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Unhealthy lifestyles cost businesses, governmental organizations, and the United States military billions of dollars every year. To fight this rising cost as well as potentially save lives this study sought to understand if a cognitive-behavioral motivation treatment could positively affect the cognitive variables (attitude, self-efficacy, and locus of control) that induce long term behavior change. Anthropometric measurements, specifically body mass index, abdominal circumference, and abdominal height, were used to determine if long term behavior change resulted from the treatment. The Theory of Planned Behavior was the basis of this thesis' model, while the Valence, Instrumentality, and Expectancy (VIE) theory was the foundation for the cognitive-behavioral motivation treatment. Structural Equation Modeling (SEM) tested the theory based model and found two results: a cognitive-behavioral motivation treatment can positively affect cognitive changes that improve behavior and health and, a causal or mediation relationship among the cognitive variables of locus of control and self-efficacy was found instead of the predicted parallel relationship. Effective implementation of an intervention like the one used in this study could lower the United States Air Force's health care bill by as much as $40 million, improve employee efficiency and mission capability, enable longer healthier lives, and prevent premature death.

Metabolic syndrome is a set of risk factor symptoms of cardiovascular disease and diabetes mellitus. Risk factor symptoms are found on Officers of Tanjung Perak Port Class I Health Office, some of them are urban society lifestyle, heterogenous workload and stress based on the working scope, administrative and field work. This research is aimed to analyze the relation between lifestyle, workload, and work stress with metabolic syndrome and its five indicators (blood pressure levels, pre-prandial blood glucose levels, HDL cholesterol levels, abdominal circumference, and triglycerides levels) This research is an observational research with cross sectional research design. The number of research respondents is 39 Government Employees. Lifestyle, workload, and work stress are independent variables. The dependent variables are metabolic syndrome and its five indicators. 13.4% of respondents have metabolic syndrome. Analysis of fisher test found there is a significant relation between frequency of fruit consumption and metabolic syndrome (p=0,047). It is suggested to do a regular medical examination program and provide some variation of fruits menu to be served in meetings or office agendas in order to increase the frequency of fruits consumption.

Background: Commonly fetal parameter for gestational age (GA) assessment have pitfall mostly in progressive pregnancy and pregnancy complicated by fetal structure abnormality. Objective: Correlating of gestational age in the second and third trimesters with umbilical cord diameter. Methods: A cross-sectional sonographic study of 370 pregnant women with gestational age from 14 weeks to 40 weeks was done in Government Tehsil Headquarters Hospital Kahn a nau Lahore, Ferozpur Road, Lahore. The gestational age was first estimated using Naegele's GA estimation formula based on the starting date of the last menstrual period of each subject. Fetal parameters like biparietal diameter, femur length, circumference of the head and abdominal circumference have been used to estimate gestational age. The umbilical cord diameter has been measured to find a correlation between gestation age and umbilical cord diameter. Results: The fetal parameters and umbilical cord diameter increase in the fetus as the gestational age increases. There seems to be a linear relationship and significant statistical correlation (p<0.05) in between umbilical cord diameter and the gestational age estimation. The umbilical cord diameter appeared to increase by the rate of 1mm/week between 14TH to 40TH weeks of the gestational period. Conclusions: The umbilical cord diameter has a strong linear relationship with commonly used parameters for the assessment of fetal gestational age and is able to use as a reliable method to evaluate fetal growth as well as prediction of gestational age.

Ministerio de Ciencia e Innovacion, Grant/Award Number: FJCI-2017-34967; Sixth Framework Programme, Grant/Award Number: 016181 (FOOD) ; Background Metabolic risk and inflammatory state have an early life onset and are associated with future diseases. Objectives To assess the association between metabolic syndrome (MetS) and metabolic health with high-sensitive C-reactive protein (hsCRP), cross-sectionally and longitudinally, in children. Methods 2913 European children (2-10 years) from eight countries from the IDEFICS study were investigated. Data were collected at baseline and 2 years later (follow-up). A MetS z-score was computed with waist circumference (WC), insulin resistance index, blood pressure, high-density lipoprotein cholesterol and triglycerides. Metabolically unhealthy (MU) status was assessed. Multi-level linear and logistic regressions were performed. Results Among the MetS markers, WC was more consistently associated with hsCRP cross-sectional and prospectively. Baseline MetS score was significantly associated with greater risk of high hsCRP at follow-up and with prevalence and incidence of hsCRP. Those children who became MU overtime were significantly (P < .05) associated with future higher levels of hsCRP, independently of weight status at baseline. Conclusions Transition over time to a MU state was associated with higher levels of hsCRP at follow-up, independent of weight status at baseline. Screening of metabolic factors and routine measurement of WC are needed to prevent inflammatory status and related chronic diseases in children. ; Instituto de Salud Carlos III Spanish Government European Commission FJCI-2017-34967 ; European Commission 016181

AbstractSelective intrauterine growth restriction (sIUGR) in monochorionic twin pregnancies is associated with greater morbidity and mortality for both fetuses when compared to singleton and dichorionic pregnancies. This retrospective cohort study aimed to assess the perinatal outcomes of monochorionic twin pregnancies affected by this disorder and conducted expectantly, by analyzing the results according to the end-diastolic flow in the umbilical artery Doppler of the smaller twin (type I: persistently forward/type II: persistently absent or reversed/type III: intermittently absent or reversed). Seventy-five monochorionic diamniotic twin pregnancies with sIUGR were included in this study. sIUGR was defined by estimated fetal weight below the 3rd centile for gestational age, or below the 10th centile, when associated with at least one of the following three criteria: abdominal circumference below the 10th percentile, umbilical artery pulsatility index of the smaller twin above the 95th percentile, or estimated fetal weight discordance of 25% or more. Perinatal outcomes were analyzed from the prenatal period to hospital discharge and included perinatal death, neurological injury, retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), and sepsis. The mortality rate was 1.33% in this cohort. The overall morbidity rate was lower in type I twin pregnancies. In conclusion, this study shows that sIUGR type I has lower morbidity than types II and III in expectant management.

BACKGROUND: Birth weight is an early correlate of disease later in life, and animal studies suggest that low birth weight is associated with reduced activity and increased sedentary time. Whether birth weight predicts later sedentary time in humans is uncertain. OBJECTIVES: We examined the relation between birth weight and sedentary time in youth and examined whether this association was mediated by central adiposity. DESIGN: We used pooled cross-sectional data from 8 observational studies conducted between 1997 and 2007 that consisted of 10,793 youth (boys: 47%) aged 6-18 y from the International Children's Accelerometry Database. Birth weight was measured in hospitals or maternally reported, sedentary time was assessed by using accelerometry (<100 counts/min), and abdominal adiposity (waist circumference) was measured according to WHO procedures. A mediation analysis with bootstrapping was used to analyze data. RESULTS: The mean (±SD) time spent sedentary was 370 ± 91 min/d. Birth weight was positively associated with sedentary time (B = 4.04, P = 0.006) and waist circumference (B = 1.59, P < 0.001), whereas waist circumference was positively associated with sedentary time (B = 0.82, P < 0.001). Results of the mediation analysis showed a significant indirect effect of birth weight on sedentary time through waist circumference (B: 1.30; 95% bias-corrected CI: 0.94, 1.72), and when waist circumference was controlled for, the effect of birth weight on sedentary time was attenuated by 32% (B = 2.74, P = 0.06). CONCLUSION: The association between birth weight and sedentary time appears partially mediated by central adiposity, suggesting that both birth weight and abdominal adiposity may be correlates of sedentary time in youth. ; The pooling of data was funded through grant G0701877 from the United Kingdom National Prevention Research Initiative (http://www.mrc.ac.uk/ Ourresearch/Resourceservices/NPRI/index.htm). Funding partners relevant to this award are as follows: the British Heart Foundation, Cancer Research UK, the Department of Health, Diabetes UK, the Economic and Social Research Council, the Medical Research Council, the Research and Development Office for the Northern Ireland Health and Social Services, the Chief Scientist Office, the Scottish Executive Health Department, The Stroke Association, and the Welsh Assembly Government and World Cancer Research Fund. This work was further supported by the Medical Research Council [MC_UU_12015/4; MC_UU_12015/7], Bristol University, Loughborough University, and the Norwegian School of Sport Sciences. This is an open access article distributed under the CC-BY license (http://creativecommons. org/licenses/by/3.0/). ; This is the final published version. It first appeared at http://ajcn.nutrition.org/content/101/5/983.full#ack-1.

This study evaluated the clinical effects of two different amounts of melon, with a high sugar content, suddenly offered to unadapted sheep. Twelve rumem cannulated crossbred 8-months-old sheep , weighing 25 kg each, were used. These sheep had never been fed with food concentrated with sugar or fruits. The animals were kept in collective pens with a basal diet of roughage and then randomly divided into two equal groups. The sheep in the two groups received 25% and 75% of dry matter (DM) of the diet the crushed melon, administered by the rumen cannula. Physical examination and measurement of rumen fluid pH was performed at the following times: 0, 3, 6, 12, 18 and 24 h. The animals of G25% did not present clinical signs despite subacute acidosis expected after administration of the melon. However, in the G75%, sheep developed clinical manifestation indicative of lactic acidosis with rumen fluid pH lower than 5.0 from T6h, but did not present with dehydration. In sheep from G75 %, tachycardia was observed at 3 h and continued until the end of the study; tachypnea was also observed at 3 h, which was caused by increased abdominal circumference. Based on the results obtained, the supplementation of high amounts of melon (75% DM) in the diet is not recommended for sheep, although the use of 25% DM is safe. However, greater amounts of this fruit could be used in the diet of sheep with gradual adaptation to the substrate.

Abstract Background A genome wide association study found significant association of a sequence variant, rs7566605, in the insulin-induced gene 2 ( INSIG2 ) with obesity. However, the association remained inconclusive in follow-up studies. We tested for association of four tagging SNPs (tagSNPs) including this variant with body mass index (BMI) and abdominal circumference (ABDCIR) in the Samoans of the Western Pacific, a population with high levels of obesity. Methods We studied 907 adult Samoan participants from a longitudinal study of adiposity and cardiovascular disease risk in two polities, American Samoa and Samoa. Four tagSNPs were identified from the Chinese HapMap database based on pairwise r 2 of ≥0.8 and minor allele frequency of ≥0.05. Genotyping was performed using the TaqMan assay. Tests of association with BMI and ABDCIR were performed under the additive model. Results We did not find association of rs7566605 with either BMI or ABDCIR in any group of the Samoans. However, the most distally located tagSNPs in Intron 3 of the gene, rs9308762, showed significant association with both BMI (p-value 0.024) and ABDCIR (p-value 0.009) in the combined sample and with BMI (p-value 0.038) in the sample from Samoa. Conclusion Although rs7566605 was not significantly associated with obesity in our study population, we can not rule out the involvement of INSIG2 in obesity related traits as we found significant association of another tagSNP in INSIG2 with both BMI and ABDCIR. This study suggests the importance of comprehensive assessment of sequence variants within a gene in association studies.

The prevalence of metabolic syndrome has reached epidemic levels in the Samoan Islands. In this cross-sectional study conducted in 2002–2003, dietary patterns were described among American Samoan (n = 723) and Samoan (n = 785) adults (≥18 y) to identify neo-traditional and modern eating patterns and to relate these patterns to the presence of metabolic syndrome using Adult Treatment Panel III criteria. The neo-traditional dietary pattern, similar across both polities, was characterized by high intake of local foods, including crab/lobster, coconut products, and taro, and low intake of processed foods, including potato chips and soda. The modern pattern, also similar across both polities, was characterized by high intake of processed foods such as rice, potato chips, cake, and pancakes and low intake of local foods. The neo-traditional dietary pattern was associated with significantly higher serum HDL-cholesterol in American Samoa (P-trend = 0.05) and a decrease in abdominal circumference in American Samoa and Samoa (P-trend = 0.004 and 0.01, respectively). An inverse association was found with metabolic syndrome, although it did not reach significance (P = 0.23 in American Samoa; P = 0.13 in Samoa). The modern pattern was significantly positively associated with metabolic syndrome in Samoa (prevalence ratio = 1.21 for the fifth compared with first quintile; 95% CI: 0.93.1.57; P-trend = 0.05) and with increased serum triglyceride levels in both polities (P < 0.05). Reduced intake of processed foods high in refined grains and adherence to a neo-traditional eating pattern characterized by plant-based fiber, seafood, and coconut products may help to prevent growth in the prevalence of metabolic syndrome in the Samoan islands.

Obesity is a complex phenotype affected by genetic and environmental influences such as sociocultural factors and individual behaviors. Previously, we performed two separate genome-wide investigations for adiposity-related traits (BMI, percentage body fat (), abdominal circumference (ABDCIR), and serum leptin and serum adiponectin levels) in families from American Samoa and in families from Samoa. The two polities have a common evolutionary history but have lately been influenced by variations in economic development, leading to differences in income and wealth and in dietary and physical activity patterns. We now present a genome-wide linkage scan of the combined samples from the two polities. We adjust for environmental covariates, including polity of residence, education, cigarette smoking, and farm work, and use variance component methods to calculate univariate and bivariate multipoint lod scores. We identified a region on 9p22 with genome-wide significant linkage for the bivariate phenotypes ABDCIR– (1-d.f. lod 3.30) and BMI– (1-d.f. lod 3.31) and two regions with genome-wide suggestive linkage on 8p12 and 16q23 for adiponectin (lod 2.74) and the bivariate phenotype leptin–ABDCIR (1-d.f. lod 3.17), respectively. These three regions have previously been reported to be linked to adiposity-related phenotypes in independent studies. However, the differences in results between this study and our previous polity-specific studies suggest that environmental effects are of different importance in the samples. These results strongly encourage further genetic studies of adiposity-related phenotypes where extended sets of carefully measured environmental factors are taken into account.

We report our experience on the application of Gratacos' classification in a cohort of monochorionic pregnancies complicated by selective intra-uterine growth retardation based on the Doppler assessment of the umbilical artery. Materials and methods: A retrospective study was conducted on 52 cases of monochorionic twin pregnancies, in which one twin presented an abdominal circumference at or below the 10th percentile for gestational age. Cases were classified into three types according to the umbilical artery Doppler in the smaller twin. Subsequently, patients were divided into two groups: the selective IntraUterine Growth Retardation group and the Twin-to-Twin Transfusion Syndrome (TTTS) group. Results: Of the total 52 cases, 37 were classified as Type I, 12 as Type II, and 3 as Type III cases. In the total group, progressive fetal deterioration of the smaller fetus requiring active management was observed in 66.7% of Type II and 11.1% of Type I cases (p < .001), and in no Type III case. Unexpected fetal death of the smaller twin was observed more frequently in Type III (two cases, 66.7%) than in Types I and II cases (5% and 33%, respectively). Among the 52 cases, TTTS with oligo-polyhydramnios sequence was diagnosed in 10 cases. The remaining 42 cases were therefore defined as selective intra-uterine growth retardation. In the selective IntraUterine Growth Retardation group, results were similar to those obtained for the whole population. Conclusions: Classification of complicated monochorionic twins based on the umbilical artery Doppler is particularly important for counseling, even when we include TTTS cases, and permits the prediction of clinical evolution and perinatal outcome.

Our aim was to investigate the relation between PBDEs and fetal growth or newborn anthropometry in a Spanish cohort (2003-2008). PBDE congeners (BDE-47, -99, -153, -154, and -209) were determined in serum of 670 mothers at gestational week 12 and in 534 umbilical cord samples. Abdominal circumference (AC), estimated fetal weight (EFW), femur length (FL), and biparietal diameter (BPD) during gestation were measured by ultrasounds. At birth, weight (BW), head circumference (HC), and length (BL) were also measured. We assessed growth in the intervals between 12-20 and 20-34 weeks of gestation and size at birth by standard deviation (SD)-scores adjusted for constitutional characteristics. We conducted multivariate linear regression analyses between PBDE congeners and their sum (ΣPBDEs) and outcomes. We found statistically significant inverse associations between ΣPBDEs and AC, EFW, and BPD at weeks 20-34 and HC at birth. Regarding congeners, the association was clearer with BDE-99, with inverse associations being found with AC, EFW, and BPD at weeks 20-34, and with BW and HC at delivery. These outcomes decreased between 1.3% and 3.5% for each 2-fold PBDE increase. Concerning matrices, we found statistically significant inverse associations with BPD, HC, and BW when using maternal serum, and for AC and EFW with cord serum. In conclusion, PBDEs may impair fetal growth in late pregnancy and reduce birth size. © 2015 American Chemical Society. ; The authors are grateful to mothers who participated in the study and to San Agustin Hospital in Aviles and La Fe Hospital in Valencia. This work was supported by grants from the European Union (FP7-ENV-2011 cod 282957 and HEALTH.2010.2.4.5-1), and grants from the Instituto de Salud Carlos III in Spain (Red INMA G03/176, CB06/02/0041, and FIS-FEDER PI03/1615, PI04/1509, PI04/1112, PI04/1931, PI04/2018, PI05/1079, PI05/1052, PI06/1213, PI07/0314, PI09/02647, PI09/02311, PI11/01007, PI11/02591, PI11/02038, MS11/0178, PI13/1944, PI13/02429, PI14/00891, and PI14/01687), Conselleria de Sanitat of the Generalitat Valenciana, Obra Social Cajastur and University of Oviedo. ; Peer reviewed

Aim: The objective of this study is to fill the information gap by providing detailed information on the development of girls' BMI and hip and waist circumferences in correlation with their menarche status and to examine the impact of considering menarcheal age in addition to numerical age in the assessment of overweight and abdominal overweight. Subjects and methods: The description of data is based on two recently conducted cross-sectional surveys: the German Health Interview and Examination Survey for Children and Adolescents (KiGGS, n = 1,942) and the Berlin School Children's Cohort (BSCOC, n = 1,606). Anthropometric data are presented stratified by age in years (11–14) and menarche status. The frequency distribution of overweight and abdominal overweight was calculated according to German reference data. Group comparisons were performed with non-parametric tests. Results: Changes regarding body composition occur mainly during pre-menarche and menarche. In girls in whom menarche had occurred more than 6 months ago, waist circumference and, to a lesser extent, BMI attained stable values, while the values for hip circumference were higher in post-menarche girls. The frequency distribution of overweight and abdominal overweight among post-menarche girls shows that they are more than twice as likely to be overweight and/or abdominally overweight as pre-menarche girls within the same age group. Conclusion: The frequency distribution of overweight and abdominal overweight among girls in a similar age group but with a different menarche status demonstrates that misclassification of girls can arise when only age is taken into account. The progress of maturation is an important factor in assessing the growth and health of adolescents.

Background: Few studies have used longitudinal ultrasound measurements to assess the effect of traffic-related air pollution on fetal growth./nObjective: We examined the relationship between exposure to nitrogen dioxide (NO2) and aromatic hydrocarbons [benzene, toluene, ethylbenzene, m/p-xylene, and o-xylene (BTEX)] on fetal growth assessed by 1,692 ultrasound measurements among 562 pregnant women from the Sabadell cohort of the Spanish INMA (Environment and Childhood) study./nMethods: We used temporally adjusted land-use regression models to estimate exposures to NO2 and BTEX. We fitted mixed-effects models to estimate longitudinal growth curves for femur length (FL), head circumference (HC), abdominal circumference (AC), biparietal diameter (BPD), and estimated fetal weight (EFW). Unconditional and conditional SD scores were calculated at 12, 20, and 32 weeks of gestation. Sensitivity analyses were performed considering time–activity patterns during pregnancy./nResults: Exposure to BTEX from early pregnancy was negatively associated with growth in BPD during weeks 20–32. None of the other fetal growth parameters were associated with exposure to air pollution during pregnancy. When considering only women who spent 2 hr/day in nonresidential outdoor locations, effect estimates were stronger and statistically significant for the association between NO2 and growth in HC during weeks 12–20 and growth in AC, BPD, and EFW during weeks 20–32./nConclusions: Our results lend some support to an effect of exposure to traffic-related air pollutants from early pregnancy on fetal growth during mid-pregnancy. ; This study was funded by grants from the European Union: NEWGENERIS FP6-2003- Food-3-A-016320, FP7-ENV-2011 cod 282957, HEALTH.2010.2.4.5-1; and by grants from Spain: Instituto de Salud Carlos III (Red INMA G03/176, CB06/02/0031, and FIS-FEDER PI03/1615, PI04/1509, PI04/1112, PI04/1931, PI04/2018, PI04/1436, PI05/1079, PI05/1052, PI06/1213, PI07/0314, PI08/1151, PI09/02647, PI09/02311, PI11/01007, PI11/02591, PI11/02038, PI13/1944, PI13/02429, PI14/0891, PI14/1687, and Miguel Servet CP11/00178 and MS13/00054), Conselleria de Sanitat Generalitat Valenciana, Generalitat de Catalunya (CIRIT 1999SGR 00241), Diputación Foral de Guipúzcoa (DFG/004), Departamento de Sanidad y Consumo Gobierno Vasco (2005111093), Obra Social Cajastur, and Oviedo University.

INTRODUCTION Elderly diabetic patients are increasing in number worldwide due to improvement in healthcare services provided by most countries. In fact, Malaysia is evolving towards geriatric population predominant country in 2030 in which a lot of health aspects surrounding geriatrics need to be taken care of from now. Diabetes comes with morbidities and complications in which quality of life of geriatric patients should be measured and the associated factors should be determined. METHODS A cross sectional study was conducted among 269 elderly diabetic patients from all government health clinics within district of Kuantan. Their sociodemographic data were recorded and level of quality of life was measured using validated Diabetes Quality of Life Instrument (DQoL). Non-parametric tests namely Mann Whitney U test and Kruskal Wallis tests were used to identify the association between domains of quality of life and variables. The predictors were identified via logistic regression analysis. RESULTS & DISCUSSION Majority of patients were female (61%), had at least primary level of education (52%) with financial income falls within B40 groups (97.4%). Majority of the clinic were located in rural area (61.3%), without presence of Family Medicine Specialist (77.7%), mostly managed by medical officers and diabetic educators only (55.8%) without any tertiary care (72.5%). Surprisingly, majority of patients had uncontrolled diabetes (71.7%), uncontrolled blood pressure readings (63.2%), uncontrolled lipid levels (74.2%) and abnormal abdominal circumferences (84.8%). Clinic location, diabetes control status and the geriatric age were statistically significant for predicting patients' diabetes quality of life. CONCLUSION This study proved that geriatric patients had better quality of life by lowering further the HbA1c target despite misconception of high likelihood of complications among elderly. Social support and financial status of patients determined the level of quality of life in elderly that should be incorporated ...