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[black small square] Dietary Quality Improving Slowly for US Kids


[black small square] New Predictive Tool May Help Screen for Gestational Diabetes


[black small square] Three of 4 US Children Don't Meet National Physical Activity Guideline



Although many obese women are categorized as being of equally high risk of gestational diabetes (GDM), most do not develop the disorder, and until now, lifestyle and pharmacological interventions have not been unsuccessful in preventing GDM in them. Researchers from England's University of Bristol developed a prediction tool for the early identification of obese women at a high risk of GDM to better facilitate targeted interventions in those most likely to benefit. Clinical and anthropometric data and nonfasting blood samples were obtained at 15 and 18 weeks of gestation in 1303 obese pregnant women from UPBEAT, a randomized controlled trial of a behavioral physical activity intervention. Twenty-one biomarkers associated with insulin resistance and a targeted nuclear magnetic resonance metabolome were measured, and prediction models were constructed using stepwise logistic regression. Twenty-six percent of the women developed GDM using International Association of Diabetes and Pregnancy Study Groups criteria. The model, based on clinical and anthropometric variables (age, previous GDM, family history of type 2 diabetes, systolic blood pressure, sum of skinfold thicknesses, and waist-height and neck-thigh ratios), provided an area under the curve of 0.71 (95% confidence interval, 0.68-0.74). This increased to 0.77 (95%confidence interval, 0.73-0.80) with the addition of maternal biomarkers (random glucose, hemoglobin A1c, fructosamine, adiponectin, sex hormone-binding globulin, triglycerides) but did not improve with the addition of nuclear magnetic resonance metabolites. Clinically translatable models for GDM prediction were developed using readily measurable variables, for example, mid-arm circumference, age, systolic blood pressure, and A1c levels. Using a 35% risk threshold, all models identified a group of high-risk obese women, and among them, approximately 50% (positive predictive value) later developed GDM, with a negative predictive value of 80%. Tools for early pregnancy identification of obese women at risk of GDM could enable targeted interventions for GDM prevention in women who will benefit the most and do not require blood sampling. They may be exportable to low- and middle-income countries, where the prevalence of GDM and obesity is rapidly increasing.


Source: PLoS One. Accessed December 8, 2016. doi:10.1371/journal.pone.0167846.



On the whole, the diet of US children improved markedly between 1999 and 2012 but remains poor, and disparities remain among key subgroups that concluded the authors of a new study that examined diet quality data from more than 38 000 kids. The measurement in the study was the standard, 100-point Healthy Eating Index (HEI-2010) score. During the study period, the mean HEI-2010 rose to 50.9 from 42.5 because children ate more healthy foods, such as whole fruit, and became increasingly likely to avoid "empty calories," such as sugary drinks. The latter improvement explained approximately a third of the total improvement.


The data were gathered from 38 487 children aged 2 to 18 years in the National Health and Nutrition Examination Survey. Although many of the components that make up the overall HEI-2010 score improved significantly for measures of whole grains; dairy; whole fruit; total fruit; seafood and plant proteins, greens and beans, and fatty acids; total protein foods; and refined grains, sodium consumption, however, got a bit worse, and in many cases, the component scores improved but only from low levels to begin with, suggesting that nutrition among US children needs to improve further. There were also important differences in subgroups. The score among non-Hispanic black children improved to 48 in 2012 from 40 in 1999, but during the same period, the score for non-Hispanic whites rose to 50 from 42. Although the gap narrowed somewhat, a clear disparity persisted.


The researchers also looked at economic correlates of nutrition. They found that, as household wealth increased, so did gains. The standard, 100-point Healthy Eating Index scores rose 24% among the wealthiest third of the sample, 19% among the middle third, and 18% among the least wealthy third. The authors also analyzed diet quality among children in federal nutrition assistance programs. During the course of the study period, the HEI-2010 scores of children in families receiving SNAP benefits began to lag those of children not receiving such benefits, whereas children benefitting from the Women Infants and Children program pulled further ahead of children not receiving that assistance. That difference might in part relate to how the 2 programs are structured; in SNAP, because consumers can buy almost any food, they might buy less healthy ones if they were less expensive. Women Infants and Children, on the other hand, limits food choices to healthier ones that adhere to dietary guidelines. Every demographic subgroup of children shared in the gains, but the pace varied, and disparities remain.


Source:Gu X, Tucker KL. Dietary quality of the US child and adolescent population: trends from 1999 to 2012 and associations with the use of federal nutrition assistance programs. Am J Clin Nutrition. 2016. doi:10.3945/ajcn.116.135095.



In a new review article, researchers from England's University of Bristol identified antiobesity medications withdrawn since 1950 because of adverse drug reactions after regulatory approval. They examined the evidence used to support such withdrawals, investigated the mechanisms of the adverse reactions, and explored the trends over time. They cast a wide net, including searches in PubMed, the World Health Organization database of drugs, the Web sites of drug regulatory authorities, and selected full texts and hand searches of references in retrieved documents for 1950 to 2015. The levels of evidence was used for making withdrawal decisions using the Oxford Centre for Evidence-Based Medicine criteria. Twenty-five antiobesity medications were withdrawn between 1964 and 2009; 23 of these were centrally acting, via monoamine neurotransmitters. Case reports of adverse drug reactions were cited as evidence for withdrawal in 80% of instances. Psychiatric disturbances, cardiotoxicity (mainly attributable to reuptake inhibitors), and drug abuse or dependence (mainly attributable to neurotransmitter releasing agents) together accounted for 83% of withdrawals. Deaths were reportedly associated with 7 products (28%). In almost half of the cases, the withdrawals occurred within 2 years of the first report of an adverse reaction. The bad news was that most of the drugs that affect monoamine neurotransmitters licensed for the treatment of obesity for the past 65 years have been withdrawn because of adverse reactions. According to the article. the list presented hereinafter represents a profile of centrally acting antiobesity products withdrawn because of associated deaths for the last 50 years.


* Aminorex: introduced in 1962, withdrawn in 1972


* Benfluorex: approved in 1976 as an add-on treatment in obese patients with diabetes mellitus, withdrawn in 2009.


* Fenfluramine: approved in 1973, withdrawn worldwide in 1997


* Methamphetamine (desoxyephedrine): introduced in 1944, withdrawn in the United States and other countries in 1973


* Phentermine: approved in 1959, withdrawn from most countries where it was marketed in 1981 but still available for short-term management of obesity in the United States


* Rimonabant: approved in Europe in 2006 for obesity treatment, withdrawn in 2007


* Sibutramine: approved in the United States in 1997 and Europe in 2001, withdrawn in Europe and United States in 2010



The frequency and reasons for withdrawal raise concerns about the wisdom of using pharmacological agents that target monoamine neurotransmitters in managing obesity. The authors urge that there is a need for greater transparency in the assessment of harms from antiobesity medications, which is therefore warranted.


Source:Onakpoya IJ, Heneghan CJ, Aronson JK. Post-marketing withdrawal of anti-obesity medicinal products because of adverse drug reactions: a systematic review. BMC Med. 2016;14:191. doi:10.1186/s12916-016-0735-y.