John A Batsis

Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States

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Publications (54)159.68 Total impact

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    ABSTRACT: Obesity and the growing population of older adults are significant public health concerns in the United States. In 2011, the Centers for Medicare and Medicaid Services introduced a Medicare benefit for obesity counselling using Intensive Behavioral Therapy that would reimburse structured visits over a 12-month period. Although we applaud this new benefit that addresses the obesity epidemic in older adults, three major shortcomings limit its utility and potential effectiveness: 1) weight loss interventions differ in older and younger adults, yet the benefit relies predominantly on data from interventions studied in younger populations; 2) body mass index is not an accurate measure for identifying obesity; and 3) tying reimbursement to clinician visits may hamper the integration of this benefit into practice. To overcome these shortcomings, we propose: 1) obesity treatment should focus on improving quality of life and physical function and on mitigating muscle and bone loss rather than focusing solely on weight loss; 2) waist circumference or waist-hip ratio should be considered as additional anthropometric measures in ascertaining obesity; and 3) allied health professionals should be reimbursed for providing this benefit. Incorporating these suggestions will improve its usability in clinical practice and increase the chances that this well-meaning benefit will improve patient outcomes.
    Journal of general internal medicine. 09/2014;
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    ABSTRACT: We previously demonstrated that BMI is associated with functional decline and reduced quality of life. While BMI in older adults is fraught with challenges, waist circumference (WC) is a marker of visceral adiposity that can also predict mortality. However, its association with function and quality of life in older adults is not well understood and hence we sought to examine the impact of WC on six-year outcomes.
    Nutrition journal. 08/2014; 13(1):81.
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    ABSTRACT: Physical activity (PA) improves function in older obese adults. However, body mass index is an unreliable adiposity indicator better reflected by waist circumference (WC). The impact of PA on physical impairment and mobility with high WC is unclear. We performed a secondary data analysis of 4,976 adults ≥60 years using National Health and Nutrition Examination Surveys (NHANES) 2005-2010. Physical limitations (PL), activities of daily living (ADL) impairments, and PA (low(<1day/week) or high (>1day/week) were self-reported. Waist circumference (WC) was dichotomized (females: 88cm; males: 102cm). Mean age was 70.1years, 55.1% were female. Prevalence of PL and ADL impairment in the high WC group were 57.7% and 18.8%, respectively, and high PA was present in 53.9%. Among high WC, high PA vs. low PA were at lower risk of PL (OR 0.58[0.48-0.70]) and ADL impairment (OR 0.46 [0.32-0.65]). High WC had higher odds of PL irrespective of PA (high PA: OR 1.57 [1.30-1.88]; low PA: OR 1.52[1.29-1.79]) and ADL impairment (high PA:OR 1.27 [1.02-1.57] and low PA:OR 1.24 [0.99-1.54]). High PA in viscerally obese individuals is associated with impairments.
    Journal of aging and physical activity. 08/2014;
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    ABSTRACT: Background:Sarcopenia is defined as the loss of skeletal muscle mass and quality, which accelerates with aging and is associated with functional decline. Rising obesity prevalence has led to a high-risk group with both disorders. We assessed mortality risk associated with sarcopenia and sarcopenic obesity in elders.Methods:A subsample of 4652 subjects ⩾60 years of age was identified from the National Health and Nutrition Examination Survey III (1988-1994), a cross-sectional survey of non-institutionalized adults. National Death Index data were linked to this data set. Sarcopenia was defined using a bioelectrical impedance formula validated using magnetic resonance imaging-measured skeletal mass by Janssen et al. Cutoffs for total skeletal muscle mass adjusted for height(2) were sex-specific (men: ⩽5.75 kg/m(2); females ⩽10.75 kg/m(2)). Obesity was based on % body fat (males: ⩾27%, females: ⩾38%). Modeling assessed mortality adjusting for age, sex, ethnicity (model 1), comorbidities (hypertension, diabetes, congestive heart failure, osteoporosis, cancer, coronary artery disease and arthritis), smoking, physical activity, self-reported health (model 2) and mobility limitations (model 3).Results:Mean age was 70.6±0.2 years and 57.2% were female. Median follow-up was 14.3 years (interquartile range: 12.5-16.1). Overall prevalence of sarcopenia was 35.4% in women and 75.5% in men, which increased with age. Prevalence of obesity was 60.8% in women and 54.4% in men. Sarcopenic obesity prevalence was 18.1% in women and 42.9% in men. There were 2782 (61.7%) deaths, of which 39.0% were cardiovascular. Women with sarcopenia and sarcopenic obesity had a higher mortality risk than those without sarcopenia or obesity after adjustment (model 2, hazard ratio (HR): 1.35 (1.05-1.74) and 1.29 (1.03-1.60)). After adjusting for mobility limitations (model 3), sarcopenia alone (HR: 1.32 ((1.04-1.69) but not sarcopenia with obesity (HR: 1.25 (0.99-1.58)) was associated with mortality. For men, the risk of death with sarcopenia and sarcopenic obesity was nonsignificant in both model-2 (HR: 0.98 (0.77-1.25), and HR: 0.99 (0.79-1.23)) and model 3 (HR: 0.98 (0.77-1.24) and HR: 0.98 (0.79-1.22)).Conclusions:Older women with sarcopenia have an increased all-cause mortality risk independent of obesity.European Journal of Clinical Nutrition advance online publication, 25 June 2014; doi:10.1038/ejcn.2014.117.
    European journal of clinical nutrition. 06/2014;
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    ABSTRACT: The objective of this study was to (a) to examine whether the association between obesity and physical functioning among older adults is moderated by physical activity (PA) and (b) to test whether this moderating effect varies by gender.
    Journal of aging and health. 06/2014;
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    ABSTRACT: Obesity defined by body mass index (BMI) is associated with higher levels of functional impairment. However, BMI strata misrepresent true adiposity, particularly in those with a normal BMI but elevated body fat (BF%) (normal weight obesity [NWO]) whom are at higher metabolic and mortality risk. Whether this subset of patients is associated with worsening functional outcomes is unclear.
    European Journal of Internal Medicine 06/2014; · 2.30 Impact Factor
  • J A Batsis, S Singh, F Lopez-Jimenez
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    ABSTRACT: Objectives: The impact of adiposity on mortality in older adults remains controversial. Some reports suggest that measures of general adiposity such as body mass index (BMI) predict better survival. We assessed the relationship between measures of adiposity and mortality in older adults. Design: Cross-sectional analysis of a population-based sample. Setting: Non-institutionalized persons in the United States participating in the National Health and Nutrition Examination Surveys III and its linked mortality dataset. Participants: A subsample of 4,489 non-institutionalized survey participants aged >60 years with measures of body composition using bioimpedance. To account for possible residual confounding, smokers, subjects with heart failure, respiratory disease, kidney disease and cancer were excluded (n=2,920). Data from 1569 subjects were analysed. Measurements: BMI, waist circumference (WC), waist-hip ratio (WHR), lean mass (LM) and % Body Fat (BF) were classified by tertiles (lowest=referent). Proportional-hazard models evaluated the association of anthropometric indices with overall and cardiovascular mortality. Results: Mean age was 69.4years, and 265(16.9%) were >80 years. There were 717(47.6%) women and 792 deaths of which 284 [35.9%] were cardiovascular related. Elevated BMI was associated with reduced cardiovascular mortality (HR 0.53 [0.30-0.84]), and remained significant after adjusting for LM (HR 0.54 [0.31-0.93]). Elevated %BF was associated with reduced mortality from cardiovascular causes (HR 0.52 [0.29-0.91]). Low BMI was associated with higher risk of cardiovascular (HR 3.66 [1.25-10.69]) and overall death (HR 2.44 [1.22-4.90]). Conclusion: Measures of adiposity in older participants are associated with lower mortality from cardiovascular causes that cannot be explained by major known confounders between obesity and mortality. Further studies need to elucidate a possible protective role and interplay between adiposity and skeletal muscle in older adults.
    The Journal of Nutrition Health and Aging 01/2014; 18(2):123-30. · 2.39 Impact Factor
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    ABSTRACT: Obesity is a multifactorial syndrome and the likelihood of success of a medical nutritional treatment (MNT) over the long term is low. As psychological and behavioural factors have an important role in both pathogenesis and the treatment of obesity, these issues were investigated in individuals with obesity who reported a long-term success or a failure in terms of weight loss following a MNT. Eighty-eight individuals of an original cohort of 251 subjects were re-evaluated 10 years after a MNT with cognitive-behavioural approach for uncomplicated obesity. Fifty-three participants were classified as failure (body weight change ≥0.5 kg) and 35 as a success (10-year body weight change <0.5 kg) of the MNT. Prior to the beginning of the weight-management program, both the Dieting Readiness Test (DRT) and the Hospital Anxiety and Depression Scale (HADS) were administered. At a 10-year follow-up after the MNT, self-reported questionnaires were administered: quality of life was assessed by the Obesity Related Well-Being (ORWELL 97) questionnaire, eating attitudes and behaviours by the Eating Disorder Examination Questionnaire (EDE-Q), the Binge Eating Scale (BES) investigated the presence and severity of binge eating and the Symptom Checklist (SCL 90-R) was used to identify the psychopathological distress. The scores of the ORWELL 97 items concerning symptoms (P = 0.005), discomfort (P = 0.03) and the total score (P = 0.02) were significantly lower in the success group. The depression score of the HADS was positively correlated with the percentage of body weight change observed 10 years after the MNT (r = 0.22; P = 0.045). The scores of the shape concern (EDE-Q) (r = 0.35; P = 0.013) and of the discomfort (ORWELL 97) (r = 0.36; P = 0.012) were significantly correlated with the percentage of body weight change 10 years after the MNT. In conclusion, this study is in agreement with the possibility that the psychological quality of life is associated even with modest amounts of weight loss in the long run. Further research should support identifying successful predictors of weight loss.
    Eating and weight disorders: EWD 09/2013; · 0.53 Impact Factor
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    ABSTRACT: Current body mass index (BMI) strata likely misrepresent the accuracy of true adiposity in older adults. Subjects with normal BMI with elevated body fat may metabolically have higher cardiovascular and overall mortality than previously suspected. We identified 4,489 subjects aged ≥60 years (BMI = 18.5 to 25 kg/m(2)) with anthropometric and bioelectrical impedance measurements from the National Health and Nutrition Examination Surveys III (1988 to 1994) and mortality data linked to the National Death Index. Normal weight obesity (NWO) was classified in 2 ways: creation of tertiles with highest percentage of body fat and body fat percent cutoffs (men >25% and women >35%). We compared overall and cardiovascular mortality rates, models adjusted for age, gender, smoking, race, diabetes, and BMI. The final sample included 1,528 subjects, mean age was 70 years, median (interquartile range) follow-up was 12.9 years (range 7.5 to 15.3) with 902 deaths (46.5% cardiovascular). Prevalence of NWO was 27.9% and 21.4% in men and 20.4% and 31.3% in women using tertiles and cutoffs, respectively. Subjects with NWO had higher rates of abnormal cardiovascular risk factors. Lean mass decreased, whereas leptin increased with increasing tertile. There were no gender-specific differences in overall mortality. Short-term mortality (<140 person-months) was higher in women, whereas long-term mortality (>140 person-months) was higher in men. We highlight the importance of considering body fat in gender-specific risk stratification in older adults with normal weight. In conclusion, NWO in older adults is associated with cardiometabolic dysregulation and is a risk for cardiovascular mortality independent of BMI and central fat distribution.
    The American journal of cardiology 08/2013; · 3.58 Impact Factor
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    ABSTRACT: OBJECTIVES: To determine the prevalence range for sarcopenic obesity and its relationship with sex, age, and ethnicity. DESIGN: Cross-sectional analysis of a population-based sample. SETTING: Noninstitutionalized persons in the United States participating in the National Health and Nutrition Examination Surveys 1999-2004. PARTICIPANTS: Subsample of 4,984 subjects aged 60 and older with dual-energy X-ray absorptiometry body composition data. MEASUREMENTS: Eight definitions of sarcopenic obesity identified from six studies found using a systematic literature review (Baumgartner, Bouchard, Davison, Zoico, Levine, Kim-1,2,3) were applied to the sample. Results were stratified according to sex, age, and ethnicity. RESULTS: Prevalence of sarcopenic obesity ranged from 4.4% to 84.0% in men and from 3.6% to 94.0% in women. Prevalence was higher in men using definitions from Baumgartner (17.9% vs 13.3%, P < .001), Levine (14.2% vs 6.6%, P < .001), and Kim-1 (30.0% vs 9.3%, P < .001); lower for men using the Davison (4.4% vs 11.1%, P < .001) and Kim-2 (83.7% vs 94.0%) definitions; and the same for men and women using the Bouchard (45.3% vs 44.3%, P = .32) and Kim-3 (75.6% vs 77.0%, P = .51) definitions. For all but one definition, sarcopenic obesity increased with each decade and was lower in non-Hispanic blacks than whites. CONCLUSION: Prevalence of sarcopenic obesity in older adults varies up to 26-fold depending on current research definitions. Such a high degree of variability suggests the need to establish consensus criteria that can be reliably applied across clinical and research settings.
    Journal of the American Geriatrics Society 05/2013; · 4.22 Impact Factor
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    ABSTRACT: Obesity is a risk factor for heart failure (HF), but the benefit of weight loss in HF is unknown. We assessed the effects of bariatric surgery (BSx) compared to non-operative treatment for morbid obesity on overall quality of life (QoL), functional capacity, and symptoms in 13 HF patients undergoing BSx and six HF patients treated without surgery. In the BSx group, median age was 62, body mass index (BMI) was 55 kg/m(2), and 5/13 were males; in the non-operative group, median age was 69, BMI was 42 kg/m(2), and 1/6 were male. Median follow-up was 4.3 and 2.7 years, respectively. At follow-up, BMI was less in the BSx group (35 vs 47 kg/m(2), p < 0.001); QoL (p < 0.01), frequency of exertional dyspnea (p = 0.01), and leg edema (p = 0.04) improved only in the BSx group. BSx induced weight loss and improved QoL and symptoms in morbidly obese patients with HF.
    Obesity Surgery 04/2013; · 3.10 Impact Factor
  • William E Monaco, John A Batsis
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    ABSTRACT: Blastomyces dermatitides is increasingly found in Canada along the St. Lawrence River. However, there are only rare reports of this disease in New England. We describe a case of disseminated blastomycosis in a patient from northern Vermont who acquired the fungus while gardening.
    Diagnostic microbiology and infectious disease 02/2013; · 2.45 Impact Factor
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    ABSTRACT: Bariatric surgery (BSx) produces clinically relevant weight loss that translates into improved quality of life, decreased mortality, and reduction in medical comorbidities, including cardiovascular (CV) risk. Little is known about patients' decision-making process to undergo BSx, but risk perception is known to influence medical decision-making. This study examined CV and BSx risk perception in obese subjects undergoing BSx (n = 268) versus those managed medically (MM) (n = 273). This retrospective population-based survey of subjects evaluated for BSx had 148 (55%) and 88 (32%) responders in the BSx and MM groups, respectively. Survey questions assessed risk perceptions and habits prior to weight loss intervention. CV risk was calculated using the Framingham Risk Score (FRS). At baseline, BSx subjects had a greater body mass index and greater prevalence of diabetes and depression. Follow-up mean weight loss was greater in the BSx group. BSx subjects perceived obesity as a greater risk to their overall health than the surgical risk. FRS declined in the BSx group (10 to 5%; p < 0.001) while there was no change in the MM group (8 to 8%; p = 0.54). Those without a measurable decrease in CV risk had a greater tendency to perceive the risk of BSx as greater than that of obesity. Obese subjects undergoing BSx are more likely than MM subjects to perceive obesity as a greater risk to their health than BSx. MM subjects generally underestimate their CV risk and overestimate the risk of BSx. Active discussion of CV risk using the FRS and the perception of risk associated with bariatric surgery can enhance patients' ability to make an informed decision regarding their management.
    European journal of preventive cardiology. 11/2012;
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    ABSTRACT: To assess the use and validity of prediction models to estimate the risk of cardiovascular disease (CVD) in Latin America and among Hispanic populations in the United States of America. This was a systematic review of three databases: Ovid MEDLINE (1 January 1950-15 April 2010), LILACS (1 January 1988-15 April 2010), and EMBASE (1 January 1988-15 April 2010). MeSH search terms and domains were related to CVD, prediction rules, Latin America (including the Caribbean), and Hispanics in the United States. Database searches were supplemented by correspondence with experts in the field. A total of 1 655 abstracts were identified, of which five cohorts with a total of 13 142 subjects met inclusion criteria. A Mexican cohort showed that the predicted/observed event-rate ratio for coronary heart disease (CHD) according to the Framingham risk score (FRS) was 1.68 (95% CI, 1.26-2.11); incident myocardial infarction, 1.36 (95% CI, 0.90-1.83); and CHD death, 1.21 (95% CI, 0.43-2.00). In Ecuador, a prediction model for CVD and total deaths in hypertensive patients had an area under the curve (AUC) of 0.79 (95% CI, 0.72-0.86), while the World Health Organization method had an AUC of 0.74 (95% CI, 0.67-0.82). A study predicting mortality risk in people with Chagas' disease had an AUC of 0.81 (95% CI, 0.72-0.90). Among a United State s cohort that included Hispanics, FRS overestimated CVD risk for Hispanics with an AUC of 0.69. Another study in the United States that assessed FRS factors predicting CVD death among Mexican-Americans had an AUC of 0.78. The evidence regarding CVD risk prediction rules in Latin America or among Hispanics in the United States is modest at best. It is likely that the FRS overestimates CVD risk in Hispanics when not properly recalibrated.
    Arquivos brasileiros de oftalmologia 08/2012; 32(2):131-9.
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    John A. Batsis, Silvio Buscemi
    Medical Complications of Type 2 Diabetes, 09/2011; , ISBN: 978-953-307-363-7
  • S. Buscemi, J. A. Batsis, S. Verga
    Diabetic Medicine 01/2011; 28(1). · 3.24 Impact Factor
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    ABSTRACT: Street Food (SF) consists of out-of-home food consumption and has old, historical roots with complex social-economic and cultural implications. Despite the emergence of modern fast food, traditional SF persists worldwide, but the relationship of SF consumption with overall health, well-being, and obesity is unknown. This is an observational, cross-sectional study. The study was performed in Palermo, the largest town of Sicily, Italy. Two groups were identified: consumers of SF (n = 687) and conventional restaurant food (RES) consumers (n = 315). Study subjects answered a questionnaire concerning their health conditions, nutritional preferences, frequency of consumption of SF and a score relative to SF consumption ranging from 0 to 20 was calculated. Body mass index (BMI, kg/m2) was significantly and independently correlated with the score of street food consumption (r = 0,103; p < 0.002). The prevalence of different diseases, including hypertension and type 2 diabetes, and the use of medications did not differ between the two groups. Milza (a sandwich stuffed with thin slice of bovine spleen and lung) consumers had a significantly higher prevalence of hypertension (12.2% vs 6.2% in non consumers; p < 0.005) and in this subgroup the use of anti-hypertensive drugs was inversely correlated with the frequency of milza consumption (r = 0.11; P = 0.010). This study suggests that SF consumption in Palermo is associated with a higher BMI and higher prevalence of hypertension in milza consumers. Further studies should evaluate whether frequent SF consumers have unfavourable metabolic and cardiovascular profile.
    Nutrition Journal 01/2011; 10:119. · 2.65 Impact Factor
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    ABSTRACT: Obesity is associated with well-known cardiovascular risk factors and a lower life expectancy. This study investigated whether nonoperative nutritional treatment of obesity without comorbidities influenced the carotid intima-media thickness (c-IMT) in the long run. Fifty-four subjects of an original cohort of 251 subjects were re-evaluated 10 years after a medical nutritional treatment (MNT) with cognitive-behavioral approach for uncomplicated obesity. Forty subjects were classified as failure (10-year body weight change > 0.5 kg) and 14 (body weight change ≤ 0.5 kg) as a success of the MNT. Ten years after MNT, c-IMT significantly increased (0.06 ± 0.02 mm; P = 0.004) in the failure group and significantly decreased (-0.07 ± 0.03 mm; P = 0.027) in the success group. Ten-year change in c-IMT correlated significantly with 10-year change in body weight (r = 0.28; P = 0.040). Multiple stepwise linear regression analysis demonstrated that age, final BMI, and group (success or failure) influenced independently the 10-year c-IMT. In conclusion, this study is in agreement with the possibility that the successful MNT of obesity may be an effective choice in the long run and seems to indicate that it may be able to reduce the cardiovascular risk as reflected by the change in c-IMT.
    Obesity 12/2010; 19(6):1187-92. · 3.92 Impact Factor
  • S Buscemi, J A Batsis, G Arcoleo, S Verga
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    ABSTRACT: Although coffee is largely consumed by adults in Western countries, controversy exists about its impact on the cardiovascular system. We recently demonstrated that caffeinated and decaffeinated espresso coffee have different acute effects on endothelial function in healthy subjects, measured using flow-mediated dilation (FMD) of the brachial artery. In this study, we measured the anti-oxidant capacity of two coffee substances in terms of free stable radical 2,2-diphenyl-1-picryl-hydrazyl 50% inhibition (I(50) DPPH). The caffeinated coffee had a slightly higher anti-oxidant capacity than decaffeinated espresso coffee (I(50) DPPH: 1.13±0.02 vs 1.30±0.03 μl; P<0.001). We suggest that the unfavourable effects observed after caffeinated coffee ingestion are due to caffeine and that the antioxidant activity is responsible for the increased FMD observed after decaffeinated coffee ingestion. Further clinical and epidemiological studies are needed to understand the chronic effects of coffee consumption on health.
    European journal of clinical nutrition 10/2010; 64(10):1242-3. · 3.07 Impact Factor
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    ABSTRACT: Aerobic capacity, as indicated by maximal oxygen uptake (VO(2) max) has an important role in contrasting the traditional cardiovascular risk factors and preventing cardiovascular morbidity and mortality. It is known that endothelial function, measured as flow-mediated dilation (FMD) of the brachial artery, is strictly linked to atherogenesis and cardiovascular risk. However, the relationship between VO(2) max and FMD has not been fully investigated especially in healthy non-obese subjects. This preliminary study cross-sectionally investigated the relationship between VO(2) max and FMD in 22 non-obese, healthy sedentary male subjects. Dividing the cohort in two subgroups of 11 subjects each according to the median value of VO(2) max, the FMD was significantly lower in the subgroup with lower VO(2) max (mean ± sem: 7.1 ± 0.7 vs. 9.5 ± 0.8 %; P = 0.035). Absolute VO(2) max (mL min(-1)) was significantly and independently correlated with body fat mass (r = -0.50; P = 0.018) and with FMD (r = 0.44; P = 0.039). This preliminary study suggests that maximal oxygen uptake is independently correlated with endothelial function in healthy non-obese adults. These results are also in agreement with the possibility that improving maximal oxygen uptake may have a favorable effect on endothelial function and vice versa.
    Acta Diabetologica 10/2010; · 4.63 Impact Factor

Publication Stats

666 Citations
159.68 Total Impact Points


  • 2010–2014
    • Geisel School of Medicine at Dartmouth
      • Department of Medicine
      Hanover, New Hampshire, United States
  • 2009–2014
    • Dartmouth–Hitchcock Medical Center
      Lebanon, New Hampshire, United States
  • 2005–2013
    • Mayo Clinic - Rochester
      • • Department of General Internal Medicine
      • • Department of Cardiovascular Diseases
      • • Department of Primary Care Internal Medicine
      • • Department of Hospital Internal Medicine
      Rochester, Minnesota, United States
  • 2011
    • Dartmouth College
      Hanover, New Hampshire, United States
  • 2005–2008
    • Mayo Foundation for Medical Education and Research
      • • Division of Cardiovascular Diseases
      • • Department of Medicine
      • • Mayo School of Graduate Medical Education
      Scottsdale, AZ, United States