A revised way of thinking is essential for promoting harm reduction strategies and reducing the negative implications of injection drug use (IDU). Despite the growth of harm reduction approaches in the United States, there is limited guidance for designing and implementing multi-sector efforts that address the external determinants that promote and facilitate IDU. Current frameworks fail to acknowledge the individual’s role and influence in multi-sector change. To address the multifaceted nature of IDU, we must address the complex relationship between people who inject drugs (PWID) and their external environment. As part of a community–academic partnership, a framework was developed to address the gaps in current theoretical models and community practice. Our Harm Reduction Collaboration Framework (HRCF) accepts PWID as key stakeholders and presents a practical framework in which PWID and community organizations partner in decision making to influence policy, systems, and environmental change. We provide examples of two organizations that have made substantive changes in implementing harm reduction strategies in their communities by utilizing the HRCF.

Increasing numbers of older adults are residing in rural areas of the USA. Many of these individuals experience greater rates of chronic diseases and lower income levels compared to their urban-residing counterparts. Aging in rural environments creates greater challenges in the provision of funding, staff and resources to meet the needs of these older adults, and contributes to immense health disparities and health inequities. Urban and rural older adult residents alike need healthcare, gerontological and public health resources to promote successful aging in place. Due to the nature of rural environments, many of these resources often exist great distances from these residents, which creates access challenges. There are also limitations in locally available facilities and trained practitioners, resulting in resource shortages for addressing chronic health conditions. The creation and use of interdisciplinary partnerships provides this much-needed support while addressing ever-increasing funding and staffing limitations. This article provides an innovative conceptual interdisciplinary partnership model that combines nursing, public health and gerontology to address the health and social challenges that rural-residing older adults face. Although well-trained practitioners who work within their discipline are an important contributor to assist with the needs of rural-residing older adults, this silo approach is expensive, inefficient, and clearly cannot support all of the needs for older adults in this type of environment. There is a need to blend the complementary skills provided by each of the presented disciplines so that the focus of the interdisciplinary partnership is on person-centered care addressing the health disparities and health inequities experienced by these older adults. To illustrate the integration of nursing, public health and gerontology disciplines, these disciplines are initially combined and presented as dyads, and are then incorporated into the full conceptual model. The dyads are public health and gerontology, public health and nursing, and gerontology and nursing. Steps are provided for the development of this (or any) interdisciplinary partnership. An example of the model's use through clinical and non-clinical disciplines and a community engagement framework is also described. Interdisciplinary approaches focused on person-centered care provide more well-rounded health and social support for rural older adults than any one discipline in isolation. Allocation of shared resources, roles, responsibilities and expenses allows practitioners engaged in interdisciplinary teams to provide superior economic and capacity efficiency. This efficiency is crucial at a time when many entities experience limitations in sustainable resources. Thus, practitioners and community agencies collaborating through interdisciplinary partnerships are better able to address the complex issues experienced by rural-residing community members.

Purpose Integrated transitions of care for rural older persons are key issues in policy and practice. Interdisciplinary partnerships are suggested as ways to improve rural-care transitions by blending complementary skills of disciplines to increase care’s holistic nature. Yet, only multidisciplinary efforts are frequently used in practice and often lack synergy and collaboration. The purpose of this paper is to present a case of a partnership model using nursing, gerontology and public health integration to support rural-residing elders as a part of building an Adult-Gerontology Acute Care Nurse Practitioner program. Design/methodology/approach This paper uses the Centre for Ageing Research and Development in Ireland/O’Sullivan framework to examine the creation of an interdisciplinary team. Two examples of interdisciplinary work are discussed. They are the creation of an interdisciplinary public health course and its team-based on-campus live simulations with a panel and site visit. Findings With team-building successes and challenges, outcomes show the need for knowledge exchange among practitioners to enhance population-centered and person-centered care to improve health care services to older persons in rural areas. Practical implications There is a need to educate providers about the importance of developing interdisciplinary partnerships. Educational programming illustrates ways to move team building through the interdisciplinary continuum. Dependent upon the needs of the community, other similarly integrated partnership models can be developed. Originality/value Transitions of care work for older people tends to be multi- or cross-disciplinary. A model for interdisciplinary training of gerontological practitioners in rural and frontier settings broadens the scope of care and improves the health of the rural older persons served.

ABSTRACT Background: Among college students, an incongruous association between physical activity (PA) and binge drinking (BD) has been reported. Purpose: The purpose of this study was to qualitatively investigate the relationship between PA and BD among college students. Methods: A trained facilitator asked open-ended questions, based on the social–ecological model, during sex-specific focus groups to inquire about PA and BD. Participants were physically active students (18–24 years, non-varsity athletes), who reported at least one binge drinking episode in the past 30 days. Transcripts were analyzed by 3 researchers to determine emergent themes. Results: Several intrapersonal, interpersonal, institutional, and community factors were identified. The most frequently occurring theme among females (n = 25) was “calorie conscious.” “Damage control: healthy/unhealthy” was the most frequent theme/subtheme among males (n = 33). Discussion: The findings suggest multiple social–ecological levels that influence the complex relationship between PA and BD in college students. Although additional research is warranted, results of this study suggest that community-level factors greatly influence several intrapersonal and interpersonal level factors described by participants. Translation to Health Education Practice: It is imperative that Health Education professionals consider all social–ecological levels of influence when developing interventions and policies to promote PA and reduce BD among college students.

CONTEXT Insulin resistance (IR) and type 2 diabetes are increasing, particularly in Hispanic (H) vs non-Hispanic White (NHW) populations. Adiponectin has a known role in IR, and therefore, understanding ethnic and sex-specific behavior of adiponectin across the lifespan is of clinical significance. OBJECTIVE To compare ethnic and sex differences in adiponectin, independent of body mass index, across the lifespan and relationship to IR. DESIGN Cross-sectional. SETTING Primary care, referral center. PATIENTS A total of 187 NHW and 117 H participants (8-57 y) without diabetes. Life stage: pre-/early puberty (Tanner 1/2), midpubertal (Tanner 3/4), late pubertal (Tanner 5, <21 years), and adult (Tanner 5, ≥21). INTERVENTIONS None. MAIN OUTCOME MEASURE(S) Fasting adiponectin, insulin, glucose, and revised homeostatic model assessment of insulin resistance. RESULTS Adiponectin was significantly inversely correlated with revised homeostatic model assessment of insulin resistance. Regarding puberty, adiponectin trended downward in late puberty, but only males were significantly lower in adulthood. By sex, adiponectin was lower in adult males vs females of both ethnicities. Regarding ethnicity, H adults of both sexes had lower adiponectin than NHW adults. Of note, in NHW females, adiponectin trended highest in adulthood, whereas in H females, adiponectin fell in late puberty and remained lower in adulthood. CONCLUSIONS Adiponectin inversely correlated with IR, trended down in late puberty, and was lowest in adult males. H adults of both sexes had lower adiponectin than NHW adults, and H females followed a more "male pattern," lacking the rebound in adiponectin seen in NHW females after puberty. These data suggest that adiponectin, independent of body mass index, may relate to the greater cardiometabolic risk seen in H populations and in particular H females.

Gay men may not be physically active at recommended levels to achieve health benefits. Thus, a need exists to identify general (i.e., common across populations) and population-specific barriers that hinder or stop gay men from participating in physical activity (PA). Salient barriers may be identified through the extent each barrier limits PA (i.e., barrier limitation) and the level of one's confidence to overcome barriers and engage in PA (i.e., self-regulatory efficacy). The purposes of this study were to (1) provide a description of general and population-specific barriers to PA among sufficiently and insufficiently active gay men, (2) identify barrier limitation and self-regulatory efficacy for the reported barriers, and (3) examine the associations between meeting the current PA recommendation, barrier limitation, and self-regulatory efficacy. Participants were 108 self-identified gay males aged 21 to 64 years who completed a web-based survey. A total of 35 general barriers and no population-specific barriers were identified by the sufficiently and insufficiently active groups. The sufficiently active group reported higher self-regulatory efficacy and lower barrier limitation for nearly all reported barriers. A binary logistic regression used to examine the associations between PA, barrier limitation, and self-regulatory efficacy was statistically significant, χ(2)(2, N = 108) = 19.26, p < .0001, R(2) = .16. Only barrier limitation significantly contributed to the model. Future research should continue to examine barriers to PA among gay men to determine whether an intervention needs to be designed specifically for gay men or whether a one-size-fits-all intervention would be effective in helping all men overcome common barriers to engaging in PA.

Objective Exercise has been suggested to have cardioprotective benefits due to a lowering of postprandial triglycerides (PPTG). We hypothesized that a morning exercise bout would significantly lower PPTG measured over a full day, in response to moderate fat meals (35% energy) in men more so than women, and in metabolic syndrome (MetS) relative to normal weight (NW) individuals. Materials/Methods Participants completed two randomized study days; one control and one exercise day (60 min of morning exercise, 60% VO2peak). Meals were consumed at breakfast, lunch and dinner with the energy expended during exercise replaced on the active day. The areas (AUC) and incremental areas (IAUC) under the curve were calculated for total triglycerides, total cholesterol and other metabolites. Results Exercise did not significantly change the PPTG AUC & IAUC overall, or within, or between, each sex or group (NW and MetS). Exercise induced a 30% decrease in total cholesterol IAUC (p=0.003) in NW subjects. Overall, women had a lower IAUC for PPTG compared to men (p=0.037), with the greatest difference between MetS women and MetS men, due to a sustained drop in TG after lunch in the women. This suggests that PP, rather than fasting, lipid analyses may be particularly important when evaluating sex differences in metabolic risk. Conclusions With energy replacement, moderate morning exercise did not result in a significant decrease in PPTG excursions. Exercise did elicit a significant decrease in PP cholesterol levels in NW subjects, suggesting a potential mechanism for the cardioprotective effects of exercise.

Despite living in an environment that promotes weight gain in many individuals, some individuals maintain a thin phenotype while self‐reporting expending little or no effort to control their weight. When compared with obesity prone (OP) individuals, we wondered if obesity resistant (OR) individuals would have higher levels of spontaneous physical activity (SPA) or respond to short‐term overfeeding by increasing their level of SPA in a manner that could potentially limit future weight gain. SPA was measured in 55 subjects (23 OP and 32 OR) using a novel physical activity monitoring system (PAMS) that measured body position and movement while subjects were awake for 6 days, either in a controlled eucaloric condition or during 3 days of overfeeding (1.4× basal energy) and for the subsequent 3 days (ad libitum recovery period). Pedometers were also used before and during use of the PAMS to provide an independent measure of SPA. SPA was quantified by the PAMS as fraction of recording time spent lying, sitting, or in an upright posture. Accelerometry, measured while subjects were in an upright posture, was used to categorize time spent in different levels of movement (standing, walking slowly, quickly, etc.). There were no differences in SPA between groups when examined across all study periods (P > 0.05). However, 3 days following overfeeding, OP subjects significantly decreased the amount of time they spent walking (−2.0% of time, P = 0.03), whereas OR subjects maintained their walking (+0.2%, P > 0.05). The principle findings of this study are that increased levels of SPA either during eucaloric feeding or following short term overfeeding likely do not significantly contribute to obesity resistance although a decrease in SPA following overfeeding may contribute to future weight gain in individuals prone to obesity.

The goals of the study were to determine if moderate weight loss in severely obese adults resulted in (i) reduction in apnea/hypopnea index (AHI), (ii) improved pharyngeal patency, (iii) reduced total body oxygen consumption (VO 2 ) and carbon dioxide production (VCO 2 ) during sleep, and (iv) improved sleep quality. The main outcome was the change in AHI from before to after weight loss. Fourteen severely obese (BMI > 40 kg/m 2 ) patients (3 males, 11 females) completed a highly controlled weight reduction program which included 3 months of weight loss and 3 months of weight maintenance. At baseline and postweight loss, patients underwent pulmonary function testing, polysomnography, and magnetic resonance imaging (MRI) to assess neck morphology. Weight decreased from 134 ±6.6 kg to 118 ± 6.1 kg (mean ± s.e.m.; F = 113.763, P < 0.0001). There was a significant reduction in the AHI between baseline and postweight loss (subject, F = 11.11, P = 0.007). Moreover, patients with worse sleep‐disordered breathing (SDB) at baseline had the greatest improvements in AHI (group, F = 9.00, P = 0.005). Reductions in VO 2 (285 ± 12 to 234 ±16 ml/min; F = 24.85, P < 0.0001) and VCO 2 (231 ± 9 to 186 ± 12 ml/min; F = 27.74, P < 0.0001) were also observed, and pulmonary function testing showed improvements in spirometry parameters. Sleep studies revealed improved minimum oxygen saturation (minSaO 2 ) (83.4 ± 61.9% to 89.1 ± 1.2%; F = 7.59, P = 0.016), and mean SaO 2 (90.4 ± 1.1% to 93.8 ± 1.0%; F = 6.89, P = 0.022), and a significant increase in the number of arousals (8.1 ± 1.4 at baseline, to 17.1 ± 3.0 after weight loss; F = 18.13, P = 0.001). In severely obese patients, even moderate weight loss (∼10%) boasts substantial benefit in terms of the severity of SDB and sleep dynamics.

Elevated biomarkers of inflammation and oxidative stress are associated with increased relative risk of cardiovascular disease in adults. The impact of obesity, diet, and acute exercise on these markers in young children are unknown. PURPOSE: To determine the effect of obesity and/or acute exercise (EX) on fasting and post-meal inflammatory and oxidative stress markers in pre- and early-pubertal children. METHODS: We studied the effects of a high-fat test meal on inflammatory markers (CRP, IL-6, TNFa) and oxidized LDL (ox-LDL) in 23 children (Tanner 1-3, 10±2yrs, 11 lean/12 obese, 11M/12F) during 2 separate study days of rest (RST) or EX (random order) each preceded by 3 days of diet/exercise control. The afternoon prior to the study day (5pm) subjects rode a cycle ergometer (25 min @ 65% max HR) or rested for the same time period. The following morning (7:30am) a milkshake test meal (50% fat, 20% protein and 30% carbohydrate) was consumed. Subjects remained resting during the study day. Blood was drawn before and after the EX bout, and before and 3 times after the test meal (6 samples EX, 5 samples RST). Main effects of group, condition, and group x condition were tested by repeated measures ANOVA; alpha set at p<0.05. RESULTS: As expected, obese were heavier (p<0.0001) with higher fat mass (p<0.0001) than lean. Fasting CRP (1.12 ± 0.84 vs 0.13 ± 0.11 mg/L, p<0.01), IL-6 (97 ± 81 vs 40 ± 39 pg/ml, p<0.05) and ox-LDL (54 ± 12 vs 40 ± 12 U/L, p<0.05) were greater in obese than lean, but fasting or post-meal TNFa did not differ by group. EX had no effect on pre- or post-meal levels of these biomarkers, nor did the test meal change concentrations from fasted values. CONCLUSIONS: Obese had greater fasting CRP, IL-6 and ox-LDL than lean children. Neither EX nor a high-fat meal changed these markers in lean or obese children. The lack of change in these markers in response to the meal suggests that acute consumption of high dietary fat does not increase these markers above levels seen due to obesity alone, and that increased levels of inflammation and oxidative stress are related to chronic obesity. These data have important chronic health implications for children with elevated adiposity, and suggest that long-term behavior modification strategies are necessary for reversal of this detrimental condition.

Increases in Type 2 diabetes in youth have serious long-term health consequences. Impaired fasting glucose contributes to Type 2 diabetes development. Aberrant post-prandial (PP) changes in insulin (INS), glucose (GLUC) and triglycerides (TG) may also play a role. Evaluating biologic and environmental factors that impact this disease progression in children is crucial. PURPOSE: To determine the effect of obesity (biologic) and/or exercise (environmental) on PP GLUC, INS and TG excursions in children. METHODS: 28 children (18 lean/10 obese, 12 M/16F, 10 ± 2 yrs) completed two study days (randomized): exercise (EX; bike ergometer, 25 mins, 65% max HR) and rest (RST), each preceded by 3-day diet/exercise control. Exercise energy cost was replaced on the EX day. At 7:30 am the next day, a liquid meal was consumed (49% FAT, 19% PRO, 30% CHO). Blood was drawn before, and hourly (6 hrs) post-meal. For each condition, incremental area under the curve (IAUC; PP changes-baseline) for GLUC, INS and TG was calculated. Main effects of group, condition, and group x condition interaction were assessed by 2 way ANOVA. RESULTS: As expected, the obese had higher fat mass than lean (p<0.0001). Fasting GLUC did not differ by group, but fasting INS and TG were higher in obese than lean (INS 12±5 vs 7±5 uU/ml, p<0.0001, TG 89±28 vs 56±26 mg/dl, p<0.0001). There was a group effect on PP INS, GLUC (p<0.001) and TG (p<0.0001) IAUC but no condition effect, or group x condition interaction. The group difference in GLUC IAUC was due to a fall in GLUC in obese on both days (RST-1197±2199 mg/dl, EX-657±1543 mg/dl) with an increase in lean (RST 333±1045 mg/dl, EX 395±1569 mg/dl) Correlations between TG IAUC and INS IAUC were significant by group (Lean r=.383, p<0.05; Obese r=.641, p<0.01). CONCLUSIONS: Obese children had greater PP INS and TG excursions and reduced GLUC excursions than lean. Acute exercise had no effect on these parameters. The PP fall below baseline for GLUC in obese but not lean, suggests the higher INS response in the obese was inappropriate for their level of glycemia. The correlation between PP TG IAUC and INS IAUC suggests the greater TG excursion in obese may have contributed to an inappropriately high INS secretion. These data have important implications for the effect of diet and the PP environment on aberrant INS and GLUC metabolism in obese children.

PURPOSE: Weight gain over time involves an imbalance between energy intake and energy expenditure. In the current obesogenic environment, this is due to the ease of over consumption in the face of low energy expenditure. However, some individuals appear to be resistant to weight gain under these conditions. Our purpose is to determine if obesity prone (OP) and obesity resistant (OR) adults differ in their physical activity (PA) response to overfeeding. METHODS: We studied the effects of 3 days overfeeding (OF: 40% excess intake) vs. 3 days of eucaloric (EUC) feeding on free-living PA in 34 lean (BMI 21.65±2.38) OP (n=14) and OR (n=20) adults (25-35yrs). Each controlled feeding period was followed by 3 days of ad lib food intake. Subjects wore pedometers prior to diet intervention (7-day baseline) and for the 6 days (diet control +ad lib) of each diet phase. Diet phases were randomly assigned and were separated by 1 month. T-tests and ANOVA were used to assess differences between groups and conditions, significance set at p<0.05. RESULTS: In the OP group, there was no difference in PA between the 6 days OF/ad lib vs the 6 days EUC/ad lib. In contrast, the OR group showed a trend (p=0.06) toward a higher PA during OF/ad lib (8370±2136) compared to EUC/ad lib (7335±2177). When evaluating the 3 days of diet control only, however, PA during the OF period was significantly lower than the EUC period in the OP group (p=0.045). To evaluate if the groups differed regarding an increase or decrease in PA when given the OF diet, we compared the difference in PA (OF minus EUC) and found that the OP tended to have reduced PA on the OF when compared to EUC (−773.07 ± 1716.74), whereas the OR tended to have greater PA on the OF compared to EUC (1035.58 ± 2638.32) (p=0.032). CONCLUSIONS: OR individuals appear to respond to a brief period of overfeeding by increasing their PA whereas OP individuals appear to do the opposite. These changes in PA that occur with overfeeding would tend to promote weight gain in OP individuals as compared to OR, and may be involved in the propensity of these individuals to gain weight in the current obesogenic environment.

PURPOSE: An increased post-prandial triglyceride (PPTG) excursion is an independent risk factor for coronary heart disease, therefore, evaluating factors that increase or decrease this parameter is important. Women reportedly have a lower PPTG after a single meal compared to men whereas moderate exercise decreases PPTG after consumption of a single, very high fat meal. The aims of this study, therfore, were to a) determine if a single bout of morning exercise can significantly decrease PPTGs over an entire day, when consuming meals of a more typical macronutrient composition and b) to determine if there is a sex difference in the daily PPTG excursion with and/or without exercise. METHODS: Non-obese (BMI 20-27 kg/m2), untrained, healthy, women (n = 11) and men (n = 12) were recruited and matched for fasting TG levels (101 ± 27 and 100 ± 14 mg/dl, respectively). Subjects completed an exercise and a rest study day (randomized order) separated by 3-4 weeks. Prior to each study day, subjects consumed a controlled diet (5 days) and abstained from planned exercise (60 hrs). After an overnight stay on the clinical research unit, subjects commenced testing at 7:15 am after an overnight fast. On the exercise day, subjects walked on a treadmill for 60 mins at 60% VO2 peak and on the rest day, subjects rested for the same time period. Breakfast was consumed at 8:30 am, with lunch and dinner at 12:30 pm and 5:30 pm, respectively. Macronutrient composition of each meal was 34% fat, 15% protein and 51% carbohydrate. Subjects remained resting from 8:30 am onwards and energy intake was calculated to meet energy requirements of the corresponding day. Blood samples were drawn before exercise (or rest) and continued throughout the remainder of the day (total of 26 time points). RESULTS: The integrated area under the curve (IAUC) for total TGs over the entire day was significantly lower on the exercise vs rest day in both women (7766 ± 2977 vs 22947 ± 2979 mg/dl/840 mins, respectively P < 0.0001) and men (20196 ± 5660 vs 29721 ± 5252 mg/dl/840 mins). There was an overall significant sex difference in the daily PPTG excursion (IAUC, P = 0.05), mainly due to the lower response in women vs men on the exercise day (P = 0.07). In both sexes, the difference in the PPTG excursion on the exercise vs rest day was greatest after lunch (P = 0.0003 women, P = 0.03 men) and dinner (P < 0.0001 and P = 0.05, respectively). There were no sex or day differences in the daily insulin and glucose excursions. CONCLUSIONS: In conclusion, a single bout of moderate exercise can reduce the daily PPTG response when consuming meals of a typical macronutrient composition, and this response tends to be more pronounced in women vs men.

The role of ingested fat in the etiology of obesity is controversial. The aims of this study were to determine the contributions of ingested fat oxidation to: 1) 24-h total energy expenditure (TEE), and 2) substrate oxidation during acute stationary cycle exercises in adult humans. Healthy, moderately obese (n 18; BMI 31 1 kg/m) subjects (8 men; 10 women) were each studied in a whole-room calorimeter for 24 h. They were fed mixed meals (55, 30, and 15% as energy from carbohydrate, fat and protein, respectively) to maintain energy balance. Each subject performed 1255-kJ cycle exercises at 50% VO2max in the calorimeter. Study test meal fat was labeled with carbon-13 (C). Ingested fat oxidation was estimated from breath CO2 excretion and the subject’s chamber CO2 production. Total fat and carbohydrate oxidations were estimated from nonprotein respiratory quotient (NP-RQ) values. Endogenous fat oxidation was estimated as the difference between total fat and ingested fat oxidations. TEE was estimated from gas exchanges; 28 3% of ingested fat was oxidized and it provided 8 1% of 24-h TEE. During cycle exercises, ingested fat provided 50% of total fat oxidized and 13.0 2% of energy expended. Endogenous fat oxidation contributed 10.4 3% of energy expenditure during cycle exercises. This study extended to 24-h observations of previous studies that lasted 6–9 h on ingested fat oxidation in humans. Understanding the factors that promote ingested fat oxidation could lead to more effective obesity intervention programs. J. Nutr. 135: 2159–2165, 2005.

PURPOSE:Hormonal changes associated with menopause, chronological aging, and lifestyle, specifically physical activity, may all influence the changes in body composition and fat distribution experienced by midlife women. This cross-sectional study examined those relations in a representative sample of 248 white and Chinese women, ages 47-57, participating in an ancillary study to the Study of Women's Health Across the Nation (SWAN), a multi-center, longitudinal investigation of the natural history of the menopause in a racially/ethnically diverse cohort. METHODS:Body composition (lean mass, percent body fat) was assessed with dual energy x-ray absorptiometry, and central adiposity was determined by waist circumference. Physical activity was assessed from 7 d of accelerometer recordings. Menopausal status was based on self-reported bleeding patterns. RESULTS:Higher levels of physical activity, particularly vigorous-intensity activity, were generally independently associated with decreased percent body fat and smaller waist circumference, although these findings were not statistically significant in the Chinese women. Among the white women, every half a standard deviation increase in total activity was associated with a 1.6-point decrease in percent body fat (P = 0.002). Waist circumference decreased from 96.2 cm (SE = 1.04) in those doing no vigorous-intensity activity to 81.4 cm (SE = 1.05) in those doing 10 min or more a day (P for trend = 0.05). For both the whites and the Chinese, late peri- and postmenopausal status was associated with lower lean mass, and among the Chinese, tended to be associated with higher percent body fat. CONCLUSION:These findings suggest that regular physical activity may help to mitigate the tendency for weight gain and adverse changes in body composition and fat distribution that accompany aging and the menopausal transition.

Body weights (BW) in the U.S. have increased over the past two decades. 35%of Hispanic and African American, and 20%of Caucasian children are overweight. Studies have evaluated the relationship between obesity, fat distribution, and risk of chronic disease in adults, but few studies have examined these issues in at risk (particularly Hispanic) youth. PURPOSE To determine if change in BW, adiposity, body fat distribution, and physical fitness over two years are related to change in type 2 diabetes risk and cardiovascular disease (CVD) risk in adolescents. METHODS Subjects were 26 male and 57 female high school students (13–18 yrs) (74%Hispanic, 21%Caucasian). Most were overweight (29.1% ± 9.9% body fat). Body composition by BIA, waist circumference (WC), one mile walk-run test (WR), fasting glucose and insulin (for Type 2 diabetes risk), and fasting total cholesterol, HDL, and triglycerides (for CVD risk) were measured at the schools. T-tests were used to test differences in change from baseline in the variables. Pearson correlations, controlling for school, gender and race, were used to test the relationships between the independent variables and the dependent variables of disease risk change (change in glucose, insulin, cholesterol, triglyceride, HDL). Significance set at p<0.05. RESULTS BW (p<0.001), WC (p<0.001), BMI (p<0.001), and fasting glucose (p<0.01) increased, and fitness (WR) decreased (p<0.05) over 2 yrs. BW change was positively related with change in insulin (.276, p = 0.025), total cholesterol (.373, p = 0.002), and triglycerides (.468, p<0.01). There was a negative trend between change in BW and change in HDL (p = 0.071). Change in WC was positively related to change in total cholesterol (.302, p = 0.015), and triglycerides (.247, p = 0.047) over the two years. Change in BMI was associated with increases in insulin (.264, p = 0.032), total cholesterol (.369, p = .002), and triglycerides (.416, p = 0.001). Change in fitness, as assessed by WR, was not significantly related to change in any chronic disease risk factors. CONCLUSIONS The results of this study indicate that BMI, WC, and BW change over a two-year period are good predictors of a concurrent change in disease risk, and that change in chronic disease risk is apparent as early as adolescence. It is imperative that public health professionals address the issue of increasing adiposity during youth before we develop a generation of individuals who have to live with lifestyle-related chronic disease beginning early in life. Supported by NIH R01 DK48159, NIH M01RR00051 and NIH M01RR00069.

Hispanics are disproportionately affected by the obesity epidemic in the United States. Obesity is a primary risk factor for the development of cardiovascular disease (CVD) and Type 2 diabetes, which are problematic in Hispanic adults. There are limited data relating obesity status in Hispanic adolescents to diabetes and CVD risk.We studied 115 lean and obese adolescents (89 Hispanic, 26 Caucasian), ranging in body mass index (BMI) from 15 to 52 kg/m(2). We assessed the relationships between four anthropometric indices of obesity and risk factors for Type 2 diabetes (insulin (INS), glucose (GLU)), and CVD (total cholesterol, triglycerides, HDL, and systolic (SBP) and diastolic (DBP) blood pressure).All anthropometric indices were positively correlated with total cholesterol, triglycerides, log(INS), GLU, SBP, and DBP, and negatively correlated with HDL. Correlations and multiple regression analyses indicated that weight and waist circumference (WC) were generally the best single predictors of disease risk. Using more than one anthropometric measure in multiple regression did not improve predictions of risk over using a single predictor.These results indicate that overweight adolescents (particularly Hispanics) are at risk for developing Type 2 diabetes and CVD, and that WC and weight are useful for identifying those at particular risk.