Doug Brunk

SAN DIEGO – More than half of American men and women report a pattern of consuming breakfast, lunch, and dinner daily, results from a large survey found.

However, obese adults are less likely than normal-weight adults to report a three-meal daily eating pattern. They also are less likely than their normal-weight counterparts to consume four or more snacks per day.

"Snacking may not contribute to weight gain," lead researcher Donna G. Rhodes said in an interview after the study was presented during a late-breaking abstract session at the annual meeting of the Obesity Society. "When it comes to weight maintenance, the total amount of calories we consume is important."

The findings come from a sample of 1-day dietary data extracted from "What We Eat in America" (National Health and Nutrition Examination Survey, 2007-2008), which was released this year. Dietary data and 36 summary data tables are available on the Food Surveys Research Group Web site. Ms. Rhodes presented findings from a 24-hour dietary recall made by 2,662 men and 2,758 women, aged 20 years and older, who participated in the nationally representative survey.

Ms. Rhodes, a nutritionist at the U.S. Department of Agriculture’s Agricultural Research Service, and her associates used the USDA Automated Multiple Pass Method to collect the recall data from the 5,420 participants. During the recall, the name of each eating occasion was self-reported from a fixed list.

In all, 59% of men and 64% of women reported consuming the standard three-meal pattern of breakfast, lunch, and dinner, and about 90% of both sexes reported at least one snack occasion per day, which consisted of at least one food or beverage item that contained calories.

Despite differences in energy intake between men (mean, 2,507 calories per day) and women (mean, 1,766 calories per day), both sexes "consume similar percentages of total daily energy at the same eating occasion," Ms. Rhodes said. "The percent of daily energy consumed is 16% at breakfast, 24% at lunch, 36% at dinner/supper, and 24% at snacks."

Obese adults (defined as those having a body mass index of 30 kg/m2 or greater), were less likely than normal-weight adults to report a three meal per day eating pattern (58% vs. 65%, respectively). However, a smaller proportion of obese adults reported four or more snack occasions per day, compared with normal-weight adults (15% vs. 22%).

One limitation of the study, Ms. Rhodes said, was that dietary intake "was determined from one 24-hour dietary recall, which may not represent usual intake."

Ms. Rhodes said that she had no relevant financial conflicts to disclose.

SAN DIEGO – More than half of American men and women report a pattern of consuming breakfast, lunch, and dinner daily, results from a large survey found.

However, obese adults are less likely than normal-weight adults to report a three-meal daily eating pattern. They also are less likely than their normal-weight counterparts to consume four or more snacks per day.

"Snacking may not contribute to weight gain," lead researcher Donna G. Rhodes said in an interview after the study was presented during a late-breaking abstract session at the annual meeting of the Obesity Society. "When it comes to weight maintenance, the total amount of calories we consume is important."

The findings come from a sample of 1-day dietary data extracted from "What We Eat in America" (National Health and Nutrition Examination Survey, 2007-2008), which was released this year. Dietary data and 36 summary data tables are available on the Food Surveys Research Group Web site. Ms. Rhodes presented findings from a 24-hour dietary recall made by 2,662 men and 2,758 women, aged 20 years and older, who participated in the nationally representative survey.

Ms. Rhodes, a nutritionist at the U.S. Department of Agriculture’s Agricultural Research Service, and her associates used the USDA Automated Multiple Pass Method to collect the recall data from the 5,420 participants. During the recall, the name of each eating occasion was self-reported from a fixed list.

In all, 59% of men and 64% of women reported consuming the standard three-meal pattern of breakfast, lunch, and dinner, and about 90% of both sexes reported at least one snack occasion per day, which consisted of at least one food or beverage item that contained calories.

Despite differences in energy intake between men (mean, 2,507 calories per day) and women (mean, 1,766 calories per day), both sexes "consume similar percentages of total daily energy at the same eating occasion," Ms. Rhodes said. "The percent of daily energy consumed is 16% at breakfast, 24% at lunch, 36% at dinner/supper, and 24% at snacks."

Obese adults (defined as those having a body mass index of 30 kg/m2 or greater), were less likely than normal-weight adults to report a three meal per day eating pattern (58% vs. 65%, respectively). However, a smaller proportion of obese adults reported four or more snack occasions per day, compared with normal-weight adults (15% vs. 22%).

One limitation of the study, Ms. Rhodes said, was that dietary intake "was determined from one 24-hour dietary recall, which may not represent usual intake."

Ms. Rhodes said that she had no relevant financial conflicts to disclose.

SAN DIEGO – More than half of American men and women report a pattern of consuming breakfast, lunch, and dinner daily, results from a large survey found.

However, obese adults are less likely than normal-weight adults to report a three-meal daily eating pattern. They also are less likely than their normal-weight counterparts to consume four or more snacks per day.

"Snacking may not contribute to weight gain," lead researcher Donna G. Rhodes said in an interview after the study was presented during a late-breaking abstract session at the annual meeting of the Obesity Society. "When it comes to weight maintenance, the total amount of calories we consume is important."

The findings come from a sample of 1-day dietary data extracted from "What We Eat in America" (National Health and Nutrition Examination Survey, 2007-2008), which was released this year. Dietary data and 36 summary data tables are available on the Food Surveys Research Group Web site. Ms. Rhodes presented findings from a 24-hour dietary recall made by 2,662 men and 2,758 women, aged 20 years and older, who participated in the nationally representative survey.

Ms. Rhodes, a nutritionist at the U.S. Department of Agriculture’s Agricultural Research Service, and her associates used the USDA Automated Multiple Pass Method to collect the recall data from the 5,420 participants. During the recall, the name of each eating occasion was self-reported from a fixed list.

In all, 59% of men and 64% of women reported consuming the standard three-meal pattern of breakfast, lunch, and dinner, and about 90% of both sexes reported at least one snack occasion per day, which consisted of at least one food or beverage item that contained calories.

Despite differences in energy intake between men (mean, 2,507 calories per day) and women (mean, 1,766 calories per day), both sexes "consume similar percentages of total daily energy at the same eating occasion," Ms. Rhodes said. "The percent of daily energy consumed is 16% at breakfast, 24% at lunch, 36% at dinner/supper, and 24% at snacks."

Obese adults (defined as those having a body mass index of 30 kg/m2 or greater), were less likely than normal-weight adults to report a three meal per day eating pattern (58% vs. 65%, respectively). However, a smaller proportion of obese adults reported four or more snack occasions per day, compared with normal-weight adults (15% vs. 22%).

One limitation of the study, Ms. Rhodes said, was that dietary intake "was determined from one 24-hour dietary recall, which may not represent usual intake."

Ms. Rhodes said that she had no relevant financial conflicts to disclose.

Major Finding: During the 1999-2000 holiday winter quarter, 73% of men and women gained 0.1 kg or more, with 19% gaining 2 kg or more. No correlations were seen between weight gain and total energy expenditure.

Data Source: An analysis of 443 men and women aged 40-69 years who participated in the Observing Protein and Energy Nutrition (OPEN) study.

Disclosures: The study was funded by the National Cancer Institute Intramural Research Program. Mr. Cook said he had no relevant financial conflicts.

SAN DIEGO – Adults with high total daily energy expenditure are not protected from holiday weight gain, results from a large study demonstrated.

This is one of only a few studies that did not find evidence for the prevention of body weight gain via physical activity across the typical daily physical activity levels observed in the general population, Chad M. Cook said in an interview during a poster session at the meeting.

“We hypothesized that people who habitually burn more daily calories than predicted for their age, height, and body weight may be protected against holiday weight gain,” said Mr. Cook, who is a graduate student in nutritional sciences at the University of Wisconsin–Madison. “We found that's not true, at least in this particular population studied.”

Mr. Cook and his associates analyzed body weight change during the 1999-2000 winter quarter in 443 men and women aged 40-69 years with doubly labeled water data who participated in the National Cancer Institute–sponsored Observing Protein and Energy Nutrition (OPEN) study. The original purpose of the OPEN study, completed in 2000, was to assess self-reported dietary measurement error by comparing results from self-reported dietary intake questionnaires with objective biomarkers: doubly labeled water and urinary nitrogen.

The researchers used doubly labeled water to measure total energy expenditure, and calculated residual total energy expenditure after adjusting for age, height, and body weight. Over an average of 107 days, nearly three-quarters of study participants (73%) gained 0.1 kg or more, with 19% gaining 2 kg or more. Men gained more than women (an average of 1.1 kg vs. 0.7 kg).

Men with a baseline body mass index of 30 kg/m

Mr. Cook also reported that there were no correlations seen between increased body weight and total energy expenditure or between increased body weight and total energy expenditure after the researchers adjusted for age and body size. Residual total energy expenditure above or below the average for body size ranged from −877 to 1,813 calories per day, with a median of −36 calories per day.

Increased body weight at holiday time was not tied to total energy expenditure.

Source ©Olga Lyubkin/Fotolia.com

Major Finding: During the 1999-2000 holiday winter quarter, 73% of men and women gained 0.1 kg or more, with 19% gaining 2 kg or more. No correlations were seen between weight gain and total energy expenditure.

Data Source: An analysis of 443 men and women aged 40-69 years who participated in the Observing Protein and Energy Nutrition (OPEN) study.

Disclosures: The study was funded by the National Cancer Institute Intramural Research Program. Mr. Cook said he had no relevant financial conflicts.

SAN DIEGO – Adults with high total daily energy expenditure are not protected from holiday weight gain, results from a large study demonstrated.

This is one of only a few studies that did not find evidence for the prevention of body weight gain via physical activity across the typical daily physical activity levels observed in the general population, Chad M. Cook said in an interview during a poster session at the meeting.

“We hypothesized that people who habitually burn more daily calories than predicted for their age, height, and body weight may be protected against holiday weight gain,” said Mr. Cook, who is a graduate student in nutritional sciences at the University of Wisconsin–Madison. “We found that's not true, at least in this particular population studied.”

Mr. Cook and his associates analyzed body weight change during the 1999-2000 winter quarter in 443 men and women aged 40-69 years with doubly labeled water data who participated in the National Cancer Institute–sponsored Observing Protein and Energy Nutrition (OPEN) study. The original purpose of the OPEN study, completed in 2000, was to assess self-reported dietary measurement error by comparing results from self-reported dietary intake questionnaires with objective biomarkers: doubly labeled water and urinary nitrogen.

The researchers used doubly labeled water to measure total energy expenditure, and calculated residual total energy expenditure after adjusting for age, height, and body weight. Over an average of 107 days, nearly three-quarters of study participants (73%) gained 0.1 kg or more, with 19% gaining 2 kg or more. Men gained more than women (an average of 1.1 kg vs. 0.7 kg).

Men with a baseline body mass index of 30 kg/m

Mr. Cook also reported that there were no correlations seen between increased body weight and total energy expenditure or between increased body weight and total energy expenditure after the researchers adjusted for age and body size. Residual total energy expenditure above or below the average for body size ranged from −877 to 1,813 calories per day, with a median of −36 calories per day.

Increased body weight at holiday time was not tied to total energy expenditure.

Source ©Olga Lyubkin/Fotolia.com

Major Finding: During the 1999-2000 holiday winter quarter, 73% of men and women gained 0.1 kg or more, with 19% gaining 2 kg or more. No correlations were seen between weight gain and total energy expenditure.

Data Source: An analysis of 443 men and women aged 40-69 years who participated in the Observing Protein and Energy Nutrition (OPEN) study.

Disclosures: The study was funded by the National Cancer Institute Intramural Research Program. Mr. Cook said he had no relevant financial conflicts.

SAN DIEGO – Adults with high total daily energy expenditure are not protected from holiday weight gain, results from a large study demonstrated.

This is one of only a few studies that did not find evidence for the prevention of body weight gain via physical activity across the typical daily physical activity levels observed in the general population, Chad M. Cook said in an interview during a poster session at the meeting.

“We hypothesized that people who habitually burn more daily calories than predicted for their age, height, and body weight may be protected against holiday weight gain,” said Mr. Cook, who is a graduate student in nutritional sciences at the University of Wisconsin–Madison. “We found that's not true, at least in this particular population studied.”

Mr. Cook and his associates analyzed body weight change during the 1999-2000 winter quarter in 443 men and women aged 40-69 years with doubly labeled water data who participated in the National Cancer Institute–sponsored Observing Protein and Energy Nutrition (OPEN) study. The original purpose of the OPEN study, completed in 2000, was to assess self-reported dietary measurement error by comparing results from self-reported dietary intake questionnaires with objective biomarkers: doubly labeled water and urinary nitrogen.

The researchers used doubly labeled water to measure total energy expenditure, and calculated residual total energy expenditure after adjusting for age, height, and body weight. Over an average of 107 days, nearly three-quarters of study participants (73%) gained 0.1 kg or more, with 19% gaining 2 kg or more. Men gained more than women (an average of 1.1 kg vs. 0.7 kg).

Men with a baseline body mass index of 30 kg/m

Mr. Cook also reported that there were no correlations seen between increased body weight and total energy expenditure or between increased body weight and total energy expenditure after the researchers adjusted for age and body size. Residual total energy expenditure above or below the average for body size ranged from −877 to 1,813 calories per day, with a median of −36 calories per day.

Increased body weight at holiday time was not tied to total energy expenditure.

Source ©Olga Lyubkin/Fotolia.com

SAN DIEGO – There were no significant differences in the amount of weight lost at 18-month follow-up among adults randomized to a weight management program delivered online, compared with those randomized to the same program delivered in person.

However, a significantly greater proportion of self-monitoring records were submitted by adults assigned to the online group, compared with those assigned to the in-person group.

“We didn't know whether or not the delivery channel impacts weight-loss maintenance, but there are reasons to think it might be different online,” Delia Smith West, Ph.D., said at the meeting.

“We know that the maintenance phase is characterized by a decrease in session attendance. It can be a fairly marked decrease between the initial weekly sessions of weight-loss reduction and weight maintenance. We also know that self-monitoring falls off,” she noted. “The ability to attend your session online might be associated with a decreased burden and therefore greater adherence.”

For the study, Dr. West and her associates evaluated weight maintenance and treatment adherence among 481 adults who received the identical group weight-loss program.

The treatment goals were to help participants modify eating and exercise habits, with modest calorie restriction, 25% or fewer calories from fat, exercise up to 200 minutes per week, and daily self-monitoring of dietary intake and physical activity.

For this component, the participants who were randomized to the in-person group tracked their progress in a paper-based journal while the online group tracked their progress in a computer-based journal.

Of the 481 patients, 161 were randomized to online delivery of the program during weekly sessions for 6 months, 159 were randomized to in-person group delivery of the program during weekly in-person sessions for 6 months, and 161 were randomized to receive a mix of both weekly online and in-person delivery sessions for 6 months. Maintenance continued for 12 months, said Dr. West of the Fay W. Boozman College of Public Health at the University of Arkansas for Medical Sciences, Little Rock.

The mean age of subjects was 47 years, 28% were black, and 93% were female. Their mean weight was 97 kg, and mean body mass index was 36 kg/m

Dr. West reported that at 6 months, the amount of weight loss significantly favored the in-person group (a mean of 18 lbs, compared with a mean of 14 lbs for the hybrid group and a mean of 12 lbs for the online group). However, there were no statistically significant differences in total weight loss between the groups at 18 months (a mean of 12 lbs for the in-person group, a mean of 9 lbs for the hybrid group, and a mean of 6 lbs for the online group).

The overall rate of weight regain at 18 months was similar between the groups (a mean of 6 lbs for the in-person group, a mean of 4 lbs for the hybrid group, and a mean of 5 lbs for the online group).

The proportion of study participants who were able to attend all scheduled sessions over the 12 months of the maintenance program did not differ between the groups (37% for the in-person group, 33% for the hybrid group, and 41% for the online group), but a significantly greater proportion of self-monitoring records were submitted by the Internet group (28%, compared with 14% by the in-person group and 20% by the hybrid group).

The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases. Dr. West said that she had no relevant financial disclosures.

SAN DIEGO – There were no significant differences in the amount of weight lost at 18-month follow-up among adults randomized to a weight management program delivered online, compared with those randomized to the same program delivered in person.

However, a significantly greater proportion of self-monitoring records were submitted by adults assigned to the online group, compared with those assigned to the in-person group.

“We didn't know whether or not the delivery channel impacts weight-loss maintenance, but there are reasons to think it might be different online,” Delia Smith West, Ph.D., said at the meeting.

“We know that the maintenance phase is characterized by a decrease in session attendance. It can be a fairly marked decrease between the initial weekly sessions of weight-loss reduction and weight maintenance. We also know that self-monitoring falls off,” she noted. “The ability to attend your session online might be associated with a decreased burden and therefore greater adherence.”

For the study, Dr. West and her associates evaluated weight maintenance and treatment adherence among 481 adults who received the identical group weight-loss program.

The treatment goals were to help participants modify eating and exercise habits, with modest calorie restriction, 25% or fewer calories from fat, exercise up to 200 minutes per week, and daily self-monitoring of dietary intake and physical activity.

For this component, the participants who were randomized to the in-person group tracked their progress in a paper-based journal while the online group tracked their progress in a computer-based journal.

Of the 481 patients, 161 were randomized to online delivery of the program during weekly sessions for 6 months, 159 were randomized to in-person group delivery of the program during weekly in-person sessions for 6 months, and 161 were randomized to receive a mix of both weekly online and in-person delivery sessions for 6 months. Maintenance continued for 12 months, said Dr. West of the Fay W. Boozman College of Public Health at the University of Arkansas for Medical Sciences, Little Rock.

The mean age of subjects was 47 years, 28% were black, and 93% were female. Their mean weight was 97 kg, and mean body mass index was 36 kg/m

Dr. West reported that at 6 months, the amount of weight loss significantly favored the in-person group (a mean of 18 lbs, compared with a mean of 14 lbs for the hybrid group and a mean of 12 lbs for the online group). However, there were no statistically significant differences in total weight loss between the groups at 18 months (a mean of 12 lbs for the in-person group, a mean of 9 lbs for the hybrid group, and a mean of 6 lbs for the online group).

The overall rate of weight regain at 18 months was similar between the groups (a mean of 6 lbs for the in-person group, a mean of 4 lbs for the hybrid group, and a mean of 5 lbs for the online group).

The proportion of study participants who were able to attend all scheduled sessions over the 12 months of the maintenance program did not differ between the groups (37% for the in-person group, 33% for the hybrid group, and 41% for the online group), but a significantly greater proportion of self-monitoring records were submitted by the Internet group (28%, compared with 14% by the in-person group and 20% by the hybrid group).

The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases. Dr. West said that she had no relevant financial disclosures.

SAN DIEGO – There were no significant differences in the amount of weight lost at 18-month follow-up among adults randomized to a weight management program delivered online, compared with those randomized to the same program delivered in person.

However, a significantly greater proportion of self-monitoring records were submitted by adults assigned to the online group, compared with those assigned to the in-person group.

“We didn't know whether or not the delivery channel impacts weight-loss maintenance, but there are reasons to think it might be different online,” Delia Smith West, Ph.D., said at the meeting.

“We know that the maintenance phase is characterized by a decrease in session attendance. It can be a fairly marked decrease between the initial weekly sessions of weight-loss reduction and weight maintenance. We also know that self-monitoring falls off,” she noted. “The ability to attend your session online might be associated with a decreased burden and therefore greater adherence.”

For the study, Dr. West and her associates evaluated weight maintenance and treatment adherence among 481 adults who received the identical group weight-loss program.

The treatment goals were to help participants modify eating and exercise habits, with modest calorie restriction, 25% or fewer calories from fat, exercise up to 200 minutes per week, and daily self-monitoring of dietary intake and physical activity.

For this component, the participants who were randomized to the in-person group tracked their progress in a paper-based journal while the online group tracked their progress in a computer-based journal.

Of the 481 patients, 161 were randomized to online delivery of the program during weekly sessions for 6 months, 159 were randomized to in-person group delivery of the program during weekly in-person sessions for 6 months, and 161 were randomized to receive a mix of both weekly online and in-person delivery sessions for 6 months. Maintenance continued for 12 months, said Dr. West of the Fay W. Boozman College of Public Health at the University of Arkansas for Medical Sciences, Little Rock.

The mean age of subjects was 47 years, 28% were black, and 93% were female. Their mean weight was 97 kg, and mean body mass index was 36 kg/m

Dr. West reported that at 6 months, the amount of weight loss significantly favored the in-person group (a mean of 18 lbs, compared with a mean of 14 lbs for the hybrid group and a mean of 12 lbs for the online group). However, there were no statistically significant differences in total weight loss between the groups at 18 months (a mean of 12 lbs for the in-person group, a mean of 9 lbs for the hybrid group, and a mean of 6 lbs for the online group).

The overall rate of weight regain at 18 months was similar between the groups (a mean of 6 lbs for the in-person group, a mean of 4 lbs for the hybrid group, and a mean of 5 lbs for the online group).

The proportion of study participants who were able to attend all scheduled sessions over the 12 months of the maintenance program did not differ between the groups (37% for the in-person group, 33% for the hybrid group, and 41% for the online group), but a significantly greater proportion of self-monitoring records were submitted by the Internet group (28%, compared with 14% by the in-person group and 20% by the hybrid group).

The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases. Dr. West said that she had no relevant financial disclosures.

Major Finding: Women enrolled in an in-person center-based intervention for weight reduction lost a mean of 7.4 kg in 2 years, compared with 6.2 kg in a telephone-based intervention group, and 2.0 kg in a usual-care group.

Data Source: A randomized, controlled trial of 442 overweight and obese women enrolled at four study sites over a 2-year period.

Disclosures: The study was supported by Jenny Craig Inc. Dr. Rock disclosed that she served on the advisory board of the company from 2003 to 2004. None of her coauthors reported having any relevant financial conflicts.

Overweight or obese women who were assigned to a structured weight-loss program with free prepared meals lost a significantly greater amount of weight at 2 years than did those who received usual care.

In addition, a greater proportion of women enrolled in the program maintained a 5% weight loss at 2 years than did those who received usual care.

“For clinical practitioners, the evidence suggests that the structured program as applied in this study provides another route for their overweight or obese patients to achieve and maintain weight loss through behavioral changes for at least a 2-year period,” researchers led by Cheryl L. Rock, Ph.D., of the University of California, San Diego, wrote (JAMA 2010 Oct. 9 [Epub doi:10.1001/jama.2010.1503]). For the study, 442 overweight or obese women at one of four study sites were randomly assigned to one of three groups: an in-person center-based intervention group, a telephone-based intervention group, or a usual-care group.

Women in the intervention groups received free one-on-one weight-loss counseling for 2 years, and were educated on recommendations for a nutritionally sound, reduced-calorie diet with 20%-30% of calories from fat, and 30 minutes of physical exercise at least 5 days per week. They also received free access to prepackaged prepared foods from Jenny Craig Inc. to help them achieve their nutritional goals.

“Over time, participants were transitioned to a meal plan based mainly not on food provided from the commercial program, although participants could choose to include one prepackaged meal per day during weight-loss maintenance,” Dr. Rock and her associates noted.

Women assigned to the usual-care group received a 1-hour consultation with a dietetics professional at baseline and at 6 months.

During these sessions, they received publicly available materials on dietary and physical activity recommendations to achieve and maintain weight loss, as well as sample meal plans and advice on reading food labels and estimating serving sizes. Women in this group were followed up monthly via e-mail or telephone contact.

All study participants received $25 for each completed clinic visit, but no payment was provided for participating in the intervention or counseling sessions.

The mean age of study participants was 44 years, and 73% were non-Hispanic white. At 2 years, 407 participants remained in the trial, for a retention rate of 92%. The mean weight loss was 7.4 kg in the center-based group, 6.2 kg in the telephone-based group, and 2.0 kg in the usual-care group. In addition, 62% in the center-based group and 56% in the telephone-based group had maintained a weight loss of at least 5% by the end of the study period, compared with just 29% in the usual care group.

A reduction in C-reactive protein levels and improvement in leptin levels were greater in both intervention groups compared with the usual-care group, but there were no significant intervention effects on other measures, including cardiopulmonary fitness and cholesterol levels.

Dr. Rock and her associates acknowledged certain limitations of the study, including the fact that the prepackaged foods were provided free of charge. If women in the intervention groups were paying out of pocket, participant food costs would have averaged $85 per week for a total of $4,080 for the year, they wrote.

They also noted that weight-loss program counselors were unblinded, “which may have influenced their behavior and effectiveness, although they were instructed to provide the program and services as designed to be delivered to paying customers.”

View on the News

Providing Programs for Free Might Be Worthwhile

The fact that participants received both the food and the counseling without incurring any cost, and received reimbursement for completed follow-up visits, may have increased their length of stay in the program and affected the results achieved.

The findings of this trial raise the possibility that if structured commercial weight-loss programs could be provided free of charge to participants, both retention and average weight-loss outcomes might be far better than when participants must pay for these programs. Currently, insurance companies will cover the cost of bariatric surgery for obesity (estimated at $19,000-$29,000 per patient from insurance data), but they do not cover the cost of commercial weight-loss programs (such as that evaluated in this study, with estimated costs of approximately $1,600 for 12 weeks of the program and for food).

Providing commercial weight-loss programs free of charge to participants might be a worthwhile health care investment. Future studies should examine whether providing commercial programs free of charge to participants would be a cost-effective approach.

RENA R. WING, PH.D., is director of the Weight Control and Diabetes Research Center at Miriam Hospital, Providence, R.I. Her comments were made in an editorial published online (JAMA 2010 Oct. 9 [Epub doi:10.1001/jama.2010.1529). She disclosed that preparation of the editorial was supported by the National Institute of Diabetes and Digestive and Kidney Diseases.

Vitals

Major Finding: Women enrolled in an in-person center-based intervention for weight reduction lost a mean of 7.4 kg in 2 years, compared with 6.2 kg in a telephone-based intervention group, and 2.0 kg in a usual-care group.

Data Source: A randomized, controlled trial of 442 overweight and obese women enrolled at four study sites over a 2-year period.

Disclosures: The study was supported by Jenny Craig Inc. Dr. Rock disclosed that she served on the advisory board of the company from 2003 to 2004. None of her coauthors reported having any relevant financial conflicts.

Overweight or obese women who were assigned to a structured weight-loss program with free prepared meals lost a significantly greater amount of weight at 2 years than did those who received usual care.

In addition, a greater proportion of women enrolled in the program maintained a 5% weight loss at 2 years than did those who received usual care.

“For clinical practitioners, the evidence suggests that the structured program as applied in this study provides another route for their overweight or obese patients to achieve and maintain weight loss through behavioral changes for at least a 2-year period,” researchers led by Cheryl L. Rock, Ph.D., of the University of California, San Diego, wrote (JAMA 2010 Oct. 9 [Epub doi:10.1001/jama.2010.1503]). For the study, 442 overweight or obese women at one of four study sites were randomly assigned to one of three groups: an in-person center-based intervention group, a telephone-based intervention group, or a usual-care group.

Women in the intervention groups received free one-on-one weight-loss counseling for 2 years, and were educated on recommendations for a nutritionally sound, reduced-calorie diet with 20%-30% of calories from fat, and 30 minutes of physical exercise at least 5 days per week. They also received free access to prepackaged prepared foods from Jenny Craig Inc. to help them achieve their nutritional goals.

“Over time, participants were transitioned to a meal plan based mainly not on food provided from the commercial program, although participants could choose to include one prepackaged meal per day during weight-loss maintenance,” Dr. Rock and her associates noted.

Women assigned to the usual-care group received a 1-hour consultation with a dietetics professional at baseline and at 6 months.

During these sessions, they received publicly available materials on dietary and physical activity recommendations to achieve and maintain weight loss, as well as sample meal plans and advice on reading food labels and estimating serving sizes. Women in this group were followed up monthly via e-mail or telephone contact.

All study participants received $25 for each completed clinic visit, but no payment was provided for participating in the intervention or counseling sessions.

The mean age of study participants was 44 years, and 73% were non-Hispanic white. At 2 years, 407 participants remained in the trial, for a retention rate of 92%. The mean weight loss was 7.4 kg in the center-based group, 6.2 kg in the telephone-based group, and 2.0 kg in the usual-care group. In addition, 62% in the center-based group and 56% in the telephone-based group had maintained a weight loss of at least 5% by the end of the study period, compared with just 29% in the usual care group.

A reduction in C-reactive protein levels and improvement in leptin levels were greater in both intervention groups compared with the usual-care group, but there were no significant intervention effects on other measures, including cardiopulmonary fitness and cholesterol levels.

Dr. Rock and her associates acknowledged certain limitations of the study, including the fact that the prepackaged foods were provided free of charge. If women in the intervention groups were paying out of pocket, participant food costs would have averaged $85 per week for a total of $4,080 for the year, they wrote.

They also noted that weight-loss program counselors were unblinded, “which may have influenced their behavior and effectiveness, although they were instructed to provide the program and services as designed to be delivered to paying customers.”

View on the News

Providing Programs for Free Might Be Worthwhile

The fact that participants received both the food and the counseling without incurring any cost, and received reimbursement for completed follow-up visits, may have increased their length of stay in the program and affected the results achieved.

The findings of this trial raise the possibility that if structured commercial weight-loss programs could be provided free of charge to participants, both retention and average weight-loss outcomes might be far better than when participants must pay for these programs. Currently, insurance companies will cover the cost of bariatric surgery for obesity (estimated at $19,000-$29,000 per patient from insurance data), but they do not cover the cost of commercial weight-loss programs (such as that evaluated in this study, with estimated costs of approximately $1,600 for 12 weeks of the program and for food).

Providing commercial weight-loss programs free of charge to participants might be a worthwhile health care investment. Future studies should examine whether providing commercial programs free of charge to participants would be a cost-effective approach.

RENA R. WING, PH.D., is director of the Weight Control and Diabetes Research Center at Miriam Hospital, Providence, R.I. Her comments were made in an editorial published online (JAMA 2010 Oct. 9 [Epub doi:10.1001/jama.2010.1529). She disclosed that preparation of the editorial was supported by the National Institute of Diabetes and Digestive and Kidney Diseases.

Vitals

Major Finding: Women enrolled in an in-person center-based intervention for weight reduction lost a mean of 7.4 kg in 2 years, compared with 6.2 kg in a telephone-based intervention group, and 2.0 kg in a usual-care group.

Data Source: A randomized, controlled trial of 442 overweight and obese women enrolled at four study sites over a 2-year period.

Disclosures: The study was supported by Jenny Craig Inc. Dr. Rock disclosed that she served on the advisory board of the company from 2003 to 2004. None of her coauthors reported having any relevant financial conflicts.

Overweight or obese women who were assigned to a structured weight-loss program with free prepared meals lost a significantly greater amount of weight at 2 years than did those who received usual care.

In addition, a greater proportion of women enrolled in the program maintained a 5% weight loss at 2 years than did those who received usual care.

“For clinical practitioners, the evidence suggests that the structured program as applied in this study provides another route for their overweight or obese patients to achieve and maintain weight loss through behavioral changes for at least a 2-year period,” researchers led by Cheryl L. Rock, Ph.D., of the University of California, San Diego, wrote (JAMA 2010 Oct. 9 [Epub doi:10.1001/jama.2010.1503]). For the study, 442 overweight or obese women at one of four study sites were randomly assigned to one of three groups: an in-person center-based intervention group, a telephone-based intervention group, or a usual-care group.

Women in the intervention groups received free one-on-one weight-loss counseling for 2 years, and were educated on recommendations for a nutritionally sound, reduced-calorie diet with 20%-30% of calories from fat, and 30 minutes of physical exercise at least 5 days per week. They also received free access to prepackaged prepared foods from Jenny Craig Inc. to help them achieve their nutritional goals.

“Over time, participants were transitioned to a meal plan based mainly not on food provided from the commercial program, although participants could choose to include one prepackaged meal per day during weight-loss maintenance,” Dr. Rock and her associates noted.

Women assigned to the usual-care group received a 1-hour consultation with a dietetics professional at baseline and at 6 months.

During these sessions, they received publicly available materials on dietary and physical activity recommendations to achieve and maintain weight loss, as well as sample meal plans and advice on reading food labels and estimating serving sizes. Women in this group were followed up monthly via e-mail or telephone contact.

All study participants received $25 for each completed clinic visit, but no payment was provided for participating in the intervention or counseling sessions.

The mean age of study participants was 44 years, and 73% were non-Hispanic white. At 2 years, 407 participants remained in the trial, for a retention rate of 92%. The mean weight loss was 7.4 kg in the center-based group, 6.2 kg in the telephone-based group, and 2.0 kg in the usual-care group. In addition, 62% in the center-based group and 56% in the telephone-based group had maintained a weight loss of at least 5% by the end of the study period, compared with just 29% in the usual care group.

A reduction in C-reactive protein levels and improvement in leptin levels were greater in both intervention groups compared with the usual-care group, but there were no significant intervention effects on other measures, including cardiopulmonary fitness and cholesterol levels.

Dr. Rock and her associates acknowledged certain limitations of the study, including the fact that the prepackaged foods were provided free of charge. If women in the intervention groups were paying out of pocket, participant food costs would have averaged $85 per week for a total of $4,080 for the year, they wrote.

They also noted that weight-loss program counselors were unblinded, “which may have influenced their behavior and effectiveness, although they were instructed to provide the program and services as designed to be delivered to paying customers.”

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Providing Programs for Free Might Be Worthwhile

The fact that participants received both the food and the counseling without incurring any cost, and received reimbursement for completed follow-up visits, may have increased their length of stay in the program and affected the results achieved.

The findings of this trial raise the possibility that if structured commercial weight-loss programs could be provided free of charge to participants, both retention and average weight-loss outcomes might be far better than when participants must pay for these programs. Currently, insurance companies will cover the cost of bariatric surgery for obesity (estimated at $19,000-$29,000 per patient from insurance data), but they do not cover the cost of commercial weight-loss programs (such as that evaluated in this study, with estimated costs of approximately $1,600 for 12 weeks of the program and for food).

Providing commercial weight-loss programs free of charge to participants might be a worthwhile health care investment. Future studies should examine whether providing commercial programs free of charge to participants would be a cost-effective approach.

RENA R. WING, PH.D., is director of the Weight Control and Diabetes Research Center at Miriam Hospital, Providence, R.I. Her comments were made in an editorial published online (JAMA 2010 Oct. 9 [Epub doi:10.1001/jama.2010.1529). She disclosed that preparation of the editorial was supported by the National Institute of Diabetes and Digestive and Kidney Diseases.

Vitals

SAN DIEGO – Patients with heart failure on optimal medical therapy who received a multidisciplinary, nonpharmacologic intervention for follow-up care and observation had a 38% reduction in death and rehospitalization for heart failure at 1 year, compared with patients who received usual care.

They also had significant improvements in depression scores from baseline, compared with their counterparts, Dr. Viacheslav Mareev reported at the meeting.

“It's well known that many patients with congestive heart failure have depression,” said Dr. Mareev of the Russian Society of Heart Failure Specialists, Moscow. A meta-analysis of trials studying the association found that the prevalence ranges from 19% to 34%, and that the prevalence of depression worsens as heart failure (HF) worsens (J. Am. Coll. Cardiol. 2006;48:1527-37).

For the current trial, known as CHANCE (Congestive Heart Failure: A Multidisciplinary Nonpharmacological Approach for Changing in Rehospitalization and Prognosis), Dr. Mareev and his associates at 38 sites in 24 cities in Russia randomized 385 patients with New York Heart Association class III or IV heart failure to receive optimal medical treatment plus usual care, and 360 patients to receive optimal medical treatment plus education and observation by a multidisciplinary team of clinicians.

Patients in the intervention group attended four 30-minute, in-hospital educational sessions about how to live optimally with heart failure. After discharge, bilateral phone contact was made once weekly during the first month, twice a month until month 6, and then monthly until month 12. To date, none of the patients has been lost to follow-up, Dr. Mareev said.

Both groups of patients completed the HADS (Hospital Anxiety and Depression Scale) at baseline and at 12 months. In this scale, a score of less than 7 suggests the absence of anxiety and/or depression, a score of 7-10 suggests subclinical or minor anxiety and/or depression, and a score greater than 10 suggests clinically relevant, severe anxiety and/or depression.

The mean age of the study participants was 63 years, 60% were male, and 72% had NYHA class III heart failure.

Dr. Mareev reported that patients in the intervention group had a 38% reduction in death and rehospitalization for heart failure, compared with patients in the usual care group.

Baseline HADS scores in the intervention group fell significantly (from 9.7 at baseline to 7.1 at 1 year), whereas scores in the usual care group dropped slightly but not significantly (from 9.3 to 8.7). Dr. Mareev said that the number of patients who scored greater than 10 on the HADS dropped slightly between baseline and 1 year for patients in the usual care group (from 31% to 30%), but dropped markedly for patients in the intervention group (from 37% to 18%).

The relative risk of death among all patients who scored greater than 10 on the HADS was 50% higher chan for patients who scored 7-10 or less than 7.

Patients in the intervention group who scored less than 10 on the HADS had a 25% relative risk reduction of death, compared with their counterparts in the usual care group, whereas patients in the intervention group who scored greater than 10 on the HADS had a 17% relative risk reduction of death, compared with their counterparts in the usual care group.

The multidisciplinary intervention improved the prognosis of heart failure, “even in the group of patients with clinically relevant depression,” Dr. Mareev concluded.

The results support the recent findings of the SADHART-CHF (Sertraline Against Depression and Heart Disease in Chronic Heart Failure) trial, which found that a nonmedical intervention by a specially trained nurse improved prognosis and matched the efficacy of sertraline (J. Am. Coll. Cardiol. 2010;56:692-9). At the meeting, tone of the investigatorsofn that trial, Dr. Christopher M. O'Connor of Duke University in Durham, N.C., saidthae CHANCE study “confirms that depression is an important risk factor and confers an increased risk in morbidity and mortality” in heart failure. “This is an important advance in the field. We need more long-term studies like this.”

Dr. Mareev said that he had no relevant financial conflicts to disclose.

SAN DIEGO – Patients with heart failure on optimal medical therapy who received a multidisciplinary, nonpharmacologic intervention for follow-up care and observation had a 38% reduction in death and rehospitalization for heart failure at 1 year, compared with patients who received usual care.

They also had significant improvements in depression scores from baseline, compared with their counterparts, Dr. Viacheslav Mareev reported at the meeting.

“It's well known that many patients with congestive heart failure have depression,” said Dr. Mareev of the Russian Society of Heart Failure Specialists, Moscow. A meta-analysis of trials studying the association found that the prevalence ranges from 19% to 34%, and that the prevalence of depression worsens as heart failure (HF) worsens (J. Am. Coll. Cardiol. 2006;48:1527-37).

For the current trial, known as CHANCE (Congestive Heart Failure: A Multidisciplinary Nonpharmacological Approach for Changing in Rehospitalization and Prognosis), Dr. Mareev and his associates at 38 sites in 24 cities in Russia randomized 385 patients with New York Heart Association class III or IV heart failure to receive optimal medical treatment plus usual care, and 360 patients to receive optimal medical treatment plus education and observation by a multidisciplinary team of clinicians.

Patients in the intervention group attended four 30-minute, in-hospital educational sessions about how to live optimally with heart failure. After discharge, bilateral phone contact was made once weekly during the first month, twice a month until month 6, and then monthly until month 12. To date, none of the patients has been lost to follow-up, Dr. Mareev said.

Both groups of patients completed the HADS (Hospital Anxiety and Depression Scale) at baseline and at 12 months. In this scale, a score of less than 7 suggests the absence of anxiety and/or depression, a score of 7-10 suggests subclinical or minor anxiety and/or depression, and a score greater than 10 suggests clinically relevant, severe anxiety and/or depression.

The mean age of the study participants was 63 years, 60% were male, and 72% had NYHA class III heart failure.

Dr. Mareev reported that patients in the intervention group had a 38% reduction in death and rehospitalization for heart failure, compared with patients in the usual care group.

Baseline HADS scores in the intervention group fell significantly (from 9.7 at baseline to 7.1 at 1 year), whereas scores in the usual care group dropped slightly but not significantly (from 9.3 to 8.7). Dr. Mareev said that the number of patients who scored greater than 10 on the HADS dropped slightly between baseline and 1 year for patients in the usual care group (from 31% to 30%), but dropped markedly for patients in the intervention group (from 37% to 18%).

The relative risk of death among all patients who scored greater than 10 on the HADS was 50% higher chan for patients who scored 7-10 or less than 7.

Patients in the intervention group who scored less than 10 on the HADS had a 25% relative risk reduction of death, compared with their counterparts in the usual care group, whereas patients in the intervention group who scored greater than 10 on the HADS had a 17% relative risk reduction of death, compared with their counterparts in the usual care group.

The multidisciplinary intervention improved the prognosis of heart failure, “even in the group of patients with clinically relevant depression,” Dr. Mareev concluded.

The results support the recent findings of the SADHART-CHF (Sertraline Against Depression and Heart Disease in Chronic Heart Failure) trial, which found that a nonmedical intervention by a specially trained nurse improved prognosis and matched the efficacy of sertraline (J. Am. Coll. Cardiol. 2010;56:692-9). At the meeting, tone of the investigatorsofn that trial, Dr. Christopher M. O'Connor of Duke University in Durham, N.C., saidthae CHANCE study “confirms that depression is an important risk factor and confers an increased risk in morbidity and mortality” in heart failure. “This is an important advance in the field. We need more long-term studies like this.”

Dr. Mareev said that he had no relevant financial conflicts to disclose.

SAN DIEGO – Patients with heart failure on optimal medical therapy who received a multidisciplinary, nonpharmacologic intervention for follow-up care and observation had a 38% reduction in death and rehospitalization for heart failure at 1 year, compared with patients who received usual care.

They also had significant improvements in depression scores from baseline, compared with their counterparts, Dr. Viacheslav Mareev reported at the meeting.

“It's well known that many patients with congestive heart failure have depression,” said Dr. Mareev of the Russian Society of Heart Failure Specialists, Moscow. A meta-analysis of trials studying the association found that the prevalence ranges from 19% to 34%, and that the prevalence of depression worsens as heart failure (HF) worsens (J. Am. Coll. Cardiol. 2006;48:1527-37).

For the current trial, known as CHANCE (Congestive Heart Failure: A Multidisciplinary Nonpharmacological Approach for Changing in Rehospitalization and Prognosis), Dr. Mareev and his associates at 38 sites in 24 cities in Russia randomized 385 patients with New York Heart Association class III or IV heart failure to receive optimal medical treatment plus usual care, and 360 patients to receive optimal medical treatment plus education and observation by a multidisciplinary team of clinicians.

Patients in the intervention group attended four 30-minute, in-hospital educational sessions about how to live optimally with heart failure. After discharge, bilateral phone contact was made once weekly during the first month, twice a month until month 6, and then monthly until month 12. To date, none of the patients has been lost to follow-up, Dr. Mareev said.

Both groups of patients completed the HADS (Hospital Anxiety and Depression Scale) at baseline and at 12 months. In this scale, a score of less than 7 suggests the absence of anxiety and/or depression, a score of 7-10 suggests subclinical or minor anxiety and/or depression, and a score greater than 10 suggests clinically relevant, severe anxiety and/or depression.

The mean age of the study participants was 63 years, 60% were male, and 72% had NYHA class III heart failure.

Dr. Mareev reported that patients in the intervention group had a 38% reduction in death and rehospitalization for heart failure, compared with patients in the usual care group.

Baseline HADS scores in the intervention group fell significantly (from 9.7 at baseline to 7.1 at 1 year), whereas scores in the usual care group dropped slightly but not significantly (from 9.3 to 8.7). Dr. Mareev said that the number of patients who scored greater than 10 on the HADS dropped slightly between baseline and 1 year for patients in the usual care group (from 31% to 30%), but dropped markedly for patients in the intervention group (from 37% to 18%).

The relative risk of death among all patients who scored greater than 10 on the HADS was 50% higher chan for patients who scored 7-10 or less than 7.

Patients in the intervention group who scored less than 10 on the HADS had a 25% relative risk reduction of death, compared with their counterparts in the usual care group, whereas patients in the intervention group who scored greater than 10 on the HADS had a 17% relative risk reduction of death, compared with their counterparts in the usual care group.

The multidisciplinary intervention improved the prognosis of heart failure, “even in the group of patients with clinically relevant depression,” Dr. Mareev concluded.

The results support the recent findings of the SADHART-CHF (Sertraline Against Depression and Heart Disease in Chronic Heart Failure) trial, which found that a nonmedical intervention by a specially trained nurse improved prognosis and matched the efficacy of sertraline (J. Am. Coll. Cardiol. 2010;56:692-9). At the meeting, tone of the investigatorsofn that trial, Dr. Christopher M. O'Connor of Duke University in Durham, N.C., saidthae CHANCE study “confirms that depression is an important risk factor and confers an increased risk in morbidity and mortality” in heart failure. “This is an important advance in the field. We need more long-term studies like this.”

Dr. Mareev said that he had no relevant financial conflicts to disclose.

Major Finding: Compared with a reference population from the Nurses' Health Study, healthy black women with low adherence to a DASH-type diet had worse nitroglycerine-dependent dilatation and more insulin resistance, regardless of body weight.

Data Source: A study of 52 healthy black women aged 18-45 years.

Disclosures: The study was supported by grants from the National Center for Research Resources. Dr. Pemu said she had no relevant financial conflicts.

SAN DIEGO – Low adherence to the Dietary Approaches to Stop Hypertension diet, including increased intake of dietary sodium and sweetened beverages, predicted vascular dysfunction and insulin resistance among a cohort of healthy black women, regardless of body weight.

Although the reason for the association remains unclear, genetic susceptibility and lifestyle factors may play a role, Dr. Priscilla E. Pemu said in an interview during a poster session at the meeting Endorsed by the National Institutes of Health, the principles of the DASH diet are based on a low-sodium eating plan rich in fruits and vegetables, along with low-fat or nonfat dairy products (www.dashdiet.org

“One of the main components of the DASH diet is intake of low-fat dairy products,” said Dr. Pemu, an internist at Morehouse School of Medicine, Atlanta. In the black population, “there tends to be avoidance of dairy products because of lactose intolerance. Offering people alternatives – things they can tolerate – would be important in this population.”

Dr. Pemu and her associates enrolled 52 healthy, normotensive, lean and obese black women (aged 18-45 years) in an effort to determine the contribution of dietary factors to vascular dysfunction.

The women completed the Willett Food Frequency Questionnaire, and blood was collected for measurement of endothelial progenitor cells, C-reactive protein, adiponectin, tumor necrosis factor–alpha, and insulin resistance by homeostasis model assessment (HOMA), in which a level of 2.2 or greater was defined as insulin resistance.

The researchers also used high-frequency ultrasound to measure flow-mediated dilatation and nitroglycerine-dependent dilatation.

Study participants had less adherence to a DASH-type diet, compared with a reference population from the Nurses' Health Study (Arch. Intern. Med. 2008;168:713-20), as evidenced by lower mean dietary intake of fruits per day (1.27 vs. 1.4, respectively), as well as a significantly higher mean daily intake of sodium (2,360 mg vs. 2,070 mg) and number of daily servings of sweetened beverages (2.33 vs. 0.26).

Lower DASH adherence scores among the study participants were associated with worse nitroglycerine-dependent dilatation, a correlation that was unaffected by age, blood pressure, or body mass index, Dr. Pemu reported.

Low DASH adherence scores, including higher intake of sodium and sugar-sweetened beverages, also predicted insulin resistance as measured by HOMA.

Based on these findings, Dr. Pemu recommended that black women “increase the amount of fruits and vegetables that they consume, as well as nuts, legumes, and low-fat dairy products, because we are starting to see a relationship with vascular dysfunction even in the absence of cardiovascular disease.”

Dr. Pemu, who is also director of clinical trials at the clinical research center at Morehouse, acknowledged certain limitations of the study, including its small sample size and the potential for error in the self-reported food frequency questionnaires. “However, our data compared favorably with a much larger data set in the Nurses' Health Study, giving us confidence in the relationships we have identified.”

Black women should eat more fruits and vegetables, nuts, legumes, and low-fat dairy products.

Source DR. PEMU

Major Finding: Compared with a reference population from the Nurses' Health Study, healthy black women with low adherence to a DASH-type diet had worse nitroglycerine-dependent dilatation and more insulin resistance, regardless of body weight.

Data Source: A study of 52 healthy black women aged 18-45 years.

Disclosures: The study was supported by grants from the National Center for Research Resources. Dr. Pemu said she had no relevant financial conflicts.

SAN DIEGO – Low adherence to the Dietary Approaches to Stop Hypertension diet, including increased intake of dietary sodium and sweetened beverages, predicted vascular dysfunction and insulin resistance among a cohort of healthy black women, regardless of body weight.

Although the reason for the association remains unclear, genetic susceptibility and lifestyle factors may play a role, Dr. Priscilla E. Pemu said in an interview during a poster session at the meeting Endorsed by the National Institutes of Health, the principles of the DASH diet are based on a low-sodium eating plan rich in fruits and vegetables, along with low-fat or nonfat dairy products (www.dashdiet.org

“One of the main components of the DASH diet is intake of low-fat dairy products,” said Dr. Pemu, an internist at Morehouse School of Medicine, Atlanta. In the black population, “there tends to be avoidance of dairy products because of lactose intolerance. Offering people alternatives – things they can tolerate – would be important in this population.”

Dr. Pemu and her associates enrolled 52 healthy, normotensive, lean and obese black women (aged 18-45 years) in an effort to determine the contribution of dietary factors to vascular dysfunction.

The women completed the Willett Food Frequency Questionnaire, and blood was collected for measurement of endothelial progenitor cells, C-reactive protein, adiponectin, tumor necrosis factor–alpha, and insulin resistance by homeostasis model assessment (HOMA), in which a level of 2.2 or greater was defined as insulin resistance.

The researchers also used high-frequency ultrasound to measure flow-mediated dilatation and nitroglycerine-dependent dilatation.

Study participants had less adherence to a DASH-type diet, compared with a reference population from the Nurses' Health Study (Arch. Intern. Med. 2008;168:713-20), as evidenced by lower mean dietary intake of fruits per day (1.27 vs. 1.4, respectively), as well as a significantly higher mean daily intake of sodium (2,360 mg vs. 2,070 mg) and number of daily servings of sweetened beverages (2.33 vs. 0.26).

Lower DASH adherence scores among the study participants were associated with worse nitroglycerine-dependent dilatation, a correlation that was unaffected by age, blood pressure, or body mass index, Dr. Pemu reported.

Low DASH adherence scores, including higher intake of sodium and sugar-sweetened beverages, also predicted insulin resistance as measured by HOMA.

Based on these findings, Dr. Pemu recommended that black women “increase the amount of fruits and vegetables that they consume, as well as nuts, legumes, and low-fat dairy products, because we are starting to see a relationship with vascular dysfunction even in the absence of cardiovascular disease.”

Dr. Pemu, who is also director of clinical trials at the clinical research center at Morehouse, acknowledged certain limitations of the study, including its small sample size and the potential for error in the self-reported food frequency questionnaires. “However, our data compared favorably with a much larger data set in the Nurses' Health Study, giving us confidence in the relationships we have identified.”

Black women should eat more fruits and vegetables, nuts, legumes, and low-fat dairy products.

Source DR. PEMU

Major Finding: Compared with a reference population from the Nurses' Health Study, healthy black women with low adherence to a DASH-type diet had worse nitroglycerine-dependent dilatation and more insulin resistance, regardless of body weight.

Data Source: A study of 52 healthy black women aged 18-45 years.

Disclosures: The study was supported by grants from the National Center for Research Resources. Dr. Pemu said she had no relevant financial conflicts.

SAN DIEGO – Low adherence to the Dietary Approaches to Stop Hypertension diet, including increased intake of dietary sodium and sweetened beverages, predicted vascular dysfunction and insulin resistance among a cohort of healthy black women, regardless of body weight.

Although the reason for the association remains unclear, genetic susceptibility and lifestyle factors may play a role, Dr. Priscilla E. Pemu said in an interview during a poster session at the meeting Endorsed by the National Institutes of Health, the principles of the DASH diet are based on a low-sodium eating plan rich in fruits and vegetables, along with low-fat or nonfat dairy products (www.dashdiet.org

“One of the main components of the DASH diet is intake of low-fat dairy products,” said Dr. Pemu, an internist at Morehouse School of Medicine, Atlanta. In the black population, “there tends to be avoidance of dairy products because of lactose intolerance. Offering people alternatives – things they can tolerate – would be important in this population.”

Dr. Pemu and her associates enrolled 52 healthy, normotensive, lean and obese black women (aged 18-45 years) in an effort to determine the contribution of dietary factors to vascular dysfunction.

The women completed the Willett Food Frequency Questionnaire, and blood was collected for measurement of endothelial progenitor cells, C-reactive protein, adiponectin, tumor necrosis factor–alpha, and insulin resistance by homeostasis model assessment (HOMA), in which a level of 2.2 or greater was defined as insulin resistance.

The researchers also used high-frequency ultrasound to measure flow-mediated dilatation and nitroglycerine-dependent dilatation.

Study participants had less adherence to a DASH-type diet, compared with a reference population from the Nurses' Health Study (Arch. Intern. Med. 2008;168:713-20), as evidenced by lower mean dietary intake of fruits per day (1.27 vs. 1.4, respectively), as well as a significantly higher mean daily intake of sodium (2,360 mg vs. 2,070 mg) and number of daily servings of sweetened beverages (2.33 vs. 0.26).

Lower DASH adherence scores among the study participants were associated with worse nitroglycerine-dependent dilatation, a correlation that was unaffected by age, blood pressure, or body mass index, Dr. Pemu reported.

Low DASH adherence scores, including higher intake of sodium and sugar-sweetened beverages, also predicted insulin resistance as measured by HOMA.

Based on these findings, Dr. Pemu recommended that black women “increase the amount of fruits and vegetables that they consume, as well as nuts, legumes, and low-fat dairy products, because we are starting to see a relationship with vascular dysfunction even in the absence of cardiovascular disease.”

Dr. Pemu, who is also director of clinical trials at the clinical research center at Morehouse, acknowledged certain limitations of the study, including its small sample size and the potential for error in the self-reported food frequency questionnaires. “However, our data compared favorably with a much larger data set in the Nurses' Health Study, giving us confidence in the relationships we have identified.”

Black women should eat more fruits and vegetables, nuts, legumes, and low-fat dairy products.

Source DR. PEMU

SAN DIEGO - Although the health benefits of shedding extra pounds are generally well known to overweight and obese patients, the potential risks and side effects of rapid weight loss on the body are not, so it is wise to advise patients of these possibilities.

One such risk is the formation of gallstones, Dr. Lawrence J. Cheskin said at the annual meeting of the Obesity Society. Prevention strategies include limiting the rate of weight loss to an average of 3.3 lb/week, said Dr. Cheskin, director of the Johns Hopkins Weight Management Center in Baltimore.

Adding 10 g of fat to a low-calorie diet has also been shown to prevent gallstone formation, probably because of enhanced gallbladder emptying. "Once the gallstones get big enough to get impacted, that’s not going to work," he said.

Another strategy is to add polyunsaturated fatty acids to the diet, although this approach has not been studied beyond 6 weeks of follow-up.

Ursodeoxycholic acid has been shown to be effective in preventing gallstones, he said, whereas the results of placebo-controlled trials of prostaglandin inhibition with NSAIDS are mixed. There is also emerging evidence that EGCG (ezetimibe and epigallocatechin gallate) may play a role in the prevention of gallstones.

He went on to discuss the following medical problems that are related to rapid weight loss:

• Kidney stones. These tend to occur at greater frequency with low-carbohydrate, high-protein diets. "It likely results from elevated uric acid in blood and urine, increased urinary calcium, and acid load/acidification of the urine," Dr. Cheskin explained.

Prevention strategies include daily ingestion of potassium citrate, "because it alkalinizes the urine and solubilizes urinary calcium," he said. "There’s also some evidence that adding magnesium to potassium citrate may be even more effective."

• Gout. This can occur from temporary elevations in uric acid. "People on very-low-energy diets have a reported gout incidence rate of 1%," he said. "Generally, though, the risk of gout ultimately decreases with weight loss and its accompanying lowering of serum uric acid."

Prevention strategies include exercise, limitation of red meat and sugary beverage intake, and supplementation with coffee and vitamin C. "Coffee and vitamin C seem to lower uric acid levels in general," he said.

• Cardiac complications. Concerns about arrhythmias and deaths arose many years ago, when diets were sometimes very deficient in protein and micronutrients, "but very rarely today," he said.

• Electrolyte disorders. Dr. Cheskin advises being vigilant in monitoring levels of serum potassium and magnesium, especially in patients who are taking diuretics.

• Bone density loss. This remains an area of controversy, Dr. Cheskin said, as it is unclear if the bone loss exceeds the loss that is expected from the weight loss itself.

• Eating disorders. "Though a cause and effect [relationship] has not been well established, clearly, repeated dieting can be associated with eating disorders," he said. "We should bear this in mind and not shy away from helping people with eating disorders related to dieting."

Dr. Cheskin said that he had no relevant financial conflicts to disclose.

SAN DIEGO - Although the health benefits of shedding extra pounds are generally well known to overweight and obese patients, the potential risks and side effects of rapid weight loss on the body are not, so it is wise to advise patients of these possibilities.

One such risk is the formation of gallstones, Dr. Lawrence J. Cheskin said at the annual meeting of the Obesity Society. Prevention strategies include limiting the rate of weight loss to an average of 3.3 lb/week, said Dr. Cheskin, director of the Johns Hopkins Weight Management Center in Baltimore.

Adding 10 g of fat to a low-calorie diet has also been shown to prevent gallstone formation, probably because of enhanced gallbladder emptying. "Once the gallstones get big enough to get impacted, that’s not going to work," he said.

Another strategy is to add polyunsaturated fatty acids to the diet, although this approach has not been studied beyond 6 weeks of follow-up.

Ursodeoxycholic acid has been shown to be effective in preventing gallstones, he said, whereas the results of placebo-controlled trials of prostaglandin inhibition with NSAIDS are mixed. There is also emerging evidence that EGCG (ezetimibe and epigallocatechin gallate) may play a role in the prevention of gallstones.

He went on to discuss the following medical problems that are related to rapid weight loss:

• Kidney stones. These tend to occur at greater frequency with low-carbohydrate, high-protein diets. "It likely results from elevated uric acid in blood and urine, increased urinary calcium, and acid load/acidification of the urine," Dr. Cheskin explained.

Prevention strategies include daily ingestion of potassium citrate, "because it alkalinizes the urine and solubilizes urinary calcium," he said. "There’s also some evidence that adding magnesium to potassium citrate may be even more effective."

• Gout. This can occur from temporary elevations in uric acid. "People on very-low-energy diets have a reported gout incidence rate of 1%," he said. "Generally, though, the risk of gout ultimately decreases with weight loss and its accompanying lowering of serum uric acid."

Prevention strategies include exercise, limitation of red meat and sugary beverage intake, and supplementation with coffee and vitamin C. "Coffee and vitamin C seem to lower uric acid levels in general," he said.

• Cardiac complications. Concerns about arrhythmias and deaths arose many years ago, when diets were sometimes very deficient in protein and micronutrients, "but very rarely today," he said.

• Electrolyte disorders. Dr. Cheskin advises being vigilant in monitoring levels of serum potassium and magnesium, especially in patients who are taking diuretics.

• Bone density loss. This remains an area of controversy, Dr. Cheskin said, as it is unclear if the bone loss exceeds the loss that is expected from the weight loss itself.

• Eating disorders. "Though a cause and effect [relationship] has not been well established, clearly, repeated dieting can be associated with eating disorders," he said. "We should bear this in mind and not shy away from helping people with eating disorders related to dieting."

Dr. Cheskin said that he had no relevant financial conflicts to disclose.

SAN DIEGO - Although the health benefits of shedding extra pounds are generally well known to overweight and obese patients, the potential risks and side effects of rapid weight loss on the body are not, so it is wise to advise patients of these possibilities.

One such risk is the formation of gallstones, Dr. Lawrence J. Cheskin said at the annual meeting of the Obesity Society. Prevention strategies include limiting the rate of weight loss to an average of 3.3 lb/week, said Dr. Cheskin, director of the Johns Hopkins Weight Management Center in Baltimore.

Adding 10 g of fat to a low-calorie diet has also been shown to prevent gallstone formation, probably because of enhanced gallbladder emptying. "Once the gallstones get big enough to get impacted, that’s not going to work," he said.

Another strategy is to add polyunsaturated fatty acids to the diet, although this approach has not been studied beyond 6 weeks of follow-up.

Ursodeoxycholic acid has been shown to be effective in preventing gallstones, he said, whereas the results of placebo-controlled trials of prostaglandin inhibition with NSAIDS are mixed. There is also emerging evidence that EGCG (ezetimibe and epigallocatechin gallate) may play a role in the prevention of gallstones.

He went on to discuss the following medical problems that are related to rapid weight loss:

• Kidney stones. These tend to occur at greater frequency with low-carbohydrate, high-protein diets. "It likely results from elevated uric acid in blood and urine, increased urinary calcium, and acid load/acidification of the urine," Dr. Cheskin explained.

Prevention strategies include daily ingestion of potassium citrate, "because it alkalinizes the urine and solubilizes urinary calcium," he said. "There’s also some evidence that adding magnesium to potassium citrate may be even more effective."

• Gout. This can occur from temporary elevations in uric acid. "People on very-low-energy diets have a reported gout incidence rate of 1%," he said. "Generally, though, the risk of gout ultimately decreases with weight loss and its accompanying lowering of serum uric acid."

Prevention strategies include exercise, limitation of red meat and sugary beverage intake, and supplementation with coffee and vitamin C. "Coffee and vitamin C seem to lower uric acid levels in general," he said.

• Cardiac complications. Concerns about arrhythmias and deaths arose many years ago, when diets were sometimes very deficient in protein and micronutrients, "but very rarely today," he said.

• Electrolyte disorders. Dr. Cheskin advises being vigilant in monitoring levels of serum potassium and magnesium, especially in patients who are taking diuretics.

• Bone density loss. This remains an area of controversy, Dr. Cheskin said, as it is unclear if the bone loss exceeds the loss that is expected from the weight loss itself.

• Eating disorders. "Though a cause and effect [relationship] has not been well established, clearly, repeated dieting can be associated with eating disorders," he said. "We should bear this in mind and not shy away from helping people with eating disorders related to dieting."

Dr. Cheskin said that he had no relevant financial conflicts to disclose.

SAN DIEGO - Although the health benefits of shedding extra pounds are generally well known to overweight and obese patients, the potential risks and side effects of rapid weight loss on the body are not, so it is wise to advise patients of these possibilities.

One such risk is the formation of gallstones, Dr. Lawrence J. Cheskin said at the annual meeting of the Obesity Society. Prevention strategies include limiting the rate of weight loss to an average of 3.3 lb/week, said Dr. Cheskin, director of the Johns Hopkins Weight Management Center in Baltimore.

Adding 10 g of fat to a low-calorie diet has also been shown to prevent gallstone formation, probably because of enhanced gallbladder emptying. "Once the gallstones get big enough to get impacted, that’s not going to work," he said.

Another strategy is to add polyunsaturated fatty acids to the diet, although this approach has not been studied beyond 6 weeks of follow-up.

Ursodeoxycholic acid has been shown to be effective in preventing gallstones, he said, whereas the results of placebo-controlled trials of prostaglandin inhibition with NSAIDS are mixed. There is also emerging evidence that EGCG (ezetimibe and epigallocatechin gallate) may play a role in the prevention of gallstones.

He went on to discuss the following medical problems that are related to rapid weight loss:

• Kidney stones. These tend to occur at greater frequency with low-carbohydrate, high-protein diets. "It likely results from elevated uric acid in blood and urine, increased urinary calcium, and acid load/acidification of the urine," Dr. Cheskin explained.

Prevention strategies include daily ingestion of potassium citrate, "because it alkalinizes the urine and solubilizes urinary calcium," he said. "There’s also some evidence that adding magnesium to potassium citrate may be even more effective."

• Gout. This can occur from temporary elevations in uric acid. "People on very-low-energy diets have a reported gout incidence rate of 1%," he said. "Generally, though, the risk of gout ultimately decreases with weight loss and its accompanying lowering of serum uric acid."

Prevention strategies include exercise, limitation of red meat and sugary beverage intake, and supplementation with coffee and vitamin C. "Coffee and vitamin C seem to lower uric acid levels in general," he said.

• Cardiac complications. Concerns about arrhythmias and deaths arose many years ago, when diets were sometimes very deficient in protein and micronutrients, "but very rarely today," he said.

• Electrolyte disorders. Dr. Cheskin advises being vigilant in monitoring levels of serum potassium and magnesium, especially in patients who are taking diuretics.

• Bone density loss. This remains an area of controversy, Dr. Cheskin said, as it is unclear if the bone loss exceeds the loss that is expected from the weight loss itself.

• Eating disorders. "Though a cause and effect [relationship] has not been well established, clearly, repeated dieting can be associated with eating disorders," he said. "We should bear this in mind and not shy away from helping people with eating disorders related to dieting."

Dr. Cheskin said that he had no relevant financial conflicts to disclose.

SAN DIEGO - Although the health benefits of shedding extra pounds are generally well known to overweight and obese patients, the potential risks and side effects of rapid weight loss on the body are not, so it is wise to advise patients of these possibilities.

One such risk is the formation of gallstones, Dr. Lawrence J. Cheskin said at the annual meeting of the Obesity Society. Prevention strategies include limiting the rate of weight loss to an average of 3.3 lb/week, said Dr. Cheskin, director of the Johns Hopkins Weight Management Center in Baltimore.

Adding 10 g of fat to a low-calorie diet has also been shown to prevent gallstone formation, probably because of enhanced gallbladder emptying. "Once the gallstones get big enough to get impacted, that’s not going to work," he said.

Another strategy is to add polyunsaturated fatty acids to the diet, although this approach has not been studied beyond 6 weeks of follow-up.

Ursodeoxycholic acid has been shown to be effective in preventing gallstones, he said, whereas the results of placebo-controlled trials of prostaglandin inhibition with NSAIDS are mixed. There is also emerging evidence that EGCG (ezetimibe and epigallocatechin gallate) may play a role in the prevention of gallstones.

He went on to discuss the following medical problems that are related to rapid weight loss:

• Kidney stones. These tend to occur at greater frequency with low-carbohydrate, high-protein diets. "It likely results from elevated uric acid in blood and urine, increased urinary calcium, and acid load/acidification of the urine," Dr. Cheskin explained.

Prevention strategies include daily ingestion of potassium citrate, "because it alkalinizes the urine and solubilizes urinary calcium," he said. "There’s also some evidence that adding magnesium to potassium citrate may be even more effective."

• Gout. This can occur from temporary elevations in uric acid. "People on very-low-energy diets have a reported gout incidence rate of 1%," he said. "Generally, though, the risk of gout ultimately decreases with weight loss and its accompanying lowering of serum uric acid."

Prevention strategies include exercise, limitation of red meat and sugary beverage intake, and supplementation with coffee and vitamin C. "Coffee and vitamin C seem to lower uric acid levels in general," he said.

• Cardiac complications. Concerns about arrhythmias and deaths arose many years ago, when diets were sometimes very deficient in protein and micronutrients, "but very rarely today," he said.

• Electrolyte disorders. Dr. Cheskin advises being vigilant in monitoring levels of serum potassium and magnesium, especially in patients who are taking diuretics.

• Bone density loss. This remains an area of controversy, Dr. Cheskin said, as it is unclear if the bone loss exceeds the loss that is expected from the weight loss itself.

• Eating disorders. "Though a cause and effect [relationship] has not been well established, clearly, repeated dieting can be associated with eating disorders," he said. "We should bear this in mind and not shy away from helping people with eating disorders related to dieting."

Dr. Cheskin said that he had no relevant financial conflicts to disclose.

SAN DIEGO - Although the health benefits of shedding extra pounds are generally well known to overweight and obese patients, the potential risks and side effects of rapid weight loss on the body are not, so it is wise to advise patients of these possibilities.

One such risk is the formation of gallstones, Dr. Lawrence J. Cheskin said at the annual meeting of the Obesity Society. Prevention strategies include limiting the rate of weight loss to an average of 3.3 lb/week, said Dr. Cheskin, director of the Johns Hopkins Weight Management Center in Baltimore.

Adding 10 g of fat to a low-calorie diet has also been shown to prevent gallstone formation, probably because of enhanced gallbladder emptying. "Once the gallstones get big enough to get impacted, that’s not going to work," he said.

Another strategy is to add polyunsaturated fatty acids to the diet, although this approach has not been studied beyond 6 weeks of follow-up.

Ursodeoxycholic acid has been shown to be effective in preventing gallstones, he said, whereas the results of placebo-controlled trials of prostaglandin inhibition with NSAIDS are mixed. There is also emerging evidence that EGCG (ezetimibe and epigallocatechin gallate) may play a role in the prevention of gallstones.

He went on to discuss the following medical problems that are related to rapid weight loss:

• Kidney stones. These tend to occur at greater frequency with low-carbohydrate, high-protein diets. "It likely results from elevated uric acid in blood and urine, increased urinary calcium, and acid load/acidification of the urine," Dr. Cheskin explained.

Prevention strategies include daily ingestion of potassium citrate, "because it alkalinizes the urine and solubilizes urinary calcium," he said. "There’s also some evidence that adding magnesium to potassium citrate may be even more effective."

• Gout. This can occur from temporary elevations in uric acid. "People on very-low-energy diets have a reported gout incidence rate of 1%," he said. "Generally, though, the risk of gout ultimately decreases with weight loss and its accompanying lowering of serum uric acid."

Prevention strategies include exercise, limitation of red meat and sugary beverage intake, and supplementation with coffee and vitamin C. "Coffee and vitamin C seem to lower uric acid levels in general," he said.

• Cardiac complications. Concerns about arrhythmias and deaths arose many years ago, when diets were sometimes very deficient in protein and micronutrients, "but very rarely today," he said.

• Electrolyte disorders. Dr. Cheskin advises being vigilant in monitoring levels of serum potassium and magnesium, especially in patients who are taking diuretics.

• Bone density loss. This remains an area of controversy, Dr. Cheskin said, as it is unclear if the bone loss exceeds the loss that is expected from the weight loss itself.

• Eating disorders. "Though a cause and effect [relationship] has not been well established, clearly, repeated dieting can be associated with eating disorders," he said. "We should bear this in mind and not shy away from helping people with eating disorders related to dieting."

Dr. Cheskin said that he had no relevant financial conflicts to disclose.

SAN DIEGO - Adults with high total daily energy expenditure are not protected from holiday weight gain, results from a large study demonstrated.

This is one of only a few studies that did not find evidence for the prevention of body weight gain via physical activity across the typical daily physical activity levels observed in the general population, Chad M. Cook said in an interview during a poster session at the annual meeting of the Obesity Society.

"We hypothesized that people who habitually burn more daily calories than predicted for their age, height, and body weight may be protected against holiday weight gain," said Mr. Cook, who is a graduate student in nutritional sciences at the University of Wisconsin–Madison. "We found that’s not true, at least in this particular population studied."

Mr. Cook and his associates analyzed body weight change during the 1999-2000 winter quarter in 443 men and women aged 40-69 years with doubly labeled water data who participated in the National Cancer Institute–sponsored Observing Protein and Energy Nutrition study (OPEN). The original purpose of the OPEN study, completed in 2000, was to assess self-reported dietary measurement error by comparing results from self-reported dietary intake questionnaires with objective biomarkers: doubly labeled water and urinary nitrogen.

Photo credit:©Olga Lyubkin/Fotolia.com

The researchers used doubly labeled water to measure total energy expenditure, and calculated residual total energy expenditure after adjusting for age, height, and body weight.

Over an average of 107 days, nearly three-quarters of study participants (73%) gained 0.1 kg or more, with 19% gaining 2 kg or more. Men gained more than women (an average of 1.1 kg vs. 0.7 kg).

Men with a baseline body mass index of 30 kg/m2 or more gained an average of 1.5 kg, which was significantly more than men with a baseline BMI of 19-24 (an average of 1.0 kg) or men with a BMI of 25-29 (an average of 0.9 kg). There were no differences in body weight change between BMI categories among women, or between age and sex subgroups.

Mr. Cook also reported that there were no correlations seen between increased body weight and total energy expenditure or between increased body weight and total energy expenditure after the researchers adjusted for age and body size. Residual total energy expenditure above or below the average for body size ranged from –877 to 1,813 calories per day, with a median of –36 calories per day.

The findings suggest that interventions targeting the winter holiday quarter to prevent excess body weight gain in older men and women should focus mainly on diet, although increased activity levels should be encouraged for health reasons, the researchers said.

The study was funded by the National Cancer Institute Intramural Research Program. Mr. Cook said that he had no relevant financial conflicts to disclose.

SAN DIEGO - Adults with high total daily energy expenditure are not protected from holiday weight gain, results from a large study demonstrated.

This is one of only a few studies that did not find evidence for the prevention of body weight gain via physical activity across the typical daily physical activity levels observed in the general population, Chad M. Cook said in an interview during a poster session at the annual meeting of the Obesity Society.

"We hypothesized that people who habitually burn more daily calories than predicted for their age, height, and body weight may be protected against holiday weight gain," said Mr. Cook, who is a graduate student in nutritional sciences at the University of Wisconsin–Madison. "We found that’s not true, at least in this particular population studied."

Mr. Cook and his associates analyzed body weight change during the 1999-2000 winter quarter in 443 men and women aged 40-69 years with doubly labeled water data who participated in the National Cancer Institute–sponsored Observing Protein and Energy Nutrition study (OPEN). The original purpose of the OPEN study, completed in 2000, was to assess self-reported dietary measurement error by comparing results from self-reported dietary intake questionnaires with objective biomarkers: doubly labeled water and urinary nitrogen.

Photo credit:©Olga Lyubkin/Fotolia.com

The researchers used doubly labeled water to measure total energy expenditure, and calculated residual total energy expenditure after adjusting for age, height, and body weight.

Over an average of 107 days, nearly three-quarters of study participants (73%) gained 0.1 kg or more, with 19% gaining 2 kg or more. Men gained more than women (an average of 1.1 kg vs. 0.7 kg).

Men with a baseline body mass index of 30 kg/m2 or more gained an average of 1.5 kg, which was significantly more than men with a baseline BMI of 19-24 (an average of 1.0 kg) or men with a BMI of 25-29 (an average of 0.9 kg). There were no differences in body weight change between BMI categories among women, or between age and sex subgroups.

Mr. Cook also reported that there were no correlations seen between increased body weight and total energy expenditure or between increased body weight and total energy expenditure after the researchers adjusted for age and body size. Residual total energy expenditure above or below the average for body size ranged from –877 to 1,813 calories per day, with a median of –36 calories per day.

The findings suggest that interventions targeting the winter holiday quarter to prevent excess body weight gain in older men and women should focus mainly on diet, although increased activity levels should be encouraged for health reasons, the researchers said.

The study was funded by the National Cancer Institute Intramural Research Program. Mr. Cook said that he had no relevant financial conflicts to disclose.

SAN DIEGO - Adults with high total daily energy expenditure are not protected from holiday weight gain, results from a large study demonstrated.

This is one of only a few studies that did not find evidence for the prevention of body weight gain via physical activity across the typical daily physical activity levels observed in the general population, Chad M. Cook said in an interview during a poster session at the annual meeting of the Obesity Society.

"We hypothesized that people who habitually burn more daily calories than predicted for their age, height, and body weight may be protected against holiday weight gain," said Mr. Cook, who is a graduate student in nutritional sciences at the University of Wisconsin–Madison. "We found that’s not true, at least in this particular population studied."

Mr. Cook and his associates analyzed body weight change during the 1999-2000 winter quarter in 443 men and women aged 40-69 years with doubly labeled water data who participated in the National Cancer Institute–sponsored Observing Protein and Energy Nutrition study (OPEN). The original purpose of the OPEN study, completed in 2000, was to assess self-reported dietary measurement error by comparing results from self-reported dietary intake questionnaires with objective biomarkers: doubly labeled water and urinary nitrogen.

Photo credit:©Olga Lyubkin/Fotolia.com

The researchers used doubly labeled water to measure total energy expenditure, and calculated residual total energy expenditure after adjusting for age, height, and body weight.

Over an average of 107 days, nearly three-quarters of study participants (73%) gained 0.1 kg or more, with 19% gaining 2 kg or more. Men gained more than women (an average of 1.1 kg vs. 0.7 kg).

Men with a baseline body mass index of 30 kg/m2 or more gained an average of 1.5 kg, which was significantly more than men with a baseline BMI of 19-24 (an average of 1.0 kg) or men with a BMI of 25-29 (an average of 0.9 kg). There were no differences in body weight change between BMI categories among women, or between age and sex subgroups.

Mr. Cook also reported that there were no correlations seen between increased body weight and total energy expenditure or between increased body weight and total energy expenditure after the researchers adjusted for age and body size. Residual total energy expenditure above or below the average for body size ranged from –877 to 1,813 calories per day, with a median of –36 calories per day.

The findings suggest that interventions targeting the winter holiday quarter to prevent excess body weight gain in older men and women should focus mainly on diet, although increased activity levels should be encouraged for health reasons, the researchers said.

The study was funded by the National Cancer Institute Intramural Research Program. Mr. Cook said that he had no relevant financial conflicts to disclose.

SAN DIEGO – Low adherence to the Dietary Approaches to Stop Hypertension diet, including increased intake of dietary sodium and sweetened beverages, predicted vascular dysfunction and insulin resistance among a cohort of healthy black women, regardless of body weight.

Although the reason for the association remains unclear, genetic susceptibility and lifestyle factors may play a role, Dr. Priscilla E. Pemu said in an interview during a poster session at the annual meeting of the Obesity Society. Endorsed by the National Institutes of Health, the principles of the DASH diet are based on a low-sodium eating plan rich in fruits and vegetables, along with low-fat or nonfat dairy products (www.dashdiet.org).

"One of the main components of the DASH diet is intake of low-fat dairy products," said Dr. Pemu, an internist at Morehouse School of Medicine, Atlanta. In the black population, "there tends to be avoidance of dairy products because of lactose intolerance. Offering people alternatives – things they can tolerate – would be important in this population."

Dr. Pemu and her associates enrolled 52 healthy, normotensive, lean and obese black women (aged 18-45 years) in an effort to determine the contribution of dietary factors to vascular dysfunction. The women completed the Willett Food Frequency Questionnaire, and blood was collected for measurement of endothelial progenitor cells, C-reactive protein, adiponectin, tumor necrosis factor–alpha, and insulin resistance by homeostasis model assessment (HOMA), in which a level of 2.2 or greater was defined as insulin resistance.

The researchers also used high-frequency ultrasound to measure flow-mediated dilatation and nitroglycerine-dependent dilatation.

Study participants had less adherence to a DASH-type diet, compared with a reference population from the Nurses’ Health Study (Arch. Intern. Med. 2008;168:713-20), as evidenced by lower mean dietary intake of fruits per day (1.27 vs 2.19*, respectively), as well as a significantly higher mean daily intake of sodium (2,360 mg vs. 2,070 mg) and number of daily servings of sweetened beverages (2.33 vs. 0.26).

Lower DASH adherence scores among the study participants were associated with worse nitroglycerine-dependent dilatation, a correlation that was unaffected by age, blood pressure, or body mass index, Dr. Pemu reported.

Low DASH adherence scores, including higher intake of sodium and sugar-sweetened beverages, also predicted insulin resistance as measured by HOMA.

Based on these findings, Dr. Pemu recommends that black women "increase the amount of fruits and vegetables that they consume, as well as nuts, legumes, and low-fat dairy products, because we are starting to see a relationship with vascular dysfunction even in the absence of cardiovascular disease."

Dr. Pemu, who is also director of clinical trials at the clinical research center at Morehouse, acknowledged certain limitations of the study, including its small sample size and the potential for error in the self-reported food frequency questionnaires. "However, our data compared favorably with a much larger data set in the Nurses’ Health Study, giving us confidence in the relationships we have identified."

The study was supported by grants from the National Center for Research Resources. Dr. Pemu said that she had no relevant financial disclosures.

* CORRECTION, 1/4/2011: The original version of this article misstated the reference population's mean dietary intake of fruits and vegetables per day. This group consumed a mean of 2.19 servings of fruits and vegetables per day. This version has been updated. 

SAN DIEGO – Low adherence to the Dietary Approaches to Stop Hypertension diet, including increased intake of dietary sodium and sweetened beverages, predicted vascular dysfunction and insulin resistance among a cohort of healthy black women, regardless of body weight.

Although the reason for the association remains unclear, genetic susceptibility and lifestyle factors may play a role, Dr. Priscilla E. Pemu said in an interview during a poster session at the annual meeting of the Obesity Society. Endorsed by the National Institutes of Health, the principles of the DASH diet are based on a low-sodium eating plan rich in fruits and vegetables, along with low-fat or nonfat dairy products (www.dashdiet.org).

"One of the main components of the DASH diet is intake of low-fat dairy products," said Dr. Pemu, an internist at Morehouse School of Medicine, Atlanta. In the black population, "there tends to be avoidance of dairy products because of lactose intolerance. Offering people alternatives – things they can tolerate – would be important in this population."

Dr. Pemu and her associates enrolled 52 healthy, normotensive, lean and obese black women (aged 18-45 years) in an effort to determine the contribution of dietary factors to vascular dysfunction. The women completed the Willett Food Frequency Questionnaire, and blood was collected for measurement of endothelial progenitor cells, C-reactive protein, adiponectin, tumor necrosis factor–alpha, and insulin resistance by homeostasis model assessment (HOMA), in which a level of 2.2 or greater was defined as insulin resistance.

The researchers also used high-frequency ultrasound to measure flow-mediated dilatation and nitroglycerine-dependent dilatation.

Study participants had less adherence to a DASH-type diet, compared with a reference population from the Nurses’ Health Study (Arch. Intern. Med. 2008;168:713-20), as evidenced by lower mean dietary intake of fruits per day (1.27 vs 2.19*, respectively), as well as a significantly higher mean daily intake of sodium (2,360 mg vs. 2,070 mg) and number of daily servings of sweetened beverages (2.33 vs. 0.26).

Lower DASH adherence scores among the study participants were associated with worse nitroglycerine-dependent dilatation, a correlation that was unaffected by age, blood pressure, or body mass index, Dr. Pemu reported.

Low DASH adherence scores, including higher intake of sodium and sugar-sweetened beverages, also predicted insulin resistance as measured by HOMA.

Based on these findings, Dr. Pemu recommends that black women "increase the amount of fruits and vegetables that they consume, as well as nuts, legumes, and low-fat dairy products, because we are starting to see a relationship with vascular dysfunction even in the absence of cardiovascular disease."

Dr. Pemu, who is also director of clinical trials at the clinical research center at Morehouse, acknowledged certain limitations of the study, including its small sample size and the potential for error in the self-reported food frequency questionnaires. "However, our data compared favorably with a much larger data set in the Nurses’ Health Study, giving us confidence in the relationships we have identified."

The study was supported by grants from the National Center for Research Resources. Dr. Pemu said that she had no relevant financial disclosures.

* CORRECTION, 1/4/2011: The original version of this article misstated the reference population's mean dietary intake of fruits and vegetables per day. This group consumed a mean of 2.19 servings of fruits and vegetables per day. This version has been updated. 

SAN DIEGO – Low adherence to the Dietary Approaches to Stop Hypertension diet, including increased intake of dietary sodium and sweetened beverages, predicted vascular dysfunction and insulin resistance among a cohort of healthy black women, regardless of body weight.

Although the reason for the association remains unclear, genetic susceptibility and lifestyle factors may play a role, Dr. Priscilla E. Pemu said in an interview during a poster session at the annual meeting of the Obesity Society. Endorsed by the National Institutes of Health, the principles of the DASH diet are based on a low-sodium eating plan rich in fruits and vegetables, along with low-fat or nonfat dairy products (www.dashdiet.org).

"One of the main components of the DASH diet is intake of low-fat dairy products," said Dr. Pemu, an internist at Morehouse School of Medicine, Atlanta. In the black population, "there tends to be avoidance of dairy products because of lactose intolerance. Offering people alternatives – things they can tolerate – would be important in this population."

Dr. Pemu and her associates enrolled 52 healthy, normotensive, lean and obese black women (aged 18-45 years) in an effort to determine the contribution of dietary factors to vascular dysfunction. The women completed the Willett Food Frequency Questionnaire, and blood was collected for measurement of endothelial progenitor cells, C-reactive protein, adiponectin, tumor necrosis factor–alpha, and insulin resistance by homeostasis model assessment (HOMA), in which a level of 2.2 or greater was defined as insulin resistance.

The researchers also used high-frequency ultrasound to measure flow-mediated dilatation and nitroglycerine-dependent dilatation.

Study participants had less adherence to a DASH-type diet, compared with a reference population from the Nurses’ Health Study (Arch. Intern. Med. 2008;168:713-20), as evidenced by lower mean dietary intake of fruits per day (1.27 vs 2.19*, respectively), as well as a significantly higher mean daily intake of sodium (2,360 mg vs. 2,070 mg) and number of daily servings of sweetened beverages (2.33 vs. 0.26).

Lower DASH adherence scores among the study participants were associated with worse nitroglycerine-dependent dilatation, a correlation that was unaffected by age, blood pressure, or body mass index, Dr. Pemu reported.

Low DASH adherence scores, including higher intake of sodium and sugar-sweetened beverages, also predicted insulin resistance as measured by HOMA.

Based on these findings, Dr. Pemu recommends that black women "increase the amount of fruits and vegetables that they consume, as well as nuts, legumes, and low-fat dairy products, because we are starting to see a relationship with vascular dysfunction even in the absence of cardiovascular disease."

Dr. Pemu, who is also director of clinical trials at the clinical research center at Morehouse, acknowledged certain limitations of the study, including its small sample size and the potential for error in the self-reported food frequency questionnaires. "However, our data compared favorably with a much larger data set in the Nurses’ Health Study, giving us confidence in the relationships we have identified."

The study was supported by grants from the National Center for Research Resources. Dr. Pemu said that she had no relevant financial disclosures.

* CORRECTION, 1/4/2011: The original version of this article misstated the reference population's mean dietary intake of fruits and vegetables per day. This group consumed a mean of 2.19 servings of fruits and vegetables per day. This version has been updated.