Background Trials comparing the effectiveness and safety of weight-loss diets are frequently limited by short follow-up times and high dropout rates. Methods In this 2-year trial, we randomly assigned 322 moderately obese subjects (mean age, 52 years; mean body-mass index [the weight in kilograms divided by the square of the height in meters], 31; male sex, 86%) to one of three diets: low-fat, restricted-calorie; Mediterranean, restricted-calorie; or low-carbohydrate, non-restricted-calorie. Results The rate of adherence to a study diet was 95.4% at 1 year and 84.6% at 2 years. The Mediterranean-diet group consumed the largest amounts of dietary fiber and had the highest ratio of monounsaturated to saturated fat (P<0.05 for all comparisons among treatment groups). The low-carbohydrate group consumed the smallest amount of carbohydrates and the largest amounts of fat, protein, and cholesterol and had the highest percentage of participants with detectable urinary ketones (P<0.05 for all comparisons among treatment groups). The mean weight loss was 2.9 kg for the low-fat group, 4.4 kg for the Mediterranean-diet group, and 4.7 kg for the low-carbohydrate group (P<0.001 for the interaction between diet group and time); among the 272 participants who completed the intervention, the mean weight losses were 3.3 kg, 4.6 kg, and 5.5 kg, respectively. The relative reduction in the ratio of total cholesterol to high-density lipoprotein cholesterol was 20% in the low-carbohydrate group and 12% in the low-fat group (P = 0.01). Among the 36 subjects with diabetes, changes in fasting plasma glucose and insulin levels were more favorable among those assigned to the Mediterranean diet than among those assigned to the low-fat diet (P<0.001 for the interaction among diabetes and Mediterranean diet and time with respect to fasting glucose levels). Conclusions Mediterranean and low-carbohydrate diets may be effective alternatives to low-fat diets. The more favorable effects on lipids (with the low-carbohydrate diet) and on glycemic control (with the Mediterranean diet) suggest that personal preferences and metabolic considerations might inform individualized tailoring of dietary interventions. (ClinicalTrials.gov number, NCT00160108.

Despite decades of unequivocal evidence that waist circumference provides both independent and additive information to BMI for predicting morbidity and risk of death, this measurement is not routinely obtained in clinical practice. This Consensus Statement proposes that measurements of waist circumference afford practitioners with an important opportunity to improve the management and health of patients. We argue that BMI alone is not sufficient to properly assess or manage the cardiometabolic risk associated with increased adiposity in adults and provide a thorough review of the evidence that will empower health practitioners and professional societies to routinely include waist circumference in the evaluation and management of patients with overweight or obesity. We recommend that decreases in waist circumference are a critically important treatment target for reducing adverse health risks for both men and women. Moreover, we describe evidence that clinically relevant reductions in waist circumference can be achieved by routine, moderate-intensity exercise and/or dietary interventions. We identify gaps in the knowledge, including the refinement of waist circumference threshold values for a given BMI category , to optimize obesity risk stratification across age, sex and ethnicity. We recommend that health professionals are trained to properly perform this simple measurement and consider it as an important 'vital sign' in clinical practice.

Findings from epidemiological studies over the past 30 years have shown that visceral adipose tissue, accurately measured by CT or MRI, is an independent risk marker of cardiovascular and metabolic morbidity and mortality. Emerging evidence also suggests that ectopic fat deposition, including hepatic and epicardial fat, might contribute to increased atherosclerosis and cardiometabolic risk. This joint position statement from the International Atherosclerosis Society and the International Chair on Cardiometabolic Risk Working Group on Visceral Obesity summarises the evidence for visceral adiposity and ectopic fat as emerging risk factors for type 2 diabetes, atherosclerosis, and cardiovascular disease, with a focus on practical recommendations for health professionals and future directions for research and clinical practice. We discuss the measurement of visceral and ectopic fat, pathophysiology and contribution to adverse health outcomes, response to treatment, and lessons from a public health programme targeting visceral and ectopic fat. We identify knowledge gaps and note the need to develop simple, clinically applicable tools to be able to monitor changes in visceral and ectopic fat over time. Finally, we recognise the need for public health messaging to focus on visceral and ectopic fat in addition to excess bodyweight to better combat the growing epidemic of obesity worldwide. Measurement of visceral and ectopic fatThe development of medical imaging has been a remarkable advance that has revolutionised the study of human body composition, including visceral fat. [18][19][20] Cross-sectional

BACKGROUND The association of body-mass index (BMI) from adolescence to adulthood with obesity-related diseases in young adults has not been completely delineated. METHODS We conducted a prospective study in which we followed 37,674 apparently healthy young men for incident angiography-proven coronary heart disease and diabetes through the Staff Periodic Examination Center of the Israeli Army Medical Corps. The height and weight of participants were measured at regular intervals, with the first measurements taken when they were 17 years of age. RESULTS During approximately 650,000 person-years of follow-up (mean follow-up, 17.4 years), we documented 1173 incident cases of type 2 diabetes and 327 of coronary heart disease. In multivariate models adjusted for age, family history, blood pressure, lifestyle factors, and biomarkers in blood, elevated adolescent BMI (the weight in kilograms divided by the square of the height in meters; mean range for the first through last deciles, 17.3 to 27.6) was a significant predictor of both diabetes (hazard ratio for the highest vs. the lowest decile, 2.76; 95% confidence interval [CI], 2.11 to 3.58) and angiography-proven coronary heart disease (hazard ratio, 5.43; 95% CI, 2.77 to 10.62). Further adjustment for BMI at adulthood completely ablated the association of adolescent BMI with diabetes (hazard ratio, 1.01; 95% CI, 0.75 to 1.37) but not the association with coronary heart disease (hazard ratio, 6.85; 95% CI, 3.30 to 14.21). After adjustment of the BMI values as continuous variables in multivariate models, only elevated BMI in adulthood was significantly associated with diabetes (β = 1.115, P = 0.003; P = 0.89 for interaction). In contrast, elevated BMI in both adolescence (β = 1.355, P = 0.004) and adulthood (β = 1.207, P = 0.03) were independently associated with angiography-proven coronary heart disease (P = 0.048 for interaction). CONCLUSIONS An elevated BMI in adolescence — one that is well within the range currently considered to be normal — constitutes a substantial risk factor for obesity-related disorders in midlife. Although the risk of diabetes is mainly associated with increased BMI close to the time of diagnosis, the risk of coronary heart disease is associated with an elevated BMI both in adolescence and in adulthood, supporting the hypothesis that the processes causing incident coronary heart disease, particularly atherosclerosis, are more gradual than those resulting in incident diabetes. (Funded by the Chaim Sheba Medical Center and the Israel Defense Forces Medical Corps.)

Preferential macrophage infiltration into OM fat is a general phenomenon exaggerated by central obesity, potentially linking central adiposity with increased risk of diabetes and coronary heart disease.

Higher fasting plasma glucose levels within the normoglycemic range constitute an independent risk factor for type 2 diabetes among young men, and such levels may help, along with body-mass index and triglyceride levels, to identify apparently healthy men at increased risk for diabetes.

OBJECTIVE -To examine ethnic differences in risk of type 2 diabetes, taking dietary and lifestyle risk factors into account. -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. 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. RESEARCH DESIGN AND METHODS RESULTS Diabetes Care 29:1585-1590, 2006E thnic differences in prevalence of type 2 diabetes are well documented. In 2004, the prevalence of diagnosed diabetes in the U.S. was higher for blacks and Hispanics than for whites across all age-groups (1). For women aged 45-64 years, the prevalence was 7.8% among whites, 13.5% among Hispanics, and 15.4% among blacks. From 1980 through 2004, the age-adjusted prevalence increased by 65% among white women and 37% among black men (1-5). A random sample of 5% of Medicare feefor-service beneficiaries Ն65 years of age (6) showed the prevalence of type 2 diabetes to be the highest among Hispanics, the lowest among whites, and intermediate for blacks and Asians. The greatest increase in diabetes prevalence was observed among Asians (68%) during the 7-year period from 1997 to 2004 (6). In a recent population-based national U.S. telephone survey (7), the prevalence of diabetes was significantly higher among Asian Americans than among nonHispanic whites, after accounting for a lower BMI among Asians.Diabetes is primarily determined by obesity and lifestyle factors such as diet and exercise (8). However, no previous study has examined whether these factors can explain ethnic differences in prevalence of diabetes. Therefore, we conducted a prospective analysis of ethnic differences in type 2 diabetes risk among 78,419 apparently healthy middle-aged women in the Nurses' Health Study during 20 years of follow-up.A unique feature of this study is the detailed information on diet and lifestyle factors that has been repeatedly obtained during follow-up. RESEARCH DESIGN AND METHODSThe Nurses' Health Study population The Nurses' Health Study cohort was established in 1976 when 121,700 female registered nurses, aged 30 -55 years and residing in 11 states, completed a mailed questionnaire about their medical history and lifestyle. Follow-up questionnaires have been sent every 2 years to update information on potential risk factors and to identify newly diagnosed cases of cancer, coronary heart disease, diabetes, and other medical conditions. For the present analysis, we used information from respondents to the 1980 questionnaire, when we first inquired about diet. We excluded women who reported a diagnosis of diabetes, ca...

Adiponectin, predominantly synthesized in the adipose tissue, seems to have substantial anti-inflammatory properties and to be a major modulator of insulin resistance and dyslipidemia, mechanisms that are associated with an increased atherosclerotic risk in diabetic patients. However, it is unknown whether higher levels of adiponectin are associated with a reduced risk for coronary heart disease (CHD) among diabetic individuals. We investigated the association between plasma adiponectin levels and incidence of CHD among 745 men with confirmed type 2 diabetes in the Health Professionals Follow-up Study. A diponectin, predominantly synthesized in the adipose tissue, seems to play an important role in carbohydrate and lipid metabolism and vascular biology (1). It has been found to be a major modulator of insulin action and resistance (2) and to predict the development of type 2 diabetes (3-8). Furthermore, it seems to have substantial anti-inflammatory properties (1). Adiponectin is also related to lipid metabolism, particularly higher levels of HDL cholesterol and lower levels of triglycerides (9). These data suggest that high adiponectin levels may be related to lower risk for coronary heart disease (CHD), and we demonstrated recently that adiponectin levels are associated with a lower risk for myocardial infarction among healthy men in the Health Professionals Follow-up Study (10). Lifestyle and pharmaceutical approaches that increase adiponectin levels therefore might be valuable in decreasing atherosclerotic risk, particularly in individuals with type 2 diabetes, who are at high risk. However, it remains unclear whether adiponectin levels predict CHD risk among individuals with type 2 diabetes, in whom a complex array of metabolic abnormalities most likely contributes to the elevated risk. Glycemia, blood lipids, and inflammatory markers seem to be independently associated with adiponectin levels (11), but it also remains unresolved which pathways may mediate the potential association between adiponectin and CHD risk among diabetic individuals. We therefore evaluated whether adiponectin levels predict CHD events among diabetic men and whether inflammatory markers, cholesterol levels, or HbA 1c mediates this association. RESEARCH DESIGN AND METHODSThe Health Professionals Follow-up Study is a prospective cohort study of 51,529 U.S. male health professionals (dentists, veterinarians, pharmacists, optometrists, osteopathic physicians, and podiatrists) who were aged 40 -75 years at study initiation in 1986. This cohort is followed through biennial mailed questionnaires that focus on various lifestyle factors and health outcomes. In addition, between 1993 and 1994, 18,159 study participants provided blood samples by overnight courier. Among participants who returned blood samples, 1,000 had a confirmed diagnosis of type 2 diabetes (as reported on a supplementary questionnaire sent to all men who reported a diagnosis of diabetes) at baseline or during follow-up through 1998. The present study included 745 men who di...