• Adjusting athletes' body mass index to better reflect adiposity in epidemiological research

      Nevill, Alan M.; Winter, Edward M.; Ingham, Steve; Watts, Adam; Metsios, Giorgos S.; Stewart, Arthur D.; Research Institute of Healthcare Sciences, University of Wolverhampton, Walsall. (Routledge, 2010)
      The aim of the present study was to identify when body mass index (BMI) is unlikely to be a valid measure of adiposity in athletic populations and to propose a simple adjustment that will allow the BMI of athletes to reflect the adiposity normally associated with non-athletic populations. Using data from three previously published studies containing 236 athletes from seven sports and 293 age-matched controls, the association between adiposity (sum of 4 skinfold thicknesses, in millimetres) and BMI was explored using correlation, linear regression, and analysis of covariance (ANCOVA). As anticipated, there were strong positive correlations (r = 0.83 for both men and women) and slope parameters between adiposity and BMI in age-matched controls from Study 1 (all P < 0.001). The standard of sport participation reduced these associations. Of the correlations and linear-regression slope parameters between adiposity and BMI in the sports from Studies 2 and 3, although still positive in most groups, less than half of the correlations and slope parameters were statistically significant. When data from the three studies were combined, the ANCOVA identified that the BMI slope parameter of controls (5.81 mm . (kg . m(-2))(-1)) was greater than the BMI slope parameter for sports (2.62 mm . (kg . m(-2))(-1)) and middle-distance runners (0.94 mm . (kg . m(-2))(-1)) (P < 0.001). Based on these contrasting associations, we calculated how the BMI of athletes can be adjusted to reflect the same adiposity associated with age-matched controls. This simple adjustment allows the BMI of athletes and non-athletes to be used with greater confidence when investigating the effect of BMI as a risk factor in epidemiological research.
    • After the honeymoon period; an interpretative phenomenological analysis of the experiences of bariatric surgery patients 12 months to three years post operatively

      Parkes, Claire (2015-03)
      The role of a psychologist within bariatric services is predominately focussed on the completion of preoperative psychological assessments (NICE, 2006; Ratcliffe et al, 2014). This role requires the psychologist to determine the suitability of the patient for surgery (Bauchowitz et al., 2005; Fabricatore et al., 2006; Sogg & Mori, 2004; UK Faculty of clinical health psychology; Psychologists in weight management network meeting, 2013), however no research to date has been able to reliably determine which variables could be associated with sub optimal weight loss (Sarwer, Wadden, & Fabricatore, 2005; Van Hout, Verschure, and van Heck, 2005; Wadden, Sarwer, Fabricatore, 2007). The first part of this study examines the empirical evidence for a range of variables considered by professionals to be clear contraindications to surgery. The variables were collated from surveys conducted in America (Bauchowitz et al., 2005; Fabricatore et al., 2006). Due to conflicting evidence and various problems with the studies it is difficult for a clinician to draw any firm conclusions from the review. Therefore, an ideographic approach is suggested, which leads onto the second part of the researcher dossier. The empirical chapter presents an interpretative phenomenological analysis (IPA) of interviews with 14 bariatric participants who were 12 months to three years post-operative to explore their experience of - 21 surgery. This time frame was chosen to capture the participants after the ‘honeymoon phase’ when the participants have hit their weight plateau (Yale & Weiler, 1991; Brolin, 1992). The themes from the study were ‘pre op’ ‘phases’ weight maintenance’ ‘impact of the operation’ and an overall psychological theme of ‘locus of control’. Support was a key area for the participants, they described the lack of support they felt from professionals and means of seeking support elsewhere. The themes also highlighted the psychological struggle the participants go through post operatively with eating, however, this is balanced with the positive changes in identity and their ability to engage with life, no longer impeded by their weight. Recommendations from the study suggest the importance of psychologists being available to bariatric patients, in accordance with NICE guidance, and that all bariatric patients start their journey to surgery in a level three service (which is a weight management service with consists of a multi-disciplinary team) before being referred to the tier four surgical team. Finally weight loss prior to surgery is recommended, with an alternative method of achieving this than that presented in the recent British Obesity and Metabolic Surgery Society (2014) publication.
    • Anti-tumour necrosis factor alpha therapy improves insulin sensitivity in normal-weight but not in obese patients with rheumatoid arthritis

      Stavropoulos-Kalinoglou, A; Metsios, GS; Panoulas, VF; Nightingale, P; Koutedakis, Y; Kitas, GD (Springer Science and Business Media LLC, 2012-07-05)
      Introduction: Insulin resistance (IR), a risk factor for the development of cardiovascular disease, is common among patients with rheumatoid arthritis (RA). Inflammation, and especially tumour necrosis factor alpha (TNFα), has been associated with IR, and the administration of anti-TNFα agents is suggested to improve insulin sensitivity. However obesity, a potent contributor to IR, may limit the beneficial effects of anti-TNFα medication on IR. The aim of this study is to compare the effects of anti-TNFα therapy on IR between normal-weight and obese patients with RA.Methods: Patients who were normal-weight with IR (N+IR) or obese with IR (O+IR) and had embarked on anti-TNFα treatment, participated. Assessments included body mass index (BMI), insulin sensitivity (Homeostasis Model Assessment of insulin resistance, HOMA and the Quantitative Insulin sensitivity Check Index, QUICKI), and RA disease characteristics before and following six months of anti-TNFα treatment. Their results were compared to matched (for age, gender, BMI, disease duration and smoking status) normal-weight patients without IR (N-IR) and obese without IR (N-IR), respectively. In total, 32 patients were assessed for this study, with 8 in each group.Results: Following six months of treatment, disease activity was significantly reduced in all groups (P < 0.05) to a similar extent (P for differences between groups > 0.05 in all cases). In the total population, changes in HOMA (mean reduction at 6 m = -0.2 ± 0.1; P = 0.088) and QUICKI (mean increase at 6 m = 0.03 ± 0.022; P = 0.092) after treatment were not statistically significant, though a trend towards improvement was observed. However, N+IR patients showed a significant decrease in HOMA (mean reduction at 6 m = -0.54 ± 0.2; P = 0.002) and increase in QUICKI (mean increase at 6 m = 0.046 ± 0.02; P = 0.011). These changes were significantly different compared to the other groups (P < 0.05 in all cases). Multivariable analyses showed that the change in Erythrocyte Sedimentation Rate (ESR), and the change in C-Reactive Protein (CRP) associated with the improvement in HOMA (ESR: F 1-7 = 5.143, P = 0.019; CRP: F 1-7 = 3.122, P = 0.022) and QUICKI (ESR: F 1-7 = 3.814, P = 0.021; CRP: F 1-7 = 2.67; P = 0.041) only in the N+IR group.Conclusions: Anti-TNFα therapy, through controlling inflammation, seems to improve insulin sensitivity in normal-weight RA patients with insulin resistance, but is not sufficient to achieving the same beneficial effect in obese RA patients with insulin resistance. © 2012 Stavropoulos-Kalinoglou et al.; licensee BioMed Central Ltd.
    • Association of interleukin-6 (IL-6)-174G/C gene polymorphism with cardiovascular disease in patients with rheumatoid arthritis: The role of obesity and smoking

      Panoulas, Vasileios F.; Stavropoulos-Kalinoglou, Antonios; Metsios, Giorgos S.; Smith, Jacqueline P.; Milionis, Haralampos J.; Douglas, Karen M. J.; Nightingale, Peter; Kitas, George D. (Elsevier Ltd., 2008)
      Abstract Background Cardiovascular morbidity and mortality are increased in rheumatoid arthritis (RA). Interleukin-6 (IL-6) is high in RA and, together with smoking and obesity, an important contributor to the development of cardiovascular disease (CVD). The present study examined the potential association of IL-6-174 G/C polymorphism, together with obesity and smoking, with the presence of CVD in RA patients. Methods and results DNA samples were collected from 383 RA patients (who also had extensive clinical and laboratory evaluations). IL-6-174 G/C was identified using real time PCR and melting curve analysis. Serum IL-6 levels were measured in a subgroup of 135 RA patients to examine the functionality of the polymorphism. Carriers of the IL6-174C-allele demonstrated increased prevalence of CVD (26.2% vs. 17.0%, p = 0.041). There was a significant association with CVD, even after adjustment for traditional CVD risk factors (OR = 1.92, 95%CI: 1.03 to 3.58, p = 0.041). IL-6 levels were significantly increased in C-allele carriers [14.02 (3.21–38.81) vs. 4.48 (2.25–16.5), p = 0.028]. No significant interactions were observed between adiposity and IL6-174G/C genotypes. There was only a trend for an interaction between ever smoking and IL6 C-allele carriers on CVD. Conclusion The IL-6-174C-allele may associate with CVD in RA patients and possibly exerts its effect via increased inflammation. This finding, if confirmed in future studies, may be used as a part of a genetic screening tool for RA patients at high CVD risk.
    • Associations of obesity with modifiable risk factors for the development of cardiovascular disease in patients with rheumatoid arthritis

      Stavropoulos-Kalinoglou, Antonios; Metsios, Giorgos S.; Panoulas, Vasileios F.; Douglas, Karen M. J.; Nevill, Alan M.; Jamurtas, Athanasios Z.; Kita, Marina D.; Koutedakis, Yiannis; Kitas, George D. (BMJ Publishing, 2008)
      OBJECTIVES: To assess the associations of body mass index (BMI) with modifiable cardiovascular disease (CVD) risk factors in patients with rheumatoid arthritis (RA). METHODS: BMI, disease activity, selected CVD risk factors and CVD medication were assessed in 378 (276 females) RA patients. Patients exceeding accepted thresholds in >/=3 CVD risk factors were classified as having the metabolic syndrome (MetS). RESULTS: BMI independently associated with hypertension (OR=1.28 (95% CI=1.22-1.34); p=0.001), HDL (OR=1.10 (1.06-1.15); p=0.025), insulin resistance (OR= 1.13 (1.08-1.18); p=0.000) and the MetS (OR=1.15 (1.08-1.21); p=0.000). In multivariable analyses, BMI had the strongest associations with CVD risk factors (F1-354=8.663, p=0.000), and was followed by lipid-lowering treatment (F1-354=7.651, p=0.000), age (F1-354=7.541, p=0.000), antihypertensive treatment (F1-354=4.997, p=0.000) and gender (F1-354=4.707, p=0.000). Prevalence of hypertension (p=0.004), insulin resistance (p=0.005) and the MetS (p=0.000) was significantly different between normal, overweight and obese RA patients, and BMI differed significantly according to the number of risk factors present (p=0.000). CONCLUSIONS: Increasing BMI associates with increased CVD risk independently of many confounders. RA-specific BMI cut-off points better identify RA patients at increased CVD risk. Weight-loss regimes should be developed and applied in order to reduce CVD in RA patients.
    • Associations of socioeconomic status and physical activity with obesity measures in rural Chinese adults

      Pan, M; Tu, R; Gu, J; Li, R; Liu, X; Chen, R; Yu, S; Wang, X; Mao, Z; Huo, W; et al. (Frontiers Media, 2021-01-08)
      Background: Although independent association of socioeconomic status (SES) or physical activity (PA) with obesity has been well-documented in urban settings, their independent and joint associations on obesity measures are limited in rural regions. Methods: Almost 38,000 (n = 37,922) individuals were included from the Henan Rural Cohort Study. The International Physical Activity Questionnaire (IPAQ) was used to evaluate PA. Obesity was reflected by body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), body fat percentage (BFP), and visceral fat index (VFI). The independent and interactive effects of SES and PA on obesity were analyzed by logistic regression models and generalized linear regression models, respectively. Results: Compared with high education level, the OR (95%CI) of obesity defined by BMI with low education level was 1.466 (1.337, 1.608), 1.064 (0.924, 1.225), and 1.853 (1.625, 2.114) in total population, men and women, respectively. Besides, the OR (95%CI) of obesity defined by BMI associated with per capita monthly income were 1.089 (1.015, 1.170), 1.192 (1.055, 1.347), 1.038 (0.951, 1.133) in total population, men and women, respectively. Similar results had been observed in other obesity measures. Negative interactive association of low education level and PA on obesity measures were observed only in women (all P < 0.05). Conclusions: This study suggests that women are more susceptible to obesity concerning low SES and that adequate PA may be a potential target for mitigating the negative effect of low SES on obesity in women. Clinical Trial Registration: The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699) http://www.chictr.org.cn/showproj.aspx?proj=11375.
    • BMI fails to reflect the developmental changes in body fatness between boys and girls during adolescence

      Nevill, Alan M.; Reuter, Cézane Priscila; Brand, Caroline; Gaya, Anelise Reis; Mota, Jorge; Renner, Jane Dagmar Pollo; Duncan, Michael J; Faculty of Education, Health and Wellbeing, University of Wolverhampton, Walsall WS1 3BD, UK. (MDPI AG, 2021-07-23)
      Body mass index (BMI) is thought to reflect excess adiposity in both youth and adults alike. However, the association between BMI and fatness varies, especially as children grow into adults. Thus, the present study sought to address this issue by characterizing how BMI reflects age and sex differences in body fatness in 7–16-year-old children. Methods: This cross-sectional study was conducted with 2150 children and adolescents, aged 7 to 16 years from the city of Santa Cruz do Sul, Brazil. BMI (kg/m2), and percentage body fat, using tricipital and subscapular folds, were assessed. For statistical analysis, ANOVA and ANCOVA were used. Results: When considered in isolation, there was no significant interaction in the age-by-sex differences in BMI (p = 0.69). However, when we controlled for percent body fatness, the analysis revealed considerable age-by-sex differences in BMI (p < 0.001). Conclusion: For the same body fat (%), there are no differences in BMI in children < 10 years.
    • Body esteem in British children: differences due to weight status, ethnicity and gender

      Duncan, Michael; Al-Nakeeb, Yahya; Nevill, Alan M. (Nova Science Publishers, Inc., 2009)
      Body esteem is an important variable that has been linked to a range of negative health outcomes including depression, negative affect, obesity and increased risk of suffering from eating disorders. However, little information is available regarding the ethnic differences in body esteem in Britsih children. Objective: To examine gender, ethnic and weight status differences in body esteem in a sample of British children. Methods: The study was cross sectional in design and assesses body esteem and weight status in 756 children (394 boys, 362 girls, mean age 11.4 ± 1.6 years) Body esteem was determined using the body esteem scale for children. Height and body mass were measured directly. Body mass index was determined as kg/m². Overweight/obesity status was determined using child-specific, International Obesity task force cut-off points. Results: A 2 (gender) X 3 (ethnicity) X 2(weight status)ways analysis of variance (ANCOVA) controlling for age indicated that body esteem was higher for normal weight boys compared to girls whereas body esteem scores were similar for boys and girls in the overweight/obese category (P = 0.044). Body esteem scores were higher in boys compared to girls from white and black ethnic groups but this pattern was reversed for Asian boys and girls (P = 0.039). Conclusions: Findings of this study indicate that body esteem interacts with weight status and ethnicity across gender groups in British children after controlling for age. In the context of the current study overweight children and Asian boys may be particular populations where future research needs to focus.
    • British English translation of the Food Craving Inventory (FCI-UK).

      Nicholls, Wendy; Hulbert-Williams, Lee (Elsevier, 2013-08)
      There is evidence for cultural variation in the foods that may be craved. We have designed and tested, in a sample of 234 participants, a UK-specific version of the Food Craving Inventory. A four-factor structure comprising of sweet foods, fast foods, high fat, and complex carbohydrates was extracted. The final scale was analogous with the original US scale, and shared similar associations with external eating and dietary restraint, although no association was found with BMI. The measure has potential to contribute to the development of theoretical understanding of food craving, and to measuring outcomes in intervention studies and clinical samples.
    • Cardiovascular disease risk factors in habitual exercisers, lean sedentary men and abdominally obese sedentary men.

      O'Donovan, G.; Owen, A.; Kearney, E. M.; Jones, D. W.; Nevill, Alan M.; Woolf-May, K.; Bird, Steve (nature.com, 2005)
      OBJECTIVE: To investigate whether the favourable cardiovascular disease (CVD) risk factor profile of habitual exercisers is attributable to exercise or leanness. DESIGN: Cross-sectional study of 113 nonsmoking men aged 30-45 y. CVD risk factors were compared in exercisers (n=39) and sedentary men (n=74), and in subgroups of lean exercisers (n=37), lean sedentary men (n=46) and obese sedentary men (n=28). Waist girth was used to identify lean (<100 cm) and abdominally obese (> or =100 cm) subgroups. MEASUREMENTS: Blood pressure, physical activity (7-day recall), physical fitness (maximum oxygen consumption) and fasted lipoproteins, apolipoprotein (apo) B, triglycerides, glucose and fibrinogen. RESULTS: Exercisers were fitter and leaner than sedentary men and had a better CVD risk factor profile. Total cholesterol, LDL-cholesterol and apo B concentrations were lower in lean exercisers than in lean sedentary men, suggesting that exercise influences these risk factors. Indeed, time spent in vigorous activity was the only significant predictor of total cholesterol and LDL-cholesterol in multiple linear regression models. Exercise status had little influence on triglycerides and HDL-cholesterol (HDL-C), and unfavourable levels were only evident among obese sedentary men. Waist girth was the sole predictor of triglycerides and HDL-C, explaining 44 and 31% of the variance, respectively. CONCLUSIONS: These findings suggest that the CVD risk factor profile of habitual exercisers is attributable to leanness and exercise. Leanness is associated with favourable levels of HDL-C and triglycerides, while exercise is associated with lower levels of total cholesterol, LDL-cholesterol and apo B.
    • Chronic l-menthol-induced browning of white adipose tissue hypothesis: A putative therapeutic regime for combating obesity and improving metabolic health

      Sakellariou, Paraskevi; Valente, Angelica; Carrillo, Andres E; Metsios, George S; Nadolnik, Liliya; Jamurtas, Athanasios Z; Koutedakis, Yiannis; Boguszewski, Cesar; Andrade, Cláudia Marlise Balbinotti; Svensson, Per-Arne; et al. (Elsevier, 2016-05-11)
      Obesity constitutes a serious global health concern reaching pandemic prevalence rates. The existence of functional brown adipose tissue (BAT) in adult humans has provoked intense research interest in the role of this metabolically active tissue in whole-body energy balance and body weight regulation. A number of environmental, physiological, pathological, and pharmacological stimuli have been proposed to induce BAT-mediated thermogenesis and functional thermogenic BAT-like activity in white adipose tissue (WAT), opening new avenues for therapeutic strategies based on enhancing the number of beige adipocytes in WAT.
    • Emotional intelligence in binge eating disorder among the obese population

      Gnanaiah, Raj (2019-02-10)
      This research sought to investigate several differences between obese individuals with a Binge Eating Disorder (BED-O) and obese individuals without a Binge Eating Disorder (Non-BED-O). The first focus was on investigating whether these two groups of participants have differing levels of (a) the global Emotional Intelligence (EI) trait and its constituting dimensions, (b) the engagement in overeating behaviours (i.e., Emotional, External, and Restrained Eating), and (c) the engagement in different Coping styles. The research further sought to establish whether the global EI trait and its constituting dimensions predict the engagement in overeating behaviours, and whether coping styles mediate this relationship after controlling for depression scores. The sample consisted of 109 individuals who were recruited at a diabetic clinic in Wales. Sixteen participants (14.7%) were classified as BED-O and 90 participants (82.6%) as non-BED-O. Results revealed that BED-O and non-BED-O participants did not differ on global EI scores, although there were some differences on certain constructs and dimensions of EI. BED-O group displayed lower levels of the self-control construct and higher levels of the sociality construct. This group also had lower levels on the dimensions of self-esteem, emotional regulation, stress management, and higher levels of impulsivity, emotional management, and social awareness. BED-O individuals were also found to engage in more emotional, external, and restrained eating. Emotional eating was predicted by global EI trait and self-control; external eating by self- control; and restrained eating by emotionality and emotion regulation. BED-O individuals were additionally found to engage in less adaptive coping, more emotional coping, and less rational and detached coping when compared to Non-BED-O individuals. Finally, adaptive and maladaptive coping scores were found to mediate the relationship between global EI trait and emotional eating, after controlling for depression scores. The obtained findings are discussed in relation to both the literature and practice.
    • Establishing the optimal body mass index - body esteem relationship in young adolescents.

      Duncan, Michael J; Al-Nakeeb, Yahya; Nevill, Alan M. (BioMed Central, 2013-07-17)
      This study sought to compare the utility of either inverted body mass index or body mass index to optimise the relationship with body esteem in young adolescents Design: The study was cross sectional in design and assessed body esteem and weight status in756 young adolescents (394 boys, 362 girls, mean age +/- S.D. 11.4 +/- 1.6 years).
    • Food for thought: obstacles to menu labelling in restaurants and cafeterias

      Thomas, Erica (2015-08-03)
      Abstract Menu labelling is recommended as a policy intervention to reduce obesity and diet-related disease. The present commentary considers the many challenges the restaurant industry faces in providing nutrition information on its menus. Barriers include lack of nutrition expertise, time, cost, availability of nutrition information for exotic ingredients, ability to provide accurate nutrition information, libel risk, customer dissatisfaction, limited space on the menu, menu variations, loss of flexibility in changing the menu, staff training and resistance of employees to change current practice. Health promotion specialists and academics involved in fieldwork must help restaurateurs find solutions to these barriers for menu labelling interventions to be widely implemented and successful. Practical support for small independent restaurants such as free or subsidised nutrition analysis, nutrition training for staff and menu design may also be necessary to encourage voluntary participation.
    • Healthcare practitioners’ and patients’ perspectives of a weight management service and the place of psychological support within this

      LEHL, S (2016-07)
      Both the NHS and Public Health are keen to identify how best to manage long term health condition’s as a result from obesity and vice-versa. There is evidence to support the efficacy of psychological support in weight management programmes. This study explored the perceived importance of psychological support within weight management services; perspectives of both client and healthcare practitioners, in view of considering the implications for the role of a counselling psychologist. There were nine interviews conducted with five healthcare practitioners and four clients. The professionals’ disciplines included: physiologist, dietician, health psychologist, programme manager, and a medical consultant. Of the four patients, two had accessed psychology services as part of their weight management programme and two had not. Data was analysed using thematic analysis. Five overarching themes were identified. Tension (pivotal central theme) this connected to: Lifestyle; Quality of Life (QoL); Service Delivery Model; and Professional and Personal beliefs and values. The findings highlighted that perceived importance of psychological support was influenced by an individuals’ background and experiences by both groups. The implications for the role of a counselling psychologist was to provide training to health professionals as well as raising clients’ awareness of the role of counselling and psychological support within such programmes. Further research is needed to understand better the potential of psychological support within weight management services to help contain UK obesity.
    • LDL particle size in habitual exercisers, lean sedentary men and abdominally obese sedentary men.

      O'donovan, G; McEneny, J; Kearney, E M; Owen, A; Nevill, Alan M.; Woolf-May, K; Bird, S R (Thieme, 2007-08)
      Habitual exercisers enjoy considerable protection from coronary heart disease (CHD). Often, however, only modest differences in traditional CHD risk factors are apparent between habitual exercisers and their sedentary counterparts. For this reason, there is increasing interest in novel predictors of CHD, such as a preponderance of small, dense low-density lipoprotein (LDL) particles. Polyacrylamide gel electrophoresis was used to separate lipoprotein subfractions in 32 lean exercisers, 36 lean sedentary men and 21 obese sedentary men aged 30 - 45 years. Well-validated equations were used to determine LDL concentration and peak particle diameter. Waist girth was used to identify lean (< 100 cm) and obese (>or= 100 cm) individuals. LDL concentration was lower in lean exercisers than in lean sedentary men (2.64 +/- 0.44 vs. 3.76 +/- 0.79 mmol . l (-1), p < 0.001), suggesting that habitual exercise influences this risk factor. In contrast, there were no significant differences in LDL peak particle diameter between lean exercisers, lean sedentary men and obese sedentary men (27.92 +/- 0.67, 28.09 +/- 0.62 and 27.77 +/- 0.77 nm, respectively). In multiple linear regression analysis, triglyceride concentration was the only significant predictor of LDL PPD. These data suggest that habitual exercise influences LDL concentration but does not influence LDL particle size in men aged 30 - 45 years.
    • Longitudinal modeling of adiposity in periadolescent Greek schoolchildren.

      Koutedakis, Yiannis; Bouziotas, Constantin; Flouris, Andreas D.; Nelson, Paul N. (Lippincott Williams & Wilkins, 2005)
      PURPOSE: Obesity has an etiology that is multidimensional in nature. Given the dearth of longitudinal data, we examined changes in adipose tissue (Ad) in relation to physical activity levels (PA), aerobic fitness (AF), and energy intake (EI) in Greek schoolchildren, as they progressed from age 12 to 14 yr. METHODS: This was a 2-yr and three-time-point (TP) study. Participants (N=210 (TP1); =204 (TP2); =198 (TP3)) were assessed for anthropometry, maturity status, Ad, PA, AF, and EI. Mean values were used for exploratory analyses, whereas two generalized estimating equations (GEE) models examined for longitudinal associations between the studied parameters. The first (GEE1) aimed to extract inherent associations between the dependent (Ad) and independent (PA, AF, EI) variables for the entire study period. For further evidence of association, the second analysis (GEE2) used the independent variables at TP1 and TP2 to predict the dependent variables at TP3. RESULTS: Levels of Ad in boys decreased significantly (P<0.05) from TP1 to TP3, whereas the same variable demonstrated a nonsignificant increase (P>0.05) in girls. GEE1 revealed that longitudinal changes in Ad were significantly associated only with PA (beta=-0.16; P<0.001) and AF (beta=-0.09; P<0.05) for all schoolchildren. Similarly, GEE2 revealed that the main factors (at TP1 and TP2) predicting the development of Ad (at TP3) were PA (beta=-0.14; P<0.001) followed by AF (beta=-0.10; P<0.05). CONCLUSION: With respect to data presented, we established that longitudinal changes in Ad are mainly accompanied by changes in PA and, to a lesser extent, AF levels.
    • Longitudinal preventive-screening cutoffs for metabolic syndrome in adolescents.

      Flouris, Andreas D.; Bouziotas, Constantin; Christodoulos, A. D.; Koutedakis, Yiannis (Macmillan, 2008-10)
      OBJECTIVE: To detect metabolic risk factor cutoff points in adolescence for the diagnosis of metabolic syndrome that develops at the age of 17 years (MS17). DESIGN: This study adopted a 6-year design incorporating four data collection time points (TPs). Volunteers were assessed prospectively at the ages of 12, 13, 14 and 17. PARTICIPANTS: A total of 210, 204, 198 and 187 schoolchildren volunteered at the first (TP(1)=12 years old), second (TP2=13 years old), third (TP3=14 years old) and fourth (TP4=17 years old) data collection TP, respectively. MEASUREMENTS: At each data collection TP, anthropometrical, biological and lifestyle data were obtained. Identical protocols were used for each assessment conducted by the same trained investigators. RESULTS: A total of 12% of the participants were diagnosed with MS17, the majority of them being boys (P<0.05). The prevalence of the syndrome increased directly with the degree of obesity. Using body mass index (BMI), adiposity and/or aerobic fitness levels in both genders, MS17 could be correctly diagnosed as early as TP1. No such cutoff points were found for high-density lipoprotein cholesterol, triglycerides, blood pressure and fasting plasma glucose levels. CONCLUSION: With respect to the data presented, it has been established that the calculated longitudinal preventive-screening cutoffs allow successful diagnosis of metabolic syndrome in adolescents using BMI, adiposity or aerobic fitness levels in both sexes. Adoption of such pediatric guidelines may help mitigate future increase in the prevalence of metabolic syndrome.
    • Obesity in chronic inflammation using rheumatoid arthritis as a model: definition, significance, and effects of physical activity & lifestyle

      Koutedakis, Yiannis; Stavropoulos-Kalinoglou, Antonios (University of Wolverhampton, 2009)
      Background: Inflammation is the natural reaction of the body to an antigen. In some conditions, this reaction continues even after the elimination of the antigen, entering a chronic stage; it targets normal cells of the body and causes extensive damage. Rheumatoid arthritis (RA) is such a condition. It associates with significant metabolic alterations that lead to changes in body composition and especially body fat (BF) increases. In the general population, increased body fat (i.e. obesity) associates with a number of health disorders such as systemic low grade inflammation and a significantly increased risk for cardiovascular disease (CVD). Both effects of obesity could have detrimental effects in RA. Increased inflammation could worsen disease activity while obesity could further increase the already high CVD risk in RA. However, obesity in RA has attracted minimal scientific attention. Aims: The present project aimed to: 1) assess whether the existing measures of adiposity are able to identify the changes in body composition of RA patients, 2) if necessary develop RA-specific measures of adiposity, 3) investigate the association of obesity with disease characteristics and CVD profile of the patients, 4) and identify factors that might affect body weight and composition in these patients. Methods: A total of 1167 volunteers were assessed. Of them 43 suffered from osteoarthritis and 82 were healthy controls. These, together with 516 RA patients were used in the first study. Their body mass index (BMI), BF, and disease characteristics were assessed. In the second, third, fourth and fifth studies a separate set of 400 RA patients was assessed. In addition to the above assessments, their cardiovascular profile and more detailed disease characteristics were obtained. For the final study, 126 RA patients were assessed for all the above and also data on their physical activity levels and their diet were collected. Results: Assessments of adiposity for the general population are not valid for RA patients. Thus, we proposed RA-specific measures of adiposity. These are able to better identify RA patients with increased BF. We were also able to find associations between obesity and disease activity. Both underweight and obese RA patients had more active disease compared to normal-weight patients. Obese patients had significantly worse CVD profile compared to normal-weight. The newly devised measures of adiposity were able to identify those at increased risk. However, not all obese individuals were unhealthy and not all normal-weight healthy. Among our patients we were able to identify subtypes of obesity with distinct phenotypic characteristics that warrant special attention. Finally, we were able to identify factors that influence body weight and composition. Cigarette smoking protected against obesity while its cessation associated with increased adiposity. Physical activity was also found to be protective against obesity while diet or inflammation of the disease failed to produce any significant results. Conclusions: Obesity is a significant threat to the health of RA patients. The measures of adiposity developed herein should be used to identify obese RA patients. Physical activity seems like the sole mode for effective weight management in this population. Health and exercise professionals should actively encourage their patients to exercise as much as they can. This study has created more questions than it answered; further research in the association of obesity and inflammation, as well as in ways to treat it, is essential.