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Biomedical subjects

R R Wing

Publications and source records attributed to R R Wing.

At least 73 records · Page 4Linked to original sources
PubMed1998

Weight-loss induced changes in plasma factor VII coagulant activity and relation to the factor VII Arg/Gln353 polymorphism in moderately obese adults.

Elevated plasma factor VII coagulant activity (factor VIIc) may be an independent risk factor for coronary heart disease. Several cross-sectional studies suggest that a polymorphism of the factor VII gene (Arg-Gln353) interacts with plasma triglyceride level in determining factor VIIc, but prospective data are lacking. Factor VII genotype, factor VIIc, and triglyceride level were measured in moderately obese adults aged 25 to 45 who underwent a six-month clinical trial to evaluate strategies for weight loss. A total of 48 men and 50 women who experienced substantial weight loss (mean: 10 kg) provided samples for genetic analysis. Overall, 78% of participants were homozygous for the Arg353 allele, while the remaining 22% were heterozygous (Arg/Gln353). At the baseline examination, heterozygotes had lower mean factor VIIc than Arg353 homozygotes (92% vs. 112%; p<0.001), and genotype explained 18% of the variance of factor VIIc. Average six-month weight loss was similar in both genotypes; mean reductions in factor VIIc following weight loss were greatest among Arg353 homozygotes with high initial values (> 120%). Cross-sectional and longitudinal associations between plasma factor VIIc and triglyceride level were not dependent on genotype. These data confirm that the Gln353 allele is associated with lower factor VII coagulant activity in moderately obese adults, but they do not support the hypothesis that the Arg-Gln353 polymorphism interacts with plasma triglyceride level in determining factor VIIc.

Adult↗
PubMed1998

Maintenance of cardiovascular risk factor changes among middle-aged women in a lifestyle intervention trial.

The Women's Healthy Lifestyle Project is a 5-year randomized clinical testing whether a behavioral intervention aimed at lifestyle changes in diet and physical activity can prevent the rise in weight and low-density lipoprotein cholesterol (LDL-c) observed during menopause. Cardiovascular risk factor and behavioral data from 489 participants (intervention group n = 236; control group n = 253) who attended baseline, 6-month, and 18-month clinical assessments were analyzed to determine how well initial improvements achieved at 6 months were maintained over the subsequent year of follow-up. Results indicated that the treatment effect persisted at 18 months for weight, body mass index, total cholesterol, LDL-c, systolic blood pressure (SBP), and glucose levels. Intervention participants maintained improvements in physical activity, caloric intake, dietary cholesterol, SBP, and glucose levels between 6 and 18 months, although weight, total cholesterol, and LDL-c began to rise during this period. Eighty percent of intervention participants compared to 45% of controls were at or under baseline weight at 18 months, suggesting that promoting modest weight loss may be an effective approach to preventing weight gain in these women.

Adult↗
PubMed1997

A dietary and behavioral intervention designed to lower coronary heart disease. Risk factors are unaffected by variation at the APOE gene locus.

Variation at the apolipoprotein E (APOE) gene locus has demonstrated a consistent impact on lipoprotein levels. APOE typing was performed for 488 healthy, caucasian, premenopausal women participating in the Women's Healthy Lifestyle Project (WHLP) aimed at reducing total fat, saturated fat and cholesterol intake and promoting physical activity. Women in both the intervention and control groups were included in the trial. The purpose of the present study was to determine whether the magnitude of the changes in total cholesterol (Tc), low density lipoprotein cholesterol (LDLc) and high density lipoprotein cholesterol (HDLc) due to the dietary intervention were dependent on the variation in APOE. Weight, body mass index (BMI), and lipoprotein levels were measured at baseline and at a 6 month follow-up. ANOVA was used to determine whether the change in Tc and LDLc was dependent on dietary intervention and variation at APOE levels. The levels of Tc and LDLc were higher in women with the APOE*4 genotype. There were no statistically significant effects of APOE genotype and changes in Tc and LDLc (P > 0.1). Adjusted Tc and LDLc changes were comparable in the 3 APOE subgroups (Tc = -14.3, -12.9 and -11.7 mg/dl; LDLc = -12.1, -10.7 and -10.7 mg/dl, respectively as above). In conclusion, the genetic (APOE) background of premenopausal women in this study did not have a significant effect on their response to dietary intervention.

Apolipoproteins E↗
PubMed1997

Prospective study of the determinants of age at menopause.

The authors prospectively studied the effect of demographic, reproductive, stress-related, and health behavior factors measured at study entry on age of natural menopause in 185 healthy US women. At study entry, women were 42.5-47.5 years old and premenopausal. After a baseline examination (1983-1985), women were followed for 7-9 years, during which time they reported on a monthly basis their menstrual status and whether they were taking hormones. Menopausal age was defined as age at the last menstrual period prior to stopping menstruation for 12 months (and not taking hormones). Estimated median age at menopause was 51.5 years for the whole sample. Median age at menopause was earlier for women who reported irregular menstrual cycles at study entry (50.2 years), were African-American (49.3 years), were smokers (50.6 years), or were currently on a weight reduction diet (50.5 years). Psychosocial stress was predictive of an even earlier median age at menopause in African Americans (48.4 years) and in those with irregular cycles at baseline (49.4 years). Results suggest that premenopausal women in their forties who are experiencing irregular menstrual cycles, are smokers, are dieting, or are African-American are likely to reach menopause earlier than their contemporaries. African-American women may have a different "biological clock" than white women, especially when under stress, or they may experience more stress of longer duration.

Adult↗
PubMed1997

The psychological consequences of weight gain prevention in healthy, premenopausal women.

OBJECTIVE: This study examined the psychological consequences of a modest weight loss in a sample of healthy women aged 44 to 50. METHOD: Five hundred and thirty-five women, with body mass indices (BMIs) ranging from 20 to 34, were randomly assigned either to an intensive behavioral lifestyle intervention or to a no-treatment control group. Women in the lifestyle intervention received weight loss goals of 5 to 15 lb, depending on baseline BMI, and attended 20 weekly group meetings during which they received information on lowering dietary fat intake and increasing physical activity levels. Psychological measures administered at baseline and at a 6-month examination assessed perceived stress, mood, dietary restraint, and binge eating behaviors. RESULTS: Intervention subjects showed significant decreases in depressive symptoms over time, relative to control subjects, and this effect was observed for normal-weight, as well as heavier, subjects. Binge eating scores for all subjects declined significantly over time, with heavier subjects in the intervention showing the greatest decrease in scores. DISCUSSION: The current study found no evidence of negative psychological sequelae of participation in a behavioral lifestyle change program, regardless of weight status. Results further suggest that participation in these types of programs may exert a positive influence on the psychological status of both normal-weight and heavier women.

Adult↗
PubMed1997

Insulin sensitivity as a predictor of weight regain.

A recent study found that increases in insulin sensitivity following weight loss and stabilization were strongly related to subsequent weight regain. The present paper analyzed this relationship in two behavioral weight-loss programs. In the first study, 125 nondiabetic subjects were followed over 30 months; weight losses averaged 10 kg at six months, and subjects had regained 8 kg of their weight loss by their 30-month follow-up. Neither fasting insulin levels at six months nor changes in fasting insulin from zero to six months were related to subsequent weight regain. Similarly, insulin levels measured two hours after a 75 g glucose load were unrelated to subsequent weight regain. The second study followed 33 individuals with Type II diabetes, treated with behavior modification, and either a low calorie diet or a very low calorie diet. Weight losses averaged 18 kg at six months, and subjects had regained 10 kg by their 24-month follow-up. The Bergman minimal model was used to assess insulin sensitivity at 6-month intervals. Initial analyses suggested that changes in insulin sensitivity from zero to six months were related to subsequent weight regain, but this effect was strongly influenced by an outlier. After removing this individual, there were no significant relationships between the changes in insulin sensitivity that accompanied weight loss and future weight regain. Likewise, insulin sensitivity at 12 months did not predict weight regain from 12 to 24 months. These data do not support the hypothesis that increases in insulin sensitivity with weight loss are associated with subsequent weight regain.

Adult↗
PubMed1997

Management of obesity in primary care.

Obesity is one of the most common presenting chronic medical conditions in primary care, yet it is not adequately treated. Physicians are often reluctant to counsel patients because of their limited training in treating chronic weight problems and negative attitudes toward obese patients. This study evaluated the feasibility of training physicians to provide weight control counseling to their patients. Eleven physicians were randomly assigned to either an obesity-counseling skills training group or to a control group. Physicians in the counseling skills group received training in behavioral and motivational weight control techniques using a five-step patient-centered model; they were also given patient materials for use in their practice. To evaluate pretraining to posttraining changes in physician counseling behavior, independent samples of patients with obesity were surveyed immediately after their visit to the physician's office. Physicians in both the counseling skills training and the control groups discussed weight with 42% to 47% of their patients at baseline. This increased to 89% in physicians who received training, whereas it remained at 42% in control physicians. Scores on a counseling measure also significantly increased from a mean of 2.7 to 9.9 in the counseling group, whereas scores in the control group remained low and stable (2.3 and 1.9, respectively). The training program was effective in improving the frequency and quality of counseling that physicians delivered to their patients with obesity. Future research is needed to evaluate the effect of physician counseling on the weight and physical activity level of their patients.

Adult↗
PubMed1997

Trp64Arg substitution in the beta 3-adrenergic receptor does not relate to body weight in healthy, premenopausal women.

OBJECTIVE: To examine the contribution of the substitution of arginine for tryptophan at amino acid position 64 (Trp64Arg) of the beta 3-adrenergic receptor to body weight and weight-related factors in healthy, premenopausal women. SUBJECTS: Five hundred and five healthy, premenopausal women 44-50 y, body mass index (BMI) 20-40 kg/m2. MEASUREMENTS: Subjects were genotyped for the Trp64Arg substitution using restriction fragment length polymorphism (RFLP) analysis. Measurements for weight and weight-related factors (for example, weight, waist-hip ratio, lipid levels) were also taken. RESULTS: Two women were homozygous Arg/Arg, 75 women were heterozygous Trp/Arg, and 428 women were homozygous Trp/Trp. The frequency of the Arg substitution was 0.078. When subjects with and without the arginine substitution were compared, no significant differences were found on measures of weight or weight-related risk factors. CONCLUSION: The results confirm previous studies suggesting that the Trp64Arg substitution of the beta 3-adrenergic receptor is not related to weight or weight-related phenotypes in healthy, premenopausal women.

Alleles↗
PubMed1997

A descriptive study of individuals successful at long-term maintenance of substantial weight loss.

The National Weight Control Registry (NWCR) is, to the best of our knowledge, the largest study of individuals successful at long-term maintenance of weight loss. Despite extensive histories of overweight, the 629 women and 155 men in the registry lost an average of 30 kg and maintained a required minimum weight loss of 13.6 kg for 5 y. A little over one-half of the sample lost weight through formal programs; the remainder lost weight on their own. Both groups reported having used both diet and exercise to lose weight and nearly 77% of the sample reported that a triggering event had preceded their successful weight loss. Mean (+/-SD) current consumption reported by registry members was 5778 +/- 2200 kJ/d, with 24 +/- 9% of energy from fat, Members also appear to be highly active: they reported expending approximately 11830 kJ/wk through physical activity. Surprisingly, 42% of the sample reported that maintaining their weight loss was less difficult than losing weight. Nearly all registry members indicated that weight loss led to improvements in their level of energy, physical mobility, general mood, self-confidence, and physical health. In summary, the NWCR identified a large sample of individuals who were highly successful at maintaining weight loss. Future prospective studies will determine variables that predict continued maintenance of weight loss.

Adult↗
PubMed1997

The effects of health beliefs on weight loss in individuals at high risk for NIDDM.

OBJECTIVE: To determine whether perceived risk and other health beliefs held by individuals at high risk for developing NIDDM predict weight loss and behavior change during a behavioral weight loss program to reduce the risk of NIDDM. RESEARCH DESIGN AND METHODS: Health beliefs and objective risk factors for diabetes were examined in 154 overweight men and women with a family history of NIDDM. The effects of these factors on adherence, dietary intake, weight loss, and changes in glucose levels were examined in a subset of 79 of these subjects who participated in a 2-year behavioral weight control program. RESULTS: Those subjects who perceived themselves at highest risk of developing diabetes had a stronger family history of the disease and were more likely to be women than subjects considering themselves at more moderate risk. These participants also rated diabetes as a more serious disease, but were less likely to believe that weight loss would lower their risk. None of these health beliefs were related to attendance at meetings, dietary intake, weight loss, or fasting glucose, but higher perceived seriousness predicted larger reductions in BMI at 1 year. Of the objective risk factors for NIDDM, higher baseline BMI predicted larger weight losses throughout the program, and a stronger family history of diabetes was related to greater weight regain after an initial weight loss. CONCLUSIONS: Perceived risk of developing diabetes and other health beliefs did not predict performance in a behavioral weight loss program. These data suggest that efforts to modify health beliefs by educating high-risk individuals about their risk and benefits of weight loss may not be effective in improving long-term weight loss results.

Adult↗
PubMed1996

Prior to use of estrogen replacement therapy, are users healthier than nonusers?

Observational studies have demonstrated that women who have used postmenopausal estrogen replacement therapy (ERT) are at reduced risk of coronary heart disease. The authors examined whether premenopausal women who subsequently elected to use ERT during menopause had a better cardiovascular risk factor profile prior to use than did nonusers. A total of 541 premenopausal women had their cardiovascular risk factors and psychosocial characteristics evaluated at study entry. After approximately 8 years, 355 women had become postmenopausal, and 157 women reported ERT use during the follow-up period (mean = 93.4 months). The authors compared the premenopausal characteristics of users with those of nonusers. Relative to nonusers, ERT users were better educated (63 vs. 81% with at least some college), and prior to the use of ERT had higher levels of high density lipoprotein (HDL) cholesterol (1.49 vs. 1.59 mmol/liter), HDL2 (0.50 vs. 0.57 mmol/liter), HDL3 (0.98 vs. 1.02 mmol/liter), leisure physical activity (5, 122 vs. 7,158 Kjoules), and alcohol intake (7.5 vs. 9.7 g/day), and lower levels of apolipoprotein B (0.97 vs. 0.90g/liter), systolic blood pressure (112.1 vs. 107.1 mmHg) and diastolic blood pressure (73.8 vs. 71.4 mmHg), weight (68.5 vs. 64.2 kg), and fasting insulin (9.10 vs. 7.66 microU/liter). Prior to use of ERT, in comparison with nonusers, subsequent users reported on standardized questionnaires that they often exhibited Type A behavior, more aware of their feelings, motives, and symptoms, and had more symptoms of stress. Women who elect to use ERT have a better cardiovascular risk factor profile prior to the use of ERT than do women who subsequently do not use this treatment during the menopause, which supports the hypothesis that part of the apparent benefit associated with the use of ERT is due to preexisting characteristics of women who use ERT. This study underscores the widely recognized importance of randomized clinical trials to estimate the direct benefit of postmenopausal ERT for protecting women from cardiovascular disease.

Adult↗
PubMed1996

Effects of a personal trainer and financial incentives on exercise adherence in overweight women in a behavioral weight loss program.

Exercise is important for long-term weight loss, but few studies have examined ways to improve exercise adherence in overweight subjects participating in a behavioral weight loss program. This paper presents two studies, one conducted at the University of Pittsburgh and one at the University of Minnesota, that sought to improve exercise adherence by exerting more direct control over the environmental antecedents and consequences controlling exercise. Study 1 investigated the use of a personal trainer who called participants regularly and met them at their home or office at scheduled times for a walk. Study 2 investigated the effect of a lottery incentive for exercise adherence. In both studies, the effect of these manipulations was examined in the context of a 24-week standard behavioral weight control program with three supervised exercise sessions per week. Neither intervention achieved statistically significant improvements in exercise adherence compared to control conditions, perhaps due in part to the limited statistical power of the studies. Future studies should focus on better understanding the barriers to exercise and designing behavioral interventions that address these barriers.

Adult↗
PubMed1996

Urinary markers of estrogen metabolism 2- and 16 alpha-hydroxylation in premenopausal women.

There is considerable scientific interest in whether measurement of the major estrogen metabolites 2- and 16 alpha-hydroxyestrone will shed light on the role of estrogen in the risk of breast cancer. These have been difficult to measure in large numbers because of the need for radiolabeled tracers, but a new assay is able to utilize spot urine samples. The main objective of this study was to assess the reliability of a newly developed enzyme immunoassay (EIA) for the measurement of 2- and 16 alpha-hydroxyestrone in urine samples collected from a large group of healthy premenopausal women enrolled in a clinical trial A secondary objective was to assess the impact of several factors such as body weight on the urinary estrogen metabolite ratios. The study cohort included 174 women aged 44-50, who were enrolled in the Cardiovascular Risk Factors and Menopause Trial, also referred to as the Women's Healthy Lifestyle Project (WHLP), an ongoing 5-year clinical trial of 535 premenopausal women randomized either to an intensive dietary life-style intervention group or to an assessment-only control group. Measurements of 2- and 16 alpha-hydroxyestrone showed a high intraclass correlation for blind duplicate urine samples (R = 0.94 and R = 0.80), cross-sectionally and over time (R = 0.79 and R = 0.62), in this population of healthy premenopausal women. The intervention diet (of 25% of total calories from fat) did not appear to influence the estrogen metabolite ratio. This new estrogen metabolite EIA demonstrates good reliability and thus may be appropriate for use in large epidemiologic studies of estrogen-related diseases. There was no relation between dietary fat reduction, weight loss, and increased exercise and change in the ratio among premenopausal women in this study.

Adult↗
PubMed1996

Waist to hip ratio and psychosocial factors in adults with insulin-dependent diabetes mellitus: the Pittsburgh Epidemiology of Diabetes Complications study.

The relationship between waist to hip ratio (WHR) and psychosocial factors has seldom been investigated, although both may contribute to cardiovascular risk. Therefore, these variables were examined in adults with insulin-dependent diabetes mellitus ([IDDM] N = 592; mean age, 29 years; mean duration, 20 years), a population at increased risk of developing cardiovascular disease. Moreover, the association between changes in psychosocial factors and change in WHR was considered. After adjusting for body mass index (BMI), WHR in men was correlated with higher levels of depressive symptomatology (r = .19, P < .001), greater anxiety (r = .13, P < .05), less social support (r = -.20, P < .01), and lower type A scores (r = -.25, P < .001). In women, WHR was significantly correlated with higher levels of depressive symptomatology (r = .18, P < .01), greater stress (r = .16, P < .01), and alcohol consumption (r = .12, P < .05). For both sexes, smokers had a significantly greater mean WHR than nonsmokers (P < .01). For men, multiple regression analyses adjusting for BMI and age demonstrated that smoking, lower income, less exercise, and lower type A scores were the most significant variables associated with WHR. In women, the independent predictors of WHR were a history of smoking, lower educational level, and depressive symptomatology. The most significant independent predictors of change in WHR from baseline to 2-year follow-up study were change in weight (men), change in BMI (women), and change in depression scores (both sexes). These results suggest that psychosocial factors may affect cardiovascular disease risk through their influence on body fat distribution, and both may be important in identifying those most at risk for cardiovascular disease in populations with IDDM.

Adult↗
PubMed1996

Weight cycling, psychological health, and binge eating in obese women.

This study examined the relationship between weight cycling and psychological health in 120 obese women. Weight cycling was defined in 2 ways by retrospective self-report: total lifetime weight loss and total number of weight cycles > or = 20 lbs (> or = 9.07 kg). Psychological self-report measures assessed psychiatric symptoms, eating behavior, mood, stress, and perceptions of physical health. Of the 52 associations between weight cycling and psychological parameters, 8 were significant, with the most consistent association being between weight cycling and binge eating. Binge eating was also strongly associated with psychological distress, as found in previous studies. After adjusting for binge eating, however, weight cycling was independently related to only one of the psychological measures: perceived physical health.

Adult↗
PubMed1996

Relationship between weight loss maintenance and changes in serum leptin levels.

Serum leptin concentrations are higher in obese humans than in lean and are decreased by initial weight loss. This study examined the effects of maintenance of weight loss on leptin concentrations and tested whether leptin concentrations at baseline or after initial weight loss are related to the ability to maintain a reduced body weight. Fifty-two overweight women [body mass index (kg/m2) averaging 31.3] were studied before and after a 4 month weight loss program and at 6 month follow-up. Subjects lost 8.1 kg over the 4 month program, and leptin concentrations decreased from 30.1 to 20.4 ng/ml. Initial leptin level per unit body mass index (r = -0.61, p < 0.0001) and weight loss during months 0 to 4 (r = 0.39, p = 0.004) were both significantly associated with initial changes in leptin, and together explained 60% of the variance in change in leptin. Subjects who maintained their weight losses over the 6-month follow-up maintained their reductions in leptin levels; again, weight changes during follow-up were correlated with changes in serum leptin levels (r = 0.41, p = 0.003). There was no evidence that baseline leptin concentration (or leptin/body mass index) or the changes in leptin which accompanied initial weight loss were predictive of subsequent weight regain. Thus, changes in leptin concentration during weight loss track with changes in weight. However, neither baseline concentrations nor initial changes in leptin predict success at weight loss or maintenance.

Adult↗
PubMed1996

A double-blind, placebo-controlled trial of the effect of fluoxetine on dietary intake in overweight women with and without binge-eating disorder.

This study examined mechanisms by which fluoxetine may reduce energy consumption and body weight. Women with binge-eating disorder (BED; n = 38) and age- and weight-matched women without BED (n = 32) monitored their dietary intake and concurrently recorded mood variables on a hand-held computer for 6 d of baseline and for 6 d after being randomly assigned to receive placebo or fluoxetine (60 mg). Fluoxetine reduced eating more than did the placebo on days 4-6 of treatment. The frequency of episodes was not affected, suggesting that fluoxetine affects satiety, not hunger. Fluoxetine did not preferentially reduce carbohydrate intake, did not affect snack consumption as compared with meal consumption, and did not affect negative-mood eating more than positive-mood eating, nor did fluoxetine affect subjects' mood ratings. Benefits of fluoxetine were of approximately equal magnitude for women with and without BED. However, women who reported higher energy consumption at baseline were more responsive to fluoxetine than were women who reported lower energy consumption at baseline, and binge-eating status was associated with greater energy consumption at all time points, including baseline. Fluoxetine affects dietary intake within 4 d of its consumption, and if future research shows that this remains true on repeated applications, this drug may be useful for short periods when difficulty with overeating is anticipated, such as during vacations.

Adult↗