Is obesity going to pose a huge recruiting problem?: At present, 62 percent of active duty military members over the age of 20 have a body mass index that falls into either the overweight or obese category

Posted By Thomas E. RicksTuesday, October 9, 2012 – 10:22 AM

By Jim Gourley

Best Defense department of physical fitness and national security

Obesity and weight-related health conditions have become a prevalent concern to American policy in the last decade. National military leadership was also exposed to obesity’s potential risks to national security with the release of the report “Too Fat to Fight” by Mission Readiness in 2010. The group’s primary message is that a burgeoning population of overweight American children will drastically reduce an already diminished pool of viable candidates for military service in the next ten years. However, these reports indicate only the most general aspects of the problem and focus on projections of future implications. When the scope of the American obesity epidemic is examined specifically within the context of its impact on the armed forces, data shows clearly that the threat is not imminent, but existential.

At present, 62 percent of active duty military members over the age of 20 have a body mass index that falls into either the overweight or obese category. For personnel under the age of 20, the number stands at 35 percent. That is actually an improvement from a 2005 rate of 46 percent. These statistics are often challenged due to the disputable methods of calculating Body Mass Index (BMI). However, the 2011 Annual Summary of the Armed Forces Health Survey Center cites 21,185 medical diagnoses for overweight, obesity and hyperalimentation (overeating). Research also dispels service culture stigmas. No service is immune to overweight issues. Comparing the relative percentages of overweight/obese service members, the Navy is the fattest service at 62.7 percent, followed by the Army at 61 percent, the Air Force at 58.8 percent. The Marines register the fittest at 55.1 percent, still substantially more than half overweight. Closer examination shows that more than 12 percent of active duty service members in each service are obese. The Marines break the trend more significantly in this category with a 6.1 percent obesity rate.

The increase of girth in the military progressed at a linear rate between 1995 and 2005, but has remained fairly consistent since then. However, emerging data indicates that the overweight population may rise further in the next ten years if the military is to meet recruiting goals. A new study by the Trust for America’s Health predicts that more than half of Americans in 39 states will be obese by 2030. This is disturbing enough, but it becomes even more troubling for the armed forces when individual state recruitment trends are compared to their childhood obesity rates. All ten states that contributed the most military inductees in 2010 have childhood obesity rates greater than 15 percent. Three of them (including Texas, which was second in total recruitment with over 15,000 new military members) exhibit rates between 20-25 percent. The preponderance of our young military members come from the most ponderous states.

The problem is not simply one of cosmetics or intangible metrics of combat performance. The costs of an unfit military carry a real-dollar value. A 2007 joint study by The Lewin Group and TRICARE management activity estimated that the Defense Department spends $1.1 billion annually on medical care for obesity and overweight conditions. This study included dependents and retirees who qualified for TRICARE Prime coverage. More restricted to the active duty component are the costs to manpower. The AFHSC report tallied 245 “bed days” for medical treatment directly linked to weight issues, and 4,555 service members were involuntarily separated for failing to meet weight standards in 2008. The recruiting and initial entry training costs alone represent a loss of $225 million. Adding in specific military job training, logistics, equipment and the cost of lost duty days brings the annual price tag of overweight service members to about $1.5 billion. That exceeds the military’s budget for Predator drones in 2010. Themilitary still fails to grasp the true scale of the problem so long as comorbidities of overweight and obesity remain unexamined. There were more than 42,000 service members affected by hypertension and another 5,700 by diabetes in 2011. Hypertension alone ranks in the top thirty conditions affecting active duty service members. Also overlooked is the expense of XXL chemical warfare suits and development of other plus-sized uniform items.

The military’s response to the problem has been mixed. The Army provided waivers to 1,500 new recruits who failed to meet weight standards in 2007. The program remains in place but the numbers of waivers issued in subsequent years have not been published. The Navy had a similar program until 2010. The Air Force never offered such a program and the Marines actually tightened standards in the 2009-2011 time period. Trends suggest that weight standards are on a sliding scale driven largely by manpower requirements and retention problems in a wartime military.

Therein lies the greatest problem. It seems all but certain that American society will continue gaining weight over the next decade. In this regard, the military may be a kind of canary in the cave given its emphasized dependence on physical fitness for mission success. However, without an established position on the matter of physical fitness standards and given the likelihood that leaders at every level will themselves be at an unhealthy weight, it is possible that the military will experience substantial increases in operating costs and diminished capability in the next decade.

Jim Gourley is a Best Defense jolly good fellow.

http://ricks.foreignpolicy.com/posts/2012/10/09/super_sizing_the_soldier_is_obesity_going_to_pose_a_huge_recruiting_problem

Obese kids’ artery plaque similar to middle-aged adults

Contact: AHA News Media Staff Office
bridgette.mcneill@heart.org
504-670-6524
American Heart Association

Abstract 6077; this abstract is also featured in a news conference

The neck arteries of obese children and teens look more like those of 45-year-olds, according to research presented at the American Heart Association’s Scientific Sessions 2008.

“There’s a saying that ‘you’re as old as your arteries,’ meaning that the state of your arteries is more important than your actual age in the evolution of heart disease and stroke,” said Geetha Raghuveer, M.D., M.P.H., associate professor of pediatrics at the University of Missouri Kansas City School of Medicine and cardiologist at Children’s Mercy Hospital. “We found that the state of the arteries in these children is more typical of a 45-year-old than of someone their own age.”

Researchers used ultrasound to measure the thickness of the inner walls of the neck (carotid) arteries that supply blood to the brain. Increasing carotid artery intima-media thickness (CIMT) indicates the fatty buildup of plaque within arteries feeding the heart muscle and the brain, which can lead to heart attack or stroke.

Investigators calculated CIMT in 34 boys and 36 girls who were “at-risk,” (average age 13, 89 percent white) and found:

These children had abnormal levels of one or more types of cholesterol – elevated levels of low-density lipoprotein (LDL), which is known as “bad cholesterol;” low levels of high-density lipoprotein (HDL), which is the “good cholesterol;” or high triglyceride levels.
Forty (57 percent) had a body mass index (BMI, a calculation of weight for height) above the 95th percentile.

Their average CIMT was 0.45 millimeters (mm), with a maximum of 0.75 mm.

The children’s “vascular age” — the age at which the level of thickening would be normal for their gender and race — was about 30 years older than their actual age, Raghuveer said.

The children were deemed at high risk for future heart disease because of obesity, abnormal cholesterol, and/or a family history of early heart disease.

On average, these children had:

total cholesterol levels of 223.4 milligrams per deciliter (mg/dL) (less than 170 is considered acceptable by American Heart Association recommendations);
LDL cholesterol levels of 149.8 mg/dL (less than 110 is considered acceptable); and
triglycerides levels of 151.9 mg/dL (below 150 is considered acceptable).

Researchers found that having a higher BMI and higher systolic blood pressure had the most impact on CIMT.

Of the various risk factors, the children with triglycerides over 100 mg/dL were most likely to have an advanced vascular age. Thirty-eight children with high triglycerides had a CIMT above the 25th percentile for 45-year-olds, while only five in the group were below the 25th percentile. Children with lower triglycerides were evenly divided between those who scored below (13) or above (14) the 25th percentile on the charts for 45-year-olds.

“Vascular age was advanced the furthest in the children with obesity and high triglyceride levels, so the combination of obesity and high triglycerides should be a red flag to the doctor that a child is at high risk of heart disease,” Raghuveer said.

Further studies are needed to determine whether artery build-up will decrease if children lose weight, exercise, or are treated for abnormal lipids. Some studies have shown that CIMT can be reduced when children at extremely high risk are treated with cholesterol-lowering statin medications, and that exercise can improve blood vessel function in children with a high BMI.

“I’m optimistic that something can be done,” Raghuveer said. “In children, the buildup in the vessels is not hardened and calcified. We can improve the vessel walls and blood flow in adults through treatment, and I’m sure we can help children even more.”

Other risk factors for high CIMT in children are high blood pressure, exposure to secondhand smoke and insulin resistance – which is frequently seen in obese children.

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Co-authors are: Joseph Le, medical student; Menees Spencer, medical student; David McCrary, M.D.; Danna Zhang, M.S.; and Chen Jie, Ph.D. Individual author disclosures are available on the abstract.

The Sarah Morrison Medical Student Research Grant from the University of Missouri, Kansas City, funded the research.

Editor’s note: In May 2005, the American Heart Association and the William J. Clinton Foundation formed the Alliance for a Healthier Generation. The alliance is working to reduce the nationwide increase in childhood obesity by 2010, and to empower kids nationwide to make healthy lifestyle choices. For more information visit: www.HealthierGeneration.org.

Statements and conclusions of study authors that are presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position. The association makes no representation or warranty as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing science content. Revenues from pharmaceutical and device corporations are available at www.americanheart.org/corporatefunding.

NR08-1135 (SS08/Raghuveer)

Regular consumption of sugary beverages linked to increased genetic risk of obesity

Contact: Todd Datz
tdatz@hsph.harvard.edu
617-432-8413
Harvard School of Public Health

Researchers from Harvard School of Public Health have found that greater consumption of sugar-sweetened beverages (SSBs) is linked with a greater genetic susceptibility to high body mass index (BMI) and increased risk of obesity. The study reinforces the view that environmental and genetic factors may act together to shape obesity risk.

The study appears September 21, 2012 in an advance online edition of the New England Journal of Medicine.

“Our study for the first time provides reproducible evidence from three prospective cohorts to show genetic and dietary factors—sugar-sweetened beverages—may mutually influence their effects on body weight and obesity risk. The findings may motivate further research on interactions between genomic variation and environmental factors regarding human health,” said Lu Qi, assistant professor in the Department of Nutrition at HSPH and senior author of the study.

In the past three decades, consumption of SSBs has increased dramatically worldwide. Although widespread evidence supports a link between SSBs, obesity and chronic diseases such as diabetes, there has been little research on whether environmental factors, such as drinking sugary beverages, influence genetic predisposition to obesity.

The research was based on data from three large cohorts, 121,700 women in the Nurses’ Health Study, 51,529 men in the Health Professionals Follow-up Study and 25,000 in the Women’s Genome Health Study. All of the participants had completed food-frequency questionnaires detailing their food and drink consumption over time.

The researchers analyzed data from 6,934 women from NHS, 4,423 men from HPFS, and 21,740 women from WGHS who were of European ancestry and for whom genotype data based on genome-wide association studies were available. Participants were divided into four groups according to how many sugary drinks they consumed: less than one serving of SSB per month, between 1-4 servings per month, between 2-6 servings per week, and one or more servings per day. To represent the overall genetic predisposition, a genetic predisposition score was calculated on the basis of the 32 single-nucleotide polymorphisms known to be associated with BMI (weight in kilograms divided by the square of the height in meters).

The results showed that the genetic effects on BMI and obesity risk among those who drank one or more SSBs per day were about twice as large as those who consumed less than one serving per month. The findings suggest that regular consumption of sugary beverages may amplify the genetic risk of obesity. In addition, individuals with greater genetic predisposition to obesity appear to be more susceptible to harmful effects of SSBs on BMI. “SSBs are one of the driving forces behind the obesity epidemic,” says Frank Hu, professor of nutrition and epidemiology at HSPH and a coauthor of this study. “The implication of our study is that the genetic effects of obesity can be offset by healthier food and beverage choices.”

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Support for the study was provided by grants DK091718, HL071981, HL073168, CA87969, CA49449, CA055075, HL34594, HL088521, U01HG004399, DK080140, 5P30DK46200, U54CA155626, DK58845, U01HG004728-02, EY015473, DK70756, and DK46200 from the National Institutes of Health (NIH); and Merck Research Laboratories. The WGHS is supported by NIH grants HL043851, HL69757, and CA047988.

“Sugar-Sweetened Beverages and Genetic Risk of Obesity,” Qibin Qi, Audrey Y. Chu, Jae H. Kang, Majken K. Jensen, Gary C. Curhan, Louis R. Pasquale, Paul M. Ridker, David J. Hunter, Walter C. Willett, Eric B. Rimm, Daniel I. Chasman, Frank B. Hu, Lu Qi, New England Journal of Medicine, online Sept. 21, 2012

Higher levels of BPA in children and teens associated with obesity

Contact: Jessica Guenzel Jessica.Guenzel@nyumc.org 212-404-3591 JAMA and Archives Journals

NEW YORK – In a nationally representative sample of nearly 3,000 children and adolescents, those who had higher concentrations of urinary bisphenol A (BPA), a manufactured chemical found in consumer products, had significantly increased odds of being obese, according to a study in the September 19 issue of JAMA, and theme issue on obesity.

Leonardo Trasande, M.D., M.P.P., of the NYU School of Medicine, New York City, presented the findings of the study at a JAMA media briefing.

“In the U.S. population, exposure [to BPA] is nearly ubiquitous, with 92.6 percent of persons 6 years or older identified in the 2003-2004 National Health and Nutrition Examination Survey (NHANES) as having detectable BPA levels in their urine. A comprehensive, cross-sectional study of dust, indoor and outdoor air, and solid and liquid food in preschool-aged children suggested that dietary sources constitute 99 percent of BPA exposure,” according to background information in the article. “In experimental studies, BPA exposure has been shown to disrupt multiple metabolic mechanisms, suggesting that it may increase body mass in environmentally relevant doses and therefore contribute to obesity in humans.” BPA exposure is plausibly linked to childhood obesity, but evidence is lacking.

Dr. Trasande and colleagues conducted a study to examine association between urinary BPA concentrations and body mass in children. The study consisted of a cross-sectional analysis of a nationally representative subsample of 2,838 participants, ages 6 through 19 years, randomly selected for measurement of urinary BPA concentration in the 2003-2008 National Health and Nutrition Examination Surveys. Body mass index (BMI), converted to sex- and age-standardized z scores (indicates how many units [of the standard deviation] a child’s BMI is above or below the average BMI value for their age group and sex) was used to classify participants as overweight (BMI 85th percentile or greater for age/sex) or obese (BMI 95th percentile or greater). The median (midpoint) urinary BPA concentration for participants in the study was 2.8 ng/mL. The prevalence of obesity was 17.8 percent (n = 590), and overweight 34.1 percent (n = 1,047). The BPA concentrations of the participants were divided into quartiles (four groups). Controlling for race/ethnicity, age, caregiver education, poverty to income ratio, sex, serum cotinine level, caloric intake, television watching, and urinary creatinine level, children in the lowest urinary BPA quartile had a lower estimated prevalence of obesity (10.3 percent) than those in quartiles 2 (20.1 percent), 3 (19.0 percent), and 4 (22.3 percent). Compared with the first quartile, participants in the third quartile had approximately twice the odds for obesity. Participants in the fourth quartile had a 2.6 higher odds of obesity.

Further analyses showed this association to be statistically significant in only 1 racial subpopulation, white children and adolescents. The researchers also found that obesity was not associated with exposure to other environmental phenols commonly used in other consumer products, such as sunscreens and soaps.

“To our knowledge, this is the first report of an association of an environmental chemical exposure with childhood obesity in a nationally representative sample,” the authors write.

The researchers note that advocates and policy makers have long been concerned about BPA exposure. “We note the recent FDA ban of BPA in baby bottles and sippy cups, yet our findings raise questions about exposure to BPA in consumer products used by older children. Last year, the FDA declined to ban BPA in aluminum cans and other food packaging, announcing ‘reasonable steps to reduce human exposure to BPA in the human food supply’ and noting that it will continue to consider evidence on the safety of the chemical. Carefully conducted longitudinal studies that assess the associations identified here will yield evidence many years in the future.”

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Editor’s Note: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

(JAMA. 2012;308[11]:1113-1121. Available pre-embargo to the media at http://media.jamanetwork.com)

To contact Leonardo Trasande, M.D., M.P.P., call Jessica Guenzel at 212-404-3591 or email Jessica.Guenzel@nyumc.org.

Having a tonsillectomy can cause Obesity

Contact: David March
dmarch1@jhmi.edu
410-955-1534
Johns Hopkins Medicine

Age, not underlying diagnosis, key factor in weight gain in children after tonsillectomy

Potentially worrisome weight gains following tonsillectomy occur mostly in children under the age of 6, not in older children, a study by Johns Hopkins experts in otolaryngology- head and neck surgery shows.

Sudden increases in body mass index, or BMI, have been routinely observed for months after some of the more than half-million surgeries performed annually in the United States to remove the sore and swollen tissues at the back of the throat.

The Johns Hopkins study, in 115 children in the Baltimore region, is believed to be the first to dispel long-held beliefs that such weight gains occurred mostly in children whose tonsils were removed as primary treatment for diagnosed sleep apnea, when the swollen, paired tissues partially obstruct breathing and disrupt sleep. It is also believed to be the largest study to analyze weight gain specific to every child’s age group, from 1 through 17.

Although researchers have yet to pinpoint the underlying cause of the weight-gain phenomena, they did find that it happened at the same rate in the 85 children who had the surgery for obstructive sleep apnea as in the 30 who had it due to recurrent episodes of tonsil inflammation.

Senior study investigator, otolaryngologist and sleep medicine expert Stacey Ishman, M.D., M.P.H., says her team’s study findings, scheduled to be presented Sept. 12 at the annual meeting of the American Academy of Otolaryngology—Head and Neck Surgeons in Washington, D.C., should help alleviate rising concerns among many parents whose adolescent children are already overweight that tonsillectomy may aggravate the problem; or start one in normal weight kids. Recent surveys have shown that record numbers of American children, as many as one-third, are overweight or obese.

“Our study results show that parents’ current concerns about weight gain are serious, but only underweight or normal weight children between the ages of 2 and 6 are most likely to gain even more weight, not older children,” says Ishman, an assistant professor at the Johns Hopkins University School of Medicine.

“Parents with overweight adolescent children need not fear tonsillectomy, and those with younger, normal weight and overweight children just really need to closely watch their child’s diet following surgery, and make caloric adjustments,” says Ishman, who has performed hundreds of the roughly 30-minute procedures that typically require a general anesthetic.

In the study, researchers analyzed the medical records of children between the ages of 6 months and 18 years who had had their tonsils removed at the Johns Hopkins Outpatient Center between 2008 and 2011. Researchers looked only at those medical records for children who had been routinely examined for at least six months after their procedure, with detailed measurements of any possible weight gain, which were averaged and compared based on a formula involving age, gender and height. All also had a history of recurrent tonsillitis or obstructive sleep apnea, as strictly determined by an individual sleep study analysis.

Results showed an averaged post-surgical weight gain of 2 to 5 pounds – or a 1.0- to 1.2-point increase in averaged BMI scores—but the gains were not dependent on whether the underlying condition was inflammation or sleep apnea. Only age mattered, researchers say, after discounting gender and height.

Ishman says that while such weight gains might appear small, in these children’s small bodies, whose initial weight was between 22 and 60 pounds (or between 10 to 30 kilos), “a 10 percent weight gain can be quite worrisome.”

Results showed a normal weight, 5-year-old boy, weighing 40 pounds (or 18 kilos) and measuring 42 inches tall, who gained 3 pounds after tonsillectomy, would move from the 68th percentile to the 89th percentile in their age-weight group, and become overweight. For an underweight 5-year-old boy of similar height, originally weighing 34 pounds (15 kilos), the same 3-pound weight gain would shift them from the 24th percentile group to the 28th percentile, moving them closer to a normal weight.

However, she says, in an overweight 10-year-old boy, already weighing 90 pounds (41 kilos) and 55 inches tall, there was no weight gain post tonsillectomy, and he remained in the 92nd percentile group, meaning his poor condition did not worsen.

Ishman says her team’s next steps are to gain a better understanding of why and how children’s age affects weight gain post-tonsillectomy. She already has plans to monitor children immediately after surgery to find out what factors or interventions may help underweight children gain pounds, while helping those who are overweight to not get any bigger.

Since 2002 tonsillectomy has been recommended by the American Academy of Pediatrics as the primary treatment for obstructive sleep apnea, as sleeping aids and drug therapies are not as effective. Studies have shown that if left untreated, sleep apnea can lead to long-term health problems, including increased heart and lung diseases, even death.

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Funding support for this study was provided by The Johns Hopkins Hospital.

In addition to Ishman, other Johns Hopkins researchers involved in this study were David Smith, M.D., Ph.D., and Emily Boss, M.D., M.P.H. Other study co-investigators included Ami Vikani, B.S., at the George Washington University School of Medicine, in Washington, D.C.; and Fernando Aguirre-Amezquita, M.D., at Escuela de Medicina Ignacio A. Santos de Monterrey, in Mexico.

For more information, go to:
http://www.hopkinsmedicine.org/otolaryngology/our_team/faculty/ishman.html
http://www.entannualmeeting.org/12/

Older overweight children consume fewer calories than their healthy weight peers

Contact: Tom Hughes tahughes@unch.unc.edu 919-966-6047 University of North Carolina Health Care

A study by UNC pediatrics researchers finds there is no such thing as a ‘1 size fits all’ explanation for childhood obesity



		IMAGE:Asheley Cockrell Skinner, Ph.D., assistant professor in the Department of Pediatrics in the UNC School of Medicine, is lead author of the study. Click here for more information.

CHAPEL HILL, N.C. – A new study by University of North Carolina School of Medicine pediatrics researchers finds a surprising difference in the eating habits of overweight children between ages 9 and 17 years compared to those younger than 9.

Younger children who are overweight or obese consume more calories per day than their healthy weight peers. But among older overweight children the pattern is reversed: They actually consume fewer calories per day than their healthy weight peers.

How to explain such a seemingly counterintuitive finding?

“Children who are overweight tend to remain overweight,” said Asheley Cockrell Skinner, PhD, assistant professor of pediatrics at UNC and lead author of the study published online Sept. 10, 2012 by the journal Pediatrics.

“So, for many children, obesity may begin by eating more in early childhood. Then as they get older, they continue to be obese without eating any more than their healthy weight peers,” Skinner said. “One reason this makes sense is because we know overweight children are less active than healthy weight kids. Additionally, this is in line with other research that obesity is not a simple matter of overweight people eating more — the body is complex in how it reacts to amount of food eaten and amount of activity.”

These results also suggest that different strategies may be needed to help children in both age groups reach a healthy weight. “It makes sense for early childhood interventions to focus specifically on caloric intake, while for those in later childhood or adolescence the focus should instead be on increasing physical activity, since overweight children tend to be less active,” Skinner said. “Even though reducing calories would likely result in weight loss for children, it’s not a matter of wanting them to eat more like healthy weight kids — they would actually have to eat much less than their peers, which can be a very difficult prospect for children and, especially, adolescents.”

These findings “have significant implications for interventions aimed at preventing and treating childhood obesity,” Skinner said.

In the study, Skinner and co-authors Eliana Perrin, MD, MPH, and Michael Steiner, MD, examined dietary reports from 19,125 children ages 1-17 years old that were collected from 2001 to 2008 as part of the National Health and Nutrition Examination Survey (NHANES). They categorized the weight status based on weight-for-length percentile in children less than 2 years old, or body mass index (BMI) percentile for children between 2 and 17, and performed statistical analyses to examine the interactions of age and weight category on calorie intake.

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All three study authors are faculty members in the UNC Department of Pediatrics.