Diabetes Hub

Youth who received at least 3 months of antipsychotics were about two to three times more likely to develop type 2 diabetes, compared with controls, a meta-analysis of 13 studies shows.

The risk was especially apparent for olanzapine, confirming “that [type 2 diabetes] risk with second-generation antipsychotics is not homogeneous, and that olanzapine treatment is a major modifiable risk factor,” said Dr. Britta Galling of Zucker Hillside Hospital in Glen Oaks, N.Y., and her associates. Youth should receive antipsychotics only if safer treatments have failed, for the shortest possible effective duration, with proactive monitoring of cardiovascular risk factors and counseling about possible adverse effects, healthy nutrition, and physical activity, according to the meta-analysis, published online Jan. 19.

©donskarpo/thinkstockphotos.com

The researchers searched PubMed and PsycINFO through May 2015 for longitudinal studies of antipsychotics and type 2 diabetes in children, adolescents, and young adults who did not have diabetes at baseline. The resulting studies included 185,105 individuals and 310,438 patient-years. Patients averaged 14.1 years of age (range, 2-24 years), were followed for an average of 1.7 years, and 60% were male (JAMA Psychiatry. 2016 Jan 20. doi: 10.1001/jamapsychiatry.2015.2923).

Antipsychotic exposure doubled the odds (95% confidence interval, 1.56-4.24; P less than .0001) and tripled the incidence (95% CI, 1.7-5.3; P less than .0001) of type 2 diabetes, compared with healthy controls. Antipsychotic-exposed youth also had double the odds and 1.8 times the incidence of type 2 diabetes, compared with psychiatric controls.

The multivariate analysis linked greater cumulative type 2 diabetes risk with longer follow-up (P less than .001), olanzapine exposure (P less than .001), and male sex (P = .002). However, the incidence of type 2 diabetes was lower in youth with autism spectrum disorders (P = .048), perhaps because of other medications or the fact that other psychiatric disorders have a higher type 2 diabetes risk, compared with ASDs, the researchers said.

“These risks should be considered in the clinical risk-benefit evaluation when initiating or continuing antipsychotic treatment in this age group,” they wrote.

The research was funded by the Zucker Hillside Hospital, the National Institute of Mental Health–funded Advanced Center for Interventions and Services Research in Schizophrenia, and the Agency for Healthcare Research & Quality. Dr. Galling had no disclosures. Senior author Dr. Christoph U. Correll, medical director of the recognition and prevention program at the Zucker Hillside Hospital, and his 11 coauthors reported financial relationships the numerous pharmaceutical companies and nonprofit institutions.

Youth who received at least 3 months of antipsychotics were about two to three times more likely to develop type 2 diabetes, compared with controls, a meta-analysis of 13 studies shows.

The risk was especially apparent for olanzapine, confirming “that [type 2 diabetes] risk with second-generation antipsychotics is not homogeneous, and that olanzapine treatment is a major modifiable risk factor,” said Dr. Britta Galling of Zucker Hillside Hospital in Glen Oaks, N.Y., and her associates. Youth should receive antipsychotics only if safer treatments have failed, for the shortest possible effective duration, with proactive monitoring of cardiovascular risk factors and counseling about possible adverse effects, healthy nutrition, and physical activity, according to the meta-analysis, published online Jan. 19.

©donskarpo/thinkstockphotos.com

The researchers searched PubMed and PsycINFO through May 2015 for longitudinal studies of antipsychotics and type 2 diabetes in children, adolescents, and young adults who did not have diabetes at baseline. The resulting studies included 185,105 individuals and 310,438 patient-years. Patients averaged 14.1 years of age (range, 2-24 years), were followed for an average of 1.7 years, and 60% were male (JAMA Psychiatry. 2016 Jan 20. doi: 10.1001/jamapsychiatry.2015.2923).

Antipsychotic exposure doubled the odds (95% confidence interval, 1.56-4.24; P less than .0001) and tripled the incidence (95% CI, 1.7-5.3; P less than .0001) of type 2 diabetes, compared with healthy controls. Antipsychotic-exposed youth also had double the odds and 1.8 times the incidence of type 2 diabetes, compared with psychiatric controls.

The multivariate analysis linked greater cumulative type 2 diabetes risk with longer follow-up (P less than .001), olanzapine exposure (P less than .001), and male sex (P = .002). However, the incidence of type 2 diabetes was lower in youth with autism spectrum disorders (P = .048), perhaps because of other medications or the fact that other psychiatric disorders have a higher type 2 diabetes risk, compared with ASDs, the researchers said.

“These risks should be considered in the clinical risk-benefit evaluation when initiating or continuing antipsychotic treatment in this age group,” they wrote.

The research was funded by the Zucker Hillside Hospital, the National Institute of Mental Health–funded Advanced Center for Interventions and Services Research in Schizophrenia, and the Agency for Healthcare Research & Quality. Dr. Galling had no disclosures. Senior author Dr. Christoph U. Correll, medical director of the recognition and prevention program at the Zucker Hillside Hospital, and his 11 coauthors reported financial relationships the numerous pharmaceutical companies and nonprofit institutions.

Youth who received at least 3 months of antipsychotics were about two to three times more likely to develop type 2 diabetes, compared with controls, a meta-analysis of 13 studies shows.

The risk was especially apparent for olanzapine, confirming “that [type 2 diabetes] risk with second-generation antipsychotics is not homogeneous, and that olanzapine treatment is a major modifiable risk factor,” said Dr. Britta Galling of Zucker Hillside Hospital in Glen Oaks, N.Y., and her associates. Youth should receive antipsychotics only if safer treatments have failed, for the shortest possible effective duration, with proactive monitoring of cardiovascular risk factors and counseling about possible adverse effects, healthy nutrition, and physical activity, according to the meta-analysis, published online Jan. 19.

©donskarpo/thinkstockphotos.com

The researchers searched PubMed and PsycINFO through May 2015 for longitudinal studies of antipsychotics and type 2 diabetes in children, adolescents, and young adults who did not have diabetes at baseline. The resulting studies included 185,105 individuals and 310,438 patient-years. Patients averaged 14.1 years of age (range, 2-24 years), were followed for an average of 1.7 years, and 60% were male (JAMA Psychiatry. 2016 Jan 20. doi: 10.1001/jamapsychiatry.2015.2923).

Antipsychotic exposure doubled the odds (95% confidence interval, 1.56-4.24; P less than .0001) and tripled the incidence (95% CI, 1.7-5.3; P less than .0001) of type 2 diabetes, compared with healthy controls. Antipsychotic-exposed youth also had double the odds and 1.8 times the incidence of type 2 diabetes, compared with psychiatric controls.

The multivariate analysis linked greater cumulative type 2 diabetes risk with longer follow-up (P less than .001), olanzapine exposure (P less than .001), and male sex (P = .002). However, the incidence of type 2 diabetes was lower in youth with autism spectrum disorders (P = .048), perhaps because of other medications or the fact that other psychiatric disorders have a higher type 2 diabetes risk, compared with ASDs, the researchers said.

“These risks should be considered in the clinical risk-benefit evaluation when initiating or continuing antipsychotic treatment in this age group,” they wrote.

The research was funded by the Zucker Hillside Hospital, the National Institute of Mental Health–funded Advanced Center for Interventions and Services Research in Schizophrenia, and the Agency for Healthcare Research & Quality. Dr. Galling had no disclosures. Senior author Dr. Christoph U. Correll, medical director of the recognition and prevention program at the Zucker Hillside Hospital, and his 11 coauthors reported financial relationships the numerous pharmaceutical companies and nonprofit institutions.

Vancouver, B.C. – Resveratrol increased cerebral blood vessel dilation in a small study of adults with type 2 diabetes mellitus, suggesting a possible role for slowing disease-related cognitive decline, according to investigators from the University of Newcastle (Australia).

Type 2 diabetes impairs the ability of blood vessels to dilate effectively in response to demand, which may impact mental performance and perhaps contribute to the greater risk of dementia in people with the disease, according to investigator Rachel Wong, Ph.D., a biomedical researcher at the university.

Her team previously demonstrated that resveratrol – a polyphenol found in berries, nuts, grapes, and, famously, red wine – improves vasodilation in the systemic circulation, so they wanted to see if would do the same in the brain (Nutr Metab Cardiovasc Dis. 2011 Nov;21(11):851-6).

Thirty-six dementia-free adults with type 2 diabetes took one of three doses of synthetic resveratrol – 75 mg, 150 mg, and 300 mg – or placebo at weekly intervals. Before and about an hour after each dose, the patients briefly breathed carbogen gas (95% oxygen, 5% carbon dioxide) to induce hypercapnia and subsequent cerebral vasodilation. Transcranial Doppler ultrasound was used to assess the change in blood flow in the middle and posterior cerebral arteries before and after dosing.

The percentage change in mean blood flow velocity in the middle cerebral arteries increased after all three doses of resveratrol, but not after placebo. The 75 and 300 mg doses both increased flow velocity by about 10%, while the 150 mg dose increased it by about 6%. Meanwhile, the 75 mg dose was the only one to increase vasodilator responsiveness in the posterior cerebral arteries.

“This is the first clinical evidence that resveratrol can enhance vasodilator responsiveness in people with type 2 diabetes. We are now investigating if regular supplementation can restore cerebral perfusion, and if that can attenuate the accelerated cognitive decline seen in this population,” Dr. Wong said.

They plan to test that with the 75 mg dose, the amount of resveratrol in about 30 liters of red wine. “I think it’s better to get it in the synthetic form,” she said.

The patients in the study were 68 years old on average, with a mean body mass index of 30 kg/m². They had diabetes for about 10 years, and their mean hemoglobin A_1c was 6.7%. The majority of subjects were on oral diabetes therapies; none of them was on insulin.

The investigators have no disclosures. The work was funded in part by the Australian National University and by DSM Nutritional Products, which provided the resveratrol.

[email protected]

Vancouver, B.C. – Resveratrol increased cerebral blood vessel dilation in a small study of adults with type 2 diabetes mellitus, suggesting a possible role for slowing disease-related cognitive decline, according to investigators from the University of Newcastle (Australia).

Type 2 diabetes impairs the ability of blood vessels to dilate effectively in response to demand, which may impact mental performance and perhaps contribute to the greater risk of dementia in people with the disease, according to investigator Rachel Wong, Ph.D., a biomedical researcher at the university.

Her team previously demonstrated that resveratrol – a polyphenol found in berries, nuts, grapes, and, famously, red wine – improves vasodilation in the systemic circulation, so they wanted to see if would do the same in the brain (Nutr Metab Cardiovasc Dis. 2011 Nov;21(11):851-6).

Thirty-six dementia-free adults with type 2 diabetes took one of three doses of synthetic resveratrol – 75 mg, 150 mg, and 300 mg – or placebo at weekly intervals. Before and about an hour after each dose, the patients briefly breathed carbogen gas (95% oxygen, 5% carbon dioxide) to induce hypercapnia and subsequent cerebral vasodilation. Transcranial Doppler ultrasound was used to assess the change in blood flow in the middle and posterior cerebral arteries before and after dosing.

The percentage change in mean blood flow velocity in the middle cerebral arteries increased after all three doses of resveratrol, but not after placebo. The 75 and 300 mg doses both increased flow velocity by about 10%, while the 150 mg dose increased it by about 6%. Meanwhile, the 75 mg dose was the only one to increase vasodilator responsiveness in the posterior cerebral arteries.

“This is the first clinical evidence that resveratrol can enhance vasodilator responsiveness in people with type 2 diabetes. We are now investigating if regular supplementation can restore cerebral perfusion, and if that can attenuate the accelerated cognitive decline seen in this population,” Dr. Wong said.

They plan to test that with the 75 mg dose, the amount of resveratrol in about 30 liters of red wine. “I think it’s better to get it in the synthetic form,” she said.

The patients in the study were 68 years old on average, with a mean body mass index of 30 kg/m². They had diabetes for about 10 years, and their mean hemoglobin A_1c was 6.7%. The majority of subjects were on oral diabetes therapies; none of them was on insulin.

The investigators have no disclosures. The work was funded in part by the Australian National University and by DSM Nutritional Products, which provided the resveratrol.

[email protected]

Vancouver, B.C. – Resveratrol increased cerebral blood vessel dilation in a small study of adults with type 2 diabetes mellitus, suggesting a possible role for slowing disease-related cognitive decline, according to investigators from the University of Newcastle (Australia).

Type 2 diabetes impairs the ability of blood vessels to dilate effectively in response to demand, which may impact mental performance and perhaps contribute to the greater risk of dementia in people with the disease, according to investigator Rachel Wong, Ph.D., a biomedical researcher at the university.

Her team previously demonstrated that resveratrol – a polyphenol found in berries, nuts, grapes, and, famously, red wine – improves vasodilation in the systemic circulation, so they wanted to see if would do the same in the brain (Nutr Metab Cardiovasc Dis. 2011 Nov;21(11):851-6).

Thirty-six dementia-free adults with type 2 diabetes took one of three doses of synthetic resveratrol – 75 mg, 150 mg, and 300 mg – or placebo at weekly intervals. Before and about an hour after each dose, the patients briefly breathed carbogen gas (95% oxygen, 5% carbon dioxide) to induce hypercapnia and subsequent cerebral vasodilation. Transcranial Doppler ultrasound was used to assess the change in blood flow in the middle and posterior cerebral arteries before and after dosing.

The percentage change in mean blood flow velocity in the middle cerebral arteries increased after all three doses of resveratrol, but not after placebo. The 75 and 300 mg doses both increased flow velocity by about 10%, while the 150 mg dose increased it by about 6%. Meanwhile, the 75 mg dose was the only one to increase vasodilator responsiveness in the posterior cerebral arteries.

“This is the first clinical evidence that resveratrol can enhance vasodilator responsiveness in people with type 2 diabetes. We are now investigating if regular supplementation can restore cerebral perfusion, and if that can attenuate the accelerated cognitive decline seen in this population,” Dr. Wong said.

They plan to test that with the 75 mg dose, the amount of resveratrol in about 30 liters of red wine. “I think it’s better to get it in the synthetic form,” she said.

The patients in the study were 68 years old on average, with a mean body mass index of 30 kg/m². They had diabetes for about 10 years, and their mean hemoglobin A_1c was 6.7%. The majority of subjects were on oral diabetes therapies; none of them was on insulin.

The investigators have no disclosures. The work was funded in part by the Australian National University and by DSM Nutritional Products, which provided the resveratrol.

[email protected]

Vancouver, B.C. – Screening for “diabetes distress” should probably be a part of routine care for patients with type 2 diabetes mellitus, according to investigators from the University of British Columbia, Vancouver.

The team administered the Diabetes Distress Scale (DDS) questionnaire to 148 consecutive patients with type 2 diabetes at a university diabetes clinic; 39% scored positively for diabetes distress, as indicated by a score of 2 or more on the DDS, and stress correlated with poorer glycemic control. In particular, higher hemoglobin A_1c scores correlated, although weakly, with a higher perception of emotional burden from diabetes (r² = 0.198) and greater stress over treatment regimens (r² = 0.249). The correlation between stress and worse glycemic control was strongest in patients with hemoglobin A1c above 9% (r² = 0.387).

After its first appearance in the medical literature over a decade ago, diabetes distress has been shown to impact how well patients do. It’s a mix of negative emotions – for instance, frustration, anxiety, and burnout – related to the management of disease, and it’s been diagnosed in up to 43% of patients in previous studies. Diabetes distress is distinct from clinical depression. In fact, just 12% of the study subjects screened positive for depression on the Personal Health Questionnaire-9, which was administered along with the DDS,. Depression, although related to the use of insulin, had no impact on glycemic control.

“Diabetes distress, particularly emotional and self-care-related distress, is quite high in this population; I think it’s clinically important that we address it. We should be using some sort of screening for distress,” said investigator Dr. Evelyn Wong, an endocrinology fellow at the university.

Previous investigations have found that if distress is reduced, glycemic control improves. How exactly to do that is the subject of ongoing investigation, but education on self-management seems to help. Improving relationships with health care providers and helping patients find alternatives for problematic regimens might also help, Dr. Wong said at the World Diabetes Congress.

“Diabetes is a bit of a silent disease,” at least until complications emerge, “so patients may not understand why they need to take insulin, or why it’s important to bring down hemoglobin A_1c. We” have to make sure they understand such issues and help them come to terms with their illness. Overall, “I think it’s the time spent with the patient that is important,” she said.

A unique finding of the Vancouver study was that patients who felt less satisfied with their providers had better glycemic control. Perhaps they had stricter physicians or were more vigilant about their diabetes because they didn’t have much faith in their physician.

The DDS is a 17 item scale that uses 6-point Likert scales to measure the emotional burden of diabetes; its impact on personal relationships; patient concerns about treatment regimens; and the quality of relationships with providers. For instance, patients are asked the degree to which a “feeling that I will end up with serious long-term complications no matter what I do” applies to them. A two-question diabetes distress screening scale is also available.

Subjects in the study were in their mid-50s on average, the majority were white, and two-thirds were men. They had type 2 diabetes for an average of 9 years; and 20% were on insulin; the mean hemoglobin A_1c was 8.7%.

The investigators have no conflicts of interest.

[email protected]

Vancouver, B.C. – Screening for “diabetes distress” should probably be a part of routine care for patients with type 2 diabetes mellitus, according to investigators from the University of British Columbia, Vancouver.

The team administered the Diabetes Distress Scale (DDS) questionnaire to 148 consecutive patients with type 2 diabetes at a university diabetes clinic; 39% scored positively for diabetes distress, as indicated by a score of 2 or more on the DDS, and stress correlated with poorer glycemic control. In particular, higher hemoglobin A_1c scores correlated, although weakly, with a higher perception of emotional burden from diabetes (r² = 0.198) and greater stress over treatment regimens (r² = 0.249). The correlation between stress and worse glycemic control was strongest in patients with hemoglobin A1c above 9% (r² = 0.387).

After its first appearance in the medical literature over a decade ago, diabetes distress has been shown to impact how well patients do. It’s a mix of negative emotions – for instance, frustration, anxiety, and burnout – related to the management of disease, and it’s been diagnosed in up to 43% of patients in previous studies. Diabetes distress is distinct from clinical depression. In fact, just 12% of the study subjects screened positive for depression on the Personal Health Questionnaire-9, which was administered along with the DDS,. Depression, although related to the use of insulin, had no impact on glycemic control.

“Diabetes distress, particularly emotional and self-care-related distress, is quite high in this population; I think it’s clinically important that we address it. We should be using some sort of screening for distress,” said investigator Dr. Evelyn Wong, an endocrinology fellow at the university.

Previous investigations have found that if distress is reduced, glycemic control improves. How exactly to do that is the subject of ongoing investigation, but education on self-management seems to help. Improving relationships with health care providers and helping patients find alternatives for problematic regimens might also help, Dr. Wong said at the World Diabetes Congress.

“Diabetes is a bit of a silent disease,” at least until complications emerge, “so patients may not understand why they need to take insulin, or why it’s important to bring down hemoglobin A_1c. We” have to make sure they understand such issues and help them come to terms with their illness. Overall, “I think it’s the time spent with the patient that is important,” she said.

A unique finding of the Vancouver study was that patients who felt less satisfied with their providers had better glycemic control. Perhaps they had stricter physicians or were more vigilant about their diabetes because they didn’t have much faith in their physician.

The DDS is a 17 item scale that uses 6-point Likert scales to measure the emotional burden of diabetes; its impact on personal relationships; patient concerns about treatment regimens; and the quality of relationships with providers. For instance, patients are asked the degree to which a “feeling that I will end up with serious long-term complications no matter what I do” applies to them. A two-question diabetes distress screening scale is also available.

Subjects in the study were in their mid-50s on average, the majority were white, and two-thirds were men. They had type 2 diabetes for an average of 9 years; and 20% were on insulin; the mean hemoglobin A_1c was 8.7%.

The investigators have no conflicts of interest.

[email protected]

Vancouver, B.C. – Screening for “diabetes distress” should probably be a part of routine care for patients with type 2 diabetes mellitus, according to investigators from the University of British Columbia, Vancouver.

The team administered the Diabetes Distress Scale (DDS) questionnaire to 148 consecutive patients with type 2 diabetes at a university diabetes clinic; 39% scored positively for diabetes distress, as indicated by a score of 2 or more on the DDS, and stress correlated with poorer glycemic control. In particular, higher hemoglobin A_1c scores correlated, although weakly, with a higher perception of emotional burden from diabetes (r² = 0.198) and greater stress over treatment regimens (r² = 0.249). The correlation between stress and worse glycemic control was strongest in patients with hemoglobin A1c above 9% (r² = 0.387).

After its first appearance in the medical literature over a decade ago, diabetes distress has been shown to impact how well patients do. It’s a mix of negative emotions – for instance, frustration, anxiety, and burnout – related to the management of disease, and it’s been diagnosed in up to 43% of patients in previous studies. Diabetes distress is distinct from clinical depression. In fact, just 12% of the study subjects screened positive for depression on the Personal Health Questionnaire-9, which was administered along with the DDS,. Depression, although related to the use of insulin, had no impact on glycemic control.

“Diabetes distress, particularly emotional and self-care-related distress, is quite high in this population; I think it’s clinically important that we address it. We should be using some sort of screening for distress,” said investigator Dr. Evelyn Wong, an endocrinology fellow at the university.

Previous investigations have found that if distress is reduced, glycemic control improves. How exactly to do that is the subject of ongoing investigation, but education on self-management seems to help. Improving relationships with health care providers and helping patients find alternatives for problematic regimens might also help, Dr. Wong said at the World Diabetes Congress.

“Diabetes is a bit of a silent disease,” at least until complications emerge, “so patients may not understand why they need to take insulin, or why it’s important to bring down hemoglobin A_1c. We” have to make sure they understand such issues and help them come to terms with their illness. Overall, “I think it’s the time spent with the patient that is important,” she said.

A unique finding of the Vancouver study was that patients who felt less satisfied with their providers had better glycemic control. Perhaps they had stricter physicians or were more vigilant about their diabetes because they didn’t have much faith in their physician.

The DDS is a 17 item scale that uses 6-point Likert scales to measure the emotional burden of diabetes; its impact on personal relationships; patient concerns about treatment regimens; and the quality of relationships with providers. For instance, patients are asked the degree to which a “feeling that I will end up with serious long-term complications no matter what I do” applies to them. A two-question diabetes distress screening scale is also available.

Subjects in the study were in their mid-50s on average, the majority were white, and two-thirds were men. They had type 2 diabetes for an average of 9 years; and 20% were on insulin; the mean hemoglobin A_1c was 8.7%.

The investigators have no conflicts of interest.

[email protected]

Daily consumption of sugar-sweetened beverages was associated with a 27% increase in visceral adipose tissue over time, according to an analysis of the Framingham Heart Study published online on Jan. 11 in Circulation.

“There is evidence linking sugar-sweetened beverages with cardiovascular disease and type 2 diabetes. Our message to consumers is to follow the current dietary guidelines and to be mindful of how much sugar-sweetened beverages they drink. To policy makers, this study adds another piece of evidence to the growing body of research suggesting sugar-sweetened beverages may be harmful to our health,” Dr. Caroline Fox of the National Heart, Lung, and Blood Institute’s Framingham Heart Study and Population Sciences Branch said in a press release.

American Heart Association

These results coincide with the recent release of the updated dietary guidelines by the U.S. Department of Health and Human Services which note to limit added sugars to less than 10% of daily caloric intake.

Furthermore, sugar-sweetened beverages are a major contributor of additional sugar in the American diet. According to the study, cardiometabolic risk can potentially be associated with an increase in abdominal adipose tissue. Likewise, type 2 diabetes and cardiovascular disease have been linked to larger amounts of visceral adipose tissue (VAT).

Dr. Fox and her colleagues conducted a prospective study of participants in the third generation cohort of the Framingham Heart Study to explore the relationship between sugar-sweetened beverage intake vs. diet soda and differences over time in VAT and subcutaneous adipose tissue (SAT) on CT scans. Measurements of the quantity and quality of abdominal adipose tissue were obtained from two CT scans taken roughly 6 years apart. Participants were assessed for frequency of sugar-sweetened beverage vs. diet soda intake, and body measurements were obtained.

The mean age of the 1,003 participants was 45.3 years, and women made up 45%. Of them, 85% (852) reported drinking a combination of diet soda and sugar-sweetened beverages and 14% (138) reported not drinking either. Sugar-sweetened beverage intake was reported as daily, frequent, occasional, or not at all, in 13%, 35%, 20%, and 32% of the participants, respectively. Those consuming sugar-sweetened beverages were less likely to have diabetes but more likely to be young, male, report more physical activity, and smoke.

Interestingly, those reporting diet soda intake had a higher prevalence of diabetes, had an increased body mass index, and reported less activity (Circulation. 2016 Jan 11).

Over the 6 years, they found more sugar-sweetened beverage consumption was associated with greater change in VAT volume, which was significant after accounting for the change in body weight (P less than .001). As the consumption of sugar-sweetened beverages increased from no consumption to daily consumption, the VAT volume increased by 658 cm³, 649 cm³, 707 cm³, and 852 cm³, respectively.

Finally, they found no association with diet soda intake and change in weight or change in VAT volume.

“In this prospective observational study of middle-aged adults, we observed that individuals who consumed at least one serving of sugar-sweetened beverages per day ... had a 27% greater increase in VAT volume over 6 years compared to non-consumers,” the investigators wrote.

The authors reported having no disclosures. The study was funded by the National Heart, Lung, and Blood Institute.

Daily consumption of sugar-sweetened beverages was associated with a 27% increase in visceral adipose tissue over time, according to an analysis of the Framingham Heart Study published online on Jan. 11 in Circulation.

“There is evidence linking sugar-sweetened beverages with cardiovascular disease and type 2 diabetes. Our message to consumers is to follow the current dietary guidelines and to be mindful of how much sugar-sweetened beverages they drink. To policy makers, this study adds another piece of evidence to the growing body of research suggesting sugar-sweetened beverages may be harmful to our health,” Dr. Caroline Fox of the National Heart, Lung, and Blood Institute’s Framingham Heart Study and Population Sciences Branch said in a press release.

American Heart Association

These results coincide with the recent release of the updated dietary guidelines by the U.S. Department of Health and Human Services which note to limit added sugars to less than 10% of daily caloric intake.

Furthermore, sugar-sweetened beverages are a major contributor of additional sugar in the American diet. According to the study, cardiometabolic risk can potentially be associated with an increase in abdominal adipose tissue. Likewise, type 2 diabetes and cardiovascular disease have been linked to larger amounts of visceral adipose tissue (VAT).

Dr. Fox and her colleagues conducted a prospective study of participants in the third generation cohort of the Framingham Heart Study to explore the relationship between sugar-sweetened beverage intake vs. diet soda and differences over time in VAT and subcutaneous adipose tissue (SAT) on CT scans. Measurements of the quantity and quality of abdominal adipose tissue were obtained from two CT scans taken roughly 6 years apart. Participants were assessed for frequency of sugar-sweetened beverage vs. diet soda intake, and body measurements were obtained.

The mean age of the 1,003 participants was 45.3 years, and women made up 45%. Of them, 85% (852) reported drinking a combination of diet soda and sugar-sweetened beverages and 14% (138) reported not drinking either. Sugar-sweetened beverage intake was reported as daily, frequent, occasional, or not at all, in 13%, 35%, 20%, and 32% of the participants, respectively. Those consuming sugar-sweetened beverages were less likely to have diabetes but more likely to be young, male, report more physical activity, and smoke.

Interestingly, those reporting diet soda intake had a higher prevalence of diabetes, had an increased body mass index, and reported less activity (Circulation. 2016 Jan 11).

Over the 6 years, they found more sugar-sweetened beverage consumption was associated with greater change in VAT volume, which was significant after accounting for the change in body weight (P less than .001). As the consumption of sugar-sweetened beverages increased from no consumption to daily consumption, the VAT volume increased by 658 cm³, 649 cm³, 707 cm³, and 852 cm³, respectively.

Finally, they found no association with diet soda intake and change in weight or change in VAT volume.

“In this prospective observational study of middle-aged adults, we observed that individuals who consumed at least one serving of sugar-sweetened beverages per day ... had a 27% greater increase in VAT volume over 6 years compared to non-consumers,” the investigators wrote.

The authors reported having no disclosures. The study was funded by the National Heart, Lung, and Blood Institute.

Daily consumption of sugar-sweetened beverages was associated with a 27% increase in visceral adipose tissue over time, according to an analysis of the Framingham Heart Study published online on Jan. 11 in Circulation.

“There is evidence linking sugar-sweetened beverages with cardiovascular disease and type 2 diabetes. Our message to consumers is to follow the current dietary guidelines and to be mindful of how much sugar-sweetened beverages they drink. To policy makers, this study adds another piece of evidence to the growing body of research suggesting sugar-sweetened beverages may be harmful to our health,” Dr. Caroline Fox of the National Heart, Lung, and Blood Institute’s Framingham Heart Study and Population Sciences Branch said in a press release.

American Heart Association

These results coincide with the recent release of the updated dietary guidelines by the U.S. Department of Health and Human Services which note to limit added sugars to less than 10% of daily caloric intake.

Furthermore, sugar-sweetened beverages are a major contributor of additional sugar in the American diet. According to the study, cardiometabolic risk can potentially be associated with an increase in abdominal adipose tissue. Likewise, type 2 diabetes and cardiovascular disease have been linked to larger amounts of visceral adipose tissue (VAT).

Dr. Fox and her colleagues conducted a prospective study of participants in the third generation cohort of the Framingham Heart Study to explore the relationship between sugar-sweetened beverage intake vs. diet soda and differences over time in VAT and subcutaneous adipose tissue (SAT) on CT scans. Measurements of the quantity and quality of abdominal adipose tissue were obtained from two CT scans taken roughly 6 years apart. Participants were assessed for frequency of sugar-sweetened beverage vs. diet soda intake, and body measurements were obtained.

The mean age of the 1,003 participants was 45.3 years, and women made up 45%. Of them, 85% (852) reported drinking a combination of diet soda and sugar-sweetened beverages and 14% (138) reported not drinking either. Sugar-sweetened beverage intake was reported as daily, frequent, occasional, or not at all, in 13%, 35%, 20%, and 32% of the participants, respectively. Those consuming sugar-sweetened beverages were less likely to have diabetes but more likely to be young, male, report more physical activity, and smoke.

Interestingly, those reporting diet soda intake had a higher prevalence of diabetes, had an increased body mass index, and reported less activity (Circulation. 2016 Jan 11).

Over the 6 years, they found more sugar-sweetened beverage consumption was associated with greater change in VAT volume, which was significant after accounting for the change in body weight (P less than .001). As the consumption of sugar-sweetened beverages increased from no consumption to daily consumption, the VAT volume increased by 658 cm³, 649 cm³, 707 cm³, and 852 cm³, respectively.

Finally, they found no association with diet soda intake and change in weight or change in VAT volume.

“In this prospective observational study of middle-aged adults, we observed that individuals who consumed at least one serving of sugar-sweetened beverages per day ... had a 27% greater increase in VAT volume over 6 years compared to non-consumers,” the investigators wrote.

The authors reported having no disclosures. The study was funded by the National Heart, Lung, and Blood Institute.

ORLANDO – Moderate aerobic exercise and a more intensive regimen proved equally effective in reducing intrahepatic triglyceride content in centrally obese patients with nonalcoholic fatty liver disease in a 12-month randomized, controlled trial.

However, the more intensive exercise program had the edge in terms of favorable impact on metabolic risk factors. While both exercise prescriptions reduced body weight and blood pressure to a similar extent over the course of 12 months, the intensive-exercise group showed bigger reductions in body fat mass, visceral fat, and subcutaneous fat (see graphic), Dr. Hui-Jie Zhang of Xiamen (China) University said at the American Heart Association scientific sessions.

The observer-blinded study included 220 middle-age Chinese patients with central obesity and confirmed nonalcoholic fatty liver disease (NAFLD), a common risk factor for cardiovascular disease. They were randomized to three groups: a moderate exercise program that consisted of brisk walking for 150 minutes per week for 12 months; an intensive exercise regimen involving 30 minutes of treadmill running at 65%-80% of maximum oxygen consumption 5 days per week for 6 months, followed by 6 months of brisk walking on the same schedule as the moderate exercise group; or a usual-care control group that received lifestyle counseling.

The primary endpoint was change in intrahepatic triglyceride content as measured by proton magnetic resonance spectroscopy at 12 months. It was reduced from baseline by 6.45% in the intensive exercise group and similarly by 6.19% with moderate exercise, both significantly greater effects than the 2.85% decrease in the control group.

Dr. Zhang reported having no financial conflicts of interest regarding this study.

[email protected]

ORLANDO – Moderate aerobic exercise and a more intensive regimen proved equally effective in reducing intrahepatic triglyceride content in centrally obese patients with nonalcoholic fatty liver disease in a 12-month randomized, controlled trial.

However, the more intensive exercise program had the edge in terms of favorable impact on metabolic risk factors. While both exercise prescriptions reduced body weight and blood pressure to a similar extent over the course of 12 months, the intensive-exercise group showed bigger reductions in body fat mass, visceral fat, and subcutaneous fat (see graphic), Dr. Hui-Jie Zhang of Xiamen (China) University said at the American Heart Association scientific sessions.

The observer-blinded study included 220 middle-age Chinese patients with central obesity and confirmed nonalcoholic fatty liver disease (NAFLD), a common risk factor for cardiovascular disease. They were randomized to three groups: a moderate exercise program that consisted of brisk walking for 150 minutes per week for 12 months; an intensive exercise regimen involving 30 minutes of treadmill running at 65%-80% of maximum oxygen consumption 5 days per week for 6 months, followed by 6 months of brisk walking on the same schedule as the moderate exercise group; or a usual-care control group that received lifestyle counseling.

The primary endpoint was change in intrahepatic triglyceride content as measured by proton magnetic resonance spectroscopy at 12 months. It was reduced from baseline by 6.45% in the intensive exercise group and similarly by 6.19% with moderate exercise, both significantly greater effects than the 2.85% decrease in the control group.

Dr. Zhang reported having no financial conflicts of interest regarding this study.

[email protected]

ORLANDO – Moderate aerobic exercise and a more intensive regimen proved equally effective in reducing intrahepatic triglyceride content in centrally obese patients with nonalcoholic fatty liver disease in a 12-month randomized, controlled trial.

However, the more intensive exercise program had the edge in terms of favorable impact on metabolic risk factors. While both exercise prescriptions reduced body weight and blood pressure to a similar extent over the course of 12 months, the intensive-exercise group showed bigger reductions in body fat mass, visceral fat, and subcutaneous fat (see graphic), Dr. Hui-Jie Zhang of Xiamen (China) University said at the American Heart Association scientific sessions.

The observer-blinded study included 220 middle-age Chinese patients with central obesity and confirmed nonalcoholic fatty liver disease (NAFLD), a common risk factor for cardiovascular disease. They were randomized to three groups: a moderate exercise program that consisted of brisk walking for 150 minutes per week for 12 months; an intensive exercise regimen involving 30 minutes of treadmill running at 65%-80% of maximum oxygen consumption 5 days per week for 6 months, followed by 6 months of brisk walking on the same schedule as the moderate exercise group; or a usual-care control group that received lifestyle counseling.

The primary endpoint was change in intrahepatic triglyceride content as measured by proton magnetic resonance spectroscopy at 12 months. It was reduced from baseline by 6.45% in the intensive exercise group and similarly by 6.19% with moderate exercise, both significantly greater effects than the 2.85% decrease in the control group.

Dr. Zhang reported having no financial conflicts of interest regarding this study.

[email protected]

WASHINGTON – Childhood obesity is soaring in the United States, especially among Hispanic and African-American children. At the heart of this “epidemic” are dietary and behavioral factors that are linked to stress and poverty rather than race and ethnicity, and the risks may even begin prenatally, according to experts attending an Institute of Medicine forum on early childhood obesity.

Based on data from the 2009-2010 NHANES (National Health and Nutrition Examination Survey), over 8% of children aged 2-5 years in the United States are obese; based on ethnicity, 18% of Hispanic boys and 15% of Hispanic girls in this age group are obese. Nearly 18% of U.S. children aged 6-11 years are obese; nearly 29% of Hispanic boys and 26% of non-Hispanic black girls in this age group are obese.

“If we’re looking for reasons why black and Hispanic children have these disparities ... then we’re looking at what happens in their early years and during pregnancy,” Dr. Elsie Taveras, chief of general academic pediatrics at Massachusetts General Hospital, Boston, said at the IOM meeting.

Chief among the culprits responsible for the “metabolic programming of risk” is the mother’s pregestational weight, according to Dr. Lisa Bodnar, associate professor of endocrinology at the University of Pittsburgh. “Children may already be programmed to become obese as a result of their intrauterine exposure to an obesogenic environment.”

A 2013 report from the Centers for Disease Control and Prevention found that about 1 in 5 women aged 20 years and older who delivered a live-born infant in 2009 were obese prior to becoming pregnant. The prevalence of obesity was highest among women who were 35 years of age and older (24%); were black, non-Hispanic (32%); had a high school education (28%); and reported Medicaid as their source of insurance coverage before pregnancy (30%). The prevalence of obesity was lowest among women who were 20-34 years of age (22%); were of “other” race/ethnicity (13%); had more than a high school education (20%); and who reported having private insurance coverage before pregnancy (20%), according to the report.

Studies have established that pre-pregnancy body mass index is highly correlated with rates of childhood obesity, but Dr. Bodnar believes the most elegant study, published in Pediatrics in 2004, links the birth records of 8,500 children born to low-income mothers in Ohio with corresponding Women, Infants, and Children data for their children’s respective weights and heights at ages 2, 3, and 4 years. Mothers with pre-pregnancy BMIs in the obese and severely obese ranges had a 3-4 times greater probability that their children had similar BMIs.

More recent U.S. data show that nearly half of all expectant mothers with normal pregravid weights also gain more weight prenatally than the IOM-recommended amounts. The tendency is even more prevalent in those with BMIs in the overweight and obese ranges: 70% of women with pre-gestational BMIs between 25 and 29.9, and 65% of those with BMIs of 30 and over gain too much weight. A 2013 meta-analysis published in JAMA correlated these weight gain patterns with a 90% increased risk of children being obese before the age of 5 years, and a 40% overall lifetime increased risk of obesity.

Stress and sociodemographic factors also can contribute to overeating and unhealthy eating, Dr. Mary Jo Messito, director of the Starting Early Child Obesity Prevention Program at Bellevue Hospital, New York, said in an interview. “High stress can lead to eating higher levels of sugary and processed food.” In lower socioeconomic neighborhoods, processed and fast foods can also be more affordable and more readily available, she added.

At least one study (Sleep Med Rev. 2012 Jun;16[3]:203-11) has established a link between later bedtimes and obesity.

This generation of children sleeps nearly a half hour less per night than did their parents, Dr. Taveras said, and the culprits include later bedtimes, the intake of caffeinated and sugary beverages, and electronic intrusions. A television left on in the room where the child sleeps can make the child dependent upon external means rather than self regulation for putting themselves to sleep, according to Dr. Taveras’ research, published in Pediatrics.

Dr. Taveras also lead a 7-year prospective prebirth cohort study (JAMA Pediatr. 2013 Aug 1;167[8]:731-8) of 1,116 mother and child dyads. In that study, the higher levels of obesity in racial and ethnic minority children were linked to modifiable risk factors. Black and Hispanic 2-year-olds were twice as likely as white ones to have had a cola or other sweetened or caffeinated drink prior to bedtime. By age 4 years, 6.4% of white children, 53% of black children, and 61% of Hispanic children in the study fell to sleep with a television on.

“Dietary patterns in the U.S. are poor, start early, and persist,” Dr. Jose M. Saavedra, chief medical officer for the nutrition division of Nestle USA, said at the meeting. Recently published data in Journal of Obesity (doi: 10.1155/2012/123023) indicate that children who consume sugar-sweetened beverages during infancy are twice as likely to consume them at age 6 years. Similarly, children who do not consume fruits and vegetables daily in infancy were also found to consume them infrequently at the age of 6.

“The patterns start much earlier than what we’ve been paying attention to,” said Dr. Saavedra. He thinks that the window of behavioral plasticity is widest at age 20 months, and urged his peers to find ways to help parents to establish good habits in their children during that time.

Discussing healthy behaviors with parents can help, and may elicit some parental behaviors that can be corrected. During the question and answer session at the meeting, for example, an audience member shared an anecdote about a mother who would only serve her children soda because she’d come from an island nation where the water supply was often unsafe.

Others noted that parents and grandparents who have grown up under conditions of food scarcity can view a “chubby” baby as a healthy baby. Mothers also can feel pressured into overfeeding infants, beginning with supplementing formula.

Also, food is often used as a quick and easy reward, Dr. Messito said. When money is tight, a cookie is an inexpensive treat.

[email protected]

On Twitter @whitneymcknight

WASHINGTON – Childhood obesity is soaring in the United States, especially among Hispanic and African-American children. At the heart of this “epidemic” are dietary and behavioral factors that are linked to stress and poverty rather than race and ethnicity, and the risks may even begin prenatally, according to experts attending an Institute of Medicine forum on early childhood obesity.

Based on data from the 2009-2010 NHANES (National Health and Nutrition Examination Survey), over 8% of children aged 2-5 years in the United States are obese; based on ethnicity, 18% of Hispanic boys and 15% of Hispanic girls in this age group are obese. Nearly 18% of U.S. children aged 6-11 years are obese; nearly 29% of Hispanic boys and 26% of non-Hispanic black girls in this age group are obese.

“If we’re looking for reasons why black and Hispanic children have these disparities ... then we’re looking at what happens in their early years and during pregnancy,” Dr. Elsie Taveras, chief of general academic pediatrics at Massachusetts General Hospital, Boston, said at the IOM meeting.

Chief among the culprits responsible for the “metabolic programming of risk” is the mother’s pregestational weight, according to Dr. Lisa Bodnar, associate professor of endocrinology at the University of Pittsburgh. “Children may already be programmed to become obese as a result of their intrauterine exposure to an obesogenic environment.”

A 2013 report from the Centers for Disease Control and Prevention found that about 1 in 5 women aged 20 years and older who delivered a live-born infant in 2009 were obese prior to becoming pregnant. The prevalence of obesity was highest among women who were 35 years of age and older (24%); were black, non-Hispanic (32%); had a high school education (28%); and reported Medicaid as their source of insurance coverage before pregnancy (30%). The prevalence of obesity was lowest among women who were 20-34 years of age (22%); were of “other” race/ethnicity (13%); had more than a high school education (20%); and who reported having private insurance coverage before pregnancy (20%), according to the report.

Studies have established that pre-pregnancy body mass index is highly correlated with rates of childhood obesity, but Dr. Bodnar believes the most elegant study, published in Pediatrics in 2004, links the birth records of 8,500 children born to low-income mothers in Ohio with corresponding Women, Infants, and Children data for their children’s respective weights and heights at ages 2, 3, and 4 years. Mothers with pre-pregnancy BMIs in the obese and severely obese ranges had a 3-4 times greater probability that their children had similar BMIs.

More recent U.S. data show that nearly half of all expectant mothers with normal pregravid weights also gain more weight prenatally than the IOM-recommended amounts. The tendency is even more prevalent in those with BMIs in the overweight and obese ranges: 70% of women with pre-gestational BMIs between 25 and 29.9, and 65% of those with BMIs of 30 and over gain too much weight. A 2013 meta-analysis published in JAMA correlated these weight gain patterns with a 90% increased risk of children being obese before the age of 5 years, and a 40% overall lifetime increased risk of obesity.

Stress and sociodemographic factors also can contribute to overeating and unhealthy eating, Dr. Mary Jo Messito, director of the Starting Early Child Obesity Prevention Program at Bellevue Hospital, New York, said in an interview. “High stress can lead to eating higher levels of sugary and processed food.” In lower socioeconomic neighborhoods, processed and fast foods can also be more affordable and more readily available, she added.

At least one study (Sleep Med Rev. 2012 Jun;16[3]:203-11) has established a link between later bedtimes and obesity.

This generation of children sleeps nearly a half hour less per night than did their parents, Dr. Taveras said, and the culprits include later bedtimes, the intake of caffeinated and sugary beverages, and electronic intrusions. A television left on in the room where the child sleeps can make the child dependent upon external means rather than self regulation for putting themselves to sleep, according to Dr. Taveras’ research, published in Pediatrics.

Dr. Taveras also lead a 7-year prospective prebirth cohort study (JAMA Pediatr. 2013 Aug 1;167[8]:731-8) of 1,116 mother and child dyads. In that study, the higher levels of obesity in racial and ethnic minority children were linked to modifiable risk factors. Black and Hispanic 2-year-olds were twice as likely as white ones to have had a cola or other sweetened or caffeinated drink prior to bedtime. By age 4 years, 6.4% of white children, 53% of black children, and 61% of Hispanic children in the study fell to sleep with a television on.

“Dietary patterns in the U.S. are poor, start early, and persist,” Dr. Jose M. Saavedra, chief medical officer for the nutrition division of Nestle USA, said at the meeting. Recently published data in Journal of Obesity (doi: 10.1155/2012/123023) indicate that children who consume sugar-sweetened beverages during infancy are twice as likely to consume them at age 6 years. Similarly, children who do not consume fruits and vegetables daily in infancy were also found to consume them infrequently at the age of 6.

“The patterns start much earlier than what we’ve been paying attention to,” said Dr. Saavedra. He thinks that the window of behavioral plasticity is widest at age 20 months, and urged his peers to find ways to help parents to establish good habits in their children during that time.

Discussing healthy behaviors with parents can help, and may elicit some parental behaviors that can be corrected. During the question and answer session at the meeting, for example, an audience member shared an anecdote about a mother who would only serve her children soda because she’d come from an island nation where the water supply was often unsafe.

Others noted that parents and grandparents who have grown up under conditions of food scarcity can view a “chubby” baby as a healthy baby. Mothers also can feel pressured into overfeeding infants, beginning with supplementing formula.

Also, food is often used as a quick and easy reward, Dr. Messito said. When money is tight, a cookie is an inexpensive treat.

[email protected]

On Twitter @whitneymcknight

WASHINGTON – Childhood obesity is soaring in the United States, especially among Hispanic and African-American children. At the heart of this “epidemic” are dietary and behavioral factors that are linked to stress and poverty rather than race and ethnicity, and the risks may even begin prenatally, according to experts attending an Institute of Medicine forum on early childhood obesity.

Based on data from the 2009-2010 NHANES (National Health and Nutrition Examination Survey), over 8% of children aged 2-5 years in the United States are obese; based on ethnicity, 18% of Hispanic boys and 15% of Hispanic girls in this age group are obese. Nearly 18% of U.S. children aged 6-11 years are obese; nearly 29% of Hispanic boys and 26% of non-Hispanic black girls in this age group are obese.

“If we’re looking for reasons why black and Hispanic children have these disparities ... then we’re looking at what happens in their early years and during pregnancy,” Dr. Elsie Taveras, chief of general academic pediatrics at Massachusetts General Hospital, Boston, said at the IOM meeting.

Chief among the culprits responsible for the “metabolic programming of risk” is the mother’s pregestational weight, according to Dr. Lisa Bodnar, associate professor of endocrinology at the University of Pittsburgh. “Children may already be programmed to become obese as a result of their intrauterine exposure to an obesogenic environment.”

A 2013 report from the Centers for Disease Control and Prevention found that about 1 in 5 women aged 20 years and older who delivered a live-born infant in 2009 were obese prior to becoming pregnant. The prevalence of obesity was highest among women who were 35 years of age and older (24%); were black, non-Hispanic (32%); had a high school education (28%); and reported Medicaid as their source of insurance coverage before pregnancy (30%). The prevalence of obesity was lowest among women who were 20-34 years of age (22%); were of “other” race/ethnicity (13%); had more than a high school education (20%); and who reported having private insurance coverage before pregnancy (20%), according to the report.

Studies have established that pre-pregnancy body mass index is highly correlated with rates of childhood obesity, but Dr. Bodnar believes the most elegant study, published in Pediatrics in 2004, links the birth records of 8,500 children born to low-income mothers in Ohio with corresponding Women, Infants, and Children data for their children’s respective weights and heights at ages 2, 3, and 4 years. Mothers with pre-pregnancy BMIs in the obese and severely obese ranges had a 3-4 times greater probability that their children had similar BMIs.

More recent U.S. data show that nearly half of all expectant mothers with normal pregravid weights also gain more weight prenatally than the IOM-recommended amounts. The tendency is even more prevalent in those with BMIs in the overweight and obese ranges: 70% of women with pre-gestational BMIs between 25 and 29.9, and 65% of those with BMIs of 30 and over gain too much weight. A 2013 meta-analysis published in JAMA correlated these weight gain patterns with a 90% increased risk of children being obese before the age of 5 years, and a 40% overall lifetime increased risk of obesity.

Stress and sociodemographic factors also can contribute to overeating and unhealthy eating, Dr. Mary Jo Messito, director of the Starting Early Child Obesity Prevention Program at Bellevue Hospital, New York, said in an interview. “High stress can lead to eating higher levels of sugary and processed food.” In lower socioeconomic neighborhoods, processed and fast foods can also be more affordable and more readily available, she added.

At least one study (Sleep Med Rev. 2012 Jun;16[3]:203-11) has established a link between later bedtimes and obesity.

This generation of children sleeps nearly a half hour less per night than did their parents, Dr. Taveras said, and the culprits include later bedtimes, the intake of caffeinated and sugary beverages, and electronic intrusions. A television left on in the room where the child sleeps can make the child dependent upon external means rather than self regulation for putting themselves to sleep, according to Dr. Taveras’ research, published in Pediatrics.

Dr. Taveras also lead a 7-year prospective prebirth cohort study (JAMA Pediatr. 2013 Aug 1;167[8]:731-8) of 1,116 mother and child dyads. In that study, the higher levels of obesity in racial and ethnic minority children were linked to modifiable risk factors. Black and Hispanic 2-year-olds were twice as likely as white ones to have had a cola or other sweetened or caffeinated drink prior to bedtime. By age 4 years, 6.4% of white children, 53% of black children, and 61% of Hispanic children in the study fell to sleep with a television on.

“Dietary patterns in the U.S. are poor, start early, and persist,” Dr. Jose M. Saavedra, chief medical officer for the nutrition division of Nestle USA, said at the meeting. Recently published data in Journal of Obesity (doi: 10.1155/2012/123023) indicate that children who consume sugar-sweetened beverages during infancy are twice as likely to consume them at age 6 years. Similarly, children who do not consume fruits and vegetables daily in infancy were also found to consume them infrequently at the age of 6.

“The patterns start much earlier than what we’ve been paying attention to,” said Dr. Saavedra. He thinks that the window of behavioral plasticity is widest at age 20 months, and urged his peers to find ways to help parents to establish good habits in their children during that time.

Discussing healthy behaviors with parents can help, and may elicit some parental behaviors that can be corrected. During the question and answer session at the meeting, for example, an audience member shared an anecdote about a mother who would only serve her children soda because she’d come from an island nation where the water supply was often unsafe.

Others noted that parents and grandparents who have grown up under conditions of food scarcity can view a “chubby” baby as a healthy baby. Mothers also can feel pressured into overfeeding infants, beginning with supplementing formula.

Also, food is often used as a quick and easy reward, Dr. Messito said. When money is tight, a cookie is an inexpensive treat.

[email protected]

On Twitter @whitneymcknight

ORLANDO – A 12-week intervention involving a smartphone app and weekly coaching by telephone resulted in sustained, clinically meaningful improvement in multiple unhealthy diet and activity behaviors in the randomized, controlled Make Better Choices 2 study.

“It’s far more possible than I would have believed to produce sustained, large-magnitude changes in cardiovascular risk behaviors without using large financial incentives through the use of technologic support and a scalable approach to coaching,” principal investigator Bonnie J. Spring, Ph.D., said at the American Heart Association scientific sessions.

Bruce Jancin/Frontline Medical News

This is an example of what preventive medicine experts term “primordial prevention.” It’s intervention further upstream than primary prevention, which addresses the standard modifiable cardiovascular risk factors before a cardiovascular event has occurred. Primordial prevention addresses the unhealthy behaviors that eventually lead to the standard risk factors.

Make Better Choices 2 included 212 adults, all of whom had four unhealthy behaviors of interest: low fruit and vegetable intake, high consumption of saturated fat, low levels of moderate to vigorous physical activity, and excessive sedentary leisure TV and computer screen time.

The smartphone app was used for self-monitoring on the journey toward goal attainment. The data were uploaded regularly to the remote coach, who provided individualized instruction weekly for 3 months, then every 2 weeks during the next 3 months, and monthly for the final 3 months, explained Dr. Spring, professor of preventive medicine and director of the Center for Behavior and Health at Northwestern University, Chicago.

The study expanded upon the success of the earlier 204-subject Make Better Choices 1 study, which showed that targeting two of the four unhealthy behaviors resulted in efficiently synergistic improvement in all four (Arch Intern Med. 2012 May 28;172[10]:789-96). However, in the earlier trial, participants were paid $175 if they reached their goals. In Make Better Choices 2, Dr. Spring and her coworkers wanted to see if behavioral change could be achieved without a large financial incentive.

Make Better Choices 2 participants were randomized to one of three study arms: simultaneous targeting of fruit and vegetable intake, sedentary screen time, and low moderate to vigorous physical activity; sequential targeting of fruit/vegetables and screen time followed by the physical activity intervention; or a control group that received instruction on reducing stress and improving sleep.

The simultaneous and sequential interventions proved equally effective. And as in Make Better Choices 1, a carryover effect was seen: At 9 months, not only was fruit and vegetable consumption increased by 5.9 servings per day, compared with baseline and leisure screen time reduced by 2 hours and 7 minutes per day, but participants reduced their saturated fat intake by an absolute 3.7% of total calories consumed daily, even though saturated fat wasn’t targeted.

“We think the improvement in saturated fat intake was due mostly to cutting down on hand to mouth snacking behavior by decreasing TV time,” she explained.

Moderate to vigorous physical activity time was increased by an average of 16 minutes per day in the two active treatment arms, compared with controls at 6 months. However, at 9 months, there was no significant difference among the three groups.

“The hardest behavior change for us to initiate and maintain is moderate to vigorous physical activity. I think that warrants more research,” according to Dr. Spring.

Adherence was good, with roughly an 18% dropout rate through 9 months in each study arm.

Session moderator Dr. Sidney C. Smith of the University of North Carolina, Chapel Hill, noted that only about 25% of participants in the trial were men. He’s observed a similarly skewed ratio in other behavioral studies, and he wondered why, given that men have their acute MIs an average of 10 years earlier than women.

“This is a classic challenge in behavior intervention trials. It’s very difficult to get men to enroll,” Dr. Spring replied. “There’s starting to be a body of work trying to address this challenge.”

She added that she believes for some men it’s an issue of control. They want to do things their way, and they confuse support with control.

“This is one of the hopes of having technology available: If you’re a do-it-yourselfer, here are tools to help you do it yourself,” Dr. Spring said.

Once men get on board, however, a consistent finding in behavioral intervention studies is that the strategies work as well in men as in women, she observed.

Make Better Choices 2 was funded by Northwestern University and the National Institutes of Health. Dr. Spring reported having no financial conflicts of interest.

[email protected]

ORLANDO – A 12-week intervention involving a smartphone app and weekly coaching by telephone resulted in sustained, clinically meaningful improvement in multiple unhealthy diet and activity behaviors in the randomized, controlled Make Better Choices 2 study.

“It’s far more possible than I would have believed to produce sustained, large-magnitude changes in cardiovascular risk behaviors without using large financial incentives through the use of technologic support and a scalable approach to coaching,” principal investigator Bonnie J. Spring, Ph.D., said at the American Heart Association scientific sessions.

Bruce Jancin/Frontline Medical News

This is an example of what preventive medicine experts term “primordial prevention.” It’s intervention further upstream than primary prevention, which addresses the standard modifiable cardiovascular risk factors before a cardiovascular event has occurred. Primordial prevention addresses the unhealthy behaviors that eventually lead to the standard risk factors.

Make Better Choices 2 included 212 adults, all of whom had four unhealthy behaviors of interest: low fruit and vegetable intake, high consumption of saturated fat, low levels of moderate to vigorous physical activity, and excessive sedentary leisure TV and computer screen time.

The smartphone app was used for self-monitoring on the journey toward goal attainment. The data were uploaded regularly to the remote coach, who provided individualized instruction weekly for 3 months, then every 2 weeks during the next 3 months, and monthly for the final 3 months, explained Dr. Spring, professor of preventive medicine and director of the Center for Behavior and Health at Northwestern University, Chicago.

The study expanded upon the success of the earlier 204-subject Make Better Choices 1 study, which showed that targeting two of the four unhealthy behaviors resulted in efficiently synergistic improvement in all four (Arch Intern Med. 2012 May 28;172[10]:789-96). However, in the earlier trial, participants were paid $175 if they reached their goals. In Make Better Choices 2, Dr. Spring and her coworkers wanted to see if behavioral change could be achieved without a large financial incentive.

Make Better Choices 2 participants were randomized to one of three study arms: simultaneous targeting of fruit and vegetable intake, sedentary screen time, and low moderate to vigorous physical activity; sequential targeting of fruit/vegetables and screen time followed by the physical activity intervention; or a control group that received instruction on reducing stress and improving sleep.

The simultaneous and sequential interventions proved equally effective. And as in Make Better Choices 1, a carryover effect was seen: At 9 months, not only was fruit and vegetable consumption increased by 5.9 servings per day, compared with baseline and leisure screen time reduced by 2 hours and 7 minutes per day, but participants reduced their saturated fat intake by an absolute 3.7% of total calories consumed daily, even though saturated fat wasn’t targeted.

“We think the improvement in saturated fat intake was due mostly to cutting down on hand to mouth snacking behavior by decreasing TV time,” she explained.

Moderate to vigorous physical activity time was increased by an average of 16 minutes per day in the two active treatment arms, compared with controls at 6 months. However, at 9 months, there was no significant difference among the three groups.

“The hardest behavior change for us to initiate and maintain is moderate to vigorous physical activity. I think that warrants more research,” according to Dr. Spring.

Adherence was good, with roughly an 18% dropout rate through 9 months in each study arm.

Session moderator Dr. Sidney C. Smith of the University of North Carolina, Chapel Hill, noted that only about 25% of participants in the trial were men. He’s observed a similarly skewed ratio in other behavioral studies, and he wondered why, given that men have their acute MIs an average of 10 years earlier than women.

“This is a classic challenge in behavior intervention trials. It’s very difficult to get men to enroll,” Dr. Spring replied. “There’s starting to be a body of work trying to address this challenge.”

She added that she believes for some men it’s an issue of control. They want to do things their way, and they confuse support with control.

“This is one of the hopes of having technology available: If you’re a do-it-yourselfer, here are tools to help you do it yourself,” Dr. Spring said.

Once men get on board, however, a consistent finding in behavioral intervention studies is that the strategies work as well in men as in women, she observed.

Make Better Choices 2 was funded by Northwestern University and the National Institutes of Health. Dr. Spring reported having no financial conflicts of interest.

[email protected]

ORLANDO – A 12-week intervention involving a smartphone app and weekly coaching by telephone resulted in sustained, clinically meaningful improvement in multiple unhealthy diet and activity behaviors in the randomized, controlled Make Better Choices 2 study.

“It’s far more possible than I would have believed to produce sustained, large-magnitude changes in cardiovascular risk behaviors without using large financial incentives through the use of technologic support and a scalable approach to coaching,” principal investigator Bonnie J. Spring, Ph.D., said at the American Heart Association scientific sessions.

Bruce Jancin/Frontline Medical News

This is an example of what preventive medicine experts term “primordial prevention.” It’s intervention further upstream than primary prevention, which addresses the standard modifiable cardiovascular risk factors before a cardiovascular event has occurred. Primordial prevention addresses the unhealthy behaviors that eventually lead to the standard risk factors.

Make Better Choices 2 included 212 adults, all of whom had four unhealthy behaviors of interest: low fruit and vegetable intake, high consumption of saturated fat, low levels of moderate to vigorous physical activity, and excessive sedentary leisure TV and computer screen time.

The smartphone app was used for self-monitoring on the journey toward goal attainment. The data were uploaded regularly to the remote coach, who provided individualized instruction weekly for 3 months, then every 2 weeks during the next 3 months, and monthly for the final 3 months, explained Dr. Spring, professor of preventive medicine and director of the Center for Behavior and Health at Northwestern University, Chicago.

The study expanded upon the success of the earlier 204-subject Make Better Choices 1 study, which showed that targeting two of the four unhealthy behaviors resulted in efficiently synergistic improvement in all four (Arch Intern Med. 2012 May 28;172[10]:789-96). However, in the earlier trial, participants were paid $175 if they reached their goals. In Make Better Choices 2, Dr. Spring and her coworkers wanted to see if behavioral change could be achieved without a large financial incentive.

Make Better Choices 2 participants were randomized to one of three study arms: simultaneous targeting of fruit and vegetable intake, sedentary screen time, and low moderate to vigorous physical activity; sequential targeting of fruit/vegetables and screen time followed by the physical activity intervention; or a control group that received instruction on reducing stress and improving sleep.

The simultaneous and sequential interventions proved equally effective. And as in Make Better Choices 1, a carryover effect was seen: At 9 months, not only was fruit and vegetable consumption increased by 5.9 servings per day, compared with baseline and leisure screen time reduced by 2 hours and 7 minutes per day, but participants reduced their saturated fat intake by an absolute 3.7% of total calories consumed daily, even though saturated fat wasn’t targeted.

“We think the improvement in saturated fat intake was due mostly to cutting down on hand to mouth snacking behavior by decreasing TV time,” she explained.

Moderate to vigorous physical activity time was increased by an average of 16 minutes per day in the two active treatment arms, compared with controls at 6 months. However, at 9 months, there was no significant difference among the three groups.

“The hardest behavior change for us to initiate and maintain is moderate to vigorous physical activity. I think that warrants more research,” according to Dr. Spring.

Adherence was good, with roughly an 18% dropout rate through 9 months in each study arm.

Session moderator Dr. Sidney C. Smith of the University of North Carolina, Chapel Hill, noted that only about 25% of participants in the trial were men. He’s observed a similarly skewed ratio in other behavioral studies, and he wondered why, given that men have their acute MIs an average of 10 years earlier than women.

“This is a classic challenge in behavior intervention trials. It’s very difficult to get men to enroll,” Dr. Spring replied. “There’s starting to be a body of work trying to address this challenge.”

She added that she believes for some men it’s an issue of control. They want to do things their way, and they confuse support with control.

“This is one of the hopes of having technology available: If you’re a do-it-yourselfer, here are tools to help you do it yourself,” Dr. Spring said.

Once men get on board, however, a consistent finding in behavioral intervention studies is that the strategies work as well in men as in women, she observed.

Make Better Choices 2 was funded by Northwestern University and the National Institutes of Health. Dr. Spring reported having no financial conflicts of interest.

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