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PubMed2004

Identifying children at high risk for overweight at school entry by weight gain during the first 2 years.

OBJECTIVE: To assess the best anthropometric predictor from birth to 2 years for later overweight, based on recent studies reporting that large infant weight or length gain predicts subsequent overweight. DESIGN: Retrospective cohort study. SETTING: Southern Germany. PARTICIPANTS: German children (n = 4235) aged 5.0 to 6.9 years. MAIN OUTCOME MEASURES: Overweight at school entry was defined according to sex- and age-specific body mass index cutpoints proposed by the International Obesity Task Force. Weight, length, body mass index, and ponderal index differences between birth, 6 months, 12 months, and 24 months of age were compared by receiver operating characteristic curves and predictive values. RESULTS: For all variables, the largest area under the receiver operating characteristic curve was observed with a 24-month follow-up: 0.76 (95% confidence interval [CI], 0.74-0.79) for weight, 0.70 (95% CI, 0.67-0.72) for body mass index, and 0.58 (95% CI, 0.55-0.61) for length gain. The highest Youden index ([sensitivity plus specificity] minus 1) for weight gain from birth to 24 months (41%) was attained for a cutpoint of 9764 g, with a corresponding positive likelihood ratio of 2.39 (95% CI, 2.20-2.59) and positive predictive value of 19% (95% CI, 17%-21%), despite an odds ratio of 5.7 (95% CI, 4.5-7.1). CONCLUSIONS: Weight gain from birth to 24 months was the best overall predictor of later overweight compared with other anthropometric markers and intervals. However, the corresponding poor positive predictive value suggests that only 1 of 5 children with a large weight gain in the first 2 years is overweight at school entry and reflects an insufficient predictability in the general population.

Body Mass Index↗

PubMed1999

The disease burden associated with overweight and obesity.

CONTEXT: Overweight and obesity are increasing dramatically in the United States and most likely contribute substantially to the burden of chronic health conditions. OBJECTIVE: To describe the relationship between weight status and prevalence of health conditions by severity of overweight and obesity in the US population. DESIGN AND SETTING: Nationally representative cross-sectional survey using data from the Third National Health and Nutrition Examination Survey (NHANES III), which was conducted in 2 phases from 1988 to 1994. PARTICIPANTS: A total of 16884 adults, 25 years and older, classified as overweight and obese (body mass index [BMI] > or =25 kg/m2) based on National Institutes of Health recommended guidelines. MAIN OUTCOME MEASURES: Prevalence of type 2 diabetes mellitus, gallbladder disease, coronary heart disease, high blood cholesterol level, high blood pressure, or osteoarthritis. RESULTS: Sixty-three percent of men and 55% of women had a body mass index of 25 kg/m2 or greater. A graded increase in the prevalence ratio (PR) was observed with increasing severity of overweight and obesity for all of the health outcomes except for coronary heart disease in men and high blood cholesterol level in both men and women. With normal-weight individuals as the reference, for individuals with BMIs of at least 40 kg/m2 and who were younger than 55 years, PRs were highest for type 2 diabetes for men (PR, 18.1; 95% confidence interval [CI], 6.7-46.8) and women (PR, 12.9; 95% CI, 5.7-28.1) and gallbladder disease for men (PR, 21.1; 95% CI, 4.1-84.2) and women (PR, 5.2; 95% CI, 2.9-8.9). Prevalence ratios generally were greater in younger than in older adults. The prevalence of having 2 or more health conditions increased with weight status category across all racial and ethnic subgroups. CONCLUSIONS: Based on these results, more than half of all US adults are considered overweight or obese. The prevalence of obesity-related comorbidities emphasizes the need for concerted efforts to prevent and treat obesity rather than just its associated comorbidities.

Adult↗

PubMed1999

Dietary sodium intake and subsequent risk of cardiovascular disease in overweight adults.

CONTEXT: Dietary sodium is positively associated with blood pressure, and ecological and animal studies both have suggested that high dietary sodium intake increases stroke mortality. OBJECTIVE: To examine the risk of cardiovascular disease associated with dietary sodium intake in overweight and nonoverweight persons. DESIGN: Prospective cohort study. SETTING: The first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study, conducted in 1982-1984, 1986, 1987, and 1992. PARTICIPANTS: Of those aged 25 to 74 years when the survey was conducted in 1971 -1975 (14407 participants), a total of 2688 overweight and 6797 nonoverweight persons were included in the analysis. MAIN OUTCOME MEASURES: Dietary sodium and energy intake were estimated at baseline using a single 24-hour dietary recall method. Incidence and mortality data for cardiovascular disease were obtained from medical records and death certificates. RESULTS: For overweight and nonoverweight persons, over an average of 19 years of follow-up, the total number of documented cases were as follows: 680 stroke events (210 fatal), 1727 coronary heart disease events (614 fatal), 895 cardiovascular disease deaths, and 2486 deaths from all causes. Among overweight persons with an average energy intake of 7452 kJ, a 100 mmol higher sodium intake was associated with a 32% increase (relative risk [RR], 1.32; 95% confidence interval [CI], 1.07-1.64; P = .01) in stroke incidence, 89% increase (RR, 1.89; 95% CI, 1.31-2.74; P<.001) in stroke mortality, 44% increase (RR, 1.44; 95% CI, 1.14-1.81; P = .002) in coronary heart disease mortality, 61% increase (RR, 1.61; 95% CI, 1.32-1.96; P<.001) in cardiovascular disease mortality, and 39% increase (RR, 1.39; 95% CI, 1.23-1.58; P<.001) in mortality from all causes. Dietary sodium intake was not significantly associated with cardiovascular disease risk in nonoverweight persons. CONCLUSIONS: Our analysis indicates that high sodium intake is strongly and independently associated with an increased risk of cardiovascular disease and all-cause mortality in overweight persons.

Adult↗

PubMed2005

Mortality in overweight and underweight children with acute myeloid leukemia.

CONTEXT: Current treatment for acute myeloid leukemia (AML) in children cures about half the patients. Of the other half, most succumb to leukemia, but 5% to 15% die of treatment-related complications. Overweight children with AML seem to experience excess life-threatening and fatal toxicity. Nothing is known about how weight affects outcomes in pediatric AML. OBJECTIVE: To compare survival rates in children with AML who at diagnosis are underweight (body mass index [BMI] < or =10th percentile), overweight (BMI > or =95th percentile), or middleweight (BMI = 11th-94th percentiles). DESIGN, SETTING, AND PARTICIPANTS: Retrospective review of BMI and survival in 768 children and young adults aged 1 to 20 years enrolled in Children's Cancer Group-2961, an international cooperative group phase 3 trial for previously untreated AML conducted August 30, 1996, through December 4, 2002. Data were collected through January 9, 2004, with a median follow-up of 31 months (range, 0-78 months). MAIN OUTCOME MEASURES: Hazard ratios (HRs) for survival and treatment-related mortality. RESULTS: Eighty-four of 768 patients (10.9%) were underweight and 114 (14.8%) were overweight. After adjustment for potentially confounding variables of age, race, leukocyte count, cytogenetics, and bone marrow transplantation, compared with middleweight patients, underweight patients were less likely to survive (HR, 1.85; 95% confidence interval [CI], 1.19-2.87; P = .006) and more likely to experience treatment-related mortality (HR, 2.66; 95% CI, 1.38-5.11; P = .003). Similarly, overweight patients were less likely to survive (HR, 1.88; 95% CI, 1.25-2.83; P = .002) and more likely to have treatment-related mortality (HR, 3.49; 95% CI, 1.99-6.10; P<.001) than middleweight patients. Infections incurred during the first 2 courses of chemotherapy caused most treatment-related deaths. CONCLUSION: Treatment-related complications significantly reduce survival in overweight and underweight children with AML.

Adolescent↗

PubMed2000

Family functioning and psychosocial adjustment in overweight youngsters.

OBJECTIVE: To analyze the relationship between family functioning and psychosocial adjustment in Dutch overweight children and adolescents. METHOD: Seventy-three overweight (weight-for-height >P90) and 70 normal-weight youngsters between the ages of 10 and 16 years were recruited by school physicians during routine medical screening. The Family Dimension Scale, the Child Behavior Checklist, the Teacher Report Form, the Self-Perceived Competence Scale, and the Body-Esteem Scale were filled out, as well as a specific weight-related questionnaire. RESULTS: Both parents and teachers report more behavior problems in overweight children, particularly in the younger than 13 age group. Lower body-esteem was found in older overweight girls, whereas in older overweight boys higher levels of body-esteem were found. More significant relationships were found with the weight-related Parental Concern Scale than with the Family Dimension Scale. DISCUSSION: The results suggest that a developmental psychological approach reveals important age and sex differences. Weight-related instruments may be more useful than general questionnaires.

Adolescent↗

PubMedDate not supplied

Growth pattern of overweight preschool children in the Siouxland WIC program.

Demographic, nutritional, and anthropometric data were collected from 134 preschool children enrolled in the Siouxland Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). All children were diagnosed as overweight between the ages of 8 months and 3 years. Weight and length/height z-scores were calculated for birth measurements and for postnatal measurements up to 3 years. The main hypothesis involved stability of weight and length/height z-scores between successive WIC visits. Average changes in z-scores between measurements were calculated and tested for significance using paired t-tests. Multiple regression analysis was used to test relationships between changes in weight z-scores and demographic/nutritional characteristics. The overweight group had a higher percentage of Hispanic children than the total Siouxland WIC population. Overweight children were also significantly different in terms of birthweight, monthly household income, number in the house, and mother's education level. The children displayed a large average increase in weight z-scores between birth and 8 months (P < 0.001). Weight z-scores also increased significantly between 12 and 30 months. Length z-scores increased significantly between 18 and 30 months but remained lower than weight z-scores. Initial weight, sex of child, breastfeeding, and household size were significantly related to changes in weight z-scores among overweight children. Results of recent studies suggest that rapid weight gain in infancy may increase the risk of overweight during later childhood.

Analysis of Variance↗

PubMedDate not supplied

Prevalence of overweight and obesity in 7-9-year-old Portuguese children: trends in body mass index from 1970-2002.

The aim of this study was to assess the prevalence of overweight and obesity in Portuguese children age 7-9 years and to analyze trends in body mass index (BMI) from 1970-2002. Data were collected from October 2002 to June 2003 in a random sample of Portuguese children. Height and weight were measured and BMI (Kg/m(2)) was calculated. The International Obesity TaskForce (IOTF) cutoffs to define overweight and obesity were used. In the total sample we found 20.3% of overweight children and 11.3% of obese children. These results indicate a prevalence of overweight/obesity of 31.5%. Girls presented higher percentages of overweight than boys except at age 7.5. Girls also showed a higher percentages of obesity than boys except at age 9. From 1970 to 1992 and 1992 to 2002, height, weight, and BMI increased at different velocities: weight increased faster than height, and, consequently, BMI increased more in the last period than in the first one, leading to an increase in obesity values. Compared to published data by IOTF on other European countries, who applied the same methods to define overweight and obesity, Portuguese children showed the second-highest mean values in overweight/obesity. Italy showed the highest values (36%). The present study shows a very high prevalence of overweight/obesity (31.5%) in Portuguese children compared to other European countries. Portugal followed the trend of other Mediterranean countries like Spain (30%), Greece (31%), and Italy (36%). These high values require a national intervention program to control childhood obesity.

Body Height↗

PubMed2002

The cumulative impact of being overweight on women's body esteem: a preliminary study.

As much research indicates that a woman's current weight status is an important predictor of her body esteem, we examined the relationship between weight status history (retrospective self-report since the age of 5 years) and current body esteem among 266 female college students, who completed a measure of body esteem and reported whether they had been "underweight", "normal weight", or "overweight" during 3 age ranges. Analysis of variance (ANOVA) was used to examine differences in current body esteem between groups characterised by the following weight history trajectories: "always overweight", "always normal/underweight", "increase in weight over time" and "decrease in weight over time". Although the women in the groups "always overweight" and "increase in weight over time" were currently overweight [according to self-reported body mass index (BMI)], the current body esteem of the former was significantly lower (worse) than that of the latter. We introduce the idea that being overweight for a long period of time has a cumulatve negative impact on adult body esteem.

Adolescent↗

PubMed1990

Effect of weight reduction on hepatic abnormalities in overweight patients.

The effects of weight reduction on hepatic test results and physical findings related to the liver were retrospectively evaluated in 39 overweight patients screened to exclude other factors affecting the liver. An additional 11 overweight patients with primary liver disease were retrospectively evaluated to compare the effect of weight reduction in patients with liver disease with its effect in those without primary liver disease. This study showed that in overweight adults without primary liver disease, a weight reduction of greater than or equal to 10% corrected abnormal hepatic test results, decreased hepatosplenomegaly, and resolved some stigmata of liver disease. In similarly studied overweight patients with primary liver disease, some findings improved, but the changes did not correlate with a greater than or equal to 10% weight loss. Increased alanine aminotransferase activity was the most frequent hepatic enzyme abnormality in this population. For every 1% reduction in body weight, alanine aminotransferase activity improved by 8.1%. After other causes of liver disease are eliminated by clinical and biochemical parameters, weight reduction should be tried for overweight patients with abnormal hepatic test results in the absence of obvious primary liver disease as judged by clinical and biochemical parameters before extensive and expensive studies are undertaken.

Alanine Transaminase↗

PubMed1990

Effects of variety on food intake of underweight, normal-weight and overweight women.

The food intake of 27 underweight, normal-weight and overweight women was monitored during laboratory luncheon meals of solid food units (SFUs), bite-sized spirals of bread with different sandwich fillings. Simultaneous, but not sequential, presentation of three SFU flavors increased intake compared to presentation of a single flavor in normal-weight and overweight women. Neither variety manipulation enhanced intake in the underweight women, who are more than the other subjects in all conditions. The fact that the foods were so similar probably reduced the effectiveness of the variety manipulations. Overweight and normal-weight subjects had different patterns of intake, but only when eating a single flavor of SFU. Only overweight subjects ate less when three flavors of SFUs were hidden from view in the apparatus used to monitor intake. This procedure prevented subjects from selecting particular flavors of SFUs. Differences in cognitive restraint probably do not explain the differences in the eating behavior of normal-weight and overweight subjects in the present study. Lack of dietary restraint or a high level of hunger may account for the different eating behavior of the underweight subjects compared to the other subjects.

Adult↗

PubMed1996

Similar fragmentation and dissolution after extracorporeal shock wave lithotripsy in eutrophic and overweight patients with gallstones.

The aim of this study was to assess the relative importance of overweight and adjuvant treatment with bile acids to obtain fragment dissolution and clearance after biliary extracorporeal shock wave lithotripsy (BESWL), in eutrophic and overweight patients with gallbladder stones. During a 3-year period 103 patients were treated with BESWL. Patients were strictly selected in terms of the number and type of stones. Of the total of 103 patients, 53 were women and 50 men. Mean age was 50.8 +/- 14.3 (range 17 to 86) years. Body mass index was calculated for each patient. All patients underwent BESWL with an electromagnetic device. Medical therapy for stone dissolution included the combination of chenodeoxycholic acid plus ursodeoxycholic acid (50% + 50%), at a total dose of 10-15 mg/day. Of the 103 patients, 45 were eutrophic and 58 were considered overweight. Age was similar in both groups. Number of lithotripsy sessions in eutrophic patients was 1.96 +/- 1.07 and 1.88 +/- 0.84 in overweight patients, but no statistical differences were found. Complete clearance of calculi was observed in more than 50% of the cases after 6 months, and reached 98% after 22 months of therapy in both groups. Total clearance of calculi was similar in patients with single and multiple stones. In conclusion, our results suggest that the time required to obtain complete gallstone clearance after BESWL is similar in eutrophic and overweight patients with gallbladder stones, and also that adjuvant therapy with bile acids plays an important role in gallstone fragment dissolution in these patients.

Adolescent↗

PubMed2006

Frequency of attendance at religious services, overweight, and obesity in American women and men: the Third National Health and Nutrition Examination Survey.

PURPOSE: Few data have been published on the association of overweight and obesity and indices of religiousness, a putative protective factor for cardiovascular morbidity and mortality, in representative samples of multiethnic total populations. METHODS: To test the hypothesis that frequency of attendance at religious services is unrelated to the prevalence of overweight and obesity, the following data from American men and women aged 20 years and older (N = 16,657) in a cross-sectional survey of a large national sample, the Third National Health and Nutrition Examination Survey, were analyzed: self-reported frequency of attendance at religious services, cigarette smoking, health status, sociodemographic variables, and measured body mass index (BMI). RESULTS: In persons 20 years and older, 58% of frequent attenders (> or = 52 times/y) and 53% of others were overweight or obese (BMI > or = 25 kg/m2). After stratifying to eliminate interactions in a logistic regression model and controlling for sociodemographics, smoking, and health status, no significant association was seen in European-American women overall. In all others, the significant positive associations of frequency of attendance and overweight could be explained by these other variables (fully adjusted odds ratio, 1.16; 95% confidence interval, 0.98-1.36; p = 0.08). The same was true for obesity (BMI > or = 30 kg/m2). CONCLUSION: In a national sample of the US population, the prevalence of overweight or obesity is greater in self-reported frequent attenders of religious services than in others, but the association was explained by controlling for multiple sociodemographic and health variables.

Cross-Sectional Studies↗

PubMed2004

Girls at risk for overweight at age 5 are at risk for dietary restraint, disinhibited overeating, weight concerns, and greater weight gain from 5 to 9 years.

OBJECTIVE: The goal of this study was to investigate the emergence of dietary restraint, disinhibited eating, weight concerns, and body dissatisfaction among girls from 5 to 9 years old, and to assess whether girls at risk for overweight at age 5 were at greater risk for the emergence of restraint, disinhibited overeating, weight concerns, and body dissatisfaction. DESIGN: Longitudinal data were used to assess the relationship between weight status and the development of dietary restraint, aspects of disinhibited overeating, weight concern, and body dissatisfaction at ages 5, 7, and 9 years. SUBJECTS: Participants were 153 girls from predominately middle class and exclusively non-Hispanic white families living in central Pennsylvania. Statistical analyses Differences in weight status, dietary restraint, disinhibition, weight concern, and body dissatisfaction between girls at risk (>85th percentile body mass index) or not at risk for overweight at age 5 were assessed using repeated measures analysis of variance at ages 5, 7, and 9 years. RESULTS: Girls who were at risk for overweight at age 5 reported significantly higher levels of restraint, disinhibition, weight concern, and body dissatisfaction by age 9. Girls at risk for overweight at age 5 also showed greater increases in weight status from 5 to 9 years of age. CONCLUSIONS: Higher levels of dietary restraint, weight concern, and body dissatisfaction among young girls at risk for overweight were accompanied by greater weight gain from 5 to 9 years of age, consistent with other recent findings suggesting that youths' attempts at weight control may promote weight gain. Positive alternatives to attempts at dietary restriction are essential to promoting healthful weight status among children, and should include encouraging physical activity, promoting children's acceptance of a variety of low-energy-density foods, and providing guides to appropriate portion sizes.

Analysis of Variance↗

PubMed2004

Risk factors for childhood overweight: a prospective study from birth to 9.5 years.

OBJECTIVES: To ascertain risk factors for the development of overweight in children at 9.5 years of age. STUDY DESIGN: This was a prospective study of 150 children from birth to 9.5 years of age, with assessment of multiple hypothesized risk factors drawn from research reports. RESULTS: Five independent risk factors for childhood overweight were found. The strongest was parent overweight, which was mediated by child temperament. The remaining risk factors were low parent concerns about their child's thinness, persistent child tantrums over food, and less sleep time in childhood. Possible mechanisms by which each of these factors influence weight gain are outlined. Two different pathways to childhood overweight/obesity were found, depending on degree of parental overweight. CONCLUSIONS: There is evidence of considerable interaction between parent and child characteristics in the development of overweight. Several of the identified risk factors are amenable to intervention possibly leading to the development of early prevention programs.

Body Mass Index↗

PubMed2005

Pubertal alterations in growth and body composition: IX. Altered spontaneous secretion and metabolic clearance of growth hormone in overweight youth.

Deconvolution analysis was used to determine 12-hour spontaneous nocturnal growth hormone (GH) secretion and GH half-life in lean (body mass index, <85th percentile; n = 39) and overweight (body mass index, > or =85th percentile; n = 18) youth. The integrated GH concentration, GH burst mass, and half-life were lower (P < .05) in overweight than in lean youth. For each unit increase in percentage of body fat, integrated serum GH concentrations, secretory burst mass, and half-life declined by 83.6 microg/L per minute (r = -0.39, P < .01), 0.22 microg/L (r = -0.28, P < .05), and 0.2 minute (r = -0.38, P < .01), respectively. The effect of overweight on GH secretion was independent of pubertal status. Hierarchical regression models tested the hypothesis that altered GH secretion in youth is more related to total adiposity than abdominal visceral fat. When age, sex, fat-free mass, testosterone, and estradiol were held constant, the sequential addition of abdominal visceral fat did not increase R2 for any GH secretion variable. Sequential addition of percentage of body fat increased R2 (P < .05) for integrated GH concentration, total secretory rate, secretory burst mass, and pulsatile production rate. We conclude that serum GH concentrations are reduced in overweight youth primarily because of reduced GH burst mass with no change in the number of secretory events and secondarily to reduced GH half-life. Based on the model that GH-releasing hormone predominantly increases GH pulse amplitude whereas somatostatin primarily controls GH pulse frequency, these results suggest that overweight in youth diminishes GH-releasing hormone stimulation resulting in truncated GH bursts but does not alter the number of somatostatin withdrawal intervals so that GH burst frequency is conserved.

Abdomen↗

PubMed2004

Hypothalamic neurons of postnatally overfed, overweight rats respond differentially to corticotropin-releasing hormones.

Adult overweight rats previously subjected to early postnatal overnutrition in small litters are hyperphagic, hyperleptinemic and differ in emotional behaviour from rats of control litters. We proved the hypothesis that neurons of the hypothalamic regulatory system of body weight differentially react to peptides of the corticotropin-releasing factor (CRF) family in these overweight rats. Single unit activity was recorded in brain slices. In controls, CRF and the CRF(2) receptor agonist stresscopin-related peptide (SRP) predominantly activated neurons of the dorsomedial part of ventromedial hypothalamic nucleus (VMHDM), but in overweight rats, SRP induced a significant inhibition. Increased neuronal firing to CRF and SRP of the medial parvocellular part of paraventricular hypothalamic nucleus (PaMP) in controls similarly changed to more inhibition in overweight rats. Inhibition of neuronal activity in VMHDM and PaMP can contribute to reduce satiety signals and to decrease energy expenditure in rats. In contrast, medial arcuate (ArcM) neurons of controls were significantly inhibited by SRP, whereas neurons of overweight rats could also be activated. The difference in the expression of these response types was significant. Activation of ArcM neurons known to produce neuropeptide Y can increase food intake. The results are discussed in terms of a trophic action of leptin changing synaptic wiring and the expression of excitatory and inhibitory synapses. The altered responses of hypothalamic neurons in adult small-litter rats may reflect a general mechanism of neurochemical plasticity acquired during the postnatal critical differentiation period, thus leading to permanently altered function of the regulatory system of body weight.

Age Factors↗

PubMed2004

Association of physical activity intensity levels with overweight and obesity in a population-based sample of adults.

BACKGROUND: Clarify the association between physical activity intensity and overweight/obesity. METHODS: Population-based 1997-2001 survey in Geneva, Switzerland (n=5,757, ages 35 to 74). Intensity of physical activity energy expenditure (EE) defined as percentage of total EE in moderate activities [3-3.9 x basal metabolism rate (BMR), e.g., normal walking, household chores] and high-intensity activities (> or =4 x BMR, e.g., brisk walking, sports). Overweight or obesity based on measured body mass index (BMI). RESULTS: Comparing participants in the lowest vs. the highest tertile of the percentage of high-intensity EE, the odds ratios (ORs) were, for obesity vs. normal weight, 2.8 (95% confidence interval: 2.0-3.8, P<0.0001) in men and 2.4 (1.7-3.4, P<0.0001) in women. For obese vs. overweight, the men/women ORs were 1.9 (1.4-2.6, P<0.0001)/1.5 (1.0-2.2, P<0.05). For overweight vs. normal weight, the men/women ORs were 1.4 (1.1-1.7, P<0.002)/1.7 (1.3-2.1, P<0.0001). Less or no relationship was found for the percentage of moderate-intensity EE. CONCLUSIONS: This cross-sectional study cannot determine whether exercise is an effective strategy for weight control or whether overweight or obese people exercise less. However, clear dose-response associations in both genders between obesity or overweight and energy expenditure in high (but not in moderate)-intensity activities are findings with potentially major public health implications meriting validation in an experimental intervention study.

Adult↗

PubMed2002

Dietary patterns predict the development of overweight in women: The Framingham Nutrition Studies.

OBJECTIVE: To investigate relationships between dietary patterns and the development of overweight. DESIGN: Longitudinal analyses during 12 years of follow-up involved the identification of dietary patterns at baseline using cluster analysis applied to a 145-item semiquantitative food frequency questionnaire. SUBJECTS/SETTING: 737 non-overweight women in the Framingham Offspring/Spouse cohort (mean age, 45 years). MAIN OUTCOME MEASURE: Development of overweight (BMI> or =25) at follow-up. STATISTICAL ANALYSES: Relative risks were calculated using Proc Genmod and multivariate models comprehensively considered potential confounders. RESULTS: Five dietary patterns were identified among the cohort at baseline: Heart Healthy, Light Eating, Wine and Moderate Eating, High Fat, and Empty Calorie. Over 12 years, the crude risk of becoming overweight was 29% overall, ranging from 22% of women in the Wine and Moderate Eating cluster to 41% of women in the Empty Calorie cluster. Compared with women who ate a lower-fat, nutritionally varied Heart Healthy diet, women who ate an Empty Calorie diet that was rich in sweets and fats with fewer servings of nutrient-dense fruits, vegetables, and lean food choices were at higher risk for developing overweight [RR 1.4, 95% CI (0.9, 2.2)] after adjusting for age, smoking status, physical activity, menopausal status, energy intake, intentional dieting, and usual weight pattern. Women who ate an Empty Calorie dietary pattern were also younger and were more likely to smoke. CONCLUSIONS: Behavioral interventions for weight management and obesity prevention may be enhanced by creatively targeting differences in eating patterns, dietary quality, and other lifestyle behaviors of distinct subgroups of the population.

Adult↗