F. Pi-sunyer - Academia.edu (original) (raw)

Papers by F. Pi-sunyer

Canadian Medical Association Journal, Mar 7, 2011

T he prevalence of obesity has dramatically increased in past decades in both developed and devel... more T he prevalence of obesity has dramatically increased in past decades in both developed and developing countries. The World Health Organization (WHO) reported that 1.6 billion adults are overweight and at least 400 million are obese. 1 The WHO further predicted that by the year 2015, about 2.3 billion adults will be overweight and more than 700 million will be obese. 1 In Taiwan, according to a national survey performed between 1993-1996 and 2005-2008, the prevalence of overweight and obesity (defined as body mass index [BMI] ≥ 24 kg/m 2) had increased dramatically, from 33.4% to 50.8% among men and from 31.7% to 36.9% among women. 2 Overweight and obesity have been recognized as important and independent risk factors for many chronic diseases such as diabetes mellitus, hypertension, stroke, cardiovascular diseases and malignant diseases. 3-7 Substantial epidemiologic evidence shows that obesity is associated with an increased risk of cardiovascular-related and allcause mortality. 8,9 Therefore, obesity has become a major public health problem around the world. Current definitions of obesity and overweight in adults are based on data from white populations. The WHO has proposed another definition for Asian people, but most of the data it used were from cross-sectional studies. 10 One study showed that, for a given BMI, Asian people had higher body fat than white people. 11 Furthermore, the association between BMI and all-cause mortality has been reported to be J-shaped or Ushaped. Most of the studies involved white people, with only a few involving Asian populations. Gu and colleagues reported a U-shaped association between BMI and all-cause mortality among Chinese people. 12 However, they included only middle-aged adults over 40 years old and not all adults over 20 years. We designed a large prospective cohort study to assess the association between BMI and allcause mortality in a nationwide representative sample of Chinese adults over 20 years old in Taiwan. We also intended to find the optimal BMI cutoff values for overweight and obesity among Chinese adults.

Diabetic Medicine, May 29, 2015

Aim-To examine concentrations of biomarkers (adiponectin, C-reactive protein, fibrinogen and tiss... more Aim-To examine concentrations of biomarkers (adiponectin, C-reactive protein, fibrinogen and tissue plasminogen-activator antigen) associated with glucose homeostasis and diabetes risk by history of gestational diabetes. Methods-We conducted a secondary analysis of the Diabetes Prevention Program, a randomized trial of lifestyle intervention or metformin for diabetes prevention. At baseline, participants were overweight and had impaired glucose tolerance. Biomarkers at baseline and 1 year after enrolment were compared between parous women with (n=350) and without a history of gestational diabetes (n=1466). Cox proportional hazard models evaluated whether history of gestational diabetes was associated with diabetes risk, after adjustment for baseline biomarker levels as well as for change in biomarker levels, demographic factors and anthropometrics. Results-At baseline, women with histories of gestational diabetes had lower adiponectin (7.5 μg/ml vs. 8.7 μg/ml; p<0.0001) and greater log C-reactive protein (−0.90 mg/l vs. −0.78 mg/l, p=0.04) levels than women without histories of gestational diabetes, but these associations did not

The American Heart Association makes every effort to avoid any actual or potential conflicts of i... more The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.

Diabetes Care

OBJECTIVE Patients with type 2 diabetes are encouraged to lose weight, but excessive weight loss ... more OBJECTIVE Patients with type 2 diabetes are encouraged to lose weight, but excessive weight loss in older adults may be a marker of poor health and subsequent mortality. We examined weight change during the postintervention period of Look AHEAD, a randomized trial comparing intensive lifestyle intervention (ILI) with diabetes support and education (DSE) (control) in overweight/obese individuals with type 2 diabetes and sought to identify predictors of excessive postintervention weight loss and its association with mortality. RESEARCH DESIGN AND METHODS These secondary analyses compared postintervention weight change (year 8 to final visit; median 16 years) in ILI and DSE in 3,999 Look AHEAD participants. Using empirically derived trajectory categories, we compared four subgroups: weight gainers (n = 307), weight stable (n = 1,561), steady losers (n = 1,731), and steep losers (n = 380), on postintervention mortality, demographic variables, and health status at randomization and year ...

OBJECTIVE: To conduct post-hoc secondary analysis examining the association between change in phy... more OBJECTIVE: To conduct post-hoc secondary analysis examining the association between change in physical activity (PA), measured with self-report and accelerometry, from baseline to 1 and 4 years and cardiovascular disease (CVD) outcomes in the Look AHEAD Trial. RESEARCH DESIGN AND METHODS: Participants were adults with overweight/obesity and type 2 diabetes with PA data at baseline and year 1 or 4 (n = 1,978). Participants were randomized to diabetes support and education or intensive lifestyle intervention. Measures included accelerometry-measured moderate-to-vigorous PA (MVPA), self-reported PA, and composite (morbidity and mortality) CVD outcomes. RESULTS: In pooled analyses of all participants, using Cox proportional hazards models, each 100 MET-min/wk increase in accelerometry-measured MVPA from baseline to 4 years was associated with decreased risk of the subsequent primary composite outcome of CVD. Results were consistent for changes in total MVPA [HR=0.97 (95% CI: 0.95, 0.99)...

Translational Journal of the American College of Sports Medicine, 2020

Purpose Obesity and type 2 diabetes are associated with an increased risk of cardiovascular disea... more Purpose Obesity and type 2 diabetes are associated with an increased risk of cardiovascular disease (CVD), and the combination of weight loss and increased physical exercise are commonly recommended to reduce CVD. This study examined whether people with obesity and type 2 diabetes with an abnormal graded exercise tolerance test (GXT) or a history of CVD would have less success in achieving weight loss and improved fitness compared with adults without these conditions. Methods The Look AHEAD Study examined whether an intensive lifestyle intervention (ILI) compared with diabetes support and education (DSE) reduced cardiovascular events in adults with overweight/obesity and type 2 diabetes. Participants underwent a baseline maximal GXT and provided medical history data. Weight loss and fitness change were examined in 5011 participants over 4 yr in those with or without an abnormal baseline GXT and/or history of CVD. Results After 4 yr, weight loss in both ILI and DSE were significantly...

Journal of the American Geriatrics Society, 2020

Background/Objectives.-Type 2 diabetes and obesity are sometimes described as conditions that acc... more Background/Objectives.-Type 2 diabetes and obesity are sometimes described as conditions that accelerate aging. Multidomain lifestyle interventions have shown promise to slow the accumulation of age-related diseases, a hallmark of aging. However they have not been assessed among at-risk individuals with these two conditions. We examined the relative impact of eight years of a multidomain lifestyle intervention on an index of multimorbidity.

The journals of gerontology. Series A, Biological sciences and medical sciences, Jan 19, 2017

Lifestyle interventions have been shown to improve physical function over the short term; however... more Lifestyle interventions have been shown to improve physical function over the short term; however, whether these benefits are sustainable is unknown. The long-term effects of an intensive lifestyle intervention on physical function were assessed using a randomized post-test design in the Look AHEAD trial. Overweight and obese (BMI ≥25 kg/m 2) middle-aged and older adults (aged 45-76 years at enrollment) with type 2 diabetes enrolled in Look AHEAD, a trial evaluating an intensive lifestyle intervention (ILI) designed to achieve weight loss through caloric restriction and increased physical activity compared to diabetes support and education (DSE), underwent standardized assessments of performance-based physical function including a 4- and 400-m walk, lower extremity physical performance (expanded Short Physical Performance Battery, SPPBexp), and grip strength approximately 11 years post-randomization and 1.5 years after the intervention was stopped (n=3,783). Individuals randomized t...

Sleep, Jan 5, 2015

To examine the effect of changes in cardiorespiratory fitness on obstructive sleep apnea (OSA) se... more To examine the effect of changes in cardiorespiratory fitness on obstructive sleep apnea (OSA) severity prior to and following adjustment for changes in weight over the course of a 4-y weight loss intervention. Prospective analysis of baseline, 1- and 4-y follow-up data from a randomized controlled trial. Four Look AHEAD clinical centers. Two hundred sixty-three overweight/obese adults with type 2 diabetes and OSA. Intensive lifestyle intervention or education control condition. Change in the apnea-hypopnea index (AHI) served as the primary outcome. The percentage change in fitness (submaximal metabolic equivalents (METs)) and change in weight (kg) were the primary independent variables. Primary analyses collapsed intervention conditions with statistical adjustment for treatment group and baseline METs, weight, and AHI among other relevant covariates. At baseline, greater METs were associated with lower AHI (B(SE) = -1.48(0.71), P = 0.038), but this relationship no longer existed (B...

Obesity Research & Clinical Practice, 2014

research letter Efficacy and safety of liraglutide 3.0 mg for weight management are similar acros... more research letter Efficacy and safety of liraglutide 3.0 mg for weight management are similar across races: subgroup analysis across the SCALE and phase II randomized trials The efficacy and safety of liraglutide 3.0 mg versus placebo, as adjunct to diet and exercise, was evaluated in racial subgroups. This post hoc analysis of pooled data from five double-blind randomized, placebo-controlled trials was conducted in 5325 adults with either a body mass index (BMI) ≥27 kg/m 2 plus ≥1 comorbidity or a BMI ≥30 kg/m 2. Statistical interaction tests evaluated possible treatment effect differences between racial subgroups: white (4496, 84.4%), black/African-American (550, 10.3%), Asian (168, 3.2%) and other (111, 2.1%). Effects of liraglutide 3.0 mg on weight loss, associated metabolic effects and safety profile were generally consistent across racial subgroups. All achieved statistically significant mean weight loss at end-of-treatment with liraglutide 3.0 mg versus placebo: white 7.7% versus 2.3%, black/African-American 6.3% versus 1.4%, Asian 6.3% versus 2.5%, other 7.3% versus 0.49%. Treatment effects on weight and cardiovascular risk markers generally showed no dependence on race (interaction test p > 0.05). Adverse events were similar across racial subgroups.

Journal of applied physiology (Bethesda, Md. : 1985), Jan 15, 2014

Whether lean body mass (LBM) composition, especially skeletal muscle and abdominal organs, differ... more Whether lean body mass (LBM) composition, especially skeletal muscle and abdominal organs, differs in adults with type 2 diabetes (T2DM) compared with nondiabetic healthy controls has not been investigated. A subset of African-American and Caucasian participants with T2DM from the Look AHEAD (Action for Health in Diabetes) trial had body composition assessed and compared with a sample of healthy controls. Skeletal muscle mass (SMM), liver, kidneys, and spleen mass were quantified using a contiguous slice magnetic resonance imaging (MRI) protocol. Cardiac mass was quantified by either a cardiac gated MRI protocol or by echocardiography. MRI volumes were converted to mass using assumed densities. Dual-energy X-ray absorptiometry assessed LBM. Using general linear models adjusted for height, weight, sex, age, race, and interactions of diabetes status with race or sex, persons with T2DM (n = 95) had less LBM (49.7 vs. 51.6 kg) and SMM (24.1 vs. 25.4 kg) and larger kidneys (0.40 vs. 0.36...

Sleep, 2013

Study Objectives: To examine whether the initial benefit of weight loss on obstructive sleep apne... more Study Objectives: To examine whether the initial benefit of weight loss on obstructive sleep apnea (OSA) severity at 1 year is maintained at 4 years. Design: Randomized controlled trial with follow-up at 1, 2, and 4 years. Setting: 4 Look AHEAD clinical centers. Participants: Two hundred sixty-four obese adults with type 2 diabetes and OSA. Interventions: Intensive lifestyle intervention with a behavioral weight loss program or diabetes support and education. Measurements: Change in apnea-hypopnea index on polysomnogram. Results: The intensive lifestyle intervention group's mean weight loss was 10.7 ± 0.7 (standard error), 7.4 ± 0.7, and 5.2 ± 0.7 kg at 1, 2, and 4 years respectively, compared to a less than 1-kg weight loss for the control group at each time (P < 0.001). Apnea-hypopnea index difference between groups was 9.7 ± 2.0, 8.0 ± 2.0, and 7.7 ± 2.3 events/h at 1, 2 and 4 years respectively (P < 0.001). Change in apnea-hypopnea index over time was related to the amount of weight loss (P < 0.0001) and intervention, independent of weight loss (P = 0.001). Remission of OSA at 4 years was 5 times more common with intensive lifestyle intervention (20.7%) than diabetes support and education (3.6%). Conclusions: Among obese adults with type 2 diabetes and OSA, intensive lifestyle intervention produced greater reductions in weight and apnea-hypopnea index over a 4 year period than did diabetes support and education. Beneficial effects of intensive lifestyle intervention on apneahypopnea index at 1 year persisted at 4 years, despite an almost 50% weight regain. Effect of intensive lifestyle intervention on apnea-hypopnea index was largely, but not entirely, due to weight loss.

PLoS ONE, 2012

Background: Albuminuria is recognized as a marker of vascular dysfunction. Central obesity increa... more Background: Albuminuria is recognized as a marker of vascular dysfunction. Central obesity increases the risk of cardiovascular disease. Little is known about the association between albuminuria and central obesity in Chinese. We aimed to assess the association between central obesity and prevalence and incidence of albuminuria in a middle-aged population-based cohort study. Methods: This is a cross-sectional and longitudinal cohort study. A total of 2350 subjects aged 40yearswererecruitedin2004inTaiwanforcross−sectionalanalysis.Longitudinalanalysisincluded1432baselinenormoalbuminuriasubjectswithamean2.8yearsfollow−up,67ofwhomexhibitedincidentalbuminuria.Albuminuriawasdefinedasurinaryalbumin−tocreatinineratio40 years were recruited in 2004 in Taiwan for cross-sectional analysis. Longitudinal analysis included 1432 baseline normoalbuminuria subjects with a mean 2.8 years follow-up, 67 of whom exhibited incident albuminuria. Albuminuria was defined as urinary albumin-tocreatinine ratio 40yearswererecruitedin2004inTaiwanforcross−sectionalanalysis.Longitudinalanalysisincluded1432baselinenormoalbuminuriasubjectswithamean2.8yearsfollow−up,67ofwhomexhibitedincidentalbuminuria.Albuminuriawasdefinedasurinaryalbumin−tocreatinineratio30 mg/g creatinine. Multiple logistic regression analyses were used to evaluate the relationship between central obesity and prevalence and incidence of albuminuria after adjustment for age, gender, body mass index, blood pressure, renal function, glucose, high sensitivity c-reactive protein, smoking, betel nut chewing, alcohol drinking, and physical activity. Results: At baseline, albuminuria is significantly associated with central obesity. The adjusted odds ratio of having albuminuria among subjects with central obesity was 1.73(95% confidence interval (CI): 1.04-2.85), compared to the subjects without central obesity. In multivariable models, participants with central obesity at baseline had a 112% increase in risk of incident albuminuria (adjusted incidence rate ratio (95% CI): 2.12(1.01-4.44)) compared with participants with noncentral obesity. Conclusions: Abdominal adiposity was independently associated with increased prevalence and incidence of albuminuria in Chinese. The mechanisms linking adiposity and albuminuria need to be addressed.

Obesity, 2010

This 56‐week, randomized, placebo‐controlled trial examined the efficacy and safety of naltrexone... more This 56‐week, randomized, placebo‐controlled trial examined the efficacy and safety of naltrexone plus bupropion as an adjunct to intensive behavior modification (BMOD). A total of 793 participants (BMI = 36.5 ± 4.2 kg/m2) was randomly assigned in a 1:3 ratio to: (i) placebo + BMOD (N = 202); or (ii) naltrexone sustained‐release (SR, 32 mg/day), combined with bupropion SR (360 mg/day) plus BMOD (i.e., NB32 + BMOD; N = 591). Both groups were prescribed an energy‐reduced diet and 28 group BMOD sessions. Co‐primary end points were percentage change in weight and the proportion of participants who lost ≥5% weight at week 56. Efficacy analyses were performed on a modified intent‐to‐treat population (ITT; i.e., participants with ≥1 postbaseline weight while taking study drug (placebo + BMOD, N = 193; NB32 + BMOD, N = 482)). Missing data were replaced with the last observation obtained on study drug. At week 56, weight loss was 5.1 ± 0.6% with placebo + BMOD vs. 9.3 ± 0.4% with NB32 + BMOD...

Medicine & Science in Sports & Exercise, 2010

Purpose-This study describes baseline physical activity (PA) patterns of individuals with type 2 ... more Purpose-This study describes baseline physical activity (PA) patterns of individuals with type 2 diabetes mellitus enrolled in the multi-center Look AHEAD Study using an objective measure of PA (accelerometry). Methods-2,240 participants (age = 59.0±6.8 years; BMI = 36.5±6.0 kg/m 2) with type 2 diabetes mellitus (T2DM) provided data for this sub-study. Participants were instructed to wear an accelerometer during waking hours over 7 days. Accelerometry data were analyzed to identify periods meeting the criteria of ≥3 METs per minute for ≥10 minutes (MVPA) and ≥6 METs per minute for ≥10 minutes (VPA). Self-reported PA was also assessed with a questionnaire. Accelerometry and self-reported PA data were compared across categories of BMI, sex, race, age, fitness, diabetes medication usage, and history of cardiovascular disease Results-Self reported PA was lower at higher levels of BMI, was higher in males, was lowest for African-American/Black, and positively associated with fitness. Multivariate analyses for accelerometer measured MVPA and VPA showed that more PA bouts per day, minutes per bout, METs per minute, and MET-minutes were associated with higher fitness. For MVPA, bouts per day were higher in men, and METs per minute were higher in women. For VPA, bouts per day was positively associated with increasing age and differed by race/ethnicity. METs per minute were significantly lower at higher levels of BMI and in women. Diabetes medication usage and history of cardiovascular disease were not associated with patterns of physical activity examined. Conclusions-Results provide information of factors that contribute to PA patterns in adults with T2DM when PA is assessed using both objective and subjective measures. These data may inform interventions to improve PA in adults with T2DM.

The Lancet, 2007

Background Since the prevalence of obesity continues to increase, there is a demand for effective... more Background Since the prevalence of obesity continues to increase, there is a demand for effective and safe anti-obesity agents that can produce and maintain weight loss and improve comorbidity. We did a meta-analysis of all published randomised controlled trials to assess the efficacy and safety of the newly approved anti-obesity agent rimonabant. Methods We searched The Cochrane database and Controlled Trials Register, Medline via Pubmed, Embase via WebSpirs, Web of Science, Scopus, and reference lists up to July, 2007. We collected data from four double-blind, randomised controlled trials (including 4105 participants) that compared 20 mg per day rimonabant with placebo. Findings Patients given rimonabant had a 4•7 kg (95% CI 4•1-5•3 kg; p<0•0001) greater weight reduction after 1 year than did those given placebo. Rimonabant caused significantly more adverse events than did placebo (OR=1•4; p=0•0007; number needed to harm=25 individuals [95% CI 17-58]), and 1•4 times more serious adverse events (OR=1•4; p=0•03; number needed to harm=59 [27-830]). Patients given rimonabant were 2•5 times more likely to discontinue the treatment because of depressive mood disorders than were those given placebo (OR=2•5; p=0•01; number needed to harm=49 [19-316]). Furthermore, anxiety caused more patients to discontinue treatment in rimonabant groups than in placebo groups (OR=3•0; p=0•03; number needed to harm=166 [47-3716]). Interpretation Our findings suggest that 20 mg per day rimonabant increases the risk of psychiatric adverse events-ie, depressed mood disorders and anxiety-despite depressed mood being an exclusion criterion in these trials. Taken together with the recent US Food and Drug Administration finding of increased risk of suicide during treatment with rimonabant, we recommend increased alertness by physicians to these potentially severe psychiatric adverse reactions.

JAMA, 2003

Context Although commercial weight loss programs provide treatment to millions of clients, their ... more Context Although commercial weight loss programs provide treatment to millions of clients, their efficacy has not been evaluated in rigorous long-term trials. Objective To compare weight loss and health benefits achieved and maintained through self-help weight loss vs with a structured commercial program.

BMC Public Health, 2010

Background: Previous studies have shown that neighborhood factors are associated with obesity, bu... more Background: Previous studies have shown that neighborhood factors are associated with obesity, but few studies have evaluated the association with weight control behaviors. This study aims to conduct a multi-level analysis to examine the relationship between neighborhood SES and weight-related health behaviors. Methods: In this ancillary study to Look AHEAD (Action for Health in Diabetes) a trial of long-term weight loss among individuals with type 2 diabetes, individual-level data on 1219 participants from 4 clinic sites at baseline were linked to neighborhood-level data at the tract level from the 2000 US Census and other databases. Neighborhood variables included SES (% living below the federal poverty level) and the availability of food stores, convenience stores, and restaurants. Dependent variables included BMI, eating patterns, weight control behaviors and resource use related to food and physical activity. Multi-level models were used to account for individual-level SES and potential confounders. Results: The availability of restaurants was related to several eating and weight control behaviors. Compared to their counterparts in neighborhoods with fewer restaurants, participants in neighborhoods with more restaurants were more likely to eat breakfast (prevalence Ratio [PR] 1.29 95% CI: 1.01-1.62) and lunch (PR = 1.19, 1.04-1.36) at non-fast food restaurants. They were less likely to be attempting weight loss (OR = 0.93, 0.89-0.97) but more likely to engage in weight control behaviors for food and physical activity, respectively, than those who lived in neighborhoods with fewer restaurants. In contrast, neighborhood SES had little association with weight control behaviors. Conclusion: In this selected group of weight loss trial participants, restaurant availability was associated with some weight control practices, but neighborhood SES was not. Future studies should give attention to other populations and to evaluating various aspects of the physical and social environment with weight control practices.

American Journal of Psychiatry, 2004

The American Journal of Clinical Nutrition, 2008

Background: Capsinoids from the Capsicum genus of plants are nonpungent capsaicin-related substan... more Background: Capsinoids from the Capsicum genus of plants are nonpungent capsaicin-related substances with effects on metabolism and body weight in animals. Objectives: Our objectives were to explore the safety and efficacy of capsinoids taken orally (6 mg/d) for weight loss, fat loss, and change in metabolism and to examine whether candidate genes are predictors of capsinoid response. Design: This was a 12-wk, placebo-controlled, double-blind, randomized study. Eligibility criteria included a body mass index (BMI; in kg/m 2) of 25-35. Body weight was measured, and dualenergy X-ray absorptiometry, indirect calorimetry (men only), and genotyping were conducted. Results: Forty women and 40 men with a mean (6 SD) age of 42 6 8 y and BMI of 30.4 6 2.4 were randomly assigned to a capsinoid or placebo group. Capsinoids were well tolerated. Mean (6 SD) weight change was 0.9 6 3.1 and 0.5 6 2.4 kg in the capsinoid and placebo groups, respectively (P ¼ 0.86). There was no significant group difference in total change in adiposity, but abdominal adiposity decreased more (P ¼ 0.049) in the capsinoid group (21.11 6 1.83%) than in the placebo group (20.18 6 1.94%), and this change correlated with the change in body weight (r ¼ 0.46, P , 0.0001). Changes in resting energy expenditure did not differ significantly between groups, but fat oxidation was higher at the end of the study in the capsinoid group (least-squares mean difference: 21.0 mg/min; P ¼ 0.06). Of 13 genetic variants tested, TRPV1 Val585Ile and UCP2 2866 G/A correlated significantly with change in abdominal adiposity. Conclusions: Treatment with 6 mg/d capsinoids orally appeared to be safe and was associated with abdominal fat loss. Capsinoid ingestion was associated with an increase in fat oxidation that was nearly significant. We identified 2 common genetic variants that may be predictors of therapeutic response.

Canadian Medical Association Journal, Mar 7, 2011

T he prevalence of obesity has dramatically increased in past decades in both developed and devel... more T he prevalence of obesity has dramatically increased in past decades in both developed and developing countries. The World Health Organization (WHO) reported that 1.6 billion adults are overweight and at least 400 million are obese. 1 The WHO further predicted that by the year 2015, about 2.3 billion adults will be overweight and more than 700 million will be obese. 1 In Taiwan, according to a national survey performed between 1993-1996 and 2005-2008, the prevalence of overweight and obesity (defined as body mass index [BMI] ≥ 24 kg/m 2) had increased dramatically, from 33.4% to 50.8% among men and from 31.7% to 36.9% among women. 2 Overweight and obesity have been recognized as important and independent risk factors for many chronic diseases such as diabetes mellitus, hypertension, stroke, cardiovascular diseases and malignant diseases. 3-7 Substantial epidemiologic evidence shows that obesity is associated with an increased risk of cardiovascular-related and allcause mortality. 8,9 Therefore, obesity has become a major public health problem around the world. Current definitions of obesity and overweight in adults are based on data from white populations. The WHO has proposed another definition for Asian people, but most of the data it used were from cross-sectional studies. 10 One study showed that, for a given BMI, Asian people had higher body fat than white people. 11 Furthermore, the association between BMI and all-cause mortality has been reported to be J-shaped or Ushaped. Most of the studies involved white people, with only a few involving Asian populations. Gu and colleagues reported a U-shaped association between BMI and all-cause mortality among Chinese people. 12 However, they included only middle-aged adults over 40 years old and not all adults over 20 years. We designed a large prospective cohort study to assess the association between BMI and allcause mortality in a nationwide representative sample of Chinese adults over 20 years old in Taiwan. We also intended to find the optimal BMI cutoff values for overweight and obesity among Chinese adults.

Diabetic Medicine, May 29, 2015

Aim-To examine concentrations of biomarkers (adiponectin, C-reactive protein, fibrinogen and tiss... more Aim-To examine concentrations of biomarkers (adiponectin, C-reactive protein, fibrinogen and tissue plasminogen-activator antigen) associated with glucose homeostasis and diabetes risk by history of gestational diabetes. Methods-We conducted a secondary analysis of the Diabetes Prevention Program, a randomized trial of lifestyle intervention or metformin for diabetes prevention. At baseline, participants were overweight and had impaired glucose tolerance. Biomarkers at baseline and 1 year after enrolment were compared between parous women with (n=350) and without a history of gestational diabetes (n=1466). Cox proportional hazard models evaluated whether history of gestational diabetes was associated with diabetes risk, after adjustment for baseline biomarker levels as well as for change in biomarker levels, demographic factors and anthropometrics. Results-At baseline, women with histories of gestational diabetes had lower adiponectin (7.5 μg/ml vs. 8.7 μg/ml; p<0.0001) and greater log C-reactive protein (−0.90 mg/l vs. −0.78 mg/l, p=0.04) levels than women without histories of gestational diabetes, but these associations did not

The American Heart Association makes every effort to avoid any actual or potential conflicts of i... more The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.

Diabetes Care

OBJECTIVE Patients with type 2 diabetes are encouraged to lose weight, but excessive weight loss ... more OBJECTIVE Patients with type 2 diabetes are encouraged to lose weight, but excessive weight loss in older adults may be a marker of poor health and subsequent mortality. We examined weight change during the postintervention period of Look AHEAD, a randomized trial comparing intensive lifestyle intervention (ILI) with diabetes support and education (DSE) (control) in overweight/obese individuals with type 2 diabetes and sought to identify predictors of excessive postintervention weight loss and its association with mortality. RESEARCH DESIGN AND METHODS These secondary analyses compared postintervention weight change (year 8 to final visit; median 16 years) in ILI and DSE in 3,999 Look AHEAD participants. Using empirically derived trajectory categories, we compared four subgroups: weight gainers (n = 307), weight stable (n = 1,561), steady losers (n = 1,731), and steep losers (n = 380), on postintervention mortality, demographic variables, and health status at randomization and year ...

OBJECTIVE: To conduct post-hoc secondary analysis examining the association between change in phy... more OBJECTIVE: To conduct post-hoc secondary analysis examining the association between change in physical activity (PA), measured with self-report and accelerometry, from baseline to 1 and 4 years and cardiovascular disease (CVD) outcomes in the Look AHEAD Trial. RESEARCH DESIGN AND METHODS: Participants were adults with overweight/obesity and type 2 diabetes with PA data at baseline and year 1 or 4 (n = 1,978). Participants were randomized to diabetes support and education or intensive lifestyle intervention. Measures included accelerometry-measured moderate-to-vigorous PA (MVPA), self-reported PA, and composite (morbidity and mortality) CVD outcomes. RESULTS: In pooled analyses of all participants, using Cox proportional hazards models, each 100 MET-min/wk increase in accelerometry-measured MVPA from baseline to 4 years was associated with decreased risk of the subsequent primary composite outcome of CVD. Results were consistent for changes in total MVPA [HR=0.97 (95% CI: 0.95, 0.99)...

Translational Journal of the American College of Sports Medicine, 2020

Purpose Obesity and type 2 diabetes are associated with an increased risk of cardiovascular disea... more Purpose Obesity and type 2 diabetes are associated with an increased risk of cardiovascular disease (CVD), and the combination of weight loss and increased physical exercise are commonly recommended to reduce CVD. This study examined whether people with obesity and type 2 diabetes with an abnormal graded exercise tolerance test (GXT) or a history of CVD would have less success in achieving weight loss and improved fitness compared with adults without these conditions. Methods The Look AHEAD Study examined whether an intensive lifestyle intervention (ILI) compared with diabetes support and education (DSE) reduced cardiovascular events in adults with overweight/obesity and type 2 diabetes. Participants underwent a baseline maximal GXT and provided medical history data. Weight loss and fitness change were examined in 5011 participants over 4 yr in those with or without an abnormal baseline GXT and/or history of CVD. Results After 4 yr, weight loss in both ILI and DSE were significantly...

Journal of the American Geriatrics Society, 2020

Background/Objectives.-Type 2 diabetes and obesity are sometimes described as conditions that acc... more Background/Objectives.-Type 2 diabetes and obesity are sometimes described as conditions that accelerate aging. Multidomain lifestyle interventions have shown promise to slow the accumulation of age-related diseases, a hallmark of aging. However they have not been assessed among at-risk individuals with these two conditions. We examined the relative impact of eight years of a multidomain lifestyle intervention on an index of multimorbidity.

The journals of gerontology. Series A, Biological sciences and medical sciences, Jan 19, 2017

Lifestyle interventions have been shown to improve physical function over the short term; however... more Lifestyle interventions have been shown to improve physical function over the short term; however, whether these benefits are sustainable is unknown. The long-term effects of an intensive lifestyle intervention on physical function were assessed using a randomized post-test design in the Look AHEAD trial. Overweight and obese (BMI ≥25 kg/m 2) middle-aged and older adults (aged 45-76 years at enrollment) with type 2 diabetes enrolled in Look AHEAD, a trial evaluating an intensive lifestyle intervention (ILI) designed to achieve weight loss through caloric restriction and increased physical activity compared to diabetes support and education (DSE), underwent standardized assessments of performance-based physical function including a 4- and 400-m walk, lower extremity physical performance (expanded Short Physical Performance Battery, SPPBexp), and grip strength approximately 11 years post-randomization and 1.5 years after the intervention was stopped (n=3,783). Individuals randomized t...

Sleep, Jan 5, 2015

To examine the effect of changes in cardiorespiratory fitness on obstructive sleep apnea (OSA) se... more To examine the effect of changes in cardiorespiratory fitness on obstructive sleep apnea (OSA) severity prior to and following adjustment for changes in weight over the course of a 4-y weight loss intervention. Prospective analysis of baseline, 1- and 4-y follow-up data from a randomized controlled trial. Four Look AHEAD clinical centers. Two hundred sixty-three overweight/obese adults with type 2 diabetes and OSA. Intensive lifestyle intervention or education control condition. Change in the apnea-hypopnea index (AHI) served as the primary outcome. The percentage change in fitness (submaximal metabolic equivalents (METs)) and change in weight (kg) were the primary independent variables. Primary analyses collapsed intervention conditions with statistical adjustment for treatment group and baseline METs, weight, and AHI among other relevant covariates. At baseline, greater METs were associated with lower AHI (B(SE) = -1.48(0.71), P = 0.038), but this relationship no longer existed (B...

Obesity Research & Clinical Practice, 2014

research letter Efficacy and safety of liraglutide 3.0 mg for weight management are similar acros... more research letter Efficacy and safety of liraglutide 3.0 mg for weight management are similar across races: subgroup analysis across the SCALE and phase II randomized trials The efficacy and safety of liraglutide 3.0 mg versus placebo, as adjunct to diet and exercise, was evaluated in racial subgroups. This post hoc analysis of pooled data from five double-blind randomized, placebo-controlled trials was conducted in 5325 adults with either a body mass index (BMI) ≥27 kg/m 2 plus ≥1 comorbidity or a BMI ≥30 kg/m 2. Statistical interaction tests evaluated possible treatment effect differences between racial subgroups: white (4496, 84.4%), black/African-American (550, 10.3%), Asian (168, 3.2%) and other (111, 2.1%). Effects of liraglutide 3.0 mg on weight loss, associated metabolic effects and safety profile were generally consistent across racial subgroups. All achieved statistically significant mean weight loss at end-of-treatment with liraglutide 3.0 mg versus placebo: white 7.7% versus 2.3%, black/African-American 6.3% versus 1.4%, Asian 6.3% versus 2.5%, other 7.3% versus 0.49%. Treatment effects on weight and cardiovascular risk markers generally showed no dependence on race (interaction test p > 0.05). Adverse events were similar across racial subgroups.

Journal of applied physiology (Bethesda, Md. : 1985), Jan 15, 2014

Whether lean body mass (LBM) composition, especially skeletal muscle and abdominal organs, differ... more Whether lean body mass (LBM) composition, especially skeletal muscle and abdominal organs, differs in adults with type 2 diabetes (T2DM) compared with nondiabetic healthy controls has not been investigated. A subset of African-American and Caucasian participants with T2DM from the Look AHEAD (Action for Health in Diabetes) trial had body composition assessed and compared with a sample of healthy controls. Skeletal muscle mass (SMM), liver, kidneys, and spleen mass were quantified using a contiguous slice magnetic resonance imaging (MRI) protocol. Cardiac mass was quantified by either a cardiac gated MRI protocol or by echocardiography. MRI volumes were converted to mass using assumed densities. Dual-energy X-ray absorptiometry assessed LBM. Using general linear models adjusted for height, weight, sex, age, race, and interactions of diabetes status with race or sex, persons with T2DM (n = 95) had less LBM (49.7 vs. 51.6 kg) and SMM (24.1 vs. 25.4 kg) and larger kidneys (0.40 vs. 0.36...

Sleep, 2013

Study Objectives: To examine whether the initial benefit of weight loss on obstructive sleep apne... more Study Objectives: To examine whether the initial benefit of weight loss on obstructive sleep apnea (OSA) severity at 1 year is maintained at 4 years. Design: Randomized controlled trial with follow-up at 1, 2, and 4 years. Setting: 4 Look AHEAD clinical centers. Participants: Two hundred sixty-four obese adults with type 2 diabetes and OSA. Interventions: Intensive lifestyle intervention with a behavioral weight loss program or diabetes support and education. Measurements: Change in apnea-hypopnea index on polysomnogram. Results: The intensive lifestyle intervention group's mean weight loss was 10.7 ± 0.7 (standard error), 7.4 ± 0.7, and 5.2 ± 0.7 kg at 1, 2, and 4 years respectively, compared to a less than 1-kg weight loss for the control group at each time (P < 0.001). Apnea-hypopnea index difference between groups was 9.7 ± 2.0, 8.0 ± 2.0, and 7.7 ± 2.3 events/h at 1, 2 and 4 years respectively (P < 0.001). Change in apnea-hypopnea index over time was related to the amount of weight loss (P < 0.0001) and intervention, independent of weight loss (P = 0.001). Remission of OSA at 4 years was 5 times more common with intensive lifestyle intervention (20.7%) than diabetes support and education (3.6%). Conclusions: Among obese adults with type 2 diabetes and OSA, intensive lifestyle intervention produced greater reductions in weight and apnea-hypopnea index over a 4 year period than did diabetes support and education. Beneficial effects of intensive lifestyle intervention on apneahypopnea index at 1 year persisted at 4 years, despite an almost 50% weight regain. Effect of intensive lifestyle intervention on apnea-hypopnea index was largely, but not entirely, due to weight loss.

PLoS ONE, 2012

Background: Albuminuria is recognized as a marker of vascular dysfunction. Central obesity increa... more Background: Albuminuria is recognized as a marker of vascular dysfunction. Central obesity increases the risk of cardiovascular disease. Little is known about the association between albuminuria and central obesity in Chinese. We aimed to assess the association between central obesity and prevalence and incidence of albuminuria in a middle-aged population-based cohort study. Methods: This is a cross-sectional and longitudinal cohort study. A total of 2350 subjects aged 40yearswererecruitedin2004inTaiwanforcross−sectionalanalysis.Longitudinalanalysisincluded1432baselinenormoalbuminuriasubjectswithamean2.8yearsfollow−up,67ofwhomexhibitedincidentalbuminuria.Albuminuriawasdefinedasurinaryalbumin−tocreatinineratio40 years were recruited in 2004 in Taiwan for cross-sectional analysis. Longitudinal analysis included 1432 baseline normoalbuminuria subjects with a mean 2.8 years follow-up, 67 of whom exhibited incident albuminuria. Albuminuria was defined as urinary albumin-tocreatinine ratio 40yearswererecruitedin2004inTaiwanforcross−sectionalanalysis.Longitudinalanalysisincluded1432baselinenormoalbuminuriasubjectswithamean2.8yearsfollow−up,67ofwhomexhibitedincidentalbuminuria.Albuminuriawasdefinedasurinaryalbumin−tocreatinineratio30 mg/g creatinine. Multiple logistic regression analyses were used to evaluate the relationship between central obesity and prevalence and incidence of albuminuria after adjustment for age, gender, body mass index, blood pressure, renal function, glucose, high sensitivity c-reactive protein, smoking, betel nut chewing, alcohol drinking, and physical activity. Results: At baseline, albuminuria is significantly associated with central obesity. The adjusted odds ratio of having albuminuria among subjects with central obesity was 1.73(95% confidence interval (CI): 1.04-2.85), compared to the subjects without central obesity. In multivariable models, participants with central obesity at baseline had a 112% increase in risk of incident albuminuria (adjusted incidence rate ratio (95% CI): 2.12(1.01-4.44)) compared with participants with noncentral obesity. Conclusions: Abdominal adiposity was independently associated with increased prevalence and incidence of albuminuria in Chinese. The mechanisms linking adiposity and albuminuria need to be addressed.

Obesity, 2010

This 56‐week, randomized, placebo‐controlled trial examined the efficacy and safety of naltrexone... more This 56‐week, randomized, placebo‐controlled trial examined the efficacy and safety of naltrexone plus bupropion as an adjunct to intensive behavior modification (BMOD). A total of 793 participants (BMI = 36.5 ± 4.2 kg/m2) was randomly assigned in a 1:3 ratio to: (i) placebo + BMOD (N = 202); or (ii) naltrexone sustained‐release (SR, 32 mg/day), combined with bupropion SR (360 mg/day) plus BMOD (i.e., NB32 + BMOD; N = 591). Both groups were prescribed an energy‐reduced diet and 28 group BMOD sessions. Co‐primary end points were percentage change in weight and the proportion of participants who lost ≥5% weight at week 56. Efficacy analyses were performed on a modified intent‐to‐treat population (ITT; i.e., participants with ≥1 postbaseline weight while taking study drug (placebo + BMOD, N = 193; NB32 + BMOD, N = 482)). Missing data were replaced with the last observation obtained on study drug. At week 56, weight loss was 5.1 ± 0.6% with placebo + BMOD vs. 9.3 ± 0.4% with NB32 + BMOD...

Medicine & Science in Sports & Exercise, 2010

Purpose-This study describes baseline physical activity (PA) patterns of individuals with type 2 ... more Purpose-This study describes baseline physical activity (PA) patterns of individuals with type 2 diabetes mellitus enrolled in the multi-center Look AHEAD Study using an objective measure of PA (accelerometry). Methods-2,240 participants (age = 59.0±6.8 years; BMI = 36.5±6.0 kg/m 2) with type 2 diabetes mellitus (T2DM) provided data for this sub-study. Participants were instructed to wear an accelerometer during waking hours over 7 days. Accelerometry data were analyzed to identify periods meeting the criteria of ≥3 METs per minute for ≥10 minutes (MVPA) and ≥6 METs per minute for ≥10 minutes (VPA). Self-reported PA was also assessed with a questionnaire. Accelerometry and self-reported PA data were compared across categories of BMI, sex, race, age, fitness, diabetes medication usage, and history of cardiovascular disease Results-Self reported PA was lower at higher levels of BMI, was higher in males, was lowest for African-American/Black, and positively associated with fitness. Multivariate analyses for accelerometer measured MVPA and VPA showed that more PA bouts per day, minutes per bout, METs per minute, and MET-minutes were associated with higher fitness. For MVPA, bouts per day were higher in men, and METs per minute were higher in women. For VPA, bouts per day was positively associated with increasing age and differed by race/ethnicity. METs per minute were significantly lower at higher levels of BMI and in women. Diabetes medication usage and history of cardiovascular disease were not associated with patterns of physical activity examined. Conclusions-Results provide information of factors that contribute to PA patterns in adults with T2DM when PA is assessed using both objective and subjective measures. These data may inform interventions to improve PA in adults with T2DM.

The Lancet, 2007

Background Since the prevalence of obesity continues to increase, there is a demand for effective... more Background Since the prevalence of obesity continues to increase, there is a demand for effective and safe anti-obesity agents that can produce and maintain weight loss and improve comorbidity. We did a meta-analysis of all published randomised controlled trials to assess the efficacy and safety of the newly approved anti-obesity agent rimonabant. Methods We searched The Cochrane database and Controlled Trials Register, Medline via Pubmed, Embase via WebSpirs, Web of Science, Scopus, and reference lists up to July, 2007. We collected data from four double-blind, randomised controlled trials (including 4105 participants) that compared 20 mg per day rimonabant with placebo. Findings Patients given rimonabant had a 4•7 kg (95% CI 4•1-5•3 kg; p<0•0001) greater weight reduction after 1 year than did those given placebo. Rimonabant caused significantly more adverse events than did placebo (OR=1•4; p=0•0007; number needed to harm=25 individuals [95% CI 17-58]), and 1•4 times more serious adverse events (OR=1•4; p=0•03; number needed to harm=59 [27-830]). Patients given rimonabant were 2•5 times more likely to discontinue the treatment because of depressive mood disorders than were those given placebo (OR=2•5; p=0•01; number needed to harm=49 [19-316]). Furthermore, anxiety caused more patients to discontinue treatment in rimonabant groups than in placebo groups (OR=3•0; p=0•03; number needed to harm=166 [47-3716]). Interpretation Our findings suggest that 20 mg per day rimonabant increases the risk of psychiatric adverse events-ie, depressed mood disorders and anxiety-despite depressed mood being an exclusion criterion in these trials. Taken together with the recent US Food and Drug Administration finding of increased risk of suicide during treatment with rimonabant, we recommend increased alertness by physicians to these potentially severe psychiatric adverse reactions.

JAMA, 2003

Context Although commercial weight loss programs provide treatment to millions of clients, their ... more Context Although commercial weight loss programs provide treatment to millions of clients, their efficacy has not been evaluated in rigorous long-term trials. Objective To compare weight loss and health benefits achieved and maintained through self-help weight loss vs with a structured commercial program.

BMC Public Health, 2010

Background: Previous studies have shown that neighborhood factors are associated with obesity, bu... more Background: Previous studies have shown that neighborhood factors are associated with obesity, but few studies have evaluated the association with weight control behaviors. This study aims to conduct a multi-level analysis to examine the relationship between neighborhood SES and weight-related health behaviors. Methods: In this ancillary study to Look AHEAD (Action for Health in Diabetes) a trial of long-term weight loss among individuals with type 2 diabetes, individual-level data on 1219 participants from 4 clinic sites at baseline were linked to neighborhood-level data at the tract level from the 2000 US Census and other databases. Neighborhood variables included SES (% living below the federal poverty level) and the availability of food stores, convenience stores, and restaurants. Dependent variables included BMI, eating patterns, weight control behaviors and resource use related to food and physical activity. Multi-level models were used to account for individual-level SES and potential confounders. Results: The availability of restaurants was related to several eating and weight control behaviors. Compared to their counterparts in neighborhoods with fewer restaurants, participants in neighborhoods with more restaurants were more likely to eat breakfast (prevalence Ratio [PR] 1.29 95% CI: 1.01-1.62) and lunch (PR = 1.19, 1.04-1.36) at non-fast food restaurants. They were less likely to be attempting weight loss (OR = 0.93, 0.89-0.97) but more likely to engage in weight control behaviors for food and physical activity, respectively, than those who lived in neighborhoods with fewer restaurants. In contrast, neighborhood SES had little association with weight control behaviors. Conclusion: In this selected group of weight loss trial participants, restaurant availability was associated with some weight control practices, but neighborhood SES was not. Future studies should give attention to other populations and to evaluating various aspects of the physical and social environment with weight control practices.

American Journal of Psychiatry, 2004

The American Journal of Clinical Nutrition, 2008

Background: Capsinoids from the Capsicum genus of plants are nonpungent capsaicin-related substan... more Background: Capsinoids from the Capsicum genus of plants are nonpungent capsaicin-related substances with effects on metabolism and body weight in animals. Objectives: Our objectives were to explore the safety and efficacy of capsinoids taken orally (6 mg/d) for weight loss, fat loss, and change in metabolism and to examine whether candidate genes are predictors of capsinoid response. Design: This was a 12-wk, placebo-controlled, double-blind, randomized study. Eligibility criteria included a body mass index (BMI; in kg/m 2) of 25-35. Body weight was measured, and dualenergy X-ray absorptiometry, indirect calorimetry (men only), and genotyping were conducted. Results: Forty women and 40 men with a mean (6 SD) age of 42 6 8 y and BMI of 30.4 6 2.4 were randomly assigned to a capsinoid or placebo group. Capsinoids were well tolerated. Mean (6 SD) weight change was 0.9 6 3.1 and 0.5 6 2.4 kg in the capsinoid and placebo groups, respectively (P ¼ 0.86). There was no significant group difference in total change in adiposity, but abdominal adiposity decreased more (P ¼ 0.049) in the capsinoid group (21.11 6 1.83%) than in the placebo group (20.18 6 1.94%), and this change correlated with the change in body weight (r ¼ 0.46, P , 0.0001). Changes in resting energy expenditure did not differ significantly between groups, but fat oxidation was higher at the end of the study in the capsinoid group (least-squares mean difference: 21.0 mg/min; P ¼ 0.06). Of 13 genetic variants tested, TRPV1 Val585Ile and UCP2 2866 G/A correlated significantly with change in abdominal adiposity. Conclusions: Treatment with 6 mg/d capsinoids orally appeared to be safe and was associated with abdominal fat loss. Capsinoid ingestion was associated with an increase in fat oxidation that was nearly significant. We identified 2 common genetic variants that may be predictors of therapeutic response.