Obesity: Willett WC

Rivera JA, Muñoz-Hernández O, Rosas-Peralta M, Aguilar-Salinas CA, Popkin BM, Willett WC, Anonymous00019. · Instituto Nacional de Salud Pública, Cuemrnavaca, Morelos, México. · Gac Med Mex. · Pubmed #19043956 No free full text.

Abstract: The Expert Committee in charge of developing the Beverage Consumption Recommendations for the Mexican Population was convened by the Ministry of Health with the aim of drafting evidence-based guidelines for consumers, health professionals, and government officials. The prevalence of overweight, obesity and diabetes have dramatically increased in Mexico; beverages contribute a fifth of all calories consumed by Mexicans. Extensive research has documented that caloric beverages increase the risk of obesity. Taking into consideration multiple factors, including health benefits, risks, and nutritional implications associated with beverage consumption, as well as consumption patterns in Mexico, the committee classified beverages in six categories. Classifications were made based on caloric content, nutritional value, and health risks associated with the consumption of each type of beverage. Ranges included healthier (level 1) to least healthy (level 6) options as follows: Level 1: water; Level 2: skim or low fat (1%) milk and sugar free soy beverages; Level 3: coffee and tea without sugar; Level 4: non-caloric beverages with artificial sweeteners; Level 5: beverages with high caloric content and limited health benefits (fruit juices, whole milk, and fruit smoothies with sugar or honey; alcoholic and sports drinks), and Level 6: beverages high in sugar and with low nutritional value (soft drinks and other beverages with significant amounts of added sugar like juices, flavored waters, coffee and tea). The committee recommends the consumption of water as a first choice, followed by no or low-calorie drinks, and skim milk. These beverages should be favored over beverages with high caloric value or sweetened beverages, including those containing artificial sweeteners. Portion size recommendations are included for each beverage category together with healthy consumption patterns for men and women.

Rivera JA, Muñoz-Hernández O, Rosas-Peralta M, Aguilar-Salinas CA, Popkin BM, Willett WC, Anonymous00004. · Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México. · Salud Publica Mex. · Pubmed #18372998 links to  free full text

Abstract: The Expert Committee in charge of developing the Beverage Consumption Recommendations for the Mexican Population was convened by the Secretary of Health for the purpose of developing evidence-based guidelines for consumers, health professionals, and government officials. The prevalence of overweight, obesity and diabetes have dramatically increased in Mexico; beverages contribute a fifth of all calories consumed by Mexicans. Extensive research has found that caloric beverages increase the risk of obesity. Taking into consideration multiple factors, including the health benefits, risks, and nutritional implications associated with beverage consumption, as well as consumption patterns in Mexico, the committee classified beverages into six levels. Classifications were made based on caloric content, nutritional value, and health risks associated with the consumption of each type of beverage and range from the healthier (level 1) to least healthy (level 6) options, as follows: Level 1: water; Level 2: skim or low fat (1%) milk and sugar free soy beverages; Level 3: coffee and tea without sugar; Level 4: non-caloric beverages with artificial sweeteners; Level 5: beverages with high caloric content and limited health benefits (fruit juices, whole milk, and fruit smoothies with sugar or honey; alcoholic and sports drinks), and Level 6: beverages high in sugar and with low nutritional value (soft drinks and other beverages with significant amounts of added sugar like juices, flavored waters, coffee and tea). The committee recommends the consumption of water as a first choice, followed by no or low-calorie drinks, and skim milk. These beverages should be favored over beverages with high caloric value or sweetened beverages, including those containing artificial sweeteners. Portion size recommendations are included for each beverage category and healthy consumption patterns for men and women are illustrated.

Willett WC. · No affiliation provided · Ann Intern Med. · Pubmed #15148073 links to  free full text

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Willett WC. · No affiliation provided · CA Cancer J Clin. · Pubmed #11929005 links to  free full text

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Mahoney MC, Bevers T, Linos E, Willett WC. · Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA. · CA Cancer J Clin. · Pubmed #18981297 links to  free full text

Abstract: Due to the high incidence of breast cancer among US females, risk-reduction strategies are essential. Before considering approaches to breast cancer risk reduction, it is important for clinicians to complete individualized qualitative and quantitative assessments of risk for their patients in order to inform physicians' clinical decision making and management and to engage patients collaboratively in a thorough discussion of risks and benefits. This review will summarize information on potential pharmacologic, nutritional, surgical, and behavioral approaches to reducing breast cancer risk. While there is no clear evidence that specific dietary components can effectively reduce breast cancer risk, weight gain and obesity in adulthood are risk factors for the development of postmenopausal breast cancer. Alcohol consumption, even at moderate levels, increases breast cancer risk, although some of the detrimental effects may be reduced by sufficient folate intake. Women at increased risk of breast cancer can opt to reduce their breast cancer risk through the use of tamoxifen or raloxifene; other chemopreventive agents remain under investigation. Surgical approaches to risk reductions are restricted to those patients with a substantially increased risk of developing breast cancer. Patients should be encouraged to maintain a healthy lifestyle for their overall well-being and to remain up to date with recommendations for screening and surveillance.

Manson JE, Bassuk SS, Hu FB, Stampfer MJ, Colditz GA, Willett WC. · Division of Preventive Medicine, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts 02215, USA. · J Womens Health (Larchmt). · Pubmed #17388733 No free full text.

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Prentice RL, Willett WC, Greenwald P, Alberts D, Bernstein L, Boyd NF, Byers T, Clinton SK, Fraser G, Freedman L, Hunter D, Kipnis V, Kolonel LN, Kristal BS, Kristal A, Lampe JW, McTiernan A, Milner J, Patterson RE, Potter JD, Riboli E, Schatzkin A, Yates A, Yetley E. · Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N, M3-A410, Seattle, WA 98109-1024, USA. · J Natl Cancer Inst. · Pubmed #15339966 links to  free full text

Abstract: A shortage of credible information exists on practical dietary and physical activity patterns that have potential to reverse the national obesity epidemic and reduce the risk of major cancers and other chronic diseases. Securing such information is a challenging task, and there is considerable diversity of opinion concerning related research designs and priorities. Here, we put forward some perspectives on useful methodology and infrastructure developments for progress in this important area, and we list high-priority research topics in the areas of 1) assessment of nutrient intake and energy expenditure; 2) development of intermediate outcome biomarkers; 3) enhancement of cohort and cross-cultural studies; and 4) criteria for and development of full-scale nutrition and physical activity intervention trials.

Key TJ, Schatzkin A, Willett WC, Allen NE, Spencer EA, Travis RC. · Cancer Research UK Epidemiology Unit, University of Oxford, Oxford, UK. · Public Health Nutr. · Pubmed #14972060 No free full text.

Abstract: OBJECTIVE: To assess the epidemiological evidence on diet and cancer and make public health recommendations. DESIGN: Review of published studies, concentrating on recent systematic reviews, meta-analyses and large prospective studies. CONCLUSIONS AND RECOMMENDATIONS: Overweight/obesity increases the risk for cancers of the oesophagus (adenocarcinoma), colorectum, breast (postmenopausal), endometrium and kidney; body weight should be maintained in the body mass index range of 18.5-25 kg/m(2), and weight gain in adulthood avoided. Alcohol causes cancers of the oral cavity, pharynx, oesophagus and liver, and a small increase in the risk for breast cancer; if consumed, alcohol intake should not exceed 2 units/d. Aflatoxin in foods causes liver cancer, although its importance in the absence of hepatitis virus infections is not clear; exposure to aflatoxin in foods should be minimised. Chinese-style salted fish increases the risk for nasopharyngeal cancer, particularly if eaten during childhood, and should be eaten only in moderation. Fruits and vegetables probably reduce the risk for cancers of the oral cavity, oesophagus, stomach and colorectum, and diets should include at least 400 g/d of total fruits and vegetables. Preserved meat and red meat probably increase the risk for colorectal cancer; if eaten, consumption of these foods should be moderate. Salt preserved foods and high salt intake probably increase the risk for stomach cancer; overall consumption of salt preserved foods and salt should be moderate. Very hot drinks and foods probably increase the risk for cancers of the oral cavity, pharynx and oesophagus; drinks and foods should not be consumed when they are scalding hot. Physical activity, the main determinant of energy expenditure, reduces the risk for colorectal cancer and probably reduces the risk for breast cancer; regular physical activity should be taken.

Willett WC, Leibel RL. · Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts 02115, USA. · Am J Med. · Pubmed #12566139 No free full text.

Abstract: The percentage of energy from fat in diets has been thought to be an important determinant of body fat, and several mechanisms have been proposed. Comparisons of diets and the prevalence of obesity between affluent and poor countries have been used to support this relationship, but these contrasts are seriously confounded by differences in physical activity and food availability. Within areas of similar economic development, regional intake of fat and prevalence of obesity have not been positively correlated. Randomized trials are the preferable method to evaluate the effect of dietary fat on adiposity and are feasible because the number of subjects needed is not large. In short-term trials, a modest reduction in body weight is typically seen in individuals randomized to diets with a lower percentage of calories from fat. However, compensatory mechanisms appear to operate, because in randomized trials lasting >or=1 year, fat consumption within the range of 18% to 40% of energy appears to have little if any effect on body fatness. The weighted mean difference was -0.25 kg overall and +1.8 kg (i.e., less weight loss on the low-fat diets) for trials with a control group that received a comparable intensity intervention. Moreover, within the United States, a substantial decline in the percentage of energy from fat during the last 2 decades has corresponded with a massive increase in the prevalence of obesity. Diets high in fat do not appear to be the primary cause of the high prevalence of excess body fat in our society, and reductions in fat will not be a solution.

Willett WC. · Departments of Epidemiology and Nutrition, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA. · Obes Rev. · Pubmed #12120421 No free full text.

Abstract: The percentage of dietary energy from fat has been suggested to be an important determinant of body fat, and this presumed effect has been invoked to justify the general promotion of low-fat diets. Dietary fat and the prevalence of obesity are lower in poor countries than in affluent countries. However, these contrasts are seriously confounded by differences in physical activity and food availability; within areas of similar economic development, per capita intake of fat and the prevalence of obesity have not been positively correlated. Randomized trials are the preferable method for evaluating the effect of dietary fat on adiposity because they avoid problems of confounding that are difficult to control in other studies. In short-term trials, a small reduction in body weight is typically seen in individuals randomized to diets with a lower percentage of calories from fat. In a meta-analysis of these trials, it was estimated that a decrease in 10% of energy from fat would reduce weight by 16 g d-1, which would correspond to a 9-kg weight loss by 18 months. However, compensatory mechanisms appear to operate because in trials lasting one year or longer, fat consumption within the range of 18-40% of energy has consistently had little, if any, effect on body fatness. Moreover, within the United States (US), a substantial decline in the percentage of energy from fat during the last two decades has corresponded with a massive increase in obesity, and similar trends are occurring in other affluent countries. Diets high in fat do not account for the high prevalence of excess body fat in Western countries; reductions in the percentage of energy from fat will have no important benefits and could further exacerbate this problem. The emphasis on total fat reduction has been a serious distraction in efforts to control obesity and improve health in general.

Adami HO, Day NE, Trichopoulos D, Willett WC. · Department of Medical Epidemiology, Karolinska Institutet, PO Box 281, SE-171 77 Stockholm, Sweden. · Eur J Cancer. · Pubmed #11602378 No free full text.

Abstract: Overall, cancer is a highly preventable disease. Indeed, modifiable external factors, discovered by epidemiological studies during the last 50 years, account for a majority of all cancer deaths. In this review, we discuss briefly these factors and their contribution to the current burden of cancer with an emphasis on the developed countries. Needless to say, tobacco smoking remains the largest contributor to the cancer landscape, whilst the contribution of poor diet and obesity may be equally important, but much more difficult to quantify. Our main goal was to assess what prevention of cancer has accomplished and might accomplish in the next two decades. Based on (necessarily crude) estimates, age-adjusted mortality rates from cancer in year 2000 had been reduced by approximately 13% due to primary prevention and an additional 6% due to the combined effect of early diagnosis and screening (secondary prevention). According to a realistic goal for the year 2020, a further 29% reduction might be achieved by primary, and 4% by secondary prevention. The main contribution to such accomplishments would be a reduction in tobacco smoking, improvements in diet--including reduced alcohol intake--and arrest of the obesity epidemic, in part through increased physical exercise. Rather than being granted, these goals require great effort and major commitment from all those who share responsibility for public health.

Willett WC, Dietz WH, Colditz GA. · Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. · N Engl J Med. · Pubmed #10432328 No free full text.

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Liu S, Manson JE, Buring JE, Stampfer MJ, Willett WC, Ridker PM. · Center of Cardiovascular Prevention, the Division of Preventive Medicine, Harvard Medical School, Boston 02215, USA. · Am J Clin Nutr. · Pubmed #11864854 links to  free full text

Abstract: BACKGROUND: Recent prospective data suggest that intake of rapidly digested and absorbed carbohydrates with a high dietary glycemic load is associated with an increased risk of ischemic heart disease. OBJECTIVE: We examined whether a high dietary glycemic load was associated with elevated hs-CRP concentrations and whether this association was modified by body mass index (BMI; in kg/m(2)). DESIGN: In 244 apparently healthy women, we measured plasma hs-CRP concentrations and determined average dietary glycemic loads with a validated semiquantitative food-frequency questionnaire. Using multiple regression models, we evaluated the association between dietary glycemic load and plasma hs-CRP after adjusting for age; treatment status; smoking status; BMI; physical activity level; parental history of myocardial infarction; history of hypertension, diabetes, and high cholesterol; postmenopausal hormone use; alcohol intake; and other dietary variables. RESULTS: We found a strong and statistically significant positive association between dietary glycemic load and plasma hs-CRP. The median hs-CRP concentration for the lowest quintile of dietary glycemic load was 1.9 mg/L and for the highest quintile was 3.7 mg/L; corresponding multivariate-adjusted geometric means were 1.4 and 3.8 mg/L, respectively (P for trend < 0.01). This association was significantly modified by BMI. Among women with a BMI greater-than-or-equal 25, the multivariate-adjusted geometric mean hs-CRP concentration in the lowest quintile was 1.6 mg/L and in the highest quintile was 5.0 mg/L; however, among women with a BMI < 25, the corresponding means were 1.1 and 3.1 mg/L, respectively (P = 0.01 for interaction). CONCLUSIONS: Dietary glycemic load is significantly and positively associated with plasma hs-CRP in healthy middle-aged women, independent of conventional risk factors for ischemic heart disease. Exacerbation of the proinflammatory process may be a mechanism whereby a high intake of rapidly digested and absorbed carbohydrates increases the risk of ischemic heart disease, especially in overweight women prone to insulin resistance.

Tsai CJ, Leitzmann MF, Willett WC, Giovannucci EL. · Division of Digestive Diseases and Nutrition, University of Kentucky Medical Center, Lexington, Kentucky 40536-0298, USA. · Am J Gastroenterol. · Pubmed #18853969 No free full text.

Abstract: Cholelithiasis is a major source of digestive morbidity worldwide. Cholesterol stones account for the majority of gallstones in the United States and other Western countries. The pathogenesis of cholesterol gallstone disease is multifactorial with key factors including cholesterol supersaturation of bile, altered biliary motility, and nucleation and growth of cholesterol crystals. Increasing evidence suggests that many, but not all, causative factors of cholesterol gallstones are related to insulin resistance which, in association with obesity, has reached an epidemic level worldwide. Experimental studies show that hyperinsulinemia, a key feature of insulin resistance, may cause increased hepatic cholesterol secretion and cholesterol supersaturation of bile and gallbladder dysmotility, and thereby may enhance gallstone formation. Insulin resistance syndrome can be modified by environmental factors, including dietary factors. The impact of diet on insulin sensitivity is mediated by both dietary composition and its energy content. The contribution of specific dietary elements to the prevalence and incidence of cholesterol gallstone disease has been explored in animal and human studies. There is considerable evidence to suggest that different types of fatty acids, independent of the total amount of fat consumption, affect insulin sensitivity and cholesterol gallstone disease differently. The effects of salt intake, consumption of protein and carbohydrates, and alcohol drinking on insulin resistance are controversial. Additional intervention trials and controlled experimental feeding studies are needed to further clarify these relationships and to provide useful prophylactic and therapeutic strategies.

Rivera JA, Muñoz-Hernández O, Rosas-Peralta M, Aguilar-Salinas CA, Popkin BM, Willett WC. · Instituto Nacional de Salud Pública, Cuernavaca, Mor. · Rev Invest Clin. · Pubmed #18637573 No free full text.

Abstract: The Expert Committee in charge of developing the Beverage Consumption Recommendations for the Mexican Population was convened by the Secretary of Health for the purpose of developing evidence-based guidelines for consumers, health professionals, and government officials. The prevalence of overweight, obesity and diabetes have dramatically increased in Mexico; beverages contribute a fifth of all calories consumed by Mexicans. Extensive research has found that caloric beverages increase the risk of obesity. Taking into consideration multiple factors, including the health benefits, risks, and nutritional implications associated with beverage consumption, as well as consumption patterns in Mexico, the committee classified beverages into six levels. Classifications were made based on caloric content, nutritional value, and health risks associated with the consumption of each type of beverage and range from the healthier (level 1) to least healthy (level 6) options, as follows: Level 1: water; Level 2: skim or low fat (1%) milk and sugar free soy beverages; Level 3: coffee and tea without sugar; Level 4: non-caloric beverages with artificial sweeteners; Level 5: beverages with high caloric content and limited health benefits (fruit juices, whole milk, and fruit smoothies with sugar or honey; alcoholic and sports drinks), and Level 6: beverages high in sugar and with low nutritional value (soft drinks and other beverages with significant amounts of added sugar like juices, flavored waters, coffee and tea). The committee recommends the consumption of water as a first choice, followed by no or low-calorie drinks, and skim milk. These beverages should be favored over beverages with high caloric value or sweetened beverages, including those containing artificial sweeteners. Portion size recommendations are included for each beverage category and healthy consumption patterns for men and women are illustrated.

Thygesen LC, Grønbaek M, Johansen C, Fuchs CS, Willett WC, Giovannucci E. · Department of Nutrition, Harvard School of Public Health, Boston, USA. · Int J Cancer. · Pubmed #18546286 No free full text.

Abstract: Epidemiological studies are remarkably consistent, especially among men, in showing that overweight and obesity [body mass index (BMI) >25] are associated with increased risk of colon cancer. However, no prospective studies address the influence of weight change in adulthood on subsequent colon cancer risk. In this study, we investigated whether weight change influences colon cancer risk utilizing prospectively collected weight data. We included 46,349 men aged 40-75 participating in the Health Professionals Follow-Up Study. Questionnaires including items on weight were completed every second year during follow-up from 1986 to 2004. Updated weight change between consecutive questionnaires during follow-up and recalled weight gain since age 21 was evaluated. All eligible men were cancer-free at baseline. Proportional hazard and restricted spline regression models were implemented. Over an 18-year period, we documented 765 cases of colon cancer. Cumulative mean BMI >22.5 was associated with significantly increased risk of colon cancer. The short-term weight change in the prior 2 to 4 years was positively and significantly associated with risk [HR = 1.14 (95% confidence interval, 1.00-1.29) for 4.54 kg (10 pounds) increment, p = 0.04 for overall trend]. Weight gain per 10 years since age 21 was associated with significantly increased risk [HR = 1.33 (1.12-1.58) for 4.54 kg increase per 10 years, p = 0.001]. We estimated that 29.5% of all colon cancer cases was attributable to BMI above 22.5. Our results add support that overweight and obesity are modifiable risk factors for colon cancer among men and suggest that weight has an important influence on colon cancer risk even in later life.

Janghorbani M, Amini M, Willett WC, Mehdi Gouya M, Delavari A, Alikhani S, Mahdavi A. · School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran. · Obesity (Silver Spring). · Pubmed #18070771 No free full text.

Abstract: OBJECTIVE: The goal was to estimate the prevalence of overweight, obesity, underweight, and abdominal obesity among the adult population of Iran. RESEARCH METHODS AND PROCEDURES: A nationwide cross-sectional survey was conducted from December 2004 to February 2005. The selection was conducted by stratified probability cluster sampling through household family members in Iran. Weight, height, and waist circumference (WC) of 89,404 men and women 15 to 65 years of age (mean, 39.2 years) were measured. The criteria for underweight, normal-weight, overweight, and Class I, II, and III obesity were BMI <18.5, 18.5 to 24.9, 25 to 29.9, 30 to 34.9, 35 to 39.9, and >or=40 (kg/m(2)), respectively. Abdominal obesity was defined as WC >or=102 cm in men and >or=88 cm in women. RESULTS: The age-adjusted means for BMI and WC were 24.6 kg/m(2) in men and 26.5 kg/m(2) in women and 86.6 cm in men and 89.6 cm in women, respectively. The age-adjusted prevalence of overweight or obesity (BMI >or=25) was 42.8% in men and 57.0% in women; 11.1% of men and 25.2% of women were obese (BMI >or=30), while 6.3% of men and 5.2% of women were underweight. Age, low physical activity, low educational attainment, marriage, and residence in urban areas were strongly associated with obesity. Abdominal obesity was more common among women than men (54.5% vs. 12.9%) and greater with older age. DISCUSSION: Excess body weight appears to be common in Iran. More women than men present with overweight and abdominal obesity. Prevention and treatment strategies are urgently needed to address the health burden of obesity.

Michels KB, Willett WC, Graubard BI, Vaidya RL, Cantwell MM, Sansbury LB, Forman MR. · Obstetrics and Gynecology Epidemiology Center, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. · Int J Obes (Lond). · Pubmed #17452993 No free full text.

Abstract: BACKGROUND: The Centers for Disease Control and Prevention and the US Department of Health and Human Services promote breastfeeding as a strategy for reducing childhood overweight. We evaluated the relation between infant feeding and the development of overweight and obesity throughout life course. METHODS: We investigated the association between infant feeding and obesity among 35,526 participants in the Nurses' Health Study II who were followed prospectively from 1989 to 2001. Mothers of participants provided information by mailed questionnaires on the duration of breast- and bottle-feeding, as well as the type of milk or milk substitute in the bottle. Information on body shape at ages 5 and 10, weight at age 18, current weight between 1989 and 2001, and height was reported by the participants. RESULTS: The duration of breastfeeding, including exclusive breastfeeding, was not related to being overweight (25< or = body mass index (BMI) <30 kg/m(2)) or obese (BMI> or =30 kg/m(2)) during adult life. Women who were exclusively breastfed for more than 6 months had a risk of 0.94 (95% confidence interval (CI) 0.83-1.07) of becoming obese as adults compared with women who were not breastfed. Exclusive breastfeeding for more than 6 months was associated with leaner body shape at age 5 (odds ratio (OR)=0.81; 95% CI 0.65-1.01 for the highest vs the lowest category of body shape) compared to women who were not breastfed or breastfed for less than 1 week, but this association did not persist during adolescence or adulthood. CONCLUSIONS: We did not find that having been breastfed was associated with women's likelihood of becoming overweight or obese throughout life course. Although breastfeeding promotes the health of mother and child, it is unlikely to play an important role in controlling the obesity epidemic.

Azadbakht L, Kimiagar M, Mehrabi Y, Esmaillzadeh A, Padyab M, Hu FB, Willett WC. · Department of Human Nutrition, School of Nutrition and Food Science, Shaheed Beheshti University of Medical Sciences, Tehran, Iran. · Am J Clin Nutr. · Pubmed #17344494 links to  free full text

Abstract: BACKGROUND: Little evidence exists regarding the effects of soy consumption on the metabolic syndrome in humans. OBJECTIVE: We aimed to determine the effects of soy consumption on components of the metabolic syndrome, plasma lipids, lipoproteins, insulin resistance, and glycemic control in postmenopausal women with the metabolic syndrome. DESIGN: This randomized crossover clinical trial was undertaken in 42 postmenopausal women with the metabolic syndrome. Participants were randomly assigned to consume a control diet (Dietary Approaches to Stop Hypertension, DASH), a soy-protein diet, or a soy-nut diet, each for 8 wk. Red meat in the DASH period was replaced by soy-protein in the soy-protein period and by soy-nut in the soy-nut period. RESULTS: The soy-nut regimen decreased the homeostasis model of assessment-insulin resistance score significantly compared with the soy-protein (difference in percentage change: -7.4 +/- 0.8; P < 0.01) or control (-12.9 +/- 0.9; P < 0.01) diets. Consumption of soy-nut also reduced fasting plasma glucose more significantly than did the soy-protein (-5.3 +/- 0.5%; P < 0.01) or control (-5.1 +/- 0.6%; P < 0.01) diet. The soy-nut regimen decreased LDL cholesterol more than did the soy-protein period (-5.0 +/- 0.6%; P < 0.01) and the control (-9.5 +/- 0.6%; P < 0.01) diet. Soy-nut consumption significantly reduced serum C-peptide concentrations compared with control diet (-8.0 +/- 2.1; P < 0.01), but consumption of soy-protein did not. CONCLUSION: Short-term soy-nut consumption improved glycemic control and lipid profiles in postmenopausal women with the metabolic syndrome.

Tworoger SS, Eliassen AH, Kelesidis T, Colditz GA, Willett WC, Mantzoros CS, Hankinson SE. · Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Third Floor, Boston, Massachusetts 02115, USA. · J Clin Endocrinol Metab. · Pubmed #17213279 links to  free full text

Abstract: INTRODUCTION: Previous retrospective case-control studies suggest that adiponectin, an obesity-related hormone, is inversely associated with breast cancer risk, particularly in postmenopausal women; however, no prospective studies exist. Therefore, we conducted a prospective case-control study nested within the Nurses' Health Study (NHS) and NHSII cohorts examining the association between plasma adiponectin concentrations and breast cancer risk. MATERIALS AND METHODS: Blood samples were collected from 1989 through 1990 (NHS) and 1996 through 1999 (NHSII); adiponectin was measured by RIA. The analysis included 1477 breast cancer cases diagnosed after blood collection and before June 2000 (NHS) or June 2003 (NHSII) who had one or two controls (n=2196) matched on age, menopausal status, postmenopausal hormone (PMH) use, fasting, and time of day and month of blood collection. We adjusted for body mass index at age 18, weight change from age 18 to blood draw, family history of breast cancer, history of benign breast disease, duration of PMH use, ages at menarche and first birth, and parity. RESULTS: Although we observed no association between adiponectin and breast cancer risk overall, there was a nearly significant interaction by menopausal status (P=0.08), with a relative risk, top vs. bottom quartile of 0.73 (95% confidence interval, 0.55-0.98; P trend=0.08) among postmenopausal women and 1.30 (95% confidence interval, 0.80-2.10; P trend=0.09) for premenopausal women. Among postmenopausal women, adiponectin appeared more strongly inversely associated in women who never used PMH (P heterogeneity=0.05) and women with low circulating estradiol levels (P heterogeneity=0.05). DISCUSSION: Our results suggest that adiponectin may be inversely associated with postmenopausal breast cancer risk, particularly in a low-estrogen environment.

Halton TL, Willett WC, Liu S, Manson JE, Albert CM, Rexrode K, Hu FB. · Departments of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA. · N Engl J Med. · Pubmed #17093250 links to  free full text

Abstract: BACKGROUND: Low-carbohydrate diets have been advocated for weight loss and to prevent obesity, but the long-term safety of these diets has not been determined. METHODS: We evaluated data on 82,802 women in the Nurses' Health Study who had completed a validated food-frequency questionnaire. Data from the questionnaire were used to calculate a low-carbohydrate-diet score, which was based on the percentage of energy as carbohydrate, fat, and protein (a higher score reflects a higher intake of fat and protein and a lower intake of carbohydrate). The association between the low-carbohydrate-diet score and the risk of coronary heart disease was examined. RESULTS: During 20 years of follow-up, we documented 1994 new cases of coronary heart disease. After multivariate adjustment, the relative risk of coronary heart disease comparing highest and lowest deciles of the low-carbohydrate-diet score was 0.94 (95% confidence interval [CI], 0.76 to 1.18; P for trend=0.19). The relative risk comparing highest and lowest deciles of a low-carbohydrate-diet score on the basis of the percentage of energy from carbohydrate, animal protein, and animal fat was 0.94 (95% CI, 0.74 to 1.19; P for trend=0.52), whereas the relative risk on the basis of the percentage of energy from intake of carbohydrates, vegetable protein, and vegetable fat was 0.70 (95% CI, 0.56 to 0.88; P for trend=0.002). A higher glycemic load was strongly associated with an increased risk of coronary heart disease (relative risk comparing highest and lowest deciles, 1.90; 95% CI, 1.15 to 3.15; P for trend=0.003). CONCLUSIONS: Our findings suggest that diets lower in carbohydrate and higher in protein and fat are not associated with increased risk of coronary heart disease in women. When vegetable sources of fat and protein are chosen, these diets may moderately reduce the risk of coronary heart disease.

Shai I, Jiang R, Manson JE, Stampfer MJ, Willett WC, Colditz GA, Hu FB. · Department of Epidemiology, Harvard School of Public Health, Epidemiology, 677 Huntington Ave., Boston, MA 02115, USA. · Diabetes Care. · Pubmed #16801583 links to  free full text

Abstract: OBJECTIVE: To examine ethnic differences in risk of type 2 diabetes, taking dietary and lifestyle risk factors into account. RESEARCH DESIGN AND METHODS: A prospective (1980-2000) cohort (from The Nurses' Health Study) including 78,419 apparently healthy women (75,584 whites, 801 Asians, 613 Hispanics, and 1,421 blacks) was studied. Detailed dietary and lifestyle information for each participant was repeatedly collected every 4 years. RESULTS: During 1,294,799 person-years of follow-up, we documented 3,844 incident cases of diabetes. Compared with whites, the age-adjusted relative risks (RRs) were 1.43 (95% CI 1.08-1.90) for Asians, 1.76 (1.32-2.34) for Hispanics, and 2.18 (1.82-2.61) for blacks. After adjustment for BMI, the RRs changed to 2.26 (1.70-2.99) for Asians, 1.86 (1.40-2.47) for Hispanics, and 1.34 (1.12-1.61) for blacks. For each 5-unit increment in BMI, the multivariate RR of diabetes was 2.36 (1.83-3.04) for Asians, 2.21 (1.75-2.79) for Hispanics, 1.96 (1.93-2.00) for whites, and 1.55 (1.36-1.77) for blacks (P for interaction <0.001). For each 5-kg weight gain between age 18 and the year 1980, the risk of diabetes was increased by 84% (95% CI 58-114) for Asians, 44% (26-63) for Hispanics, 38% (28-49) for blacks, and 37% (35-38%) for whites. A healthy diet high in cereal fiber and polyunsaturated fat and low in trans fat and glycemic load was more strongly associated with a lower risk of diabetes among minorities (RR 0.54 [95% CI 0.39-0.73]) than among whites (0.77 [0.72-0.84]). CONCLUSIONS: The risk of diabetes is significantly higher among Asians, Hispanics, and blacks than among whites before and after taking into account differences in BMI. Weight gain is particularly detrimental for Asians. Our data suggest that the inverse association of a healthy diet with diabetes is stronger for minorities than for whites.

Janghorbani M, Feskanich D, Willett WC, Hu F. · School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran. · Diabetes Care. · Pubmed #16801581 links to  free full text

Abstract: OBJECTIVE: The purpose of this study was to determine whether women with type 1 and type 2 diabetes are at higher risk of hip fractures. RESEARCH DESIGN AND METHODS: A total of 109,983 women aged 34-59 years in 1980 were followed through 2002 for the occurrence of hip fracture. At baseline and through biennial follow-up, women were asked about their history and treatment of diabetes and other potential risk factors for hip fracture. RESULTS: During 2.22 million person-years of follow-up, 1,398 women had a hip fracture. Compared with women without diabetes, the age-adjusted relative risk (RRs) of hip fracture was 7.1 (95% CI 4.4-11.4) for women with type 1 diabetes and 1.7 (1.4-2.0) for those with type 2 diabetes. After further adjustment for BMI, smoking, physical activity, menopausal status, daily intake of calcium, vitamin D, protein, and postmenopausal hormone use, the multivariate RR of incident hip fracture in individuals with type 1 diabetes compared with individuals without diabetes was 6.4 (3.9-10.3) and with type 2 diabetes was 2.2 (1.8-2.7). The RRs increased with longer duration of type 2 diabetes (3.1 [2.3-4.0] for >or=12 years compared with no diabetes, P for trend < 0.001) and ever use of insulin. CONCLUSIONS: These data indicate that both type 1 and type 2 diabetes are associated with an increased risk of hip fracture. The results of this study highlight the need for fracture-prevention strategies in women with diabetes.

Lopez-Garcia E, van Dam RM, Rajpathak S, Willett WC, Manson JE, Hu FB. · Department of Nutrition, Harvard School of Public Health, Cambridge, MA, USA. · Am J Clin Nutr. · Pubmed #16522916 links to  free full text

Abstract: BACKGROUND: The long-term effects of caffeine intake on weight have not been examined prospectively. OBJECTIVE: The objective was to assess the relation between caffeine intake and 12-y weight change. DESIGN: We conducted a prospective study of 18 417 men and 39 740 women, with no chronic diseases at baseline, who were followed from 1986 to 1998. Caffeine intake was assessed repeatedly every 2-4 y. Weight change was calculated as the difference between the self-reported weight in 1986 and in 1998. RESULTS: The participants reported a change in caffeine intake that varied across quintiles, from decreases of 296 and 342 mg/d to increases of 213 and 143 mg/d in men and women, respectively. Age-adjusted models showed a lower mean weight gain in participants who increased their caffeine consumption than in those who decreased their consumption, but the differences between extreme quintiles were small: -0.43 kg (95% CI: -0.17, -0.69) in men and -0.41 kg (95% CI: -0.20, -0.62) in women. After adjustment for potential confounders and baseline and change in total energy intake and other nutrients and foods, the differences remained similar for men and diminished slightly for women (men: -0.43 kg; 95% CI: -0.17, -0.68; women: -0.35; 95% CI: -0.14, -0.56). An increase in coffee and tea consumption was also associated with less weight gain. In men, the association between caffeine intake and weight was stronger in younger participants (P for interaction < 0.001); in women, the association was stronger in those who had a body mass index (in kg/m2) > or = 25, who were less physically active, or who were current smokers (P for interaction < 0.001). CONCLUSION: Increases in caffeine intake may lead to a small reduction in long-term weight gain.

Rajpathak SN, Rimm EB, Rosner B, Willett WC, Hu FB. · Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA. · Am J Clin Nutr. · Pubmed #16522901 links to  free full text

Abstract: BACKGROUND: The role of calcium in the maintenance of body weight remains controversial. OBJECTIVE: We investigated the association between calcium and dairy intakes and 12-y weight change in US men. DESIGN: This study was conducted with the use of data from the Health Professionals Follow-up Study, a prospective cohort of men aged 40-75 y in 1986. Data on lifestyle factors and diet were updated biennially with self-administered questionnaires. The participants reported their body weight in 1986 and in 1998. The outcome in our study was 12-y weight change. We used multivariate linear regression to examine how baseline calcium intake (n = 23,504) and change in calcium intake (n = 19,615) were associated with weight change. Because dairy foods are the predominant source of calcium in the diet, we also evaluated a similar association with dairy intake. RESULTS: In a multivariate analysis with adjustment for potential confounders, baseline or change in intake of total calcium was not significantly associated with weight change. In addition, we did not find any association with dietary, dairy, or supplemental calcium intake when evaluated separately. The men with the largest increase in total dairy intake gained slightly more weight than did the men who decreased intake the most (3.14 compared with 2.57 kg; P for trend = 0.001). This association was primarily due to an increase in high-fat dairy intake. Low-fat dairy intake was not significantly associated with weight change. CONCLUSION: Our data do not support the hypothesis that an increase in calcium intake or dairy consumption is associated with lower long-term weight gain in men.