A community intervention reduces BMI z-score in children: Shape Up Somerville first year results

Objective: The objective was to test the hypothesis that a community‐based environmental change intervention could prevent weight gain in young children (7.6 ± 1.0 years). Research Methods and Procedures: A non‐randomized controlled trial was conducted in three culturally diverse urban cities in Massachusetts. Somerville was the intervention community; two socio‐demographically‐matched cities were control communities. Children (n = 1178) in grades 1 to 3 attending public elementary schools participated in an intervention designed to bring the energy equation into balance by increasing physical activity options and availability of healthful foods within the before‐, during‐, after‐school, home, and community environments. Many groups and individuals within the community (including children, parents, teachers, school food service providers, city departments, policy makers, healthcare providers, before‐ and after‐school programs, restaurants, and the media) were engaged in the intervention. The main outcome measure was change in BMI z‐score. Results: At baseline, 44% (n = 385), 36% (n = 561), and 43% (n = 232) of children were above the 85th percentile for BMI z‐score in the intervention and the two control communities, respectively. In the intervention community, BMI z‐score decreased by ?0.1005 (p = 0.001, 95% confidence interval, ?0.1151 to ?0.0859) compared with children in the control communities after controlling for baseline covariates. Discussion: A community‐based environmental change intervention decreased BMI z‐score in children at high risk for obesity. These results are significant given the obesigenic environmental backdrop against which the intervention occurred. This model demonstrates promise for communities throughout the country confronted with escalating childhood obesity rates.     

A pediatric weight management program for high-risk populations: a preliminary analysis

Objective: To determine whether a multidisciplinary pediatric weight management program effectively improves BMI, BMI z‐score, and cardiovascular risk factors (CVRFs) in high‐risk populations. Methods and Procedures: A retrospective chart review was performed on children seen in the NEW Kids Program at the Children's Hospital of Wisconsin, a family‐based clinic that treats pediatric obesity using medical management, nutrition education, behavioral intervention, and physical activity. Inclusion criteria were program participation for ≥9 months and >4 visits. Analyses were performed to identify factors associated with pre‐ to postintervention changes in BMI, BMI z‐score, and CVRF laboratory values. Results: A total of 66 patients met inclusion criteria; the mean age was 11 years (s.d. ± 3.4), 56% were racial/ethnic minorities, 45% were Medicaid recipients, 48% resided in impoverished communities, and 38% had a BMI ≥40 kg/m². Of the 66 patients, 91% had more than one weight‐related comorbidity, 88% had CVRFs, and the preintervention mean BMI was 37 kg/m². After the intervention, there was an overall increase in absolute BMI, but a small, yet significant decrease in BMI z‐score (mean ?0.03 ± 0.16; P < 0.05). There were significant pregroup to postgroup improvements in total cholesterol, low‐density lipoprotein, and triglycerides levels (P < 0.05). Insurance coverage, race/ethnicity, gender, age, and initial BMI were not significantly associated with changes in BMI or BMI z‐score. Discussion: A multidisciplinary pediatric weight management program can improve the weight status of high‐risk populations, including minorities, Medicaid recipients, patients with multiple comorbidities and CVRFs, and the severely obese.     

A satisfaction enhancement intervention for long-term weight loss

Objective: To compare the effects of two satisfaction enhancement interventions for weight control on behavioral and weight changes among individuals in a 15‐month weight loss program. The primary hypothesis was that long‐term weight loss would be improved by an intervention that enhances perceived satisfaction with achieved outcomes. Research Methods and Procedures: Men and women (331) were randomized to weight control programs comprised of diet and exercise counseling and a cognitive intervention that emphasized either comparing experienced outcomes with expectation of ideal outcomes or comparing experienced outcomes with pretreatment status. The latter was expected to cause greater satisfaction with weight loss progress. Results: The intervention manipulation was not successful in influencing cognitions, satisfaction, or weight change. Discussion: The potential for intervening on satisfaction per se for the purpose of achieving greater or more sustained weight loss remains to be demonstrated.     

Effectiveness of a Randomized Controlled Lifestyle Intervention to Prevent Obesity among Chinese Primary School Students: CLICK-Obesity Study

Background

Childhood obesity has been increasing rapidly worldwide. There is limited evidence for effective lifestyle interventions to prevent childhood obesity worldwide, especially in developing countries like China. The objective of this study was to assess the effectiveness of a school-based multi-component lifestyle childhood obesity prevention program (the CLICK-Obesity study) in Mainland China.

Methods

A cluster randomized controlled trial was developed among grade 4 students from 8 urban primary schools (638 students in intervention, 544 as control) in Nanjing City, China. Students were randomly allocated to the control or intervention group at school-level. A one-year multi-component intervention program (classroom curriculum, school environment support, family involvement and fun programs/events) together with routine health education was provided to the intervention group, while the control group received routine health education only. The main outcome variables assessed were changes in body mass index, obesity occurrence, obesity-related lifestyle behaviors and knowledge.

Results

Overall, 1108 (93.7%) of the 1182 enrolled students completed the intervention study. The intervention group had a larger marginal reduction than did the control group in overall mean BMI value (-0.32±1.36 vs. -0.29±1.40, p = 0.09), although this was not significant. Compared with the control group, the intervention group was more likely to decrease their BMI (OR = 1.44, 95%CI = 1.10, 1.87) by 0.5 kg/m² or above, increase the frequency of jogging/running (OR = 1.55, 95%CI = 1.18, 2.02), decrease the frequency of TV/computer use (OR = 1.41, 95%CI = 1.09, 1.84) and of red meat consumption (OR = 1.50, 95%CI = 1.15, 1.95), change commuting mode to/from school from sedentary to active mode (OR = 2.24, 95%CI = 1.47, 3.40), and be aware of the harm of selected obesity risk factors.

Conclusions

The school-based lifestyle intervention program was practical and effective in improving health behaviors and obesity-related knowledge for children in China. This study provides important policy implications on school-based intervention programs for modifications of obesity-related lifestyles.

Trial Registration

Chinese Clinical Trial Registry ChiCTR-ERC-11001819     

Changes in obesity-related attitudes in women seeking weight reduction

Objective: To examine changes in obesity‐related attitudes in a sample of obese women who participated in either dieting or non‐dieting interventions. Research Methods and Procedures: A total of 123 obese women were randomly assigned to one of three weight control programs: meal replacement diet, balanced deficit diet, or a non‐dieting program. (The first two groups were combined as a single dieting condition.) Participants completed questionnaires (at baseline, Week 20, and Week 40) to assess beliefs and attitudes about obesity, along with measures of self‐esteem, depression, and body image. Results: At Weeks 20 and 40, participants in the non‐dieting condition reported significantly less negativity about obesity than those in the dieting group. Women in the dieting condition did not report an increase in negative attitudes toward obesity, despite losing significantly more weight than non‐dieting participants. Both groups experienced improvements in self‐esteem, body image, and depressive symptoms. Improvement in self‐esteem was associated with a reduction in negativity about obesity and with improvements in body image. Discussion: The non‐dieting program produced greater reductions in negative attitudes toward obesity than the dieting intervention. Dieting (with successful weight loss), however, did not result in greater negativity toward obesity. Non‐dieting programs seem to be useful in obese women for improving self‐esteem, body image, and internalized negative attitudes about obesity.     

Long-Term Effectiveness of a Lifestyle Intervention for the Primary Prevention of Type 2 Diabetes in a Low Socio-Economic Community – An Intervention Follow-Up Study on Reunion Island

In type 2 diabetes (T2D) prevention research, evidence for maintenance of risk factor reduction after three years of follow-up is needed. The objective of this study was to evaluate the long-term effectiveness of a combined lifestyle intervention aiming at controlling body weight (BW) and waist circumference (WC) in non-diabetic, overweight/obese adults living in a low socio-economic community. On Reunion Island, 445 adults living in deprived areas, aged 18–40 and at high-risk for T2D, were included in an intervention versus control trial for primary prevention (2001–2002). The intervention promoted a healthy diet and moderate regular physical activity, through actions strengthening individuals or community and improving living conditions. The control group received a one-shot medical information and nutritional advices. After the end of the trial (2003), 259 of the subjects participated in a follow-up study (2010–2011). The outcomes were the nine-year changes from baseline in BW, body mass index (BMI) and WC measurements, separately. Statistical analyses were performed on an intention-to-treat basis, using available and imputed datasets. At inclusion, T2D risk factors were prevalent: family history of diabetes in first-degree relatives (42%), women with a personal history of gestational diabetes (11%), total obesity (43%, median BMI 29.1 kg/m²) and central obesity (71%). At follow-up, the adjusted effect on imputed dataset was significant for WC -2.4 cm (95% confidence interval: -4.7 to -0.0 cm, p = 0.046), non-significant for BW -2.2 kg (-4.6 to +0.2 kg, p = 0.073) and BMI -0.81 kg/m² (-1.69 to +0.08 kg/m², p = 0.074). A specific long-term effect was the increased likelihood of reduction in adiposity: BW loss, BMI reduction, and WC reduction were more frequent in the intervention group. In the context of low socio-economic communities, our data support the assumption of long-term effect of lifestyle interventions targeting total obesity and central obesity two major drivers of T2D.     

Hip-Hop to Health Jr. Obesity Prevention Effectiveness Trial: postintervention results

The preschool years offer an opportunity to interrupt the trajectory toward obesity in black children. The Hip-Hop to Health Jr. Obesity Prevention Effectiveness Trial was a group-randomized controlled trial assessing the feasibility and effectiveness of a teacher-delivered weight control intervention for black preschool children. The 618 participating children were enrolled in 18 schools administered by the Chicago Public Schools. Children enrolled in the nine schools randomized to the intervention group received a 14-week weight control intervention delivered by their classroom teachers. Children in the nine control schools received a general health intervention. Height and weight, physical activity, screen time, and diet data were collected at baseline and postintervention. At postintervention, children in the intervention schools engaged in more moderate-to-vigorous physical activity (MVPA) than children in the control schools (difference between adjusted group means = 7.46 min/day, P = 0.02). Also, children in the intervention group had less total screen time (-27.8 min/day, P = 0.05). There were no significant differences in BMI, BMI Z score, or dietary intake. It is feasible to adapt an obesity prevention program to be taught by classroom teachers. The intervention showed positive influences on physical activity and screen time, but not on diet. Measuring diet and physical activity in preschool children remains a challenge, and interventions delivered by classroom teachers require both intensive initial training and ongoing individualized supervision.     

Effects of a reimbursement incentive on enrollment in a weight control program

Objective: The objective was to examine the effect of offering a reimbursement incentive on the percentage of inquirers who enrolled in a weight control program and on weight loss and program attendance among enrollees. Research Methods and Procedures: We used a sequential control‐intervention design to observe how inquirers of the University of Alabama at Birmingham EatRight Lifestyle Program responded to an enrollment incentive for potential 50% ($150) reimbursement of the total program fee if they attended 10 of 12 classes and lost at least 6% of their current body weight. Inquirers had to be adults with a BMI ≥30 kg/m², seeking information about a weight control program, and informed of the program cost. Outcomes included proportion of inquirers enrolled, overall number of classes attended, and weight loss. Results: Of the 401 people who inquired during the study periods, 24.5% and 25.0% enrolled in the intervention and control periods, respectively. There was a trend toward higher attendance in the intervention group, compared with the control group; there were no differences in percentage of weight loss. The odds of attending ≥10 classes were 2.4 times as high, and both losing >6% body weight and attending ≥10 classes were three times as high in the intervention subjects compared with controls, although non‐significant. Discussion: The potential of earning a performance‐based reimbursement incentive did not affect enrollment in the EatRight Lifestyle Program. Performance‐based incentives may be an ideal mechanism for extending coverage of weight‐loss interventions by insurers because of limited financial risk and improved adherence.     

Impact of variation in the FTO gene on whole body fat distribution, ectopic fat, and weight loss

Polymorphisms in the fat mass- and obesity-associated (FTO) gene have been identified to be associated with obesity and diabetes in large genome-wide association studies. We hypothesized that variation in the FTO gene has an impact on whole body fat distribution and insulin sensitivity, and influences weight change during lifestyle intervention. To test this hypothesis, we genotyped 1,466 German subjects, with increased risk for type 2 diabetes, for single-nucleotide polymorphism rs8050136 in the FTO gene and estimated glucose tolerance and insulin sensitivity from an oral glucose tolerance test (OGTT). Distribution of fat depots was quantified using whole body magnetic resonance (MR) imaging and spectroscopy in 298 subjects. Two-hundred and four subjects participated in a lifestyle intervention program and were examined after a follow-up of 9 months. In the cross-sectional analysis, the A allele of rs8050136 in FTO was associated with a higher BMI, body fat, and lean body mass (all P < 0.001). There was a significant effect of variation in the FTO gene on subcutaneous fat (P < or = 0.05) and a trend for liver fat content, nonvisceral adipose tissue, and visceral fat (all P < or = 0.1). However, the single-nucleotide polymorphism was not associated with insulin sensitivity or secretion independent of BMI (all P > 0.05). During lifestyle intervention, there was also no influence of the FTO polymorphism on changes in body weight or fat distribution. In conclusion, despite an association with BMI and whole body fat distribution, variation in the FTO locus has no effect on the success of a lifestyle intervention program.     

Modest Lifestyle Intervention and Glucose Tolerance in Obese African Americans

Objective: Previous studies have demonstrated the benefit of short‐term diets on glucose tolerance in obese individuals. The purpose of this study was to evaluate the effectiveness of modest lifestyle changes in maintaining improvements in glucose tolerance induced by short‐term energy restriction in obese African Americans with impaired glucose tolerance or type 2 diabetes mellitus. Research Methods and Procedures: An intervention group (n = 45; 47 ± 1 year [mean ± SE]), 105 ± 4 kg; body mass index: 39 ± 1 kg/m²) received an energy‐restricted diet (943 ± 26 kcal/d) for 1 week, followed by a lifestyle program of reduced dietary fat (?125 kcal/d) and increased physical activity (+125 kcal/d) for 1 year. Body weight and plasma concentrations of glucose, insulin, and C‐peptide during an oral glucose tolerance test were measured at baseline, 1‐week, and 4‐month intervals. A control group (n = 24; 48 ± 1 year; 110 ± 5 kg; body mass index: 41 ± 2 kg/m²) underwent these measurements at 4‐month intervals. Results: No changes in weight or glucose tolerance were observed in the control group. The intervention group had significant (p < 0.05) improvements in body weight and glucose tolerance in response to the 1‐week diet, which persisted for 4 months (p < 0.001 vs. control for change in weight). A total of 19 subjects (42%) continued the intervention program for 1 year, with sustained improvements (weight: ?4.6 ± 1.0 kg; p < 0.001 vs. control; oral glucose tolerance test glucose area: ?103 ± 44 mM · min; p < 0.05 vs. control). Discussion: A modest lifestyle program facilitates weight loss and enables improvements in glucose tolerance to be maintained in obese individuals with abnormal glucose tolerance. However, attrition was high, despite the mild nature of the program.     

新疆贫困地区维吾尔族农民肥胖与血脂异常相关性研究

肥胖及血脂异常研究很少涉及低收入地区。本研究分析了新疆低收入地区维吾尔族农民体质指数(BMI)、超重及肥胖与多种血脂分子异常的关系,探讨贫困地区筛查高危人群的适宜策略。在新疆喀什农村对3 286名年龄≥18岁个体(男1 585人,女1 701人) 进行问卷检查、体格检查及多项血脂分子的检测。数据采用Pearson相关性、ROC、Logistic回归等统计学分析。结果显示,在男女性中,随着BMI的增加,甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDLC)的血浓度呈现递增趋势（P<0.01）;男/女性TG、LDLC、TC血浓度均与BMI有显著相关性(P<0.01)。单项或多项血脂异常率均随BMI增加而上升;同一个体2个血脂指标同时异常的高危组合分别是TG+HDLC(高密度脂蛋白胆固醇)和TC+TG。Logistic联合多变量ROC曲线分析表明, 单项指标HDLC(AUC=089)在血脂异常诊断中的权重最高;而组合指标TG+HDLC(AUC=095)的权重高于其它任何组合。单因素Logistic回归分析发现,超重和肥胖是代谢综合征相关血脂指标TG、TC和HDLC异常的危险因素(P<0.05)。上述结果表明,在南疆农村贫困维吾尔族人群中,男女性超重与肥胖者均与血脂指标异常升高相关;HDLC、TG和 TC 任意两个指标同时异常,为血脂异常的高危状态。肥胖伴有“TG+HDLC”异常升高可能是血脂异常相关疾病的“集合危险因素”,在贫困地区具有临床筛查参考价值。     

The Costs and Cost-Effectiveness of a School-Based Comprehensive Intervention Study on Childhood Obesity in China

Background

The dramatic rise of overweight and obesity among Chinese children has greatly affected the social economic development. However, no information on the cost-effectiveness of interventions in China is available. The objective of this study is to evaluate the cost and the cost-effectiveness of a comprehensive intervention program for childhood obesity. We hypothesized the integrated intervention which combined nutrition education and physical activity (PA) is more cost-effective than the same intensity of single intervention.

Methods

And Findings: A multi-center randomized controlled trial conducted in six large cities during 2009-2010. A total of 8301 primary school students were categorized into five groups and followed one academic year. Nutrition intervention, PA intervention and their shared common control group were located in Beijing. The combined intervention and its’ control group were located in other 5 cities. In nutrition education group, ‘nutrition and health classes’ were given 6 times for the students, 2 times for the parents and 4 times for the teachers and health workers. "Happy 10" was carried out twice per day in PA group. The comprehensive intervention was a combination of nutrition and PA interventions. BMI and BAZ increment was 0.65 kg/m² (SE 0.09) and 0.01 (SE 0.11) in the combined intervention, respectively, significantly lower than that in its’ control group (0.82±0.09 for BMI, 0.10±0.11 for BAZ). No significant difference were found neither in BMI nor in BAZ change between the PA intervention and its’ control, which is the same case in the nutrition intervention. The single intervention has a relative lower intervention costs compared with the combined intervention. Labor costs in Guangzhou, Shanghai and Jinan was higher compared to other cities. The cost-effectiveness ratio was $120.3 for BMI and $249.3 for BAZ in combined intervention, respectively.

Conclusions

The school-based integrated obesity intervention program was cost-effectiveness for children in urban China.

Trial Registration

Chinese Clinical Trial Registry ChiCTR-PRC-09000402 URL:http://www.chictr.org/cn/     

Preventing excessive weight gain in adolescents: interpersonal psychotherapy for binge eating

The most prevalent disordered eating pattern described in overweight youth is loss of control (LOC) eating, during which individuals experience an inability to control the type or amount of food they consume. LOC eating is associated cross-sectionally with greater adiposity in children and adolescents and seems to predispose youth to gain weight or body fat above that expected during normal growth, thus likely contributing to obesity in susceptible individuals. No prior studies have examined whether LOC eating can be decreased by interventions in children or adolescents without full-syndrome eating disorders or whether programs reducing LOC eating prevent inappropriate weight gain attributable to LOC eating. Interpersonal psychotherapy, a form of therapy that was designed to treat depression and has been adapted for the treatment of eating disorders, has shown efficacy in reducing binge eating episodes and inducing weight stabilization among adults diagnosed with binge eating disorder. In this paper, we propose a theoretical model of excessive weight gain in adolescents at high risk for adult obesity who engage in LOC eating and associated overeating patterns. A rationale is provided for interpersonal psychotherapy as an intervention to slow the trajectory of weight gain in at-risk youth, with the aim of preventing or ameliorating obesity in adulthood.     

Lifestyle intervention in obese patients with type 2 diabetes: impact of the patient's educational background

Objective: To determine whether people with different educational backgrounds respond differently to a lifestyle intervention program for obese patients with type 2 diabetes. Research Methods and Procedures: The study consisted of a 12‐month randomized controlled trial of 147 health plan members with type 2 diabetes who were overweight or obese (BMI ≥ 27 kg/m²). Participants were randomized to lifestyle case management or usual care. Case management (CM) involved group and individual education, support, and referral by registered dietitians. Usual care (UC) participants received educational material. Both groups received ongoing primary care. A post hoc analysis was performed, evaluating the impact of education level on intervention group differences with respect to change in weight and waist circumference. Results: There was a significant education by group interaction for both changes in weight (p = 0.02) and waist circumference (p = 0.01) during the study period. Contrary to expectations, CM participants with less formal education had greater risk reductions compared with more educated participants. Models predicted that, by 12 months, those with less education in the UC group gained 1.71 kg more in weight and 3.67 cm more in waist circumference than those with greater education. However, by 12 months, those in the CM group with less education lost a model‐predicted 3.30 kg more in weight and 4.95 cm more in waist circumference than those with more formal education. Discussion: People with varied educational backgrounds may respond differently to a lifestyle intervention for weight management and diabetes control.     

Mediators of Weight Loss in a Family‐Based Intervention Presented over the Internet

Objective: To assess the process variables involved in a weight loss program for African‐American adolescent girls. Several process variables have been identified as affecting success in in vivo weight loss programs for adults and children, including program adherence, self‐efficacy, and social support. The current study sought to broaden the understanding of these process variables as they pertain to an intervention program that is presented using the Internet. It was hypothesized that variables such as program adherence, dietary self‐efficacy, psychological factors, and family environment factors would mediate the effect of the experimental condition on weight loss. Research Methods and Procedures: Participants were 57 adolescent African‐American girls who joined the program with one obese parent; family pairs were randomized to either a behavioral or control condition in an Internet‐based weight loss program. Outcome data (weight loss) are reported for the first 6 months of the intervention. Results: Results partially supported the hypotheses. For weight loss among adolescents, parent variables pertaining to life and family satisfaction were the strongest mediating variables. For parental weight loss, changes in dietary practices over the course of 6 months were the strongest mediators. Discussion: The identification of factors that enhance or impede weight loss for adolescents is an important step in improving weight loss programs for this group. The current findings suggest that family/parental variables exert a strong influence on weight loss efforts for adolescents and should be considered in developing future programs.     

Primum Non Nocere: Obesity Stigma and Public Health

Several recent anti-obesity campaigns appear to embrace stigmatization of obese individuals as a public health strategy. These approaches seem to be based on the fundamental assumptions that (1) obesity is largely under an individual’s control and (2) stigmatizing obese individuals will motivate them to change their behavior and will also result in successful behavior change. The empirical evidence does not support these assumptions: Although body weight is, to some degree, under individuals’ personal control, there are a range of biopsychosocial barriers that make weight regulation difficult. Furthermore, there is accumulating evidence that stigmatizing obese individuals decreases their motivation to diet, exercise, and lose weight. Public health campaigns should focus on facilitating behavioral change, rather than stigmatizing obese people, and should be grounded in the available empirical evidence. Fundamentally, these campaigns should, first, do no harm.     

High allelic burden of four obesity SNPs is associated with poorer weight loss outcomes following gastric bypass surgery

Genome‐wide association and linkage studies have identified multiple susceptibility loci for obesity. We hypothesized that such loci may affect weight loss outcomes following dietary or surgical weight loss interventions. A total of 1,001 white individuals with extreme obesity (BMI >35 kg/m²) who underwent a preoperative diet/behavioral weight loss intervention and Roux‐en‐Y gastric bypass surgery were genotyped for single‐nucleotide polymorphisms (SNPs) in or near the fat mass and obesity‐associated (FTO), insulin induced gene 2 (INSIG2), melanocortin 4 receptor (MC4R), and proprotein convertase subtilisin/kexin type 1 (PCSK1) obesity genes. Association analysis was performed using recessive and additive models with pre‐ and postoperative weight loss data. An increasing number of obesity SNP alleles or homozygous SNP genotypes was associated with increased BMI (P < 0.0006) and excess body weight (P < 0.0004). No association between the amounts of weight lost from a short‐term dietary intervention and any individual obesity SNP or cumulative number of obesity SNP alleles or homozygous SNP genotypes was observed. Linear mixed regression analysis revealed significant differences in postoperative weight loss trajectories across groups with low, intermediate, and high numbers of obesity SNP alleles or numbers of homozygous SNP genotypes (P < 0.0001). Initial BMI interacted with genotype to influence weight loss with initial BMI <50 kg/m², with evidence of a dosage effect, which was not present in individuals with initial BMI ≥50 kg/m². Differences in metabolic rate, binge eating behavior, and other clinical parameters were not associated with genotype. These data suggest that response to a surgical weight loss intervention is influenced by genetic susceptibility and BMI.     

新疆贫困地区维吾尔族农民肥胖与血脂异常相关性研究

肥胖及血脂异常研究很少涉及低收入地区。本研究分析了新疆低收入地区维吾尔族农民体质指数(BMI)、超重及肥胖与多种血脂分子异常的关系,探讨贫困地区筛查高危人群的适宜策略。在新疆喀什农村对3 286名年龄≥18岁个体(男1 585人,女1 701人) 进行问卷检查、体格检查及多项血脂分子的检测。数据采用Pearson相关性、ROC、Logistic回归等统计学分析。结果显示,在男女性中,随着BMI的增加,甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDLC)的血浓度呈现递增趋势（P<0.01）;男/女性TG、LDLC、TC血浓度均与BMI有显著相关性(P<0.01)。单项或多项血脂异常率均随BMI增加而上升;同一个体2个血脂指标同时异常的高危组合分别是TG+HDLC(高密度脂蛋白胆固醇)和TC+TG。Logistic联合多变量ROC曲线分析表明, 单项指标HDLC(AUC=089)在血脂异常诊断中的权重最高;而组合指标TG+HDLC(AUC=095)的权重高于其它任何组合。单因素Logistic回归分析发现,超重和肥胖是代谢综合征相关血脂指标TG、TC和HDLC异常的危险因素(P<0.05)。上述结果表明,在南疆农村贫困维吾尔族人群中,男女性超重与肥胖者均与血脂指标异常升高相关;HDLC、TG和 TC 任意两个指标同时异常,为血脂异常的高危状态。肥胖伴有“TG+HDLC”异常升高可能是血脂异常相关疾病的“集合危险因素”,在贫困地区具有临床筛查参考价值。     

Stressors,Supports and the Social Ecology of Displacement: Psychosocial Dimensions of an Emergency Education Program for Chechen Adolescents Displaced in Ingushetia,Russia

This study explored the psychosocial benefits of an emergency education intervention serving adolescents displaced by the war in Chechnya. It set out to describe key stressors and sources of social support available to youth served by the International Rescue Committee's (IRC) emergency education program. Interviews were conducted with 57 Chechen adolescents living in spontaneous settlements in Ingushetia, Russia in the fall of 2000. Of particular interest was the degree to which the education program addressed specified psychosocial goals. Findings indicated that young people and their families faced a number of physical and emotional stressors. The data indicated that the emergency education program provided benefits by enriching sources of social support, providing meaningful activity and a sense of hope for the future, and creating a space for young people to spend time and connect to others. However, the contrast between the desire of adolescents “to live like other kids” and the options available to them presented a dilemma for the emergency education program: adolescents craved normalcy, but for any intervention to be delivered, it had to first begin with creative and adaptive strategies that were by no means a complete replacement for formal, mainstream education. The programmatic and policy implications of these findings are presented here.