Carol Braunschweig - Academia.edu (original) (raw)

Papers by Carol Braunschweig

American Journal of Clinical Nutrition

Adult obesity is associated with the metabolic syndrome; however, the prevalence of the metabolic... more Adult obesity is associated with the metabolic syndrome; however, the prevalence of the metabolic syndrome among young children has not been reported. Clinic-based screening efforts for the metabolic syndrome in low-income neighborhoods, where obesity is prevalent, are limited by minimal health insurance coverage and inadequate access to health care. School-based obesity screening programs may effectively target high-risk populations. The objective was to describe the prevalence of overweight and features of the metabolic syndrome (defined as the presence of > or =3 of the following risk factors: HDL < or = 40 mg/dL, triacylglycerol > or = 110 mg/dL, and blood pressure or waist circumference at or above the 90th percentile) in a pilot, school-based screening program. A cross-sectional study of obesity and the metabolic syndrome was conducted in third- to sixth-grade, low-income, urban, African American children. Lipid and glucose concentrations were measured in fasting capi...

The American journal of clinical nutrition, 2005

Background: Adult obesity is associated with the metabolic syndrome ; however, the prevalence of ... more Background: Adult obesity is associated with the metabolic syndrome ; however, the prevalence of the metabolic syndrome among young children has not been reported. Clinic-based screening efforts for the metabolic syndrome in low-income neighborhoods, where obesity is prevalent, are limited by minimal health insurance coverage and inadequate access to health care. School-based obesity screening programs may effectively target high-risk populations. Objective: The objective was to describe the prevalence of overweight and features of the metabolic syndrome (defined as the presence of 3 of the following risk factors: HDL 40 mg/dL, triacylglycerol 110 mg/dL, and blood pressure or waist circumference at or above the 90th percentile) in a pilot, school-based screening program. Design: A cross-sectional study of obesity and the metabolic syndrome was conducted in third-to sixth-grade, low-income, urban, African American children. Lipid and glucose concentrations were measured in fasting capillary finger-stick samples. Results: Age-and sex-specific BMI percentiles were assessed in 385 students, 90 of whom were full participants in this study (participants) and 295 of whom had only height and weight measurements taken (other students). Risk factors of the metabolic syndrome were assessed in the 90 participants (23%). No significant differences in BMI percentiles were found between the participants and the other students. Overall, 44% of the participants had BMIs at or above the 85th percentile, and 59% had an elevated BMI or one metabolic syndrome risk factor. The metabolic syndrome was present in 5.6% of all participants, in 13.8% of participants with BMIs at or above the 95th percentile, and in 0% of participants with BMIs below the 95th percentile. Conclusions: Most of the African American children attending 2 urban schools in low-income neighborhoods were overweight or had one or more risk factors for the metabolic syndrome. School-based screening programs in high-risk populations may provide an efficient venue for the screening of obesity and related risk factors. Am J Clin Nutr 2005;81:970 –5.

Liang H, Tomey K, Chen D, Savar NL, Rim-mer JH, Braunschweig CL. Objective measures of neighborho... more Liang H, Tomey K, Chen D, Savar NL, Rim-mer JH, Braunschweig CL. Objective measures of neighborhood environment and self-reported physical activity in spinal cord injured men. Arch Phys Med Rehabil 2008;89:1468-73. Objectives: To assess the relationship between objective neighborhood environment and self-reported physical activity (PA) and between PA and obesity-related risk factors in people with spinal cord injury (SCI). Design: A cross-sectional study. Setting: Urban university. Participants: Men with SCI (N131), 20 to 59 years old, at least 1 year postinjury and using wheelchair for mobility most of the time. Interventions: Not applicable. Main Outcome Measures: Metabolic syndrome (abdominal obesity, elevated blood pressure, glucose, triglycerides, and low-high density lipoprotein cholesterol) and high C-reactive protein (CRP), as well as total PA metabolic equivalent score. Results: Lower PA was associated with higher prevalence rate for elevated triglycerides, metabolic syndrome, and high CRP. Compared with those in low PA tertile, those in high PA tertile had significantly lower odds for elevated triglycerides (odds ratio [OR].19; 95% confidence interval [CI], .04 –.80), metabolic syndrome (OR.15; 95% CI, .03–.66) and high CRP (OR.17; 95% CI, .04 –.71) while adjusting for relevant factors. In crude analysis, lower PA was associated with neighborhood environmental characteristics including shorter distance to nearest transit stops, smaller mean block area, greater number of transit stops, high vacant housing, and higher neighborhood crime rate. In multivariate analysis higher total crime was the only risk factor significantly associated with lower PA level. Those living in higher crime rate neighborhoods had 86% lower odds of having greater than median PA level (OR.14; 95% CI, .04 –.49) than their counterparts. Conclusions: In men with SCI, lower PA is independently associated with having elevated triglycerides, metabolic syndrome , and high CRP. Additionally, lower PA is associated with higher neighborhood crime rate.

Tomey KM, Chen DM, Wang X, Braun-schweig CL. Dietary intake and nutritional status of urban commu... more Tomey KM, Chen DM, Wang X, Braun-schweig CL. Dietary intake and nutritional status of urban community-dwelling men with paraplegia. Arch Phys Med Rehabil 2005;86:664-71. Objectives: To evaluate nutritional status, dietary intake, nutrition knowledge, and depression of healthy urban men with chronic spinal cord injury (SCI) and to compare these findings with national guidelines and data. Design: Cross-sectional. Setting: Urban university. Participants: Ninety-five community-dwelling men with paraplegia (age range, 20 –59y). Interventions: Not applicable. Main Outcome Measures: Dietary intake, body mass index (BMI), waist circumference, knowledge of nutrition, and depression. Results: Diets included too much total and saturated fat, and inadequate fiber, calcium, fruit, and dairy intake. Most participants met protein needs, but most calorie levels were at or below recommendations. By using standard BMI and waist circumference cut-points for the able-bodied, approximately half of participants were overweight, 19% were obese, 7.5% were underweight, and more than one third had large waist circumferences. Participants with low knowledge of nutrition and high BMI who lived alone, smoked, and who had low family incomes were at significantly higher risk for lower quality diets. African Americans had the poorest diets. Conclusions: Intake of several key nutrients did not meet guidelines, and many BMI and waist circumference values were outside recommended ranges. These data highlight the need for clinicians to screen, counsel, and treat people with SCI to prevent related chronic diseases.

Nutritional status and biochemical risk factors for chronic disease were assessed in 48 community... more Nutritional status and biochemical risk factors for chronic disease were assessed in 48 community-dwelling adults with Down syndrome in the Chicago area. Dietary intake was measured using a food frequency questionnaire completed by the participant's primary caregiver; anthropometric measures included height and weight and waist circumference. Plasma glucose and lipid concentrations were assessed following a 10-hour fast. Overall, 89% of participants were overweight or obese, 54% had large waist circumferences, and none met the current guidelines for fruit and vegetable intake. Mean concentrations for lipids and glucose, however, were within normal limits; and prevalence for hypertension, elevated lipids, and glucose were less than those for the general population of the United States.

American Journal of Gastroenterology, 2007

The American Journal of Gastroenterology is published by Nature Publishing Group (NPG) on behalf ... more The American Journal of Gastroenterology is published by Nature Publishing Group (NPG) on behalf of the American College of Gastroenterology (ACG). Ranked the #1 clinical journal covering gastroenterology and hepatology*, The American Journal of Gastroenterology (AJG) ...

Metabolism-clinical and Experimental, 2009

Adipose tissue physiology plays an important role in mediating disease risk. Weight loss in obese... more Adipose tissue physiology plays an important role in mediating disease risk. Weight loss in obese individuals improves indicators of adipocyte physiology. However, the minimum degree of weight loss required to elicit improvements remains unknown. The objective of the present study was to determine the minimum weight loss required to improve adipokine profile and decrease fat cell size in severely obese women. Thirteen severely obese women (body mass index, 50 ± 3 kg/m2; age, 35 ± 1 years) consumed a low-calorie diet for 3 weeks with the goal of losing 5% of their initial weight. Subjects were divided into 2 weight loss groups posttreatment: less than 5% weight loss and 5% to 10% weight loss. Body weight was reduced (P < .05) in both groups (−1.4 ± 1.0 and −6.8 ± 0.6 kg, respectively). Adiponectin concentrations increased (P < .05) by 20% in the 5% to 10% weight loss group only. Likewise, leptin and resistin decreased (P < .05) by 37% and 27%, respectively, in the group that lost more weight. Visceral and subcutaneous fat cell size was 41% and 37% smaller (P < .01), respectively, in the 5% to 10% weight loss group. Smaller visceral adipocyte size was related to lower insulin (r = 0.82, P = .01) and glucose (r = 0.58, P = .04) concentrations posttreatment. These findings suggest that a minimum weight loss of 5% is required to improve adipokine profile and decrease fat cell size in severely obese women. These changes in adipocyte physiology may be linked to reductions in metabolic disease risk in this population.

Archives of Physical Medicine and Rehabilitation, 2007

Liang H, Chen D, Wang Y, Rimmer JH, Braunschweig CL. Different risk factor patterns for metabolic... more Liang H, Chen D, Wang Y, Rimmer JH, Braunschweig CL. Different risk factor patterns for metabolic syndrome in men with spinal cord injury compared with able-bodied men despite similar prevalence rates.To determine if the prevalence of metabolic syndrome and risk factors differs between age- and race-matched men with spinal cord injury (SCI) and able-bodied men.Cross-sectional.Urban university.Men with SCI (n=185), ages 20 to 59 years, were matched 1 to 1 with able-bodied men from the 1999−2002 National Health and Nutrition Examination Surveys.Not applicable.Waist circumference, blood pressure, glucose, triglyceride (TG), total (TC), and low- (LDL) and high-density lipoprotein (HDL) cholesterol.Despite similar prevalence for metabolic syndrome, different risk factor patterns were found between groups. Men with SCI had a significantly lower mean HDL, TG, and glucose in addition to lower TC and LDL. After adjusting for smoking, education, and household income by using conditional logistic regression, men with SCI had a higher risk for abdominal obesity (odd ratio [OR]=1.78; 95% confidence interval [CI], 1.07−2.96) and reduced HDL (OR=1.76; 95% CI, 1.06−2.94) but lower risks for elevated glucose (OR=0.55; 95% CI, 0.33−0.94) than their able-bodied counterparts. By using linear regression and controlling for waist circumference, men with SCI had lower TC, LDL, TG, and glucose concentrations but lower HDL. Racial differences in risks were found in both SCI and able-bodied men; however, among the SCI men, prevalence for low HDL and elevated glucose was similar between whites and African Americans.Men with SCI do not appear to have an increased prevalence of metabolic syndrome compared with able-bodied counterparts, suggesting that other nontraditional risks may contribute to their increased mortality from cardiovascular disease and diabetes.

Archives of Physical Medicine and Rehabilitation, 2005

Tomey KM, Chen DM, Wang X, Braunschweig CL. Dietary intake and nutritional status of urban commun... more Tomey KM, Chen DM, Wang X, Braunschweig CL. Dietary intake and nutritional status of urban community-dwelling men with paraplegia. Arch Phys Med Rehabil 2005;86:664–71.To evaluate nutritional status, dietary intake, nutrition knowledge, and depression of healthy urban men with chronic spinal cord injury (SCI) and to compare these findings with national guidelines and data.Cross-sectional.Urban university.Ninety-five community-dwelling men with paraplegia (age range, 20–59y).Not applicable.Dietary intake, body mass index (BMI), waist circumference, knowledge of nutrition, and depression.Diets included too much total and saturated fat, and inadequate fiber, calcium, fruit, and dairy intake. Most participants met protein needs, but most calorie levels were at or below recommendations. By using standard BMI and waist circumference cut-points for the able-bodied, approximately half of participants were overweight, 19% were obese, 7.5% were underweight, and more than one third had large waist circumferences. Participants with low knowledge of nutrition and high BMI who lived alone, smoked, and who had low family incomes were at significantly higher risk for lower quality diets. African Americans had the poorest diets.Intake of several key nutrients did not meet guidelines, and many BMI and waist circumference values were outside recommended ranges. These data highlight the need for clinicians to screen, counsel, and treat people with SCI to prevent related chronic diseases.

Journal of The American Dietetic Association, 2004

Objective To determine whether total parenteral nutrition (TPN)-induced hyperglycemia is associat... more Objective To determine whether total parenteral nutrition (TPN)-induced hyperglycemia is associated with adverse clinical outcomes. Design A retrospective cohort investigation comparing the medical records of hematopoietic stem cell transplant patients was conducted to determine clinical differences between those who received TPN and those who did not receive TPN during transplant. Subjects/Setting Forty-eight adult patients (Ն18 years) undergoing initial autologous or allogeneic hematopoietic stem cell transplant at two urban university-affiliated hospitals were eligible for inclusion. Main Outcome Measures Hyperglycemia (glucose Ն6.1 mmol/L or 110 mg/dL), presence of infection, infection duration, and in-hospital mortality. Statistical Analyses Performed 2 , Student t, and Wilcoxon rank-sum tests were used to detect differences among the study participants. Results Patients had similar baseline demographic and clinical characteristics, with 63% receiving TPN during transplant. When standardized for time, TPN recipients at both institutions experienced significantly more hyperglycemia (PϽ.05) after TPN initiation. TPN patients also experienced 69% of all infections and 100% of repeat positive cultures. Additionally, significantly greater differences for TPN recipients were found for length of stay and daily charges than those who did not receive TPN. No differences were found for in-hospital mortality. Conclusions TPN is strongly associated with hyperglycemia, which may be linked to increased infections of longer duration in a profoundly immunocompromised group of patients who frequently receive TPN. The implications of these findings are limited by the small number of subjects; a larger investigation is warranted.

In light of the high rates of child and adolescent obesity, we examined the nutritional content o... more In light of the high rates of child and adolescent obesity, we examined the nutritional content of food advertising seen by American children and adolescents. We drew samples of top-rated television shows by using ratings data to examine the nutritional content for fat, saturated fat, sugar, sodium, and fiber of food-product advertisements seen on television by both children and adolescents. Food products were examined in aggregate and by 5 separate categories that included cereal, sweets, snacks, drinks, and other food products. For 2- to 11-year-olds and 12- to 17-year-olds, respectively, a sample of 50,351 and 47,955 30-second-equivalent food-product advertisements and their related nutritional content were weighted by television ratings data to provide actual exposure measures of the nutritional content of food advertising seen by children and adolescents. Study results showed that 97.8% and 89.4% of food-product advertisements viewed by children 2 to 11 years old and adolescents 12 to 17 years old, respectively, were high in fat, sugar, or sodium. On average, 46.1% and 49.1% of total calories among the products advertised came from sugar in the advertisements seen by these respective age groups. A total of 97.6% of cereal advertisements seen by children 2 to 11 years old were for high-sugar cereals. No substantial differences were found in the nutritional content of advertisements seen by black and white children 2 to 11 years old. However, a slightly higher proportion of food advertisements in general and across all food-product categories seen by black versus white adolescents were for high-sugar products. The overwhelming majority of food-product advertisements seen on television by American children and adolescents are of poor nutritional content.

Journal of The American Dietetic Association, 2009

Iron deficiency is more prevalent in overweight children and adolescents but the mechanisms that ... more Iron deficiency is more prevalent in overweight children and adolescents but the mechanisms that underlie this condition remain unclear. The purpose of this cross-sectional study was to assess the relationship between iron status and excess adiposity, inflammation, menarche, diet, physical activity, and poverty status in female adolescents included in the National Health and Nutrition Examination Survey 2003-2004 dataset. Descriptive and simple comparative statistics (t test, 2 ) were used to assess differences between normal-weight (5thՅbody mass index [BMI] percentile Ͻ85th) and heavier-weight girls (Յ85th percentile for BMI) for demographic, biochemical, dietary, and physical activity variables. In addition, logistic regression analyses predicting iron deficiency and linear regression predicting serum iron levels were performed. Heavier-weight girls had an increased prevalence of iron deficiency compared to those with normal weight. Dietary iron, age of and time since first menarche, poverty status, and physical activity were similar between the two groups and were not independent predictors of iron deficiency or log serum iron levels. Logistic modeling predicting iron deficiency revealed having a BMI Ն85th percentile and for each 1 mg/dL increase in C-reactive protein the odds ratio for iron deficiency more than doubled. The best-fit linear model to predict serum iron levels included both serum transferrin receptor and C-reactive protein following log-transformation for normalization of these variables. Findings indicate that heavier-weight female adolescents are at greater risk for iron deficiency and that inflammation stemming from excess adipose tissue contributes to this phenomenon. Food and nutrition professionals should consider elevated BMI as an additional risk factor for iron deficiency in female adolescents.

The Diabetes educator

This feasibility study was undertaken to determine if a group of predominantly low-income, low-ed... more This feasibility study was undertaken to determine if a group of predominantly low-income, low-education, African American women with type 2 diabetes could achieve good compliance and improved health outcomes with a carefully structured health promotion intervention. The sample consisted of 30 participants from an urban setting who were diagnosed with type 2 diabetes but also had multiple chronic conditions (e.g., obesity, hypertension, joint pain, and depression). Participants attended a university-based health promotion program where they completed a 12-week intervention that addressed diet, nutrition, and health behavior. Transportation was provided at no cost to the participants. Compliance with the 12-week program was 72.5%. Participants made significant improvements in total cholesterol and LDL-cholesterol levels, cardiovascular fitness, muscular strength and endurance, and nutrition knowledge. African American women with type 2 diabetes residing in difficult living environments (i.e., poverty, high crime, and lack of family support) can achieve good compliance and health outcomes with a structured health promotion program provided that barriers to participation (e.g., transportation, cost, and commitment) are removed prior to and during the intervention.

Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition, 2004

Who benefits from parenteral nutrition (PN) has been the subject of much debate and 4 recent meta... more Who benefits from parenteral nutrition (PN) has been the subject of much debate and 4 recent meta-analyses. We reviewed the 4 meta-analyses that examined the prospective, randomized, clinical trials (PRCT) that compared PN with no nutrition support (standard care) for design, study population, outcomes evaluated, and results. Overall, a total of 113 PRCT were included in the 4 meta-analyses; however, only 4 studies were included in all of them. Despite the differences in populations studied and outcomes evaluated, some similarities emerged: (1) PN does not affect mortality; (2) PN does not reduce complications in normally nourished patients; (3) in malnourished patients, PN demonstrated a trend for reduced infections and complication rates; and (4) PN reduced postoperative complications in patients having surgery for cancer of the esophagus or stomach. PN does not appear to be beneficial for most hospitalized patients. Among those with malnutrition or with upper gastrointestinal cancer, benefits may exist; however, these were influenced by quality of the study and year of publication.

Journal of the American Dietetic Association, 2011

JPEN. Journal of parenteral and enteral nutrition

JPEN. Journal of parenteral and enteral nutrition, 2014

Declines in nutrition status and adverse body composition changes frequently occur in the critica... more Declines in nutrition status and adverse body composition changes frequently occur in the critically ill. The objective of this cross-sectional study was to examine the prevalence of sarcopenia and its occurrence in patients classified as normal nourished using subjective global assessment (SGA). Exploiting diagnostic CT images, skeletal muscle mass at the L3 region was quantified and used to determine sarcopenia and its association with normal nutrition status in 56 patients with respiratory failure. Sarcopenia was defined as an L3 skeletal muscle index of ≤38.5 cm(2)/m(2) for women and ≤52.4 cm(2)/m(2) for men. CT imaging and SGA classifications completed within 14, 10 and 7 days of each other were analyzed to assess sarcopenia and the influence of time between scans on misclassification (ie, normal nourished and sarcopenic). Descriptive statistics were conducted. The average patient was 59.2 (± 15.6) years old, admitted with sepsis/infection, an APACHE II score of 26 (± 8.0), and BMI of 28.3 (± 5.8). Sarcopenia and sarcopenic obesity were prevalent in a minimum of 56% and 24% of patients, respectively, depending on the number of days between CT imaging and SGA assessment. Misclassified individuals were predominantly male, minority and overweight or obese. Controlling for age, no significant differences were noted for patients classified as normal nourished vs malnourished by SGA for lumbar muscle cross-sectional, whole-body lean mass, or skeletal muscle index. Sarcopenia is highly prevalent among patients with respiratory failure requiring mechanical ventilation (MV) and not readily detected in patients classified as normal nourished using SGA.

Contemporary clinical trials, 2014

Other uses, including reproduction and distribution, or selling or licensing copies, or posting t... more Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited.

The acute phase response (APR) that follows injury or infection is characterized by a decrease in... more The acute phase response (APR) that follows injury or infection is characterized by a decrease in serum zinc concentrations, which we hypothesized benefits the host. Additionally, we proposed that preventing this decline by supplementing zinc would result in an exaggerated APR as indicated by elevated temperatures, increased serum cytokine concentrations, interleukin 6 and the acute phase protein (ceruloplasmin). A prospective, randomized, double-blinded, clinical trial was conducted. Patients on home parenteral nutrition with a diagnosis of catheter sepsis and patients with a diagnosis of pancreatitis, also on total parenteral nutrition (TPN), were recruited for the study. Following enrollment, block randomization was used to assign patients to receive 0 mg (n Å 23) or 30 mg (n Å 21) of zinc per day for the first 3 d of TPN. Blood samples for measurement of serum zinc, copper, ceruloplasmin and interleukin-6 were obtained upon enrollment and on d 1 through 3 of TPN. The highest temperatures reported on these days in the medical record were also recorded. Repeated measures ANOVA was used to determine differences in the primary outcome variables over time. No significant differences between groups were observed in serum interleukin-6 or ceruloplasmin concentrations. A significantly higher (P Å 0.035) temperature was observed in the zinc-supplemented group compared with the control group on d 3 of parenteral nutrition. We conclude that parenteral zinc supplementation in patients experiencing a mild APR resulted in an exaggerated APR as evidenced by a significantly higher febrile response.