Identifying the Energy Gap: Magnitude and Determinants of 5‐Year Weight Gain in Midage Women

Objective: The aims of this study were to estimate average yearly weight gain in midage women and to identify the determinants of weight gain and gaining weight at double the average rate. Research Methods and Procedures: The study sample comprised 8071 participants (45 to 55 years old) in the Australian Longitudinal Study on Women's Health who completed mailed surveys in 1996, 1998, and 2001. Results: On average, the women gained almost 0.5 kg per year [average 2.42 kg (95% confidence interval, 2.29 to 2.54) over 5 years]. In multivariate analyses, variables associated with energy balance (physical activity, sitting time, and energy intake), as well as quitting smoking, menopause/hysterectomy, and baseline BMI category were significantly associated with weight gain, but other behavioral and demographic characteristics were not. After adjustment for all of the other biological and behavioral variables, the odds of gaining weight at about twice the average rate (>5 kg over 5 years) were highest for women who quit smoking (odds ratio = 2.94; 95% confidence interval, 2.17, 3.96). There were also independent relationships between the odds of gaining >5 kg and lower levels of habitual physical activity, more time spent sitting, energy intake (but only in women with BMI > 25 at baseline), menopause transition, and hysterectomy. Discussion: The average weight gain equates with an energy imbalance of only about 10 kcal or 40 kJ per day, which suggests that small sustained changes in the modifiable behavioral variables could prevent further weight gain.     

Randomised comparison of oestrogen versus oestrogen plus progestogen hormone replacement therapy in women with hysterectomy. Medical Research Council's General Practice Research Framework.

OBJECTIVE: To compare the acceptability and symptomatic and metabolic effects of two regimens of hormone replacement therapy in women with hysterectomy. DESIGN: Randomised, double blind comparison. SETTING: Seven group practices in the Medical Research Council''s general practice research framework. SUBJECTS: 321 women with hysterectomy aged 35-59. INTERVENTIONS: Hormone replacement therapy with (a) conjugated equine oestrogen 625 micrograms daily alone or (b) conjugated equine oestrogen 625 micrograms daily plus the progestogen norgestrel 150 micrograms daily for the last 12 days of the ''cycle.'' MAIN OUTCOME MEASURES: Changes in blood pressure, weight, symptoms, and haemostatic and lipid values. RESULTS: After two years 36% (57/158) of women randomly allocated to take oestrogen alone had discontinued treatment as compared with 30% (49/163) of women allocated to take oestrogen plus progestogen. Smokers were more likely to withdraw than non-smokers. There were no clear differences between the two groups in symptoms often attributed to hormone replacement therapy or in blood pressure or weight. At one year low density lipoprotein cholesterol concentrations had fallen substantially in both groups. High density lipoprotein cholesterol concentrations rose to significantly higher values in women taking oestrogen alone compared with those taking oestrogen plus progestogen, though triglyceride concentrations and factor VII activity were also significantly higher in this group. Fibrinogen concentration tended to fall, though not significantly, in both groups, possibly more in women taking oestrogen alone. CONCLUSIONS: Oestrogen plus progestogen was no less well tolerated than oestrogen alone. There was a fairly even balance between possibly beneficial and adverse effects of the two regimens on lipid concentrations and coagulability. Concern that the combined regiment may not have the cardioprotective effects ascribed to oestrogen alone can to some extent be allayed, with reassurance for the growing numbers of women with intact uteri using the combined regiment. Misgivings about the combined regiment in women with hysterectomy on the grounds of its acceptability and its effects on lipid values may also be unfounded.     

Patterns of Weight Control Strategies Predict Differences in Women's 4‐Year Weight Gain

The purpose of this study was to explore whether differences in patterns of weight control strategies predict 4‐year weight change among women. Participants (N = 176), were assessed at baseline and biennially on three occasions. Weight control strategies were assessed by the Weight Loss Behavior Scale. Height and weight were measured to calculate BMI. Latent class analysis (LCA) identified groups of women differing in their reported weight control strategies. Repeated measures were employed to examine the relationship between using different types of weight control strategies and weight change before and after adjusting for education, income, and initial BMI. LCA yielded a three‐group solution: use of none (N), healthy (H), and healthy plus unhealthy (H+U) weight control strategies. The N group had the lowest initial BMIs. Women's pattern of weight gain differed by latent group membership after adjusting for covariates: H+U group gained significantly more weight (4.56 kg) than the N group (1.51 kg) and H group (1.02 kg). Similar patterns emerged predicting weight change between years 2 and 4: H+U group gained significantly more weight (2.86 kg) than the H group (0.03 kg) and N group (0.44 kg). H+U weight control group had higher scores on weight concerns, dietary restraint, and eating attitudes than women in the H or N groups. These findings provide evidence that self‐reported weight control attempts do not necessarily lead to large weight gains; rather the amount of weight gain may depend on the type of weight control strategies that women are practicing.     

Higher Adiponectin Levels Predict Greater Weight Gain in Healthy Women in the Nurses' Health Study

Adiponectin and resistin's possible roles in weight regulation have received little attention. We tested the hypothesis that adipokine levels predict future weight gain in women in the Nurses' Health Study. Among women who provided blood samples in 1990, we studied 1,063 women who did not develop diabetes (“healthy”) and 984 women who subsequently developed diabetes. Total and high‐molecular‐weight (HMW) adiponectin and resistin levels were measured using enzyme‐linked immunosorbent assay. Women who did not developed diabetes had a mean BMI of 26.3 ± 6.0 kg/m² at baseline and gained 2.0 ± 6.1 kg over 4 years. Women who developed diabetes had a mean BMI of 30.1 ± 5.4 kg/m² at baseline, and gained 2.4 ± 7.1 kg over 4 years. In women who did not developed diabetes, higher baseline levels of total and HMW adiponectin were associated with significantly greater weight gain after adjustment for age, BMI, physical activity, diet, and other covariates: women in the highest quintile of total adiponectin gained 3.18 kg compared to women in the lowest quintile who gained 0.80 kg (fully adjusted; P for trend <0.0001). Adiponectin was not significantly associated with weight gain in women who subsequently developed diabetes. Resistin levels were not associated with weight gain in either women who did or did not develop diabetes during the follow‐up. We conclude that elevated adiponectin levels are associated with higher weight gain in healthy women, independent of confounding risk factors. High adiponectin production by adipocytes might be a sign of “healthy” adipose tissue with further capacity to store fat.     

Resting Energy Expenditure in Obese African American and Caucasian Women

The prevalence of obesity among African American women approaches 50% and greatly exceeds rates for Caucasian women. In addition, black women lose less weight than white during obesity treatment and gain more weight when untreated. This study assessed resting energy expenditure (REE) and body composition in obese white (n=122) and black (n=44) women to explore the relationship between biological variables and these observed differences. REE and body composition were assessed by indirect calorimetry and densitometry, respectively, before weight loss. REE was significantly lower in black subjects (1637.6 ± 236.9 kcal/d) than in white (1731.4 ± 262.0) (p=0.04). REE remained significantly lower in blacks than whites after adjusting for body weight (p=0.02). REE, adjusted for fat-free mass, was also significantly lower in blacks than whites (p<0.0001), although the overestimation of fat-free mass by densitometry in blacks may have contributed to this finding. There were no differences between the groups in respiratory quotient. These results suggest that a decreased REE may exist in obese black women, and it may be related to the observed differences between black and white women in the prevalence of obesity and in the response to weight loss treatment. These crosssectional findings await confirmation in longitudinal studies.     

The Influence of Overweight and Obesity on Longitudinal Trends in Maternal Serum Leptin Levels During Pregnancy

Maternal obesity influences a number of metabolic factors that can affect the course of pregnancy. Among these factors, leptin plays an important role in energy metabolism and fetal development during pregnancy. Our objective was to estimate the influence of maternal overweight/obesity on variation in the maternal serum leptin profile during pregnancy. In a prospective cohort of 143 adult gravidas with singleton pregnancies presenting for general prenatal care, we measured serum leptin levels at 6–10, 10–14, 16–20, 22–26, and 32–36 weeks' gestation. The longitudinal effects of maternal prepregnancy BMI, categorized as nonoverweight (≤26.0 kg/m²) and overweight/obese (>26.0 kg/m²), on serum leptin concentration were analyzed using linear mixed models. Overweight/obese women had significantly higher serum leptin concentrations than their nonoverweight counterparts throughout pregnancy (P < 0.01). Although these concentrations increased significantly across gestation for both groups, the rate of increase was significantly smaller for overweight/obese women (P < 0.05). To investigate whether these differences merely reflected differences in weight‐gain patterns between the two groups, we examined an index of leptin concentration per unit body weight (leptin (ng/ml)/weight (kg)). Overweight/obese women had a significantly higher index throughout pregnancy (P < 0.01). However, although this index increased significantly across pregnancy for nonoverweight women, it actually decreased significantly for overweight/obese women (P < 0.01). Our results suggest that factors other than fat mass alone influence leptin concentrations in overweight/obese women compared to normal‐weight women during pregnancy. Such factors may contribute to differences in the intrauterine environment and its influence on pregnancy outcomes in the two groups.     

Risk Profiles for Weight Gain among Postmenopausal Women: A Classification and Regression Tree Analysis Approach

Purpose

Risk factors for obesity and weight gain are typically evaluated individually while “adjusting for” the influence of other confounding factors, and few studies, if any, have created risk profiles by clustering risk factors. We identified subgroups of postmenopausal women homogeneous in their clustered modifiable and non-modifiable risk factors for gaining ≥ 3% weight.

Methods

This study included 612 postmenopausal women 50–79 years old, enrolled in an ancillary study of the Women''s Health Initiative Observational Study between February 1995 and July 1998. Classification and regression tree and stepwise regression models were built and compared.

Results

Of 27 selected variables, the factors significantly related to ≥ 3% weight gain were weight change in the past 2 years, age at menopause, dietary fiber, fat, alcohol intake, and smoking. In women younger than 65 years, less than 4 kg weight change in the past 2 years sufficiently reduced risk of ≥ 3% weight gain. Different combinations of risk factors related to weight gain were reported for subgroups of women: women 65 years or older (essential factor: < 9.8 g/day dietary factor), African Americans (essential factor: currently smoking), and white women (essential factor: ≥ 5 kg weight change for the past 2 years).

Conclusions

Our findings suggest specific characteristics for particular subgroups of postmenopausal women that may be useful for identifying those at risk for weight gain. The study results may be useful for targeting efforts to promote strategies to reduce the risk of obesity and weight gain in subgroups of postmenopausal women and maximize the effect of weight control by decreasing obesity-relevant adverse health outcomes.     

不同子宫手术方案对生育期妇女卵巢功能的影响

目的:研究不同子宫手术方案对生育期妇女卵巢功能的影响。方法:随机选取自2014年1月至2015年4月于我院进行手术治疗的200例生育期妇女作为研究对象。针对所有患者在术前1d及术后6个月分别进行静脉采血5 m L,比较患者手术前后促卵泡激素(FSH)及雌二醇(E2)水平,不同年龄与手术方案患者手术前后血清抗苗勒氏管激素(AMH)的水平。结果:术后患者的FSH及E2水平与术前比较,差异无统计学意义(P0.05)。40岁者手术后的血清AMH水平显著低于术前,差异有统计学意义(P0.05)。在手术方式中,子宫切除术(子宫全切及广泛性子宫切除)后患者血清AMH显著低于术前的水平,差异有统计学意义(P0.05)。在手术途径中,腹腔镜辅助子宫切除术后患者血清AMH显著低于术前的水平,差异有统计学意义(P0.05)。结论:≥40岁患者在接受子宫手术时可能会影响其卵巢储备功能,而子宫全切、广泛性子宫切除以及腹腔镜辅助子宫切除术对患者术后卵巢功能影响更大。     

Effects of ovariectomy on indices of insulin resistance, hypertension, and cardiac energy metabolism in middle-aged spontaneously hypertensive rats (SHR).

Insulin resistance is a risk factor for coronary heart disease. The protection of young women from coronary events is sharply reduced with menopause. To assess the impact of menopause on glucose tolerance, insulin resistance, body weight gain, heart size, and cardiac energy metabolism, we studied 28-week-old female SHR and Wistar-Kyoto (WKY) rats, who were either ovariectomized (SHR(OVX) and WKY(OVX)) or sham-operated (SHR(SHAM) and WKY(SHAM)). Animals underwent blood-pressure measurement and an oral glucose tolerance test (OGTT). Hearts were weighed and assayed for metabolic enzyme activities. Female SHR were 33 % lighter and hypertensive (+ 36 mmHg), with 33 % larger hearts (when corrected for body weight differences) compared to WKY. Although ovariectomized animals of both strains were heavier overall than their sham-operated counterparts, when heart weights were corrected for body weight, both OVX strains had lighter hearts than both SHAM strains. Glucose and insulin responses during OGTT were similar between the four groups; however, free fatty acid (FFA) responses were approximately 50 % greater in SHR than WKY, although less in SHR(OVX) than SHR(SHAM). WKY(OVX) demonstrated 8 % lower ventricular hexokinase activity than WKY(SHAM), which may reflect reduced cardiac glucose utilization. We also noted 16 % higher citrate synthase activity in WKY hearts. In conclusion, the insulin resistance characteristic of younger SHR is blunted in middle-aged female rats, although FFA responses remain elevated. Ovariectomy did not alter in vivo glucose tolerance in this group; however, sex hormones may be important in maintaining normal heart size and the potential for cardiac glucose metabolism.     

Gender difference in cardiovagal baroreflex gain in humans.

We tested the hypothesis that women would demonstrate lower cardiovagal baroreflex gain compared with men. If so, we further hypothesized that the lower cardiovagal baroreflex gain in women would be associated with their lower aerobic fitness and higher body fat percentage compared with men. To accomplish this, we measured cardiovagal baroreflex gain (modified Oxford technique) in sedentary, nonobese (body mass index < 25 kg/m2) men (age = 26.0 +/- 2.1 yr, n = 11) and women (age = 26.9 +/- 1.6 yr, n = 14). Resting R-R interval and diastolic blood pressure were similar in the two groups, but systolic blood pressure was lower (P < 0.05) in the women. Cardiovagal baroreflex gain was significantly lower in the women compared with the men (13.3 +/- 1.5 vs. 20.0 +/- 2.8 ms/mmHg, P < 0.05). The lower cardiovagal baroreflex gain in the women was not related (P > 0.05) to their lower aerobic fitness and was only marginally related to their higher body fat percentage (r = -0.34, P < 0.05). There were no gender differences in the threshold and saturation, operating range, or operating point (all P > 0.05), although the operating point fell significantly to left (i.e., at a lower systolic blood pressure) compared with men. Therefore, the findings of this study suggest that the gain of the cardiovagal baroreflex is reduced whereas other parameters were similar in women compared with men. The mechanisms responsible for the reduced cardiovagal baroreflex gain remain unclear.     

The individual age at menopause — An appropriate indicator of postmenopausal body composition?

The interaction between age at menopause and postmenopausal body composition development was tested with in 178 Viennese women aged 47 to 68 years (x=55.4 yr). Postmenopausal body composition was described using dual energy x-ray absorptiometry by absolute fat and lean mass and bone mineral content of the whole body, the arms, legs, the trunk and the head. Upper and lower amount of body fat, the fat percentages of the individual body compartments and the fat distribution index were calculated. Postmenopausal body fat and lean soft tissue mass and postmenopausal bone mineral content were significantly associated with the age at menopause. Women whose menopause occurred late showed the highest amount of body fat (31.2+/−7.7kg) and lean body mass (41.2+/−4.4 kg) postmenopausally, while women with an early menopause exhibited the lowest amount of body fat (27.5+/−8.9kg) and lean body mass (38.4+/−5.4 kg) during the postreproductive phase of life (p<0.05). Women whose menopause occurred later than 51 had a significant higher postmenopausal bone mass (2.26+/−0.9kg versus 2.09+/−0.3 kg; p<0.05). A late menopause was associated with a significantly higher value in fat mass, lean body mass and in bone mineral content. Therefore age at menopause may be assumed as an indicator for body fat and bone mineral content during postmenopause and postmenopausal fat distribution patterns.     

Maternal weight change between 1 and 2 years postpartum: the importance of 1 year weight retention

Pregnancy weight gain may lead to long-term increases in maternal BMI for some women. The objective of this study was to examine maternal body weight change 1y-2y postpartum, and to compare classifications of 2y weight retention with and without accounting for 1y-2y weight gain. Early pregnancy body weight (EPW, first trimester) was measured or imputed, and follow-up measures obtained before delivery, 1 year postpartum (1y) and 2 years postpartum (2y) in an observational cohort study of women seeking prenatal care in several counties in upstate New York (n = 413). Baseline height was measured; demographic and behavioral data were obtained from questionnaires and medical records. Associations of 1y-2y weight change (kg) and 1y-2y weight gain (≥2.25 kg) with anthropometric, socioeconomic, and behavioral variables were evaluated using linear and logistic regressions. While mean ± SE 1y-2y weight change was 0.009 ± 4.6 kg, 1y-2y weight gain (≥2.25 kg) was common (n = 108, 26%). Odds of weight gain 1y-2y were higher for overweight (OR(adj) = 2.63, CI(95%) = 1.43-4.82) and obese (OR(adj) = 2.93, CI(95%) = 1.62-5.27) women than for women with BMI <25. Two year weight retention (2y-EPW ≥2.25 kg) was misclassified in 38% (n = 37) of women when 1y-2y weight gain was ignored. One year weight retention (1YWR) (1y-EPW) was negatively related to 1y-2y weight change (β(adj) ± SE = -0.28 ± 0.04, P < 0.001) and weight gain (≥2.25 kg) (OR(adj) = 0.91, CI(95%) = 0.87-0.95). Relations between 1y weight retention and 1y-2y weight change were attenuated for women with higher early pregnancy BMI. Weight change 1y-2y was predicted primarily by an inverse relation with 1y weight retention. The high frequency of weight gain has important implications for classification of postpartum weight retention.     

Muscle fiber type is associated with obesity and weight loss

The purpose of this study was to test the hypothesis that muscle fiber type is related to obesity. Fiber type was compared 1) in lean and obese women, 2) in Caucasian (C) and African-American (AA) women, and 3) in obese individuals who lost weight after gastric bypass surgery. When lean (body mass index 24.0 +/- 0.9 kg/m(2), n = 28) and obese (34.8 +/- 0.9 kg/m(2), n = 25) women were compared, there were significant (P < 0.05) differences in muscle fiber type. The obese women possessed fewer type I (41.5 +/- 1.8 vs. 54.6 +/- 1.8%) and more type IIb (25.1 +/- 1.5 vs. 14.4 +/- 1.5%) fibers than the lean women. When ethnicity was accounted for, the percentage of type IIb fibers in obese AA was significantly higher than in obese C (31.0 +/- 2.4% vs. 19.2 +/- 1.9%); fewer type I fibers were also found in obese AA (34.5 +/- 2.8% vs. 48.6 +/- 2.2%). These data are consistent with the higher incidence of obesity and greater weight gain reported in AA women. With weight loss intervention, there was a positive relationship (r = 0.72, P < 0.005) between the percentage of excess weight loss and the percentage of type I fibers in morbidly obese patients. These findings indicate that there is a relationship between muscle fiber type and obesity.     

Self-Reported Substantial 1-Year Weight Change Among Men and Women in the United States

Population-based data have not been readily available on relatively short-term changes in weight. Therefore, we sought to determine the nature of self-reported substantial (> 10%) weight change over one year in a representative sample of the US population which participated in the 1989 National Health Interview Survey (NHIS). Across all ages, a larger proportion of women than men reported both weight loss as well as weight gain of any amount (18.9% vs. 16.1% for weight loss and 20.0% vs. 16.1% for weight gain). In sex-specific logistic regression analyses, significant risk factors common to both sexes for substantial weight loss included divorced/separated marital status, smoking, increased number of blood pressure checks, increased BMI (body mass index) and increased number of bed days. Black race reduced the risk of weight loss for both men and women. Sex-specific risk factors for weight loss in men only were widowhood or never married marital status, while increasing age was a protective factor in women only. Concerning weight gain > 10% over the past year, increased number of blood pressure checks and having one or more diabetic parents were significant risk factors among both men and women; while never being married, increased age, BMI, and education exerted a protective effect in both sexes. For women only, risk factors for weight gain included black race, increased number of contacts with a health professional, and being unemployed. Intention to lose weight was associated with both weight gain and weight loss in both sexes, although it did not serve as a confounder in any of these relationships. A greater likelihood of substantial weight loss among women relative to men was diminished for persons with higher BMI, higher number of blood pressure checks, being widowed, divorced or separated, and intention to lose weight. A greater likelihood of substantial weight gain among women relative to men was diminished for persons with low BMI. The results of this cross-sectional study of weight change, involving a one-year follow-up period, generally correspond with the results obtained by longitudinal studies involving a longer follow-up.     

Stress‐related Development of Obesity and Cortisol in Women

Chronic exposure to environmental stress may play a role in the development of obesity, through hyperactivation of the hypothalamic–pituitary–adrenocortical (HPA) axis. This study investigated the dynamics of weight gain and the activity of the HPA axis in women who developed weight gain after a stressful event. This is a case–control retrospective study. Two groups of age‐matched premenopausal women were selected. One (n = 14) included women characterized by a rapid weight gain following a stressful event, defined as the “stress‐related obesity” (SRO) group, and the other (n = 21) women with nonstress‐related development of obesity, defined as the “nonstress‐related obesity” (NSRO) group. Twenty‐one healthy premenopausal women served as normal‐weight controls. Baseline hormonal and metabolic parameters, and 24‐h urinary free cortisol (UFC/24 h) excretion rate (as a measure of HPA‐axis activity) were measured in all women. Anthropometry, diet, and physical activity were similar in both obese groups. Both obese groups showed similar metabolic and hormonal profiles, but the SRO group had UFC/24 h values (41.1 ± 14.3 µg) significantly higher (P < 0.001) with respect to the NSRO (26.6 ± 17.6 µg) or the normal‐weight control groups (21.1 ± 9.8 µg). Moreover, time (years) to achieve maximum Δweight gain (kg) and the Δweight gain/time ratio were significantly shorter (P < 0.001) and higher (P < 0.001) in the SRO group with respect to the NSRO group, respectively. In the SRO group, there was a tendency to a significant correlation between UFC/24 h and the Δweight gain/time ratio. These findings support the concept that SRO has distinct pathophysiological mechanisms, including hyperactivity of the HPA axis.     

凡纳滨对虾饲料中酵母水解物替代鱼粉适宜比例的研究

试验添加酵母水解物替代不同比例鱼粉, 添加量分别为0(对照组)、2.5%、5.0%、7.5%、10%和12.5%,替代鱼粉的比例分别为0、8%、16%、24%、32%和40%, 通过评估生长性能、消化酶和免疫相关酶活性等指标评价酵母水解物替代鱼粉对凡纳滨对虾健康生长的影响。选择健康凡纳滨对虾[初重(0.630.01) g]随机分为6组, 每组3个重复, 养殖8周。结果表明, Y2.5和Y5.0处理组对虾增重率和特定生长率与Y0相比差异不显著(P0.05), 但是显著高于其余各组(P0.05), Y2.5组饲料系数和Y0组相比差异不显著, 显著低于其余各组(P0.05); Y5.0组肝胰腺糜蛋白酶和Y0组相比差异不显著(P0.05), 显著高于其余各组(P0.05); Y2.5和Y7.5组胰蛋白酶和Y0组相比差异不显著, 但是显著高于其余各组(P0.05); Y2.5组与Y5.0酚氧化酶活性显著高于其余各组(P0.05), Y2.5组与Y7.5组和Y0组总一氧化氮合酶活性显著高于其余各组(P0.05), Y5.0组和Y7.5组血清溶菌酶活性显著高于其余各组(P0.05)。以增重率为判据, 经二次曲线拟合得出, 获得最大增重率时酵母水解物添加量为1.62%, 替代鱼粉比例为5.19%; 酵母水解物替代鱼粉比例达24%时不会对增重率产生显著影响。     

Menopause in Blackfeet women--a life span perspective

A lifespan perspective, combining quantitative and qualitative approaches, is used to examine factors related to the timing of menopause in Blackfeet women of northern Montana (USA). Cross-sectional survey data demonstrate a median age at menopause using a status quo method of 51.6 years, and a mean age of 47.0 +/- 5.0 years among those women who had already experienced menopause. Age at menopause is inversely associated with age at menarche and having been breastfed, and positively associated with use of contraceptives, household income, and current or recent employment. Household income and age at menarche influence menopause age jointly in multivariate models. These and other patterns are examined in the lives of two women with very divergent ages at menopause. Although these data support an effect of early life influences on shaping reproductive trajectories that culminate in menopause, environmental factors and human agency during adult life may play a modifying role.     

Young adult weight trajectories through midlife by body mass category

Objective : To estimate the expected weight gain through midlife for those in a given BMI category in young adulthood. Design and Methods : Group‐based trajectory modeling and National Longitudinal Survey of Youth 1979 data from 1990 to 2008 were used to quantify weight trajectories through midlife for 10,038 young adult men and women stratified by BMI category. Logistic regression was used to assess the association of trajectory membership with obesity‐related conditions (hypertension, diabetes, arthritis) in middle age. Results : Annual weight gain averaged 0.53 kg (1.17 lb) across the entire sample. However, there was considerable variation by and within BMI categories. More than 98% of men and 92% of women were on upward‐sloping trajectories, generally moving into a higher BMI category by middle age. Those who experienced early and rapid weight gain during young adulthood were most likely to be on a steeper trajectory and had greater risks for obesity‐related conditions. Conclusion : This study points to the health and weight benefits of entering young adulthood with a normal BMI, but further reveals that this is no guarantee of maintaining a healthy weight through midlife. For those who are young adults today, weight maintenance is unlikely to occur without significant environmental or technical innovation.     

Relationship of serum and saliva calcium, phosphorus and alkaline phosphatase with dry mouth feeling in menopause

doi: 10.1111/j.1741‐2358.2012.00619.x Relationship of serum and saliva calcium, phosphorus and alkaline phosphatase with dry mouth feeling in menopause Objectives: The aim of this study was to compare serum and saliva calcium, phosphorus and alkaline phosphatase of menopausal women with/without dry mouth (DM) feeling. Background: The composition of saliva in menopause women with/without DM feeling is different. Some of these differences are in hormones that are related to bone turnover. Methods: A case–control study was carried out on 60 selected menopausal women aged 45–79 years with or without DM feeling (30 as case, 30 as control), conducted at the Clinic of Oral Medicine, Tehran University of Medical Sciences. The phosphorus concentration was measured by photometrical measurement of the blue colour formed after the addition of ammonium molybdate and stannous chloride; calcium was measured by Arsenazo reaction; and alkaline phosphatase by the pNPP‐AMP method. Statistical analysis of Student’s t‐test was used. Results: The mean serum phosphorus and alkaline phosphatase, stimulated and unstimulated saliva calcium and alkaline phosphatase levels were significantly higher in the menopausal women suffering from DM. There were no significant differences between groups regarding saliva phosphorus and serum calcium concentration. Conclusion: Calcium, phosphorus and alkaline phosphatase appear associated with DM feeling in menopause.     

The eVALuate study: two parallel randomised trials,one comparing laparoscopic with abdominal hysterectomy,the other comparing laparoscopic with vaginal hysterectomy

Objective To compare the effects of laparoscopic hysterectomy and abdominal hysterectomy in the abdominal trial, and laparoscopic hysterectomy and vaginal hysterectomy in the vaginal trial.Design Two parallel, multicentre, randomised trials.Setting 28 UK centres and two South African centres.Participants 1380 women were recruited; 1346 had surgery; 937 were followed up at one year.Primary outcome Rate of major complications.Results In the abdominal trial laparoscopic hysterectomy was associated with a higher rate of major complications than abdominal hysterectomy (11.1% v 6.2%, P = 0.02; difference 4.9%, 95% confidence interval 0.9% to 9.1%) and the number needed to treat to harm was 20. Laparoscopic hysterectomy also took longer to perform (84 minutes v 50 minutes) but was less painful (visual analogue scale 3.51 v 3.88, P = 0.01) and resulted in a shorter stay in hospital after the operation (3 days v 4 days). Six weeks after the operation, laparoscopic hysterectomy was associated with less pain and better quality of life than abdominal hysterectomy (SF-12, body image scale, and sexual activity questionnaires).In the vaginal trial we found no evidence of a difference in major complication rates between laparoscopic hysterectomy and vaginal hysterectomy (9.8% v 9.5%, P = 0.92; difference 0.3%, -5.2% to 5.8%), and the number needed to treat to harm was 333. We found no evidence of other differences between laparoscopic hysterectomy and vaginal hysterectomy except that laparoscopic hysterectomy took longer to perform (72 minutes v 39 minutes) and was associated with a higher rate of detecting unexpected pathology (16.4% v 4.8%, P = < 0.01). However, this trial was underpowered.Conclusions Laparoscopic hysterectomy was associated with a significantly higher rate of major complications than abdominal hysterectomy. It also took longer to perform but was associated with less pain, quicker recovery, and better short term quality of life. The trial comparing vaginal hysterectomy with laparoscopic hysterectomy was underpowered and is inconclusive on the rate of major complications; however, vaginal hysterectomy took less time.