BACKGROUND: Rheumatoid arthritis (RA) is an autoimmune disease that causes inflammatory polyarthritis, typically of the small joints. Obesity, a serious global epidemic, has been shown to increase systemic inflammatory biomarkers, several of which are related to RA pathophysiology. Associations have been observed between obesity and worsened RA disease activity outcomes in crosssectional studies. Limited longitudinal studies investigated the effects of weight change on RA disease activity measures. Surgical interventions for weight loss in RA patients showed marked improvement in RA disease activity measures and outcomes but typical weight change in a clinical setting has not been investigated. OBJECTIVE: To investigate the impact of typical weight change on RA disease activity measures. METHODS: We conducted a retrospective cohort study on 178 RA patients seen in typical clinical practice that met the inclusion criteria for the study, which included patients with a minimum of two clinical disease activity assessments (CDAI) with corresponding body mass index (BMI) measures. Medical record review was conducted for each clinic visit where CDAI and BMI were measured, and at each of these visits, sociodemographic, lifestyle, medication usage, questionnaire data, RA characteristics, laboratory values, and comorbidities were collected. Linear regression was used to analyze the association between ΔBMI and ΔCDAI, defined at the dates of minimum and maximum BMI for each subject, adjusting for confounders including sex, age, disease duration, smoking status, serologic status, and steroid usage. Logistic regression was performed to evaluate whether ΔBMI was associated with low/remission RA disease activity according to accepted CDAI cutoffs. RESULTS: Unadjusted linear regression was performed on all 178 subjects to analyze the overall trend within the sample population. For every 1 kg/m2 increase in BMI, CDAI increased by 0.49 points, but these results were not statistically significant (p=0.155, 95%CI -0.176, 1.097). Subjects were stratified into BMI gain, stable, and loss groups. Within the BMI loss group (defined as those whose BMI decreased by more than 1 kg/m2), a significant association was found with ΔCDAI (β= -2.61 [p=0.028, 95%CI -4.91, -0.298]). Unadjusted linear regression on the BMI gain and stable groups was found to be not statistically significant. This association remained significant after adjusting for sex, age, disease duration, smoking status, serologic status, and steroid usage (β=-2.499 [p=0.044, 95%CI -4.94, -0.061]). There was no association between ΔBMI and low/remission RA disease activity (OR 0.990, (95%CI 0.855, 1.146). When stratified by BMI gain, stable, and loss groups there was no significant association with low/remission RA disease activity. CONCLUSION: These results suggest that weight loss may be associated with improved disease activity among patients with RA seen in a typical clinical setting. Weight loss has the potential to be a non-pharmacologic intervention to improve RA disease activity. Prospective studies of weight loss and RA disease activity are necessary to replicate these results.

Background: Weight gain, fat gain and loss of lean tissue are common among a growing population of breast cancer survivors. These unfavourable changes in body composition are distressing for many women and may lead to metabolic disturbance, increased risk of obesity-related disorders and poorer prognosis. Although data are accumulating on the adverse health effects of obesity and weight gain in this population, relationships between acute and chronic effects of treatment, dietary change and weight gain after diagnosis are poorly understood. Objectives: The purpose of this thesis was to gain an appreciation of the experience of food intake and body weight over the treatment trajectory, from the perspective of women who have received chemotherapy for breast cancer. Study 1 was designed to explore the unique challenges associated with chemotherapy in relation to diet and weight management and to investigate possible relationships among psychosocial and treatment-related factors, dietary intake and weight gain during treatment. Study 2 was a follow-up to study 1, within the same study population. The purpose of study 2 was to investigate relationships among persistent side effects of treatment, diet and weight gain since the completion of chemotherapy treatment. Methods: Twenty-eight early stage breast cancer survivors, who were within 12 months of completing chemotherapy, were recruited from four regions in southwestern Ontario, to participate in comprehensive qualitative interviews, identify changes in diet since diagnosis, provide 3-day food records and complete validated surveys to assess current (past week) symptoms of physical and psychological distress. Demographic, medical, treatment and weight history were collected via questionnaire. Current weight was measured at the time of interview. Results: The mean weight change during treatment (mean = 15±4 weeks) was +0.8± 4.6 kg (range = -12.3 - +9.1). Among women who gained (n=11) or lost (n=6) >2.0 kg during treatment, the mean weight change was + 5.1 and -5.2 kg, respectively. Based on the recalled experiences of women, who were on average 6.4±4.4 months from completing chemotherapy treatment, food intake during treatment appears to be highly responsive to treatment day, with most women reporting lower food intake and irregular eating patterns for the first few days after treatment. Women who lost weight during treatment tended to report more severe and persistent side effects of treatment, leading to a more prolonged reduction of food intake after each cycle. Increased appetite, food cravings and intake of energy dense comfort foods seemed to be more common among women who gained weight during treatment. In these women, changes in taste, nausea and emotional distress were central in promoting these dietary responses. Most women reported a reduction in physical activity during treatment. The mean weight change from the completion of chemotherapy treatment to the time of interview was -0.4± 3.2 kg (range = - 6.0 - +5.2), with six women gaining (mean=3.5 kg) and seven women losing (mean=5.1 kg) > 2.0 kg during this time frame. Most women (84%) reported changes in diet after diagnosis. Dietary changes were largely consistent with current recommendations for cancer prevention, however some women were still above the guidelines for total and saturated fat and many were below recommendations for vegetables/fruit and milk/alternatives. Based on the EAR cut-point method, the prevalence of inadequate calcium and vitamin D intakes from foods was high (47-96%). Although symptoms were highly variable, the mean levels of physical and psychological distress in this sample were similar to previous reports among early stage breast cancer patients in active treatment and appear to be markedly higher than previous reports of distress among cancer-free adults. Fatigue duration (proportion of daytime) was negatively correlated with weight change after treatment (r = -0.46, p<0.05). Conclusions: While the etiology of weight change in this population is complex, findings from this study suggest that food intake and dietary patterns may play an important role for some women. A theoretical model based on qualitative analysis supports several pathways by which psychosocial factors and treatment-related side effects might influence diet and eating patterns in ways that promote weight change during treatment. Relatively high levels of physical and psychological distress after treatment suggest that these symptoms may persist for many breast cancer survivors in the first year after completing chemotherapy, and may associate with weight change during this time frame. Data on dietary change and current dietary habits highlight several possible targets for intervention in this population. Understanding the unique challenges related to diet and weight management after diagnosis, in the context of psychosocial and treatment-related factors, may serve to inform future research and to guide the development of effective diet and weight management interventions after diagnosis.

Multivariable modeling was performed using data from the Nutrition Care in Canadian Hospitals Study, identifying factors independently associated with weight change, and specifically weight loss, prior to, during, and following acute hospitalization in older patients (≥65y, n=503). Male gender (OR=1.83, 95% CI 1.23-2.73) and oral nutrition supplement use (OR=2.1, 95% CI 1.31-3.36) were associated with self-reported weight loss (n=445, R2=0.06). Higher BMI (β=-0.2, p=0.001), occurrence of adverse events (β=-0.15, p=0.008), mean intake <75% of meals during admission (β=-0.19, p=0.001), and antibiotic use during admission (β=-0.11, p=0.049) were significantly associated with weight loss during admission (n=290, R2=0.14). Post hospital weight loss was associated with a poor self-reported appetite at follow-up (OR=3.82, 95% CI 2.1-6.97), eating with others never or rarely (OR=2.48, 95% CI 1.31-4.69), and having been admitted to a surgical ward (OR=1.86, 95% CI 1.03-3.35) (n=279, R2=0.16).

Background: Weight gain, fat gain and loss of lean tissue are common among a growing population of breast cancer survivors. These unfavourable changes in body composition are distressing for many women and may lead to metabolic disturbance, increased risk of obesity-related disorders and poorer prognosis. Although data are accumulating on the adverse health effects of obesity and weight gain in this population, relationships between acute and chronic effects of treatment, dietary change and weight gain after diagnosis are poorly understood. Objectives: The purpose of this thesis was to gain an appreciation of the experience of food intake and body weight over the treatment trajectory, from the perspective of women who have received chemotherapy for breast cancer. Study 1 was designed to explore the unique challenges associated with chemotherapy in relation to diet and weight management and to investigate possible relationships among psychosocial and treatment-related factors, dietary intake and weight gain during treatment. Study 2 was a follow-up to study 1, within the same study population. The purpose of study 2 was to investigate relationships among persistent side effects of treatment, diet and weight gain since the completion of chemotherapy treatment. Methods: Twenty-eight early stage breast cancer survivors, who were within 12 months of completing chemotherapy, were recruited from four regions in southwestern Ontario, to participate in comprehensive qualitative interviews, identify changes in diet since diagnosis, provide 3-day food records and complete validated surveys to assess current (past week) symptoms of physical and psychological distress. Demographic, medical, treatment and weight history were collected via questionnaire. Current weight was measured at the time of interview. Results: The mean weight change during treatment (mean = 15±4 weeks) was +0.8± 4.6 kg (range = -12.3 - +9.1). Among women who gained (n=11) or lost (n=6) >2.0 kg during treatment, the mean weight change was + 5.1 and -5.2 kg, respectively. Based on the recalled experiences of women, who were on average 6.4±4.4 months from completing chemotherapy treatment, food intake during treatment appears to be highly responsive to treatment day, with most women reporting lower food intake and irregular eating patterns for the first few days after treatment. Women who lost weight during treatment tended to report more severe and persistent side effects of treatment, leading to a more prolonged reduction of food intake after each cycle. Increased appetite, food cravings and intake of energy dense comfort foods seemed to be more common among women who gained weight during treatment. In these women, changes in taste, nausea and emotional distress were central in promoting these dietary responses. Most women reported a reduction in physical activity during treatment. The mean weight change from the completion of chemotherapy treatment to the time of interview was -0.4± 3.2 kg (range = - 6.0 - +5.2), with six women gaining (mean=3.5 kg) and seven women losing (mean=5.1 kg) > 2.0 kg during this time frame. Most women (84%) reported changes in diet after diagnosis. Dietary changes were largely consistent with current recommendations for cancer prevention, however some women were still above the guidelines for total and saturated fat and many were below recommendations for vegetables/fruit and milk/alternatives. Based on the EAR cut-point method, the prevalence of inadequate calcium and vitamin D intakes from foods was high (47-96%). Although symptoms were highly variable, the mean levels of physical and psychological distress in this sample were similar to previous reports among early stage breast cancer patients in active treatment and appear to be markedly higher than previous reports of distress among cancer-free adults. Fatigue duration (proportion of daytime) was negatively correlated with weight change after treatment (r = -0.46, p<0.05). Conclusions: While the etiology of weight change in this population is complex, findings from this study suggest that food intake and dietary patterns may play an important role for some women. A theoretical model based on qualitative analysis supports several pathways by which psychosocial factors and treatment-related side effects might influence diet and eating patterns in ways that promote weight change during treatment. Relatively high levels of physical and psychological distress after treatment suggest that these symptoms may persist for many breast cancer survivors in the first year after completing chemotherapy, and may associate with weight change during this time frame. Data on dietary change and current dietary habits highlight several possible targets for intervention in this population. Understanding the unique challenges related to diet and weight management after diagnosis, in the context of psychosocial and treatment-related factors, may serve to inform future research and to guide the development of effective diet and weight management interventions after diagnosis.

Objective: To examine whether weight history and weight transitions over adult lifespan contribute to physical impairment among postmenopausal women. Design: BMI categories were calculated among postmenopausal women who reported their weight and height at age 18 years. Multiple-variable logistic regression was used to determine the association between BMI at age 18 years and BMI transitions over adulthood on severe physical impairment (SPI), defined as scoring <60 on the Physical Functioning subscale of the Rand thirty-six-item Short-Form Health Survey. Setting: Participants were part of the Women's Health Initiative Observational Study (WHI OS), where participants' health was followed over time via questionnaires and clinical assessments. Subjects: Postmenopausal women (n 76 016; mean age 635 (sd 73) years). Results: Women with overweight (BMI=250-299 kg/m(2)) or obesity (BMI = 300 kg/m(2)) at 18 years had greater odds (OR (95 % CI)) of SPI (151 (135, 169) and 214 (172, 265), respectively) than normal-weight (BMI=185-249 kg/m(2)) counterparts. Transitions from normal weight to overweight/obese or to underweight (BMI<185 kg/m(2)) were associated with greater odds of SPI (197 (184, 211) and 135 (106, 171), respectively) compared with weight stability. Shifting from underweight to overweight/obese also had increased odds of SPI (152 (111, 209)). Overweight/obese to normal BMI transitions resulted in a reduced SPI odds (052 (039, 071)). Conclusions: Higher weight history and transitions into higher weight classes were associated with higher likelihood of SPI, while transitioning into lower weight classes for those with overweight/obesity was protective among postmenopausal women.

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第22389号 / 人健博第75号 / 新制||人健||5(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 黒木 裕士, 教授 桂 敏樹, 教授 横出 正之 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

No description available.

Objective: To determine if weight gain in college subjects is associated with meal frequency, breakfast consumption, breakfast type, and alcohol intake over one year of college. Secondary aims were to determine whether BMI and body fat percent are associated with breakfast consumption and type as well as meal frequency. Design: A longitudinal observational study. Health history, work schedule and sleep patterns were recorded. Subjects fasted overnight and height, weight, skin fold measurements, waist, and hip measurements were taken. Two seven day food and activity records were self recorded in September 2005 and in April of 2006. Subjects: One-thousand fifty college students enrolled in freshman level foods and nutrition or personal health courses in fall 2005 were invited to participate in the study; 507 agreed to participate in the study. Main Outcome Measures: Weight change, meal frequency, number of breakfasts per week, breakfast type, and amount of alcohol consumed were analyzed. Weight change by breakfast category was also analyzed. Statistical analyses: Diet records were entered into Nutritionist Pro™ for nutrient analysis. Associations between weight change and meal frequency, breakfast consumption, and alcohol intake in college students were analyzed using independent t-test and analysis of variance (ANOVA). Results: Two-hundred and thirty subjects completed the study. Subjects ate more breakfasts per week in September (148.5 ± 32.5) compared to April (149.6 ± 32.5, p > .05). Non-breakfast eaters gained slightly more weight than breakfast eaters (p = .099). Similar results were found for meal frequency and weight change. Those who consumed more meals per day gained less weight compared to those who ate 4 or fewer meals per day (p = .206). Non drinkers gained significantly more weight than heavy drinkers (p = .004). Conclusion: Although significant associations between breakfast consumption, meal frequency and weight change were not found, results from this study suggest that increasing breakfast consumption as well as meal frequency may be beneficial in reducing the amount of weight gained over time. Although non-drinkers gained significantly more weight than heavy drinkers, more studies are warranted to investigate this finding. Application: This study strengthens the literature on meal frequency and breakfast consumption as they are associated with changes in body weight. The study was also the first of our knowledge to assess these associations in a college setting. Based on these findings, more studies are warranted to determine whether the associations between weight changes and meal frequency as well as breakfast consumption and breakfast type are strongly correlated when a larger and more diverse population base is used. / Master of Science

Contexte : La corpulence de la femme est fortement associée à la croissance foetale. C’est pourquoi l’augmentation du poids des femmes en France devrait s’accompagner d’une augmentation parallèle du poids de naissance. Des modèles animaux ont récemment suggéré qu’en dehors de l’IMC avant grossesse, les variations du poids maternel dans la période périconceptionnelle peuvent être des indicateurs de son statut nutritionnel pendant cette période et influencer la croissance foetale et le déroulement de la grossesse.Objectif : 1) Evaluer les évolutions de la corpulence des femmes et du poids de naissance. 2) Analyser le rôle de la nutrition périconceptionnelle maternelle sur la croissance foetale et le déroulement de la grossesse.Populations : Les données utilisées pour cette thèse sont celles des enquêtes ObEpi, des enquêtes nationales périnatales françaises et de l’étude EDEN. 1) Pour chaque année d’enquête ObEpi (1997, 2000, 2003, 2006), des données sur le poids et la taille ont été obtenues par des questionnaires envoyés à 20000 ménages représentatifs de la population nationale. 2) Les paires mère-enfant parmi les naissances uniques vivantes des enquêtes périnatales de 1972, 1981, 1995, 1998 et 2003 ont été sélectionnées (n=8664, 4494, 11445, 12006, 12692, respectivement). Lors des enquêtes périnatales, les mères ont répondu à des questionnaires quelques jours après l’accouchement et des données sur le nouveau-né et l’accouchement ont été obtenues à partir du dossier médical. 3) Dans l’étude EDEN qui a inclu 2002 femmes recrutées dans les centres de Nancy et de Poitiers, les poids des femmes à l’âge de 20 ans et juste avant la grossesse, l’anthropométrie du foetus aux 2nd et 3`eme trimestres, le poids de naissance et les complications de la grossesse ont été recueillis. Des mesures de poids des femmes au cours de la grossesse ont été disponibles et ont permis d’estimer le poids des femmes à chaque semaine de la grossesse avec un modèle mixte.Résultats : L’analyse d’un effet cohorte de naissance avec les données des enquêtes ObEpi a montré une accélération de l’augmentation de la prévalence de l’obésité pour les générations nées après les années 1960 en particulier chez les femmes. L’augmentation de l’IMC avant grossesse en France s’est accompagnée d’une augmentation du poids de naissance de 1972 à 1995, avec une tendance à la baisse du poids de naissance par la suite. Par ailleurs, nous avons mis en évidence qu’une perte de poids depuis l’âge de 20 ans chez les femmes qui avaient un IMC <25kg/m2 était associée à un risque augmenté d’avoir un bébé petit pour son âge gestationnel après ajustement sur l’IMC avant grossesse. Une prise de poids avant la grossesse était associée à des risques augmentés de diabète et d’hypertension gestationnels après ajustement sur l’IMC avant grossesse. La variation du poids de la femme au premier trimestre de la grossesse était spécifiquement associée à la croissance fœtale et à la corpulence du nouveau-né indépendamment des variations au 2nd et au 3ème trimestres.Conclusion : Les hommes et les femmes nés après les années 1960 ont été exposés à un environnement qui a augmenté leur susceptibilité à l’obésité tout au long de la vie. Par ailleurs, des recherches supplémentaires sont nécessaires pour comprendre les facteurs associés à la non augmentation du poids de naissance depuis les années 1995 malgré une augmentation du poids des femmes. Nos résultats font penser que les variations de poids pré-conceptionnelles pourraient être prises en compte dans l’évaluation du risque obstétrical. / Birthweight is strongly and positively related to maternal preconceptional weight as well as with weight gain during pregnancy. Therefore, it would be expected that the increase in maternal weight before pregnancy, and weight gain during pregnancy, would be associated with an increase in birthweight in France. Animal models suggested that maternal weight changes in the periconceptional period can be considered as indicators of maternal energy balance and nutritional status, and may be involved in fetal growth and pregnancy outcomes.Obejective : 1) To evaluate time trends in maternal body size and birthweight. 2) To investigate the association of maternal weight changes in the periconceptional period with fetal growth and adverse pregnancy outcomes.Background : Birthweight is strongly and positively related to maternal preconceptional weight as well as with weight gain during preg Populations : Data were from ObEpi surveys ; French nationally representative perinatal surveys and the EDEN study. 1) For every ObEpi survey (1997, 2000, 2003 and 2006), data on weight and height were obtained for 20000 households representative of the French population.2) Mother-child pairs among singleton live births were included in the national perinatal surveys in 1972, 1981, 1995, 1998 and 2003 (n=8664, 4494, 11445, 12692 respectively). Mothers were interviewed a few days after delivery and data on delivery and the newborn were extracted from hospital records. 3) In the EDEN mother-child cohort, 1756 mother–child pairs had information on mother’s weight at 20 years, weight just before pregnancy, fetal anthropometry at second and third trimesters, infant’s birthweight and pregnancy complications. Also in the EDEN study 1744 women had prepregnancy weight available and at least 5 measures of weight in pregnancy. We extrapolated women’s weight at each week of gestation with a three-degrees polynomial model and estimated weight change during each trimester of gestation.Results : 1) Analyses based on data from ObEPI surveys showed that more recent cohorts (those born after the 1960’s) experienced an accelerated increase in the prevalence of obesity in relation to age during 1997-2006 particularly for women when compared with older birth cohorts. 2) Body mass index and weight gain during pregnancy increased between 1972 and 2003 ; paradoxically birth weight did not show a parallel increase. In fact, after adjusting for several potential confounders birthweight showed a decrease between 1995 and 2003.This corresponded with an increase in babies born small-for-gestational age (SGA) and a decrease in those born large-for-gestational age (LGA). 3) In women with BMI < 25 kg/m2, weight loss before pregnancy was associated with less fetal growth and increased risk of SGA.Factors including anemia and pathologies such as cancer were also considered but did not explain the findings. On the other hand, “large” weight gain between age 20 and pregnancy was associated with increased risk of gestational diabetes irrespective of overweight status of the woman. 4) Lastly, a significant association between the variation in maternal weightover the first trimester of pregnancy and fetal growth was noted even after accounting for the variation in weight over the last two trimesters. This association was independent of weight gain later in pregnancy and was partly explained by placental weight showing the importance of periconceptual nutritional status.Conclusion : Although the obesity epidemic became apparent in adults only in the 1990s in France, some of its origins can be found as early as the mid 1960s. The increasing trend in the prevalence of SGA in France, and in other countries such like the US, should prioritize research efforts towards a better understanding of the causes of this time trend. Our datasuggest that weight changes in periconceptional period could be taken into account when evaluating the obstetrical risk.

Change in body weight is an important determinant of risk of osteoporotic hip fracture in aging adults. Weight loss has been associated with an increased risk of hip fracture and weight gain has been associated with a decreased risk of hip fracture . . Weight gain cannot be recommended as appropriate prevention against hip fracture, however, because it is associated with such adverse health outcomes as cardiovascular disease and diabetes, and weight loss is commonly recommended in the treatment of these types of diseases. Clarification of how weight loss is related to risk of hip fracture is needed to resolve this issue. An extensive review of published literature was completed to assess the relationships between hip fracture and body weight, weight change, and involuntary and voluntary weight loss. Change in body weight and weight lll loss that was either intentional or unintentional were then assessed for their effects on risk of hip fracture in a population-based case-control study of risk factors for osteoporotic hip fracture in aging Utah residents. Analyses of risk of hip fracture by quintile of weight change since age 18 and according to weight loss intention were performed through logistic regression modeling. Weight loss after age 18 was associated with an increased risk of hip fracture in men and women, and above average weight gain after age 18 was protective against hip fracture in women. Involuntary weight loss of more than 20 pounds was associated with an increased risk of hip fracture in men and women aged 50 to 69 years, but was not related to risk of hip fracture in participants aged 70 to 89. Voluntary weight loss of more than 20 pounds did not significantly increase risk of hip fracture in either age group. It was concluded that involuntary weight loss may be an important predictor of risk of hip fracture in aging adults and that voluntary weight loss may be safely recommended to aging adults without increasing their risk of hip fracture