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Ford D.W.,Emory University | Hartman T.J.,Emory University | Still C.,Geisingers Obesity Institute | Still C.,Pennsylvania State University | And 8 more authors.
Journal of the Academy of Nutrition and Dietetics | Year: 2014

Health care resource consumption is a growing concern. The aim of this study was to examine the associations between diet quality and body mass index with health care resource use (HRU) in a cohort of advanced age. Participants in the Geisinger Rural Aging Study (n=5,993) were mailed demographic and dietary questionnaires in 2009. Of those eligible, 2,995 (50%; 1,267 male, 1,728 female; mean age 81.4±4.4 years) provided completed surveys. Multivariate negative binomial models were used to estimate relative risk and 95% CI of HRU outcomes with diet quality as assessed by the Dietary Screening Tool score and body mass index determined from self-reported height and weight. Poor diet quality was associated with a 20% increased risk for emergency room (ER) visits. Fruit and vegetable consumption was grouped into quintiles of intake, with the highest quintile serving as the reference group in analyses. The three lowest fruit and vegetable quintiles were associated with increased risk for ER visits (23% to 31%); the lowest quintile increased risk for inpatient visits (27%). Obesity increased risk of outpatient visits; however, individuals with class I obesity were less likely than normal-weight individuals to have ER visits (relative risk=0.84; 95% CI 0.70 to 0.99). Diets of greater quality, particularly with greater fruit and vegetable intake, are associated with favorable effects on HRU outcomes among older adults. Overweight and obesity are associated with increased outpatient HRU and, among obese individuals, with decreased ER visits. These findings suggest that BMI and diet quality beyond age 74 years continue to affect HRU measures. © 2014 Academy of Nutrition and Dietetics. Source

Lotfi K.,Center for Nutrition and Weight Management | Palmer K.,Boston Medical Center | Apovian C.M.,Boston University
Obesity | Year: 2015

This patient with BMI 36 kg/m2 and T2DM on insulin glargine and glyburide as well as atenolol for HTN was able to lose 10% of his initial body weight with a low-carbohydrate diet and exercise and adjustment of medications in approximately a 36-week time frame. Insulin glargine and glyburide were reduced gradually with blood glucose monitoring and replaced by an increase in metformin, start of liraglutide, and eventually phentermine/topiramate and canagliflozin (Figure). Therefore, medications that can exacerbate weight gain were discontinued in place of medications which promote weight loss (1). © 2015 The Obesity Society. Source

Apovian C.M.,Boston University | Apovian C.M.,Center for Nutrition and Weight Management | Murphy M.C.,Dash Inc | Cullum-Dugan D.,Center for Nutrition and Weight Management | And 8 more authors.
Public Health Nutrition | Year: 2010

Objective With the upsurge in online dietary modification programmes, online dietary assessment tools are needed to capture food intake. Although the DASH (Dietary Approaches to Stop Hypertension) diet is recommended by the US Department of Agriculture, there are no online instruments that capture DASH food servings. Our objective was to assess the validity of a new, short, online dietary questionnaire developed to capture intake of DASH food servings. The DASH Online Questionnaire (OLQ) was validated against the well-known Block Food Frequency Questionnaire (FFQ).Design This was a cross-sectional validation of the DASH OLQ, which contained eleven food groups (breakfast cereals; dairy; drinks; fats and oils; fruits; grains and snacks; meat, fish and poultry; mixed dishes; sweets; vegetables; and nuts, seeds and legumes). Each subject completed a DASH OLQ once weekly for four weeks and one 98.2 Block FFQ (110 questions) between weeks 2 and 4. DASH OLQ were averaged and then compared with the Block FFQ for nutrient intakes as well as intakes of DASH food groups.Setting Boston University Medical Center, Boston, Massachusetts.Subjects One hundred and ninety-one faculty and staff at Boston University Medical Center aged 20-70 years.Results There were significant positive correlations between the Block FFQ and the DASH OLQ for all food groups ranging from r = 0.8 for the nuts/seeds/legumes category to r = 0.3 for vegetables and mixed dishes. A comparison of nutrient intakes found strong positive correlations in all nutrient categories. Of particular interest in the DASH diet and the web-based nutrition and physical activity programme were total fat (r = 062), total carbohydrate (r = 0.67), total K (r = 0.68), total Ca (r = 0.69), total vitamin C (r = 0.60) and total energy intake (r = 0.68).Conclusions The DASH OLQ captures food and nutrient intake well in relation to the more established Block FFQ. © 2009 The Authors. Source

Bucaloiu I.D.,Geisinger Medical Center | Craig Wood G.,Biostatistics and Research Data core | Norfolk E.R.,Geisinger Medical Center | Still C.D.,Center for Nutrition and Weight Management | And 2 more authors.
International Journal of Nephrology and Renovascular Disease | Year: 2011

Purpose: Precise estimation of creatinine clearance in obese individuals relies on the appropriate assessment of lean body weight (LBW). Anthropometric methods of predicting LBW have not been validated in morbidly obese populations. Patients and methods: Using an existing dataset of anthropometric data for a female cohort with morbid obesity who had undergone measured FFW with dual energy absorptiometry, we evaluated the performance of five previously reported estimating equations for the prediction of LBW. Linear regression was used to derive a new LBW prediction formula and was then compared with the other formulae. Results: Seventy females (mean [standard deviation] age, weight, and body mass index 43.0 [11.0] years, 128.1 [13.8] kg, and 48.3 [4.8] kg/m 2, respectively) were identified. LBW as estimated by the method of Garrow and Webster correlated well (r = 0.87) with measured mass while demonstrating the highest accuracy, best precision, and smallest bias (93%, 2.1 kg, and 2.9 kg, respectively; P < 0.0001 for all comparisons). The derived formula further improved bias, precision, and accuracy. Conclusion: Among females with morbid obesity, most previously reported estimating equations for LBW predicted FFW poorly. These findings have important clinical implications for the assessment of kidney function and for safe and effective drug dosing. © 2011 Bucaloiu et al. Source

Ruth M.R.,Center for Nutrition and Weight Management | Port A.M.,Center for Nutrition and Weight Management | Shah M.,Center for Nutrition and Weight Management | Bourland A.C.,Center for Nutrition and Weight Management | And 4 more authors.
Metabolism: Clinical and Experimental | Year: 2013

Objective High fat, low carbohydrate (HFLC) diets have become popular tools for weight management. We sought to determine the effects of a HFLC diet compared to a low fat high carbohydrate (LFHC) diet on the change in weight loss, cardiovascular risk factors and inflammation in subjects with obesity. Methods Obese subjects (29.0-44.6 kg/m2) recruited from Boston Medical Center were randomized to a hypocaloric LFHC (n = 26) or HFLC (n = 29) diet for 12 weeks. Results The age range of subjects was 21-62 years. As a percentage of daily calories, the HFLC group consumed 33.5% protein, 56.0% fat and 9.6% carbohydrate and the LFHC group consumed 22.0% protein, 25.0% fat and 55.7% carbohydrate. The change in percent body weight, lean and fat mass, blood pressure, flow mediated dilation, hip:waist ratio, hemoglobin A1C, fasting insulin and glucose, and glucose and insulin response to a 2 h oral glucose tolerance test did not differ (P > 0.05) between diets after 12 weeks. The HFLC group had greater mean decreases in serum triglyceride (P = 0.07), and hs-CRP (P = 0.03), and greater mean increases in HDL cholesterol (P = 0.004), and total adiponectin (P = 0.045) relative to the LFHC. Secreted adipose tissue adiponectin or TNF-α did not differ after weight loss for either diet. Conclusions Relative to the LFHC group, the HFLC group had greater improvements in blood lipids and systemic inflammation with similar changes in body weight and composition. This small-scale study suggests that HFLC diets may be more beneficial to cardiovascular health and inflammation in free-living obese adults compared to LFHC diets. © 2013 Elsevier Inc. Source

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