Barbara A Gower

University of Alabama at Birmingham, Birmingham, Alabama, United States

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Publications (220)944.87 Total impact

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    ABSTRACT: Obesity and late-night food consumption are associated with impaired glucose tolerance. Late-night carbohydrate consumption may be particularly detrimental during late pregnancy because insulin sensitivity declines as pregnancy progresses. Further, women who were obese (Ob) prior to pregnancy have lower insulin sensitivity than do women of normal weight (NW). The aim of this study is to test the hypothesis that night-time carbohydrate consumption is associated with poorer glucose tolerance in late pregnancy and that this association would be exacerbated among Ob women. Forty non-diabetic African American women were recruited based upon early pregnancy body mass index (NW, <25 kg m(-2) ; Ob, ≥30 kg m(-2) ). Third trimester free-living dietary intake was assessed by food diary, and indices of glucose tolerance and insulin action were assessed during a 75-g oral glucose tolerance test. Women in the Ob group reported greater average 24-h energy intake (3055 kcal vs. 2415 kcal, P < 0.05). Across the whole cohort, night-time, but not day-time, carbohydrate intake was positively associated with glucose concentrations after the glucose load and inversely associated with early phase insulin secretion (P < 0.05). Multiple linear regression modelling within each weight group showed that the associations among late-night carbohydrate intake, glucose concentrations and insulin secretion were present only in the Ob group. This is the first study to report an association of night-time carbohydrate intake specifically on glucose tolerance and insulin action during pregnancy. If replicated, these results suggest that late-night carbohydrate intake may be a potential target for intervention to improve metabolic health of Ob women in late pregnancy. © 2015 John Wiley & Sons Ltd.
    Maternal and Child Nutrition 03/2015; DOI:10.1111/mcn.12181 · 2.97 Impact Factor
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    ABSTRACT: To evaluate ictal adipokine levels in episodic migraineurs and their association with pain severity and treatment response. This was a double-blind, placebo-controlled trial evaluating peripheral blood specimens from episodic migraineurs at acute pain onset and 30 to 120 minutes after treatment with sumatriptan/naproxen sodium vs placebo. Total adiponectin (T-ADP), ADP multimers (high molecular weight [HMW], middle molecular weight, and low molecular weight [LMW]), leptin, and resistin levels were evaluated by immunoassays. Thirty-four participants (17 responders, 17 nonresponders) were included. In all participants, pretreatment pain severity increased with every quartile increase in both the HMW:T-ADP ratio (coefficient of variation [CV] 0.51; 95% confidence interval [CI]: 0.08, 0.93; p = 0.019) and resistin levels (CV 0.58; 95% CI: 0.21, 0.96; p = 0.002), but was not associated with quartile changes in leptin levels. In responders, T-ADP (CV -0.98; 95% CI: -1.88, -0.08; p = 0.031) and resistin (CV -0.95; 95% CI: -1.83, -0.07; p = 0.034) levels decreased 120 minutes after treatment as compared with pretreatment. In addition, in responders, the HMW:T-ADP ratio (CV -0.04; 95% CI: -0.07, -0.01; p = 0.041) decreased and the LMW:T-ADP ratio (CV 0.04; 95% CI: 0.01, 0.07; p = 0.043) increased at 120 minutes after treatment. In nonresponders, the LMW:T-ADP ratio (CV -0.04; 95% CI: -0.07, -0.01; p = 0.018) decreased 120 minutes after treatment. Leptin was not associated with treatment response. Both pretreatment migraine pain severity and treatment response are associated with changes in adipokine levels. Adipokines represent potential novel migraine biomarkers and drug targets. © 2015 American Academy of Neurology.
    Neurology 03/2015; 84(14). DOI:10.1212/WNL.0000000000001443 · 8.30 Impact Factor
  • Barbara A Gower, Amy M Goss
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    ABSTRACT: Obesity, particularly visceral and ectopic adiposity, increases the risk of type 2 diabetes. The aim of this study was to determine if restriction of dietary carbohydrate is beneficial for body composition and metabolic health. Two studies were conducted. In the first, 69 overweight/obese men and women, 53% of whom were European American (EA) and 47% of whom were African American (AA), were provided with 1 of 2 diets (lower-fat diet: 55%, 18%, and 27% of energy from carbohydrate, protein, and fat, respectively; lower-carbohydrate diet: 43%, 18%, and 39%, respectively) for 8 wk at a eucaloric level and 8 wk at a hypocaloric level. In the second study, 30 women with polycystic ovary syndrome (PCOS) were provided with 2 diets (lower-fat diet: 55%, 18%, and 27% of energy from carbohydrate, protein, and fat, respectively; lower-carbohydrate diet: 41%, 19%, and 40%, respectively) at a eucaloric level for 8 wk in a random-order crossover design. As previously reported, among overweight/obese adults, after the eucaloric phase, participants who consumed the lower-carbohydrate vs. the lower-fat diet lost more intra-abdominal adipose tissue (IAAT) (11 ± 3% vs. 1 ± 3%; P < 0.05). After weight loss, participants who consumed the lower-carbohydrate diet had 4.4% less total fat mass. Original to this report, across the entire 16-wk study, AAs lost more fat mass with a lower-carbohydrate diet (6.2 vs. 2.9 kg; P < 0.01), whereas EAs showed no difference between diets. As previously reported, among women with PCOS, the lower-carbohydrate arm showed decreased fasting insulin (-2.8 μIU/mL; P < 0.001) and fasting glucose (-4.7 mg/dL; P < 0.01) and increased insulin sensitivity (1.06 arbitrary units; P < 0.05) and "dynamic" β-cell response (96.1 · 10(9); P < 0.001). In the lower-carbohydrate arm, women lost both IAAT (-4.8 cm(2); P < 0.01) and intermuscular fat (-1.2 cm(2); P < 0.01). In the lower-fat arm, women lost lean mass (-0.6 kg; P < 0.05). Original to this report, after the lower-carbohydrate arm, the change in IAAT was positively associated with the change in tumor necrosis factor α (P < 0.05). A modest reduction in dietary carbohydrate has beneficial effects on body composition, fat distribution, and glucose metabolism. This trial was registered at as NCT00726908 and NCT01028989. © 2015 American Society for Nutrition.
    Journal of Nutrition 01/2015; 145(1):177S-83S. DOI:10.3945/jn.114.195065 · 4.23 Impact Factor
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    ABSTRACT: The role of vitamin D in cardiovascular health remains debated as results have been inconsistent. Previous studies have not considered the bioavailability of 25-hydroxy vitamin D [25(OH)D]. Objectives of our study were to investigate the association between serum concentrations of total, free and bioavailable 25(OH)D and independent predictors of cardiovascular risk such as flow mediated dilatation (FMD) and augmentation index (AIx). This cross-sectional study included 47 post-menarchal, adolescent females [31 African American (AA) and 16 European American (EA)]. AIx was standardized to a heart rate of 75 beats/min (AIx75). Free and bioavailable 25(OH)D concentrations were calculated from standard formulas. Mean age of the participants was 15.8±1.4 years and mean body mass index was 23.1±4.0 kg/m2. Serum total 25(OH)D was not associated with FMD, but was positively associated with AIx75 in the adjusted model (rho = 0.4, P = 0.03). AIx75 was positively associated with bioavailable 25(OH)D (rho = 0.4, P = 0.004) and free 25(OH)D (rho = 0.4, P = 0.009) and the associations persisted after adjusting for covariates. In race-specific analyses, total, free and bioavailable 25(OH)D were strongly positively associated with AIx75 in AA (rho = 0.5, 0.4, 0.4, respectively), which persisted even after adjusting for covariates. Whereas in EA there was an inverse association between total 25(OH)D and AIx75 in EA (rho = -0.6), which attenuated after adjusting for covariates. Circulating total, free and bioavailable 25(OH)D were associated with arterial stiffness in adolescent girls, and these associations were race dependent. Notwithstanding, the implications of associations between vascular function indices and 25(OH)D remains unclear.
    PLoS ONE 12/2014; 9(12):e114689. DOI:10.1371/journal.pone.0114689 · 3.53 Impact Factor
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    ABSTRACT: We conducted a study designed to evaluate whether the benefits of intentional weight loss exceed the potential risks in a group of community-dwelling obese older adults who were at increased risk for cardiometabolic disease. The CROSSROADS trial used a prospective randomized controlled design to compare the effects of changes in diet composition alone or combined with weight loss with an exercise only control intervention on body composition and adipose tissue deposition (Specific Aim #1: To compare the effects of changes in diet composition alone or combined with weight loss with an exercise only control intervention on body composition, namely visceral adipose tissue), cardiometabolic disease risk (Specific Aim #2: To compare the effects of a change in diet composition alone or combined with weight loss with an exercise only control intervention on cardiometabolic disease risk), and functional status and quality of life (Specific Aim #3: To compare the effects of a change in diet composition alone or combined with weight loss with an exercise only control intervention on functional status and quality of life). Participants were randomly assigned to one of three groups: Exercise Only (Control) Intervention, Exercise + Diet Quality + Weight Maintenance Intervention, or Exercise + Diet Quality + Weight Loss Intervention. CROSSROADS utilized a lifestyle intervention approach consisting of exercise, dietary, and behavioral components. The development and implementation of the CROSSROADS protocol, including a description of the methodology, detailing specific elements of the lifestyle intervention, assurances of treatment fidelity, and participant retention; outcome measures and adverse event monitoring; as well as unique data management features of the trial results, are presented in this article.
    11/2014; 33(4):376-400. DOI:10.1080/21551197.2014.965993
  • The Journal of Headache and Pain 09/2014; 15(Suppl 1):E25-E25. DOI:10.1186/1129-2377-15-S1-E25 · 3.28 Impact Factor
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    ABSTRACT: The inability of current recommendations to control the epidemic of diabetes, the specific failure of the prevailing low-fat diets to improve obesity, cardiovascular risk, or general health and the persistent reports of some serious side effects of commonly prescribed diabetic medications, in combination with the continued success of low-carbohydrate diets in the treatment of diabetes and metabolic syndrome without significant side effects, point to the need for a reappraisal of dietary guidelines. The benefits of carbohydrate restriction in diabetes are immediate and well documented. Concerns about the efficacy and safety are long term and conjectural rather than data driven. Dietary carbohydrate restriction reliably reduces high blood glucose, does not require weight loss (although is still best for weight loss), and leads to the reduction or elimination of medication. It has never shown side effects comparable with those seen in many drugs. Here we present 12 points of evidence supporting the use of low-carbohydrate diets as the first approach to treating type 2 diabetes and as the most effective adjunct to pharmacology in type 1. They represent the best-documented, least controversial results. The insistence on long-term randomized controlled trials as the only kind of data that will be accepted is without precedent in science. The seriousness of diabetes requires that we evaluate all of the evidence that is available. The 12 points are sufficiently compelling that we feel that the burden of proof rests with those who are opposed. (C) 2015 The Authors. Published by Elsevier Inc.
    Nutrition 07/2014; 31(1). DOI:10.1016/j.nut.2014.06.011 · 3.05 Impact Factor
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    ABSTRACT: Objective To determine if consumption of a reduced-carbohydrate (CHO) diet would result in preferential loss of adipose tissue under eucaloric conditions, and whether changes in adiposity were associated with changes in postprandial insulin concentration. Methods In a crossover-diet intervention, 30 women with PCOS consumed a reduced-CHO diet (41:19:40%energy from CHO:protein:fat) for 8 weeks and a standard diet (55:18:27) for 8 weeks. Body composition by DXA and fat distribution by CT were assessed at baseline and following each diet phase. Insulin AUC was obtained from a solid meal test (SMT) during each diet phase. Results Participants lost 3.7% and 2.2% total fat following the reduced-CHO diet and STD diet, resp. (p< 0.05 for difference between diets). The reduced-CHO diet induced a decrease in subcutaneous-abdominal, intra-abdominal, and thigh-intermuscular adipose tissue (-7.1%, -4.6%, and -11.5%, resp.), and the STD diet induced a decrease in total lean mass. Loss of fat mass following the reduced CHO diet arm was associated with lower insulin AUC (p< 0.05) during the SMT. Conclusions In women with PCOS, consumption of a diet lower in CHO resulted in preferential loss of fat mass from metabolically harmful adipose depots, whereas a diet high in CHO appeared to promote repartitioning of lean mass to fat mass.
    Metabolism 07/2014; 63(10). DOI:10.1016/j.metabol.2014.07.007 · 3.61 Impact Factor
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    ABSTRACT: To test the hypothesis that a breakfast meal with high carbohydrate/low fat results in an earlier increase in postprandial glucose and insulin, a greater decrease below baseline in postprandial glucose, and an earlier return of appetite, compared to a low carbohydrate/high fat meal. Overweight but otherwise healthy adults (n=64) were maintained on one of two eucaloric diets: high carbohydrate/low fat (HC/LF; 55:27:18% kcals from carbohydrate: fat: protein) versus low carbohydrate/high fat (LC/HF; 43:39:18% kcals from carbohydrate: fat: protein). After 4 weeks of acclimation to the diets, participants underwent a meal test during which circulating glucose and insulin and self-reported hunger and fullness, were measured before and after consumption of breakfast from their assigned diets. The LC/HF meal resulted in a later time at the highest and lowest recorded glucose, higher glucose concentrations at 3 and 4 hours post-meal, and lower insulin incremental area under the curve. Participants consuming the LC/HF meal reported lower appetite 3 and 4 hours following the meal, a response that was associated with the timing of the highest and lowest recorded glucose. Modest increases in meal arbohydrate content at the expense of fat content may facilitate weight gain over the long-term by contributing to an earlier rise and fall of postprandial glucose concentrations and an earlier return of appetite.
    Appetite 05/2014; DOI:10.1016/j.appet.2014.04.031 · 2.52 Impact Factor
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    ABSTRACT: Previous studies suggest that circulating 25(OH)D may favorably influence cardiorespiratory fitness and fat oxidation. However, these relationships have not been examined in older adult women of different ethnic groups. The objectives of this study were to determine whether serum 25(OH)D is related to cardiovascular fitness (VO2max) in sedentary women ages ≥60 years and to determine whether these associations differ between African Americans (AA) and European Americans (EA). A secondary aim was to determine whether serum 25(OH)D is correlated with respiratory quotient (RQ) during submaximal exercise. This cross-sectional analysis included 67 AA and EA women ages 60-74 years. VO2max was measured by a modified Bruce graded treadmill protocol, and measurements were adjusted for percent fat and lean body mass assessed by air displacement plethysmography. Indirect calorimetry was used to measure RQ at rest and during four submaximal exercise tests. Fasting blood samples were obtained to quantify serum 25(OH)D. Serum 25(OH)D was associated with VO2max (ml/kg LBM/min) independent of percent body fat (r = 0.316, p = 0.010). However, subgroup analysis revealed that this relationship was specific to AA (r = 0.727, p = 0.005 for AA; r = 0.064, p = 0.643 for EA). In all subjects combined, 25(OH)D was inversely correlated (p < 0.01) with all measures of submaximal RQ. Higher serum 25(OH)D was associated with greater cardiorespiratory fitness in older adult AA women. Among both AA and EA, inverse associations between serum 25(OH)D and RQ suggest that women with higher levels of circulating vitamin D also demonstrated greater fat oxidation during submaximal exercise.
    Endocrine 02/2014; 47(3). DOI:10.1007/s12020-014-0210-5 · 3.53 Impact Factor
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    ABSTRACT: Context: We hypothesized that similar to the coordinated homeostatic regulation of most hormones, the concentration of free and bioavailable 25-hydroxy vitamin D [25(OH)D] will be tightly controlled by total 25(OH)D and vitamin D binding protein (VDBP); and, that the VDBP concentrations will be associated with insulin resistance status. Objective: Our primary objective was to investigate associations between total, free and bioavailable 25(OH)D and VDBP. We also evaluated the relationships of VDBP with insulin resistance indices. Study design was cross sectional in the setting of a University children's hospital. The relative concentration of bioavailable 25(OH)D to total 25(OH)D [bioavailable 25(OH)D /total 25(OH)D was expressed as a percentage [% bioavailable 25(OH)D]. Results: Subjects were 47, post menarchal, female adolescents, mean age 15.8 ± 1.4 years, mean BMI 23.1 ± 4.0 kg/m(2). Total 25(OH)D was strongly associated with VDBP (rho = 0.57, P = <0.0001). At lower total 25(OH)D concentrations, the concentration of bioavailable 25(OH)D relative to total 25(OH)D was higher (23.8% vs. 14.9%, P<0.0001), whereas the relative concentration of free 25(OH)D was similar (P=0.44). VDBP was inversely associated with fasting insulin (rho=-0.51, P=0.0003) and HOMA-IR (rho=-0.45, P=0.002), and positively with WBISI (rho=0.33, P=0.02); these relationships were persisted after adjusting for percent fat and attenuated after adjusting for race. Conclusion: Our data suggest that, VDBP concentrations are regulated by total 25(OH)D levels to maintain adequate concentrations of bioavailable 25(OH)D. VDBP concentrations are inversely associated with hyperinsulinemia and insulin resistance.Background.
    The Journal of Clinical Endocrinology and Metabolism 10/2013; 99(1). DOI:10.1210/jc.2013-2452 · 6.31 Impact Factor
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    ABSTRACT: Little is known about early coincidental changes in bone and vascular properties, particularly in the context of skeletal anabolism (puberty) versus relative equilibrium (young adulthood). We aimed to determine if subclinical markers of vascular function were associated with bone mineral content (BMC) and to evaluate the contribution of systemic factors in healthy females ages 14-42 years. Endothelial function was assessed by flow mediated dilatation (FMD), arterial stiffness by pulse wave velocity (PWV) and augmentation index (AIx), blood pressure (BP) by sphygmomanometer, BMC by DXA, and systemic factors by fasting blood draw. General linear models controlled for age, race and height indicated a positive association between systolic BP (SBP) and BMC independent of systemic factors. When stratified by age using 19 years as a cut-point, there was an inverse relationship between AIx75 in adolescents with insulin (P<0.10) or inflammatory markers (P<0.10) in statistical models. Conversely, there was a positive relationship between BMC and both PWV and AIx75 in young adults (P<0.05). The link between bone and the vasculature may be life stage-dependent. In the context of a less dynamic microenvironment in young adult females, metabolic factors appear to moderate less of an effect of hemodynamic properties on the skeleton relative to adolescents.
    09/2013; 1(3). DOI:10.4248/BR201303007
  • Barbara A Gower, Krista Casazza
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    ABSTRACT: Historically, obesity was thought to be advantageous for maintaining healthy bones due to the greater bone mineral density observed in overweight individuals. However, recent observations of increased fracture in some obese individuals have led to concern that common metabolic complications of obesity, such as type 2 diabetes, metabolic syndrome, impaired glucose tolerance, insulin resistance, hyperglycemia, and inflammation may be associated with poor bone health. In support of this hypothesis, greater visceral fat, a hallmark of insulin resistance and metabolic syndrome, is associated with lower bone mineral density. Research is needed to determine if and how visceral fat and/or poor metabolic health are causally associated with bone health. Clinicians should consider adding a marker metabolic health, such as waist circumference or fasting plasma glucose concentration, to other known risk factors for osteoporosis and fracture.
    Journal of Clinical Densitometry 09/2013; 16(4). DOI:10.1016/j.jocd.2013.08.010 · 1.60 Impact Factor
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    ABSTRACT: OBJECTIVE: Qualitative aspects of diet may affect body composition and propensity for weight gain or loss. We tested the hypothesis that consumption of a relatively low glycemic load (GL) diet would reduce total and visceral adipose tissue under both eucaloric and hypocaloric conditions. DESIGN AND METHODS: Participants were 69 healthy overweight men and women. Body composition was assessed by DXA and fat distribution by CT scan at baseline, after 8 weeks of a eucaloric diet intervention, and after 8 weeks of a hypocaloric (1000 kcal/day deficit) diet intervention. Participants were provided all food for both phases, and randomized to either a low GL diet (<45 points per 1000 kcal; n = 40) or high GL diet (>75 points per 1000 kcal, n = 29). RESULTS: After the eucaloric phase, participants who consumed the low GL diet had 11% less intra-abdominal fat (IAAT) than those who consumed the high GL diet (P < 0.05, adjusted for total fat mass and baseline IAAT). Participants lost an average of 5.8 kg during the hypocaloric phase, with no differences in the amount of weight loss with diet assignment (P = 0.39). Following weight loss, participants who consumed the low GL diet had 4.4% less total fat mass than those who consumed the high GL diet (P < 0.05, adjusted for lean mass and baseline fat mass). CONCLUSIONS: Consumption of a relatively low GL diet may affect energy partitioning, both inducing reduction in IAAT independent of weight change, and enhancing loss of fat relative to lean mass during weight loss.
    Obesity 06/2013; 21(6). DOI:10.1002/oby.20191 · 4.39 Impact Factor
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    ABSTRACT: Context:Animal studies indicate that osteocalcin (OC), particularly the undercarboxylated isoform (unOC), affects insulin sensitivity and secretion, but definitive data from humans are lacking.Objective:To determine if total OC and unOC are independently associated with insulin sensitivity and β-cell response in overweight/obese adults; whether glucose tolerance status affects these associations; and whether associations are independent of bone formation, as reflected in procollagen type 1 amino propeptide (P1NP).Design, Setting, and Participants:This was a cross-sectional study conducted at a University Research Center involving 63 overweight/obese adults with normal (n=39) or impaired fasting glucose (IFG, n=24).Main outcome measures:Serum concentrations of total/undercarboxylated OC and P1NP were assessed by RIA; insulin sensitivity was determined by intravenous glucose tolerance test (SI-IVGTT), liquid meal test (SI-meal), and HOMA-IR; β-cell response to glucose (basal, PhiB; dynamic, PhiD; static, PhiS; and total, PhiTOT) was derived using C-peptide modeling of meal test data; and intra-abdominal adipose tissue (IAAT) was measured using CT scanning.Results:Multiple linear regression, adjusting for IAAT and P1NP, revealed that total OC was positively associated with SI-IVGTT (P<0.01) in the total sample. OC was not associated with SI-meal or HOMA-IR. In participants with IFG, unOC was positively associated with PhiS and PhiTOT (P<0.05) independent of insulin sensitivity.Conclusions:In overweight/obese individuals, total OC may be associated with skeletal muscle but not hepatic insulin sensitivity. unOC is uniquely associated with β-cell function only in individuals with IFG. Further research is needed to probe the causal inference of these relationships, and to determine if indirect nutrient sensing pathways underlie these associations.
    The Journal of Clinical Endocrinology and Metabolism 04/2013; 98(7). DOI:10.1210/jc.2013-1203 · 6.31 Impact Factor
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    ABSTRACT: OBJECTIVE: To assess ictal adiponectin (ADP) levels before and after acute abortive treatment in women episodic migraineurs. METHODS: Peripheral blood specimens were collected from women episodic migraineurs before and after acute abortive treatment with sumatriptan/naproxen sodium vs placebo. Univariate and multivariate models were utilized to examine the relationship between serum total ADP (T-ADP), ADP oligomers (high molecular weight [HMW], middle molecular weight, and low molecular weight [LMW]-ADP), and ADP ratio levels and pain severity. Paired t-tests and random intercept longitudinal models were utilized to assess the mean changes in T-ADP, ADP oligomers, and ratios over time in treatment responders and nonresponders. RESULTS: Twenty participants (11 responders, 9 nonresponders) have been studied to date. In all participants, increases in the HMW : LMW ADP ratio were associated with an increase in pain severity. For every 1 point increase in the HMW : LMW ratio, pain severity increased by 0.22 (Confidence Interval [CI]: 0.07, 0.37; P = .004). In contrast, for every 0.25 μg/mL increase in LMW-ADP, pain severity decreased by 0.20 (CI: -0.41, -0.002; P = .047). In treatment responders, T-ADP levels were reduced at 30 minutes (12.52 ± 3.4; P = .03), 60 minutes (12.32 ± 3.2; P = .017), and 120 minutes (12.65 ± 3.2; P = .016) after treatment as compared with onset (13.48 ± 3.8). Additionally, in responders, the HMW : LMW ratio level was greater at pain onset (3.70 ± 1.9 μg/mL) as compared with nonresponders (2.29 ± 0.71 μg/mL), P = .050. Responders also showed a decrease in the HMW : LMW ratio at 60 minutes (2.37 ± 1.1; P = .002) and 120 minutes (2.76 ± 1.4; P = .02) after treatment as compared with onset (3.70 ± 1.9). These changes in responders remained significant after adjusting for covariates, including measured body mass index (m-BMI). Although nonresponders showed no significant changes in unadjusted T-ADP or ADP oligomer or ratio levels, the HMW : LMW ratio was increased in nonresponders after adjustments (P = .025). CONCLUSION: In this pilot study of women episodic migraineurs, the HMW : LMW ADP ratio level was associated with migraine severity and predictive of acute treatment response. ADP and the HMW : LMW ratio of ADP represent potential novel biomarkers and drug targets for episodic migraine.
    Headache The Journal of Head and Face Pain 03/2013; 53(3):474-490. DOI:10.1111/head.12071 · 3.19 Impact Factor
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    ABSTRACT: Heavier individuals have higher bone mineral density (BMD) than individuals of lower body weight, but it is unclear whether BMD changes in proportion to body weight during weight loss. This study compared BMD relative to body weight following a six month weight loss program and a one year weight maintenance phase in premenopausal women and determined whether African American (AA) and European-American (EA) women's BMD respond similarly during weight loss. Premenopausal women (n=115, 34 ± 5 yrs.) were evaluated in an overweight state (BMI between 27-30 kg/m(2) ), following an 800 kcal/day diet/exercise program designed to reduce BMI <25 kg/m(2) , and one year following weight loss. Results indicated that BMD relative to body weight (Z-scores) increased after weight loss, but decreased during the one year weight maintenance phase. All one year follow up BMD Z-scores were increased (except L1) compared to baseline measurements (P < 0.05). These sites included the hip neck (0.088, P=0.014), total hip (0.099, P=0.001), L2 (0.127, P=0.013), L3 (0.135, P=0.014), and L4 (0.199, P=0.002). AAs had significantly higher absolute BMD at all sites (P<0.05) compared to EAs, but no time by race interactions were evident during weight loss (except in L3). These results may indicate that weight loss is safe with regard to bone health for overweight premenopausal women.
    Obesity 03/2013; 21(3). DOI:10.1002/oby.20052 · 4.39 Impact Factor
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    ABSTRACT: WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: The assessment of insulin sensitivity and secretion provides useful information about the metabolic health of an individual. Invasive methods are needed to assess insulin sensitivity and secretion but these are difficult to perform in young children. WHAT THIS STUDY ADDS: The relatively less invasive liquid meal test provided an estimate of insulin sensitivity in a pediatric population that was comparable to that obtained via a more invasive frequently-sampled intravenous glucose tolerance test (FSIGT). Both meal- and FSIGT-derived estimates of insulin sensitivity were inversely associated with children's adiposity. The meal-derived estimate of insulin sensitivity, but not that derived by the FSIGT, was associated with fasting insulin and triglyceride concentrations. Insulin sensitivity and β-cell function are useful indices of metabolic disease risk but are difficult to assess in young children because of the invasive nature of commonly used methodology. A meal-based method for assessing insulin sensitivity and β-cell function may at least partially alleviate concerns. The objectives of this study were to: (i) determine the association of insulin sensitivity assessed by liquid meal test with that determined by an insulin-modified frequently sampled intravenous glucose tolerance test (FSIGT); (ii) examine the association of insulin sensitivity derived from each test with measures of body composition, fat distribution and metabolic health (lipids, fasting insulin and glucose, and surrogate indices of insulin sensitivity); and (iii) examine the associations of indices of β-cell function derived from each test with total and regional adiposity. Forty-seven children (7-12 years) underwent both a liquid meal test and an FSIGT. The insulin sensitivity index derived from the meal test (SI-meal) was positively associated with that from the FSIGT (SI-FSIGT; r = 0.63; P < 0.001), and inversely with all measures of insulin secretion derived from the meal test. Both SI-meal and SI-FSIGT were associated with measures of total and regional adiposity. SI-meal, but not SI-FSIGT, was associated with triglycerides and fasting insulin, after adjusting for ethnicity, gender, pubertal stage and fat mass. Basal insulin secretion measured during the meal test was positively associated with all measures of adiposity, independent of insulin sensitivity. In conclusion, a liquid meal offers a valid and sensitive means of assessing insulin sensitivity and β-cell responsivity in young children.
    Pediatric Obesity 02/2013; 9(2). DOI:10.1111/j.2047-6310.2013.00147.x · 2.42 Impact Factor
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    ABSTRACT: OBJECTIVE: Diet-induced reduction in circulating insulin may be an attractive non-pharmacological treatment for women with polycystic ovary syndrome (PCOS) among whom elevated insulin may exacerbate symptoms by stimulating testosterone synthesis. This study was designed to determine if a modest reduction in dietary carbohydrate (CHO) content affects β-cell responsiveness, serum testosterone concentration, and insulin sensitivity in women with PCOS. DESIGN: In a cross-over design, two diets ("Standard," STD, 55:18:27% energy from carbohydrate:protein:fat; lower-carbohydrate, 41:19:40) were provided for 8 weeks in random order with a 4-week wash-out between. PATIENTS: 30 women with PCOS. MEASUREMENTS: β-cell responsiveness assessed as the C-peptide response to glucose during a liquid meal test; insulin sensitivity from insulin and glucose values throughout the test; insulin resistance (HOMA-IR); and total testosterone by immunoassay. RESULTS: Paired t-test indicated that the lower-CHO diet induced significant decreases in basal β-cell response (PhiB), fasting insulin, fasting glucose, HOMA-IR, total testosterone, and all cholesterol measures, and significant increases in insulin sensitivity and dynamic ("first phase") β-cell response. The STD diet induced a decrease in HDL-C and an increase in the total cholesterol-to-HDL-C ratio. Across all data combined, the change in testosterone was positively associated with the changes in fasting insulin, PhiB, and insulin AUC (P<0.05). CONCLUSIONS: In women with PCOS, modest reduction in dietary CHO in the context of a weight-maintaining diet has numerous beneficial effects on the metabolic profile that may lead to a decrease in circulating testosterone. © 2013 Blackwell Publishing Ltd.
    Clinical Endocrinology 02/2013; 79(4). DOI:10.1111/cen.12175 · 3.35 Impact Factor
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    ABSTRACT: What is already known about this subject Children born to women with gestational diabetes have greater risk for obesity. Obesity in adults and children is associated with blunted postprandial gut hormone responses. What this study adds Children of women with gestational diabetes have a blunted postprandial response of GLP-1. Children of women with gestational diabetes have high fasting PYY concentrations. BACKGROUND: Intrauterine exposure to gestational diabetes mellitus (GDM) increases risk for obesity. Obesity is associated with a blunted postprandial gut hormone response, which may impair satiety and thereby contribute to weight gain. The postprandial response of gut hormones among children of women with GDM has not previously been investigated. OBJECTIVE: To examine whether children of women with GDM have suppressed peptide-tyrosine-tyrosine (PYY) and glucagon-like-peptide-1 (GLP-1), and higher concentrations of ghrelin, following a meal challenge. A secondary objective was to investigate associations of these hormones with children's free-living energy intake. METHODS: Children (n = 42) aged 5-10 years were stratified into two groups: offspring of GDM mothers (OGD) and of non-diabetic mothers (CTRL). Body composition was measured by dual-energy X-ray absorptiometry, and circulating PYY, GLP-1 and total ghrelin were measured during a liquid meal challenge. Energy intake was assessed by three 24-h diet recalls. RESULTS: Between-groups analyses of fasting and incremental area under the curve (AUC) found no differences in ghrelin. Incremental AUC for GLP-1 was greater among the CTRL vs. OGD (P < 0.05), and fasting PYY, but not incremental AUC, was higher among OGD vs. CTRL (P < 0.01). Associations of fasting and incremental AUC for each gut hormone with children's usual energy intake did not differ significantly by group. CONCLUSIONS: Further research is needed to more fully examine the potential role of postprandial GLP-1 suppression and high-fasting PYY concentrations on the feeding behaviour and risk for obesity among children exposed to GDM in utero.
    Pediatric Obesity 01/2013; 9(1). DOI:10.1111/j.2047-6310.2012.00140.x · 2.42 Impact Factor

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5k Citations
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  • 1994–2015
    • University of Alabama at Birmingham
      • • Department of Nutrition Sciences
      • • Department of Genetics
      Birmingham, Alabama, United States
  • 2014
    • Georgia Regents University
      Augusta, Georgia, United States
  • 1993–2011
    • University of Delaware
      • Department of Biological Sciences
      Delaware, United States
  • 2001–2006
    • University of Southern California
      • Department of Preventive Medicine
      Los Angeles, CA, United States