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American Heart Association Meeting Report
Date:3/13/2008

Study shows long-term weight control is achievable

Abstract 34

COLORADO SPRINGS, Colo., March 13 /PRNewswire-USNewswire/ -- People who shed weight and want to keep it off might benefit from monthly personal contact interventions, researchers reported at the American Heart Association's Conference on Nutrition, Physical Activity and Metabolism.

Results of the study will also be simultaneously published in the Journal of the American Medical Association.

In a test of three ways that might help people maintain weight loss, those who received monthly personal counseling were best at keeping off unwanted pounds. Overall, 42 percent of the study members maintained at least a 4-kilogram (9-pound) weight loss for 30 months.

"We know how to help people lose weight in a healthy way, but we know very little about how to help them to keep the weight off," said Laura P. Svetkey, M.D, lead author of the study and professor of medicine at Duke University Medical Center in Durham, N.C. "This study is the longest and largest to test strategies for long-term weight loss maintenance, and it suggests that long-term weight control is an achievable goal.

"The United States is in the midst of an obesity epidemic, one that portends serious future health consequences. Overweight and obesity are the leading cause of high blood pressure, diabetes and abnormal cholesterol, which are leading causes of cardiovascular disease, which is, in turn, the leading cause of death in this country," Svetkey said. "So if we really want to get to the root causes of these disorders, we need to address the obesity epidemic."

Despite the importance of obesity control, few studies have tested strategies to maintain weight loss over long periods.

Svetkey and her colleagues enrolled 1,685 participants in the two-phase Weight Loss Maintenance trial, which was conducted at four clinical centers in the United States.

Phase I consi educating them and providing them with the proper support systems," Mosca said. "If a caregiver dies of a heart attack, it's not going to help the cardiac patient."

Co-authors of the caregiver-risk paper are Brooke Fischer Aggarwal, M.S.; Ming Liao, B.S.; and Allison H. Christian, Ed.D.

Co-authors of the dietary-education report are Brooke Fischer Aggarwal, M.S.; Ming Liao, B.S.; Heidi Mochari, M.P.H., R.D.; Karen Ochoa, M.A.; and Syncia Sabain, M.S.

The National Heart, Lung, and Blood Institute of the National Institutes of Health funded the F.I.T. Heart study.

Statements and conclusions of abstract authors that are presented at American Heart Association/American Stroke Association scientific meetings are solely those of the abstract authors and do not necessarily reflect association policy or position. The associations make no representation or warranty as to their accuracy or reliability.

NR08-1034 (EPI 08/Mosca)

Editor's note: The American Heart Association/American Stroke Association supports increased federal funding for heart disease and stroke research through the National Institutes of Health. Information for those caring for heart patients is available at http://www.americanheart.org/caregivers.

Abstract P174

American Heart Association meeting report

Many teens spend 30 hours a week on 'screen time' during high school

COLORADO SPRINGS, Colo., March 12 -- While most teenagers (60 percent) spend on average 20 hours per week in front of television and computer screens, a third spend closer to 40 hours per week, and about 7 percent are exposed to more than 50 hours of 'screen-time' per week, according to a study presented at the American Heart Association's 48th Annual Conference on Cardiovascular Disease Epidemiology and Prevention.

Researchers looked at patterns of screen-time through high school, including total time viewing television, video, computer and the Internet. Then they examined the influence of neighborhood social factors on distinct patterns of screen-time.

"Boys and those whose parents had lower educational attainment were much more likely to be in the 'high-screen time' group," said Tracie A. Barnett, Ph.D., lead author of the study. "Teens with high levels of screen time may be at increased risk of obesity."

They analyzed 1,293 seventh grade students from 10 Montreal high schools. The students in the study had completed in-class questionnaires four times a year for five years, and reported their usual number of hours watching television or videos, and using the computer or surfing the Internet. The researchers defined neighborhoods by census district, looking at average education and income levels within districts.

Barnett and colleagues identified distinct levels of screen-time for each of television/video and computer/Internet use. Overall, their study showed that:

-- 52 percent of boys and 26 percent of girls reported average total screen-time levels above 42 hours per week;

-- 52 percent of boys and 39 percent of girls reported average levels of TV/video use above 23 hours per week;

-- 24 percent of boys and 7 percent of girls reported average levels of computer/Internet use of almost 30 hours per week.

"Most patterns were characterized by sustained levels throughout high school," said Barnett, a researcher at Sainte-Justine Children's Hospital Research Center and assistant professor in the Department of Social and Preventive Medicine at the University of Montreal in Canada.

Approximately 73 percent of girls and 48 percent of boys were in the 'low' total screen-time group, corresponding nevertheless to between 18 and 22 hours of screen-time per week.

However, television still accounts for most of the screen-time, with 85 percent of adolescents reporting less than 10 hours per week of computer/Internet use.

For girls, living in neighborhoods ranked as the lowest third by socio-economic factors increased the likelihood of belonging to the high screen-time group up to five-fold compared to girls in the highest ranked socio-economic neighborhoods.

For boys, living in neighborhoods that had the lowest level of education increased the odds of being in the high screen-time group two- to three-fold, versus their counterparts where education levels were highest.

A more detailed analysis revealed that these associations were more pronounced for television/video watching and weaker for computer/Internet use.

"Researchers need to explore why adolescents' (notably girls') levels of especially television and video screen-time viewing through high school are higher if they live in neighborhoods that are socio-economically disadvantaged," Barnett said. "In the meantime, we should make sure that teens living in these neighborhoods have access to safe and appealing active alternatives to sitting in front of screens."

Co-authors are: Jennifer O'Loughlin, Ph.D.; Marie Lambert, M.D.; Lise Gauvin, Ph.D.; Yan Kestens, Ph.D.; and Mark Daniel, Ph.D.

The National Cancer Institute of Canada funded the study with funds from the Canadian Cancer Society.

Statements and conclusions of abstract authors that are presented at American Heart Association/American Stroke Association scientific meetings are solely those of the abstract authors and do not necessarily reflect association policy or position. The associations make no representation or warranty as to their accuracy or reliability.

NR08-1035 (EPI 08/Barnett)

Editor's note: The American Heart Association is engaged in numerous activities to encourage behaviors that help children live longer and healthier lives. To combat the growing epidemic of childhood obesity, the American Heart Association and the William J. Clinton Foundation joined forces in 2005 to create the Alliance for a Healthier Generation. For more information, please visit http://www.healthiergeneration.org. The association also supports state and local legislation, as well as the national Fitness Integrated with Teaching (FIT) Kids Act, legislation amending the No Child Left Behind Act, to strengthen physician education programs and raise awareness about the importance of physical activity for children.

sted of 20 weekly group sessions of 18-25 participants held over six months, during which trained counselors emphasized three key elements to weight loss -- consuming fewer calories, increasing moderate physical activity, and eating a healthy diet. Researchers recommended DASH (Dietary Approaches to Stop Hypertension), a diet rich in fruits, vegetables, whole-grain and high fiber foods, that uses low-fat and fat-free dairy products and is low in total and saturated fat and sodium. DASH lowers blood pressure and cholesterol even without weight loss.

Counselors helped participants use tools like self-monitoring and goal-setting, and helped them remember why they wanted to lose weight in the first place. The group sessions also provided study members with social support from other participants.

At the end of Phase I, 61 percent of the participants in the trial were eligible for Phase II, which lasted for 30 months, because they had lost at least nine pounds and as much as 66 pounds.

Thirty-eight percent of people in Phase II were African-American and 37 percent were male. "This is important because men are often underrepresented in weight loss studies, and obesity disproportionately affects African Americans," Svetkey said.

Researchers randomly assigned the volunteers to one of three groups:

-- Personal contact (PC) -- Participants talked with an interventionist (monthly, nine times by telephone and three times face-to-face each year) who provided personal counseling and encouragement.

-- Interactive technology (IT) -- Study members had access to an interactive Web site on which they could record and track their exercise and calorie intake; set goals and monitor their progress toward them; and communicate with others in the IT group.

-- Self-directed (SD) -- Participants were urged to maintain their weight loss and then sent off without further intervention.

Results from the trial after 30 months included:

-- Overall, 71 percent weighed less than when they began Phase I. The difference in the percentage of each group that weighed less was statistically significant -- PC group (77 percent); IT group (69 percent) and SD group (67 percent).

-- Thirty-seven percent of enrollees weighed at least 5 percent below their beginning weight. Again, the PC participants (42 percent) significantly out-performed those in the SD (34 percent) and IT (29 percent) groups.

-- Among all study members, 32 percent weighed no more than 3 percent above their weight at randomization. However, differences between the three groups -- SD (29 percent), IT (29 percent) and PC (36 percent) -- were not significantly different statistically.

-- Although at 24 months the average weight regained by the IT group was less than that of the SD arm, researchers found no difference between the two at 30 months.

"The effects we observed were modest," Svetkey said. "The personal contact group regained about 3.3 pounds less than the self-directed group."

Even a small weight loss can have potential health benefits, she noted.

"Each pound of weight loss can lower blood pressure by as much as a millimeter of mercury, and the more weight you lose, the bigger the blood pressure effect," Svetkey said. "Each pound of weight loss is estimated to lower the risk of developing diabetes by 8 percent, which is quite impressive.

"Clearly more research is needed to refine these maintenance interventions to make them more effective, but this study is an important step in the right direction."

The study was conducted at four clinical sites: Duke, Pennington Biomedical Research Center, Johns Hopkins University and the Kaiser Permanente Center for Health (CHR) Research, which also served as the coordinating center.

Co-authors are: Victor J. Stevens, Ph.D. (CHR Coordinating Center); Phillip J. Brantley, Ph.D. (Pennington); Lawrence J. Appel, M.D. (Hopkins); Jack F. Hollis, Ph.D. (CHR); Catherine M. Loria, Ph.D. (NHLBI); and William M. Vollmer, Ph.D.; Cristina M. Gullion, Ph.D.; and Kristine Funk, M.S. (all at the CHR coordinating center.)

The National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH) funded the study.

Statements and conclusions of abstract authors that are presented at American Heart Association/American Stroke Association scientific meetings are solely those of the abstract authors and do not necessarily reflect association policy or position. The associations make no representation or warranty as to their accuracy or reliability.

NR08-1032 (NPAM08/Svetkey)

Abstract 2

This is featured as a video news release and podcast.

American Heart Association meeting report

Preschoolers benefit from daycare program to prevent obesity

COLORADO SPRINGS, Colo., March 12 -- A preschool-based intervention program helped prevent early trends toward obesity and instilled healthy eating habits in multi-ethnic 2- to 5-year-olds, according to a report presented at the American Heart Association's Conference on Nutrition, Physical Activity and Metabolism.

"Nobody would dispute that we are experiencing an epidemic of obesity in this country," said Ruby Natale, Ph.D., Psy.D., author of the study and assistant professor of clinical pediatrics at the University of Miami, Miller School of Medicine in Miami, Fla. "Children as young as 7 years old are experiencing health consequences of being overweight, suggesting that intervention must occur as early as possible and involve the entire family.

"Inner-city minority children spend many hours of the day in preschool, making it a significant influence in many aspects of their lives. Children depend on their parents for nutrition and physical activity choices at this age, so the home environment must be accounted for as well."

Natale and colleagues studied 2- to 5-year-old children from ethnically diverse, low-income families in eight subsidized childcare centers in Miami Dade County, Fla. The intervention group received a six-month home- and school-based obesity prevention program with two tiers.

The classroom-based (tier one) program included menu modifications and education:

-- The menu promoted water as the primary beverage for staff and children; offered only skim or 1 percent milk; limited juices and other sweetened beverages; and incorporated fruits and vegetables in snacks as much as possible.

-- Classroom teachers were educated weekly about how to incorporate nutrition and physical activity curriculums and how to better understand and overcome children's cognitive, cultural and environmental barriers to implementing a healthy low-fat, high-fiber diet.

The family-based (tier two) program reinforced what the children learned at childcare, including:

-- Monthly parent dinners to educate parents about food labels, the food guide pyramid and portion sizes.

-- Newsletters focusing on topics such as picky eaters, healthy cooking tips, healthy fast food options and recipes for healthy snacks.

-- At-home activities such as sampling different vegetables and various types of lower-fat milks.

Comparing data from the intervention group to a control group of children, researchers found that intervention is an effective obesity prevention strategy.

"While 68.4 percent of children were at normal weight at the start of the study, this increased to 73 percent at follow-up," said Sarah E. Messiah, Ph.D., M.P.H., lead author of the study and research assistant professor in the Division of Pediatric Clinical Research, University of Miami, Miller School of Medicine. "Also, the percentage of children who were at risk for overweight decreased from 16 percent to 12 percent."

From the beginning to the end of the intervention, children changed the amounts and types of foods they ate. Those at two intervention sites ate less junk food, more fresh fruits and vegetables, and drank less juice and more 1 percent milk compared to those at control sites.

Specifically, on average in the intervention groups:

-- Chip consumption decreased from daily to no consumption.

-- Cookie consumption decreased 50 percent.

-- Fresh fruit and vegetable consumption increased 25 percent.

-- Juice consumption decreased 50 percent and was replaced with a 20 percent increase in water consumption.

-- One percent milk consumption increased 20 percent.

"In the control sites, cake and cookie consumption actually increased 35 percent and 75 percent, respectively, while average fresh fruit and water consumption decreased," Messiah said. "We are hoping that our study will impact policy around the country leading to healthier standards for meals served at childcare centers. If we are successful in improving attitudes toward nutrition and physical activity in early childhood, we can potentially influence adult behavior and begin to hope that the public health epidemic of obesity can be ended."

Other co-authors are: Lee Sanders, M.D.; Gabriela Lopez-Mitnik, M.A.; and Jennifer Barth, Ph.D.

Children's Trust of Miami Dade funded the study.

Statements and conclusions of abstract authors that are presented at American Heart Association/American Stroke Association scientific meetings are solely those of the abstract authors and do not necessarily reflect association policy or position. The associations make no representation or warranty as to their accuracy or reliability.

NR08-1033 (NPAM 08/Messiah - Natale)

Editor's note: The American Heart Association is engaged in numerous activities to encourage behaviors that help children live longer and healthier lives. To combat the growing epidemic of childhood obesity, the American Heart Association and the William J. Clinton Foundation joined forces in 2005 to create the Alliance for a Healthier Generation. For more information, please visit http://www.healthiergeneration.org. The association also supports state and local legislation, as well as the national Fitness Integrated with Teaching (FIT) Kids Act, legislation amending the No Child Left Behind Act, to strengthen physician education programs and raise awareness about the importance of physical activity for children.

Abstract P171 & P129

This is featured as a video news release and podcast.

American Heart Association meeting report

Family cardiac caregivers may have higher heart disease risk

COLORADO SPRINGS, Colo., March 12 -- Caring for a family member with a serious heart ailment may increase your risk of cardiac disease, according to a report presented at the American Heart Association's 48th Annual Conference on Cardiovascular Disease Epidemiology and Prevention.

Researchers examined heart risk factors in family members of cardiac patients and found that those who provided all or most of a patient's care had higher levels of risk factors for heart disease than non-caregivers and those who reported higher caregiver strain after six months were more likely to be depressed than those who provided less or no care. There is growing evidence that suggests stress and depression may play an important role in the development of cardiovascular disease.

"It appears that cardiac caregivers may be at increased risk of cardiac diseases themselves," said Lori Mosca, M.D., Ph.D., senior author of the study and professor of medicine and director of preventive cardiology at New York-Presbyterian Hospital/Columbia University Medical Center. "When a cardiac patient is hospitalized, there may be a unique opportunity to identify and help family members at risk of heart disease themselves."

In a second study, Mosca and her colleagues found that educating caregivers and family members of hospitalized cardiac patients about their own heart risks and providing them information about a heart-healthy diet improved their eating habits after six weeks.

The researchers conducted both studies as part of the ongoing National Institutes of Health-sponsored Family Intervention Trial for Heart Health (F.I.T. Heart), for which Mosca is the principal investigator. She said participants in the trial will be followed for one year.

"As doctors, we need to recognize that cardiac caregivers may be at increased risk of heart problems," Mosca said. "And there is a high prevalence of cardiac caregivers that we can identify who may potentially benefit from education and outreach programs."

Prior to launching F.I.T. Heart, she and her team reviewed medical studies related to the health issues of people providing care to family members with chronic problems.

"Almost everything we found was on Alzheimer's disease, cancer or disabled children," Mosca said. "We found very few studies on the risks of cardiac caregivers."

For F.I.T. Heart, researchers recruited 501 family members or co-habitants of patients hospitalized for such cardiac events as a heart attack or narrowed arteries that required bypass surgery or an angioplasty procedure. Six months later, researchers determined the approximate time each spent as a caregiver, and assessed their lifestyles, psychological strain and whether they were depressed.

For their analysis, the team designated 39 percent of the sample as primary caregivers (those who provided care all or most of the time), 11 percent were caregivers most of the time, 32 percent were caregivers some of the time or occasionally, and 17 percent were caregivers none of the time. Caregivers were significantly more likely than non-caregivers to be women (63 percent), married or living with someone, older than age 50, unemployed and people who did not complete high school. They were also less likely to adhere to heart risk-reduction dietary guidelines than non-caregivers, consuming significantly more saturated fat and having larger waist measurements.

Mosca said the team identified several characteristics of caregivers that increase their risk for heart disease.

The average strain scores of caregivers six months after their loved ones were hospitalized were significantly higher among those with depression and low social support, even after the researchers adjusted for gender, marital status and levels of depression and social support at enrollment.

"There is an association between depression and higher caregiver strain," Mosca said. "We don't know if high caregiving strain leads to depression or if depression makes you more strained."

Researchers hypothesized that family members of a hospitalized heart patient might think at the time about their own risk of cardiac disease. If so, "this is a motivational moment and a unique opportunity to educate them and help them lower their risks," Mosca said.

In the second study, participants in F.I.T. Heart received dietary advice on how to reduce their heart risks, most of them during the time the patient was in the hospital.

Six weeks later, the family members showed a significant increase, 79 percent versus 53 percent at enrollment, in the number following the National Heart, Lung, and Blood Institute's Therapeutic Lifestyle Change diet. The diet restricts saturated fat to 7 percent of calories consumed, total fat to less than 30 percent of calories, and cholesterol to 200 milligrams per day.

Researchers found that participants' willingness to change their eating patterns was predicted by high blood glucose or triglycerides at enrollment, a perception of poor health and a younger age.

"It's important that we develop more systematic approaches to identifying caregivers,
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SOURCE American Heart Association
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