Objective. To determine the relationship between change in body mass and knee-joint moments and forces during walking in overweight and obese older adults with knee osteoarthritis (OA) following an 18-month clinical trial of diet and exercise.Methods. Data were obtained from 142 sedentary, overweight, and obese older adults with self-reported disability and radiographic evidence of knee OA who underwent 3-dimensional gait analysis. Gait kinetic outcome variables included peak knee-joint forces and peak internal knee-joint moments. Mixed regression models were created to predict followup kinetic values, using followup body mass as the primary explanatory variable. Baseline body mass was used as a covariate, and thus followup body mass was a surrogate measure for change in body mass (i.e., weight loss).Results. There was a significant direct association between followup body mass and peak followup values of compressive force (P ‫؍‬ 0.001), resultant force (P ‫؍‬ 0.002), abduction moment (P ‫؍‬ 0.03), and medial rotation moment (P ‫؍‬ 0.02). A weight reduction of 9.8N (1 kg) was associated with reductions of 40.6N and 38.7N in compressive and resultant forces, respectively. Thus, each weight-loss unit was associated with an ϳ4-unit reduction in knee-joint forces. In addition, a reduction in body weight of 9.8N (1 kg) was associated with a 1.4% reduction (0.496 Nm) in knee abduction moment. Conclusion. Our results indicate that each poundof weight lost will result in a 4-fold reduction in the load exerted on the knee per step during daily activities. Accumulated over thousands of steps per day, a reduction of this magnitude would appear to be clinically meaningful.The precise etiology of osteoarthritis (OA) is unknown; however, several risk factors have been identified, including age (1,2), female sex (3), and both occupational (4,5) and sports-related joint stress (6-9). The most important modifiable risk factor for the development and progression of OA is obesity (1,10-17). Weight loss reduces the risk of symptomatic knee OA (13), and for obese patients with knee OA, weight loss and exercise are recommended by both the American College of Rheumatology and the European League Against Rheumatism (18,19). We have shown that an average weight loss of 5% over 18 months in overweight and obese adults with knee OA results in an 18% improvement in function. When dietary changes are combined with exercise, function improves 24% and is accompanied by a significant improvement in mobility (20).Although obesity is strongly associated with knee OA, some obese but otherwise healthy adults adapt to their excessive weight and subsequently reduce kneejoint torques and possibly knee-joint forces during walking (21). In other obese adults, however, excessive biomechanical joint stress represents one possible pathway for the pathogenesis and progression of knee OA. We hypothesized a significant and direct relationship between weight loss and attenuation of knee-joint forces and moments during walking in overweight and obese older adu...

In this systematic study of MODY in a large pediatric US diabetes cohort, unselected by referral pattern or family history, MODY was usually misdiagnosed and incorrectly treated with insulin. Although many type 2 diabetes-like metabolic features were less common in the mutation-positive group, no single characteristic identified all patients with mutations. Clinicians should be alert to the possibility of MODY diagnosis, particularly in antibody-negative youth with diabetes.

As expected, most of the youth with T2DM were obese. Youth with T1DM had a higher prevalence of overweight, but not of obesity, than nondiabetic youth. Future studies of obesity among youth with diabetes of all types will further our understanding of the impact of obesity on diabetes both as a risk factor and a comorbidity.

Global and executive cognitive functions predict declines in gait speed. The association of ECF with gait speed decline is attenuated by comorbid conditions, particularly depression. Elucidation of the mechanisms underlying these associations may point to new pathways for the treatment of physical decline associated with diminished cognitive function.

Objective: Physical function and body composition in older obese adults with knee osteoarthritis (OA) were examined after intensive weight loss. Research Methods and Procedures:Older obese adults (n ϭ 87; Ն60 years; BMI Ն 30.0 kg/m 2 ) with symptomatic knee OA and difficulty with daily activities were recruited for a 6-month trial. Participants were randomized into either a weight stable (WS) or weight loss (WL) program. Participants in WL (10% weight loss goal) were prescribed a 1000 kcal/d energy deficit diet with exercise 3 d/wk. WS participants attended health information sessions. Body composition and physical function (Western Ontario and McMaster University Osteoarthritis Index, 6-minute walking distance, and stair climb time) were assessed at baseline and 6 months. Statistical analysis included univariate analysis of covariance on 6-month measurements using baseline values as covariates. Associations between physical function and body composition were performed.Results: Body weight decreased 8.7 Ϯ 0.8% in WL and 0.0 Ϯ 0.7% in WS. Body fat and fat-free mass were lower for WL than WS at 6 months (estimated means: fat ϭ 38.1 Ϯ 0.4% vs. 40.9 Ϯ 0.4%, respectively; fat-free mass ϭ 56.7 Ϯ 0.4 vs. 58.8 Ϯ 0.4 kg, respectively). WL had better function than WS, with lower Western Ontario and McMaster University Osteoarthritis Index scores, greater 6-minute walk distance, and faster stair climb time (p Ͻ 0.05). Changes in function were associated with weight loss in the entire cohort. Discussion: An intensive weight loss intervention incorporating energy deficit diet and exercise training improves physical function in older obese adults with knee OA. Greater improvements in function were observed in those with the most weight loss.

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This study provides clear evidence that UI is related to DS in older adults.

Embarrassment or lack of awareness of treatment options were not significant barriers to discussing UI. Adults with a fairly high frequency of UI (average of 1.7 episodes per day) did not view UI as abnormal or a serious medical condition.