F X Pi-Sunyer

OBJECTIVE: To assess the long-term effects of a prepackaged, nutritionally complete, prepared meal plan compared with a usual-care diet (UCD) on weight loss and cardiovascular risk factors in overweight and obese persons. DESIGN: In this randomized multicenter study, 302 persons with hypertension and dyslipidemia (n = 183) or with type 2 diabetes mellitus (n = 119) were randomized to the nutrient-fortified prepared meal plan (approximately 22% energy from fat, 58% from carbohydrate, and 20% from protein) or to a macronutrient-equivalent UCD. MAIN OUTCOME MEASURES: The primary outcome measure was weight change. Secondary measures were changes in blood pressure or plasma lipid, lipoprotein, glucose, or glycosylated hemoglobin levels; quality of life; nutrient intake; and dietary compliance. RESULTS: After 1 year, weight change in the hypertension/dyslipidemia group was -5.8+/-6.8 kg with the prepared meal plan vs -1.7+/-6.5 kg with the UCD plan (P<.001); for the type 2 diabetes mellitus group, the change was -3.0+/-5.4 kg with the prepared meal plan vs -1.0+/-3.8 kg with the UCD plan (P<.001) (data given as mean +/- SD). In both groups, both interventions improved blood pressure, total and low-density lipoprotein cholesterol levels, glycosylated hemoglobin level, and quality of life (P<.02); in the diabetic group, the glucose level was reduced (P<.001). Compared with those in the UCD group, participants with hypertension/dyslipidemia in the prepared meal plan group showed greater improvements in total (P<.01) and high-density lipoprotein (P<.03) cholesterol levels, systolic blood pressure (P<.03), and glucose level (P<.03); in participants with type 2 diabetes mellitus, there were greater improvements in glucose (P =.046) and glycosylated hemoglobin (P<.02) levels. The prepared meal plan group also showed greater improvements in quality of life (P<.05) and compliance (P<.001) than the UCD group. CONCLUSIONS: Long-term dietary interventions induced significant weight loss and improved cardiovascular risk in high-risk patients. The prepared meal plan simultaneously provided the simplicity and nutrient composition necessary to maintain long-term compliance and to reduce cardiovascular risk.

OBJECTIVE: The intra-uterine environment may be a critical period for the development of adiposity. Alternatively, most of the co-variance of relative weight from birth to adulthood may be genetic in origin. This study tested whether birth weight 'tracks' into adulthood, independent of genetic factors. DESIGN: Observational twin study. Birth weights and gestational ages from birth records of 8040 twins from the Minnesota Twin Registry including 699 monozygotic (MZ) male pairs, 609 dizygotic (DZ) male pairs, 939 MZ female pairs, 880 DZ female pairs, and 893 opposite sex DZ pairs ages (yrs) 28 to 52 (Mean = 40.3; s.d. = 6.2) were compared to self-reported adult height and weight. RESULTS: The correlation of birth weight with adult height was 0.236, with adult weight 0.188, and with adult body mass index 0.078 (all P-values < 0.0005). To test if this tracking was independent of genetic influences, we analyzed intra-pair differences for MZ twins. If differences in birth weight between members of a MZ twin pair correlate with adult relative weight, this association cannot be attributed to genetic influences. The correlation of intra-pair differences in birth weight with intra-pair differences in adult height was 0.316 (P < 0.0005), with adult weight 0.136 (P < 0.0005), and with adult BMI 0.026 (P = 0.331). Results were unchanged when multivariate regression modeling was employed. CONCLUSION: These data suggest that the intra-uterine environmental influences on birth weight have an enduring impact on adult height but not on adult relative weight. This suggests that the intra-uterine period is a critical period for the development of height but not for adiposity.