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Chocolate with high Cocoa content as a weight-loss accelerator
Abstract
Background: Although the focus of scientific studies on the beneficial properties of chocolate with a high cocoa content has increased in recent years, studies determining its importance for weight regulation, in particular within the context of a controlled dietary measure, have rarely been conducted. Methodology: In a study consisting of several weeks, we divided men and women between the ages of 19-67 into three groups. One group was instructed to keep a low-carb diet and to consume an additional daily serving of 42 grams of chocolate with 81% cocoa content (chocolate group). Another group was instructed to follow the same low-carb diet as the chocolate group, but without the chocolate intervention (low-carb group). In addition, we asked a third group to eat at their own discretion, with unrestricted choice of food. At the beginning of the study, all participants received extensive medical advice and were thoroughly briefed on their respective diet. At the beginning and the end of the study, each participant gave a blood sample. Their weight, BMI, and waist-to-hip ratio were determined and noted. In addition to that, we evaluated the Giessen Subjective Complaints List. During the study, participants were encouraged to weigh themselves on a daily basis, assess the quality of their sleep as well as their mental state, and to use urine test strips. Result: Subjects of the chocolate intervention group experienced the easiest and most successful weight loss. Even though the measurable effect of this diet occurred with a delay, the weight reduction of this group exceeded the results of the low-carb group by 10% after only three weeks (p = 0.04). While the weight cycling effect already occurred after a few weeks in the low-carb group, with resulting weight gain in the last fifth of the observation period, the chocolate group experienced a steady increase in weight loss. This is confirmed by the evaluation of the ketone reduction. Initially, ketone reduction was much lower in the chocolate group than in the low-carb peer group, but after a few weeks, the situation changed. The low-carb group had a lower ketone reduction than in the previous period, they reduced 145 mg/dl less ketones, whereas the chocolate group had an average reduction of an additional 145mg/dl. Effects were similarly favorable concerning cholesterol levels, triglyceride levels, and LDL cholesterol levels of the chocolate group. Moreover, the subjects of the chocolate group found a significant improvement in their well-being (physically and mentally). The controlled improvement compared to the results of the low-carb group was highly significant (p<0.001). Conclusion: Consumption of chocolate with a high cocoa content can significantly increase the success of weight-loss diets. The weightloss effect of this diet occurs with a certain delay. Long-term weight loss, however, seems to occur easier and more successfully by adding chocolate. The effect of the chocolate, the so-called "weight loss turbo," seems to go hand in hand with personal well-being, which was significantly higher than in the control groups.
... When the study was published, Bohannon and his team also produced a press release that was widely circulated and well received. Soon after the article and accompanying press release were published, the study's findings were picked up and reported by several high-profile media outlets with dramatic headlines such as 'Slim by Chocolate' and 'Why You Must Eat Chocolate Daily' (Bohannon 2015). 'Johannes Bohannon' is actually a science journalist whose real name is John Bohannon. ...
... 'Johannes Bohannon' is actually a science journalist whose real name is John Bohannon. In a personal account published later, Bohannon (2015) described the article as an intentional hoax that he and his coauthors had carried out in response to a request from a German film crew who was making a documentary on the 'junk-science diet industry'. To implement the hoax, Bohannon and his coauthors created an 'Institute of Diet and Health' that existed only as a website, and he 1 The retracted article is no longer available at the publisher's website. ...
... Cocoa_content_as_a_weight-loss_accelerator.pdf assumed the name 'Johannes Bohannon' as lead author of the study. Bohannon (2015) narrates the rest of the events as follows: ...
In today’s ‘publish or perish’ academic setting, the institutional prizing of quantity over quality has given rise to and perpetuated the dilemma of predatory publishing. Upon a close examination, however, the definition of ‘predatory’ itself becomes slippery, evading neat boxes or lists which might seek to easily define and guard against it. This volume serves to foreground a nuanced representation of this multifaceted issue. In such a rapidly evolving landscape, this book becomes a field guide to its historical, political, and economic aspects, presenting thoughtful interviews, legal analysis and original research. Case studies from both European-American and non-European-American stakeholders emphasize the worldwide nature of the challenge faced by researchers of all levels.
This coauthored book is structured into both textual and supplemental materials. Key takeaways, discussion questions, and complete classroom activities accompanying each chapter provide opportunities for engagement and real-world applications of these concepts.
Crucially relevant to early career researchers and the senior faculty, library scholars, and administrators who mentor and support them, 'The Predatory Paradox: Ethics, Politics, and Practices in Contemporary Scholarly Publishing' offers practical recommendations for navigating the complex and often contradictory advice currently available. University instructors and teaching faculty will also find the reading essential in order to properly prepare both graduate and undergraduate students for the potential pitfalls endemic to scholarly publishing.
... Health status was assessed based on several criteria, including anthropometrical data. Excessive chocolate consumption is regularly seen as a hazard for weight control [33,34], although anti-obesity actions of cocoa have been reported [35][36][37]. We found that even though no significant changes in BMI were found among the three student groups, a lower proportion of overweight subjects appeared in the moderate consumer group and a higher proportion of underweight subjects appeared in the high consumer group. ...
... Regarding the health questionnaire, the university students reported, logically, a good health status, far away from suffering chronic diseases involving neoplasm and cardiovascular diseases, the main causes of death in the Spanish population [37]. The most frequently reported chronic conditions by university students in the health questionnaire were headaches and migraines. ...
Due to its polyphenol content, cocoa’s potential health effects are attracting much attention, showing, among other things, cardioprotective, anti-inflammatory, anti-obesity, and neuroprotective actions. However, there is very limited information regarding the effect of cocoa on human immunity. This study aimed to establish the relationship between cocoa consumption and health status, focusing on physical activity habits and allergy prevalence in young people. For this, a sample of 270 university students was recruited to complete a food frequency questionnaire, the International Physical Activity Questionnaire (IPAQ), and a lifestyle and health status questionnaire. The results were analysed by classifying the participants into tertiles defined according to their cocoa consumption: low (LC), moderate (MC), and high (HC) consumers. The consumption of cocoa inversely correlated with physical activity and the MC group had significantly less chronic disease frequency than the LC group. The percentage of allergic people in the MC and HC groups was lower than that in the LC group and, moreover, the cocoa intake, especially moderate consumption, was also associated with a lower presence of allergic symptoms. Thus, from these results a positive effect of cocoa intake on allergy can be suggested in the young population.
... Cocoa and body weight: A very exciting outcome in recent human intervention studies with cocoa is that cocoa supplementation of diets did not evoke any increase in body weight or other anthropometric changes [72][73][74]. Thus, administration of diets supplemented with up to 12.5% of cocoa powder has unequivocally shown anti-obesity effects in rats [19][20][21]24,[75][76][77]. ...
... Thus, administration of diets supplemented with up to 12.5% of cocoa powder has unequivocally shown anti-obesity effects in rats [19][20][21]24,[75][76][77]. In addition, despite the fact that cocoa products commercially available are frequently high-caloric foodstuffs, they have been reported to have a similar effect in humans [72][73][74]78]. However, this anti-obesity effect of cocoa and its derivatives in humans has lately been challenged; i.e., in a prospective cohort study, Greenberg and co-workers [79] have reported a dose-response greater prospective weight gain over time after a regular chocolate consumption. ...
Type 2 Diabetes mellitus (T2D) is the most common form of diabetes and one of the most common chronic diseases. Control of hyperglycaemia by hypoglycaemic drugs is insufficient in for patients and nutritional approaches are currently being explored. Natural dietary compounds such as flavonoids, abundant in fruits and vegetables, have received broad attention because of their potential capacity to act as anti-diabetic agents. Especially cocoa flavonoids have been proved to ameliorate important hallmarks of T2D. In this review, an update of the most relevant reports published during the last decade in cell culture, animal models and human studies is presented. Most results support an anti-diabetic effect of cocoa flavonoids by enhancing insulin secretion, improving insulin sensitivity in peripheral tissues, exerting a lipid-lowering effect and preventing the oxidative and inflammatory damages associated to the disease. While it could be suggested that daily consumption of flavanols from cocoa or dark chocolate would constitute a potential preventive tool useful for the nutritional management of T2D, this recommendation should be cautious since most of commercially available soluble cocoa products or chocolates contain low amount of flavanols and are rich in sugar and calories that may aggravate glycaemic control in T2D patients.
... Once again, and more recently, another sting has come under additional scrutiny. As before, using a masqueraded name, a false institution and an email address that appeared to be valid, Bohannon et al. (2015) submitted a paper to the International Archives of Medicine (IAM) to apparently help a television reporter demonstrate "just how easy it is to turn bad science into the big headlines behind diet fads", proudly advertising that he "fooled millions into thinking chocolate helps weight loss" on the io9.com blog (Bohannon, 2015). In addition to most likely violating the guidelines of submission to IAM, Bohannon et al. used p-hacking, "which occurs when researchers collect or select data or statistical analyses until nonsignificant results become significant" (Head et al., 2015), with the objective of showing the beneficial effects of chocolate with a high content of cocoa on weight loss, as demonstrated by "significant" data, and it is for this reason that the paper was retracted (McCook, 2015;Oransky, 2015), as confirmed by the then editor-in-chief of IAM, Prof. Manuel Menendez. ...
... Once again, and more recently, another sting has come under additional scrutiny. As before, using a masqueraded name, a false institution and an email address that appeared to be valid, Bohannon et al. (2015) submitted a paper to the International Archives of Medicine (IAM) to apparently help a television reporter demonstrate "just how easy it is to turn bad science into the big headlines behind diet fads", proudly advertising that he "fooled millions into thinking chocolate helps weight loss" on the io9.com blog (Bohannon, 2015). In addition to most likely violating the guidelines of submission to IAM, Bohannon et al. used p-hacking, "which occurs when researchers collect or select data or statistical analyses until nonsignificant results become significant" (Head et al., 2015), with the objective of showing the beneficial effects of chocolate with a high content of cocoa on weight loss, as demonstrated by "significant" data, and it is for this reason that the paper was retracted (McCook, 2015;Oransky, 2015), as confirmed by the then editor-in-chief of IAM, Prof. Manuel Menendez. ...
... However, proving a causal link would mean assuming that science and journalism apply fundamentally different standards of evaluation to the question of what is to be considered true, new and relevant. Apart from numerous anecdotes, there are only a few individual experimental findings that indicate completely different standards for selecting topics [11,12]. Besides these individual cases, however, it cannot be assumed that journalism and research apply entirely different standards of evaluation. ...
The aim of this study is to reveal a robust correlation between the amount of attention international journalism devotes to scientific papers and the amount of attention scientific journals devote to the respective topics. Using a Mainstream-Media-Score (MSM) ≥ 100 (which we regard as an indicator for news media attention) from the altmetrics provider Altmetric, we link 983 research articles with 185,166 thematically similar articles from the PubMed database (which we use to operationalize attention from scientific journals). The method we use is to test whether there is a concomitant increase in scientific attention after a research article has received popular media coverage. To do so, we compare the quotient of the number of thematically similar articles published in scientific journals during the period before and after the publication of an MSM ≥ 100 article. Our main result shows that in 59 percent of cases, more thematically similar articles were published in scientific journals after a scientific paper received noteworthy news media coverage than before (p < 0.01). In this context, we neither found significant differences between various types of scientific journal (p = 0.3) nor between scientific papers that were originally published in renowned opinion-leading journals or in less renowned, non-opinion-leading journals (p = 0.1). Our findings indicate a robust correlation between the choice of topics in the mass media and in research. However, our study cannot clarify whether this correlation occurs because researchers and/or scientific journals are oriented towards public relevance (publicity effect) or whether the correlation is due to the parallelism of relevance attributions in quality journalism and research (earmark hypothesis). We infer that topics of social relevance are (more) likely to be picked up by popular media as well as by scientific journals. Altogether, our study contributes new empirical findings to the relationship between topic selection in journalism and in research.
... Questionable research practices such as phacking are way more common (60). However, frauds do occur such as the study of chocolate and weight loss by Johannes Bohannon, who caught media attention, was later retracted and possibly was published in more than one scientific journal (61,62). ...
Nutritional epidemiology has often been criticized by its inconsistency of results, these that are broadcasted to the media due to the public interest in the topic. Effect sizes in nutritional epidemiology are often small and biases are present. The cut-off of statistically significant results in the field currently is by the norm of 5%, that is, p < 0.05 equals to a positive finding. Recent evidence found that lowering this threshold makes less claims to hold true. This said, lowering the alpha level in nutritional epidemiology could reduce the scenario in the field characterized by high frequency of positive and probably implausible findings. Of course, this would require a culture shift towards encouragement of negative findings, already proposed in some fields of science.
... Prvý výskum (Bohannon, 2015;Bohannon et al., 2015) V tejto časti sa zameriame na historické a filozofické korene kvalitatívneho výskumu a od nich prejdeme k rozdielom medzi kvantitatívnym a kvalitatívnym výskumom. ...
Metodologické predmety často študentky a študenti vnímajú ako nevyhnutné zlo, niečo abstraktné, nudné, povinnú jazdu. Pričom práve metodológia je základom poznania. Je to súbor nástrojov, ktorý nám umožní poznanie vytvárať, ale zároveň aj odlišovať dobrú vedu od priemernej či mizernej. Je ideálnou vakcináciou proti pandémii dezinformácií. Prístup tejto učebnice kvalitatívnych metód sa odvíja od legendárnej učebnice všeobecnej metodológie Miroslava Dismana s názvom Jak se vyrábí sociologická znalost. Aj táto kniha si kladie za cieľ vysvetliť základné princípy tvorby poznania, a vtiahnuť čitateľov a čitateľky do fascinujúceho sveta výskumu. Pred každou kapitolou učebnica odporúča preštudovať jeden výskumný text, na ktorý potom text kapitoly odkazuje. Texty sú v rozsahu od niekoľkých strán cez štandardný vedecký článok po kompletnú knihu; tri sú v slovenčine, tri v češtine a tri v angličtine. Celkovou ambíciou knihy je poskytnúť solídny základ metodológie kvalitatívneho výskumu pre študentov a študentky bakalárskeho stupňa štúdia psychológie a príbuzných odborov.
https://uniba.sk/o-univerzite/fakulty-a-dalsie-sucasti/vydavatelstvo-uk/studijna-literatura-z-nasej-produkcie/
... Three studies did not assess differences in weight between arms pre/post, and five studies (33%) reported significant decreases in weight. Of the trials noting a low risk of bias, two studies reported significant weight loss (ranging from −1.3 kg to −3.6 kg) (78,79), whereas the other two were nonsignificant (80,81) (Supporting Information Tables S9A-D). ...
Objective
Dietary supplements and alternative therapies are commercialized as a panacea for obesity/weight gain as a result of the minimal regulatory requirements in demonstrating efficacy. These products may indirectly undermine the value of guideline-driven obesity treatments. Included in this study is a systematic review of the literature of purported dietary supplements and alternative therapies for weight loss.
Methods
A systematic review was conducted to evaluate the efficacy of dietary supplements and alternative therapies for weight loss in participants aged ≥18 years. Searches of Medline (PubMed), Cochrane Library, Web of Science, CINAHL, and Embase (Ovid) were conducted. Risk of bias and results were summarized qualitatively.
Results
Of the 20,504 citations retrieved in the database search, 1,743 full-text articles were reviewed, 315 of which were randomized controlled trials evaluating the efficacy of 14 purported dietary supplements, therapies, or a combination thereof. Risk of bias and sufficiency of data varied widely. Few studies (n = 52 [16.5%]) were classified as low risk and sufficient to support efficacy. Of these, only 16 (31%) noted significant pre/post intergroup differences in weight (range: 0.3-4.93 kg).
Conclusions
Dietary supplements and alternative therapies for weight loss have a limited high-quality evidence base of efficacy. Practitioners and patients should be aware of the scientific evidence of claims before recommending use.
... Medialną egzemplifikacją tego typu działania jest słynna prowokacja, która zyskała duży rozgłos, a która ma szczególnie istotne znaczenie w kontekście rozważanego w tym tekście "problemu frajera". Otóż w 2015 roku światową prasę obiegła informacja, że "czekolada pomaga schudnąć" [Bohannon et al. 2015] 4 . Wniosek ten został wyprowadzony na podstawie badań wykonanych przez "Instytut Zdrowia i Diety". ...
The purpose of this article is primarily to introduce the topic of scientific uncertainty to the wider context of economics and management. Scientific uncertainty is one of the manifestations of irreducible uncertainty and reflection on it should enable better decision making. An entity that bases its operation on current scientific research, which depreciates over time and ultimately leads to erroneous decisions, is referred to as the “loser”. The text indicates estimation of potential scale of this problem supplemented by an outline of sociological difficulties identified in the analysis of the process of building scientific statements. The article ends with a sketch of the answer to the question “how to act in the context of scientific uncertainty?”.
... Moreover, cocoa/ chocolate consumption also has beneficial effects on satiety, cognitive function, and mood. [4,5,15]. Studies on the effect of chocolate on metabolism of carbohydrate and Insulin Resistance reported that the possible mechanisms of action based on polyphenols content of chocolate which cause inhibition of carbohydrate digestion and glucose absorption, stimulation of insulin secretion, modulation of glucose release from the liver, activation of insulin receptors and glucose uptake in the insulin sensitive tissues, and modulation of intracellular signaling pathways and gene expression. ...
... There are examples from the food industry where several food companies such as Mars Inc., Nestle, Barry Callebaut and Hersheys, who are amongst the world's biggest producers of chocolate, have funded research studies exploring the health benefits of cocoa. 98% of all studies funded by Mars have been shown to have a beneficial effect on health, and findings have made newspaper headlines claiming the health benefits of chocolate, that are purported to reduce and even reverse age-related cognitive degeneration, promote weight loss and lower blood pressure (Sokolov et al 2013, Bohannon et al 2015, Grassi et al 2005. Claims that chocolate could reverse cognitive decline were based on the findings of a study published in Nature Neuroscience (Brickman et al 2014). ...
Health for the many, and particularly the health of the poorest, has often been vulnerable to the commercial interests of powerful actors such as corporations and industry. This is exemplified by the efforts of the alcohol and tobacco industries to fight public health policies aimed at curbing alcohol and tobacco consumption: through the publishing of poor science, political lobbying and finally through legal action at national and international levels. There is clear evidence that better public health cannot be achieved solely through the promotion of healthy behaviour but also requires active efforts to counter those powerful entities with vested interests in commercial profit. The manner in which the British government’s commitment to introducing a minimum unit price (MUP) for alcohol in England and Wales saw an extraordinary U-turn has been described as a cautionary tale of the power of the alcohol industry to influence public health policy. In Scotland, where the bill was passed, legislative success was followed by a five-year legal battle with alcohol industry trade bodies. MUP as a policy exposed just how strategically and earnestly industry will fight to preserve its profits and its interests at the expense of public health.
... The students, if they have done the reading, should be in agreement. We had asked them to read "Chocolate with High Cocoa Content as a Weight-Loss Accelerator" ( Bohannon et al. 2015). We put up a nice slide full of happy headlines reporting on the joy of chocolate as a new weight loss tool and we pull out the bare bones of the methods for the students. ...
Statisticians are in general agreement that there are flaws in how science is currently practiced; there is less agreement in how to make repairs. Our prescription for a Post-p < 0.05 Era is to develop and teach courses that expand our view of what constitutes the domain of statistics and thereby bridge undergraduate statistics coursework and the graduate student experience of applying statistics in research. Such courses can speed up the process of gaining statistical wisdom by giving students insight into the human propensity to make statistical errors, the meaning of a single test within a research project, ways in which p-values work and don't work as expected, the role of statistics in the lifecycle of science, and best practices for statistical communication. The course we have developed follows the story of how we use data to understand the world, leveraging simulation-based approaches to perform customized analyses and evaluate the behavior of statistical procedures. We provide ideas for expanding beyond the traditional classroom, two example activities, and a course syllabus as well as the set of statistical best practices for creating and consuming scientific information that we develop during the course.
... En otras poblaciones otros autores han mostrado un efecto similar en la reducción de peso y la obesidad abdominal (15)(16)(17)(18). Este efecto se atribuye a que el consumo de sólidos de cacao puede aumentar la sensación de saciedad principalmente por la teobromina, facilitar la adherencia de los pacientes a las dietas, modificar la digestión de grasas y carbohidratos, hacer más precoz la pérdida de peso, incrementar el gasto calórico, aumentar la captación de glucosa por el músculo esquelético y disminuir la expresión de genes encargados de síntesis de ácidos grasos. ...
Objetivo: determinar el efecto del consumo de cacao en pacientes con síndrome metabólico.
Diseño: se realizó un ensayo clínico aleatorizado, de grupos paralelos, controlado con placebo,
prospectivo, doble enmascarado.
Pacientes: personas entre 18 y 70 años de edad, no diabéticos, con resistencia a la insulina.
Intervención: durante ocho semanas se evaluó el efecto del consumo de 50 g de chocolate rico
en polifenoles, el grupo control recibió placebo.
Mediciones: al inicio y al fnal del estudio el índice HOMA-IR, circunferencia abdominal, índice
de masa corporal (IMC), glucemia y perfl lipídico.
Resultados: en el grupo experimental (n=37) hubo reducción del HOMA IR (3.24 inicial y 2.77
fnal, p= 0.02), reducción del peso corporal, en promedio 1.53 Kg (inicial 86.3 Kg y fnal de 84.8
Kg, p=0.002), disminución del IMC (34.3 Kg/m2 al inicio y 33.5 Kg/m2 al fnal, p= 0.0001) y
disminución de la cintura abdominal (inicial 106.3 cm y fnal 102.5 cm, p= 0.0001). Al comparar
los resultados del grupo tratado con chocolate negro con los del grupo control (n=38) hubo diferencia estadísticamente signifcativa en la media de cintura abdominal al fnal entre ambos grupos
(102.5 cm para el experimental y 108.0 cm para el control, p=0.01).
Conclusiones: este ensayo sugiere que el consumo de 50 gramos diarios de chocolate rico en
sólidos de cacao durante ocho semanas se asocia con una disminución de la circunferencia abdominal
y el índice HOMA-IR. Además, aporta una evidencia de mayor calidad que los estudios observacionales sobre el uso de cacao en la reducción de la obesidad, la adiposidad y en la prevención de
la enfermedad cardiometabólica en pacientes colombianos.
Registro en Clinical Trials: NCT03034291
... The value of preregistration is nicely illustrated by the study that set out to document the benefits of chocolate (Bohannon, Koch, Homm, & Driehaus, 2015). A total of 15 participants were assigned to one of three diets for 3 weeks: a low-carb diet, a low-carb diet plus a daily 1.5-ounce bar of dark chocolate, or no dietary changes (the control group). ...
Prespecification of confirmatory hypothesis tests is a useful tool that makes our statistical tests informative. On the other hand, selectively reporting studies, measures, or statistical tests renders the probability of false positives higher than the p values would imply. The bad news is that it is usually difficult to tell how much higher the probability is. Fortunately, there are enormous opportunities to improve the quality of our science by preregistering our research plans. Preregistration is a highly distinctive strength that should increase our faith in the veracity and replicability of a research result. (PsycINFO Database Record
This chapter provides an overview of pertinent Ethics topics for the field of health analytics and informatics. We first start with a brief introduction to Ethics in general and the issues pertaining to Data Ethics. This includes how to appropriately present data, and visualize results in a manner that is understandable and transparent. This will also include when to conduct a study, and when there are biases that exist in a particular study. We will then discuss the topic of inferring genetic risk from published research and the gaps that exist in genetics specifically around the lack of diversity. This lack of diversity can affect the interpretation of the genetic results in populations that have not been studied previously. We will also touch on healthcare disparities and the impact that those disparities can have on health analytics studies. This goes beyond the impact of genetics and the lack of diversity within genetic studies but touches on issues such as structural Racism and how that can impact human health and disease risk. Finally, we will discuss reproducibility and transparency of research results; this includes both the data themselves and the code and analysis scripts. After reading this chapter, you should be able to confidently answer the following questions, and understand the following material:
What are the seven deadly sins of research?
What are the ten common statistical mistakes seen in research?
How to detect a common statistical mistake in an analysis.
Understand the importance of participant consent in research.
Delve into the effects (biases and skewness) that participant characteristics can have, resulting from uneven consent across populations.
How to appropriately apply genetic findings reported in the literature (that are often conducted on non-diverse populations) in specific ancestry groups to real-world populations that are diverse.
Understand how religious beliefs can correlate with certain genetic ancestries and how this can alter findings in both genetics and health analytics methods that use clinical data.
Learn the importance of sharing data and analysis scripts for reproducibility and transparency.
Delve into the role that Artificial Intelligence can have on exacerbating existing biases.
Tips for conducting analyses that are conscious around potential biases.
This paper covers the methods for measuring rhythm and the main paradigms used to study rhythm perception. An overview of ideas about speech rhythm is provided, starting with the traditional view of isochrony and rhythm classes. Production and perception methods used to establish rhythm-class differences are presented and critically reviewed, as are a number of research practices associated with them. Recent developments leading to an alternative view of rhythm are discussed, and suggestions for pedagogical practice and future research are provided.
This chapter identifies the critical issues that must be addressed to accelerate the digital transition in the chartering market. The maritime industry is one of the pillars of global trade, where change is a constant. Again, shipping is at the cusp of a new era—one driven by data. The authors review the state-of-the-art technology that is useful to automate chartering processes. · The Fourth Industrial Revolution (or Industry 4.0) starts to change the bulk shipping markets leveraging the data flow between industrial processes in the physical and virtual world. · The internet of things accelerates data flow from things in the real world to the virtual world and enables us to control processes in real-time. Machine-to-machine communication, together with artificial intelligence, creates autonomous systems in many areas of production and logistics. Based on the gathered elements, eShip's case study was analyzed, and future steps have been defined for the data analysis in the shipping industry.
IIntroduction: The extent and nature of addiction among women of our country has been less known. For this reason, their requirements and needs are not addressed in planning process for control addiction. The present study was designed to compare the resilience with spirituality among addicted and non- addicted women. Method: In order to conduct this investigation, 45 addicted women were chosen as referents to female detoxification centers in Kerman city (Shahid Beheshti and Monadian Salamat) by means of simple randomized sampling method. Each of addicted women introduced one of her relatives, who had no background in addiction and s/he was cohort similar to her in terms of age, education, economic status, and marital status. All participants completed the demographic questions and Spirituality Questionnaire (SQ, Dunning & Parsian) and ConnerDavidson Resilience Scale (CD-RISK) Inventory. Data were analyzed by means of independent T-Test, Mann-Whitney U, Chi-Square, Fisher Test, Kruskal-Wallis test, and Spearman’s Correlation Coefficient. Findings: The addicted and non-addicted women showed significant difference in both variables of resilience and spirituality (P< 0.0001) while non- addicted women acquired higher spores in variables of resilience and spirituality. Likewise, direct significant relationship was found between two addicted and non-addicted groups in terms of resilience and spirituality in which as variable of spirituality is added, the variable of residence was also increased. Conclusion: The women with lower spirituality and resilience were more likely subjected to drug abuse therefore with strengthening spirituality and resilience in women who are exposed to addiction risk one can prevent from their possible tendency to drug abuse. Similarly, it is suggested to employ improving skills to increase resilience in the addicted women in detoxification centers including spirituality, meaning of life, and training of resilience for them.ntroduction: The extent and nature of addiction among women of
Cocoa is rich in polyphenols and methylxanthines and it has been reported that its consumption, among other properties, has beneficial effects on metabolism. This study aimed to investigate the role of theobromine in cocoa’s metabolic properties in healthy rats. In addition to morphometric measurements, biochemical markers of lipids and glucose metabolism and gene expression of molecules related to immune cells in adipose and hepatic tissues were assessed after 7 or 18 days of diet. Additionally, a metabolomic analysis was carried out at day 7. This study revealed the presence of six discriminant metabolites in plasma due to the diets. Moreover, the results showed that theobromine is the main responsible factor for cocoa’s effects on body weight gain as well as on lipid and glucose metabolism. The effects on body weight and lipids appeared as early as after 7 days of diet, whereas those affecting glucose metabolism required a longer intervention.
Das Framework for Information Literacy for Higher Education bietet neue, ganzheitliche Möglichkeiten für die Konzeption, Gestaltung und Vermittlung von Informationskompetenz. Dieser Beitrag zeigt, wie das Rahmenmodell der amerikanischen Association of College & Research Libraries (ACRL) für Schulungsangebote in Deutschland genutzt werden kann. Vorgestellt werden Aspekte aus Theorie und Forschung sowie ein adaptives Best Practice-Beispiel der Universitätsbibliothek Bamberg. Die prämierten Framework Information Literacy Lessons (FILL) liefern nachhaltige Erkenntnisse zum wissenschaftlichen Arbeiten. Das fördert Kollaboration, Kommunikation sowie forschendes Lernen und gestaltet Zukunft. Teaching Libraries können so für die digitale Informationswelt kritisch sensibilisieren.
Basic chemical engineering and processes control tools were utilized to describe the flow of news information in the Internet. Data on the news coverage of scientific articles provided by Altmetric were analyzed for six chemistry journals. The timecourse of the news was modeled using linear system dynamics, resulting in an interpretable description of the timescales involved. The model was additionally tested by applying it to the flow of nonscientific news information. An investigation on the distribution of news items per scientific article further identified online news generation as a preferential growth process. The model results allowed a discussion on scientific impact in public media and an analysis on how this impact can be influenced by authors and journals. In respect to the field of engineering, the work shows that traditional ChemE and process control tools developed for the abstraction of physical and chemical systems can also be utilized to describe social and information related processes.
To study the long term consequences of low carbohydrate diets, generally characterised by concomitant increases in protein intake, on cardiovascular health.
Prospective cohort study.
Uppsala, Sweden.
From a random population sample, 43,396 Swedish women, aged 30-49 years at baseline, completed an extensive dietary questionnaire and were followed-up for an average of 15.7 years.
Association of incident cardiovascular diseases (ascertained by linkage with nationwide registries), overall and by diagnostic category, with decreasing carbohydrate intake (in tenths), increasing protein intake (in tenths), and an additive combination of these variables (low carbohydrate-high protein score, from 2 to 20), adjusted for intake of energy, intake of saturated and unsaturated fat, and several non-dietary variables.
A one tenth decrease in carbohydrate intake or increase in protein intake or a 2 unit increase in the low carbohydrate-high protein score were all statistically significantly associated with increasing incidence of cardiovascular disease overall (n=1270)--incidence rate ratio estimates 1.04 (95% confidence interval 1.00 to 1.08), 1.04 (1.02 to 1.06), and 1.05 (1.02 to 1.08). No heterogeneity existed in the association of any of these scores with the five studied cardiovascular outcomes: ischaemic heart disease (n=703), ischaemic stroke (n=294), haemorrhagic stroke (n=70), subarachnoid haemorrhage (n=121), and peripheral arterial disease (n=82).
Low carbohydrate-high protein diets, used on a regular basis and without consideration of the nature of carbohydrates or the source of proteins, are associated with increased risk of cardiovascular disease.
In this systematic review, we summarize risk factors for low bone mineral density and bone loss in healthy men age 50 years or older. Consistent risk factors were: age, smoking, low weight, physical/functional limitations, and previous fracture. Data specific to men has clinical and policy implications.
Osteoporosis is a significant health care problem in men as well as women, yet the majority of evidence on diagnosis and management of osteoporosis is focused on postmenopausal women. The objective of this systematic review is to examine risk factors for low bone mineral density (BMD) and bone loss in healthy men age 50 years or older.
A systematic search for observational studies was conducted in MEDLINE, Cochrane Database of Systematic Reviews, DARE, CENTRAL, CINAHL and Embase, Health STAR. The three main search concepts were bone density, densitometry, and risk factors. Trained reviewers assessed articles using a priori criteria.
Of 642 screened abstracts, 299 articles required a full review, and 25 remained in the final assessment. Consistent risk factors for low BMD/bone loss were: advancing age, smoking, and low weight/weight loss. Although less evidence was available, physical/functional limitations and prevalent fracture (after age 50) were also associated with low BMD/bone loss. The evidence was inconsistent or weak for physical activity, alcohol consumption, calcium intake, muscle strength, family history of fracture/osteoporosis, and height/height loss.
In this systematic review, we identified several risk factors for low BMD/bone loss in men that are measurable in primary practice.
Although commercial weight loss programs provide treatment to millions of clients, their efficacy has not been evaluated in rigorous long-term trials.
To compare weight loss and health benefits achieved and maintained through self-help weight loss vs with a structured commercial program.
A 2-year, multicenter randomized clinical trial with clinic visits at 12, 26, 52, 78, and 104 weeks conducted at 6 academic research centers in the United States between January 1998 and January 2001.
Overweight and obese men (n = 65) and women (n = 358) (body mass index, 27-40) aged 18 to 65 years.
Random assignment to either a self-help program (n = 212) consisting of two 20-minute counseling sessions with a nutritionist and provision of self-help resources or to a commercial weight loss program (n = 211) consisting of a food plan, an activity plan, and a cognitive restructuring behavior modification plan, delivered at weekly meetings.
Weight change was the primary outcome measure. Secondary outcomes included waist circumference, body mass index, blood pressure, serum lipids, glucose, and insulin levels.
At 2 years, 150 participants (71%) in the commercial group and 159 (75%) in the self-help group completed the study. In the intent-to-treat analysis, mean (SD) weight loss of participants in the commercial group was greater than in the self-help group at 1 year (-4.3 [6.1] kg vs -1.3 [6.1] kg, respectively; P<.001) and at 2 years (-2.9 [6.5] kg vs -0.2 [6.5] kg, respectively; P<.001). Waist circumference (P =.003) and body mass index (P<.001) decreased more in the commercial group. Changes in blood pressure, lipids, glucose, and insulin levels were related to changes in weight in both groups, but between-group differences in biological parameters were mainly nonsignificant by year 2.
The structured commercial weight loss program provided modest weight loss but more than self-help over a 2-year period.
Despite the popularity of the low-carbohydrate, high-protein, high-fat (Atkins) diet, no randomized, controlled trials have evaluated its efficacy.
We conducted a one-year, multicenter, controlled trial involving 63 obese men and women who were randomly assigned to either a low-carbohydrate, high-protein, high-fat diet or a low-calorie, high-carbohydrate, low-fat (conventional) diet. Professional contact was minimal to replicate the approach used by most dieters.
Subjects on the low-carbohydrate diet had lost more weight than subjects on the conventional diet at 3 months (mean [+/-SD], -6.8+/-5.0 vs. -2.7+/-3.7 percent of body weight; P=0.001) and 6 months (-7.0+/-6.5 vs. -3.2+/-5.6 percent of body weight, P=0.02), but the difference at 12 months was not significant (-4.4+/-6.7 vs. -2.5+/-6.3 percent of body weight, P=0.26). After three months, no significant differences were found between the groups in total or low-density lipoprotein cholesterol concentrations. The increase in high-density lipoprotein cholesterol concentrations and the decrease in triglyceride concentrations were greater among subjects on the low-carbohydrate diet than among those on the conventional diet throughout most of the study. Both diets significantly decreased diastolic blood pressure and the insulin response to an oral glucose load.
The low-carbohydrate diet produced a greater weight loss (absolute difference, approximately 4 percent) than did the conventional diet for the first six months, but the differences were not significant at one year. The low-carbohydrate diet was associated with a greater improvement in some risk factors for coronary heart disease. Adherence was poor and attrition was high in both groups. Longer and larger studies are required to determine the long-term safety and efficacy of low-carbohydrate, high-protein, high-fat diets.
Dark chocolate derived from the plant (Theobroma cacao) is a rich source of flavonoids. Cardioprotective effects including antioxidant properties, inhibition of platelet activity, and activation of endothelial nitric oxide synthase have been ascribed to the cocoa flavonoids.
To investigate the effects of flavonoid-rich dark chocolate on endothelial function, measures of oxidative stress, blood lipids, and blood pressure in healthy adult subjects.
The study was a randomized, double-blind, placebo-controlled design conducted over a 2 week period in 21 healthy adult subjects. Subjects were randomly assigned to daily intake of high-flavonoid (213 mg procyanidins, 46 mg epicatechin) or low-flavonoid dark chocolate bars (46 g, 1.6 oz).
High-flavonoid chocolate consumption improved endothelium-dependent flow-mediated dilation (FMD) of the brachial artery (mean change = 1.3 +/- 0.7%) as compared to low-flavonoid chocolate consumption (mean change = -0.96 +/- 0.5%) (p = 0.024). No significant differences were noted in the resistance to LDL oxidation, total antioxidant capacity, 8-isoprostanes, blood pressure, lipid parameters, body weight or body mass index (BMI) between the two groups. Plasma epicatechin concentrations were markedly increased at 2 weeks in the high-flavonoid group (204.4 +/- 18.5 nmol/L, p < or = 0.001) but not in the low-flavonoid group (17.5 +/- 9 nmol/L, p = 0.99).
Flavonoid-rich dark chocolate improves endothelial function and is associated with an increase in plasma epicatechin concentrations in healthy adults. No changes in oxidative stress measures, lipid profiles, blood pressure, body weight or BMI were seen.
Numerous studies indicate that flavanols may exert significant vascular protection because of their antioxidant properties and increased nitric oxide bioavailability. In turn, nitric oxide bioavailability deeply influences insulin-stimulated glucose uptake and vascular tone. Thus, flavanols may also exert positive metabolic and pressor effects.
The objective was to compare the effects of either dark or white chocolate bars on blood pressure and glucose and insulin responses to an oral-glucose-tolerance test in healthy subjects.
After a 7-d cocoa-free run-in phase, 15 healthy subjects were randomly assigned to receive for 15 d either 100 g dark chocolate bars, which contained approximately 500 mg polyphenols, or 90 g white chocolate bars, which presumably contained no polyphenols. Successively, subjects entered a further cocoa-free washout phase of 7 d and then were crossed over to the other condition. Oral-glucose-tolerance tests were performed at the end of each period to calculate the homeostasis model assessment of insulin resistance (HOMA-IR) and the quantitative insulin sensitivity check index (QUICKI); blood pressure was measured daily.
HOMA-IR was significantly lower after dark than after white chocolate ingestion (0.94 +/- 0.42 compared with 1.72 +/- 0.62; P < 0.001), and QUICKI was significantly higher after dark than after white chocolate ingestion (0.398 +/- 0.039 compared with 0356 +/- 0.023; P = 0.001). Although within normal values, systolic blood pressure was lower after dark than after white chocolate ingestion (107.5 +/- 8.6 compared with 113.9 +/- 8.4 mm Hg; P < 0.05).
Dark, but not white, chocolate decreases blood pressure and improves insulin sensitivity in healthy persons.
Epidemiological evidence suggests blood pressure-lowering effects of cocoa and tea. We undertook a meta-analysis of randomized controlled trials to determine changes in systolic and diastolic blood pressure due to the intake of cocoa products or black and green tea.
MEDLINE, EMBASE, SCOPUS, Science Citation Index, and the Cochrane Controlled Trials Register were searched from 1966 until October 2006 for studies in parallel group or crossover design involving 10 or more adults in whom blood pressure was assessed before and after receiving cocoa products or black or green tea for at least 7 days.
Five randomized controlled studies of cocoa administration involving a total of 173 subjects with a median duration of 2 weeks were included. After the cocoa diets, the pooled mean systolic and diastolic blood pressure were -4.7 mm Hg (95% confidence interval [CI], -7.6 to -1.8 mm Hg; P = .002) and -2.8 mm Hg (95% CI, -4.8 to -0.8 mm Hg; P = .006) lower, respectively, compared with the cocoa-free controls. Five studies of tea consumption involving a total of 343 subjects with a median duration of 4 weeks were selected. The tea intake had no significant effects on blood pressure. The estimated pooled changes were 0.4 mm Hg (95% CI, -1.3 to 2.2 mm Hg; P = .63) in systolic and -0.6 mm Hg (95% CI, -1.5 to 0.4 mm Hg; P = .38) in diastolic blood pressure compared with controls.
Current randomized dietary studies indicate that consumption of foods rich in cocoa may reduce blood pressure, while tea intake appears to have no effect.
Previous studies with plant sterols (PS) and cocoa flavanols (CF) provide support for their dietary use in maintaining cardiovascular health. This double-blind, placebo-controlled, cross-over study evaluated the efficacy of daily consumption of a cocoa flavanol-containing dark chocolate bar with added PS on serum lipids, blood pressure, and other circulating cardiovascular health markers in a population with elevated serum cholesterol. We recruited 49 adults (32 women, 17 men) with serum total cholesterol concentrations of 5.20-7.28 mmol/L and blood pressure of < or = 159/99 mm Hg. Following a 2-wk lead-in utilizing the AHA style diet, participants were randomized into 2 groups and instructed to consume 2 cocoa flavanol-containing dark chocolate bars per day with (1.1 g sterol esters per bar) or without PS. Each 419-kJ bar was nutrient-matched and contained approximately 180 mg CF. Participants consumed 1 bar 2 times per day for 4 wk then switched to the other bar for an additional 4 wk. Serum lipids and other cardiovascular markers were measured at baseline and after 4 and 8 wk. Blood pressure was measured every 2 wk. Regular consumption of the PS-containing chocolate bar resulted in reductions of 2.0 and 5.3% in serum total and LDL cholesterol (P < 0.05), respectively. Consumption of CF also reduced systolic blood pressure at 8 wk (-5.8 mm Hg; P < 0.05). Results indicate that regular consumption of chocolate bars containing PS and CF as part of a low-fat diet may support cardiovascular health by lowering cholesterol and improving blood pressure.
Impaired endothelial function in obesity may reduce blood flow to sites of metabolism, contributing to impaired fat oxidation and insulin resistance. This study investigated the effects of cocoa flavanols and regular exercise, interventions known to improve endothelial function, on cardiometabolic function and body composition in obese individuals.
Overweight and obese adults were randomly assigned to high-flavanol cocoa (HF, 902 mg flavanols), HF and exercise, low-flavanol cocoa (LF, 36 mg flavanols), or LF and exercise for 12 weeks (exercise duration was 3 x 45 min per week at 75% of age-predicted maximum heart rate). Body composition was assessed by dual-energy X-ray absorptiometry at 0 and 12 weeks. Brachial artery flow-mediated dilatation (FMD), supine blood pressure (BP) and fasting plasma insulin, and glucose levels were assessed at 0, 6 and 12 weeks, respectively. Insulin sensitivity/resistance was determined using the modified homeostasis model assessment of insulin resistance (HOMA2).
A total of 49 subjects (M=18; F=31) completed the intervention. Baseline averages were as follows: body mass index=33.5 kg/m(2); BP=123/76 mm Hg; HOMA2=2.4; FMD=4.3%; rate of fat oxidation during exercise=0.34 g min(-1); abdominal fat=45.7% of total abdominal mass. Compared to LF, HF increased FMD acutely (2 h post-dose) by 2.4% (P<0.01) and chronically (over 12 weeks; P<0.01) by 1.6% and reduced insulin resistance by 0.31% (P<0.05), diastolic BP by 1.6 mm Hg and mean arterial BP by 1.2 mm Hg (P<0.05), independent of exercise. Regular exercise increased fat oxidation during exercise by 0.10 g min(-1) (P<0.01) and reduced abdominal fat by 0.92% (P<0.05).
Although HF consumption was shown to improve endothelial function, it did not enhance the effects of exercise on body fat and fat metabolism in obese subjects. However, it may be useful for reducing cardiometabolic risk factors in this population.
There is interest in the potential of cocoa flavanols, including monomers and procyanidins, to prevent obesity and type-2 diabetes. Fermentation and processing of cocoa beans influence the qualitative and quantitative profiles of individual cocoa constituents. Little is known regarding how different cocoa flavanols contribute to inhibition of obesity and type-2 diabetes. The objective of this study was to compare the impacts of long-term dietary exposure to cocoa flavanol monomers, oligomers and polymers on the effects of high-fat feeding. Mice were fed a high-fat diet supplemented with either a cocoa flavanol extract, or a flavanol fraction enriched with monomeric, oligomeric, or polymeric procyanidins for 12 weeks. The oligomer-rich fraction proved to be most effective in preventing weight gain, fat mass, impaired glucose tolerance, and insulin resistance in this model. This is the first long-term feeding study to examine the relative activities of cocoa constituents on diet-induced obesity and insulin resistance.
Chocolate products are often rich in sugar and fat, contributing to assumptions that chocolate boosts BMI. This study does not obviate the possibility that some chocolate-containing products do so, that some chocolate consumption profiles do so, or that for some people, even frequent modest chocolate consumption does so. Moreover, since findings are cross-sectional, causality in the observed association cannot be presumed. However, the finding fits with the literature suggesting benefits of chocolate for other metabolic factors, and we failed to identify a link of chocolate to key BMI-relevant confounders in a direction to explain the finding. Moreover, our findings comport with recent findings from experimental frequent feeding of modest doses of epicatechin from chocolate to rats.⁸,9 Polyphenols (eg, catechins) in chocolate¹ have antioxidant properties and are candidates to underlie favorable chocolate associations with metabolic factors. Cocoa-derived epicatechin, specifically, is reported to increase mitochondrial biogenesis and capillarity, muscular performance, and lean muscle mass and to reduce weight without changing calories or exercise in rodent studies.⁸,9 Parallel processes in humans, if present, could underlie our findings.
Epidemiological data demonstrate that regular dietary intake of plant-derived foods and beverages reduces the risk of coronary heart disease and stroke. Among many ingredients, cocoa might be an important mediator. Indeed, recent research demonstrates a beneficial effect of cocoa on blood pressure, insulin resistance, and vascular and platelet function. Although still debated, a range of potential mechanisms through which cocoa might exert its benefits on cardiovascular health have been proposed, including activation of nitric oxide and antioxidant and antiinflammatory effects. This review summarizes the available data on the cardiovascular effects of cocoa, outlines potential mechanisms involved in the response to cocoa, and highlights the potential clinical implications associated with its consumption.
To study significant factors associated with the risk of hypertension among obese women, with and without a history of weight cycling (WC).
Case-control study.
Obesity Clinic of Chieti University, Italy.
A group of 258 obese women aged 25-64 y (103 cases with hypertension and 155 controls) were recruited. All obese subjects had the same clinical characteristics, were without a family history for hypertension, were non-smokers, had normal lipidemic profiles and normal glucose tolerance, were not taking any medication and were otherwise healthy.
In the weight cycling women, the history of WC was established on the basis of at least five weight losses in the previous 5 y due to dieting, with a weight loss of at least 4.5 kg per cycle. A logistic regression model adjusted for confounding variables such as waist-to-hip ratio (WHR) and weight cycling history parameters was used and the odds ratio (OR) with 95% confidence intervals was calculated.
The risk of hypertension increases in subjects with larger WHR (OR 7.8; 95% CI 3.4-17.9) and with a positive history for WC (OR 4.1; 95% CI 2.4-6.9). Further, in obese patients with WC, the weight cycling index and the sum of the weight regained are also important risk factors for hypertension.
These findings could support the hypothesis that it is the combined exposure of central-type obesity and WC that strongly raises the risk of hypertension.
This work has been financially supported by a grant of Ministero dell'Università e della Ricerca Scientifica e Tecnologica.
Although insulin resistance and metabolic syndrome are often used synonymously, concordance is not established.
Metabolic, hemodynamic, and hormonal data were analyzed on 141 patients in the Trial of Preventing Hypertension (TROPHY) Sub-Study with high-normal blood pressure (BP) (130 to 139/85 to 89 mm Hg [mean +/- SD, 133 +/- 8/85 +/- 6 mm Hg]; age, 48 +/- 9 years; body mass index 30 +/- 5 kg/m(2)).
Fifty-three of 141 subjects (37.6%; approximately 3/8) had the metabolic syndrome based on three or more of the five risk factors (BP, waist circumference, fasting triglycerides, HDL-cholesterol, glucose). To maintain consistency in proportions, insulin resistance was defined as the upper 3/8 of the distribution on the homeostatic model assessment (HOMA), which uses fasting glucose and insulin and a modified Matsuda-DeFronzo index, based on fasting, 1- and 2-h glucose and insulin values. Among metabolic syndrome patients, 57% and 55% were in the upper 3/8 of the distribution for insulin resistance by HOMA and Matsuda-DeFronzo, respectively. Among subjects without the metabolic syndrome, 26% and 27% were insulin resistant by HOMA and Matsuda-DeFronzo criteria. The proportion of patients with metabolic syndrome and insulin resistance increased strongly and similarly with increasing body mass index. However, metabolic syndrome and insulin resistance were different compared with their respective controls in the lower 5/8 of the distribution, in waist/hip ratios, fasting and 1-h insulin, HDL-cholesterol, heart rate, and systolic BP responses to exercise and plasma renin, angiotensin, and aldosterone.
The findings suggest that metabolic syndrome and insulin resistance are not synonymous anthropometrically, metabolically, hemodynamically, or hormonally in patients with high-normal BP.
Previous studies evaluating the association between weight fluctuation and mortality are limited and have conflicting results. This study will further evaluate the association between weight fluctuation and mortality in a nationally representative cohort by performing survival analysis of NHANES I and NHANES I Epidemiologic Follow-up Study (n = 8479; weighted sample = 68,200,905). This cohort was followed from 1971 to 1992 and categorized using weight change over five time points into stable non-obese, stable obese, weight gain, weight loss and weight fluctuation groups. All-cause mortality (ACM) and cardiovascular mortality (CM) were evaluated. Respondents with weight fluctuation had higher ACM (HR: 1.83, 95% CI: 1.25-2.69) and CM hazards ratios (HR: 1.86, 95% CI: 1.10-3.15) than the stable non-obese group, even after controlling for pre-existing disease, initial BMI and excluding those in poor health or incapacitated. Increased mortality was also seen in the weight loss group (ACM HR: 3.36, 95% CI: 2.47-4.55), (CM HR 4.22, 95% CI: 2.60-6.84). The stable obese group did not have increased ACM, but did have increased CM prior to the exclusion of those in poor health or incapacitated. (HR: 2.17, 95% CI: 1.10-4.28). Weight fluctuation is associated with a higher risk of all-cause and cardiovascular disease mortality in the US population, even after adjustment for pre-existing disease, initial BMI and the exclusion of those in poor health or incapacitated. Thus, health care providers should promote a commitment to maintaining weight loss to avoid weight fluctuation and consider patients' weight histories when assessing their risk status.
A low sodium diet has often been implicated in the protection of low blood pressure populations from hypertension, but several other dietary factors, including those as yet unidentified, may also be involved. The Kuna Indians of Panama are free of hypertension and cardiovascular disease, but this is changing with migration to urban areas. We compared the indigenous diet of Kuna Indians living on remote islands in Panama (Ailigandi), whose lifestyle is largely hunter-gatherer, with those who have moved to a suburb of Panama City (Vera Cruz). Between April and October 1999, members of a Kuna research team administered a 118-item food frequency questionnaire to133 adult Kuna from Ailigandi and 183 from Vera Cruz. Single 24-hour urine collections and nonfasting blood samples were obtained. The Kuna in Ailigandi reported consuming a 10-fold higher amount of cocoa-containing beverages, 4 times the amount of fish, and twice the amount of fruit as urban Kuna (P<0.05 by t test). Salt added was ample among those living in Ailigandi and Vera Cruz according to both self-report (7.1+/-1.1 and 4.6+/-0.3 tsp weekly) and urinary sodium levels (177+/-9 and 160+/-7 mEq Na/g creatinine), respectively. The low blood pressure of island-dwelling Kuna does not seem to be related to a low salt diet. Among dietary factors that varied among migrating Kuna, the notably higher intake of flavanol-rich cocoa is a potential candidate for further study.
The long-term effect of repeated intentional weight loss and weight regain on the risk of gallstone disease in men is not clear.
Participants in the Health Professionals Follow-up Study provided information on intentional weight loss during the previous 4 years in 1992. Weight cyclers were men who had intentional weight loss and weight regain. Men free of gallstone disease at baseline were followed from 1992 to 2002. On biennial questionnaires the participants reported newly diagnosed gallstone disease.
During 264,760 person-years of follow-up we ascertained 1222 cases of symptomatic gallstones. We examined the effect of weight cycling on the risk of gallstone disease. The multivariate relative risk of weight cyclers, compared with weight maintainers, after adjusting for potential confounding variables, including body mass index, was 1.11 (95% confidence interval [CI], 0.94-1.31) in light cyclers, 1.18 (95% CI, 0.97-1.43) in moderate cyclers, and 1.42 (95% CI, 1.11-1.81) in severe cyclers. We further examined the effect of number of cycling episodes. Among weight cyclers, the relative risk associated with having more than 1 weight cycle, compared with weight maintainers, was 1.10 (95% CI, 0.88-1.37) in light cyclers, 1.28 (95% CI, 1.03-1.59) in moderate cyclers, and 1.51 (95% CI, 1.13-2.02) in severe cyclers.
Our findings suggest that weight cycling, independent of body mass index, may increase the risk of gallstone disease in men. Larger weight fluctuation and more weight cycles are associated with greater risk.
Research suggests that weight loss treatment generally benefits psychological well-being but these effects have never been quantitatively reviewed. A meta-analysis of 117 weight loss treatment tests showed that weight loss treatment was associated with lowered depression and increased self-esteem. Treatment type moderated treatment effects on depression and self-esteem. Actual weight loss moderated treatment effects on self-esteem but not depression; only treatments that produced actual weight loss predicted increased self-esteem whereas improvements in depression were independent of weight loss. The clinical implications of the findings and the possible causal relationships among weight, depression and self-esteem are discussed.
To investigate the effect of weight change and weight fluctuations on all-cause-mortality in men.
Within a prospective population-based cohort of 1,160 men aged 40-59 years at recruitment, complete weight change patterns from baseline and three follow-up examinations during a period of 15 years of follow-up was used to categorize the 505 men into stable obese, stable non-obese, weight gain, weight loss and weight fluctuation groups. For these men (age range: 55-74 years at start time of survival analysis) further survival was analyzed during the subsequent 15 years.
Overall, 183 deaths were observed among the 505 men. Only weight fluctuations had a clear significant impact on all-cause mortality. Adjusted hazard rate ratio (HRR (95%-CI)) was 1.86 (1.31-2.66) after adjustment for age group, pre-existing cardiovascular disease or diabetes mellitus, smoking and socio-economic status. The risk rate due to weight loss was borderline significant (HRR = 1.81 (0.99-3.31)). Risk of death due to weight gain (HRR = 1.15 (0.70-1.88)) or stable obesity (HRR = 1.16 (0.69-1.94)), however, were not significantly increased compared to men staying non-obese for the first 15 years after cohort recruitment.
Weight fluctuations are a major risk factor for all-cause mortality in middle aged men. Moreover, stable obesity does not increase further mortality in men aged 55-74 years in long-term follow-up.