Posts Tagged ‘lipids’

Lipid Levels Drop for US Adults

October 16th, 2012

Serum total cholesterol and low-density lipoprotein cholesterol (LDL-C) contribute to atherosclerosis and its effects on heart health. An update on these lipid levels among American adults has just been published in JAMA. The paper by Margaret D Carroll and colleagues found that mean total cholesterol declined from 206 in 1988-1994 to 129. Mean HDL-C increased. Mean serum triglyceride levels increased from 118 in 1988-1994 to 123 in 1999-2002 and decreased to 110 in 2007-2010. The prevalence of lipid-lowering medication use increased from 3.4% in 1988-1994 to 15.5% in 2007-2010. Among adults not receiving lipid-lowering medications, trends in lipids were similar to those reported for adults overall. Among obese adults, mean TC, non–HDL-C, LDL-C, and mean triglycerides declined between 1988 and 2010. JAMA: Trends in Lipids and Lipoproteins in US Adults, 1988-2010

 

NIH Disses Physical Activity as Cure of Childhood Obesity

November 23rd, 2011

The National Heart, Lung and Blood Institute has issued guidelines endorsed by the American Academy of Pediatrics. They are directed to all primary pediatric care providers to address the known risk factors of cardiovascular disease, including obesity, blood pressure, cholesterol, tobacco and lipids.

The report notes that longitudinal data on non-white populations are lacking and that “Clinically important differences in prevalence of risk factors exist according to race and gender, particularly with regard to tobacco-use rates, obesity prevalence, hypertension, and dyslipidemia.”

The report notes, “Obesity tracks more strongly than any other risk factor, among many reports from studies that have demonstrated this fact…Tracking data on physical data is more limited.”

Regarding overweight and obesity, the report states,

“The dramatic increases in childhood overweight and obesity in the United States since 1980 are an important public health focus. Despite efforts over the last decade to prevent and control obesity, recent reports from the National Health and Nutrition Examination Survey show sustained high prevalence: 17% of children and adolescents have a BMI at the >95th percentile for age and gender. The presence of obesity in childhood in childhood and adolescence is associated with increased evidence of atherosclerosis at autopsy and of subclinical measures of atherosclerosis on vascular imaging. Because of its strong association with many of the other established risk factors for cardiovascular disease, obesity is even more powerfully correlated with atherosclerosis; this association has been shown for BP, dyslipidemia, and insulin resistance in each of the major pediatric epidemiologic studies. Of all of the risk factors, obesity tracks most strongly from childhood into adult life.”

Given that physical activity is a primary prescription for preventing childhood and adolescent obesity, it is interesting to read what the expert panel has to say about its utility:

“A moderate number of RCTs (randomized controlled clinical trials) have evaluated the effect of interventions that addressed only physical activity and/or sedentary behavior on prevention of overweight and obesity. In a small number of these studies, the intervention was effective. It should be noted that these successful interventions often addressed reduction in sedentary behavior rather than attempts to increase physical activity. In a majority of these studies there was no significant difference in body-size measures. Sample sizes were often small and follow-up was often short (frequently < 6 months). ..Overall, the expert panel concluded that on the basis of the evidence review, increasing activity in isolation is of little benefit in preventing obesity. By contrast, the review suggests that reducing sedentary behavior might be beneficial in preventing the development of obesity.”

The report identifies populations at special risk for obesity: children with a BMI between the 85 and 95th percentiles;children in whom there is a positive family history of obesity in 1 or both parents; early onset of increasing weight; excessive weight gain during adolescence; children who have been very active and become inactive. See Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents- NHLBI, NIH

New Support for Medicare Coverage of Intensive Counseling for Obesity

October 5th, 2011

If the Centers for Medicare and Medicaid Services needed any more support today for including intensive behavioral counseling for obesity as a covered service, it received it today from the U.S. Preventive Services Task Force (USPSTF.)  The USPSTF today released an update of its 2003 recommendation, which was the basis for the Medicare proposal. The update review of literature clearly supports the value of intensive behavioral counseling. It concludes:

  1. Behaviorally based treatment resulted in 6.6 lb greater weight loss in intervention than control participants after 12-18 months, with more treatment sessions associated with greater loss.

  2. Controls generally lost little or no weight, whereas intervention groups lost an average of 4% of baseline weight.

  3. Weight-loss treatment reduced diabetes incidence in patients with pre-diabetes.

  4. Effects on lipids and blood pressure were mixed and small.

The update is published in the Annals of Internal Medicine. Effectiveness of primary care-relevant treatm… [Ann Intern Med. 2011] – PubMed – NCBI

Maintenance and Effects of Weight Loss

September 27th, 2009

Commercial program shows impressive duration of weight loss Weight-loss maintenance 1, 2 and 5 years after suc…[Br J Nutr. 2008] – PubMed Result

Weight loss maintainers use several dietary strategies Use of artificial sweeteners and fat-modified food…[Int J Obes (Lond). 2009] – PubMed Result

Weight loss in obese diabetic and non-diabetic ind…[Diabetes Obes Metab. 2004] – PubMed Result

Overweight and obesity and weight change in middle…[J Epidemiol Community Health. 2005] – PubMed Result

Effect of weight loss on reducing lipids in obese women Reducing diet and/or exercise training decreases t…[J Am Coll Nutr. 2002] – PubMed Result

Effect of weight loss on reducing hypertension Long-term effects of weight loss and dietary sodiu…[Hypertension. 2000] – PubMed Result

Influences of weight loss on long-term diabetes ou…[Proc Nutr Soc. 2008] – PubMed Result

Losing weight improves quality of life even if weight is regained Health-related quality of life following a clinical weight loss intervention among overweight and obese adults: intervention and 24 month follow-up effects

Economic effect of weight loss treatments Systematic review of the long-term effects and eco…[Health Technol Assess. 2004] – PubMed Result