Satvinder S. Dhaliwal

Effects of whey protein isolate on body composition, lipids, insulin and glucose in overweight and obese individuals

The health benefits currently associated with increased dairy intake may be attributable to the whey component of dairy proteins. The present study evaluated the effects of whey protein supplementation on body composition, lipids, insulin and glucose in comparison to casein and glucose (control) supplementation in overweight/obese individuals for 12 weeks. The subjects were randomised to whey protein, casein or glucose supplementation for 12 weeks according to a parallel design. Fasting blood samples and dual-energy X-ray absorptiometry measurements were taken. Seventy men and women with a mean age of 48.4 (SEM 0.86) years and a mean BMI of 31.3 (SEM 0.8) kg/m2 completed the study. Subjects supplemented with whey protein had no significant change in body composition or serum glucose at 12 weeks compared with the control or casein group. Fasting TAG levels were significantly lowered in the whey group compared with the control group at 6 weeks (P = 0.025) and 12 weeks (P = 0.035). There was a significant decrease in total cholesterol and LDL cholesterol at week 12 in the whey group compared with the casein (P = 0.026 and 0.045, respectively) and control groups (P < 0.001 and 0.003, respectively). Fasting insulin levels and homeostasis model assessment of insulin resistance scores were also significantly decreased in the whey group compared with the control group (P = 0.049 and P = 0.034, respectively). The present study demonstrated that supplementation with whey proteins improves fasting lipids and insulin levels in overweight and obese individuals.

Preferred clinical measures of central obesity for predicting mortality

Objective:To define the clinical measures of obesity that best predict all cause mortality and cardiovascular disease (CVD) mortality.Design and Setting:Eleven-year mortality follow-up of an Australian urban population sample of 9309 adults aged 20–69 years in 1989. Baseline measures of obesity included body mass index (BMI), waist circumference (WC), waist-to-stature ratio and the waist-to-hip ratio. The age-standardized hazard ratios for mortality were calculated for 1 s.d. above the mean for each measure of obesity using Cox regression analysis. We constructed receiver operator characteristic (ROC) curves to assess sensitivity and specificity of the measures and to identify approximate cut-points for the prediction of risk.Results:Waist-to-hip ratio was superior by magnitude and significance in predicting all cause mortality (male hazard ratio 1.25, P=0.003, female hazard ratio 1.24, P=0.003) and CVD mortality (male hazard ratio 1.62, P<0.001, female hazard ratio 1.59, P<0.001). Waist-to-stature ratio and WC were highly significant but less powerful predictors for CVD mortality. ROC analysis showed higher ‘area under the curve’ values for waist-related measures in males, with similar less marked trends in females. The ROC cut-points yielded values that corresponded to current promulgated criteria.Conclusions:The waist-to-hip ratio is the preferred clinical measure of obesity for predicting all cause and CVD mortality. WC is a practical alternative. Waist-to-stature ratio is not more useful than WC alone.

The effect of 12 weeks of aerobic, resistance or combination exercise training on cardiovascular risk factors in the overweight and obese in a randomized trial.

BackgroundEvidence suggests that exercise training improves CVD risk factors. However, it is unclear whether health benefits are limited to aerobic training or if other exercise modalities such as resistance training or a combination are as effective or more effective in the overweight and obese. The aim of this study is to investigate whether 12 weeks of moderate-intensity aerobic, resistance, or combined exercise training would induce and sustain improvements in cardiovascular risk profile, weight and fat loss in overweight and obese adults compared to no exercise.MethodsTwelve-week randomized parallel design examining the effects of different exercise regimes on fasting measures of lipids, glucose and insulin and changes in body weight, fat mass and dietary intake. Participants were randomized to either: Group 1 (Control, n = 16); Group 2 (Aerobic, n = 15); Group 3 (Resistance, n = 16); Group 4 (Combination, n = 17). Data was analysed using General Linear Model to assess the effects of the groups after adjusting for baseline values. Within-group data was analyzed with the paired t-test and between-group effects using post hoc comparisons.ResultsSignificant improvements in body weight (−1.6%, p = 0.044) for the Combination group compared to Control and Resistance groups and total body fat compared to Control (−4.4%, p = 0.003) and Resistance (−3%, p = 0.041). Significant improvements in body fat percentage (−2.6%, p = 0.008), abdominal fat percentage (−2.8%, p = 0.034) and cardio-respiratory fitness (13.3%, p = 0.006) were seen in the Combination group compared to Control. Levels of ApoB48 were 32% lower in the Resistance group compared to Control (p = 0.04).ConclusionA 12-week training program comprising of resistance or combination exercise, at moderate-intensity for 30 min, five days/week resulted in improvements in the cardiovascular risk profile in overweight and obese participants compared to no exercise. From our observations, combination exercise gave greater benefits for weight loss, fat loss and cardio-respiratory fitness than aerobic and resistance training modalities. Therefore, combination exercise training should be recommended for overweight and obese adults in National Physical Activity Guidelines.This clinical trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), registration number: ACTRN12609000684224.

Bone mineral density, adiposity, and cognitive functions

Cognitive decline and dementia due to Alzheimers disease (AD) have been associated with genetic, lifestyle, and environmental factors. A number of potentially modifiable risk factors should be taken into account when preventive or ameliorative interventions targeting dementia and its preclinical stages are investigated. Bone mineral density (BMD) and body composition are two such potentially modifiable risk factors, and their association with cognitive decline was investigated in this study. 164 participants, aged 34–87 years old (62.78 ± 9.27), were recruited for this longitudinal study and underwent cognitive and clinical examinations at baseline and after 3 years. Blood samples were collected for apolipoprotein E (APOE) genotyping and dual energy x-ray absorptiometry (DXA) was conducted at the same day as cognitive assessment. Using hierarchical regression analysis, we found that BMD and lean body mass, as measured using DXA were significant predictors of episodic memory. Age, gender, APOE status, and premorbid IQ were controlled for. Specifically, the List A learning from California Verbal Learning Test was significantly associated with BMD and lean mass both at baseline and at follow up assessment. Our findings indicate that there is a significant association between BMD and lean body mass and episodic verbal learning. While the involvement of modifiable lifestyle factors in human cognitive function has been examined in different studies, there is a need for further research to understand the potential underlying mechanisms.

Physical Activity and Calcium Consumption Are Important Determinants of Lower Limb Bone Mass in Older Women

A population‐based study of 1363 older women showed that the 24% who achieved high physical activity and dietary calcium intakes had a 5.1% higher hip BMD than those who did not, supporting the concept that lifestyle factors play an important role in the maintenance of lower extremity bone mass in older women.

Education and Support for Fathers Improves Breastfeeding Rates A Randomized Controlled Trial

Background: Studies have identified numerous factors affecting breastfeeding initiation and duration, including maternal education, mode of delivery, birth weight, socioeconomic status, and support of the infant’s father. Objective: The objective was to investigate the effects of an antenatal education session and postnatal support targeted to fathers. Methods: The Fathers Infant Feeding Initiative (FIFI Study) is a randomized controlled trial to increase the initiation and duration of breastfeeding that was conducted in 8 public maternity hospitals in Perth, Western Australia. A total of 699 couples were randomized within hospitals to either intervention or control groups. The intervention consisted of a 2-hour antenatal education session and postnatal support provided to fathers. Results: The any breastfeeding rate for the intervention group was significantly greater at 6 weeks: 81.6% in the intervention group compared to 75.2% in the control group, odds ratio 1.46 (95% CI, 1.01-2.13). After adjustment for age and hospital, the odds ratio for any breastfeeding in the intervention group was 1.58 (1.06-2.35) and for socioeconomic status (SES), 1.56 (1.06-2.30). The infants of older fathers were more likely to be breastfed at 6 weeks compared to infants of younger fathers (P < .01), and infants of fathers with high SES more likely than infants of fathers with low SES (P = .013). Conclusion: Even a small increase in breastfeeding rates brings public health benefits. In this study, a minimal intervention was found to significantly increase any breastfeeding at 6 weeks: 81.6% in the intervention group compared to 75.2% in the control group.

Central obesity and multivariable cardiovascular risk as assessed by the Framingham prediction scores.

To evaluate the role of measurements of central obesity in the multivariable prediction of cardiovascular risk using the Framingham risk scores, we studied 4,175 representative men from Australian cities, free of heart disease, stroke, and diabetes in 1989, and followed the cohort for mortality to 2004. Baseline lipids, blood pressure, and current cigarette smoking were recorded. Obesity was assessed by body mass index, waist circumference (WC), and waist-to-hip ratio (WHR) by strictly standardized methods. The Framingham equations were strong predictors of coronary heart disease (CHD) and cardiovascular disease (CVD) deaths. Of the obesity measurements, WHR and WC predicted deaths using Cox proportional hazards regression but body mass index did not. In the multivariable analyses, WHR was an independent predictor of CHD deaths, and WHR and WC were independent predictors of CVD deaths. There was little or no attenuation of hazard ratios for WHR and WC after correction for the Framingham scores. The 2 measurements of central obesity were more strongly predictive of CHD and CVD deaths in subjects at the lower levels of Framingham risk. In contrast, cigarette smoking risk appeared to contribute more in the higher Framingham risk categories. In conclusion, central obesity significantly and independently contributes to cardiovascular outcomes and to residual risk after accounting for the Framingham equations.

Western Australian women's perceptions of the style and quality of midwifery postnatal care in hospital and at home

AIM AND BACKGROUND An important part of maternity service provision is the care provided by midwives in the immediate postpartum period. Evidence suggests that postpartum morbidity and its impact on womens health after childbirth is an area of genuine concern. In Western Australia there is limited information on womens postpartum health needs and/or the quality of midwifery care provided in hospital and at home. This paper describes Western Australian (WA) womens perceptions of midwifery care in the early postpartum period. METHOD A cross-sectional, self report survey was used to describe the practical, emotional and informational support provided by midwives in the initial postpartum period. A questionnaire, specially designed for this population, was posted at 8 weeks postpartum to every woman with a registered live birth in WA between February and June 2006. Completed questionnaires were received from 2699 women. Data were analysed using descriptive statistics, t-tests and chi-squared. RESULTS Results indicate that overall, women were happy with most aspects of midwifery care related to practical advice and assistance in relation to baby care and their immediate physical recovery. Areas that received a less positive rating were related to providing consistent advice, availability of the midwife, emotional care and information on maternal health needs, immunisation and contraception. In general, first time mothers rated both the style and quality of care more negatively than multiparous women. There was a trend by women accessing private hospital care to rank their care less favourably. There were minimal differences noted between women in metropolitan and non-metropolitan areas. Midwifery care at home was rated very positively and significantly better than hospital care (p</=0.002). CONCLUSION Although the majority of women in this study were satisfied with the components of physical care and information and assistance with infant feeding and sleep and settling provided in the short-term, there was less satisfaction with emotional care and preparation for life at home with a new baby. This study adds to our understandings of womens experiences of the early postnatal period and provides information on which to base improvements in postnatal care and maternity services in WA and across Australia.

Association between yogurt, milk, and cheese consumption and common carotid artery intima-media thickness and cardiovascular disease risk factors in elderly women

BACKGROUND Despite the contribution of dairy foods to total dietary saturated fat intake, available data indicate that dairy consumption may lower the risk of cardiovascular disease. OBJECTIVE The objective of this study was to investigate the relation between consumption of milk, cheese, and yogurt and common carotid artery intima-media thickness (CCA-IMT) in a cohort of elderly women. DESIGN Dairy consumption was assessed with a validated food-frequency questionnaire in 1080 participants randomly selected from ambulant white women aged >70 y living in Perth, Western Australia. CCA-IMT was assessed by using B-mode carotid ultrasound 3 y later. Cardiovascular disease risk factors, including serum lipids and blood pressure, were assessed at baseline. RESULTS Total dairy product, milk, and cheese consumption was not associated with CCA-IMT (P > 0.05), whereas yogurt consumption was negatively associated with CCA-IMT (unadjusted standardized β = -0.081, P = 0.008; baseline risk factor-adjusted standardized β = -0.075, P = 0.015). Participants who consumed >100 g yogurt/d had a significantly lower CCA-IMT than did participants with lower consumption (unadjusted = -0.024 mm, P = 0.002). This relation remained significant after adjustment for baseline, dietary, and lifestyle risk factors (multivariable analysis = -0.023 mm, P = 0.003). CONCLUSION Increased consumption of yogurt, but not of other dairy products, is associated with a lower CCA-IMT, independent of other risk factors.

Do sleep problems or urinary incontinence predict falls in elderly women

The objectives of this cross-sectional study were: (1) To determine if night-time sleep disturbance, daytime sleepiness, or urinary incontinence were associated with an increased risk of falling in older Australian women and (2) to explore the interrelationships between daytime sleepiness, night-time sleep problems, and urge incontinence. Participants were 782 ambulatory, community-dwelling women aged 75 to 86 recruited from within the existing Calcium Intake Fracture Outcome Study, in which women above 70 years were selected at random from the electoral roll. Daytime sleepiness, night-time sleep problems, urinary incontinence and falls data were collected via self-complete questionnaires. Thirty-five per cent of participants had fallen at least once in the past 12 months and 37.7% reported at least one night-time sleep problem. However, only 8.1% of the study sample experienced abnormal daytime sleepiness (Epworth Sleepiness Scale score > 10). Pure stress, pure urge, and mixed incontinence occurred in 36.8%, 3.7%, and 32.6% of participants respectively. In forward stepwise multiple logistic regression analysis, urge incontinence (OR 1.76; 95% CI 1.29 to 2.41) and abnormal daytime sleepiness (OR 2.05; 95% CI 1.21 to 3.49) were significant independent risk factors for falling after controlling for other falls risk factors (age, central nervous system drugs, cardiovascular drugs). As urge incontinence and abnormal daytime sleepiness were independently associated with an increased falls risk, effective management of these problems may reduce the risk of falling in older women.