Best Weight Loss Programs That Work

The 2 Week Diet

The 2-week diet promises to help you shed as much as 19 pounds of body fat in just 14 days (2 weeks). In addition to this, the diet also promises to help you tone up your muscles, decrease cellulite, and improve energy levels. Once you have started the 2 Week Diet, your body responds quickly, and the pounds will start to drop off. With the 2 Week Diet, you will lose weight, but you will do it in a way that is healthy, and that will last after the weight is gone. So many people know the frustrating cycle of losing a few pounds and gaining it right back. The 2-week diet is well written, easy to follow and very informative. You will like the calculations for calorie consumption to lose weight and also how to maintain your body to your satisfaction.This productGuarantee for weight loss. Read more...

The 2 Week Diet Summary

Rating:

4.8 stars out of 98 votes

Contents: Ebook, Online Program
Author: Brian Flatt
Official Website: www.2weekdiet.com
Price: $37.00

Access Now

My The 2 Week Diet Review

Highly Recommended

All of the information that the author discovered has been compiled into a downloadable pdf so that purchasers of The 2 Week Diet can begin putting the methods it teaches to use as soon as possible.

As a whole, this e-book contains everything you need to know about this subject. I would recommend it as a guide for beginners as well as experts and everyone in between.

Social and Environmental Determinants of Eating Behaviors

Like physical activity, healthy eating comprises a complex set of behaviors that are challenging to measure. A detailed discussion of eating behavior assessment is provided in Chapter 4, but is described briefly here. A key consideration in dietary assessment is that there are many different elements of eating behavior that can be measured, including overall diet, patterns of food intake, consumption of specific foods, dietary habits, and nutrient intakes. It is therefore essential that a clear research question with a well-defined focus is established to assist in the selection of an appropriate assessment tool. Assessments of eating behaviors are generally conducted via self-report and involve

The use of functional foods to meet dietary guidelines

Many consumers struggle to meet dietary recommendations. The United States Department of Agriculture (USDA) reported in 1998 that the average intake of added fats and sugars was too high and the intake of fruits, vegetables, dairy products, lean meats and foods made from unrefined grains was too low compared with serving recommendations.9 Comparable findings in The Netherlands10 and the rest of Europe (supplement 2 to the British Journal of Nutrition 1999, vol. 81) have been reported. Functional foods enriched with vitamins, dietary fibres or specific fatty acids, or foods that are designed to be low in sodium or saturated fat, can therefore make a valuable contribution to our diet, as will be discussed in the following paragraphs. The evidence-based strategies for a reduction in CVD risk have been used as a guide. In the US, vegetable consumption is close to the recommended daily intake but fruit consumption is less than half of the recommended amount.9 In Europe, fruit and vegetable...

Overview of Dietary Assessment in Behavioral Medicine

Nutritional status is one of the most important predictors of health risk. Research consistently demonstrates that diets rich in fruit, vegetables, whole grains, and lean meats from poultry and fish are inversely associated with risk of age-related chronic diseases such as cardiovascular disease, cancer, and diabetes (Kushi et al, 2006 Lampe, 1999 Neuhouser, 2004 Pool-Zobel et al, 1997 Prentice et al, 2004 World Cancer Research Fund AICR, 2007). Conversely, diets high in refined grains and added sugars, but low in diverse plant foods, increase risk for obesity and obesity-related disorders including cardiovascular disease, cancer, and diabetes (Boynton et al, 2007 Kristal et al, 2000 National Research Council Committee on Diet and Health, 1989 Patterson et al, 2004). Despite the strong and consistent diet-disease associations and recommendations to the public to make healthy food choices and limit or avoid added fats, sodium, and empty calorie-type foods, consumers still, for the most...

Eating Behavior Instruments

A class of dietary assessment instruments particularly well suited for behavioral medicine are those focused specifically on eating behaviors (in contrast to absolute intake measures in standard instruments). The development of these dietary behavior instruments was initially motivated by problems with assessing dietary intervention effectiveness, particularly low-fat interventions (Kristal et al, 1990). The fat-related diet habits questionnaire was based on an anthropologic model that described low-fat dietary change as four types (1) avoiding high-fat foods (exclusion) (2) altering available foods to make them lower in fat (modification) (3) using new, specially formulated or processed, lower fat foods instead of their higher fat forms (substitution) and (4) using preparation techniques or food ingredients that replace the common higher fat alternative (replacement) (Shannon et al, 1997). A recently developed mindful eating questionnaire was designed as a cognitive approach for...

Dietary prevention of sudden cardiac death SCD the role of dietary fatty acids alcohol and antioxidants

We now examine whether diet (and more precisely, certain dietary factors) may prevent (or help prevent) SCD in patients with established CHD. We focus our analyses on the effects of the different families of fatty acids, antioxidants and alcohol.2 by about 30 per cent) in patients who had at least two servings of fatty fish per week.3 The authors suggested that the protective effect of fish might be explained by a preventive action on ventricular fibrillation (VF), since no benefit was observed on the incidence of nonfatal acute myocardial infarction (AMI). This hypothesis was consistent with experimental evidence suggesting that n-3 polyunsaturated fatty acids (PUFA), the dominant fatty acids in fish oil and fatty fish, have an important effect on the occurrence of VF in the setting of myocardial ischaemia and reperfusion in various animal models, both in vivo and in vitro.4-5 In the same studies, it was also apparent that saturated fatty acids are proarrhythmic compared with...

Dietary strategies to prevent the development of heart disease

The oxidised LDL theory is not inconsistent with the well-established lipid-lowering treatment of CHD, as there is a positive correlation between plasma levels of LDL and markers of lipid peroxidation93,98 and a low absolute LDL level results in reduced amounts of LDL available for oxidative modification. LDL levels can be lowered by drugs or by reducing saturated fats in the diet. Reduction of the oxidative susceptibility of LDL was reported when replacing dietary fat with carbohydrates. Pharmacological quantitative (lowering of cholesterol) and nutritional qualitative (high antioxidant intake) approaches of the prevention of CHD are not mutually exclusive but additive and complementary. An alternative way to reduce LDL concentrations is to replace saturated fats with polyunsaturated fats in the diet. However, diets high in polyunsaturated fatty acids increase the polyunsaturated fatty acid content of LDL particles and render them more susceptible to oxidation28 which would argue...

Dietary prevention of postangioplasty restenosis

Patients treated with percutaneous transluminal coronary angioplasty (PTCA) have a high (15 to 50 per cent, depending on studies) risk of developing restenosis within the first 6 months after the procedure. At present, with the exception of stents coated with antifibrotic substances113 and probucol (the later with many unacceptable side effects), there is no drug treatment to prevent that complication. On the other hand, a dietary approach with either n-3 fatty acid or folate supplementation has been proposed. It is noteworthy that in these negative trials, patients were treated with quite high doses of n-3 fatty acids, up to 8 g per day,115 and that no previous data did support the use of such doses in the prevention of CHD. In addition, these studies were all performed in patients having had conventional balloon PTCA, and there are no data on patients receiving any type of stent. One major limitation of the dietary approach of the prevention of restenosis is the theoretic...

Dietary control of conventional risk factors cholesterol blood pressure type 2 diabetes and obesity

Cholesterol is a determinant of CHD mortality, and its blood level is at least partly regulated by diet. However, few epidemiological studies have prospec-tively included analyses of the dietary habits of the studied populations in the evaluation of their risk.119 In the Seven Countries Study, marked differences in CHD mortality, dietary habits and cholesterol distribution were observed in the different cohorts.119 Cholesterol levels were high in Northern Europe and in the USA (an average level of 7mmol L), and low in rural Japan (an average of 4mmol L), and population cholesterol levels were positively associated with CHD mortality. Secondary prevention trials with statins in Northern Europe120 and Australia121 confirmed the importance of cholesterol by demonstrating a A major (and often underestimated) finding of the Seven Countries Study was the large difference in absolute risk of CHD death at the same level of serum cholesterol in the different cohorts. At a cholesterol level of...

Conclusion using the Mediterranean diet to prevent coronary heart disease

Despite the increased evidence that dietary prevention is critical in the post-AMI patient, many physicians (and their patients) remain rather poorly informed about the potential of diet to reduce cardiac mortality, the risk of new CHD complications and the need for recurrent hospitalisation and investigation. There are many reasons for that, the main one probably being an insufficient knowledge of nutrition.156 For that reason (and knowing the resistance of many physicians to accept the idea that diet is important in CHD), we propose a minimum dietary programme that every CHD patient, whatever his or her medical and familial environment, should know and follow. This minimum 'Mediterranean' dietary programme has been recently described,157 and should include the following Reduced consumption of animal saturated fat (for instance, by totally excluding butter and cream from the daily diet and drastic reduction of fatty meat) and increased consumption of n-3 fatty acids through increased...

Dietary Restriction and Oxidative Stress in Annual Fish Mutants

Once the mutagenesis is achieved, dietary resistant mutants and oxidative stress resistant mutants could be selected which might suggest genes involved in such a mechanism. For example a paraquat resistance mutant could be selected and then tested for lifespan extension. Similarly, mutants could be fed with a high fat and high nutrient diet which, in contrast to dietary restriction, should shorten the lifespan and the mutants that live under these conditions could be selected. However, these require careful feeding experiments. Likewise, by feeding -3 fatty acids, the mutants that do not prolong the lifespan in the presence of -3 fatty acids could be selected. All these imaginative screens will be feasible once the Nothobranchius model is available as a genetic model.

Project Title Dietary Etilogies Of Heart Disease And Cancer

Summary (Adapted from Investigator's Abstract) The authors propose to continue the follow-up of 51,529 male health professionals, aged 40 to 75 years in 1986, to address a series of dietary hypotheses related to risk of coronary heart disease, stroke, and peripheral vascular disease. Diet has been assessed in 1986, 1990, and 1994 by a semiquantitative food frequency questionnaire developed and refined by the group over the last 15 years. Detailed studies in a subsample of participants demonstrate that this questionnaire performs well the average correlation between the questionnaire and 14 days of diet recording for 16 nutrients of interest was 0.66. This study population has substantial variation in dietary intake, for example, fat intake varies from 25 to 42 of calories between extreme quintiles. Body fat distribution (assessed by waist and hip circumferences) has been measured twice (1987 and 1996) and weight is updated during every 2-year cycle. The first three follow-up cycles...

Project Title Dietary Etiologies Of Heart Disease And Cancer

Summary (provided by applicant) We propose to continue the biennial follow-up of cardiovascular disease among 51,529 male health professionals, age 40 to 75 years in 1986, to address a series of new dietary hypotheses related to risk of a coronary heart disease and stroke. We project over 4,000 incident MI, fatal CHD, and stroke cases through the end of the follow-up period. Nested within this cohort, over 18,000 participants provided blood samples in 1994 from which we propose to investigate several biological (plasma and genetic) determinants of disease. We will concentrate on several hypotheses related to nutritional and genetic determinants of cardiovascular disease (CVD). With this exceptional resource of repeated assessments of diet and lifestyle characteristics tied to potential genetic markers of disease, we will prospectively evaluate in relation to coronary heart disease 1) n-6 fatty acids across a wide range of n-3 fatty acid intake from fish and vegetable sources, 2) foods...

Dietary Fat and Fiber

Much attention has been focused on dietary differences, particularly in fat consumption, to ex Many case-control studies of fat consumption and breast cancer have found only small differences between cases and controls, generally no larger than the differences in total caloric consumption. However, Howe and colleagues68 combined 12 large case-control studies representing populations with a wide range of dietary habits and underlying rates of breast cancer to study the diet-breast cancer relationship. They found that the breast cancer risk of post-menopausal women was positively associated with both total fat intake (RR 1.46 for 100 g day, p 0.0002) and saturated fat intake (RR 1.57 for highest quintile of intake, p < 0.0001). Nonetheless, cohort studies that have examined total fat, saturated fat, or vegetable fat69-72 have found little or no difference in breast cancer risk over a wide range of fat intakes.73 There have been several attempts to demonstrate a reduction in serum...

Body Mass Index and Obesity

Several reviews highlight the growing body of research examining features of the physical and social environments of neighborhoods in relation to body mass index (BMI) (Black and Macinko, 2008 Larson et al, 2009 Papas et al, 2007). For example, a review in 2007 identified 20 studies between 2002 and 2006 investigating associations between the built environments of neighborhoods in relation to BMI (Papas et al, 2007). The majority of these studies (17 out of 20) documented significant associations between an array of built environment measures and BMI. The most consistent associations were between greater walkability and access to recreational resources. There have also been recent studies linking the local retail environment to BMI obesity. The results of this work suggested that poor access to supermarkets was associated with greater BMI (Larson et al, 2009).

Dietary antioxidants and the prevention of CHD epidemiological evidence

A large number of epidemiological studies have evaluated potential relationships between dietary intake of antioxidants and coronary heart disease (CHD). These are summarised in Table 5.1. Among these, the Nurses' Health study,36 included over 87 000 female nurses 34 to 59 years of age, who completed dietary questionnaires that assessed their consumption of a wide range of nutrients, including vitamin E. During follow-up of up to 8 years 552 cases of major coronary disease were documented. As compared with women in the lowest fifth of the cohort with respect to vitamin E intake, those in the top fifth had a relative risk of major coronary disease of 0.66 after adjustment for age and smoking. Further adjustment for a variety of other coronary risk factors and nutrients, including other antioxidants, had little effect on the results. Similarly, the Health Professionals' Follow-up study, among almost 40 000 males of 40-75 years, followed up for four years, showed a lower risk of coronary...

Dietary antioxidants and the prevention of CHD evidence from clinical trials

While most epidemiological studies have demonstrated that dietary intake of vitamin E is inversely related to coronary heart complications, supplementation studies gave conflicting results. Clinical trials with antioxidants have been done in patients with or without previous history of cardiovascular disease (Table 5.2). Surrogate endpoints, such as analysis of atherosclerosis progression, or 'hard' endpoints, such as vascular death and MI, have been used to evaluate the clinical benefits of antioxidant vitamins. The Alpha-Tocopherol-Beta-Carotene-Cancer (ATBC)52 prevention study was a randomized, double-blind, placebo-controlled primary-prevention trial to determine whether daily supplementation with alpha-tocopherol, beta-carotene or both reduced the incidence of lung cancer and other cancers. A total of 29 133 male smokers, 50-69 years of age, were randomly assigned to one of four regimens alpha-tocopherol (50 mg per day) alone, beta-carotene (20 mg per day) alone, both...

Dietary Requirements for Vitamin A

The Food and Nutrition Board of the Institute of Medicine has made new recommendations of vitamin A intake by life stage and gender group (Table 2) (246). These Dietary Reference Intakes (DRIs) are reference values that are quantitative estimates of nutrient intakes to be used for planning and assessing diets in apparently healthy people and include Recommended Dietary Allowances (RDAs), Estimated Average Requirement (EAR), and Adequate Intake (AI) (246). The RDA is defined as the dietary intake level that is sufficient to meet the nutrient requirement of nearly all (97 to 98 percent) healthy individuals in a particular life stage and gender group. The EAR is defined as a nutrient intake that is estimated to meet the requirement of half of the healthy individuals in a life stage and gender group. AI is defined as a recommended intake value based on observed or experimentally determined approximations or estimates of nutrient intake by a group (or groups) of healthy people that are...

Dietary iron intake absorption and metabolism

Although there is no physiological means of iron excretion, a well-balanced diet containing sufficient iron is needed. Only about 10 per cent of ingested iron is absorbed in the gut. Therefore, around 10-20 mg of dietary iron intake is needed to balance the 1 or 2mg of daily losses. The normal amount of total body iron is about 40-50 mg kg body weight. In the body, iron is mainly needed to form the porphyrin complex of haemoglobin (30 mg kg), myoglobin in muscle cells (48 mg kg) and also iron-containing enzymes, such as cytochromes, oxidases and peroxidases. Up to 30 per cent of body iron (12mg kg) may be stored as ferritin and hemosiderin in the bone marrow, spleen and liver. The efficiency of iron absorption is mainly regulated by body requirements to maintain iron homeostasis. Iron deficiency causes an increase in iron absorption, while iron overload reduces but does not eliminate absorption. Fertile women, for example, need to absorb up to 2-5 mg of iron each day to compensate for...

Obesity Susceptibility Genes Food Intake and Energy Expenditure

The identification of the novel obesity susceptibility loci has instigated new studies exploring through which arm of the energy balance, i.e. food intake or energy expenditure, these loci lead to obesity. In particular for the FTO locus, which was discovered as the first obesity susceptibility locus, new insights have begun to accumulate. Some studies have provided evidence for a role of the FTO locus in food intake. For example, two studies in a total of > 8000 British children consistently showed that the BMI-increasing allele of the FTO locus was associated with increased energy intake, independent of body size (Cecil et al, 2008 Timpson et al, 2008). A third study in 3337 children showed that homozygotes for the FTO risk allele had a significantly reduced satiety responsiveness score (Wardle et al, 2008). This observation was confirmed in a smaller study of 131 children with careful registration of the children's consumption of palatable food presented after having eaten a meal...

Genetic Prediction of Obesity and Diabetes

In a recent study (Willer et al, 2009), the predictive value of eight validated obesity susceptibility loci (TMEM18, KCTD15, SH2B1, MTCH2, NEGR1, GNPDA2, FTO and MC4R) on obesity risk was examined in 14,409 men and women of the population-based EPIC-Norfolk cohort. A genetic predisposition score for each individual, summing the number of BMI-increasing alleles, was calculated. The average BMI of individuals carrying 13 or more risk alleles (< 2 of the population) was 1.46 kg m-2 (or 3.7-4.7 kg in body weight) higher compared to those carrying three or fewer risk alleles (< 2 of the population). However, together, the eight variants explained less than 1 of the variation in BMI and had very limited power in prediction of obesity, contributing only 2-3 to the prediction on top of classical clinical predictors such as age and gender.

Gene Environment Interactions in Obesity and Diabetes

Susceptibility to obesity and diabetes is determined by both genetic and lifestyle factors. Suggestive evidence of gene-lifestyle interaction (Box 33.3) in the development of common diseases such as obesity and type 2 diabetes was first provided by descriptive epidemiological studies such as migration studies that compare the disease risk between genetically related populations who live different lifestyles. A classical example is the comparison of the risk of obesity and type 2 diabetes between Pima Indians living in the obesogenic environment of Arizona (69 of whom are obese and 55 have type 2 diabetes) and those living in the restrictive environment of the remote Mexican Sierra Madre Mountains (13 of whom are obese with only 6 having type 2 diabetes) (Esparza et al, 2000 Ravussin et al, 1994). These findings illustrate that despite a similar genetic predisposition, different lifestyles result in different prevalences of obesity and type 2 diabetes.

Dietary strategies for preventing the onset of diabetes

The different natures of the two types of diabetes requires diverse dietary strategies in order to prevent their onset. For type 1 diabetes, while the exact causes are still being investigated, it is acknowledged that various environmental factors increase the risk of diabetes in genetically susceptible subjects. If these factors can be identified, there could be a good chance of decreasing the incidence of the disease. Other dietary factors being investigated include the active form of vitamin D,5 which is thought to help prevent the development of autoimmune diabetes and gluten since studies have shown that islet cell antibodies may disappear after a gluten-free diet in celiac patients.6'7 However, time is needed before an answer on the efficacy of these dietary intervention trials is known. There are various risk factors for developing type 2 diabetes. One of the primary ones being obesity as defined by a body mass index of over 30 (Table 7.1). Other risk factors include increased...

Dietary strategies for the control of diabetes carbohydrates and lipids

According to the American Diabetes Association, the goals of medical nutritional therapy for diabetes are to prevent and treat complications such as cardiovascular disease, hypertension, nephropathy, obesity and dislipidaemia, and include Attention should be paid to the daily energy requirement of children with type 1 diabetes, as they might lose weight at the onset of the disease. The weight-height charts used by paediatricians are useful to measure the adequacy of the energy intake. For adult type 1 diabetic patients, the daily energy requirement is not different from that of a normal individual. In this case it is also advisable to keep a desirable lean weight throughout life. However, for type 2 diabetes, since it usually occurs in overweight people, weight loss and behavioural changes are to be stressed.

Obesity a major public health threat

Obesity is broadly defined as a condition in which body fat stores have increased to the extent that health may be adversely affected. Obesity is associated with substantially increased mortality from cardiovascular and cerebrovascular disease, diabetes and certain cancers (Kopelman, 2000) (Figure 22.1). It also results in morbidity from musculoskeletal, gastrointestinal, psychiatric and reproductive diseases and is associated with lowered quality of life, self-esteem and socioeconomic performance (Kopelman, 2000). The precise measurement of body fat is quite challenging and accurate methods are not applicable to large populations, therefore, surrogates such as the Body Mass Index (BMI) (weight in kilograms divided by the square of the height in metres) are most often used in population studies and in the clinic. The World Health Organization has defined obesity as a BMI exceeding 30 kg m2. Using this definition, currently at least 20 of the population of the USA and most Western...

Is genetics important in determining susceptibility to human obesity

The recent and relatively rapid rise in the prevalence of obesity occurring over a timescale which would make conventional evolutionary explanations implausible has, understandably, led some to question the importance of genetics in the etiology of obesity. There are some obvious candidates for the causation of secular changes in obesity prevalence including the increased availability of palatable energy dense foods and the reduced requirement for physical exertion during working and domestic life. It is therefore timely to review the evidence for inherited determinants of obesity and related intermediate traits. We will focus on data from twin and adoption studies as these are the most powerful tools to address this question.

Why look for human obesity genes

The discovery of human obesity genes will undoubtedly lead to health benefits. Firstly some obesity syndromes are very severe, occur at a young age and are associated with other developmental and clinical manifestations. It is clear that knowledge of the underlying genetic defect in these syndromes will be of considerable clinical benefit in terms of recognising other treatable aspects of the particular syndrome and providing more informed genetic counseling. As illustrated by congenital leptin deficiency (see below) the precise identification of some of these syndromes may turn out to have therapeutic relevance. Thirdly, and most speculatively, it is possible that by recognizing common genetic variants which predispose to obesity through different mechanisms, we can classify obese subjects into subgroups

Methodological issues in the hunt for human obesity genes

Obesity is defined as an excess of body fat, which can be measured directly using dual energy X-ray absorptiometry and isotopic dilution techniques. However, these are costly and their limited availability makes it difficult to perform such measurements in large numbers of subjects. In some studies fat mass has been measured indirectly using bioelectrical impedance or skin-fold thickness both of which correlate reasonably well within the normal range but less so in the very lean or the obese. The most commonly used marker of adiposity is BMI (weight in kg height in m2) which is a measure of heaviness that can be performed in large epidemiological studies and correlates reasonably well with body fat content. Body fat distribution provides an additional risk that is not given by simply the amount of body fat. Abdominal fat mass, for example, can vary significantly within a narrow range of total body fat or BMI. Furthermore, within a given BMI, men have on average twice the amount of...

Obesity as a disease state or adiposity as a continuous variable

Obesity as a clinical condition is currently defined as an excess accumulation of adipose tissue resulting in a BMI greater than 30kg m2. While the diagnosis of obesity by this criterion has clinical relevance with regards to intervention, management, and treatment, from an epidemiological perspective, it may hamper the study of the genetics underlying variation in body fat mass and distribution. For example, BMI exhibits a normal distribution with no clear division between the ''clinically obese'' (BMI > 30) and the non-obese. Such a pattern of continuous distribution is not restricted to merely BMI but is found in all obesity-related phenotypes, including anthropo-metric measures (e.g. skin folds, and waist circumference), measures of body composition (e.g. percentage body fat, fat mass), and associated biochemical markers (e.g. leptin). Therefore the division of individuals into ''obese'' versus ''non-obese'' categories has a certain degree of arbitrariness that does not appear...

Monogenic disorders leading to human obesity

It is well established that obesity runs in families, although the vast majority of cases do not segregate with a clear Mendelian pattern of inheritance. There are about 30 Mendelian disorders with obesity as a clinical feature but often associated with mental retardation, dysmorphic features and organ-specific developmental abnormalities (i.e. pleiotropic syndromes). A number of families with these rare pleiotropic obesity syndromes have been studied by linkage analysis and the chromosomal loci for obesity syndromes are known. For a comprehensive list of syndromes in which obesity is a recognized part of the phenotype, see Online Mendelian Inheritance in Man (OMIM), www.ncbi.nlm.nih.gov omim .

Novel human monogenic obesity syndromes

In the past eight years several human disorders of energy balance that arise from genetic defects have been described. All of these are in molecules identical or similar to those known to cause obesity in genetic and experimental syndromes of obesity in rodents (Leibel et al., 1997) and all have been identified using a candidate gene approach (Figure 22.2). These mutations all result in morbid obesity in childhood without the developmental pleiotropic features characteristic of the recognized syndromes of childhood obesity.

Germfree Animals And Dietary Requirements

Contrary to what is generally believed, germ-free animals require a higher dietary caloric intake than their conventional counterparts. The main reason is very simple. A normal microbiota will break down indigestible dietary substances to compounds that can be absorbed by the host. That is most prominent in ruminants, i.e., the microbiota digest cellulose into short chain fatty acids (SCFAs). In many germ-free macroorganisms, there might be a demand for an increased dietary intake of some vitamins. Broadly speaking, the gastrointestinal microbiota, placed between the ingesta and the host, may utilize dietary vitamins or produce vitamins themselves. Among the earliest evidence that the vitamin synthesis is connected to functions by the intestinal microbes was the demonstration that germ-free rats reared without a dietary source of vitamin K developed hemorrhages and hypoprotothrombinemia soon, whereas their conventional controls had normal prothrombin levels and no bleeding tendencies...

Linkage studies in common obesity

The number of genome wide scans conducted in human populations has risen steadily over the last few years. Whilst many of these studies have yielded somewhat equivocal results, often due to limited sample size, there are now several studies showing evidence of linkage (LOD likelihood of odds ratio scores greater than 2.5) and these are discussed in this section. For a comprehensive list of all linkage studies performed see Human Obesity Gene Map (link to www.obesite.chaire.ulaval.ca genemap.html). To date, significant linkage results for obesity-related phenotypes have been published from a wide variety of human populations and importantly several studies have now replicated human obesity quantitative trait loci (QTLs) across different ethnic groups. To this extent there is now an emerging pattern with evidence that several major genes contribute to the variation in obesity related phenotypes in humans. Interestingly, not only are these linkage signals supported by significant LOD...

Association studies in common obesity

To date, association studies have largely been restricted to candidate genes whose dysfunction might reasonably be expected to result in obesity by virtue of their having putative effects on energy intake, energy expenditure or nutrient partitioning. Genome-wide association studies are still in the future. The interpretation of association studies always requires caution because of the possibilities of problems such as population stratification, small sample size and publication bias. Some of these problems are exemplified by a common polymorphism in the b3-adrenergic receptor, where despite over 40 association studies, involving more than 7000 subjects, the findings have been markedly inconsistent (Barsh et al., 2000). While significant and consistent associations have been obtained in large case-control studies for some variants including the insulin VNTR (Le Stunff et al., 2001) and IGF-1 SNPs (Hart et al., 2004), it is true to say that as of now, no single common variant is widely...

Gh Secretion In Abdominal Obesity

With increased adiposity, GH secretion is blunted with a decrease in the mass of GH secreted per burst but without any major impact on GH secretory burst frequency (46). Moreover, the metabolic clearance rate of GH is accelerated (32). The serum insulin-like growth factor (IGF)-1 concentration is primarily GH dependent and influences GH secretion though a negative feed-back system (47). The serum levels of IGF-1 are inversely related to the percentage of body fat (46). In addition, the low serum IGF-1 concentration in obesity is predominantly related to the amount of visceral adipose tissue and not to the amount of subcutaneous fat mass (48). The relationship between regional fat distribution and GH secretion has only recently been considered. No significant correlation was found between the waist-to-hip ratio and 24-h GH secretion rates in a study of 21 healthy men (49). However, measured by computed tomography, the amount of visceral adiposity was a major determinant of stimulated...

Epidemiology of Obesity and the Metabolic Syndrome

Based on measures of BMI, it was reported (National Center for Health Statistics, 2008b Steinberger et al, 2009) that 32.7 of US adults over the age of 20 are overweight (BMI 25.029.9), 34.3 are obese (BMI > 30.0), and 5.9 are extremely obese (BMI > 40.0). Although the prevalence of overweight Americans has remained stable since 1980, the prevalence of obesity in adults has more than doubled during that time period. Among ethnic groups, 45 of non-Hispanic black adults and 36.8 of Mexican Americans were obese, whereas approximately 30 of non-Hispanic white adults were obese. It was also reported that 17.1 of US children and adolescents are overweight a figure that has tripled since 1980 (Ogden et al, 2006). prevalence increases with each decade of life, paralleling age-related increases in obesity and central adiposity and based on National Health and Nutrition Examination Survey (NHANES) data, reaches 50-60 by 60-69 years of age (Cornier et al, 2008). Metabolic syndrome prevalence...

Gh Treatment Of Patients With Abdominal Obesity

As GH promotes lipolysis low levels of GH has therefore been suggested to be of importance for the maintenance of the obese condition. The calorigenic effects of GH in obese subjects has also been known for many years (99). Some trials have therefore addressed the question of whether GH administration through its calorigenic and lipolytic action might enhance weight loss during dietary restriction in obese subjects. Both short-term (100) and several weeks of GH treatment (101,102) in combination with dietary restriction were unable to enhance the loss of body fat or body weight as compared with saline treatment. The GH administration may, however, decrease the loss of lean body mass during dietary restriction (100,102). These results, therefore, suggest that GH is not useful in the induction or enhancement of weight loss in obese subjects. We have learned that GH can improve several of the aberrations that occur both in GH deficiency and Syndrome X. Thus, in GH-deficient adults the...

Dietary Prostate Cancer Risk Factors

There are at least seven major dietary macro- or micronutrients that are under intense scrutiny currently as dietary risk or protective factors (Table 15.1). Prominent among these is dietary fat or some component of fat (e.g., saturated fat), which first received attention as a mechanism to possibly explain the low risk in native Asian populations and the apparent rapid shift in risk upon migration of Asian populations to the United States. There are suggestive data that increased fat consumption is associated with higher circulating testosterone levels, providing a possible mechanism for a fat-prostate cancer relation Antioxidant vitamins and minerals are of great current interest, not only as antiprostate cancer agents but also as anticarcinogenic agents in a broad sense. Antioxidants are potential anticancer agents because they bind free radicals, chemical entities that can damage DNA, create mutations, and lead to malignant transforma-tion.12 Two antioxidants are of special...

Nondietary Prostate Cancer Risk Factors

Although most attention has focused on possible dietary risk or protective factors for prostate cancer as the most likely environmental risk factor category to explain the racial ethnic variation in incidence and the impact of migration on risk modification, other factors have also been evaluated over the past few decades. Among these, cigarette smoking and a history of any type of sexually transmitted disease are among the most reproducible. As there are no highly suspected carcinogens to the prostate found in cigarette smoke or any direct evidence of an infectious etiology of prostate cancer, it has been proposed that both of these risk factors might be indices Obesity and indices of body size have also been of interest in terms of prostate cancer risk. Body mass index and height are of interest mechanistically in terms of both possible impact on steroid hormone levels and possible relationships with insulin-like growth factors (see below, Insulin-like Growth Factor Signaling...

Increased height and weight gain

Birth height and weight of children who later developed type 1 diabetes have been similar to the controls in most of the studies (Virtanen & Knip 2003), although in some studies cases have been longer and weighted more than controls at the time of birth (e.g. Dahlquist et al. 1999). In the only cohort study available, higher birth weight was related to an increased risk of type 1 diabetes (Stene et al. 2001). Increased height gain during childhood seems to be related to greater risk of type 1 diabetes (e.g. Blom et al. 1992 Price et al. 1992). Higher weight gain in infancy is consistently related to greater risk of type 1 diabetes according to case-control evidence (e.g. Baum et al. 1975 Hypponen et al. 1999), whereas the findings on the role of weight gain after infancy are inconsistent (e.g. Blom et al. 1992 Hypponen et al. 2000). Clearly results from cohort studies are awaited to settle the putative importance of height and weight gain in the development of this disease.

Blurring the Distinctions Between Prebiotics Dietary Fibers and Other Fermentable Dietary Carbohydrates in the Colon

The greatest volume of research and evidence for prebiotic effects has been accrued for fructo-oligosaccharides and inulin, but there is accumulating evidence of prebiotic actions by a number of non-digestible carbohydrates. Lactulose and galacto-oligosaccharides have strong claims to be classified as prebiotics, while there is promising evidence for prebiotic activity by isomalto-, xylo-, and soybean-oligosaccharides. There is growing interest in the impact of dietary fibers on the composition as well as the activity of the intestinal microbiota, and resistant starches and arabinoxylans in particular warrant further study for bifidogenic and other prebiotic effects.

Testing Dietary Interventions in Autoimmune Prone Mice to Delay Aging and Age Associated Diseases

Research because CR is the only known experimental regimen to increase life span in all experimental models tested including yeast, nematodes, flies, and rodents (Jolly, 2004). The models examined are not malnourished because the CR diets have enriched vitamin and mineral content to compensate for the decreased food intake. CR is also potent at delaying the onset of diseases like autoimmune disease and certain types of cancer. Therefore, it appears that CR may be a dietary regimen that not only increases life span by altering the biological process of aging, but also improves the quality of life by decreasing the severity of age-related diseases. The primary immune cell studied examining the impact of CR feeding on immune function in aging and age-associated disease has focused on the T cell. The main reason for this is that the T cell is critical in determining both the type and extent of an immune response. Two of the most consistent effects of CR on aged T cell function in rodents...

Health Functional and Therapeutic Implications of Obesity in Aging

Body weight generally increases from puberty through middle life. Some of this is due to muscle gain in the early years, but mostly it is fat. When weight gain is excessive, there is increased morbidity and mortality from diabetes, vascular disease, other chronic diseases, and malignancy. Although the prevalence of obesity is increasing, prognosis from associated chronic diseases is also improving. The consequence is that increasing proportions of the population reach old age and are either overweight or obese, or they become so in later life. The relationship between obesity and risk of death in later years of life is less clearcut than in younger subjects. There are no evidence-based guidelines for desirable body weight or managing obesity in the elderly. We do not really know how to measure obesity meaningfully in this age group. In fact, low body weight or weight loss appears to be a much more significant determinant of health in older subjects. However, obesity is associated with...

Epidemiology of Obesity and Aging

The prevalence of obesity in human populations increased markedly in the last four decades of the second millennium. On average, body weight increases throughout adult life up to the age of about 60 years. Most of the increase in weight with aging is due to fat accumulation in several depots in the body. After the age of 60, average body weight begins to decline and by the age of 80 the prevalence of obesity is only about a third of that at age 60. The factors responsible for the decline in body weight with age are complex and incompletely understood. They include loss of muscle (sarcopenia), due in part to decreased activity and the endocrine changes that accompany aging. There is also an element of selection since obesity increases risk of conditions, including cardiovascular diseases and cancer, which shorten life. Furthermore, there is a well-established association between calorie restriction and longevity. Influences on the body weight of aging cohorts are multiple and need to...

Dietary sources and intake levels of flavonoids

Only a few of the thousands of different flavonoids identified in plants are present in considerable amounts in the human diet, and the intake of these dietary flavonoids varies among countries and cultures (Table 9.1) The dihydrochalcone phloretin and its glycoside phloridzin are found in large amounts in apple, but no estimates of intake levels have been reported. The flavanones are present mainly in citrus fruits, predominated by naringin (the glycoside of naringenin), responsible for the bitter taste of grapefruit, and hesperidin (the glycoside of hesperetin) found in oranges. Since the intake of orange juice is extensive in many Western countries, e.g. Denmark and Finland, the intake of in particular the citrus flavanone hesperetin is very high (Kumpulainen et al., 1999 Justesen et al., 2000). Table 9.1 Dietary sources and intake of flavonoids Major dietary

Dietary prevention of chronic heart failure CHF the role of micronutrients dietary fatty acids and reduced sodium intake

The vital importance of micronutrients for health and the fact that several micronutrients have antioxidant properties are now fully recognised. These may be as direct antioxidants, such as vitamins C and E, or as components of antioxidant enzymes superoxide dismutase or glutathione peroxidase.56 It is now widely believed (but still not causally demonstrated) that diet-derived antioxidants may play a role in the development (and thus in the prevention) of CHF. For instance, clinical and experimental studies have suggested that CHF may be associated with increased free radical formation57 and reduced antioxidant defences58 and that vitamin C may improve endothelial function in patients with CHF.59 In the secondary prevention of CHD, in dietary trials in which the tested diet included high intakes of natural antioxidants, the incidence of new episodes of CHF was reduced in the experimental groups.18,60 Taken altogether, these data suggest (but do not demonstrate) that antioxidant...

The Metabolic Syndrome Obesity and Insulin Resistance

A major worldwide health issue is the dramatic increase in the prevalence of overweight and obese individuals. According to the World Health Organization (WHO, 2006), globally there are over 1.6 billion overweight adults, with approximately 400 million of them obese, and it is projected that by 2015 approximately 2.3 billion adults will be overweight and over 700 million obese. In the United States, the prevalence of obesity has more than doubled from 15 of the adult population in 1973-1976 to 34 in 2003-2006 (National Center for Health Statistics, 2008a), while the proportion of overweight individuals has remained relatively unchanged over the same period at approximately one-third of the population. During the same time period the incidence of overweight and obese children in the United States aged 2-5 years old has also more than doubled from 5 to 11 , but remained relatively constant in older children (approximately 17 ). Increased ponderosity places individuals at risk for...

Dietary Sources and Metabolism of Vitamin A 321 Food Sources of Vitamin A

Vitamin A is available in dietary sources as either preformed vitamin A or as provitamin A carotenoids. Rich dietary sources of preformed vitamin A include egg yolk, liver, butter, cheese, whole milk, and cod-liver oil. In animal foods, vitamin A is mostly in the form of retinyl esters, such as retinyl palmitate. In many developing countries, the consumption of foods containing preformed vitamin A is limited, and provitamin A carotenoids often comprise the major dietary source of vitamin A (134). The major provitamin A carotenoids consist of a-carotene and P-carotene, found in such foods as dark green leafy vegetables, carrots, sweet potatoes, mangoes, and papayas, and P-cryptoxanthin, found in foods such as oranges, tangerines, and kiwi fruit. Recent studies show that the bioavailability of provitamin A carotenoids is probably lower than previously believed (135,136). Many factors can affect the absorption and utilization of carotenoids, including the digestibility of the food...

Body Composition Changes And Obesity

Most dramatically, not only is there an increase in the fat cell mass but also its distribution is changing, because this enhancement is due to an enrichment at the abdominal site (central distribution). This central redistribution of the fat cell mass has dramatic consequences for the metabolic environment and is a risk factor for several obesity and age-related metabolic abnormalities. Thus, the frontier between aging and obesity is very thin (Harris, 1999). Interestingly, the normal relationship between total body fat mass and circulating leptin levels appears to be disrupted in the elderly, suggesting that abnormal secretion of this adipostat may play a role in body fat changes with aging (Moller et al., 1998). The increase in visceral and central fat cell mass with or without reduction of peripheral fat mass has dramatic consequences for the metabolic environment and is a risk factor for several obesity and age-related metabolic abnormalities, such as hypertension and...

Advantages and Disadvantages of Standard Dietary Assessment Instruments

Dietary records and recalls provide similar types of data detailed information on all foods and beverages consumed on specified days. While these methods are intended to capture data on actual foods consumed, there is a somewhat large respondent burden of recording (or recalling) food intake that can cause people to alter their food intake such that they consume less complex foods or they may avoid eating foods perceived to be less healthful (i.e., sweets, salty snacks). Further, even when participants record foods in real time, mistakes can still occur in food descriptions, portion size estimation, and lack of food composition data on various ethnic foods and complex mixtures. Theoretically, unannounced interviewer administered 24-h dietary recalls avoid the problem of changes in food intake since respondents cannot change what they ate retrospectively. However, a disadvantage of dietary recalls is that they rely on the respondent's memory and ability to estimate portion sizes,...

Biomarkers of Healthy Eating

Although some researchers think of biomarkers as potential gold standards of dietary intake, there are good reasons to accept such a view only with thoughtful reservations (Weinstein et al., 2004). Subjects are well known to vary in metabolic pathways for reasons of sex, genetics, and previous nutrient exposures (Arab et al., 2003). These differences include age-related variations in absorption, the impact of coingestion of foods that may inhibit the absorption of others (e.g., green vegetables contain oxalic acid, which impairs the absorption of calcium). Likewise, renal excretion is subject to tight controls designed to remove unwanted metabolic products and excess nutrients but to retain needed nutrients. Urinary analyses, for these reasons, can be misleading as they indicate the net outcome of these diverse processes (including saturation) and are not directly correlated with intakes. In nutritional gerontology, the issue of differences in cognitive ability in the assessment of...

Dietary Recalls

A 24-h dietary recall is a structured interview in which detailed questions are asked about all foods and beverages consumed over the previous 24 h. Dietary recall interviews can be conducted in person or by telephone and typically last 20-30 min. Data from 24-h recalls have been used to characterize large populations in the United States via the survey, What We Eat in America (Conway et al, 2004 Dwyer et al, 2003a). When conducted in large population groups, recalls provide a general snapshot of population dietary intake. Regardless of whether 24-h dietary recalls are done in-person or over the telephone, the protocols work best when interviewer scripts are standardized on a computer screen with direct data entry into a software program. It is very important that the interviewer be well trained since tone of voice, body posture (when inperson), and reactions to participant descriptions of foods consumed can influence the quality of the data, including omissions or phantom food...

Caloric Restriction

Beginning with the early work of McCay and Maynard (1935) who reported a life-prolonging effect of caloric restriction in rats, numerous attempts have been made to study the underlying causes of this obviously general mechanism. It could be shown that a reduction of caloric intake of 30 to 50 prolonged the life of rodents up to 60 . The same results were obtained in young animals and in older adults which received the reduced diet later in life. The results of the studies on rodents could be confirmed in numerous studies on other vertebrates, nematodes and even protozoa (see Masoro, 2000). Evidence for enhanced survival under dietary restriction in insects was provided by studies on waterstriders (Kaitala, 1991), carabid beetles (Ernsting and Isaaks, 1991), and Drosophila (see chapters in this book). Longtime studies using primates started in the eighties and continue up to now, revealing exciting results (Mattison et al., 2003). The influence of dietary restriction on the organism is...

Dietary Restriction

Dietary restriction is the only environmental manipulation that can bring robust extension of lifespan in a variety of model organisms, and is one of the most important themes in aging studies. Despite a great deal of effort, the precise mechanisms by which it works are not clear. Exploration of its mechanism has also been Using demographic analyses, it has been shown that dietary restriction extends lifespan in flies by altering baseline mortality rate without altering the rate of aging (Mair et al., 2003). (Figure 22.1).

Obesity

The GH response to a variety of provocative stimuli (insulin-hypoglycemia, arginine, opiates, glucagon, levodopa and GHRH), is diminished in obese subjects (52). One study evaluating spontaneous GH secretory dynamics in obese men (body mass index BMI > 42) demonstrated a reduction in endogenous GH half-life relative to control subjects (BMI < 31), a daily production rate of GH 4.1-fold less compared with controls and a threefold decrease in GH secretory burst frequency despite preservation of the GH ultradian rhythm (52). This principle applies to children as well. Cholinesterase inhibitors, including pyridostigmine, decrease somatostatin tone. Following exogenous pyridostigmine, obese subjects have an increase in the GH secretory response to provocative stimuli, supporting the SRIF hypothesis. These reports suggest the postprandial period is associated with reduced cholinergic tone and a parallel increase in somatostatin tone in normal and obese subjects (53). Sustained weight...

Dietary toxins

Case-control studies suggest that dietary V-nitroso compounds (Dahlquist et al. 1990) and nitrite (Dahlquist et al. 1990 Virtanen et al. 1994b) increase the risk of type 1 diabetes in children. Also mother's intake of nitrite at the time of pregnancy was positively related to the risk of type 1 diabetes in children independently of child's nitrite intake (Virtanen et al. 1994b). Nitrate is a naturally occurring compound in vegetables. Nitrate and nitrite are both used as food additives in the processing of meat products. In food and the human gastrointestinal tract nitrate is reduced to nitrite by bacteria, and V-nitroso compounds are formed from nitrite in the chemical or bacterial nitrosation reaction with amino compounds (Slorach 1981). Vitamin C and alpha-tocopherol inhibit and thiocyanate ions accelerate the formation of V-nitroso compounds (Leaf et al. 1989).

Dietary Patterns

People eat mixes of foods, not isolated nutrients. Within individuals there are strong correlations between the consumption of individual nutrients so that it is often very difficult to separate the contribution to health or disease of one nutrient from a group of nutrients. Therefore, interest has grown in the identification of patterns of food consumption and the extent to which particular patterns can be linked to health outcomes (dietary pattern analysis). This interest represents an understandable expansion of awareness of the importance of particular food combinations and the role of nutrient-nutrient interactions (Hu et al., 1999 Millen et al., 2004). In large part, the interest is based on ecological comparisons between communities who differ in risk of specific diseases that can be plausibly linked to dietary habits. Where the aim is to understand an overall picture of the relationships between diet and disease, dietary patterns may be more informative than study of single...

Theoretical Frameworks

In attempting to understand the determinants of physical activity and eating behaviors, theoretical frameworks offer a useful starting point to conceptualize the multitude of potential determinant factors. Many different theories have been developed in an attempt to explain behavior, and these can be broadly classified as intra-personal theories or inter-personal theories. Intra-personal theories, such as the health belief model (Becker and Maiman, 1975) and the theory of planned behavior (Ajzen, 1985), are primarily concerned with psychological factors and are based on the premise that behavior is largely choice-driven by individuals (see Chapter 2). In contrast, interpersonal theories, such as social cognitive theory (Bandura, 1986) and ecological models (Sallis and Owen, 2002 Stokols, 1992), posit that there are multiple layers of influence on behavior and emphasize the role of the broader environment in enabling or hindering individuals in their efforts to make healthy choices. To...

Socioeconomic Position

In general, those of lower socioeconomic position tend to consume poorer diets than those of higher socioeconomic position (Diez-Roux et al, 1999). For example, cross-sectional data from the Netherlands demonstrated that men and women in the lower socioeconomic groups (defined according to education, occupation, and occupational position) tended to have dietary patterns less conducive to good health, including greater intakes of sugars and sweets (Hulshof et al, 2003). Similarly, findings from the Australian National Nutrition Survey found men and women of higher socioeconomic status (defined according to occupation) more frequently consumed foods promotive of good health such as breakfast cereals and wholemeal bread (Mishra et al, 2002). A Swedish study found many differences in associations between dietary intake and socioeconomic position across two different measures of socioeconomic position, educational attainment, and occupational status (Galobardes et al, 2001). For instance,...

Family and Household Composition

Household composition is likely to influence eating behavior. The available evidence suggests that being married is positively associated with fruit and vegetable intake (Kamphuis et al, 2006), but also positively associated with energy and total fat intake and inversely associated with saturated fat intake (Giskes et al, 2007a). Fewer studies have focused on associations with fruit and vegetable consumption than energy or fat intake, and those existing studies have tended to focus on women, limiting the ability to draw conclusions related to marital status and fruit and vegetable consumption among men. For instance, a UK study of more than 35,000 women found that married participants had 62 higher odds of having a high fruit and vegetable consumption compared with their single counterparts (Pollard et al, 2001). A Canadian study of older adults found that a significantly greater proportion of those who were married consumed fruit and vegetables at least five times per day compared...

Availability and Access

While a number of studies have investigated availability of different food stores, or of food items within food stores, across different neighborhoods, very few have linked these data with data on eating behaviors at the individual level. Consequently, evidence from empirical studies examining the relationship between availability of food and eating behaviors is relatively limited and remains equivocal. For instance, the presence of local grocery stores and the shelf space occupied by healthy foods in stores has been found to be negatively associated with fat intakes (Cheadle et al, 1991 Morland et al, 2002), but the presence of supermarkets, fullservice restaurants, or fast-food restaurants has not (Morland et al, 2002). Two recent reviews of the relationship between the environment and fat and energy intake (Giskes et al, 2007a) and fruit and vegetable intake found that the limited available evidence made firm conclusions difficult (Kamphuis et al, 2006) however, there was some...

Field Measures 61 Pedometers

Although step-counting accuracy has been found to vary between different pedometer brands and models, contemporary electronic pedometers are fairly accurate in counting steps in individuals with regular, steady, gait patterns (Bassett et al, 1996 Schneider et al, 2003). There is some evidence that pedometers may underestimate steps taken at slower speeds (e.g., 71 accuracy at speeds < 2.0 mph) and that accuracy may reach 96 at speeds greater than 3.0 mph (Melanson et al, 2004). Pedometers have also been reported to be less reliable in individuals who have a body mass index > 30 (Shepherd et al, 1999).

Food Records and Diaries

Food records are somewhat burdensome for clients or study participants to complete. In fact, some studies have shown that individuals might change their food intake on recording days to consume more easy-to-prepare items that require less recording, but the ultimate influence of this practice is unknown (Craig et al, 2000 Rebro et al, 1998). Clients or study participants should always be reminded to eat as they normally do during the food-recording period. Advances in digital mobile devices (phones, cameras, PDAs) now make it possible to record and transmit food record data, which alleviates some of this participant burden and may provide more accurate data (Beasley et al, 2005 Kretsch and Fong, 1990 Wang et al, 2002). Digital devices are becoming such a routine part of people's lives that realtime digital recording of one's food and beverage intake may not feel as burdensome as a paper and pencil diary. Other disciplines in medicine, physical activity, and pain monitoring have been...

Food Frequency Questionnaires

FFQ food lists or line items are created to capture data on (1) major sources of energy and nutrients in the population of interest, (2) between-person variability in food intake, and (3) specific scientific hypotheses (Willett, 1998). Since the food list possibly cannot include the universe of all food and food combination possibilities, decisions must be made about which foods to include and which ones to omit. For example, one approach is to use national consumption data from 24-h dietary recalls to determine the most commonly eaten foods and major nutrient sources in the diet (Block et al, 1994, 1986 Willett, 1998). Details about nutrients are limited though for foods consumed in specific population groups (e.g., certain ethnic foods) and there are limited data on bioactive constituents of foods that are not considered nutrients but nonetheless have biological actions (e.g., isoth-iocyanates, polyphenols). Finally, to save space and reduce respondent burden, similar foods are...

Household Food Inventories

Household food inventories are ecological measures of diet. They cannot give information on an individual or even a family's absolute intake, but they provide a snapshot of eating behaviors or even food culture. For example, households that have many high-fat, nutrient-poor foods (i.e., potato chips, candies, sweets, and other prepared snacks) and few fruits and vegetables may be more likely to have overall high-fat diets or be at risk for obesity. A common approach for family-level weight management programs is for the nutritionist to conduct a food inventory of the pantry and advise the family to discard items with excess energy and poor nutritional value. This point is illustrated in one study reporting that the presence (in the house) of 15 high-fat foods was found to correlate with household members' individual dietary fat intake at 0.42 (p < 0.001) (Patterson et al, 1997). Individuals with < 4 high-fat foods in their house had a mean of 32 energy from fat compared to 37 for...

Summary and Conclusions

In conclusion, dietary assessment is a complex task. While it might seem intuitive to simply ask study participants or patients to recall foods eaten or complete a form on eating patterns, food intake behaviors are difficult to capture with reasonable accuracy due to the complex and varied items available to consumers, the burden that may be associated with asking participants to record foods and beverages and limitations in standard instruments that are currently available. In addition, underreporting of dietary intake has been identified as a significant problem in dietary assessment. Newer methods of dietary assessment that rely on PDAs, mobile phones, and other electronic technologies will likely be increasingly used in the future with the hope that more accurate data will be obtained. Non-traditional dietary assessment methods may be particularly useful. While not designed to measure absolute intake of foods or nutrients, they are intended to capture dietary behaviors, such as...

Risk Factors and Neurocognition

Numerous lifestyle factors that promote or reduce risk for chronic disease have known a impact on cognitive function and its decline. Various health-compromising behaviors exert a negative influence on cognitive function, whereas health-enhancing behaviors are associated with higher levels of performance or potential improvement with intervention. Lifestyle factors can influence cognitive performance by impacting the brain directly or by promoting or reducing the development of chronic diseases that in turn affect the brain. Examples of health-compromising behaviors that are associated with lower levels of cognitive function include smoking (Swan and Lessov-Schlaggar, 2007), heavy alcohol consumption (Oscar-Berman and Marinkovic, 2007), dietary insufficiencies (Gillette et al, 2007), and physical inactivity (Colcombe et al, 2004). Health-enhancing behaviors such as greater intake of antioxidants including omega-3 fatty acids, and vitamins C and E have been associated with higher...

Medical Decision Making

Planning of strategies for future behavior, the initiation and execution of these strategies, and the ability to troubleshoot ineffective strategies and implement new ones. Emotion regulation is also relevant to the maintenance of health behaviors and implementation of behavior changes. As an example, an obese individual interested in losing weight must initiate, execute, and maintain a weight loss plan in order to successfully achieve his or her goal. Furthermore, good problemsolving strategies and effective regulation of emotional reactions to this process may increase chances of success. Similarly, executive functioning deserves consideration in the context of management of chronic illness and adherence to medical treatment regimens. As noted above, on average, individuals with obesity, diabetes, hypertension, peripheral vascular disease, renal dysfunction, pulmonary disease, HIV AIDS, and other illnesses demonstrate poorer executive function than individuals without these...

Positive Well Being and Physical Health

Fortunately, other studies provide stronger evidence. A good example is Kubzansky and Thurston's (2007) study of emotional vitality and coronary heart disease (CHD). A cohort of 6025 men and women aged 25-75 years who were initially free of CHD were followed for an average of 15 years, during which time 1141 developed CHD. Emotional vitality, a combination of vitality (sense of energy and pep), positive well-being (happiness and life satisfaction), and emotional self-control (feeling emotionally stable and secure), was assessed at baseline. Participants with greater emotional vitality were at markedly reduced risk for CHD, and this effect remained significant after accounting statistically for age, gender, ethnicity, marital status, educational attainment, blood pressure, cholesterol, body mass index (BMI), smoking, alcohol use, physical activity level, diabetes, hypertension, and psychological illness. All three components of emotional vitality appeared to contribute to the health...

Psychological Well Being and Health Behaviors

Studies of the relationship between positive well-being and healthy behavior choices have generated rather variable results. Although positive affect and more enduring traits such as life satisfaction have been associated with greater physical activity, not smoking and moderate alcohol consumption in some studies (Dear et al, 2002 Patterson et al, 2004 Schnohr et al, 2005), other investigations have generated null or even reverse results (Diener and Seligman, 2002 Graham et al, 2004 Murphy et al, 2005). Rather less is known about the associations between well-being and other health behaviors such as dietary choice. We carried out an analysis of the relationship between life satisfaction and seven health behaviors using data on more than 17,000 young adults in 21 countries (Grant et al, 2009). Greater life satisfaction was consistently associated with a reduced likelihood of smoking and with an increased rate of regular exercise in all the regions of the world that were tested,...

Mechanisms Linking Social Networks to Health Outcomes

Neuroendocrine responses even in the absence of mobilizing emotional support. For example, in Sheldon Cohen's experiments exposing volunteers to an intranasal dose of the cold virus, individuals reporting high social network diversity (i.e., the presence of social ties in many domains including the work-place, community groups, churches) experienced roughly half the risk of succumbing to a symptomatic cold compared to more isolated individuals, even though the experiments did not involve any manipulation of social support in the laboratory (1997). Presumably, this finding is explained by some as-yet unaccounted for the effect of social network integration on immune functioning (i.e., the ability to fend off the cold virus). Furthermore, longitudinal data from the Framingham Study (Loucks et al, 2006) as well as the MacArthur Successful Aging Study (Loucks et al, 2006) have reported associations between higher levels of social networks and lower levels of inflammatory markers such as...

Consequences of Misperceptions for Behaviors

Similar findings have been obtained in relation to other problematic behaviors. For example, perceptions of the prevalence of peer use of cigarettes and marijuana predict personal cigarette and marijuana use (Graham et al, 1991 Juvonen et al, 2007). The body image and disordered eating literatures have documented disturbing relationships of perceived norms for weight and body size with unhealthy behaviors among young women. Sanderson and colleagues (2002) found that women who had greater discrepancies between their own body mass index and the perceived average body mass index of their peers were at increased risk for both experiencing an extreme desire to be thin and engaging in behaviors that are symptomatic of bulimia, such as binging and purging. Similarly, Bergstrom et al (2004) documented greater unhealthy weight loss behaviors, including vomiting, fasting, and use of laxatives and diuretics, among women who overestimated men's endorsement of overly thin women as attractive.

Applications of Social Norms Theory to Behavior Change

Selective social norms interventions, those targeting groups at an elevated risk for developing problematic behaviors (Mrazek and Haggerty, 1994), have also focused on a range of health behaviors. Targeting the thinness norms largely influenced and dictated by the media, Mutterperl and Sanderson (2002) provided college women with a brochure depicting accurate information about their peers' dieting and exercise behaviors. Particularly among women who did not compare themselves with celebrities, exposure to the brochure was associated with higher ideal weight and lower reports of disordered eating.

Introduction It Is About People

It may seem a long stretch from Helen's success in running a local pub to a text book on public health, but she does have a crucial common agenda with those working in infant immunization, smoking cessation, and obesity prevention she too is dealing in voluntary behavior change. She wants - needs - people to visit her pub, buy her beer, tell their friends and family what a good pub it is, visit her pub again, organize their wedding receptions with her And she knows they have a choice she cannot compel them to do these things, so she has to seduce them. This means she has to understand their needs absolutely and cater to them at every opportunity. She has to avoid the trap of taking refuge in the technicalities of her work, focusing purely on the science of good beer or minutiae of stock management. These things matter, but only in so far as they help her meet her customers' needs.

Measurement of Neighborhoods

A more fundamental issue related to defining and operationalizing neighborhood boundaries is identifying the appropriate spatial scale. The different spatial scales represented in the literature are in part driven by data availability such that the most common option is the use of administrative sources with pre-specified boundaries at various spatial scales. However, the most relevant spatial scale for investigation depends on many other factors including (1) the processes through which area features are hypothesized to affect specific health outcome, (2) the neighborhood exposures being measured, and (3) the most appropriate spatial scale for intervention or policy-relevant solutions. Different spatial scales may be more or less relevant for specific health processes under investigation. For example, the immediate area (i.e., smaller neighborhood boundaries) may be important for understanding how environmental exposures (i.e., toxins) relate to asthma. Alternatively, larger areas...

Impact of a Normal Screening Result

A possible downside of a normal result is a complacency effect, which may have an undesired impact on future screening attendance and other health-related behaviors. There is, for example, evidence from one study that people who take part in flexible sigmoidoscopy screening and have no polyps found may be less likely to give up smoking or to maintain a healthy weight than people who do have polyps found (Hoff et al, 2001) but this was not confirmed in another study in the UK (Miles et al, 2003).

Impact of Abnormal Results

Abnormal screening results may also have desirable effects, including improvements in health behaviors and increased likelihood of attendance at future screening. However, although there is some evidence that a false positive mammography result increases the likelihood of future screening attendance in the USA, other findings are conflicting and may vary between countries (Brewer et al, 2007). As mentioned earlier, one study found that people who had polyps discovered at sigmoidoscopy screening were more likely to stop smoking and less likely to gain weight than people who were given the all-clear (Hoff et al, 2001).

Gene Environment Interaction

A second way to test gene-environment interaction is to add the observed environmental factor as a moderator variable to the path loadings of the genetic factor on the observed variable. This extension of the twin model does not need to be restricted to the interaction of genetic with shared or unique environmental factors and can also be used to test for interaction within the two types of environment, i.e., Cx E or Ex E interactions (Purcell, 2002). Figure 28.7 depicts two ways of doing this. The left-hand side is a modified version of the models used by studies that aimed to detect possible moderating effects of regular physical activity on the genetic risk for obesity (McCaffery et al, 2009 Mustelin et al, 2009). A classical ACE decomposition is used, but now the effects of the latent factors are allowed to be modified by the measured environmental variable. Physical activity was allowed to act as an environmental modulator of the genetic effects on BMI ( 1) as well as of the...

Clinical Relevance and Disease Prediction

The second translational route is through the use of genetic knowledge to develop more personalized approaches to disease prediction, prevention, and management. The major limitation here for most complex diseases is that the variants so far identified provide limited information on disease risk above and beyond conventional risk factors. For example, a recent study concluded that the combined impact of 18 risk variants for type 2 diabetes does not provide strong predictive value at the population level in addition to age, sex, and body mass index

Examples of Gene Environment Interaction

Many examples of gene-environment interactions involving health-related behaviors may be cited. For instance, high density lipopro-tein cholesterol (HDL) concentrations have been shown to vary by interaction of dietary fat intake and genetic variation in hepatic lipase, a key enzyme in HDL metabolism (0rdovas et al, 2002 Tai et al, 2003). In addition, the degree of cholesterol lowering achieved by consumption of a polyunsaturated, compared to saturated, fat diet may be predicted by polymorphic variation in genes encoding the cholesterol ester transfer protein (CETP) and lipopro-tein lipase (LPL) (Wallace et al, 2000). An asparagine aspartic acid substitution in LPL has also been shown to magnify effects of cigarette smoking on risk of incident ischemic heart disease (Talmud et al, 2000). Likewise, the e4 allele of the apolipoprotein E gene (APOE) increases smoking-related risk for coronary disease events in prospective investigations (Humphries et al, 2001, 2003). A third health...

Gene Stress Interaction

Gene-environment interaction can be detected by both quantitative genetic analyses and molecular studies of specific genetic variation (gene polymorphisms). Among the former, for instance, the heritability of body mass (body mass index) has been found lower among men who engage in vigorous exercise than in the less physically active (McCaffery et al, 2009), and the heritability of hypertension appears to rise with higher levels of educational attainment (McCaffery et al, 2008). Molecular studies of gene-stress interaction are more common than quantitative genetic studies, though, and these generally fall into two categories (1) those that examine how naturally occurring stressors moderate genetic influences on aspects of disease risk and, in psychiatric genetics, liability to psychopathologies of mood or conduct and (2) studies examining the genetic modulation of physiological responses to acute psychological stressors, as manipulated experimentally. The latter investigations add to a...

Pharmacodynamic Candidate Genes

The OPRM1 gene has been associated with NRT treatment outcome in two studies. The first study observed that the G allele at the A118G locus was associated with better quit rates on the nicotine patch, quicker recoveries from a cigarette lapse, significant decline in negative mood symptoms during the first two weeks of abstinence, and lower weight gain compared to A A genotype individuals (Lerman et al, 2004). The second study observed an opposite finding in that participants with the A A genotype had higher quit rates on nicotine patch, compared with placebo, with no difference in quit rates on either nicotine patch or placebo for the * G allele participants (Munafo et al, 2007). However, when these results were examined by gender, female participants with the * G allele were more likely to quit on nicotine patch compared to placebo patch (Munafo et al, 2007). Further, the discrepancy between the two studies could be due to the fact that the latter study (Munafo et al, 2007) was able...

Candidate Gene Studies

The number of candidate gene studies (Box 33.1) for common obesity has grown steadily over the past 15 years. The latest update of Human Obesity Gene Map, which covers the literature available at the end of October 2005, reports 127 candidate genes associated with obesity-related traits (Rankinen et al, 2006). Among those, findings for 12 genes (ADIPOQ, ADRB2, ADRB3, GNB3, HTR2C, NR3C1, LEP, LEPR, PPARG, UCP1, UCP2 and UCP3) were replicated in 10 or more studies. Despite this number of replications, many other studies have shown no or even opposite association, and thus the overall conclusion for most of these genes remains inconclusive (Rankinen et al, 2006).

Future Directions

Most of the studies, so far, have used BMI as a simple and inexpensive proxy measure of adiposity, which is easy to collect in large samples. More accurate measures of adiposity might further improve power, yet these are often more expensive and harder to collect. Genome-wide association studies for body fat percentage, waist circumference, extreme obesity risk and for mediating traits that underlie obesity, such as food intake and energy expenditure, may reveal new obesity susceptibility loci that are currently hidden in studies that use BMI as the main outcome. Similarly for type 2 diabetes, genome-wide association studies for fasting glucose, fasting insulin levels, HbA1C and other Another strategy would be to examine the contribution of other sources of genetic variations such as copy number variants and rare variants to the predisposition to obesity and diabetes, which have so far been unexplored. Further advances in technology will be required before the analyses of copy number...

Tracking from Childhood and Adolescence into Adult Life

Tracking can be defined as the stability of health behavior over time or the 'preservation of relative position in rank of behavior over time' (Wardle, 1995) occurring from childhood to adulthood. Longitudinal studies have shown that smoking tracks strongly in adolescence and up until the late twenties (Twisk et al, 1997) findings from other studies indicate that alcohol use, dietary habits and preferences, and physical activity (Herman et al, 2008 Ovesen, 2006) do not track as strongly from adolescence into young adult life. During adolescence, individuals form identity, shaping their values, beliefs, and morals (Bissonnette and Contento, 2001). These processes, together with their past experiences in relation to the different health behaviors

Implications for Policy

The comprehensive nature of life course epidemiology which allows researchers to map pathways through life that lead to patterns of health behaviors has major implications for the development of health intervention policies. First, the time dimension of the life course approach highlights the progression of health behaviors from their initiation to their maintenance and their susceptibility to change at different life stages. As has been described in Section 2.2, sensitive time periods such as early in life can provide an opportunity to initiate beneficial health behaviors. For instance, introducing children to fruit and vegetables as part of their regular diet may influence their lifelong dietary choices. Alternatively many adverse health behaviors are taken up during adolescence, such as smoking, so leading up to this life stage represents a key period for behavior modification.

The Link Between Birth Weight and Later Health

Resources, the altered metabolism and coveting of nutrients can result in a propensity for obesity. Such a scenario sometimes occurs after adoption of a young infant from an impoverished setting to an affluent country. These children are then at greater risk for becoming overweight and developing the metabolic syndrome with glucose intolerance and atherogenic dyslipidemia and are more prone to cardiovascular disease. Clinical tests indicate that these individuals also have prothrombotic and proinflammatory profiles. In addition to the human studies supporting this line of reasoning, numerous reports on rodent and sheep models have begun to delineate the hormone mechanisms and metabolic pathways accounting for these long-term effects (Murphy et al, 2006 Wintour et al, 2003). These experiments indicate that the physiological programing includes changes in the kidney, with decreases in nephron number and or size, which contribute to the later hypertension in adulthood (Moritz et al,...

Early Adversity and Health Outcomes Tests of the Model

Metabolic functioning is a complex of risk factors for coronary artery disease and diabetes and is typically defined by fasting glucose, cholesterol, triglycerides, and abdominal obesity, among other indicators. High levels of these variables contribute to metabolic syndrome, which is prognostic for heart disease, diabetes, inflammatory disorders, and all-cause mortality (see Chapter 46). The prevalence of metabolic syndrome in the United States is approximately 22 (McEwen and Seeman, 1999), making it an important contributor to chronic illness. that a harsh family environment was related to negative emotions and to obesity, which in turn predicted blood pressure as well as change in blood pressure. Low childhood SES directly predicted change in systolic blood pressure as well. The strength of these pathways did not vary by race or gender. Thus, the findings suggest that socioemotional factors contribute to biological mechanisms that may underlie the impact of early family environment...

Individual Level Child Health Behaviors

Finally, other studies suggest that lack of exercise and sedentary behaviors are also related to other negative health behaviors among adolescents. Wang et al (2006) found that low SES African American youth were not only more likely to not exercise and engage in sedentary behaviors, such as watching TV and playing video games, but were also more likely to consume fried foods and soft drinks, both of which would be particularly unhealthy in the context of an already sedentary lifestyle. Delva et al (2006) reported similar results based on a nationally representative sample of adolescents and found that in addition to being less likely to engage in good dietary and exercise habits, low SES adolescents were also less likely to eat breakfast on a regular basis.

Cardiovascular Measures

Perhaps the most common application of ambulatory blood pressure monitoring in behavioral medicine has been in studies of work stress. Job strain is more consistently related to ambulatory blood pressure than to measures taken in the clinic (Steenland et al, 2000). The reason is presumably that blood pressure is affected directly by the experience of work stress in the setting in which exposure occurs, although carry-over effects are also observed. For example, an investigation of around 200 men and women from the Whitehall II study involved ambulatory blood pressure monitoring every 20 min from early in the working day until going to bed (Steptoe and Willemsen, 2004). Systolic and diastolic blood pressure were greater in participants reporting low compared with high job control, and these effects were independent of gender, employment grade, body mass index, age, smoking status, and physical activity. Interestingly, differences were present both over the working day and the evening....

Hypothalamic PituitaryThyroid Axis

In critically ill patients, the low T3 syndrome has been considered a predictor for mortality (Chopra, 1997). In patients with anorexia nervosa, the low T3 syndrome as well as a smaller volume of the thyroid gland has been observed, which are both reversible after weight gain (Munoz and Argente, 2002). In PTSD and major depression, both hyper- and hypoactivity of the hypothalamic-pituitary-thyroid axis have been described (Boscarino, 2004 Newport and Nemeroff, 2000).

The Sympatho AdrenalMedullary System

In hypertension, a role for elevated norepinephrine levels has been established (DeQuattro and Feng, 2002). Epinephrine may furthermore interact with immune functions. In HIV, stress may be involved in disease progression partly due to epinephrine effects on HIV-infected leucocytes (Cole, 2008). In psoriasis and atopic dermatitis, a hyperre-sponsive plasma catecholamine response to psychosocial stress may be involved in dysreg-ulations in Th1 Th2 mediated immune states (Buske-Kirschbaum et al, 2006). The sympatho-adrenal-medullary system may also play a role in the pathogenesis of obesity. Epinephrine affects resting metabolic rate, lipolysis, and thermogenesis SNS overactivity is associated to visceral obesity (Tentolouris et al, 2006). Through actions on ascending vagal afferents, elevated systemic levels of epinephrine may possibly affect cognitive processes, such as memory and attention. An inverted U shape of catecholamine actions has been proposed, with moderate levels being...

Hemostasis Factors and Cardiovascular Disease

Numerous large-scale and prospectively designed epidemiologic studies suggest that hemostatic factors, for instance fibrinogen, D-dimer, VWF, and PAI-1, predict cardiovascular disease (CVD) in apparently healthy subjects as well as recurrent events in patients with established CVD (Lowe et al, 2002). These relationships have been shown to be independent of sociodemographic factors, lifestyle, and established cardiovascular risk factors smoking, diabetes, hypertension, and obesity, all of which may affect hemostasis. Altogether, this abundant epidemiologic research challenges the view that hemostasis factors are mere risk markers of CVD and do not actively contribute to atherosclerosis. It is assumed that a procoagulant milieu, as reflected by increased activity of clotting factors, coagulation activation markers, platelets, and the VWF on the one hand and impaired fibrinolysis on the other will gradually contribute to atherosclerosis progression over many decades by promoting fibrin...

Pathophysiology of the Metabolic Syndrome

No specific etiology is known to account for the metabolic syndrome, nevertheless, subjects with the syndrome exhibit a variety of metabolic abnormalities associated with the individual components of the syndrome. Most notable are obesity and insulin dysregulation, which are the most frequently occurring metabolic syndrome components (Ervin, 2009). Multiple metabolic abnormalities could additively or synergistically influence the progression of CVD and diabetes. that human obesity is characterized by increased SNS activity and decreased cardiac vagal activity, which could contribute to the adverse consequences of the metabolic syndrome (Garruti et al, 2008 Straznicky et al, 2008 Tentolouris et al, 2008). Schneiderman and Skyler (1996) proposed a pathway for atherogenesis that is based on an interactive relation among insulin resistance, hyperinsulinemia, and sympathetic tone. According to this notion, social and emotional factors can interact with insulin-sensitive metabolic variables...

Cardiovascular Disease

Taheri and colleagues (2007) found no association between sleep duration or sleep-disordered breathing and C-reactive protein (CRP). The authors suggest body mass index may mediate the association between sleep-disordered breathing and CRP, but do not report any mediation analyses. Lee and colleagues (Lee et al, 2008) examined snoring as an aspect of the obstructive sleep apnea hypopnea syndrome (OSAHS), which has been found to be associated with cerebrovascu-lar disease. Although carotid atherosclerosis was related to snoring, polysomnography measures could not be shown to mediate the relationship. Guilleminault and colleagues (1996) found a suggestive association between transient blood pressure increases and acute instances of the upper airway resistance syndrome (heightened inspiratory effort without significant hypox-emia). These studies involve EEG only as a component on the polysomnogram while emphasizing the potential importance of...

Specifying Multilevel Models

In order to exemplify multilevel models we consider the following example. Suppose we are interested in studying the variation in body mass index (BMI), as a function of certain individual and neighborhood predictors. Let us assume that the researcher collected data on a sample of 50 neighborhoods and, for each of these neighborhoods, a random sample of individuals. We then have a two-level structure where the outcome is BMI y, for individual i in neighborhood j. We will restrict this exemplification to one individual-level predictor, poverty, x1ij, coded as

Search Strategy and Selection Criteria

We identified and conducted a review of systematic reviews of behavioral intervention trials targeting lifestyle risk factors related to the prevention and or management of circulatory and related conditions. Suitable reviews were identified by conducting an electronic search with the Database of Systematic Reviews of the Cochrane Library (Issue 3, 2009) and by crossing the keywords 'diet,' 'eating,' 'physical activity,' 'exercise,' 'smoking,' 'nutrition,' 'lifestyle,' 'behavior,' 'change,' 'smoking,' 'obesity,' 'overweight,' and 'adiposity.' These were crossed separately with 'cardiovascular,' 'heart disease,' 'coronary,' 'metabolic syndrome,' 'type 2 diabetes,' 'pre-diabetes,' and 'chronic disease.' Last, the search was combined with 'intervention' or 'trial.' We identified 165 reviews published between 1997 and 2009. We selected only reviews that were published in English and related to adults aged 18 or above. Reviews were excluded if they were (1) related to medical conditions...

Intervention Outcomes

2.3.1 Dietary Interventions Evaluation of dietary advice to reduce disease risk factors or to treat an existing disease is based on six reviews with approximately 44,000 participants. Outcomes of these reviews are listed in Table 62.1 (SR1-6). Usually, they were physiological or anthropometric risk factors. While behavior was reported in some trials as an indicator of intervention compliance, it was rarely measured as an outcome. Quality of life and cost-effectiveness were not reported. Overall, small but statistically significant improvements were found in physiological and anthropometric outcomes (Table 62.1, SR1-6). Only one review (Brunner et al, 2007) reported on behavioral outcomes in comprehensive dietary interventions for reducing CVD risk, modest beneficial changes in behavior were translated into statistically significant improvements in physiological and anthropometric outcomes. Beneficial disease outcomes included reduction of cardiovascular events, but this effect could...

Communications Technology in Intervention Delivery

The majority of the studies (20 26) reported significant behavioral improvements with a medium average effect size (0.60, 0.24-1.19 ). Positive outcomes were reported for 69 of exercise studies, 83 of dietary behavior studies, and 75 of studies addressing both behaviors. Furthermore, the positive outcomes were associated with duration and intensity (number of calls) of the intervention (Eakin et al, 2007).

Features of the Intervention and Its Delivery

There is not much information in relation to which professionals are best able to delivery which kinds of lifestyle interventions. While physicians can deliver lifestyle advice and programs in an effective and durable fashion under certain circumstances, there are likely to be many other professionals who can do so much more cost-effectively. However, they do not necessarily have the same window of opportunity as physicians might have, particularly those in the primary care setting. There are also some interventions, such as dietary advice, which may be delivered quite effectively and efficiently through the use of information and communications technology. The delivery of such programs by lay leaders or peers (Dale et al, 2008 Foster et al, 2007) is another area that needs more investigation, particularly, when associated with management of a disease such as diabetes (Fisher etal, 2010).

Coronary Heart Disease 21 Risk Factors

The leading cause of death worldwide is CHD (WHO, 2008). Although atherosclerosis, the preclinical antecedent of CHD, begins in childhood, the clinical manifestations of CHD occur in adulthood and include angina pectoris, MI, heart failure, and sudden death. Major cardiovascular risk factors are those that independently influence the development of atherosclerosis and CHD. More than a half century ago the Framingham Heart Study identified cigarette smoking, elevated serum cholesterol, hypertension, and advancing age as major risk factors (Dawber et al, 1951). Since then, conventional wisdom has come to accept that four modifiable traditional cardiovascular risk factors (i.e., smoking, hypertension, hypercholesterolemia, type 2 diabetes mellitus) account for only 50 of the risk for CHD (Braunwald, 1997 Hennekens, 1998). However, some investigators have contended that the 50 figure is a myth and that traditional risk factors account for far more than half the prevalence of CHD (Canto...

Weight Loss Enigma

Weight Loss Enigma

Finally Revealed The Revolutionary & Miraculous Weight Loss Secrets! Discover How to Command Those Unwanted Pounds To Take A Hike, So That You Can Get Into Shape & Lose Weight Easily Just Like You Dream Of In Just A Matter Of Weeks! You're About to Discover The Insider's Fat Burning Diet Tips to Easily Shed Off Those Extra Pounds And Obtain a Lovable Shape In No Time Flat!

Get My Free Ebook