Objective: To provide overall and central obesity incidence estimates by gender, age and educational level in an urban Portuguese population. Methods: As part of the EPIPorto study, 1,621 Porto, Portugal adult residents were evaluated in 1999–2003 and 2005–2008. Overall obesity was defined by a BMI >=30.0 kg/m2 and central obesity by a WC >88.0 cm in women and >102.0 cm in men. Relative risks (RR) and 95% con!dence intervals (95% CI) were computed using Poisson regression. Survival analysis was also performed. Results: The age-adjusted incidence rates/100 person-years of overall and central obesity were, respectively, 1.70, 95% CI: 1.34–2.19 and 5.97, 95% CI: 5.09–7.03 in women; 1.08, 95% CI: 0.73–1.64 and 2.38, 95% CI: 1.81–3.20 in men. In multivariate analysis, older women presented a higher risk of overall obesity. Moreover, a significant inverse association was found between obesity and education in women (>11 vs. <5 years: RR=0.43, 95% CI: 0.22–0.84, for overall obesity; RR=0.45 95% CI: 0.29–0.69, for central obesity). For overall obesity, 10.1% of women and 5.1% of men became obese during the 5-year study period. Higher proportions were observed regarding central obesity, 29.1% and 11.4% for women and men, respectively. Conclusions: Over time...

OBJETIVO: Descrever a prevalência de sobrepeso, obesidade e obesidade abdominal em nipo-brasileiros residentes na cidade de Bauru (SP), Brasil. MÉTODOS: Os dados foram obtidos a partir de um estudo transversal com 1 330 nipo-brasileiros de 1ª e 2ª geração, de ambos os sexos, com idade >30 anos. Os critérios para sobrepeso e obesidade foram índice de massa corporal entre 25-29,9kg/m² e >30kg/m², respectivamente. A obesidade abdominal foi classificada com valores de circunferência da cintura >90cm, para homens, e >80cm para mulheres. Foram calculadas as prevalências de sobrepeso, obesidade e obesidade abdominal por ponto e por intervalo, com 95% de confiança. RESULTADOS: Verificou-se que a prevalência de sobrepeso em nipo-brasileiros foi de 26,1% e 27,9% na primeira geração e de 44,8% e 32,5% na segunda geração, respectivamente, para homens e mulheres. Em relação à obesidade, a prevalência entre homens foi de 3,7% e 12%, e nas mulheres de 6,6% e 9,9% respectivamente na primeira e na segunda geração. Observou-se aumento na prevalência de sobrepeso e obesidade nos homens entre as gerações, apesar de as diferenças não serem estatisticamente significantes. A obesidade abdominal nos homens de primeira e segunda geração foi de 32...

Introdução: A obesidade abdominal associa-se ao risco para diabetes mellitus tipo 2 (DM) e doença cardiovascular (DCV). Entre os fatores associados à obesidade abdominal, destaca-se o importante papel da dieta. Objetivo: O presente estudo investigou a associação entre fatores dietéticos e adiposidade em nipo-brasileiros de Bauru, Estado de São Paulo. Métodos: Para o presente estudo, 772 participantes (329 homens e 443 mulheres) com idade entre 30-92 anos foram analisados em inquérito transversal de base populacional. Um questionário quantitativo de freqüência alimentar validado para essa população foi empregado para avaliar a dieta habitual. Índice de massa corporal (IMC, em kg/m2) e circunferência de cintura (CC, em cm) foram classificados de acordo com critérios da Organização Mundial de Saúde para a população asiática (obesidade geral IMC >= 25kg/m2; obesidade abdominal CC >= 90 cm para homens e >= 80 cm para mulheres). Modelos de regressão logística múltiplos foram utilizados na comparação entre o menor e o maior tercil de consumo alimentar em relação ao risco associado para obesidade abdominal, obesidade geral ou obesidade geral com obesidade abdominal, após ajuste para co-variáveis sócio-demográficas...

Obesity is a serious health problem in developed countries. Knowledge of reliable and nationwide representative data is a must for any public health action. The dimension of this problem in Portugal was first assessed in 1995–1998. A similar populational survey using objective anthropometric measures is now being conducted (field work started in January 2003). A total of 6411 subjects aged 18– 64 years old have already been measured and their respective body mass indexes (BMIs) calculated. Results from 2003 to 2005 show 38.6% is overweight and 13.8% has obesity. The total of overweight and obesity is 52.4%. In 1995–1998 survey, overweight was 35.2% and obesity was 14.4%. The total was 49.6%. These results suggest an increase of the overweight/obesity (altogether) prevalence in the last 10 years. Actual results show that more than half of the adult sample has excessive weight and 2.4% of the sample has low BMI. Finally, 45.6% of the sample suffers increased health risks because of high waist circumference ( ≥ 80 cm for women; ≥ 94 cm for men). These results highlight the fact that, although obesity was identified as a public health problem one decade ago, action to reduce it does not seem to have been very effective to date.

Obesity is a resilient and complex chronic disease. One potential causative factor in the obesity syndrome is leptin resistance. Leptin behaves as a potent anorexic and energy-enhancing hormone in most young or lean animals, but its effects are diminished or lacking in the obese state associated with a normal genetic background. Emerging evidence suggests that leptin resistance predisposes the animal to exacerbated diet-induced obesity (DIO). Elevation of central leptin in young, lean rats induces a leptin resistance that precludes obesity on a chow diet but accelerates high-fat (HF)-induced obesity. Similarly, chronic dietary fructose consumption evokes a leptin resistance that causes obesity only upon HF exposure. Inherent central leptin insensitivity also contributes to dietary weight gain in certain obesity-prone rats. Conversely, aged, leptin-resistant animals are obese with continuous chow feeding and demonstrate aggravated obesity when challenged with an HF diet. Additionally, a submaximal central blockade with a leptin antagonist leads to obesity on both chow and HF diets, as is the case in rodents with leptin receptor deficiency of genetic origin. Despite the differences in the incidence of obesity on a chow diet, all of these forms of leptin resistance predispose rodents to aggravated HF-mediated obesity. Moreover...

This dissertation examines methods used to evaluate the cost-effectiveness of childhood obesity interventions in order to help decision-makers prioritize among competing health programs using standardized outcomes. Chapter 1 generates inputs for use in cost-effectiveness analyses (CEAs) of childhood obesity interventions. In Chapter 1.1, I use data from the Medical Expenditure Panel Survey to predict expenditures associated with obesity in childhood and adolescence. I found that obese children and adolescents have significantly different expenditures than their normal weight counterparts. I conclude that exclusion of obesity-related medical expenditures can potentially undervalue the cost-effectiveness of interventions. In Chapter 1.2, I use data from the Study of Early Child Care and Youth Development to examine the longitudinal trajectory of child weight. I derived probabilities of transitioning between weight classes that can be used in a decision-analytic model to extrapolate the effectiveness of childhood obesity interventions beyond childhood. I found that deviating from CDC BMI reference categories can more accurately capture the risk of future obesity. In Chapter 2, I evaluate the cost-effectiveness of a primary care-based obesity prevention program...

Objectives: Prevention of obesity should start as early as possible after birth. We aimed to build clinically useful equations estimating the risk of later obesity in newborns, as a first step towards focused early prevention against the global obesity epidemic. Methods: We analyzed the lifetime Northern Finland Birth Cohort 1986 (NFBC1986) (N = 4,032) to draw predictive equations for childhood and adolescent obesity from traditional risk factors (parental BMI, birth weight, maternal gestational weight gain, behaviour and social indicators), and a genetic score built from 39 BMI/obesity-associated polymorphisms. We performed validation analyses in a retrospective cohort of 1,503 Italian children and in a prospective cohort of 1,032 U.S. children. Results: In the NFBC1986, the cumulative accuracy of traditional risk factors predicting childhood obesity, adolescent obesity, and childhood obesity persistent into adolescence was good: AUROC = 0·78[0·74–0.82], 0·75[0·71–0·79] and 0·85[0·80–0·90] respectively (all p<0·001). Adding the genetic score produced discrimination improvements ≤1%. The NFBC1986 equation for childhood obesity remained acceptably accurate when applied to the Italian and the U.S. cohort (AUROC = 0·70[0·63–0·77] and 0·73[0·67–0·80] respectively) and the two additional equations for childhood obesity newly drawn from the Italian and the U.S. datasets showed good accuracy in respective cohorts (AUROC = 0·74[0·69–0·79] and 0·79[0·73–0·84]) (all p<0·001). The three equations for childhood obesity were converted into simple Excel risk calculators for potential clinical use. Conclusion: This study provides the first example of handy tools for predicting childhood obesity in newborns by means of easily recorded information...

Background: Overweight and obesity prevalence are commonly used for public and policy communication of the extent of the obesity epidemic, yet comparable estimates of trends in overweight and obesity prevalence by country are not available. Methods: We estimated trends between 1980 and 2008 in overweight and obesity prevalence and their uncertainty for adults 20 years of age and older in 199 countries and territories. Data were from a previous study, which used a Bayesian hierarchical model to estimate mean body mass index (BMI) based on published and unpublished health examination surveys and epidemiologic studies. Here, we used the estimated mean BMIs in a regression model to predict overweight and obesity prevalence by age, country, year, and sex. The uncertainty of the estimates included both those of the Bayesian hierarchical model and the uncertainty due to cross-walking from mean BMI to overweight and obesity prevalence. Results: The global age-standardized prevalence of obesity nearly doubled from 6.4% (95% uncertainty interval 5.7-7.2%) in 1980 to 12.0% (11.5-12.5%) in 2008. Half of this rise occurred in the 20 years between 1980 and 2000, and half occurred in the 8 years between 2000 and 2008. The age-standardized prevalence of overweight increased from 24.6% (22.7-26.7%) to 34.4% (33.2-35.5%) during the same 28-year period. In 2008...

Obesity is a chronic disease and epidemic, and the elderly, little is known about its prevalence and associated factors. The aim of this study was to estimate the prevalence of obesity and abdominal obesity and associated factors in elderly verify. It is cross-sectional study with multistage sampling, with the elderly (≥ 60 years) who attended the 12 months preceding the research network of primary health / SUS, Goiânia-GO. After training, standardization of interviewers and evaluators and pilot study was initiated to collect data. We applied a questionnaire containing demographic, socioeconomic, lifestyle, food consumption and health. Was collected anthropometric measurements: weight, height and waist circumference. Obesity was defined by body mass index (BMI> 27 kg/m²) and abdominal obesity by WC ≥ 102 cm for men and ≥ 88cm for women. We conducted hierarchical multiple Poisson regression with a significance level of 5%. The prevalence of obesity as measured by BMI, was 49.0% and 51.1% in women and 45.1% in men (p= 0.254). Obesity was associated with age at ages 60 and 69 (PR= 1.87) and 70 to 79 (PR= 1.87), diabetes (PR= 1.40), myocardial infarction (AMI) (PR= 1.60) and musculoskeletal disorders (PR= 1.25), inadequate consumption of whole grains (PR = 1.70) and adequate fruit (PR= 1.28). The prevalence of abdominal obesity was 65.5% in women and 34.8% in men (p<0.001). The association analysis was performed separately by sex. Among men was associated with: age 70 to 74 years (PR= 2.00)...

Directly caused by long-term imbalance in energy intake and energy expenditure, obesity and overweight are conditions of excess body fat bringing with them a range of adverse health effects. What is less well understood is their intimate connection with the action of the hormone insulin in the body, a hormone which promotes the use of ingested glucose as a primary fuel source and blocks the metabolism of stored fat. In a large number of people, genetic pre-disposition and/ or the presence of overweight leads to insulin resistance, where higher levels of the hormone are required for the same blood glucose regulating effect - a state that is highly conducive to weight gain. Indigenous populations, among them Indigenous Australian people, have a greater incidence of insulin resistance, and exposed to some elements typical of Western lifestyle, are at greater risk of developing overweight and obesity. Generally, overweight and obesity are defined in relation to the body mass index, or BMI. The BMI is a weight-for-height ratio with categories based on increasing health risk. Its universal suitability, particularly as regards muscular individuals and different ethnic groups, is contested. Generally, Aboriginal people will have a higher proportion of body fat...

This cross-sectional study aimed to examine the association between different body composition measures, menstrual cycle characteristics, and hormonal factors in a population-based sample of young women. The study sample included 726 Australian women aged 26–36 years who were not currently taking hormonal contraceptives and were not currently pregnant or breast feeding. Anthropometric measures included BMI, waist circumference (WC), and waist–hip ratio (WHR). Menstrual cycle characteristics were self-reported and usual cycles defined as short (less than or equal to 25 days), normal (26–34 days), or long (greater than or equal to 35 days). Cycles were defined as irregular if there were greater than or equal to 15 days between the longest and shortest cycle in the past 12 months. Fasting serum levels of sex hormone-binding globulin (SHBG), testosterone, insulin, and glucose were measured and the free androgen index (FAI) derived. Compared with those of normal weight, obese women had at least a twofold greater odds of having an irregular cycle, whether defined by BMI (odds ratio (OR) = 2.61; 95% CI = 1.28–5.35), WC (OR 2.28; 95% CI = 1.16–4.49), or WHR (OR = 2.27; 95% CI = 1.09–4.72). Body composition measures were significantly positively associated with fasting insulin...

The issue of overweight and obesity in childhood has received a great deal of recent attention in both the academic literature and popular media. These discussions have tended to concentrate on individual responses to behavioural and nutritional choices, with limited exploration of how the wider social and economic environment might influence weight outcomes. However there is a growing body of research which has identified area level effects on health outcomes, and this suggests that location should be an important consideration in obesity research. Currently, very little formal investigation of weight status has been conducted among children of preschool age and location is not routinely considered in obesity research, especially at the small area level and particularly with reference to children. Given that childhood overweight is known to persist into adulthood and that behavioural change may be easier to effect in preschoolers, it is appropriate to focus research attention on this age group. This study explores an administrative data set containing over 120 000 individual records collected over ten years and supplied by the South Australian Children, Youth and Women‟s Health Service. Geographical Information Systems (GIS) are used to determine the prevalence...

This thesis investigates the complexity in the relationship between obesity and asthma and asthma morbidity. Previous epidemiological studies exploring these relationships have been limited by sample bias and the use of restricted phenotypes of body mass index (BMI) and self-reported asthma, ignoring the problem of undiagnosed asthma, and more pathogenic central obesity phenotypes. Cardiovascular disease (CVD), a systemic manifestation of obesity may be augmented by asthma-related airway inflammation, yet studies inconsistently identifying an association with asthma have failed to assess the role of asthma phenotype or cardiotoxic effects of short acting beta-2 adrenergic agonists (SABA). Understanding the consequences of this complexity is fundamental to the development of appropriate policy and intervention. The North West Adelaide Health Study, a representative biomedical population sample (n=4006) permitted an examination of the role of phenotype in the association of obesity [body mass index (BMI), waist circumference, waist to hip ratio] with asthma [atopy, significant bronchodilator reversibility (SBR)]. Optimising the identification of asthma in the absence of a gold standard test is important. The prevalence of undiagnosed asthma (SBR in absence of doctor diagnosis) was variable (1.6% to 4.5%) depending on the SBR criteria specified. The observed symptom burden and lung function impairments suggest that all criteria identified subjects with probable asthma. SBR criteria were associated with different sociodemographic factors and the 9% of the predicted criterion was least biased particularly in terms of age and sex. Generalised (BMI) and central obesity were associated with asthma in females only. After consideration of atopic status...

BACKGROUND Polycystic ovary syndrome (PCOS) is closely associated with obesity but the prevalence of obesity varies between published studies. The objective of this research was to describe the prevalence of overweight, obesity and central obesity in women with and without PCOS and to assess the confounding effect of ethnicity, geographic regions and the diagnostic criteria of PCOS on the prevalence. METHODS MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL) and PSYCINFO were searched for studies reporting the prevalence of overweight, obesity or central obesity in women with and without PCOS. Data were presented as prevalence (%) and risk ratio (RR) [95% confidence interval (CI)]. Random-effect models were used to calculate pooled RR. RESULTS This systematic review included 106 studies while the meta-analysis included 35 studies (15129 women). Women with PCOS had increased prevalence of overweight [RR (95% CI): 1.95 (1.52, 2.50)], obesity [2.77 (1.88, 4.10)] and central obesity [1.73 (1.31, 2.30)] compared with women without PCOS. The Caucasian women with PCOS had a greater increase in obesity prevalence than the Asian women with PCOS compared with women without PCOS [10.79 (5.36, 21.70) versus 2.31 (1.33...

OBJECTIVE: Controlled evaluations are subject to uncertainty regarding their replication in the real world, particularly around systems of service provision. Using routinely collected data, we undertook a risk adjusted cost-effectiveness (RAC-E) analysis of alternative applied models of primary health care for the management of obese adult patients. Models were based on the reported level of involvement of practice nurses (registered or enrolled nurses working in general practice) in the provision of clinical-based activities. DESIGN AND METHODS: Linked, routinely collected clinical data describing clinical outcomes (weight, BMI, and obesity-related complications) and resource use (primary care, pharmaceutical, and hospital resource use) were collected. Potential confounders were controlled for using propensity weighted regression analyses. RESULTS: Relative to low level involvement of practice nurses in the provision of clinical-based activities to obese patients, high level involvement was associated with lower costs and better outcomes (more patients losing weight, and larger mean reductions in BMI). Excluding hospital costs, high level practice nurse involvement was associated with slightly higher costs. Incrementally, the high level model gets one additional obese patient to lose weight at an additional cost of $6...

Obesity in children has increased rapidly in Western countries over the past three decades. Childhood obesity is a major public health issue because it contributes to immediate health and psychosocial problems in children, as well as increased risk of adult obesity and associated chronic disease, and restricted life opportunities. Obesity represents an inequality in health as, in Western countries, it is now most common in the most disadvantaged groups. However, it is not clear how the prevalence of childhood obesity has come to be socially patterned. A relatively small body of literature provides theoretical insights as to what might be occurring in families of low socio-economic status (SES) to increase the likelihood of childhood obesity. From recurrent organising explanations, three were selected for investigation: food-related parenting beliefs and practices; parental work patterns; and gender roles within families. Each of these domains is shaped by broader ideologies and structural arrangements. Briefly, it is argued that contemporary parenting beliefs and practices may lead parents to oblige children’s food requests, even when not in the child’s nutritional interests. Furthermore, parents may lack the ability to negotiate with children around food or to be firm when denying requests for unhealthy food. These parenting beliefs and practices may be most common in low SES families. Secondly...

Atrial fibrillation (AF) is the most prevalent arrhythmia affecting humans. The identification of risk factors for AF has ushered a risk factor based approach for management. Obesity is a highly prevalent and novel risk factor for AF with a potential for reversibility. The epidemiological link between obesity and AF has been established in population based studies; however the atrial substrate remains to be fully characterized. Furthermore, mechanism and degree of reversibility with weight reduction has not been described. This thesis evaluates the various aspects of endocardial and epicardial atrial remodeling with sustained obesity and the underlying mechanisms in an ovine model. It also examines the endocardial atrial remodeling with obesity in humans and its relationship with epicardial adipose tissue. In addition, the reversal of obesity related atrial substrate with weight reduction has been characterized in a sustained obesity ovine model. Chapter 2 examines the endocardial electrophysiological remodeling with sustained obesity in an ovine model. Sustained obesity was associated bi-atrial slow and heterogeneous atrial conduction with increased fractionation and greater vulnerability for AF. There is no significant alteration in endocardial atrial refractoriness. Although there was no difference in mean voltage there was increased voltage heterogeneity. Obesity was associated with overexpression of pro-fibrotic TGFβ1 and increased atrial fibrosis. Infiltration of the epicardial atrial musculature by the contiguous fat was seen and this could represent a unique substrate for AF in obesity. Chapter 3 describes the reversal of the obesity related atrial substrate with weight reduction in an ovine model. Sustained obesity was associated with bi-atrial epicardial slow and heterogeneous conduction...

OBJECTIVE: The purpose of this study was to determine whether cyclooxygenase inhibition improves vascular dysfunction of adipose microvessels from obese humans. DESIGN AND METHODS: In 20 obese subjects (age 37 ± 12 years, BMI 47 ± 8 kg/m²), subcutaneous and visceral fat were collected during bariatric surgery and characterized for adipose depot-specific gene expression, endothelial cell phenotype, and microvascular function. Vasomotor function was assessed in response to endothelium-dependent agonists using videomicroscopy of small arterioles from fat. RESULTS: Arterioles from visceral fat exhibited impaired endothelium-dependent, acetylcholine-mediated vasodilation, compared to the subcutaneous depot (P < 0.001). Expression of mRNA transcripts relevant to the cyclooxygenase pathway was upregulated in visceral compared to subcutaneous fat. Pharmacological inhibition of cyclooxygenase with indomethacin improved endothelium-dependent vasodilator function of arterioles from visceral fat by twofold (P = 0.01), whereas indomethacin had no effect in the subcutaneous depot. Indomethacin increased activation via serine-1177 phosphorylation of endothelial nitric oxide synthase in response to acetylcholine in endothelial cells from visceral fat. Inhibition of endothelial nitric oxide synthase with N(ω)-nitro-L-arginine methyl ester abrogated the effects of cyclooxygenase-inhibition suggesting that vascular actions of indomethacin were related to increased nitric oxide bioavailability. CONCLUSIONS: Our findings suggest that cyclooxygenase-mediated vasoconstrictor prostanoids partly contribute to endothelial dysfunction of visceral adipose arterioles in human obesity.; Melissa G. Farb...

Contexte: L'obésité chez les jeunes représente aujourd’hui un problème de santé publique à l’échelle mondiale. Afin d’identifier des cibles potentielles pour des stratégies populationnelles de prévention, les liens entre les caractéristiques du voisinage, l’obésité chez les jeunes et les habitudes de vie font de plus en plus l’objet d’études. Cependant, la recherche à ce jour comporte plusieurs incohérences. But: L’objectif général de cette thèse est d’étudier la contribution de différentes caractéristiques du voisinage relativement à l’obésité chez les jeunes et les habitudes de vie qui y sont associées. Les objectifs spécifiques consistent à: 1) Examiner les associations entre la présence de différents commerces d’alimentation dans les voisinages résidentiels et scolaires des enfants et leurs habitudes alimentaires; 2) Examiner comment l’exposition à certaines caractéristiques du voisinage résidentiel détermine l’obésité au niveau familial (chez le jeune, la mère et le père), ainsi que l’obésité individuelle pour chaque membre de la famille; 3) Identifier des combinaisons de facteurs de risque individuels, familiaux et du voisinage résidentiel qui prédisent le mieux l’obésité chez les jeunes...

The prevalence of obesity is a growing problem worldwide. Such scenario urges for additional efforts in both investment on prevention and research relating to the identification of risk factors that may aid early intervention. It is widely accepted that obesity is a complex multifactorial and heterogeneous condition with an important genetic component in the susceptibility risk. Therefore, the identification of associated gene variants could be essential in the design of prevention strategies and management of individuals genetically predisposed to obesity. In 2007, it was identified the first single nucleotide polymorphism (SNP) located in the FTO gene (rs9939609) associated with obesity by genome-wide association studies (GWAS). Until now, more than 52 genetic loci have been unequivocally associated with obesity related-traits in several European populations. However, none of these studies was performed before in a sample of Portuguese population. The main aims of this study were i) to estimate the prevalence of obesity in 6-12 years old children from the central region of Portugal; ii) to investigate whether 14 previously described SNPs in obesity-related genes are associated with the risk of obesity in Portuguese children; iii) to identify MC4R gene mutations in children with morbid obesity (BMI ≥99th) that could justify this phenotype. Anthropometric parameters such as weight...