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The results of this systematic review identify the consistent and prevalent indicators of concussion and their associations , derived from the strongest evidence in the published literature .

BACKGROUND Currently , there is no evidence -based definition for concussion that is being uniformly applied in clinical and research setting s. OBJECTIVE To conduct a systematic review of the highest- quality literature about concussion and to assemble evidence about the prevalence and associations of key indicators of concussion . The goal was to establish an evidence -based foundation from which to derive , in future work , a definition , diagnostic criteria , and prognostic indicators for concussion .

Acute effects and recovery time following concussion in collegiate football players: the NCAA Concussion Study.

CONTEXT Lack of empirical data on recovery time following sport-related concussion hampers clinical decision making about return to play after injury . OBJECTIVE To prospect ively measure immediate effects and natural recovery course relating to symptoms , cognitive functioning , and postural stability following sport-related concussion . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study of 1631 football players from 15 US colleges . All players underwent preseason baseline testing on concussion assessment measures in 1999 , 2000 , and 2001 . Ninety-four players with concussion ( based on American Academy of Neurology criteria ) and 56 noninjured controls underwent assessment of symptoms , cognitive functioning , and postural stability immediately , 3 hours , and 1 , 2 , 3 , 5 , 7 , and 90 days after injury . MAIN OUTCOME MEASURES Scores on the Grade d Symptom Checklist ( GSC ) , St and ardized Assessment of Concussion ( SAC ) , Balance Error Scoring System ( BESS ) , and a neuropsychological test battery . RESULTS No player with concussion was excluded from participation ; 79 players with concussion ( 84 % ) completed the protocol through day 90 . Players with concussion exhibited more severe symptoms ( mean GSC score 20.93 [ 95 % confidence interval [ CI ] , 15.65 - 26.21 ] points higher than that of controls ) , cognitive impairment ( mean SAC score 2.94 [ 95 % CI , 1.50 - 4.38 ] points lower than that of controls ) , and balance problems ( mean BESS score 5.81 [ 95 % CI , -0.67 to 12.30 ] points higher than that of controls ) immediately after concussion . On average , symptoms gradually resolved by day 7 ( GSC mean difference , 0.33 ; 95 % CI , -1.41 to 2.06 ) , cognitive functioning improved to baseline levels within 5 to 7 days ( day 7 SAC mean difference , -0.03 ; 95 % CI , -1.33 to 1.26 ) , and balance deficits dissipated within 3 to 5 days after injury ( day 5 BESS mean difference , -0.31 ; 95 % CI , -3.02 to 2.40 ) . Mild impairments in cognitive processing and verbal memory evident on neuropsychological testing 2 days after concussion resolved by day 7 . There were no significant differences in symptoms or functional impairments in the concussion and control groups 90 days after concussion . CONCLUSIONS Collegiate football players may require several days for recovery of symptoms , cognitive dysfunction , and postural instability after concussion . Further research is required to determine factors that predict variability in recovery time after concussion . St and ardized measurement of postconcussive symptoms , cognitive functioning , and postural stability may enhance clinical management of athletes recovering from concussion

The results of this systematic review identify the consistent and prevalent indicators of concussion and their associations , derived from the strongest evidence in the published literature .

BACKGROUND Currently , there is no evidence -based definition for concussion that is being uniformly applied in clinical and research setting s. OBJECTIVE To conduct a systematic review of the highest- quality literature about concussion and to assemble evidence about the prevalence and associations of key indicators of concussion . The goal was to establish an evidence -based foundation from which to derive , in future work , a definition , diagnostic criteria , and prognostic indicators for concussion .

The results of this systematic review identify the consistent and prevalent indicators of concussion and their associations , derived from the strongest evidence in the published literature .

BACKGROUND Currently , there is no evidence -based definition for concussion that is being uniformly applied in clinical and research setting s. OBJECTIVE To conduct a systematic review of the highest- quality literature about concussion and to assemble evidence about the prevalence and associations of key indicators of concussion . The goal was to establish an evidence -based foundation from which to derive , in future work , a definition , diagnostic criteria , and prognostic indicators for concussion .

Diagnostic value of S100B and neuron-specific enolase in mild pediatric traumatic brain injury.

OBJECT During recent years , several biomarkers have been introduced for use in the diagnosis of traumatic brain injury ( TBI ) . The primary objective of this investigation was to determine if S100B ( or S100 calcium-binding protein B ) and neuron-specific enolase ( NSE ) serum concentrations can effectively be used to discriminate between symptomatic and asymptomatic children with minor head trauma . METHODS The authors conducted a prospect i ve clinical study that involved patients age 6 months to 15 years who had sustained minor head trauma . Children with concomitant extracranial injuries were excluded . Blood sample s were obtained within 6 hours of injury to measure S100B and NSE levels in serum . The authors defined 2 diagnostic groups : a mild TBI group ( patients with Glasgow Coma Scale [ GCS ] scores of 13 - 15 ) in whom there were clinical signs of concussion ( short loss of consciousness , amnesia , nausea , vomiting , somnolence , headache , dizziness , or impaired vision ) and a head contusion group ( patients with a GCS score of 15 ) in whom symptoms were absent . Both S100B and NSE concentrations were compared between the 2 groups . Secondary end points were defined as follows : correlation of S100B/NSE and a ) the presence of scalp lacerations , b ) GCS score , c ) age , and d ) correlation between S100B and NSE . RESULTS One hundred forty-eight patients were enrolled ( 53 in the contusion group , 95 in the mild TBI group ) . After adjusting for differences in age and time of injury to blood sample withdrawal , there was no significant difference in S100B or NSE between patients in the 2 groups . Scalp lacerations and GCS score had no affect on posttraumatic S100B or NSE concentrations . The correlation between S100B and NSE was significant . Both markers showed a significant negative correlation with age . CONCLUSIONS The authors demonstrated that S100B and NSE do not discriminate between symptomatic and asymptomatic children with minor head injury . There seem to be limitations in marker sensitivity when investigating pediatric patients with mild TBI

The results of this systematic review identify the consistent and prevalent indicators of concussion and their associations , derived from the strongest evidence in the published literature .

BACKGROUND Currently , there is no evidence -based definition for concussion that is being uniformly applied in clinical and research setting s. OBJECTIVE To conduct a systematic review of the highest- quality literature about concussion and to assemble evidence about the prevalence and associations of key indicators of concussion . The goal was to establish an evidence -based foundation from which to derive , in future work , a definition , diagnostic criteria , and prognostic indicators for concussion .

The results of this systematic review identify the consistent and prevalent indicators of concussion and their associations , derived from the strongest evidence in the published literature .

BACKGROUND Currently , there is no evidence -based definition for concussion that is being uniformly applied in clinical and research setting s. OBJECTIVE To conduct a systematic review of the highest- quality literature about concussion and to assemble evidence about the prevalence and associations of key indicators of concussion . The goal was to establish an evidence -based foundation from which to derive , in future work , a definition , diagnostic criteria , and prognostic indicators for concussion .

Mild traumatic brain injury and executive functions in school-aged children

Objective : This study sought to examine the effects of mild traumatic brain injury ( TBI ) on executive functions in school-aged children . Participants and method : The prospect i ve , longitudinal study involved 8–15 year old children , 186 with mild TBI and 99 with mild orthopaedic injuries ( OI ) . They were administered the Stockings of Cambridge and Spatial Working Memory sub-tests from the Cambridge Neuropsychological Testing Automated Battery ( CANTAB ) ∼10 days , 3 months and 12 months post-injury . Parents completed the Behavior Rating Inventory of Executive Functions ( BRIEF ) on each occasion , with ratings at the initial assessment intended to assess pre-morbid functioning retrospectively . Results : On the CANTAB , the groups did not differ on the Stockings of Cambridge and the mild TBI group unexpectedly performed better than the OI group on Spatial Working Memory . On the BRIEF , children with mild TBI showed a marginally significant trend toward more problems than the OI group on the Metacognition Index composite . The only BRIEF sub-scale on which they demonstrated significantly more problems was Organization of Material s. The presence of intracranial abnormalities on MRI was associated with more problems on the BRIEF Organization of Material s sub-scale at 3 months , but other findings were not consistent with hypothesized effects of TBI severity . The CANTAB sub-tests were significant predictors of later ratings on the BRIEF , but accounted for modest variance . Discussion : Children with mild TBI show limited evidence of deficits in executive functions , either cognitively or behaviourally , irrespective of injury characteristics . Cognitive tests of executive functions are modest predictors of ratings of executive functions in everyday life , for children both with and without mild TBI

The results of this systematic review identify the consistent and prevalent indicators of concussion and their associations , derived from the strongest evidence in the published literature .

BACKGROUND Currently , there is no evidence -based definition for concussion that is being uniformly applied in clinical and research setting s. OBJECTIVE To conduct a systematic review of the highest- quality literature about concussion and to assemble evidence about the prevalence and associations of key indicators of concussion . The goal was to establish an evidence -based foundation from which to derive , in future work , a definition , diagnostic criteria , and prognostic indicators for concussion .

The results of this systematic review identify the consistent and prevalent indicators of concussion and their associations , derived from the strongest evidence in the published literature .

BACKGROUND Currently , there is no evidence -based definition for concussion that is being uniformly applied in clinical and research setting s. OBJECTIVE To conduct a systematic review of the highest- quality literature about concussion and to assemble evidence about the prevalence and associations of key indicators of concussion . The goal was to establish an evidence -based foundation from which to derive , in future work , a definition , diagnostic criteria , and prognostic indicators for concussion .

Recovery of memory function following traumatic brain injury in pre-school children.

Traumatic brain injury ( TBI ) may have a profound impact on a child 's ongoing development . Various risk factors have been found to predict outcome , but considerable variability remains unexplained . This study used a prospect i ve , longitudinal design to examine recovery of memory function following TBI within the pre school period . Ninety-six children with TBI were divided according to injury severity ( mild , moderate , severe ) , and compared to age and SES matched healthy controls ( n = 35 ) . Children were evaluated acutely and at 6,12 and 18 months post-injury using intellectual and memory measures . Results showed a relationship between greater injury severity and poorer intellectual ability . This dose-response relationship was not clearly evident for memory function within the acute phase of recovery , but developed over time , with greater memory impairments evident for children with more severe TBI by 12 months post-injury . Children with mild TBI exhibited few memory problems . Findings are discussed in the context of theories of plasticity and recovery of function

The results of this systematic review identify the consistent and prevalent indicators of concussion and their associations , derived from the strongest evidence in the published literature .

BACKGROUND Currently , there is no evidence -based definition for concussion that is being uniformly applied in clinical and research setting s. OBJECTIVE To conduct a systematic review of the highest- quality literature about concussion and to assemble evidence about the prevalence and associations of key indicators of concussion . The goal was to establish an evidence -based foundation from which to derive , in future work , a definition , diagnostic criteria , and prognostic indicators for concussion .

The results of this systematic review identify the consistent and prevalent indicators of concussion and their associations , derived from the strongest evidence in the published literature .

BACKGROUND Currently , there is no evidence -based definition for concussion that is being uniformly applied in clinical and research setting s. OBJECTIVE To conduct a systematic review of the highest- quality literature about concussion and to assemble evidence about the prevalence and associations of key indicators of concussion . The goal was to establish an evidence -based foundation from which to derive , in future work , a definition , diagnostic criteria , and prognostic indicators for concussion .

The assessment of orientation following concussion in athletes.

The purpose of this study was to investigate the sensitivity of orientation and recent memory questions in the diagnosis of concussion . In a prospect i ve study over 7 consecutive years ( 1985 - 1991 ) , all players at a professional Australian Rules Football club who sustained a concussive injury ( n = 28 ) were administered a set of questions evaluating orientation and recent memory . Concussion was diagnosed independently on the basis of loss or disturbance of consciousness and clinical symptoms . A control group of age-matched nonconcussed players was administered the same set of questions . The results showed that items evaluating recently acquired information were more sensitive in the assessment of concussion than st and ard orientation items . The relative sensitivity of orientation questions must be considered when they are used in the clinical diagnosis of concussion in sport

The results of this systematic review identify the consistent and prevalent indicators of concussion and their associations , derived from the strongest evidence in the published literature .

BACKGROUND Currently , there is no evidence -based definition for concussion that is being uniformly applied in clinical and research setting s. OBJECTIVE To conduct a systematic review of the highest- quality literature about concussion and to assemble evidence about the prevalence and associations of key indicators of concussion . The goal was to establish an evidence -based foundation from which to derive , in future work , a definition , diagnostic criteria , and prognostic indicators for concussion .

The results of this systematic review identify the consistent and prevalent indicators of concussion and their associations , derived from the strongest evidence in the published literature .

BACKGROUND Currently , there is no evidence -based definition for concussion that is being uniformly applied in clinical and research setting s. OBJECTIVE To conduct a systematic review of the highest- quality literature about concussion and to assemble evidence about the prevalence and associations of key indicators of concussion . The goal was to establish an evidence -based foundation from which to derive , in future work , a definition , diagnostic criteria , and prognostic indicators for concussion .

Early predictors of postconcussive syndrome in a population of trauma patients with mild traumatic brain injury.

PURPOSE The purpose of this analysis was to determine which of the initial symptoms after mild traumatic brain injury ( MTBI ) can best predict the development of persistent postconcussive syndrome ( PCS ) . METHODS One hundred eighty MTBI patients admitted to a level I trauma center were enrolled in a prospect i ve study and 110 followed for 3 months . MTBI was defined as a Glasgow Coma Score of 13 to 15 with a transient loss of consciousness or report of being dazed or confused . PCS was defined as the persistence of four or more symptoms long term . Patients were screened at admission and at 3 days to 10 days and 3 months . Symptom checklists were administered to ascertain the presence of symptoms ( cognitive , emotional , and physical ) after concussion . For a subset of patients that were physically able , balance tests were also conducted . Stepwise logistic regression was used to identify which symptoms best predicted PCS . RESULTS The mean age of the subjects was 35 years , and 65 % were men . Physical symptoms were the most prevalent in the 3 days to 10 days postinjury with most declining thereafter to baseline levels . Emotional and cognitive symptoms were less prevalent but more likely to remain elevated at 3 months ; 41.8 % of subjects reported PCS at 3 months . The strongest individual symptoms that predicted long-term PCS included anxiety , noise sensitivity ( NS ) , and trouble thinking ; reported by 49 % , 27 % , and 31 % of the subjects at 3 days to 10 days , respectively . In multivariate regressions including age , gender , and early symptoms , only anxiety , NS and gender remained significant in the prediction of PCS . Interactions revealed that the effect of anxiety was seen primarily among women . NS had an odds ratio of 3.1 for PCS at 3 months . CONCLUSIONS After MTBI , anxiety among women and NS are important predictors of PCS . Other physical symptoms , while more prevalent are poor predictors of PCS

The results of this systematic review identify the consistent and prevalent indicators of concussion and their associations , derived from the strongest evidence in the published literature .

BACKGROUND Currently , there is no evidence -based definition for concussion that is being uniformly applied in clinical and research setting s. OBJECTIVE To conduct a systematic review of the highest- quality literature about concussion and to assemble evidence about the prevalence and associations of key indicators of concussion . The goal was to establish an evidence -based foundation from which to derive , in future work , a definition , diagnostic criteria , and prognostic indicators for concussion .

The results of this systematic review identify the consistent and prevalent indicators of concussion and their associations , derived from the strongest evidence in the published literature .

BACKGROUND Currently , there is no evidence -based definition for concussion that is being uniformly applied in clinical and research setting s. OBJECTIVE To conduct a systematic review of the highest- quality literature about concussion and to assemble evidence about the prevalence and associations of key indicators of concussion . The goal was to establish an evidence -based foundation from which to derive , in future work , a definition , diagnostic criteria , and prognostic indicators for concussion .

Neuropsychological Test Performance Prior To and Following Sports-Related Mild Traumatic Brain Injury

Objective To examine the utility of neuropsychological tests in assessing college athletes prior to and following a sports-related mild Traumatic Brain Injury ( mTBI ) . Design A prospect i ve study of college athletes who sustained mTBI while engaged in sport . Preinjury baseline neuropsychological test data were obtained for athletes at risk for mTBI . Following an mTBI , the athlete and his or her matched noninjured control were evaluated at 2 hours , 48 hours , 1 week , and 1 month postinjury . Setting Male and female athletes from a Division I college . Participants Male and female athletes from the football , men 's ice hockey , men 's and women 's soccer , and men 's and women 's basketball teams at Penn State University . A total of 29 injured and 20 noninjured athletes participated in the study . Interventions Neuropsychological test batteries were administered at baseline and serially following mTBI . Main Outcome Measures Post-Concussion Symptom Checklist , Hopkins Verbal Learning Test , Symbol Digit Modalities Test , Stroop Color-Word Test , Trail Making Test , VIGIL/W , List Learning , Digit Span , Penn State Cancellation Test , and Controlled Oral Word Association . Results Neuropsychological test data yielded significant differences between injured athletes and controls at 2 hours and 48 hours following cerebral concussion ; injured athletes performing significantly worse than controls . Injured athletes reported a significantly greater number of postconcussion symptoms 2 hours following injury but not at the 48-hour assessment . No multivariate group differences were found at 1 week , but univariate analyses suggested significant differences on a few measures . At 1 month postinjury , a statistically significant difference was found on one measure with injured athletes marginally outperforming controls . Conclusions Neuropsychological tests are useful in the detection of cognitive impairment following mTBI . The test data appear to be more effective than subjective report of symptoms in differentiating between injured and noninjured athletes at 48 hours postinjury . Although significant individual variability existed , most injured athletes recovered within 1 week of injury . A battery of tests , rather than any single test , is necessary to capture the variability that exists among injured athletes

The results of this systematic review identify the consistent and prevalent indicators of concussion and their associations , derived from the strongest evidence in the published literature .

BACKGROUND Currently , there is no evidence -based definition for concussion that is being uniformly applied in clinical and research setting s. OBJECTIVE To conduct a systematic review of the highest- quality literature about concussion and to assemble evidence about the prevalence and associations of key indicators of concussion . The goal was to establish an evidence -based foundation from which to derive , in future work , a definition , diagnostic criteria , and prognostic indicators for concussion .

The results of this systematic review identify the consistent and prevalent indicators of concussion and their associations , derived from the strongest evidence in the published literature .

BACKGROUND Currently , there is no evidence -based definition for concussion that is being uniformly applied in clinical and research setting s. OBJECTIVE To conduct a systematic review of the highest- quality literature about concussion and to assemble evidence about the prevalence and associations of key indicators of concussion . The goal was to establish an evidence -based foundation from which to derive , in future work , a definition , diagnostic criteria , and prognostic indicators for concussion .

Relationships among post-concussive symptoms and symptoms of PTSD in children following mild traumatic brain injury

Primary objective : To investigate the occurrence of post-concussive symptoms ( PCS ) and symptoms of post-traumatic stress disorder ( PTSD ) in children following mild traumatic brain injuries ( TBI ) . Research design : Longitudinal study comparing the outcomes of mild TBI and orthopaedic injuries ( OI ) in children aged 8–15 . Methods and procedures : One hundred and eighty-six children with mild TBI and 99 with OI were recruited prospect ively . Parents rated children 's PCS and symptoms of PTSD at 2 weeks , 3 months and 12 months post-injury . One hundred and sixty-seven with mild TBI and 84 with OI completed all assessment s. Main outcomes and results : Controlling for symptoms of PTSD , the mild TBI group demonstrated more PCS than the OI group , although the magnitude of group differences diminished with time . Controlling for PCS , the OI group displayed more symptoms of PTSD than the mild TBI group at baseline , but not thereafter . Symptoms of PTSD and PCS were correlated significantly , but more highly in the OI group than the mild TBI group . Conclusions : Although PCS and symptoms of PTSD are correlated , children with mild TBI are more distinguishable from children with OI based on PCS than on symptoms of PTSD . The latter symptoms , moreover , do not account for increased PCS following mild TBI in children

The results of this systematic review identify the consistent and prevalent indicators of concussion and their associations , derived from the strongest evidence in the published literature .

BACKGROUND Currently , there is no evidence -based definition for concussion that is being uniformly applied in clinical and research setting s. OBJECTIVE To conduct a systematic review of the highest- quality literature about concussion and to assemble evidence about the prevalence and associations of key indicators of concussion . The goal was to establish an evidence -based foundation from which to derive , in future work , a definition , diagnostic criteria , and prognostic indicators for concussion .

The results of this systematic review identify the consistent and prevalent indicators of concussion and their associations , derived from the strongest evidence in the published literature .

BACKGROUND Currently , there is no evidence -based definition for concussion that is being uniformly applied in clinical and research setting s. OBJECTIVE To conduct a systematic review of the highest- quality literature about concussion and to assemble evidence about the prevalence and associations of key indicators of concussion . The goal was to establish an evidence -based foundation from which to derive , in future work , a definition , diagnostic criteria , and prognostic indicators for concussion .

Detailed concussion symptom analysis in a paediatric ED population

Primary objective : To examine the frequency of acute mild traumatic brain injury ( mTBI ) symptoms in children using a concussion symptom inventory and to identify which symptoms are most useful in identifying mTBI . It was hypothesized that symptoms associated with mTBI are more common in children with head injury than orthopaedic injury and certain symptoms are more useful than others in identifying mTBI . Research design : Prospect i ve case-control study conducted in a paediatric trauma centre emergency department . Methods and procedures : Children of 6–18 years old with head injury or a minor extremity injury were enrolled . Symptoms were assessed using a grade d symptom checklist . Symptom frequency was compared using a chi-square test . The association between individual symptoms with AMS was evaluated with logistic regression analysis . Main outcomes and results : Children with head injury displayed more frequent symptoms than controls . Head-injured cases with altered mental status ( AMS ) demonstrated the most frequent and severe symptoms ( median symptom scores : control = 1 , cases without AMS = 5 , cases with AMS = 10 ; p < 0.001 ) . Headache , nausea , dizziness , blurred/double vision and not feeling ‘ sharp ’ were associated with AMS . Conclusions : Symptoms associated with mTBI are more frequent in children with head injury . AMS magnifies this effect . A symptom inventory is integral to the evaluation of mTBI in children ; a smaller set of dichotomized symptoms may be as useful as and more easily administered than lengthier symptom scales

The results of this systematic review identify the consistent and prevalent indicators of concussion and their associations , derived from the strongest evidence in the published literature .

BACKGROUND Currently , there is no evidence -based definition for concussion that is being uniformly applied in clinical and research setting s. OBJECTIVE To conduct a systematic review of the highest- quality literature about concussion and to assemble evidence about the prevalence and associations of key indicators of concussion . The goal was to establish an evidence -based foundation from which to derive , in future work , a definition , diagnostic criteria , and prognostic indicators for concussion .

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

Timing of radiotherapy following breast-conserving surgery: outcome of 1393 patients at a single institution

Background The role of postoperative radiotherapy in breast-conserving therapy is undisputed . However , optimal timing of adjuvant radiotherapy is an issue of ongoing debate . This retrospective clinical cohort study was performed to investigate the impact of a delay in surgery – radiotherapy intervals on local control and overall survival . Patients and methods Data from an unselected cohort of 1393 patients treated at a single institution over a 17-year period ( 1990–2006 ) were analyzed . Patients were assigned to two groups ( CT+/CT− ) according to chemotherapy status . A delay in the initiation of radiotherapy was defined as > 7 weeks ( CT− group ) and > 24 weeks ( CT+ group ) . Results The 10-year regional recurrence-free survival for the CT− and CT+ groups were 95.6 and 86.0 % , respectively . A significant increase in the median surgery – radiotherapy interval was observed over time ( CT− patients : median of 5 weeks in 1990–1992 to a median of 6 weeks in 2005–2006 ; CT+ patients : median of 5 weeks in 1990–1992 to a median of 21 weeks in 2005–2006 ) . There was no association between a delay in radiotherapy and an increased local recurrence rate ( CT− group : p = 0.990 for intervals 0–6 weeks vs. ≥ 7 weeks ; CT+ group : p = 0.644 for intervals 0–15 weeks vs. ≥ 24 weeks ) or decreased overall survival ( CT− group : p = 0.386 for intervals 0–6 weeks vs. ≥ 7 weeks ; CT+ group : p = 0.305 for intervals 0–15 weeks vs. ≥ 24 weeks ) . Conclusion In the present cohort , a delay of radiotherapy was not associated with decreased local control or overall survival in the two groups ( CT−/CT+ ) . However , in the absence of r and omized evidence , delays in the initiation of radiotherapy should be avoided . ZusammenfassungHintergrundDie zentrale Rolle der postoperativen Strahlentherapie i m Rahmen der brusterhaltenden Therapie ist mittlerweile unbestritten . Allerdings ist der optimale Zeitpunkt für den Beginn der adjuvanten Strahlentherapie weiterhin ungewiss . In dieser retrospektiven Kohortenstudie wurde die mögliche Auswirkung einer verzögerten Einleitung der postoperativen Strahlentherapie auf die lokale Kontrolle , sowie auf das Gesamtüberleben untersucht . Patienten und Method eInsgesamt wurden Date n von 1393 Patienten über einen 17-Jahres-Zeitraum ( 1990–2006 ) analysiert . In Abhängigkeit vom Chemotherapiestatus wurden getrennte Analysen durchgeführt ( CT+/CT− ) . Eine verzögerte Einleitung der Strahlentherapie wurde als ein Intervall von > 7 Wochen ( CT− ) , bzw . > 24 Wochen ( CT+ ) definiert . ErgebnisseDas lokale rezidivfreie Überleben für die CT− und CT+ Gruppe lag nach 10 Jahren bei 95,6 % bzw . 86,0 % . Über den gesamten Zeitraum konnte ein signifikanter Anstieg des medianen Intervalls zwischen Operation und Strahlentherapie festgestellt werden ( CT− : von median 5 Wochen von 1990–1992 auf median 6 Wochen von 2005–2006 ; CT+ : von median 5 Wochen von 1990–1992 auf median 21 Wochen von 2005–2006 ) . Eine Korrelation zwischen verzögertem Beginn der Strahlentherapie und einer erhöhten lokalen Rezidivrate ( CT− : p = 0,990 für Intervalle 0–6 Wochen vs. ≥ 7 Wochen ; CT+ : p = 0,644 für Intervalle 0–15 Wochen vs. ≥ 24 Wochen ) oder einem verringerten Gesamtüberleben ( CT− : p = 0,386 für Intervalle 0–6 Wochen vs. ≥ 7 Wochen ; CT+ : p = 0,305 für Intervalle 0–15 Wochen vs. ≥ 24 Wochen ) wurde nicht gefunden . SchlussfolgerungIn der vorliegenden Kohorte f and sich kein Hinweis auf eine erhöhte Lokalrezidivrate oder ein verringertes Gesamtüberleben bei verzögertem Beginn der Strahlentherapie . Dennoch sollte bei fehlender r and omisierter Evidenz eine Verzögerung bei der Initiierung der Strahlentherapie aufgrund radiobiologischer Erwägungen grundsätzlich vermieden werden

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

Efficacy and safety of neoadjuvant pertuzumab and trastuzumab in women with locally advanced, inflammatory, or early HER2-positive breast cancer (NeoSphere): a randomised multicentre, open-label, phase 2 trial.

BACKGROUND Studies with pertuzumab , a novel anti-HER2 antibody , show improved efficacy when combined with the established HER2-directed antibody trastuzumab in breast cancer therapy . We investigated the combination of pertuzumab or trastuzumab , or both , with docetaxel and the combination of pertuzumab and trastuzumab without chemotherapy in the neoadjuvant setting . METHODS In this multicentre , open-label , phase 2 study , treatment-naive women with HER2-positive breast cancer were r and omly assigned ( 1:1:1:1 ) central ly and stratified by operable , locally advanced , and inflammatory breast cancer , and by hormone receptor expression to receive four neoadjuvant cycles of : trastuzumab ( 8 mg/kg loading dose , followed by 6 mg/kg every 3 weeks ) plus docetaxel ( 75 mg/m(2 ) , escalating , if tolerated , to 100 mg/m(2 ) every 3 weeks ; group A ) or pertuzumab ( loading dose 840 mg , followed by 420 mg every 3 weeks ) and trastuzumab plus docetaxel ( group B ) or pertuzumab and trastuzumab ( group C ) or pertuzumab plus docetaxel ( group D ) . The primary endpoint , examined in the intention-to-treat population , was pathological complete response in the breast . Neither patients nor investigators were masked to treatment . This study is registered with Clinical Trials.gov , number NCT00545688 . FINDINGS Of 417 eligible patients , 107 were r and omly assigned to group A , 107 to group B , 107 to group C , and 96 to group D. Patients given pertuzumab and trastuzumab plus docetaxel ( group B ) had a significantly improved pathological complete response rate ( 49 of 107 patients ; 45·8 % [ 95 % CI 36·1 - 55·7 ] ) compared with those given trastuzumab plus docetaxel ( group A ; 31 of 107 ; 29·0 % [ 20·6 - 38·5 ] ; p=0·0141 ) . 23 of 96 ( 24·0 % [ 15·8 - 33·7 ] ) women given pertuzumab plus docetaxel ( group D ) had a pathological complete response , as did 18 of 107 ( 16·8 % [ 10·3 - 25·3 ] ) given pertuzumab and trastuzumab ( group C ) . The most common adverse events of grade 3 or higher were neutropenia ( 61 of 107 women in group A , 48 of 107 in group B , one of 108 in group C , and 52 of 94 in group D ) , febrile neutropenia ( eight , nine , none , and seven , respectively ) , and leucopenia ( 13 , five , none , and seven , respectively ) . The number of serious adverse events was similar in groups A , B , and D ( 15 - 20 serious adverse events per group in 10 - 17 % of patients ) but lower in group C ( four serious adverse events in 4 % of patients ) . INTERPRETATION Patients given pertuzumab and trastuzumab plus docetaxel ( group B ) had a significantly improved pathological complete response rate compared with those given trastuzumab plus docetaxel , without substantial differences in tolerability . Pertuzumab and trastuzumab without chemotherapy eradicated tumours in a proportion of women and showed a favourable safety profile . These findings justify further exploration in adjuvant trials and support the neoadjuvant approach for accelerating drug assessment in early breast cancer . FUNDING F Hoffmann-La Roche

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

Postmastectomy radiation improves local-regional control and survival for selected patients with locally advanced breast cancer treated with neoadjuvant chemotherapy and mastectomy.

PURPOSE To evaluate the efficacy of radiation in patients treated with neoadjuvant chemotherapy and mastectomy . PATIENTS AND METHODS We retrospectively analyzed the outcomes of 542 patients treated on six consecutive institutional prospect i ve trials with neoadjuvant chemotherapy , mastectomy , and radiation . These data were compared to those of 134 patients who received similar treatment in these same trials but without radiation . RESULTS Irradiated patients had a lower rate of local-regional recurrence ( LRR ) ( 10-year rates : 11 % v 22 % , P = .0001 ) . Radiation reduced LRR for patients with clinical T3 or T4 tumors , stage > or = IIB disease ( AJCC 1988 ) , pathological tumor size > 2 cm , or four or more positive nodes ( P < or = .002 for all comparisons ) . Patients who presented with clinical ly advanced stage III or IV disease but subsequently achieved a pathological complete response to neoadjuvant chemotherapy still had a high rate of LRR , which was significantly reduced with radiation ( 10-year rates : 33 % v 3 % , P = .006 ) . Radiation improved cause-specific survival ( CSS ) in the following subsets : stage > or = IIIB disease , clinical T4 tumors , and four or more positive nodes ( P < or = .007 for all comparisons ) . On multivariate analyses of LRR and CSS , the hazard ratios for lack of radiation were 4.7 ( 95 % CI , 2.7 to 8.1 ; P < .0001 ) and 2.0 ( 95 % CI , 1.4 to 2.9 ; P < .0001 ) , respectively . CONCLUSION After neoadjuvant chemotherapy and mastectomy , comprehensive radiation was found to benefit both local control and survival for patients presenting with clinical T3 tumors or stage III-IV ( ipsilateral supraclavicular nodal ) disease and for patients with four or more positive nodes . Radiation should be considered for these patients regardless of their response to initial chemotherapy

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

Prone accelerated partial breast irradiation after breast-conserving surgery: preliminary clinical results and dose-volume histogram analysis.

PURPOSE To report the clinical and dose-volume histogram results of the first 47 patients accrued to a protocol of accelerated partial breast irradiation . Patients were treated in the prone position with three-dimensional conformal radiotherapy after breast-conserving surgery . METHODS AND MATERIAL S Postmenopausal women with Stage T1N0 breast cancer were eligible only after they had first refused to undergo 6 weeks of st and ard radiotherapy . Planning CT in the prone position was performed on a dedicated table . The postoperative cavity was defined as the clinical target volume , with a 1.5-cm margin added to determine the planning target volume . A total dose of 30 Gy at 6 Gy/fraction was delivered in five fractions within 10 days . RESULTS The median age of the patients was 67.5 years ( range , 51 - 88 years ) . The median tumor diameter was 9 mm ( range , 1.3 - 19 mm ) . In all patients , the prescribed dose encompassed the planning target volume . The mean volume of the ipsilateral breast receiving 100 % of the prescription dose was 26 % ( range , 10 - 45 % ) , and the mean volume contained within the 50 % isodose surface was 47 % ( range , 23 - 75 % ) . The lung and heart were spared by treating in the prone position . Acute toxicity was modest , limited mainly to Grade 1 - 2 erythema . With a median follow-up of 18 months , only Grade 1 late toxicity occurred , and no patient developed local recurrence . CONCLUSION These data suggest that this approach is well tolerated , with only mild acute side effects and sparing of the heart and lung

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trials.

BACKGROUND 5-year results of the UK St and ardisation of Breast Radiotherapy ( START ) trials suggested that lower total doses of radiotherapy delivered in fewer , larger doses ( fractions ) are at least as safe and effective as the historical st and ard regimen ( 50 Gy in 25 fractions ) for women after primary surgery for early breast cancer . In this prespecified analysis , we report the 10-year follow-up of the START trials testing 13 fraction and 15 fraction regimens . METHODS From 1999 to 2002 , women with completely excised invasive breast cancer ( pT1 - 3a , pN0 - 1 , M0 ) were enrolled from 35 UK radiotherapy centres . Patients were r and omly assigned to a treatment regimen after primary surgery followed by chemotherapy and endocrine treatment ( where prescribed ) . R and omisation was computer-generated and stratified by centre , type of primary surgery ( breast-conservation surgery or mastectomy ) , and tumour bed boost radiotherapy . In START-A , a regimen of 50 Gy in 25 fractions over 5 weeks was compared with 41·6 Gy or 39 Gy in 13 fractions over 5 weeks . In START-B , a regimen of 50 Gy in 25 fractions over 5 weeks was compared with 40 Gy in 15 fractions over 3 weeks . Eligibility criteria included age older than 18 years and no immediate surgical reconstruction . Primary endpoints were local-regional tumour relapse and late normal tissue effects . Analysis was by intention to treat . Follow-up data are still being collected . This study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N59368779 . FINDINGS START-A enrolled 2236 women . Median follow-up was 9·3 years ( IQR 8·0 - 10·0 ) , after which 139 local-regional relapses had occurred . 10-year rates of local-regional relapse did not differ significantly between the 41·6 Gy and 50 Gy regimen groups ( 6·3 % , 95 % CI 4·7 - 8·5 vs 7·4 % , 5·5 - 10·0 ; hazard ratio [ HR ] 0·91 , 95 % CI 0·59 - 1·38 ; p=0·65 ) or the 39 Gy ( 8·8 % , 95 % CI 6·7 - 11·4 ) and 50 Gy regimen groups ( HR 1·18 , 95 % CI 0·79 - 1·76 ; p=0·41 ) . In START-A , moderate or marked breast in duration , telangiectasia , and breast oedema were significantly less common normal tissue effects in the 39 Gy group than in the 50 Gy group . Normal tissue effects did not differ significantly between 41·6 Gy and 50 Gy groups . START-B enrolled 2215 women . Median follow-up was 9·9 years ( IQR 7·5 - 10·1 ) , after which 95 local-regional relapses had occurred . The proportion of patients with local-regional relapse at 10 years did not differ significantly between the 40 Gy group ( 4·3 % , 95 % CI 3·2 - 5·9 ) and the 50 Gy group ( 5·5 % , 95 % CI 4·2 - 7·2 ; HR 0·77 , 95 % CI 0·51 - 1·16 ; p=0·21 ) . In START-B , breast shrinkage , telangiectasia , and breast oedema were significantly less common normal tissue effects in the 40 Gy group than in the 50 Gy group . INTERPRETATION Long-term follow-up confirms that appropriately dosed hypofractionated radiotherapy is safe and effective for patients with early breast cancer . The results support the continued use of 40 Gy in 15 fractions , which has already been adopted by most UK centres as the st and ard of care for women requiring adjuvant radiotherapy for invasive early breast cancer . FUNDING Cancer Research UK , UK Medical Research Council , UK Department of Health

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

Multimodal treatment for locally advanced breast cancer. Result of chemotherapy-radiotherapy versus chemotherapy-surgery.

In a prospect i ve r and omized study , the efficacy of two combined modality approaches ( chemotherapy plus radiotherapy or chemotherapy plus mastectomy ) was tested in a total of 132 women with locally advanced breast cancer . Chemotherapy consisted of Adriamycin plus vincristine ( AV ) administered for three cycles before either local-regional modality and subsequently for seven additional cycles . Although a higher proportion of women achieved complete remission after mastectomy ( 100 % ) compared to women given radiotherapy ( 60 % ) , the total response rate at the end of combined modality was identical ( 75 % ) . There was no significant difference between the two treatment groups in terms of patterns of treatment failure , median duration of response , and total survival . Treatment was not influenced by menopausal or estrogen receptor status . Two patients of the surgical group showed Adriamycin-induced cardiomyopathy after cumulative doses less than 500 mg/m2 . The results of present study failed to indicate that surgery per se improved the overall results including local control , over radiotherapy in a combined modality setting

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

Preoperative concurrent paclitaxel-radiation in locally advanced breast cancer: pathologic response correlates with five-year overall survival

We have previously demonstrated high pathologic response rates after neoadjuvant concurrent chemoradiation in patients with locally advanced breast cancer ( LABC ) . We now report disease-free survival ( DFS ) and overall survival ( OS ) in the context of pathologic response . 105 LABC patients ( White 46 % , Non-White 54 % ) were treated with paclitaxel ( 30 mg/m2 intravenously twice a week ) for 10–12 weeks . Daily radiotherapy was delivered to breast , axillary , and supraclavicular lymph nodes during weeks 2–7 of paclitaxel treatment , at 1.8 Gy per fraction to a total dose of 45 Gy with a tumor boost of 14 Gy at 2 Gy/fraction . Pathological complete response ( pCR ) was defined as the absence of invasive cancer in breast and lymph nodes and pathological partial response ( pPR ) as the persistence of < 10 microscopic foci of invasive carcinoma in breast or lymph nodes . Pathologic response ( pCR and pPR ) after neoadjuvant chemoradiation was achieved in 36/105 patients ( 34 % ) and was associated with significantly better DFS and OS . Pathological responders had a lower risk of recurrence or death ( HR = 0.35 , P = 0.01 ) and a longer OS ( HR = 4.27 , P = 0.01 ) compared with non-responders . Median DFS and OS were 57 and 84 months for non-responders , respectively , and have not yet been reached for responders . Importantly , pathologic response was achieved in 54 % of patients with HR negative tumors ( 26/48 ) . In conclusion , pathologic response to concurrent paclitaxel-radiation translated into superior DFS and OS . Half of the patients with HR negative tumors achieved a pathologic response

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

Hormonal therapy prolongs survival in irradiated locally advanced breast cancer: a European Organization for Research and Treatment of Cancer Randomized Phase III Trial.

PURPOSE To assess the long-term contribution of adjuvant chemotherapy ( CT ) and hormonal therapy ( HT ) in patients with locally advanced breast cancer , and to evaluate the impact of time of analysis on the results during accrual and up to 8 years after closure of a r and omized phase III trial . MATERIAL S AND METHODS In a trial using a factorial design , 410 patients were r and omized between radiotherapy ( RT ) alone , RT plus CT , RT plus HT , and RT plus HT plus CT . RESULTS CT and HT each produced a significant prolongation of the time to locoregional tumor recurrence and to distant progression of disease , with the combined treatments providing the greatest therapeutic effect . At the time of trial closure , a significant improvement of survival was observed in patients who received CT ( P = .004 ) ; however , with a longer follow-up duration , this effect disappeared ( P > .05 ) . HT did not initially appear to improve survival ( P = .16 ) ; however , in the latest analysis with a long-term follow-up duration , a significant improvement of survival was seen ( P = .02 ) . A consistent 25 % reduction in the death hazards ratio has been seen at all evaluations since trial closure in patients who received HT . The best survival results were observed in patients who received RT , HT , and CT ( P = .02 ) , with a reduction of 35 % in the death hazards ratio . CONCLUSION An improvement in survival attributable to HT has been shown in patients with locally advanced breast cancer . The greatest therapeutic effect was seen in the treatment group that received both CT and HT . The improvement obtained with HT became apparent only after long-term follow-up evaluation

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

Estrogen receptor, progesterone receptor, HER-2, and response to postmastectomy radiotherapy in high-risk breast cancer: the Danish Breast Cancer Cooperative Group.

PURPOSE To examine the importance of estrogen receptor ( ER ) , progesterone receptor ( PgR ) , human epidermal growth factor receptor 2 ( HER-2 ) , and constructed subtypes in a large study r and omly assigning patients to receive or not receive postmastectomy radiotherapy ( PMRT ) . PATIENTS AND METHODS The present analysis included 1,000 of the 3,083 high-risk breast cancer patients r and omly assigned to PMRT in the Danish Breast Cancer Cooperative Group ( DBCG ) protocol 82 trials b and c. Tissue microarray sections were stained for ER , PgR , and HER-2 . Median follow-up time for patients alive was 17 years . End points were locoregional recurrence as isolated first event , distant metastases , and overall survival . For statistical analyses four subgroups were constructed from hormonal receptors ( Rec ) . Rec+ was defined as ER+ and /or PgR+ . Rec-as both ER- and PgR- . The four subgroups were Rec+/HER-2- , Rec+/HER-2 + , Rec-/HER-2-(triple negative ) , and Rec-/HER-2 + . RESULTS A significantly improved overall survival after PMRT was seen only among patients characterized by good prognostic markers such as hormonal receptor-positive and HER-2- patients ( including the two Rec+ subtypes ) . No significant overall survival improvement after PMRT was found among patients with an a priori poor prognosis , the hormonal receptor-negative and HER-2 + patients , and in particular the Rec-/HER-2 + subtype . Furthermore , comparing hazard ratios and 95 % CIs , significantly smaller improvements in locoregional recurrence control after PMRT were found for ER- and PgR-tumors compared with the ER+ and PgR+ tumors ( P = .003 and .04 , respectively ) , and for the triple-negative ( P = .02 ) , and the Rec-/HER-2 + subtypes ( P = .003 ) compared with the Rec+/HER-2-subtype . CONCLUSION Hormonal receptor status , HER-2 , and the constructed subtypes may be predictive of locoregional recurrence and survival after postmastectomy radiotherapy

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

DEGRO Practical Guidelines for Radiotherapy of Breast Cancer II

Background and Purpose : The aim of the present paper is to up date the practical guidelines for radiotherapy of breast cancer published in 2006 by the breast cancer expert panel of the German Society for Radiooncology ( DEGRO ) . These recommendations were complementing the S3 guidelines of the German Cancer Society ( DKG ) elaborated in 2004 . The present DEGRO recommendations are based on a revision of the DKG guidelines provided by an interdisciplinary panel and published in February 2008 . Methods : The DEGRO expert panel ( authors of the present manuscript ) performed a comprehensive survey of the literature . Data from lately published meta-analyses , recent r and omized trials and guidelines of international breast cancer societies , yielding new aspects compared to 2006 , provided the basis for defining recommendations referring to the criteria of evidence -based medicine . In addition to the more general statements of the DKG , this paper emphasizes specific radiooncologic issues relating to radiotherapy after mastectomy ( PMRT ) , locally advanced disease , irradiation of the lymphatic pathways , and sequencing of local and systemic treatment . Technique , targeting , and dose are described in detail . Results : PMRT significantly reduces local recurrence rates in patients with T3/T4 tumors and /or positive axillary lymph nodes ( 12.9 % with and 40.6 % without PMRT in patients with four or more positive nodes ) . The more local control is improved , the more substantially it translates into increased survival . In node-positive women the absolute reduction in 15-year breast cancer mortality is 5.4 % . Data referring to the benefit of lymphatic irradiation are conflicting . However , radiotherapy of the supraclavicular area is recommended when four or more nodes are positive and otherwise considered individually . Evidence concerning timing and sequencing of local and systemic treatment is sparse ; therefore , treatment decisions should depend on the dominating risk of recurrence . Conclusion : There is common consensus that PMRT is m and atory for patients with T3/T4 tumors and /or four or more positive axillary nodes and should be considered for patients with one to three involved nodes . Irradiation of the lymphatic pathways and the optimal time point for onset of radiotherapy are still under debate . Hintergrund und Ziel : Ziel der Arbeit ist eine Aktualisierung der 2006 publizierten Leitlinie der „ Expertengruppe Mammakarzinom “ der Deutschen Gesellschaft für Radioonkologie ( DEGRO ) . Diese war seinerzeit in Ergänzung zur interdisziplinären S3-Leitlinie der Deutschen Krebsgesellschaft ( DKG ) von 2004 verfasst worden . Zwischenzeitlich erfolgten eine Überarbeitung und Aktualisierung der S3-Leitlinie der DKG , die i m Februar 2008 publiziert wurde . Method ik : Die Expertengruppe ( identisch mit den Autoren dieses Manuskripts ) führte eine umfassende Literaturrecherche durch . Aktuelle Metaanalysen und r and omisierte Studien , die neue Aspekte gegenüber 2006 ergaben , sowie Empfehlungen internationaler Fachgesellschaften wurden in die Bewertung von Therapieindikationen einbezogen . Diese orientieren sich an den Kriterien evidenzbasierter Medizin . In Ergänzung zu den eher allgemeinen Statements der DKG 2008 werden spezielle radiotherapeutische Fragestellungen beh and elt , die eine Strahlentherapie nach Mastektomie ( PMRT ) und/oder bei fortgeschrittenen Tumoren , die Bestrahlung der Lymphabflusswege und die Sequenz von Radio- und Systemtherapie betreffen . Zielvolumendefinition und Dosierung werden i m Detail beschrieben . Ergebnisse : Die PMRT senkt die Lokalrezidivrate bei Patientinnen mit hohem Rückfallrisiko ( T3/T4-Tumoren und/oder befallene axilläre Lymphknoten ; 12,9 % mit und 40,6 % ohne PMRT ) . Je ausgeprägter die durch die Radiotherapie bewirkte lokale Tumorkontrolle ist , desto stärker wirkt sich dies auf die Überlebenswahrscheinlichkeit aus . Bei lymphonodal positiven Patientinnen ergab sich eine absolute Verminderung der tumorspezifischen Sterblichkeit um 5,4 % nach 15 Jahren . Hinsichtlich des Nutzens einer Strahlentherapie der Lymphabflusswege ist die Date nlage widersprüchlich . Eine Bestrahlung der Supraklavikularregion ist jedoch bei vier oder mehr befallenen axillären Lymphknoten stets indiziert und sollte bei ein bis drei positiven Lymphknoten erwogen werden . Bezüglich der Sequenz von Radio- und Systemtherapie gibt es keine richtungweisenden Evidenzen zugunsten einer Therapiemodalität . Postoperativ sollte die Sequenz vom dominierenden Risiko abhängig gemacht werden . Schlussfolgerung : Nach Mastektomie ist die PMRT bei T3/T4-Tumoren , Resttumor und/oder axillären Lymphknotenmetastasen obligat . Die Bestrahlung der regionalen Lymphabflusswege und die Sequenz von Radio- und Systemtherapie bleiben bei unzureichender Date nlage Gegenst and interdisziplinärer Diskussionen

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

Retrospective analysis of locally advanced noninflammatory breast cancer from Chennai, South India, 1990-1999.

PURPOSE This was a retrospective observational study to elicit the outcome of the therapeutic strategy of concurrent neoadjuvant chemoradiotherapy protocol for locally advanced breast cancer . METHODS AND MATERIAL S A large series of 1,117 consecutive cases of locally advanced breast cancer treated at the Cancer Institute ( WIA ) , in Chennai , South India , between 1990 and 1999 and followed through 2004 formed the basis for this study . Disease-free survival was the main outcome , and nodal and tumor downstaging were the intermediate outcome measures studied . RESULTS Primary tumor downstaging was observed in 45 % and nodal downstaging in 57.5 % . The disease-free survival rate of nodal downstaged patients at 5 , 10 , and 15 years was 75 % , 65 % , and 58 % , respectively . The corresponding rates for pre- and postoperative node-negative patients were 70 % , 60 % , and 59 % . The best survival was seen among those who were tumor and node negative postoperatively . Nodal downstaging halved the risk of disease recurrence and death compared with node positivity , irrespective of tumor sterility . CONCLUSIONS A r and omized trial using cyclophosphamide , methotrexate , and 5-fluorouracil vs. an anthracycline-based regimen in the setting of concurrent chemoradiotherapy appears indicated . Additional preoperative chemotherapy to maximize nodal and tumor downstaging should be investigated . A change in postoperative chemotherapy according to nodal status could also be explored

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

Combination chemotherapy with mastectomy or radiotherapy for stage III breast carcinoma: a Cancer and Leukemia Group B study.

One hundred thirteen evaluable patients with previously untreated stage III breast carcinoma were treated with three monthly cycles of cyclophosphamide ( CYC ) , doxorubicin ( DOX ) , 5-fluorouracil ( 5-FU ) , vincristine ( VCR ) , and prednisone ( PRED ) ( CAFVP ) . Subsequently , 91 ( 81 % ) were deemed operable . Patients were then r and omized to receive surgery or radiotherapy ( RT ) to determine which of these modalities afforded better local tumor control . All patients also received 2 additional years of CAFVP in a further attempt to eradicate local disease and systemic micrometastases . Forty-one of the r and omized patients have relapsed . Approximately half of the initial relapses in each arm were local . The overall duration of disease control was similar following either modality , with a median of 29.2 months for surgery patients and 24.4 months for RT patients . Similarly , there was no major difference in survival related to r and omized treatment with an overall median of 39 months ( median follow-up 37 months ) . Pre- or perimenopausal status and inflammatory disease were associated with shorter disease control and survival . Treatment was generally well tolerated and toxicity was acceptable . This study demonstrates that prolonged control of stage III breast carcinoma can be achieved with combined modality therapy in which cytotoxic chemotherapy precedes and follows treatment directly primarily at the breast tumor , using either surgery or RT . Nevertheless , new regimens must be design ed if significant advances that may lead to the cure of this disease are to be achieved

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

Delineation of target volumes and organs at risk in adjuvant radiotherapy of early breast cancer: National guidelines and contouring atlas by the Danish Breast Cancer Cooperative Group

Abstract During the past decade planning of adjuvant radiotherapy ( RT ) of early breast cancer has changed from two-dimensional ( 2D ) to 3D conformal techniques . In the planning computerised tomography ( CT ) scan both the targets for RT and the organs at risk ( OARs ) are visualised , enabling an increased focus on target dose coverage and homogeneity with only minimal dose to the OARs . To ensure uniform RT in the national prospect i ve trials of the Danish Breast Cancer Cooperative Group ( DBCG ) , a national consensus for the delineation of clinical target volumes ( CTVs ) and OARs was required . Material and methods . A CT scan of a breast cancer patient after surgical breast conservation and axillary lymph node ( LN ) dissection was used for delineation . During multiple dummy-runs seven experienced radiation oncologists contoured all CTVs and OARs of interest in adjuvant breast RT . Two meetings were held in the DBCG Radiotherapy Committee to discuss the contouring and to approve a final consensus . The Dice similarity coefficient ( DSC ) was used to evaluate the delineation agreement before and after the consensus . Results . The consensus delineations of CTVs and OARs are available online and a table is presented with a contouring description of the individual volumes . The consensus provides recommendations for target delineation in a st and ard patient both in case of breast conservation or mastectomy . Before the consensus , the average value of the DSC was modest for most volumes , but high for the breast CTV and the heart . After the consensus , the DSC increased for all volumes . Conclusion . The DBCG has provided the first national guidelines and a contouring atlas of CTVs and OARs definition for RT of early breast cancer . The DSC is a useful tool in quantifying the effect of the introduction of guidelines indicating improved inter-delineator agreement . This consensus will be used by the DBCG in our prospect i ve trials

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

Effect of Primary Tumor Extirpation in Breast Cancer Patients Who Present With Stage IV Disease and an Intact Primary Tumor

Background Currently , therapy for breast cancer patients with stage IV disease and an intact primary tumor is metastasis directed ; the primary tumor is treated only when it causes symptoms . A recent review suggested that surgery may improve long-term survival in such patients . We evaluated the effect of surgery in such patients on long-term survival and disease progression . Methods We review ed the records of all breast cancer patients treated at our institution between 1997 and 2002 who presented with stage IV disease and an intact primary tumor . Information collected included demographics , tumor characteristics , site(s ) of metastases , type/ date of operation , use of radiotherapy , chemotherapy and hormonal therapy , disease progression ( time to progression and location of progression ) in the first year after diagnosis , and last follow-up . Overall and metastatic progression-free survival were compared between surgery and nonsurgery patients . Results Of 224 patients identified , 82 ( 37 % ) underwent surgical extirpation of the primary tumor ( segmental mastectomy in 39 [ 48 % ] and mastectomy in 43 [ 52 % ] ) , and 142 ( 63 % ) were treated without surgery . The median follow-up time was 32.1 months . After adjustment for other covariates , surgery was associated with a trend toward improvement in overall survival ( P = .12 ; relative risk , .50 ; 95 % confidence interval , .21–1.19 ) and a significant improvement in metastatic progression-free survival ( P = .0007 ; relative risk , .54 ; 95 % confidence interval , .38–.77 ) . Conclusions Removal of the intact primary tumor for breast cancer patients with synchronous stage IV disease is associated with improvement in metastatic progression-free survival . Prospect i ve studies are needed to vali date these findings

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

DEGRO practical guidelines: radiotherapy of breast cancer III—radiotherapy of the lymphatic pathways

Aim The purpose of this work is to up date the practical guidelines for adjuvant radiotherapy of the regional lymphatics of breast cancer published in 2008 by the breast cancer expert panel of the German Society of Radiation Oncology ( DEGRO ) . Methods A comprehensive survey of the literature concerning regional nodal irradiation ( RNI ) was performed using the following search terms : “ breast cancer ” , “ radiotherapy ” , “ regional node irradiation ” . Recent r and omized trials were analyzed for outcome as well as for differences in target definition . Field arrangements in the different studies were reproduced and superimposed on CT slices with individually contoured node areas . Moreover , data from recently published meta-analyses and guidelines of international breast cancer societies , yielding new aspects compared to 2008 , provided the basis for defining recommendations according to the criteria of evidence -based medicine . In addition to the more general statements of the German interdisciplinary S3 guidelines up date d in 2012 , this paper addresses indications , targeting , and techniques of radiotherapy of the lymphatic pathways after surgery for breast cancer . Results International guidelines reveal substantial differences regarding indications for RNI . Patients with 1–3 positive nodes seem to profit from RNI compared to whole breast ( WBI ) or chest wall irradiation alone , both with regard to locoregional control and disease-free survival . Irradiation of the regional lymphatics including axillary , supraclavicular , and internal mammary nodes provided a small but significant survival benefit in recent r and omized trials and one meta- analysis . Lymph node irradiation yields comparable tumor control in comparison to axillary lymph node dissection ( ALND ) , while reducing the rate of lymph edema . Data concerning the impact of 1–2 macroscopically affected sentinel node ( SN ) or microscopic metastases on prognosis are conflicting . Conclusion Recent data suggest that the current restrictive use of RNI should be scrutinized because the risk – benefit relationship appears to shift towards an improvement of outcome .ZusammenfassungZielAktualisierung der DEGRO-Leitlinie von 2008 zur adjuvanten Strahlentherapie des regionalen Lymphabflusses bei Mammakarzinom und Ergänzung der allgemeinen Empfehlungen der interdisziplinären S3-Leitlinie der Deutschen Krebsgesellschaft von 2012 durch spezifisch radioonkologische Leitlinien zur Indikation , Zielvolumendefinition und Technik der postoperativen Radiotherapie . Method enDie DEGRO-Expertengruppe Mammakarzinom führte eine systematische Literaturrecherche nach r and omisierten Studien , Metaanalysen sowie internationalen Leitlinien durch , die nach 2008 publiziert wurden und sich an den Kriterien evidenzbasierter Medizin orientierten . Suchbegriffe waren „ breast cancer “ , „ radiotherapy “ und „ regional node irradiation “ . Die Studien wurden sowohl auf ihre Ergebnisse als auch hinsichtlich der Unterschiede in den Zielvolumina analysiert und auf 3-D-Planungsschnittbilder mit CT-konturierten Lymphabflussgebieten projiziert . ErgebnisseDie Indikation zur regionalen Lymphabflussbestrahlung ( RNI ) wird in internationalen Leitlinien unterschiedlich gestellt . Bei Patientinnen mit 1–3 befallenen axillären Lymphknoten wurden nach RNI i m Vergleich zur alleinigen Bestrahlung der Brust oder Brustw and Verbesserungen der lokoregionalen Kontrolle und des Überlebens beobachtet . Mehrere r and omisierte Studien und eine Metaanalyse zeigten nach RNI ( mit unterschiedlichen Zielvolumina ) eine zwar geringe , jedoch signifikante Verbesserung des Überlebens . Bei positivem Sentinel-Lymphknoten ( SN ) ist die Lymphabflussbestrahlung einer axillären Lymphonodektomie ( ALND ) gleichwertig in der lokalen Tumorkontrolle , geht aber mit einer deutlich geringeren Lymphödemrate einher . Zur Frage , ob ein solch limitierter Lymphknotenbefall und selbst eine Mikrometastasierung langfristig einen Einfluss auf die Prognose haben , ist die Date nlage widersprüchlich . SchlussfolgerungDie restriktive Indikationsstellung zur Lymphabflussbestrahlung muss angesichts neuer Date n aus r and omisierten Studien kritisch überdacht werden

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

Breast conservation and prolonged chemotherapy for locally advanced breast cancer: the University of Michigan experience.

PURPOSE To determine whether breast conservation and prolonged neoadjuvant chemotherapy have efficacy in locally advanced breast cancer ( LABC ) , as measured by survival and rate of breast conservation . MATERIAL S AND METHODS Eighty-nine patients with stage III disease were enrolled at the University of Michigan ( UM ) onto a prospect i ve nonr and omized trial . Patients received nine 21-day cycles of neoadjuvant chemohormonal therapy that consisted of doxorubicin 30 mg/m2 and cyclophosphamide 750 mg/m2 intravenously on day 1 , conjugated estrogens 0.625 mg orally twice daily on days 6 to 8 , methotrexate 40 mg/m2 and fluorouracil 500 mg/m2 intravenously on day 8 , and tamoxifen 10 mg orally twice daily on days 9 to 14 . Patients with a negative biopsy received radiation only , while those with residual disease underwent mastectomy and postoperative radiotherapy . Eight more cycles of chemohormonal therapy were administered after local-regional therapy . RESULTS The clinical response rate to neoadjuvant therapy was 97 % , 28 % of patients had a complete pathologic response evaluated at biopsy . Five-year overall and disease-free survival probabilities were 54 % and 44 % , respectively . The median disease-free survival time was 2.4 years . The 5-year actuarial rates of local-regional control with local failure as only first failure were 82 % and 78 % following radiotherapy , and mastectomy and radiotherapy , respectively ( P = .99 ) . CONCLUSION Prolonged neoadjuvant chemohormonal therapy and biopsy-driven local therapy have efficacy in LABC , with 28 % of patients being c and i date s for breast conservation and a 5-year overall survival rate of 54 %

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

Prognostic factors in inflammatory breast cancer and therapeutic implications.

223 inflammatory breast cancer patients were diagnosed at the Institut Curie between 1977 and 1987 . Patients received chemotherapy and radiation treatment according to three consecutive r and omised trials . Five- and 10- year survival rates were 41 and 32 % , respectively . Disease-free interval rates were 25.5 % at 5 years and 19 % at 10 years . Parameters significantly linked with a pejorative prognosis in a multivariate analysis were : diffuse erythema , lymph node involvement , chest wall adherence , and age above 50 years . When therapeutic response parameters were included in the multivariate analysis , the five most important prognostic factors in order of significance were complete tumour regression after completion of induction treatment ( at 8 months ) , complete regression of inflammatory symptoms after 3 months of neoadjuvant chemotherapy , limited erythema at presentation and , less significantly , complete regression of inflammatory symptoms at 8 months and tumour regression at 3 months . In conclusion , patients who achieved a rapid and complete remission had a better prognosis than patients who had an incomplete response to chemotherapy . High-dose chemotherapy and reversal or prevention of drug resistance will be evaluated in future trials . Detailed information on the biology of this disease should allow the design of new strategies aim ing to improve patient management

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

Prospective randomized trial of paclitaxel alone versus 5-fluorouracil/doxorubicin/cyclophosphamide as induction therapy in patients with operable breast cancer.

The objective of this study was to compare the antitumor activity of single-agent paclitaxel ( Taxol ; Bristol-Myers Squibb Company , Princeton , NJ ) with that of the 5-fluorouracil/doxorubicin/cyclophosphamide ( FAC ) combination by evaluating the extent of residual disease in the breast and regional lymph nodes of patients with breast cancer following four cycles of induction chemotherapy . Patients with histologically confirmed invasive but noninflammatory carcinoma of the breast stages T2 - 3 , N0 - 1 , M0 were eligible to enter the study . Patients were treated with four cycles of either FAC or single-agent paclitaxel before local therapy . Following local therapy , treatment of the two arms was identical . Of 104 operable breast cancer patients who were treated with either regimen , 78 were evaluable for response to preoperative chemotherapy and had undergone local therapy . Age , TNM classification , and estrogen receptor status of the patients were similar in the two groups . Following induction chemotherapy , the extent of disease in the breast and the distribution and number of positive nodes were similar between the two treatment arms . Disease progressed in two patients in the FAC arm and in none in the paclitaxel arm during the induction phase of therapy . A higher fraction of patients had neutropenic fever during the paclitaxel treatment . Initial data from this ongoing r and omized study show that paclitaxel alone has comparable anticancer activity with FAC in patients with early breast cancer . The degree of cytoreduction was similar with both induction therapies

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

Is surgery necessary after complete clinical remission following neoadjuvant chemotherapy for early breast cancer?

PURPOSE This retrospective analysis aim ed to identify whether breast cancer patients receiving radiotherapy alone following a complete clinical remission ( cCR ) to neoadjuvant chemotherapy had a worse outcome than those treated with surgery . PATIENTS AND METHODS One hundred thirty-six patients who had achieved a cCR to neoadjuvant chemotherapy for early breast cancer were identified from a prospect ively maintained data base of 453 patients . Of these , 67 patients had undergone surgery as their primary locoregional therapy , and 69 patients had radiotherapy alone . Outcome was assessed in relation to local recurrence-free survival , disease-free survival , and overall survival . RESULTS Median follow-up was 63 months in the surgery group and 87 months in the no surgery group . Prognostic characteristics were well balanced between the two groups . For surgery and no surgery , respectively , there were no significant differences in disease-free survival or overall survival ( 5-year , 74 % v 76 % ; 10-year , 60 % v 70 % , P = .9 ) between the two groups . There was a nonsignificant trend toward increased locoregional-only recurrence for the no surgery group ( 21 % v 10 % at 5 years ; P = .09 ) , but no long-term failures of local control . Patients in the no surgery group who also achieved an ultrasound complete remission had a 5-year local recurrence rate of only 8 % . CONCLUSION In patients achieving a cCR to neoadjuvant chemotherapy , radiotherapy alone achieve survival rates as good as with surgery , but with higher local recurrence rates . Ultrasound may identify a low recurrence rate subgroup for assessing no surgery in a prospect i ve trial

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

Pattern of rash, diarrhea, and hepatic toxicities secondary to lapatinib and their association with age and response to neoadjuvant therapy: analysis from the NeoALTTO trial.

PURPOSE We investigated the pattern of rash , diarrhea , and hepatic adverse events ( AEs ) secondary to lapatinib and their association with age and pathologic complete response ( pCR ) in the Neoadjuvant Lapatinib and /or Trastuzumab Treatment Optimisation ( NeoALLTO ) phase III trial . PATIENTS AND METHODS Patients with HER2-positive early breast cancer were r and omly assigned to receive lapatinib ( Arm A ) , trastuzumab ( Arm B ) , or their combination ( Arm C ) for 6 weeks followed by the addition of paclitaxel for 12 weeks before surgery . We investigated the frequency and time to developing each AE according to age ( ≤ 50 v > 50 years ) and their association with pCR in a logistic regression model adjusted for age , hormone receptors , tumor size , nodal status , planned breast surgery , completion of lapatinib administration , and treatment arm . RESULTS Only patients r and omly assigned to arms A and C were eligible ( n = 306 ) . Younger patients ( ≤ 50 years ) experienced significantly more rash compared with older patients ( 74.4 % v 47.9 % ; P < .0001 ) . Diarrhea and hepatic AEs were observed in 78.8 % and 41.2 % of patients , respectively , with no differences in rate or severity or time of onset according to age . Early rash ( ie , before starting paclitaxel ) was independently associated with a higher chance of pCR , mainly in patients older than 50 years ( odds ratio [ OR ] = 3.76 ; 95 % CI , 1.69 to 8.34 ) but not in those ≤ 50 years ( OR = 0.92 ; 95 % CI , 0.45 to 1.88 ; P for interaction = .01 ) . No significant association was observed between pCR and diarrhea or hepatic AEs . CONCLUSION Our results indicate that the frequency and clinical relevance of lapatinib-related rash is largely dependent on patient age

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen .

This systematic review with meta- analysis found no evidence that either material was superior to the other in the prevention of dental caries . Thus , both material s appear equally suitable for clinical application as a fissure sealant material

The purpose of this quantitative systematic review was to appraise the evidence on the caries-preventive effect of glass ionomer cement ( GIC ) in relation to resin-based fissure sealants .

A three-year follow-up of glass ionomer cement and resin fissure sealants.

The aim of the present study was to compare intraindividually a type III fissure-sealant , glass ionomer cement with a resin-based sealant . One hundred and forty-eight first permanent molars were sealed in forty-seven children . After three years 20.8 percent of the resin and 34.7 percent of the glass ionomer cement sealants were partially lost , and 0 percent and 37.5 percent , respectively , were totally lost . One tooth ( 1.4 percent ) in the glass ionomer cement group and three teeth ( 4.2 percent ) in the resin group developed caries

This systematic review with meta- analysis found no evidence that either material was superior to the other in the prevention of dental caries . Thus , both material s appear equally suitable for clinical application as a fissure sealant material

The purpose of this quantitative systematic review was to appraise the evidence on the caries-preventive effect of glass ionomer cement ( GIC ) in relation to resin-based fissure sealants .

This systematic review with meta- analysis found no evidence that either material was superior to the other in the prevention of dental caries . Thus , both material s appear equally suitable for clinical application as a fissure sealant material

The purpose of this quantitative systematic review was to appraise the evidence on the caries-preventive effect of glass ionomer cement ( GIC ) in relation to resin-based fissure sealants .

Caries-Preventive Effect of a One-Time Application of Composite Resin and Glass Ionomer Sealants after 5 Years

The aim of the present trial was to ( 1 ) compare the caries-preventive effect of glass ionomer sealants , placed according to the atraumatic restorative treatment ( ART ) procedure , with composite resin sealants over time and ( 2 ) investigate the caries-preventive effect after complete disappearance of sealant material . Forty-six boys and 57 girls , mean age 7.8 years , were r and omly divided into two treatment groups in a parallel-group study design . A light-polymerized composite resin sealant material and a high-viscosity glass ionomer were each placed in 180 fully erupted first molars in their respective treatment groups . Evaluation took place annually for 5 years by calibrated examiners . After 5 years , 86 % composite resin and 88 % glass ionomer sealants did not survive . Three categories of re-exposure periods for caries development in pits and fissures after complete loss of sealants were distinguished : 0–1 , 1–2 and 2–3 years . In the 2- to 3-year group , 13 and 3 % of pits and fissures previously sealed with composite resin and glass ionomer , respectively , were diagnosed as having developed a dentine lesion . The relative risks ( 95 % CI ) of dentine lesion development in surfaces sealed with glass ionomer compared to those sealed with composite resin after 3 , 4 and 5 years were 0.22 ( 0.06–0.82 ) , 0.32 ( 0.14–0.73 ) and 0.28 ( 0.13–0.61 ) , respectively . The relative risks of dentine lesion development in pits and fissures previously sealed with glass ionomer compared with composite resin over re-exposure periods of 1–2 and 2–3 years were 0.26 ( 0.14–0.48 ) and 0.25 ( 0.09–0.68 ) , respectively . We conclude that the caries-preventive effect of high-viscosity glass ionomer sealants , placed using the ART procedure , was between 3.1 and 4.5 times higher than that of composite resin sealants after 3–5 years . Furthermore , high-viscosity ( ART ) glass ionomer sealants appear to have a four times higher chance of preventing caries development in re-exposed pits and fissures of occlusal surfaces in first molars than light-cured composite resin sealant material over a 1- to 3-year period . A well- design ed clinical trial using different types of oral health personnel should be implemented to confirm these initial results

This systematic review with meta- analysis found no evidence that either material was superior to the other in the prevention of dental caries . Thus , both material s appear equally suitable for clinical application as a fissure sealant material

The purpose of this quantitative systematic review was to appraise the evidence on the caries-preventive effect of glass ionomer cement ( GIC ) in relation to resin-based fissure sealants .

This systematic review with meta- analysis found no evidence that either material was superior to the other in the prevention of dental caries . Thus , both material s appear equally suitable for clinical application as a fissure sealant material

The purpose of this quantitative systematic review was to appraise the evidence on the caries-preventive effect of glass ionomer cement ( GIC ) in relation to resin-based fissure sealants .

A comparison of retention and the effect on caries of fissure sealing with a glass-ionomer and a resin-based sealant.

OBJECTIVE To compare the retention and the caries preventive effect of a glass-ionomer developed for fissure sealing ( Fuji III ) and a chemically polymerized resin-based fissure sealant ( Delton ) . DESIGN A split mouth r and omized design using contralateral teeth . SETTING WHO Regional Demonstration , Training and Research Center for Oral Health , Damascus , Syrian Arab Republic . SAMPLE AND METHODS 179 children , 7 years old at the start of the study , were recruited from schools close to the Center . Only children with at least one pair of permanent first molars that were caries free or only had incipient lesions were included in the study . Follow-up examinations for sealant retention were done after 6 months , 1 year , 2 years and 3 years . The number of children available for reexamination was 129 ( after 6 months ) ; 121 ( after 1 year ) ; 115 ( after 2 years ) and 116 ( after 3 years ) . Four dental hygienists were trained in the sealant procedures and did approximately one fourth of the sealants each . RESULTS After 3 years the glass-ionomer sealant was completely lost in almost 90 % of the teeth compared to less than 10 % of the resin sealed teeth . After 3 years the relative risk of a tooth sealed with glass-ionomer over that of a tooth sealed with resin was 3.38 ( 95 % CL : 1.98 ; 5.79 ) . This finding was consistent over type of tooth . CONCLUSIONS The glass-ionomer sealant tested in the present study had poorer retention and less caries protective effect than the resin-based sealant used

This systematic review with meta- analysis found no evidence that either material was superior to the other in the prevention of dental caries . Thus , both material s appear equally suitable for clinical application as a fissure sealant material

The purpose of this quantitative systematic review was to appraise the evidence on the caries-preventive effect of glass ionomer cement ( GIC ) in relation to resin-based fissure sealants .

This systematic review with meta- analysis found no evidence that either material was superior to the other in the prevention of dental caries . Thus , both material s appear equally suitable for clinical application as a fissure sealant material

The purpose of this quantitative systematic review was to appraise the evidence on the caries-preventive effect of glass ionomer cement ( GIC ) in relation to resin-based fissure sealants .

Inhibition of mineral loss at the enamel/sealant interface of fissures sealed with fluoride- and non-fluoride containing dental materials in vitro.

OBJECTIVE In this in vitro study we evaluated the enamel mineral loss effect of fluoride-containing and non-fluoride-containing material s at different distances from the sealant margin , and verified the fluoride-releasing capability of these material s. MATERIAL AND METHODS Extracted molars were r and omly assigned into nine groups ( n = 12 ) : Concise ( C ) , FluroShield ( F ) , Helioseal Clear Chroma ( H ) , Vitremer ( V ) , Fuji II-LC ( FII ) , Ketac Molar ( KM ) , Fuji IX ( FIX ) , Single Bond ( SB ) , and Clearfil Protect Bond ( CF ) . All groups were subjected to thermo and pH cycling . Enamel mineral loss was evaluated by cross-section micro-hardness analysis at distances : -100 microm , 0 microm , 100 microm , 200 microm . The mineral loss data were analyzed using a multi-factor ANOVA with split-plot design , and fluoride-released data were su bmi tted to ANOVA and Tukey tests . RESULTS FIX demonstrated a lower mineral loss than C , F , and H , but did not differ from the SB , CF , V , FII , and KM groups , which also demonstrated no difference among them . C , F , H , and V presented the highest mineral loss , with no difference among them . V did not differ from the other groups ( p > 0.05 ) . Regarding the different distances from the sealant margin , -100 microm presented the lowest mineral loss . FIX showed the highest fluoride release on the 7th and 14th days of evaluation , while CF showed high fluoride release only on the 7th day . CONCLUSION Resin sealant did not prevent enamel mineral loss , contrary to glass-ionomer cement , which showed the highest capacity for fluoride release . It is not exclusively the presence of fluoride in a material 's composition that indicates its capability to interfere with the development of enamel caries-like lesions

This systematic review with meta- analysis found no evidence that either material was superior to the other in the prevention of dental caries . Thus , both material s appear equally suitable for clinical application as a fissure sealant material

The purpose of this quantitative systematic review was to appraise the evidence on the caries-preventive effect of glass ionomer cement ( GIC ) in relation to resin-based fissure sealants .

This systematic review with meta- analysis found no evidence that either material was superior to the other in the prevention of dental caries . Thus , both material s appear equally suitable for clinical application as a fissure sealant material

The purpose of this quantitative systematic review was to appraise the evidence on the caries-preventive effect of glass ionomer cement ( GIC ) in relation to resin-based fissure sealants .

Retention and caries preventive effects of a GIC and a resin-based fissure sealant.

Abstract Fissure sealing using partially filled resins is an established caries preventive practice . Glass ionomer cement ( GIC ) sealants may offer additional advantages due to their ability to bond chemically to enamel and release fluoride . The aim of this study was to compare the caries preventive effect and retention of a GIC and a resin-based sealant . Ketac-fil ® was tested against a chemically cured resin-based material ( Delton ® ) using a split mouth design . Perth ( Western Australia ) schoolchildren ( n= 465 ) , mean age 7 yr±0.72 ( S.D. ) , received sealants on the occlusal surfaces of sound homologous permanent first molar pairs . Test ( GIC ) and control ( resin ) sealants were systematic ally allocated to left and right sides based on the child 's month of birth , and were placed by dental therapists . After 3.64±0.11 yr , 415 children were examined by different clinicians , and the clinical status of the teeth and the extent of sealant retention recorded . Sealants were deemed retained when at least 2/3 of the fissure pattern was still sealed . In 252 tooth pairs , neither sealant was retained to this extent . In 71 pairs , the GIC was not retained and the resin sealant retained . In 40 pairs the reverse occurred ( McNemar 's test , χ2= 8.66 , P < 0.005 ) . Net gain ( additional lesions prevented by the test agent per 100 treatments ) was 6.1%(95 % CI 3.3 % , 8.9 % ) . Effectiveness of the GIC was 80.6 % ( 95 % CI 59.6 % , 90.7 % ) . The relative risk of caries in test teeth was 0.19 ( 95 % CI 0.09 , 0.40 ) . The study suggests that complete retention of GIC sealant is not necessary for caries prevention in newly erupted permanent first molars

This systematic review with meta- analysis found no evidence that either material was superior to the other in the prevention of dental caries . Thus , both material s appear equally suitable for clinical application as a fissure sealant material

The purpose of this quantitative systematic review was to appraise the evidence on the caries-preventive effect of glass ionomer cement ( GIC ) in relation to resin-based fissure sealants .

This systematic review with meta- analysis found no evidence that either material was superior to the other in the prevention of dental caries . Thus , both material s appear equally suitable for clinical application as a fissure sealant material

The purpose of this quantitative systematic review was to appraise the evidence on the caries-preventive effect of glass ionomer cement ( GIC ) in relation to resin-based fissure sealants .

A comparative study of fluoride-releasing composite resin and glass ionomer materials used as fissure sealants.

OBJECTIVES The objectives of the study were to investigate the clinical use of two fluoride-releasing fissure sealants and to study fluoride release under laboratory conditions . METHODS In the clinical part of the study the two material s , FluroShield and Baseline , were applied to matched contralateral caries-free first permanent molars in 86 children aged 7 - 8 years . In the laboratory study fluoride release from each material was measured using a model cavity system . RESULTS After 3 years FluroShield was intact on 70 % of teeth . Retention was significantly better on lower molars than upper molars . Baseline was lost from all except two teeth within 6 months . After 3 years , caries had affected four teeth sealed with FluroShield and 24 teeth sealed with Baseline ; this difference was highly significant . The laboratory study showed that FluroShield released twice as much fluoride over 9 days than did Baseline . Long term studies using FluroShield showed a small steady fluoride release over 6 months . CONCLUSIONS The conclusion of the study was that FluroShield was a much more effective fissure sealant than Baseline . The clinical performance of FluroShield was comparable to that of other inert composite resin sealants and superior to that of fluoride-releasing sealants used previously

This systematic review with meta- analysis found no evidence that either material was superior to the other in the prevention of dental caries . Thus , both material s appear equally suitable for clinical application as a fissure sealant material

The purpose of this quantitative systematic review was to appraise the evidence on the caries-preventive effect of glass ionomer cement ( GIC ) in relation to resin-based fissure sealants .

This systematic review with meta- analysis found no evidence that either material was superior to the other in the prevention of dental caries . Thus , both material s appear equally suitable for clinical application as a fissure sealant material

The purpose of this quantitative systematic review was to appraise the evidence on the caries-preventive effect of glass ionomer cement ( GIC ) in relation to resin-based fissure sealants .

Effects of glass ionomer cement, resin-based pit and fissure sealant and HF applications on occlusal caries in a developing country field trial.

The aim of this community-oriented study was to evaluate different methods to prevent fissure caries . The following products and measures were tested : 1 ) glass ionomer cement ( GIC ) applied by dentist ; 2 ) same material applied by short term ( 3 days ) trained personnel ( teachers ) ; 3 ) application of a 0.5 % HF solution three times ; 4 ) an established autopolymerized resin based sealant ( Delton ) . The study was performed in Bangkok , Thail and , a city in a developing country experiencing increasing caries prevalence . Children with at least three sound permanent molars from two age groups , 7 - 8 and 12 - 13-yr-olds respectively were chosen from very low to medium socioeconomic level families . 1264 children were systematic ally assigned to experiment or control groups based on school and DMFT . For the younger age group , the 2 yr mean DFS occlusal increment in the Control group was 0.66 surfaces . Significantly lower increments were observed in the GIC experimental group : 0.17 surfaces applied by the teachers and 0.32 applied by dentist , corresponding to 74 % and 52 % reductions , respectively . The mean increment in the HF group was 0.44 surfaces , a 33 % reduction in relation to the Control group . For the 12 - 13-yr-olds , the mean occlusal surface DF increment was 0.70 surfaces in the Control group . Almost no occlusal increment was found in the Delton group , 0.05 DFS , a 93 % reduction . In the GIC Dentist group , the DFS increment was 0.48 and in the Teacher group 0.56 , corresponding to 31 % and 20 % reduction , respectively . A slight and nonsignificant increase of caries in relation to the Control group was observed in the HF group . ( ABSTRACT TRUNCATED AT 250 WORDS

This systematic review with meta- analysis found no evidence that either material was superior to the other in the prevention of dental caries . Thus , both material s appear equally suitable for clinical application as a fissure sealant material

The purpose of this quantitative systematic review was to appraise the evidence on the caries-preventive effect of glass ionomer cement ( GIC ) in relation to resin-based fissure sealants .

This systematic review with meta- analysis found no evidence that either material was superior to the other in the prevention of dental caries . Thus , both material s appear equally suitable for clinical application as a fissure sealant material

The purpose of this quantitative systematic review was to appraise the evidence on the caries-preventive effect of glass ionomer cement ( GIC ) in relation to resin-based fissure sealants .

A 3-year clinical evaluation of glass-ionomer cements used as fissure sealants.

PURPOSE To evaluate the retention and caries-preventive effectiveness of two ionomeric material s ( conventional and resin-modified ) , used as fissure sealants . MATERIAL S AND METHODS 100 children ( 6 - 8 years old ) with a total of 400 permanent first molars received 200 conventional glass-ionomer ( Ketac Bond ) and 200 resin-modified glass-ionomer ( Vitremer ) sealants . Additionally , 108 children constituted the control group ( 432 teeth ) . Two dentists assisted by dental hygienists performed the sealant application . Clinical evaluations were carried out 6 , 12 , 24 , and 36 months after the sealant application by two other dentists , not carrying out clinical procedures , previously calibrated ( Kappa > 0.75 ) . RESULTS Total retention rates of 26 % , 12 % , 3 % , and 4 % for Ketac Bond and 61 % , 31 % , 14 % , and 13 % for Vitremer , being 6 , 12 , 24 , and 36 months after clinical evaluation , respectively . The differences between the two material s were statistically significant . The experimental groups showed a caries incidence of 93 % , 78 % , 49 % , and 56 % lower than the control group ( P < 0.01 ) for the four evaluation periods , respectively . In conclusion , the retention rates of ionomeric material s were low . Nevertheless , these material s showed a cariostatic effect , supported by statistically lower caries incidence in experimental groups compared to control group . Presence of active incipient caries was statistically associated with caries incidence in the first molars after 36 months , in relation to either experimental or control group

This systematic review with meta- analysis found no evidence that either material was superior to the other in the prevention of dental caries . Thus , both material s appear equally suitable for clinical application as a fissure sealant material

The purpose of this quantitative systematic review was to appraise the evidence on the caries-preventive effect of glass ionomer cement ( GIC ) in relation to resin-based fissure sealants .

This systematic review with meta- analysis found no evidence that either material was superior to the other in the prevention of dental caries . Thus , both material s appear equally suitable for clinical application as a fissure sealant material

The purpose of this quantitative systematic review was to appraise the evidence on the caries-preventive effect of glass ionomer cement ( GIC ) in relation to resin-based fissure sealants .

Retention of a glass ionomer cement and a resin-based fissure sealant and effect on carious outcome after 7 years.

The aim of this study was to compare the retention and caries preventive efficacy of glass ionomer ( Fuji III ; GIC ) and light-cured resin-based ( Delton ; LCR ) fissure sealants . One hundred and sixty-six 5 - 14-year-old schoolchildren received sealants on their newly erupted first or second molars ; a split mouth design was used . Previously reported 2-year results showed low retention rates for GIC sealants , but no difference in the caries increment between the groups . The same persons were invited to a dental check-up 6.1 to 7.8 ( mean 7.1 ) years after the application of sealants ; 111 persons ( 66.8 % of the original group ) participated in the study . The retention of sealants , and the caries status of occlusal surfaces and adjacent proximal surfaces was recorded . On the sealed occlusal surfaces , 10 % of GIC and 45 % of LCR sealants were totally and 9 % of GIC and 20 % of LCR sealants partially present . Twenty-three ( 23.5 % ) of the occlusal surfaces sealed with GIC and 16 ( 16.5 % ) of those sealed with LCR were carious or filled . Compared to LCR sealants , the effectiveness of GIC sealants was -44 % ( 95 % CI -71 % , -16 % ) and net gain -7 % ( 95 % CI -18 % , 4 % ) . The relative risk of caries occurring was 1.44 ( 95 % CI 0.96 , 2.14 )

This systematic review with meta- analysis found no evidence that either material was superior to the other in the prevention of dental caries . Thus , both material s appear equally suitable for clinical application as a fissure sealant material

The purpose of this quantitative systematic review was to appraise the evidence on the caries-preventive effect of glass ionomer cement ( GIC ) in relation to resin-based fissure sealants .

This systematic review with meta- analysis found no evidence that either material was superior to the other in the prevention of dental caries . Thus , both material s appear equally suitable for clinical application as a fissure sealant material

The purpose of this quantitative systematic review was to appraise the evidence on the caries-preventive effect of glass ionomer cement ( GIC ) in relation to resin-based fissure sealants .

Fissure sealants: a 4-year clinical trial comparing an experimental glass polyalkenoate cement with a bis glycidyl methacrylate resin used as fissure sealants

The 4-year results of a fissure sealant trial are reported . Glass polyalkenoate and bis GMA sealant were applied to 590 first permanent molar teeth using a half mouth study design in a group of 228 6 - 8-year-old children . Similar cariostasis was observed for the two material s at the end of 4 years despite marked differences in retention . Polyalkenoate cements probably should be regarded as ' fluoride depot ' material s rather than fissure sealants when used in this

This systematic review with meta- analysis found no evidence that either material was superior to the other in the prevention of dental caries . Thus , both material s appear equally suitable for clinical application as a fissure sealant material

The purpose of this quantitative systematic review was to appraise the evidence on the caries-preventive effect of glass ionomer cement ( GIC ) in relation to resin-based fissure sealants .

A wide range of techniques have been evaluated and some show promise for use in weight management interventions .

OBJECTIVE This systematic review aim ed to ( a ) identify and categorize techniques used to modify or manage impulsive processes associated with unhealthy eating behavior , ( b ) describe the mechanisms targeted by such techniques , and ( c ) summarize available evidence on the effectiveness of these techniques .

Training response inhibition to food is associated with weight loss and reduced energy intake

The majority of adults in the UK and US are overweight or obese due to multiple factors including excess energy intake . Training people to inhibit simple motor responses ( key presses ) to high-energy density food pictures reduces intake in laboratory studies . We examined whether online response inhibition training reduced real-world food consumption and weight in a community sample of adults who were predominantly overweight or obese ( N = 83 ) . Participants were allocated in a r and omised , double-blind design to receive four 10-min sessions of either active or control go/no-go training in which either high-energy density snack foods ( active ) or non-food stimuli ( control ) were associated with no-go signals . Participants ' weight , energy intake ( calculated from 24-h food diaries ) , daily snacking frequency and subjective food evaluations were measured for one week pre- and post-intervention . Participants also provided self-reported weight and monthly snacking frequency at pre-intervention screening , and one month and six months after completing the study . Participants in the active relative to control condition showed significant weight loss , reductions in daily energy intake and a reduction in rated liking of high-energy density ( no-go ) foods from the pre-to post-intervention week . There were no changes in self-reported daily snacking frequency . At longer-term follow-up , the active group showed significant reductions in self-reported weight at six months , whilst both groups reported significantly less snacking at one- and six-months . Excellent rates of adherence ( 97 % ) and positive feedback about the training suggest that this intervention is acceptable and has the potential to improve public health by reducing energy intake and overweight

A wide range of techniques have been evaluated and some show promise for use in weight management interventions .

OBJECTIVE This systematic review aim ed to ( a ) identify and categorize techniques used to modify or manage impulsive processes associated with unhealthy eating behavior , ( b ) describe the mechanisms targeted by such techniques , and ( c ) summarize available evidence on the effectiveness of these techniques .

A wide range of techniques have been evaluated and some show promise for use in weight management interventions .

OBJECTIVE This systematic review aim ed to ( a ) identify and categorize techniques used to modify or manage impulsive processes associated with unhealthy eating behavior , ( b ) describe the mechanisms targeted by such techniques , and ( c ) summarize available evidence on the effectiveness of these techniques .

Effects of hunger and visuo-spatial interference on imagery-induced food cravings

The present study investigated the effects of hunger and visuo-spatial interference on imagery-induced food cravings . Forty-two women were r and omly assigned to a hungry ( no food for prior 4h ) or not hungry condition . Participants were asked to form and maintain images of desired foods while looking at a blank computer screen ( control condition ) or performing a task design ed to load the visuo-spatial sketchpad of working memory ( dynamic visual noise ) . They then rated the vividness of their images and their craving intensity . Although hungry participants reported stronger food cravings , dynamic visual noise made images less vivid and cravings less intense , irrespective of participant hunger status . Thus concurrent visuo-spatial processing may offer a useful technique for treating problematic food cravings that are predominantly psychological in origin , as well as those that are hunger-driven

A wide range of techniques have been evaluated and some show promise for use in weight management interventions .

OBJECTIVE This systematic review aim ed to ( a ) identify and categorize techniques used to modify or manage impulsive processes associated with unhealthy eating behavior , ( b ) describe the mechanisms targeted by such techniques , and ( c ) summarize available evidence on the effectiveness of these techniques .

A wide range of techniques have been evaluated and some show promise for use in weight management interventions .

OBJECTIVE This systematic review aim ed to ( a ) identify and categorize techniques used to modify or manage impulsive processes associated with unhealthy eating behavior , ( b ) describe the mechanisms targeted by such techniques , and ( c ) summarize available evidence on the effectiveness of these techniques .

Comparison of acceptance-based and standard cognitive-based coping strategies for craving sweets in overweight and obese women.

Existing strategies for coping with food cravings are of unknown efficacy and rely on principles that have been shown to have paradoxical effects . The present study evaluated novel , acceptance-based strategies for coping with craving by r and omly assigning 48 overweight women to either an experimental psychological acceptance-oriented intervention or a st and ard cognitive re appraisal /distraction intervention . Participants were required to carry a box of sweets on their person for 72 h while abstaining from any consumption of sweets . Results suggested that the acceptance-based coping strategies result ed in lower cravings and reduced consumption , particularly for those who demonstrate greater susceptibility to the presence of food and report a tendency to engage in emotional eating

A wide range of techniques have been evaluated and some show promise for use in weight management interventions .

OBJECTIVE This systematic review aim ed to ( a ) identify and categorize techniques used to modify or manage impulsive processes associated with unhealthy eating behavior , ( b ) describe the mechanisms targeted by such techniques , and ( c ) summarize available evidence on the effectiveness of these techniques .

A wide range of techniques have been evaluated and some show promise for use in weight management interventions .

OBJECTIVE This systematic review aim ed to ( a ) identify and categorize techniques used to modify or manage impulsive processes associated with unhealthy eating behavior , ( b ) describe the mechanisms targeted by such techniques , and ( c ) summarize available evidence on the effectiveness of these techniques .

A comparison of acceptance- and control-based strategies for coping with food cravings: an analog study.

The present study utilized an analog paradigm to investigate the effectiveness of two strategies for coping with food cravings , which was theorized to be critical to the maintenance of weight loss . Ninety-eight undergraduate students were given transparent boxes of chocolate Hershey 's Kisses and instructed to keep the chocolates with them , but not to eat them , for 48 h. Before receiving the Kisses , participants were r and omized to receive either ( a ) no intervention , ( b ) instruction in control-based coping strategies such as distraction and cognitive restructuring , or ( c ) instruction in acceptance-based strategies such as experiential acceptance and defusion techniques . Measures included the Power of Food Scale ( PFS ; a measure of psychological sensitivity to the food environment ) , self-report ratings of chocolate cravings and surreptitiously recorded chocolate consumption . Results suggested that the effect of the intervention depended on baseline PFS levels , such that acceptance-based strategies were associated with better outcomes ( cravings , consumption ) among those reporting the highest susceptibility to the presence of food , but greater cravings among those who scored lowest on the PFS . It was observed that craving self-report measures predicted chocolate consumption , and baseline PFS levels predicted both cravings and consumption . Results are discussed in terms of the implication s for weight loss maintenance strategies

A wide range of techniques have been evaluated and some show promise for use in weight management interventions .

OBJECTIVE This systematic review aim ed to ( a ) identify and categorize techniques used to modify or manage impulsive processes associated with unhealthy eating behavior , ( b ) describe the mechanisms targeted by such techniques , and ( c ) summarize available evidence on the effectiveness of these techniques .

A wide range of techniques have been evaluated and some show promise for use in weight management interventions .

OBJECTIVE This systematic review aim ed to ( a ) identify and categorize techniques used to modify or manage impulsive processes associated with unhealthy eating behavior , ( b ) describe the mechanisms targeted by such techniques , and ( c ) summarize available evidence on the effectiveness of these techniques .

The Mind Your Health Project: A Randomized Controlled Trial of an Innovative Behavioral Treatment for Obesity

Objective To determine whether acceptance-based behavioral treatment ( ABT ) would result in greater weight loss than st and ard behavioral treatment ( SBT ) , and whether treatment effects were moderated by interventionist expertise or participants ’ susceptibility to eating cues . Recent research suggests that poor long-term weight control outcomes are due to lapses in adherence to weight control behaviors , and that adherence might be improved by enhancing SBT with acceptance-based behavioral strategies . Design and Methods Overweight participants ( n = 128 ) were r and omly assigned to 40 weeks of SBT or ABT . Results Both groups produced significant weight loss and , when administered by experts , weight loss was significantly higher in ABT than SBT at post-treatment ( 13.17 % v. 7.54 % ) and 6-month follow-up ( 10.98 % v. 4.83 % ) . Moreover , 64 % of those receiving ABT from experts ( v. 46 % for SBT ) maintained at least a 10 % weight loss by follow-up . Moderation analyses revealed a powerful advantage , at follow-up , of ABT over SBT in those potentially more susceptible to eating cues . For participants with greater baseline depression symptomology , weight loss at follow-up was 11.18 % in ABT vs. 4.63 % in SBT ; other comparisons were 10.51 % vs. 6.00 % ( emotional eating ) , 8.29 % v. 6.35 % ( disinhibition ) and 9.70 % v. 4.46 % ( responsivity to food cues ) . Mediation analyses produced partial support for theorized food-related psychological acceptance as a mechanism of action . Conclusions Results offer strong support for the incorporation of acceptance-based skills into behavioral weight loss treatments , particularly among those with greater levels of depression , responsivity to the food environment , disinhibition and emotional eating , and especially when interventions are provided by weight control experts . Trial Registration clinical trials.gov identifier :

A wide range of techniques have been evaluated and some show promise for use in weight management interventions .

OBJECTIVE This systematic review aim ed to ( a ) identify and categorize techniques used to modify or manage impulsive processes associated with unhealthy eating behavior , ( b ) describe the mechanisms targeted by such techniques , and ( c ) summarize available evidence on the effectiveness of these techniques .

A wide range of techniques have been evaluated and some show promise for use in weight management interventions .

OBJECTIVE This systematic review aim ed to ( a ) identify and categorize techniques used to modify or manage impulsive processes associated with unhealthy eating behavior , ( b ) describe the mechanisms targeted by such techniques , and ( c ) summarize available evidence on the effectiveness of these techniques .

Acute effects of brisk walking on urges to eat chocolate, affect, and responses to a stressor and chocolate cue. An experimental study

The study aim ed to investigate the effects of an acute exercise bout on urges to eat chocolate , affect , and psychological and physiological responses to stress and a chocolate cue . Following 3 days of chocolate abstinence , 25 regular chocolate eaters , took part , on separate days , in two r and omly ordered conditions , in a within-subject design : a 15-min brisk semi-self-paced brisk walk or a passive control . Following each , participants completed two tasks : the Stroop colour-word interference task , and unwrapping and h and ling a chocolate bar . Chocolate urges [ State Food Cravings Question naire ( FCQ-S ) ; Rodríguez , S. , Fernández , M. C. , Cepeda-Benito , A. , & Vila , J. ( 2005 ) . Subjective and physiological reactivity to chocolate images in high and low chocolate cravers . Biological Psychology , 70 , 9 - 18 ] , affective activation [ Felt Arousal Scale ; Svebak , S. , & Murgatroyd , S. ( 1985 ) . Metamotivational dominance : a multi method validation of reversal theory constructs . Journal of Perception and Social Psychology , 48 , 107 - 116 ] , affective pleasure/valence [ Feelings Scale ; Hardy , C. J. , & Rejeski , W. J. ( 1989 ) . Not what , but how one feels : the measurement of affect during exercise . Journal of Sport and Exercise Psychology , 11 , 304 - 317 ] , and systolic/diastolic blood pressure ( SBP/DBP ) were assessed throughout . Exercise reduced chocolate urges and there was a trend towards attenuated urges in response to the chocolate cue . Exercise also attenuated SBP/DBP increases in response to the stressor and chocolate cue . The effects on urges varied across the dimensions of the

A wide range of techniques have been evaluated and some show promise for use in weight management interventions .

OBJECTIVE This systematic review aim ed to ( a ) identify and categorize techniques used to modify or manage impulsive processes associated with unhealthy eating behavior , ( b ) describe the mechanisms targeted by such techniques , and ( c ) summarize available evidence on the effectiveness of these techniques .

A wide range of techniques have been evaluated and some show promise for use in weight management interventions .

OBJECTIVE This systematic review aim ed to ( a ) identify and categorize techniques used to modify or manage impulsive processes associated with unhealthy eating behavior , ( b ) describe the mechanisms targeted by such techniques , and ( c ) summarize available evidence on the effectiveness of these techniques .

The Future Is Now

Humans have the ability to engage in prospect i ve imagery to anticipate the future consequences of present behaviors ( Suddendorf & Busby , 2005 ) , but we often let our desire for immediate gratification lead us to devalue larger future consequences in favor of smaller immediate rewards . Discounting large future rewards in favor of smaller immediate rewards is known as delay discounting and increases with greater temporal distance between the rewards ( Bickel & Marsch , 2001 ) . One approach to reducing delay discounting is episodic future thinking ( Atance & O'Neill , 2001 ) . Episodic future thinking engages the episodic memory in prospect ively experiencing future events ( Atance & O'Neill , 2001 ; Schacter , Addis , & Buckner , 2007 ) and activates brain regions involved in prospect i ve thinking ( Benoit , Gilbert , & Burgess , 2011 ; Schacter et al. , 2007 ) . Episodic future thinking during intertemporal decision making reduces delay discounting , with the vividness of prospect i ve imagery predicting the degree of the reduction ( Peters & Buchel , 2010 ) . The inability to delay gratification is related to obesity ( Davis , Patte , Curtis , & Reid , 2010 ; Francis & Susman , 2009 ; Weller , Cook , Avsar , & Cox , 2008 ) . Delay discounting predicts intake of energy-dense convenience foods in obese women ( Appelhans et al. , 2012 ) , and poor impulse control predicts a lack of success in weight loss ( Best et al. , 2012 ) . To determine episodic future thinking 's effect on impulsive behavior , we assessed whether episodic future thinking , compared with engagement in a control imagery task , reduced impulsivity and energy intake in overweight and obese individuals

A wide range of techniques have been evaluated and some show promise for use in weight management interventions .

OBJECTIVE This systematic review aim ed to ( a ) identify and categorize techniques used to modify or manage impulsive processes associated with unhealthy eating behavior , ( b ) describe the mechanisms targeted by such techniques , and ( c ) summarize available evidence on the effectiveness of these techniques .

A wide range of techniques have been evaluated and some show promise for use in weight management interventions .

OBJECTIVE This systematic review aim ed to ( a ) identify and categorize techniques used to modify or manage impulsive processes associated with unhealthy eating behavior , ( b ) describe the mechanisms targeted by such techniques , and ( c ) summarize available evidence on the effectiveness of these techniques .

Effects of mindful eating training on delay and probability discounting for food and money in obese and healthy-weight individuals.

Obese individuals tend to behave more impulsively than healthy weight individuals across a variety of measures , but it is unclear whether this pattern can be altered . The present study examined the effects of a mindful eating behavioral strategy on impulsive and risky choice patterns for hypothetical food and money . In Experiment 1 , 304 participants completed computerized delay and probability discounting tasks for food-related and monetary outcomes . High percent body fat ( PBF ) predicted more impulsive choice for food , but not small-value money , replicating previous work . In Experiment 2 , 102 r and omly selected participants from Experiment 1 were assigned to participate in a 50-min workshop on mindful eating or to watch an educational video . They then completed the discounting tasks again . Participants who completed the mindful eating session showed more self-controlled and less risk-averse discounting patterns for food compared to baseline ; those in the control condition discounted similarly to baseline rates . There were no changes in discounting for money for either group , suggesting stimulus specificity for food for the mindful eating condition

A wide range of techniques have been evaluated and some show promise for use in weight management interventions .

OBJECTIVE This systematic review aim ed to ( a ) identify and categorize techniques used to modify or manage impulsive processes associated with unhealthy eating behavior , ( b ) describe the mechanisms targeted by such techniques , and ( c ) summarize available evidence on the effectiveness of these techniques .

A wide range of techniques have been evaluated and some show promise for use in weight management interventions .

OBJECTIVE This systematic review aim ed to ( a ) identify and categorize techniques used to modify or manage impulsive processes associated with unhealthy eating behavior , ( b ) describe the mechanisms targeted by such techniques , and ( c ) summarize available evidence on the effectiveness of these techniques .

Non-food odorants reduce chocolate cravings

The present study compared the relative effectiveness of simple , commercially available food and non-food olfactory tasks on chocolate craving reduction . Chocolate cravings were induced by a series of coloured photographs and 67 undergraduate women were asked to smell one of three odours ( green apple , jasmine , or water ) . The non-food odorant ( jasmine ) significantly reduced chocolate cravings relative to both the food and control odorants . Thus simple non-food odorants offer potential scope as a technique for curbing unwanted food cravings

A wide range of techniques have been evaluated and some show promise for use in weight management interventions .

OBJECTIVE This systematic review aim ed to ( a ) identify and categorize techniques used to modify or manage impulsive processes associated with unhealthy eating behavior , ( b ) describe the mechanisms targeted by such techniques , and ( c ) summarize available evidence on the effectiveness of these techniques .

A wide range of techniques have been evaluated and some show promise for use in weight management interventions .

OBJECTIVE This systematic review aim ed to ( a ) identify and categorize techniques used to modify or manage impulsive processes associated with unhealthy eating behavior , ( b ) describe the mechanisms targeted by such techniques , and ( c ) summarize available evidence on the effectiveness of these techniques .

Wake up and smell the cookies. Effects of olfactory food-cue exposure in restrained and unrestrained eaters

Few factors have been identified that bolster self-control processes and prevent overeating in restrained eaters ; however , research on counteractive-control theory suggests that exposure to food cues may represent such a protective factor . To further investigate the effects of food-cue exposure , restrained and unrestrained eaters were r and omly assigned to either a food-cue or no-cue condition , and their intake was measured . The results indicated that food-cue-exposed restrained eaters ate less than did non-exposed restrained eaters . The possible role of incidental food-cue exposure as a means for inhibiting intake in restrained eaters is explored

A wide range of techniques have been evaluated and some show promise for use in weight management interventions .

OBJECTIVE This systematic review aim ed to ( a ) identify and categorize techniques used to modify or manage impulsive processes associated with unhealthy eating behavior , ( b ) describe the mechanisms targeted by such techniques , and ( c ) summarize available evidence on the effectiveness of these techniques .

A wide range of techniques have been evaluated and some show promise for use in weight management interventions .

OBJECTIVE This systematic review aim ed to ( a ) identify and categorize techniques used to modify or manage impulsive processes associated with unhealthy eating behavior , ( b ) describe the mechanisms targeted by such techniques , and ( c ) summarize available evidence on the effectiveness of these techniques .

Making a good decision: value from fit.

The classic answer to what makes a decision good concerns outcomes . A good decision has high outcome benefits ( it is worthwhile ) and low outcome costs ( it is worth it ) . I propose that , independent of outcomes or value from worth , people experience a regulatory fit when they use goal pursuit means that fit their regulatory orientation , and this regulatory fit increases the value of what they are doing . The following postulates of this value from fit proposal are examined : ( a ) People will be more inclined toward goal means that have higher regulatory fit , ( b ) people 's motivation during goal pursuit will be stronger when regulatory fit is higher , ( c ) people 's ( prospect i ve ) feelings about a choice they might make will be more positive for a desirable choice and more negative for an undesirable choice when regulatory fit is higher , ( d ) people 's ( retrospective ) evaluations of past decisions or goal pursuits will be more positive when regulatory fit was higher , and ( e ) people will assign higher value to an object that was chosen with higher regulatory fit . Studies testing each of these postulates support the value-from-fit proposal . How value from fit can enhance or diminish the value of goal pursuits and the quality of life itself is discussed

A wide range of techniques have been evaluated and some show promise for use in weight management interventions .

OBJECTIVE This systematic review aim ed to ( a ) identify and categorize techniques used to modify or manage impulsive processes associated with unhealthy eating behavior , ( b ) describe the mechanisms targeted by such techniques , and ( c ) summarize available evidence on the effectiveness of these techniques .

A wide range of techniques have been evaluated and some show promise for use in weight management interventions .

OBJECTIVE This systematic review aim ed to ( a ) identify and categorize techniques used to modify or manage impulsive processes associated with unhealthy eating behavior , ( b ) describe the mechanisms targeted by such techniques , and ( c ) summarize available evidence on the effectiveness of these techniques .

The effect of learning climate on snack consumption and ego depletion among undergraduate students

We explored the effect of controlled and autonomous learning choices on the consumption of a high-energy snack food , and also examined whether snack consumption during a controlled choice learning activity could ' up-regulate ' subsequent performance on a self-regulation task . Participants were r and omly assigned to a controlled choice learning condition in which food was provided , a controlled choice learning condition in which food was not provided , or an autonomous choice learning condition in which food was provided . Results indicated that the autonomous choice group consumed significantly less snack food than the controlled-choice- and -food group . Participants in the autonomous choice condition also performed better on the subsequent self-regulation task than the controlled-choice- and -food group , even after controlling for the amount of food consumed . Furthermore , within the controlled-choice- and -food condition , there was no association between food consumption and subsequent self-regulation task performance . Discussion focuses on the potential impact of a controlled learning climate on snack food consumption and on the degradation of self-regulation capacities

A wide range of techniques have been evaluated and some show promise for use in weight management interventions .

OBJECTIVE This systematic review aim ed to ( a ) identify and categorize techniques used to modify or manage impulsive processes associated with unhealthy eating behavior , ( b ) describe the mechanisms targeted by such techniques , and ( c ) summarize available evidence on the effectiveness of these techniques .

A wide range of techniques have been evaluated and some show promise for use in weight management interventions .

OBJECTIVE This systematic review aim ed to ( a ) identify and categorize techniques used to modify or manage impulsive processes associated with unhealthy eating behavior , ( b ) describe the mechanisms targeted by such techniques , and ( c ) summarize available evidence on the effectiveness of these techniques .

A brisk walk, compared with being sedentary, reduces attentional bias and chocolate cravings among regular chocolate eaters with different body mass

Poor self-regulation of high energy snacking has been linked to weight gain . Physical activity can acutely reduce chocolate consumption and cravings but the effects on attentional bias ( AB ) are unknown . The study aim ed to test the effects of exercise among normal and overweight/obese individuals during temporary and longer abstinence . Participants were 20 normal and 21 overweight regular female chocolate eaters ( after 24 h abstinence ) , and 17 females ( after ≥1 week abstinence during Lent ) . They were r and omly assigned to engage in 15 min brisk walking or rest , on separate days . AB was assessed using an adapted dot probe task pre and post-treatment at each session , with chocolate/neutral paired images presented for 200 ms ( initial AB ; IAB ) or 1000 ms ( maintained AB ; MAB ) . Chocolate craving was assessed pre , during , immediately after , and 5 min and 10 min after treatment , using a 0 - 100 visual analogue score . Three-way mixed ANOVAs revealed that there was no significant interaction effect between group ( i.e. , BMI status , or abstinence status ) and condition × time for craving and AB to chocolate cues . Fully repeated 2-way ANOVAS revealed a significant condition × time interaction for IAB ( F(1,57)=6.39 ) and chocolate craving ( F(2.34,133.19)=14.44 ) . After exercise IAB ( t(57)=2.78 , p<0.01 ) was significantly lower than after the rest condition . Craving was significantly lower than the rest condition at all assessment s post-baseline . A short bout of physical activity reduces cravings and AB to chocolate cues , relative to control , irrespective of BMI or abstinence period

A wide range of techniques have been evaluated and some show promise for use in weight management interventions .

OBJECTIVE This systematic review aim ed to ( a ) identify and categorize techniques used to modify or manage impulsive processes associated with unhealthy eating behavior , ( b ) describe the mechanisms targeted by such techniques , and ( c ) summarize available evidence on the effectiveness of these techniques .

A wide range of techniques have been evaluated and some show promise for use in weight management interventions .

OBJECTIVE This systematic review aim ed to ( a ) identify and categorize techniques used to modify or manage impulsive processes associated with unhealthy eating behavior , ( b ) describe the mechanisms targeted by such techniques , and ( c ) summarize available evidence on the effectiveness of these techniques .

Brisk walking reduces ad libitum snacking in regular chocolate eaters during a workplace simulation

Workplace snacking can contribute to obesity . Exercise reduces chocolate cravings but effects on chocolate consumption are unknown . This study investigated the effect of brief exercise on ad libitum consumption during breaks in a computerised task . Seventy-eight regular chocolate eaters , age : 24.90±8.15 years , BMI : 23.56±3.78 kg/m(2 ) abstained for 2 days . They were r and omly assigned to one of four conditions , in a 2 × 2 factorial design , involving either a 15 min brisk walk or quiet rest , and then computerised Stroop tasks with low or high dem and ing conditions , in three 180 s blocks with a 90 s interval . Throughout , a pre-weighed bowl of chocolates was available for ad libitum eating . A two-way ANOVA revealed no interaction effect of exercise and stress on total chocolate consumption , or main effect of stress , but a main effect of exercise [ F(1 , 74)=7.12 , p<.01 ] . Mean ( SD ) chocolate consumption was less ( t(73.5)=2.69 , 95 % CI for difference 3.4 - 22.9 , ES=0.61 ) for the exercise ( 15.6 g ) than control ( 28.8 g ) group . Exercise also increased affective activation , but there was no mediating effect of change in affect on chocolate consumption . A brief walk may help to reduce ad libitum snacking in regular chocolate eaters

A wide range of techniques have been evaluated and some show promise for use in weight management interventions .

OBJECTIVE This systematic review aim ed to ( a ) identify and categorize techniques used to modify or manage impulsive processes associated with unhealthy eating behavior , ( b ) describe the mechanisms targeted by such techniques , and ( c ) summarize available evidence on the effectiveness of these techniques .

First , during anorexia nervosa adolescent females lose more central body fat , while adult females more peripheral fat . Second , partial weight restoration leads to greater fat mass deposition in the trunk region than other body regions in adolescent females . Third , after short-term weight restoration , whether partial or complete , adults show a central adiposity phenotype with respect to healthy age-matched controls . Fourth , central fat distribution is associated with increased insulin resistance , but does not adversely affect eating disorder psychopathology or cause psychological distress in female adults . Fifth , the abnormal central fat distribution seems to normalize after long-term maintenance of complete weight restoration , indicating that preferential central distribution of body fat is a transitory phenomenon .

The aim of this paper was to conduct a systematic review of body fat distribution before and after partial and complete weight restoration in individuals with anorexia nervosa .

Follow-up of bone mineral density and body composition in adolescents with restrictive anorexia nervosa: role of dual-energy X-ray absorptiometry

Background / Objectives : Restrictive Anorexia nervosa ( ANR ) is an eating disorder ( ED ) characterized by a low bone mineral content ( BMC ) and by an alteration in body composition ( reduction and abnormal distribution of fat mass — FM and lean mass — LM ) . The aim of our study was to address whether bone and body composition changes could be influenced by hormonal status and sport in female adolescents with restrictive anorexia nervosa-ANR.Subjects/ Methods : Prospect i ve study on 79 adolescents with ANR su bmi tted to Dual Energy X-Ray Absorptiometry — DXA at baseline-T0 and after 12 months-T12 . Among the 46/79—58.2 % patients that completed the study , we evaluated total and regional FM and LM% , as well as lumbar bone mineral density ( BMD ) and Z-score , linking them to clinical variables : menarche/amenorrhea/hormonal therapy and physical activity . Results : At T0 : body mass index ( BMI ) = 16.4±1.4 kg/m2 with low levels of FM% ( 21.7±5.7 ) low BMC in 12/46—26.0 % ( mean Z-score : −1.21±1.27 , with higher values related to physical activity — P=0.001 ) . At T12 : a significant increase in BMI —P=0.001 , with LM reduction and FM increase ( more evident in the trunk — P<0.001 ) ; regarding bone , no significant changes were observed , though a tendency in terms of improvement associated with resumption of menses . Conclusions : After 1 year , weight recovery was not associated with a reestablishment of bone values ; by contrast , it was associated with an increase and a distortion in FM distribution , more evident in trunk region ( potential and adjunctive risk factor for the relapse of the psychiatric condition ) . The complexity of these clinical findings suggested DXA , a low-dose and low-cost technique , in long-term monitoring of ANR patients

First , during anorexia nervosa adolescent females lose more central body fat , while adult females more peripheral fat . Second , partial weight restoration leads to greater fat mass deposition in the trunk region than other body regions in adolescent females . Third , after short-term weight restoration , whether partial or complete , adults show a central adiposity phenotype with respect to healthy age-matched controls . Fourth , central fat distribution is associated with increased insulin resistance , but does not adversely affect eating disorder psychopathology or cause psychological distress in female adults . Fifth , the abnormal central fat distribution seems to normalize after long-term maintenance of complete weight restoration , indicating that preferential central distribution of body fat is a transitory phenomenon .

The aim of this paper was to conduct a systematic review of body fat distribution before and after partial and complete weight restoration in individuals with anorexia nervosa .

First , during anorexia nervosa adolescent females lose more central body fat , while adult females more peripheral fat . Second , partial weight restoration leads to greater fat mass deposition in the trunk region than other body regions in adolescent females . Third , after short-term weight restoration , whether partial or complete , adults show a central adiposity phenotype with respect to healthy age-matched controls . Fourth , central fat distribution is associated with increased insulin resistance , but does not adversely affect eating disorder psychopathology or cause psychological distress in female adults . Fifth , the abnormal central fat distribution seems to normalize after long-term maintenance of complete weight restoration , indicating that preferential central distribution of body fat is a transitory phenomenon .

The aim of this paper was to conduct a systematic review of body fat distribution before and after partial and complete weight restoration in individuals with anorexia nervosa .

Changes in regional fat redistribution and the effects of estrogen during spontaneous weight gain in women with anorexia nervosa.

BACKGROUND Anorexia nervosa is a disease of severe acquired undernutrition with a high and increasing prevalence among young women in the United States . OBJECTIVE The objective was to investigate the effects of spontaneous outpatient weight recovery and estrogen administration on fat distribution in patients with anorexia nervosa . DESIGN Twenty-seven amenorrheic women aged 26.6 + /- 1.2 y with anorexia nervosa were identified through an outpatient study of bone loss and were r and omly assigned to receive or not receive estrogen without any dietary intervention other than calcium and multivitamin supplements . Body composition was measured at baseline and at 6 and 9 mo and was compared with cross-sectional values obtained in 20 healthy , eumenorrheic , age-matched ( 25.4 + /- 0.5 y ) control subjects . RESULTS Twenty of the 27 patients with anorexia aged 27.0 + /- 1.3 y spontaneously gained weight ( 4.1 + /- 0.9 kg ) ; body mass index ( in kg/m(2 ) ) increased from 16.1 + /- 0.3 to 17.5 + /- 0.4 . Fat mass and lean mass accounted for 68 % and 32 % of the gain in total body mass , respectively . With spontaneous weight gain , there was a significant increase in the percentage of trunk fat from 32.4 + /- 1.3 % at baseline to 36.5 + /- 1.0 % at 9 mo ( P = 0.03 ) , which correlated with urinary free cortisol ( r = 0.66 , P = 0.003 ) . Estrogen treatment was not protective against the gain in trunk fat with spontaneous weight gain . CONCLUSIONS In women with anorexia nervosa , spontaneous weight gain is associated with a significant increase in trunk adiposity , and estrogen administration may not protect against the accumulation of central fat with weight gain

First , during anorexia nervosa adolescent females lose more central body fat , while adult females more peripheral fat . Second , partial weight restoration leads to greater fat mass deposition in the trunk region than other body regions in adolescent females . Third , after short-term weight restoration , whether partial or complete , adults show a central adiposity phenotype with respect to healthy age-matched controls . Fourth , central fat distribution is associated with increased insulin resistance , but does not adversely affect eating disorder psychopathology or cause psychological distress in female adults . Fifth , the abnormal central fat distribution seems to normalize after long-term maintenance of complete weight restoration , indicating that preferential central distribution of body fat is a transitory phenomenon .

The aim of this paper was to conduct a systematic review of body fat distribution before and after partial and complete weight restoration in individuals with anorexia nervosa .

First , during anorexia nervosa adolescent females lose more central body fat , while adult females more peripheral fat . Second , partial weight restoration leads to greater fat mass deposition in the trunk region than other body regions in adolescent females . Third , after short-term weight restoration , whether partial or complete , adults show a central adiposity phenotype with respect to healthy age-matched controls . Fourth , central fat distribution is associated with increased insulin resistance , but does not adversely affect eating disorder psychopathology or cause psychological distress in female adults . Fifth , the abnormal central fat distribution seems to normalize after long-term maintenance of complete weight restoration , indicating that preferential central distribution of body fat is a transitory phenomenon .

The aim of this paper was to conduct a systematic review of body fat distribution before and after partial and complete weight restoration in individuals with anorexia nervosa .

Associations of general and abdominal obesity with multiple health outcomes in older women: the Iowa Women's Health Study.

BACKGROUND Recent clinical guidelines on the health risks of obesity use body mass index ( BMI ; calculated as weight in kilograms divided by the square of height in meters ) and waist circumference , but the waist-hip ratio may provide independent information . METHODS To assess the joint and relative associations of BMI , waist circumference , and waist-hip ratio with multiple disease end points , we conducted a prospect i ve cohort study of 31,702 Iowa women , aged 55 to 69 years and free of cancer , heart disease , and diabetes , assembled by r and om sampling and mail survey in 1986 . Study end points were total and cause-specific mortality and incidence of site-specific cancers and self-reported diabetes , hypertension , and hip fracture over 11 to 12 years . RESULTS The waist-hip ratio was the best anthropometric predictor of total mortality , with the multivariable-adjusted relative risk for quintile 5 vs 1 of 1.2 ( 95 % confidence interval , 1.1 - 1.4 ) , compared with 0.91 ( 95 % confidence interval , 0.8 - 1.0 ) for BMI and 1.1 ( 95 % confidence interval , 1.0 - 1 . 3 ) for waist circumference . The waist-hip ratio was also associated positively with mortality from coronary heart disease , other cardiovascular diseases , cancer , and other causes . The waist-hip ratio was associated less consistently than BMI or waist circumference with cancer incidence . All anthropometric indexes were associated with incidence of diabetes and hypertension . For example , women simultaneously in the highest quintiles of BMI and waist-hip ratio had a relative risk of diabetes of 29 ( 95 % confidence interval , 18 - 46 ) vs. women in the lowest combined quintiles . CONCLUSION The waist-hip ratio offers additional prognostic information beyond BMI and waist circumference

First , during anorexia nervosa adolescent females lose more central body fat , while adult females more peripheral fat . Second , partial weight restoration leads to greater fat mass deposition in the trunk region than other body regions in adolescent females . Third , after short-term weight restoration , whether partial or complete , adults show a central adiposity phenotype with respect to healthy age-matched controls . Fourth , central fat distribution is associated with increased insulin resistance , but does not adversely affect eating disorder psychopathology or cause psychological distress in female adults . Fifth , the abnormal central fat distribution seems to normalize after long-term maintenance of complete weight restoration , indicating that preferential central distribution of body fat is a transitory phenomenon .

The aim of this paper was to conduct a systematic review of body fat distribution before and after partial and complete weight restoration in individuals with anorexia nervosa .

First , during anorexia nervosa adolescent females lose more central body fat , while adult females more peripheral fat . Second , partial weight restoration leads to greater fat mass deposition in the trunk region than other body regions in adolescent females . Third , after short-term weight restoration , whether partial or complete , adults show a central adiposity phenotype with respect to healthy age-matched controls . Fourth , central fat distribution is associated with increased insulin resistance , but does not adversely affect eating disorder psychopathology or cause psychological distress in female adults . Fifth , the abnormal central fat distribution seems to normalize after long-term maintenance of complete weight restoration , indicating that preferential central distribution of body fat is a transitory phenomenon .

The aim of this paper was to conduct a systematic review of body fat distribution before and after partial and complete weight restoration in individuals with anorexia nervosa .

Body composition, eating disorder psychopathology, and psychological distress in anorexia nervosa: a longitudinal study.

BACKGROUND Although the effect of immediate weight restoration on body composition and body fat distribution has previously been studied in anorexia nervosa ( AN ) , its influence in women with AN on eating disorder psychopathology and psychological distress has not previously been investigated to our knowledge . OBJECTIVES We assessed body composition and fat mass distribution before and after body weight restoration and investigated any relation between changes in body fat patterns of patients with AN treated in a specialist inpatient unit and their eating disorder and psychological distress features . DESIGN Body composition was measured by using dual-energy X-ray absorptiometry in 50 female , adult patients with AN before and after complete weight restoration [ body mass index ( BMI ; in kg/m² ) ≥18.5 ] and 100 healthy control subjects matched by age and posttreatment BMI of study group participants . Eating disorder psychopathology and psychological distress were assessed in the AN group before and after weight restoration by using the Eating Disorder Examination interview and the Global Severity Index of the Brief Symptom Inventory ( BSI-GSI ) , respectively . RESULTS After the achievement of complete weight restoration , patients with AN had higher trunk ( P < 0.001 ) , and roid ( P < 0.001 ) , and gynoid ( P < 0.001 ) fat masses and lower arm ( P < 0.001 ) and leg ( P = 0.001 ) fat masses with respect to control subjects . No relation was shown between body-composition variables and eating disorder psychopathology in the AN group , and the only significant predictor of change in BSI-GSI was the baseline BSI-GSI score . CONCLUSION The normalization of body weight in patients with AN is associated with a preferential distribution of body fat in central regions , which does not , however , seem to influence either eating disorder psychopathology or psychological distress scores

First , during anorexia nervosa adolescent females lose more central body fat , while adult females more peripheral fat . Second , partial weight restoration leads to greater fat mass deposition in the trunk region than other body regions in adolescent females . Third , after short-term weight restoration , whether partial or complete , adults show a central adiposity phenotype with respect to healthy age-matched controls . Fourth , central fat distribution is associated with increased insulin resistance , but does not adversely affect eating disorder psychopathology or cause psychological distress in female adults . Fifth , the abnormal central fat distribution seems to normalize after long-term maintenance of complete weight restoration , indicating that preferential central distribution of body fat is a transitory phenomenon .

The aim of this paper was to conduct a systematic review of body fat distribution before and after partial and complete weight restoration in individuals with anorexia nervosa .

First , during anorexia nervosa adolescent females lose more central body fat , while adult females more peripheral fat . Second , partial weight restoration leads to greater fat mass deposition in the trunk region than other body regions in adolescent females . Third , after short-term weight restoration , whether partial or complete , adults show a central adiposity phenotype with respect to healthy age-matched controls . Fourth , central fat distribution is associated with increased insulin resistance , but does not adversely affect eating disorder psychopathology or cause psychological distress in female adults . Fifth , the abnormal central fat distribution seems to normalize after long-term maintenance of complete weight restoration , indicating that preferential central distribution of body fat is a transitory phenomenon .

The aim of this paper was to conduct a systematic review of body fat distribution before and after partial and complete weight restoration in individuals with anorexia nervosa .

Percent body fat is a risk factor for relapse in anorexia nervosa: a replication study.

OBJECTIVE We aim ed to replicate and extend our previous findings of an association between percent body fat in recently weight-restored patients with Anorexia Nervosa ( AN ) and clinical outcome in the year following treatment . METHOD Twenty-two hospitalized , weight-restored women with AN underwent whole body MRI to determine percent adipose tissue . Following hospital discharge , patients were contacted regularly , and at the end of the year , clinical outcome was determined using modified Morgan-Russell ( MR ) criteria : full , good , fair or poor . Identical to our previous study , outcome was dichotomized into " full , good or fair " and " poor " groups . RESULTS Data from 21 subjects were available for analysis . Percent body fat was significantly lower in the poor outcome group ( 22 % ± 5 % ) compared to the " full , good or fair " outcome group ( 27 % ± 4%)(p < 0.035 ) . To further examine the relationship , we combined data from the current study with data from the 26 subjects on whom we had previously reported . Univariate analysis of variance ( ANOVA ) demonstrated a significant difference in percent adipose tissue across the four MR outcome groups ( F = 3.416 , df = 3 , p<0.03 ) . DISCUSSION Lower percent adipose tissue after short-term weight normalization is associated with poor clinical outcome in the year following inpatient treatment . These findings may be important in the assessment of risk for relapse in patients with AN

First , during anorexia nervosa adolescent females lose more central body fat , while adult females more peripheral fat . Second , partial weight restoration leads to greater fat mass deposition in the trunk region than other body regions in adolescent females . Third , after short-term weight restoration , whether partial or complete , adults show a central adiposity phenotype with respect to healthy age-matched controls . Fourth , central fat distribution is associated with increased insulin resistance , but does not adversely affect eating disorder psychopathology or cause psychological distress in female adults . Fifth , the abnormal central fat distribution seems to normalize after long-term maintenance of complete weight restoration , indicating that preferential central distribution of body fat is a transitory phenomenon .

The aim of this paper was to conduct a systematic review of body fat distribution before and after partial and complete weight restoration in individuals with anorexia nervosa .

First , during anorexia nervosa adolescent females lose more central body fat , while adult females more peripheral fat . Second , partial weight restoration leads to greater fat mass deposition in the trunk region than other body regions in adolescent females . Third , after short-term weight restoration , whether partial or complete , adults show a central adiposity phenotype with respect to healthy age-matched controls . Fourth , central fat distribution is associated with increased insulin resistance , but does not adversely affect eating disorder psychopathology or cause psychological distress in female adults . Fifth , the abnormal central fat distribution seems to normalize after long-term maintenance of complete weight restoration , indicating that preferential central distribution of body fat is a transitory phenomenon .

The aim of this paper was to conduct a systematic review of body fat distribution before and after partial and complete weight restoration in individuals with anorexia nervosa .

Does percent body fat predict outcome in anorexia nervosa?

OBJECTIVE The goal of this study was to investigate the relationship of body composition and neuroendocrine levels with clinical outcome in women with anorexia nervosa in a relapse-prevention trial . METHOD Body composition and fasting cortisol and leptin levels were assessed before r and om assignment in 32 weight-recovered subjects with anorexia nervosa from the New York site of the Fluoxetine to Prevent Relapse in Women With Anorexia Nervosa trial . Clinical outcome at the end of study participation was defined using modified Morgan-Russell criteria ( full , good , fair , poor ) , then dichotomized into treatment " success " or " failure . " RESULTS In a binary logistic regression model examining the effect of percent body fat , body mass index , anorexia nervosa subtype , waist-to-hip ratio , and serum cortisol and leptin levels on treatment outcome , only percent body fat was significantly associated with outcome . CONCLUSIONS In recently weight-restored women with anorexia nervosa , lower percent body fat was associated with poor long-term outcome

First , during anorexia nervosa adolescent females lose more central body fat , while adult females more peripheral fat . Second , partial weight restoration leads to greater fat mass deposition in the trunk region than other body regions in adolescent females . Third , after short-term weight restoration , whether partial or complete , adults show a central adiposity phenotype with respect to healthy age-matched controls . Fourth , central fat distribution is associated with increased insulin resistance , but does not adversely affect eating disorder psychopathology or cause psychological distress in female adults . Fifth , the abnormal central fat distribution seems to normalize after long-term maintenance of complete weight restoration , indicating that preferential central distribution of body fat is a transitory phenomenon .

The aim of this paper was to conduct a systematic review of body fat distribution before and after partial and complete weight restoration in individuals with anorexia nervosa .

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

Zinc supplementation in infants born small for gestational age reduces mortality: a prospective, randomized, controlled trial.

BACKGROUND Low birth weight infants have been noted to have low zinc concentrations in cord blood , and zinc deficiency in childhood is associated with reduced immunocompetence and increased infectious disease morbidity . This study investigates whether zinc supplementation of infants born full term and small for gestational age affects mortality . METHODS A r and omized , double-blind , controlled trial with 2-by-2 factorial design enrolled 1154 full-term small for gestational age infants to receive in syrup 1 of the following : riboflavin ; riboflavin and zinc ( 5 mg as sulfate ) ; riboflavin , calcium , phosphorus , folate , and iron ; or riboflavin , zinc , calcium , phosphorus , folate , and iron . A fixed dosage of 5 mL per child was given daily from 30 to 284 days of age . Household visits were made 6 days per week to provide the syrup and conduct surveillance for illness and death . When a child 's death was reported , parental reports and medical records were used to ascertain the cause . The effects of zinc and of the combination of iron , folate , calcium , and phosphorus were analyzed by intent to treat . The mortality analysis was performed using a survival analytic approach that models time until death as the dependent variable ; all models had 2 terms as independent variables : 1 for the zinc effect and 1 for the vitamin and mineral ( calcium and phosphorus , folate and iron ) effect . RESULTS Zinc supplementation was associated with significantly lower mortality , with a rate ratio of 0.32 ( 95 % confidence interval : 0.12 - 0.89 ) . Calcium , phosphorus , folate , and iron supplementation was not associated with a mortality reduction , although a statistically nonsignificant trend toward reduction was observed with a rate ratio of 0.88 ( 95 % confidence interval : 0.36 - 2.15 ) . CONCLUSIONS Zinc supplementation in small for gestational age infants can result in a substantial reduction in infectious disease mortality

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

Zinc supplementation, mental development and behaviour in low birth weight term infants in northeast Brazil

Objective : To test whether zinc supplementation reduces the deficits in mental development and behaviour that are found in term infants of low birth weight in the study population . Design : A prospect i ve double-blind , part-r and omised efficacy trial . Setting : A low-income population in Pernambuco , northeast Brazil , where the economy is largely dependent on sugar-cane production , and where over 90 % of deliveries occur in health facilities . Subjects : During a 20-month period , all singleton , term infants weighing 1500–2499 g born to families of low income ( < US $ 280/month ) were enroled at birth ( n=205 ) . At 6 and 12-months , the numbers tested were 163 and 138 respectively . Intervention : Infants born from January 1993–January 1994 were r and omly assigned to receive daily , except Sundays , a placebo ( n=66 ) or 1 mg zinc ( n=68 ) . Those born February – August 1994 were given 5 mg zinc ( n=71 ) . Supplementation was for eight weeks , starting at birth . Field workers visited each infant at home to administer the supplement . Results : At 6 and 12-months , mental and psychomotor development was assessed with the Bayley Scales of Infant Development and no significant differences in the scores of the three groups were found . At 12-months , behaviour was also assessed on 5 ratings . Ratings were highest in infants given 5 mg zinc ( P=0.042 ) . Conclusions : Zinc supplementation ( 5 mg/d ) for eight weeks may reverse some of the poor behaviours , particularly responsiveness , exhibited by low birth weight infants . No amelioration of their mental and psychomotor deficits was found . Sponsorship : The Wellcome Trust , United Kingdom , provided financial support ( Grant no. 036605/Z/92 ) . Dr Lira was supported by CAPES ( Fundação Coordenação de Aperfeiçoamento de Pessoal de Nível Superior ) , Brazil

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

Adding zinc to prenatal iron and folate supplements improves maternal and neonatal zinc status in a Peruvian population.

BACKGROUND Maternal zinc deficiency during pregnancy may be widespread among women in developing countries , but few data are available on whether prenatal zinc supplementation improves maternal and neonatal zinc status . OBJECTIVE We studied whether maternal zinc supplementation improved the zinc status of mothers and neonates participating in a supplementation trial in a shantytown in Lima , Peru . DESIGN Beginning at gestation week 10 - 24 , 1295 mothers were r and omly assigned to receive prenatal supplements containing 60 mg Fe and 250 microg folate , with or without 15 mg Zn . Venous blood and urine sample s were collected at enrollment , at gestation week 28 - 30 , and at gestation week 37 - 38 . At birth , a sample of cord vein blood was collected . We measured serum zinc concentrations in 538 women , urinary zinc concentrations in 521 women , and cord zinc concentrations in 252 neonates . RESULTS At 28 - 30 and 37 - 38 wk , mothers receiving zinc supplements had higher serum zinc concentrations than mothers who did not receive zinc ( 8.8 + /- 1.9 compared with 8.4 + /- 1.5 micromol/L and 8.6 + /- 1.5 compared with 8.3 + /- 1.4 micromol/L , respectively ) . Urinary zinc concentrations were also higher in mothers who received supplemental zinc ( P < 0.05 ) . After adjustment for covariates and confounding factors , neonates of mothers receiving zinc supplements had higher cord zinc concentrations than neonates of mothers who did not receive zinc ( 12.7 + /- 2.3 compared with 12.1 + /- 2.1 micromol/L ) . Despite supplementation , maternal and neonatal zinc concentrations remained lower than values reported for well-nourished population s. CONCLUSION Adding zinc to prenatal iron and folate tablets improved maternal and neonatal zinc status , but higher doses of zinc are likely needed to further improve maternal and neonatal zinc status in this population

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

Zinc supplementation and psychosocial stimulation: effects on the development of undernourished Jamaican children.

BACKGROUND Undernourished children have poor levels of development that benefit from stimulation . Zinc deficiency is prevalent in undernourished children and may contribute to their poor development . OBJECTIVE We assessed the effects of zinc supplementation and psychosocial stimulation given together or separately on the psychomotor development of undernourished children . DESIGN This was a r and omized controlled trial with 4 groups : stimulation alone , zinc supplementation alone , both interventions , and control ( routine care only ) . Subjects were 114 children aged 9 - 30 mo and below -1.5 z scores of the National Center for Health Statistics weight-for-age references who were recruited from 18 health clinics . Clinics were r and omly assigned to receive stimulation or not ; individual children were r and omly assigned to receive zinc or placebo . The stimulation program comprised weekly home visits during which play was demonstrated and maternal-child interactions were encouraged . The supplementation was 10 mg Zn as sulfate daily or placebo . Development ( assessed by use of the Griffiths Mental Development Scales ) , length , and weight were measured at baseline and 6 mo later . Weekly morbidity histories were taken . RESULTS Significant interactions were found between zinc supplementation and stimulation . Zinc benefited the developmental quotient only in children who received stimulation , and benefits from zinc to h and and eye coordination were greater in stimulated children . Zinc supplementation alone improved h and and eye coordination , and stimulation alone benefited the developmental quotient , hearing and speech , and performance . Zinc supplementation also reduced diarrheal morbidity but did not significantly improve growth . CONCLUSION Zinc supplementation benefits development in undernourished children , and the benefits are enhanced if stimulation is also provided

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

Iron and zinc supplementation promote motor development and exploratory behavior among Bangladeshi infants.

BACKGROUND Iron and zinc deficiency are prevalent during infancy in low-income countries . OBJECTIVES The objectives were to examine whether a weekly supplement of iron , zinc , iron+zinc , or a micronutrient mix ( MM ) of 16 vitamins and minerals would alter infant development and behavior . DESIGN The participants were 221 infants from rural Bangladesh at risk of micronutrient deficiencies . Development and behavior were evaluated at 6 and 12 mo of age by using the Bayley Scales of Infant Development II and the Home Observation Measurement of Environment ( HOME ) scale . In this double-blind trial , the infants were r and omly assigned to 1 of 5 treatment conditions : iron ( 20 mg ) , zinc ( 20 mg ) , iron+zinc , MM ( 16 vitamins and minerals , including iron and zinc ) , or riboflavin weekly from 6 to 12 mo . Multivariate analyses were conducted to examine the change in development and behavior for each supplementation group , with control for maternal education , HOME score , months breastfed , anemia , growth at 6 mo , and change in growth from 6 to 12 mo . RESULTS Iron and zinc administered together and with other micronutrients had a beneficial effect on infant motor development . Iron and zinc administered individually and in combination had a beneficial effect on orientation-engagement . Two-thirds of the infants were mildly anemic , no treatment effects on hemoglobin concentration were observed , and hemoglobin was not associated with measures of development or behavior . CONCLUSION The beneficial effects of weekly iron and zinc supplementation on motor development and orientation-engagement suggest that infants benefit from these minerals when administered together

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

Zinc supplementation affects the activity patterns of rural Guatemalan infants.

Zinc deficiency has been associated with growth deficits , reduced dietary intake and appetite , and has been hypothesized to result in reduced activity . This r and omized , double-blind , placebo-controlled study examined whether 10 mg of oral zinc as zinc sulfate , given daily for up to 7 mo , affected activity patterns of 85 Guatemalan infants recruited at 6 - 9 mo of age . Infant activity was assessed by time sampling-observation method at 10-min intervals during a 12-h data collection period , at base line , 3 and 7 mo follow-up . Motor development and the percentage of time infants were observed in various positions ( being carried , lying down , sitting , crawling , st and ing or walking ) and engaged in various activities ( eating , sleeping , resting , crying/whining or playing ) were compared by treatment group . No differences in motor development were observed by treatment group . However , at follow-up 2 ( after 7 mo of supplementation ) , zinc-supplemented infants were significantly more frequently observed sitting up compared with lying down , and were playing during 4.18 + /- 1.95 % ( P < 0.05 ) more observations than unsupplemented infants . They were also somewhat less likely to be observed crying or whining ( P < 0.10 ) compared with those receiving the placebo . These effects are independent of other factors including infant age , motor development , sex , maternal education , family socioeconomic status and nutritional status at base line . Further research must be conducted to determine the long-term developmental importance of these differences in activity patterns associated with zinc supplementation in this setting

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

Zinc supplementation does not affect growth, morbidity, or motor development of US term breastfed infants at 4-10 mo of age.

BACKGROUND It has been documented that growth patterns differ between breastfed and formula-fed infants . Some investigators have suggested that these differences may be related to differences in zinc nutriture . OBJECTIVE The objective of this study was to examine the effect of zinc supplementation on growth , morbidity , and motor development in healthy , term , breastfed infants . DESIGN We conducted a r and omized double-blind intervention comparing zinc supplementation ( 5 mg/d as zinc sulfate ) with placebo in breastfed infants aged 4 - 10 mo . Growth and indexes of body composition and gross motor development were measured monthly from 3 to 10 mo . Morbidity data were collected weekly . RESULTS Eighty-five infants were enrolled , and 70 completed the study . The baseline characteristics , attained weight or length at 10 mo , growth velocity , gross motor development , and morbidity did not differ significantly between groups , even after control for potentially confounding variables . CONCLUSIONS The dietary zinc intake of these breastfed infants appeared to be adequate , given that zinc supplementation did not affect growth , development , or risk of infection ( although sample size for detection of differences in development or infection was limited ) . Previously described differences in growth between breastfed and formula-fed infants in such population s do not appear to be due to differences in zinc nutriture

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

Growth and body composition of periurban Guatemalan children in relation to zinc status: a longitudinal zinc intervention trial.

Changes in growth , body composition , and zinc indexes were evaluated after 25 wk in a double-blind zinc-supplementation study of 162 periurban Guatemalan children aged 81.5 + /- 7.0 mo ( mean + /- SD ) . Children receiving the zinc supplement ( 10 mg Zn/d as amino acid chelate ) for 90.1 + /- 9.2 d had higher mean fasting plasma zinc ( 16.2 + /- 2.9 vs 14.9 + /- 2.1 mumol/L , P < 0.01 ) , a greater increase in median triceps skinfold Z score ( 0.50 vs 0.38 , P < 0.05 ) , and a smaller deficit in median midarm circumference ( MAC ) Z score ( -0.03 vs -0.20 , P < 0.05 ) compared with the placebo group . Initial hair zinc classified as < 1.68 and > 1.68 mumol/g was the only laboratory variable that explained some of the variance in final Z scores of midarm-muscle area ( P < 0.05 ) and MAC ( P < 0.01 ) . Children responded to the zinc supplement with changes in indexes of body composition rather than growth

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

Combined iron and folic acid supplementation with or without zinc reduces time to walking unassisted among Zanzibari infants 5- to 11-mo old.

Iron and zinc deficiencies have been associated with delayed motor development in nutritionally at-risk children , albeit inconsistently . In this community-based , r and omized double-blind trial , iron+folic acid ( FeFA ) ( 12.5 mg Fe + 50 mug folic acid ) , zinc ( Zn ) ( 10 mg ) , and iron+folic acid+zinc ( FeFA+Zn ) supplements or a placebo were given daily for 1 y to nutritionally at-risk children in Pemba , Zanzibar . The effects of these treatments on attaining unassisted walking were evaluated using survival analysis for 354 children aged 5 - 11 mo at the start of supplementation . Treatment effects on changes in hemoglobin ( Hb ) and zinc protoporphyrin ( ZPP ) and height-for-age ( HAZ ) and weight-for-age ( WAZ ) Z scores were evaluated using linear regression . Attained motor milestone was recorded every 2 wk for 1 y. Hb , ZPP , HAZ , and WAZ were measured at baseline and after 6 mo of treatment . FeFA with or without Zn reduced the time it took for children to walk assisted . Children who received any iron walked unassisted sooner than those who received no iron [ median difference approximately 15 d , P = 0.035 , risk ratio ( RR ) = 1.28 , 95 % CI = 1.02 , 1.61 ] and this effect was stronger in those who had iron deficiency anemia ( IDA ) at baseline ( median difference was approximately 30 d ; P = 0.002 ; RR = 1.68 ; 95 % CI = 1.21 , 2.32 ) . FeFA alone and Zn alone improved Hb and ZPP compared with placebo . There were no significant treatment effects on changes in HAZ or WAZ . The effects of treatment on time to walking may have been mediated by improvements in iron status or hemoglobin , but were not mediated through improvements in growth

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

Iron and zinc supplementation improved iron and zinc status, but not physical growth, of apparently healthy, breast-fed infants in rural communities of northeast Thailand.

Iron deficiency is prevalent in children and infants worldwide . Zinc deficiency may be prevalent , but data are lacking . Both iron and zinc deficiency negatively affect growth and psychomotor development . Combined iron and zinc supplementation might be beneficial , but the potential interactions need to be verified . In a r and omized , placebo-controlled trial using 2 x 2 factorial design , 609 Thai infants aged 4 - 6 mo were supplemented daily with 10 mg of iron and /or 10 mg of zinc for 6 mo to investigate effects and interactions on micronutrient status and growth . Iron supplementation alone increased hemoglobin and ferritin concentrations more than iron and zinc combined . Anemia prevalence was significantly lower in infants receiving only iron than in infants receiving iron and zinc combined . Baseline iron deficiency was very low , and iron deficiency anemia was almost nil . After supplementation , prevalence of iron deficiency and iron deficiency anemia were significantly higher in infants receiving placebo and zinc than in those receiving iron or iron and zinc . Serum zinc was higher in infants receiving zinc ( 16.7 + /- 5.2 micromol/L ) , iron and zinc ( 12.1 + /- 3.8 micromol/L ) or iron alone ( 11.5 + /- 2.5 micromol/L ) than in the placebo group ( 9.8 + /- 1.9 micromol/L ) . Iron and zinc interacted to affect iron and zinc status , but not hemoglobin . Iron supplementation had a small but significant effect on ponderal growth , whereas zinc supplementation did not . To conclude , in Thai infants , iron supplementation improved hemoglobin , iron status , and ponderal growth , whereas zinc supplementation improved zinc status . Overall , for infants , combined iron and zinc supplementation is preferable to iron or zinc supplementation alone

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

A community-based randomized controlled trial of iron and zinc supplementation in Indonesian infants: effects on growth and development.

BACKGROUND Deficiencies of iron and zinc are associated with delayed development , growth faltering , and increased infectious-disease morbidity during infancy and childhood . Combined iron and zinc supplementation may therefore be a logical preventive strategy . OBJECTIVE The objective of the study was to compare the effects of combined iron and zinc supplementation in infancy with the effects of iron and zinc as single micronutrients on growth , psychomotor development , and incidence of infectious disease . DESIGN Indonesian infants ( n = 680 ) were r and omly assigned to daily supplementation with 10 mg Fe ( Fe group ) , 10 mg Zn ( Zn group ) , 10 mg Fe and 10 mg Zn ( Fe+Zn group ) , or placebo from 6 to 12 mo of age . Anthropometric indexes , developmental indexes ( Bayley Scales of Infant Development ; BSID ) , and morbidity were recorded . RESULTS At 12 mo , two-factor analysis of variance showed a significant interaction between iron and zinc for weight-for-age z score , knee-heel length , and BSID psychomotor development . Weight-for-age z score was higher in the Zn group than in the placebo and Fe+Zn groups , knee-heel length was higher in the Zn and Fe groups than in the placebo group , and the BSID psychomotor development index was higher in the Fe group than in the placebo group . No significant effect on morbidity was found . CONCLUSIONS Single supplementation with zinc significantly improved growth , and single supplementation with iron significantly improved growth and psychomotor development , but combined supplementation with iron and zinc had no significant effect on growth or development . Combined , simultaneous supplementation with iron and zinc to infants can not be routinely recommended at the iron-to-zinc ratio used in this study

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

Randomized controlled trial of the effect of zinc supplementation on the mental development of Bangladeshi infants.

BACKGROUND Zinc deficiency is thought to be common in young children in developing countries and some data suggest that it may detrimentally affect children 's development . OBJECTIVE Our goal was to assess the effect of zinc supplementation on the developmental levels and behavior of Bangladeshi infants . DESIGN This was a r and omized , double-blind , controlled trial conducted in Dhaka , Bangladesh . Three hundred one infants aged 1 mo were r and omly assigned to receive either 5 mg elemental Zn or placebo daily for 5 mo , and subsequent growth and morbidity were observed . For the present study , developmental levels were assessed in a sub sample of 212 infants at 7 and 13 mo of age with use of the Bayley Scales of Infant Development , and the infants ' behavior during the tests was observed . The children 's social background s , weights , and lengths were also recorded . RESULTS The children 's nutritional status was generally poor . The zinc-treated group had slightly lower scores on the mental development index of the Bayley Scales than did the placebo group ( beta = 3.7 , SE = 1.3 , P < 0.005 ) . This effect remained significant when nutritional status and social background were controlled for . No other significant differences between groups were noted . CONCLUSIONS The mental development index scores of the zinc-treated group were slightly but significantly lower than those of the placebo group . This finding may have been due to micronutrient imbalance . Caution should be exercised when supplementing undernourished infants with a single micronutrient

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

Randomized trial of the effect of zinc supplementation on the mental health of school-age children in Guatemala.

BACKGROUND Rates of mental illness in children are increasing throughout the world . Observational studies of depression , anxiety , and attention-deficit hyperactivity disorder suggest that zinc is an alternative treatment . OBJECTIVE We examined the effect of zinc supplementation on the mental health of school-age children in Guatemala . DESIGN From January to October 2006 , we conducted a 6-mo r and omized , double-blind , controlled trial comparing zinc supplementation ( 10 mg ZnO/d for 5 d/wk ) with a placebo ( 10 mg glucose ) in 674 Guatemalan children in grade s 1 - 4 . Outcome measures included internalizing ( ie , depression and anxiety ) and externalizing ( ie , hyperactivity and conduct disorder ) problem behaviors , positive behaviors ( ie , socialization and leadership ) , and serum zinc concentrations . RESULTS Zinc and placebo groups did not differ significantly in any behavioral measures at baseline or at follow-up . At baseline , 21.4 % of children had serum zinc concentrations < 65 μg/dL. At follow-up , both groups improved significantly , and zinc concentrations were higher in the zinc group . Increases in serum zinc concentrations were inversely associated with decreases in depressive symptoms ( estimate : -0.01 points per μg Zn/dL ; P = 0.01 ) , anxiety ( estimate : -0.012 points per μg Zn/dL ; P = 0.02 ) , internalizing symptoms ( estimate : -0.021 points per μg Zn/dL ; P = 0.02 ) , and social skills ( estimate : -0.019 points per μg Zn/dL ; P = 0.01 ) in adjusted models that were controlled for child age , sex , socioeconomic status , household , and treatment group . CONCLUSIONS Six months of zinc supplementation did not induce differences in mental health outcomes between zinc and placebo groups . However , increases in serum zinc concentrations were associated with decreases in internalizing symptoms ( ie , depression and anxiety ) in a community-based sample of children at risk of zinc deficiency . This trial was registered at clinical trials.gov as NCT00283660

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

Zinc Supplementation Improved Cognitive Performance and Taste Acuity in Indian Adolescent Girls

Objective : To test the efficacy of zinc supplementation through diet or ayurvedic zinc tablet on cognitive function and taste acuity in adolescent girls . Methods : Using zinc-rich food items , snacks were prepared by adopting food-processing methods that enhance zinc bioavailability . Ayurvedic zinc tablet ( jasad bhasma ) was chosen as a natural elemental zinc supplement . Efficacy of snacks and the tablet was assessed in 180 schoolgirls ( 12.5 ± 0.85 years ) from Pune City , India , who were r and omly allocated to any of the 3 groups : ( 1 ) ayurvedic zinc tablet — J , ( 2 ) zinc-rich snacks — D , or ( 3 ) Control — C. Supplementation was given on every school day ( 6 days/wk ) for 10 weeks . All measurements were recorded at baseline and at the end of the study period . Food intake was recorded by 24-hour diet recall on 3 r and om days . Hemoglobin , serum ferritin , and plasma zinc were estimated on a fasting blood sample . Cognitive assessment was done on each participant using tests for simple reaction time ( SRT ) , recognition reaction time ( RRT ) , visual memory , and Raven 's Progressive Matrices ( RPM ) . Taste acuity was determined by recognition thresholds for salt ( RTS ) over a range of 10 different salt concentrations . Results : A higher increase in plasma zinc ( 61.3 % ) was observed in the J group than in the D group ( 9.9 % ) ( p < 0.01 ) , whereas plasma zinc declined in the control group ( −2.2 % ) over baseline ( p > 0.1 ) . Hemoglobin showed no change in all 3 groups ( p > 0.1 ) . Percent increment in scores for memory and RPM was significantly more in the D and J groups ( 24.5%–29.6 % ) than in the C group ( 6.5 % ) ( p < 0.05 ) . Mean SRT and RRT were reduced more in the D and J groups ( 5%–16 % ) than in the C group ( 1.6 % ) ( p < 0.05 ) . A significant fall in median RTS from 5 to 2.5 mmol/L was noted after both diet and zinc supplementation ( p < 0.01 ) ; however , it remained the same at 5 mmol/L in the Control group after 10 weeks . Conclusion : Supplementation of ayurvedic zinc and zinc-rich foods are effective in improving cognitive performance and the recognition threshold for salt of adolescent girls

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

Effects of repletion with zinc and other micronutrients on neuropsychologic performance and growth of Chinese children.

The knowledge that zinc is essential for growth and neuropsychologic performance and a report of zinc-responsive stunting in Chinese children prompted this project . This article summarizes findings from a 10-wk , double-blind , controlled trial of zinc repletion in 740 urban , 6 - 9-y-old first grade rs from low-income families in Chongqing , Qingdao , and Shanghai , People 's Republic of China . Treatments were 20 mg Zn alone ( Z ) , 20 mg Zn with micronutrients ( ZM ) , and micronutrients alone ( M ) . The M mixture was based on National Research Council guidelines . Nutrients that might interfere with zinc retention were excluded or given in lower amounts . Main outcomes were changes in neuropsychologic performance and knee height . Hemoglobin , serum ferritin , plasma and hair zinc , and whole blood and hair lead were also measured . Anemia was not common , and serum ferritin concentrations were usually within the range of normal . Mean baseline plasma zinc concentrations were marginal in children from Chongqing and Qingdao and normal in children from Shanghai . After treatment with ZM or M plasma zinc increased . Hair zinc tended to decrease after all treatments . Mean baseline whole blood lead concentrations were slightly below the limit considered excessive for children by the US Centers for Disease Control and Prevention . Neuropsychologic performance and growth were most improved after treatment with ZM . These findings were consistent with the presence of zinc and other micronutrient deficiencies

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

Dietary boron, brain function, and cognitive performance.

Although the trace element boron has yet to be recognized as an essential nutrient for humans , recent data from animal and human studies suggest that boron may be important for mineral metabolism and membrane function . To investigate further the functional role of boron , brain electrophysiology and cognitive performance were assessed in response to dietary manipulation of boron ( approximately 0.25 versus approximately 3.25 mg boron/2000 kcal/day ) in three studies with healthy older men and women . Within-subject design s were used to assess functional responses in all studies . Spectral analysis of electroencephalographic data showed effects of dietary boron in two of the three studies . When the low boron intake was compared to the high intake , there was a significant ( p < 0.05 ) increase in the proportion of low-frequency activity , and a decrease in the proportion of higher-frequency activity , an effect often observed in response to general malnutrition and heavy metal toxicity . Performance ( e.g. , response time ) on various cognitive and psychomotor tasks also showed an effect of dietary boron . When contrasted with the high boron intake , low dietary boron result ed in significantly poorer performance ( p < 0.05 ) on tasks emphasizing manual dexterity ( studies II and III ) ; eye-h and coordination ( study II ) ; attention ( all studies ) ; perception ( study III ) ; encoding and short-term memory ( all studies ) ; and long-term memory ( study I ) . Collectively , the data from these three studies indicate that boron may play a role in human brain function and cognitive performance , and provide additional evidence that boron is an essential nutrient for humans

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

Effect of zinc supplementation on development and growth of Chilean infants.

OBJECTIVE To evaluate the effect of zinc supplementation on growth and development during infancy . DESIGN We r and omized 150 term neonates of low socioeconomic status to receive supplemental zinc 5 mg/d ( SG ) or a lactose placebo ( PG ) ; 112 completed a 1-year follow-up . All were breast-fed and given cow milk formula after weaning ; solid foods and iron were added at 5 months . Anthropometry measured monthly , psychomotor development ( PDI ) , mental development ( MDI ) , and behavior including motor quality factor were assessed by Bayley Scales at 6 and 12 months . The groups were comparable in maternal characteristics , birth weight , home environment , and mother-infant interaction . RESULTS No effects of zinc on weight , length , and weight for length at 12 months were found controlling for sex and breast-feeding . The mean PDI ( SG : 84.5 + /- 11.5 vs PG : 87.6 + /- 9.9 ) and MDI ( 90.9 + /- 10.5 vs 88.9 + /- 9.1 ) were similar ; however , 46 of 52 infants in the PG scored < 100 in MDI vs 42 of 57 in the SG ( P < .05 ) . A smaller proportion of the SG , 2 of 57 , scored low in motor quality factor at 6 months compared with the PG , 8 of 52 ( P = .02 ) . The mean at 12 months for the SG was 31.9 + /- 2.8 and for the PG 30.8 + /- 2.9 ( P < .05 ) ; zinc supplementation entered the multiple regression at 12 months ( P = .037 ) . CONCLUSIONS Zinc supplementation may have a beneficial effect on mental development and motor quality behavior of healthy term infants

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

Daily supplementation with iron plus folic acid, zinc, and their combination is not associated with younger age at first walking unassisted in malnourished preschool children from a deficient population in rural Nepal.

A community-based , cluster-r and omized , placebo-controlled trial of daily zinc and /or iron+folic acid supplementation was conducted in rural southern Nepal to examine motor milestone attainment among 3264 children 1 - 36 mo of age between 2001 and 2006 . Treatment groups included placebo , zinc ( 10 mg ) , iron+folic acid ( 12.5 mg iron + 50 microg folic acid ) , and zinc+iron+folic acid ( 10 mg zinc + 12.5 mg iron + 50 microg folic acid ) . Infants received half of these doses . The iron arms were stopped November 2003 by recommendation of the Data Safety and Monitoring Board ; zinc and placebo continued until January 2006 . A total of 2457 children had not walked at the time of entry into the trial and 1775 were followed through 36 mo . Mean age at first walking unassisted did not differ among groups and was 444 + /- 81 d ( mean + /- SD ) in the placebo group , 444 + /- 81 d in the zinc group , 464 + /- 85 d in the iron+folic acid group , and 446 + /- 87 d in the iron+folic acid+zinc group . Results were similar after adjustment for age at enrollment , asset ownership , maternal literacy , and prior child deaths in the household and in children who consumed at least 60 tablets . Compared with placebo , iron+folic acid was associated with an adjusted mean delay of 28.0 d ( 95 % CI : 11.3 , 44.7 ) in time to walking among infants and the delay was more pronounced with mid-upper arm circumference ( MUAC ) < 9.5 cm [ 60.6 d , ( 95 % CI : 28.5 , 92.6 ) ] . Risks and benefits of universal iron+folic acid supplementation of infants beyond improved hematologic status deserve further consideration

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

Zinc supplementation in very-low-birth-weight infants.

Inadequate zinc intake may lead to poor growth and developmental outcome in very-low-birth-weight ( VLBW ; < 1,500 g ) infants . Fifty-two infants ( mean birth weight , 1,117 + /- 287 g ; mean gestational age , 29 + /- 2.9 weeks ) were r and omly allocated to two groups . SUPP infants received a regular term formula plus zinc supplements ( 4.4 mg/L ; final content , 11 mg/L ) ; PLAC infants received the same formula plus placebo ( final content , 6.7 mg/L ) . Infants started their formula at 1,853 + /- 109 g and consumed the formula for 6 months . All subjects were evaluated at 3 , 6 , 9 , and 12 + /- 0.75 months corrected-for-gestational-age . At each evaluation , weight , length , and head circumference were measured , a Griffiths developmental assessment was performed , and a blood sample was taken . Higher plasma zinc levels ( p < 0.05 ) were found in the SUPP group at 1 and 3 months , and improved linear growth velocity was found in the SUPP group over the study period for the whole group as well as for girls alone . Maximum motor development scores were higher ( p = 0.018 ) in the SUPP ( 98 + /- 10 ) than the PLAC ( 90 + /- 8) group , indicating that increased zinc intake in early infancy may be beneficial to VLBW infants

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

Efficacy of Iron and/or Zinc Supplementation on Cognitive Performance of Lead-Exposed Mexican Schoolchildren: A Randomized, Placebo-Controlled Trial

OBJECTIVE . Lead exposure in children has been associated with both global and specific cognitive deficits . Although chelation therapy is advised for children with blood lead concentrations of > 44 μg/dL , treatment options for children with lower blood lead values are limited . Because lead absorption is related to children 's nutritional status , micronutrient supplements may be 1 strategy for combating low-level , chronic lead exposure . This study was design ed to test the efficacy of iron and zinc supplementation for lowering blood lead concentrations and improving cognitive performance in schoolchildren who live in a lead-contaminated city . METHODS . This r and omized , double-blind , placebo-controlled field trial was conducted in public elementary schools in Torreón , an industrialized city in northern Mexico . A metal foundry , located close to the city center and within 3.5 km of 9 schools , was the main source of lead exposure . A total of 602 children who were aged 6 to 8 years and regularly attending first grade in the study schools were enrolled . Children were given 30 mg of iron , 30 mg of zinc , both , or a placebo daily for 6 months . A total of 527 completed the treatment , and 515 were available for long-term follow-up , after another 6 months without supplementation . Eleven cognitive tests of memory , attention , visual-spatial abilities , and learning were administered at baseline and each follow-up . RESULTS . There were no consistent or lasting differences in cognitive performance among treatment groups . CONCLUSIONS . Daily supplementation with iron and /or zinc may be of limited usefulness for improving cognition in lead-exposed schoolchildren . However , these treatments may be effective in setting s with higher prevalence of nutritional deficiencies or in younger children

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

Iron and zinc supplementation does not improve parent or teacher ratings of behavior in first grade Mexican children exposed to lead.

OBJECTIVE To determine the efficacy of iron and zinc supplementation on behavior ratings of lead-exposed children . STUDY DESIGN In this double-blind , r and omized trial , 602 first- grade children received 30 mg ferrous fumarate , 30 mg zinc oxide , both , or placebo daily for 6 months . Lead , iron , and zinc status were determined at baseline and follow-up . Parents and teachers provided ratings of child behavior using the Conners Rating Scales . RESULTS The baseline mean ( SD ) blood lead concentration was 11.5 ( 6.1 ) mug/dL , with 51 % of children > or = 10 microg/dL. The prevalence of attention deficit hyperactivity disorder , estimated by combined parent and teacher ratings , was 6 % . At follow-up , parent ratings of oppositional , hyperactive , cognitive problems , and attention deficit hyperactivity disorder decreased by 1.5 , 1.2 , 2.5 , and 3.4 points , respectively ( P < .05 ) . Teacher ratings of hyperactivity increased by 1.1 points ( P = .008 ) , and the mean cognitive problem score declined by 0.7 points ( P = .038 ) . There were no treatment effects on mean change in scores , but children receiving any zinc had a higher likelihood of no longer receiving clinical ly-significant teacher ratings of oppositional behaviors . CONCLUSIONS This regimen of supplementation did not result in consistent improvements in ratings of behavior in lead-exposed children over 6 months

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

Effect of zinc supplementation on observed activity in low socioeconomic Indian preschool children.

OBJECTIVES To investigate whether supplementation of zinc in preschool children is associated with improvement in observed activity levels . METHODS On 2 consecutive days , we performed 5-hour observations with momentary time sampling ( instant activity every 10 minutes ) in children selected from an ongoing double-blind , r and omized trial of zinc supplementation . The study was conducted in Kalkaji , a low-socioeconomic urban population of New Delhi with high diarrheal incidence and rates of malnutrition . A total of 93 children ( 48 zinc and 45 control ) 12 to 23 months of age from an ongoing community-based , r and omized , controlled trial received supplements for at least 1 month before study ; 71 % had received supplementation for more than 120 days . Zinc gluconate ( 10 mg of elemental zinc ) was given daily , with both zinc and control groups receiving vitamins A , B1 , B2 , B6 , D3 , and E and niacinamide in addition . RESULTS Outcomes were percentages of time spent in each of five activity levels and two groups representing high and low movement and overall rating by two activity scores . Children in the zinc group spent 72 % more time performing activities in the high-movement group . Among the zinc-supplemented children , the activity rating by the children 's activity rating score was 12 % higher and by the energy expenditure score was 8.3 % higher than in the control group . CONCLUSIONS In conclusion , zinc supplementation , given along with selected vitamins , was associated with significantly greater activity levels in children . The relationship between the activity increase and locomotor development needs to be investigated , as do the long-term implication s of zinc supplementation in terms of developmental status and school performance

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

A preliminary report: effects of zinc and micronutrient repletion on growth and neuropsychological function of urban Chinese children.

OBJECTIVE Zinc is essential for growth and cognition of experimental animals . Past research found zinc repletion improved growth of stunted Chinese children . Therefore we measured effects of zinc repletion on growth and neuropsychological functions of children . DESIGN Double-blind r and omized controlled treatment trial . SETTING Elementary schools in low income districts of Chongqing , Qingdao and Shanghai . SUBJECTS Three hundred-seventy-two 6 to 9 year old first grade rs . INTERVENTIONS Treatments were 20 mg zinc , 20 mg zinc with micronutrients , or micronutrients alone . The micronutrient mixture was based on guidelines of the US NAS/NRC . Treatments were assigned to classrooms of 40 or more children each , and administered by teachers 6 days per week for 10 weeks . MEASURES OF OUTCOME Changes in knee height and neuropsychological functions . RESULTS Zinc alone had the least effect on growth while zinc with micronutrients had the largest effect ; micronutrients alone had an intermediate effect . Zinc-containing treatments improved neuropsychological functions , but micronutrients alone had little effect . CONCLUSIONS The findings confirm the essentiality of zinc for growth of children , and show , for the first time , the essentiality of zinc for neuropsychological functions of children . In addition , the need for repletion of other potentially limiting nutrients in studies examining the effects of specific nutrients on growth and neuropsychological functions was confirmed

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

Impact of zinc supplementation on mental and psychomotor scores of children aged 12 to 18 months: a randomized, double-blind trial.

OBJECTIVE To evaluate the effect of zinc supplementation on mental and psychomotor scores in children aged 12 to 18 months . STUDY DESIGN In this double-blind , r and omized , placebo-controlled trial , children aged 6 to 30 months received daily elemental zinc ( 10 mg for infants and 20 mg for others ) or placebo for 4 months . Bayley Scales of Infant Development II were used for development assessment in the 12- to 18-month subgroup at enrollment and the end of the study . RESULTS At the end of the study , the adjusted mean mental ( P = .36 ) and psychomotor ( P = .28 ) index scores were similar in the intervention and control groups . In a multivariate model , the baseline mental development index score was positively associated with the mother 's schooling , the child 's height for age , packed cell volumes , hospital birth , and attendance at a day care center , and was negatively associated with the child 's age . Breastfeeding , the child 's weight for height , and packed cell volumes were positively associated with the baseline psychomotor index score . CONCLUSION Zinc supplementation did not affect the mental or psychomotor development index scores in a setting in which zinc deficiency is common

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

Cognitive and motor development among small-for-gestational-age infants: impact of zinc supplementation, birth weight, and caregiving practices.

OBJECTIVE Infants who are born small for gestational age ( SGA ) are at risk for developmental delays , which may be related to deficiencies in zinc , an essential trace metal , or to deficiencies in their ability to elicit caregiver responsiveness ( functional isolation hypothesis ) . The objective of this study was to evaluate at 6 and 10 months of age the impact of a 9-month supplementation trial of 5 mg of zinc on the development and behavior of infants who were born SGA and to evaluate infants ' ability to elicit responsive caregiver behavior . METHODS A r and omized , controlled trial of zinc supplementation was conducted among 200 infants in a low-income , urban community in Delhi , India . Infants were recruited when they were full term ( > 36 weeks ) and SGA ( birth weight < 10th percentile weight-for-gestational age ) . Infants were r and omized to receive daily supplements of a micronutrient mix ( folate , iron , calcium , phosphorus , and riboflavin ) with or without 5 mg of zinc sulfate . The supplement was administered by field workers daily from 30 days to 9 months of age . At 6 and 10 months , infant development and behavior were measured in a clinical setting using the Bayley Scales of Infant Development II . Caregiver responsiveness , observed on an Indian version of the Home Observation for Measurement of the Environment scale , was measured during a home visit at 10 months . During both the clinic and home visits , caregivers reported on their infant 's temperament . RESULTS There were no direct effects of zinc supplementation on the infants ' development or behavior at either 6 or 10 months . In a subgroup analysis among the zinc-supplemented infants , lower birth weight infants were perceived to be more temperamentally difficult than higher weight infants ; in the control group , birth weight was not associated with temperament . Heavier birth weight infants had better scores on all measures of development and behavior at 6 months and on changes in mental and motor development from 6 to 10 months , compared with lighter birth weight infants . Boys had better weight gain and higher scores on mental development and emotional regulation than girls . Infants who were from families of higher socioeconomic status ( indexed by parental education , house size , and home ownership ) had higher scores on mental development and orientation/engagement ( exploratory behavior ) than infants who were from families of lower socioeconomic status . In keeping with the functional isolation hypothesis , caregiver responsiveness was associated with infant irritability , controlling for socioeconomic status , gender , birth weight , and weight gain . Responsive mothers were more likely to perceive their infants to be temperamentally easy than less responsive mothers . CONCLUSION Possible explanations for the lack of effects of zinc supplementation on infant development and behavior include 1 ) subtle effects of zinc supplementation that may not have been detected by the Bayley Scales , 2 ) interference with other nutritional deficiencies , or 3 ) no impact of zinc deficiency on infants ' development and behavior . The link between birth weight and irritability among infants in the zinc supplementation group suggests that the response to zinc supplementation may differ by birth weight , with irritability occurring among the most vulnerable infants . Longer term follow-up studies among zinc-supplemented infants are needed to examine whether early supplementation leads to developmental or behavioral changes that have an impact on school-age performance . The relationship between infant irritability and low maternal responsiveness lends support to the functional isolation hypothesis and the importance of asking caregivers about infant temperament

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

Adding zinc to prenatal iron and folate tablets improves fetal neurobehavioral development.

OBJECTIVE Our objective was to examine whether improvement in maternal zinc status during pregnancy is positively associated with fetal neurobehavioral development in a Peruvian population . STUDY DESIGN We electronically monitored , at 32 and 36 weeks ' gestation , 55 fetuses whose mothers were r and omly assigned to receive , during pregnancy , a daily supplement containing 60 mg iron and 250 microg folate , with or without 15 mg zinc . Fetal heart rate and movement patterns were quantified in 55 and 34 fetuses , respectively , as indexes of neurobehavioral development . RESULTS Fetuses of mothers who received zinc supplementation showed fewer episodes of minimal fetal heart rate variability , increased fetal heart rate range , an increased number of accelerations , an increased number of movement bouts , an increased amount of time spent moving , and an increased number of large movements . Differences by supplementation type increased with gestational age and were statistically significant at 36 weeks ' gestation ( P < .05 ) . CONCLUSION Improving maternal zinc status through prenatal supplementation may improve fetal neurobehavioral development

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

Effect of zinc supplementation on mood states in young women: a pilot study

The relation of zinc ( Zn ) nutriture to brain development and function has been eluci date d. The purpose of this study is to examine whether Zn supplementation improves mood states in young women . The study used a double-blind , r and omized and placebo-controlled procedure . The major outcomes were psychological measures , somatic symptoms and serum Zn . Thirty women were placed r and omly and in equal numbers into two groups , and they ingested one capsule containing multivitamins ( MVs ) or MV and 7 mg Zn daily for 10 weeks . Women who took MV and Zn showed a significant reduction in anger – hostility score ( P=0.009 ) and depression – dejection score ( P=0.011 ) in the Profile of Moods State ( POMS ) and a significant increase in serum Zn concentration ( P=0.008 ) , whereas women who took only MV did not . Our results suggest that Zn supplementation may be effective in reducing anger and depression

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

Long-term effects of iron and zinc supplementation during infancy on cognitive function at 9 y of age in northeast Thai children: a follow-up study.

BACKGROUND Iron and zinc are important micronutrients for child growth and development . One would expect that iron and zinc supplementation in infancy would affect long-term cognitive development and school achievement , but this has not been evaluated . OBJECTIVE We investigated the effect of iron or zinc supplementation or both during infancy on cognitive performance 8 y later . DESIGN A follow-up study was performed in 560 children aged 9 y or 92 % of those who had participated in a r and omized controlled trial involving 4 groups who received daily iron , zinc , iron plus zinc , or a placebo at 4 - 6 mo of age for 6 mo . Cognitive performance was assessed by using the Wechsler Intelligence Scale for Children-Third Edition ( Thai version ) , the Raven 's Colored Progressive Matrices ( CPM ) , and school performance tests . General linear mixed models were used to assess long-term effects . RESULTS No significant differences in any of the outcomes at 9 y of age were observed at follow-up between the 4 groups . Mean intelligence quotients ranged across groups from 92.9 to 93.7 for full scale , 93.9 - 95.4 for verbal , and 93.1 - 94.0 for performance . The Raven 's CPM score ranged from 21.4 to 22.4 . CONCLUSION Supplementation with iron or zinc or both during infancy does not lead to long-term cognitive improvement in 9-y-old children . This trial was registered at clinical trials.gov as NCT00824304

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

Zinc deficiency in anorexia nervosa.

Adolescents with anorexia nervosa were evaluated for clinical and biochemical evidence of zinc deficiency . To assess whether these patients would benefit from zinc supplementation , a double-blind , r and omized , controlled trial was conducted . The mean zinc intake of the anorexic group calculated on the basis of three-day dietary records was 7.7 + /- 5.2 mg/day , which is significantly below the recommended daily allowance of 15 mg for adolescents ( p less than 0.001 ) . The mean urinary zinc excretion in the anorexic group was 257.1 + /- 212.7 micrograms/24 hours compared to 749.9 + /- 897.8 micrograms/24 hours in the control group ( p less than 0.005 ) . This result suggests that the zinc status of anorexia nervosa patients may be compromised due to an inadequate zinc intake . Zinc supplementation ( 50 mg elemental zinc/day ) was followed by a decrease in the level of depression and anxiety as assessed by the Zung Depression Scale ( p less than 0.05 ) and the State-Trait Anxiety Inventory ( p less than 0.05 ) , respectively . Our data suggest that individuals with anorexia nervosa may be at risk for zinc deficiency and may respond favorably after zinc supplementation

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

A growth-limiting, mild zinc-deficiency syndrome in some southern Ontario boys with low height percentiles.

A double-blind , pair-matched 12-mo study examined the effects of a zinc supplement ( 10 mg Zn/d as ZnSO4 ) on linear growth , taste acuity , attention span , biochemical indices , and energy intakes of 60 boys ( aged 5 - 7 y ) with height less than or equal to 15th and midparent height greater than 25th percentiles . Boys with initial hair Zn less than 1.68 mumol/g ( n = 16 ) had a lower mean ( + /- SD ) weight-for-age Z score ( -0.44 + /- 0.59 vs -0.08 + /- 0.84 ) , and a higher median recognition threshold for salt ( 15 vs 7.5 mmol ; p = 0.02 ) than those with hair Zn greater than 1.68 mumol/g . Only boys with hair Zn less than 1.68 mumol/g responded to the Zn supplement with a higher mean change in height-for-age Z score ( p less than 0.05 ) ; taste acuity , energy intakes , and attention span were unaffected . A growth-limiting Zn deficiency syndrome exists in boys with low height percentiles , hair Zn levels less than 1.68 mumol/g , and impaired taste acuity

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

The Effects of Iron and/or Zinc Supplementation on Maternal Reports of Sleep in Infants from Nepal and Zanzibar

Background : There is some evidence that sleep patterns may be affected by iron deficiency anemia but the role of iron in sleep has not been tested in a r and omized iron supplementation trial . Objective : We investigated the effect of iron supplementation on maternal reports of sleep in infants in 2 r and omized , placebo-controlled trials from Pemba Isl and , Zanzibar , and Nepal . Design : In both studies , which had parallel design s and were carried out in years 2002 to 2003 , infants received iron – folic acid with or without zinc daily for 12 months , and assessment s of development were made every 3 months for the duration of the study . Eight hundred seventy-seven Pemban ( 12.5 ± 4.0 months old ) and 567 Nepali ( 10.8 ± 4.0 months ) infants participated . Maternal reports of sleep patterns ( napping frequency and duration , nighttime sleep duration , frequency of night waking ) were collected . Results : Mean Hb concentration was 9.2 ± 1.1 for Pemban and 10.1 ± 1.2 g/dL for Nepali infants . Approximately , one-third of the children were stunted . Supplemental iron was consistently associated with longer night and total sleep duration . The effects of zinc supplementation also included longer sleep duration . Conclusions : Micronutrient supplementation in infants at high risk for iron deficiency and iron deficiency anemia was related to increased night sleep duration and less night waking

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

BACKGROUND Zinc deficiency is a significant public health problem in low- and middle-income countries . Zinc is essential for the formation and migration of neurons along with the formation of neuronal synapses . Its deficiency could interfere with the formation of neural pathways and with neurotransmission , thus affecting behavior ( for example , attention , activity , engagement , temperament ) and development ( for example , gross and fine motor skills , social skills ) . Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency . OBJECTIVES To assess the effects of zinc supplementation compared to placebo on measures of psychomotor development or cognitive function in children .

We argue that despite inconsistencies in the definition , patterns across studies clearly show that healthy obesity is a state of intermediate disease risk . Expert commentary : Given the current state of population -level evidence , we conclude that obesity and metabolic dysfunction are inseparable and that healthy obesity is best viewed only as a state of relative health but not of absolute health .

INTRODUCTION Obesity is a top public health priority but interventions to reverse the condition have had limited success . About one-in-three obese adults are free of metabolic risk factor clustering and are considered ' healthy ' , and much attention has focused on the implication s of this state for obesity management .

'Mendelian randomization': can genetic epidemiology contribute to understanding environmental determinants of disease?

Associations between modifiable exposures and disease seen in observational epidemiology are sometimes confounded and thus misleading , despite our best efforts to improve the design and analysis of studies . Mendelian r and omization-the r and om assortment of genes from parents to offspring that occurs during gamete formation and conception-provides one method for assessing the causal nature of some environmental exposures . The association between a disease and a polymorphism that mimics the biological link between a proposed exposure and disease is not generally susceptible to the reverse causation or confounding that may distort interpretations of conventional observational studies . Several examples where the phenotypic effects of polymorphisms are well documented provide encouraging evidence of the explanatory power of Mendelian r and omization and are described . The limitations of the approach include confounding by polymorphisms in linkage disequilibrium with the polymorphism under study , that polymorphisms may have several phenotypic effects associated with disease , the lack of suitable polymorphisms for study ing modifiable exposures of interest , and canalization-the buffering of the effects of genetic variation during development . Nevertheless , Mendelian r and omization provides new opportunities to test causality and demonstrates how investment in the human genome project may contribute to underst and ing and preventing the adverse effects on human health of modifiable exposures

We argue that despite inconsistencies in the definition , patterns across studies clearly show that healthy obesity is a state of intermediate disease risk . Expert commentary : Given the current state of population -level evidence , we conclude that obesity and metabolic dysfunction are inseparable and that healthy obesity is best viewed only as a state of relative health but not of absolute health .

INTRODUCTION Obesity is a top public health priority but interventions to reverse the condition have had limited success . About one-in-three obese adults are free of metabolic risk factor clustering and are considered ' healthy ' , and much attention has focused on the implication s of this state for obesity management .

We argue that despite inconsistencies in the definition , patterns across studies clearly show that healthy obesity is a state of intermediate disease risk . Expert commentary : Given the current state of population -level evidence , we conclude that obesity and metabolic dysfunction are inseparable and that healthy obesity is best viewed only as a state of relative health but not of absolute health .

INTRODUCTION Obesity is a top public health priority but interventions to reverse the condition have had limited success . About one-in-three obese adults are free of metabolic risk factor clustering and are considered ' healthy ' , and much attention has focused on the implication s of this state for obesity management .

Obesity, Behavioral Lifestyle Factors, and Risk of Acute Coronary Events

Background — Whether physical activity reduces the impact of obesity on the risk of acute coronary events is much debated . However , little is known about the role of other potentially modifiable lifestyle factors in combination with obesity . Methods and Results — We followed up 54 783 women and men from the prospect i ve Danish Diet , Cancer and Health study who were 50 to 64 years at baseline ( 1993 to 1997 ) and free of coronary artery disease and cancer . During a median of 7.7 years , 1127 incident cases of acute coronary syndrome ( ACS ) occurred . After multivariable adjustments , each unit of body mass index was associated with a 5 % and 7 % higher risk of ACS among women and men , respectively ( both P<0.0001 for trend ) . Overweight ( body mass index , 25 to 29.9 kg/m2 ) and obesity ( body mass index ≥30 kg/m2 ) were associated with a higher risk of ACS among the physically active and inactive , in nonsmokers and smokers , and among those who adhered more or less to a heart-healthy dietary pattern . Obese individuals who were active 1 to 3.5 h/wk had a lower risk than sedentary , obese individuals . In addition , obese nonsmokers had a lower risk than obese smokers . Adherence to a healthy diet was associated with a lower risk of ACS ; however , the relative risk was not different among obese individuals with the most healthy diet versus obese individuals with a less healthy diet . Conclusions — Obesity confers an elevated risk of ACS in both healthy and less healthy subgroups of lifestyle behaviors . Adherence to healthy lifestyle behaviors was associated with a lower risk even among obese individuals

We argue that despite inconsistencies in the definition , patterns across studies clearly show that healthy obesity is a state of intermediate disease risk . Expert commentary : Given the current state of population -level evidence , we conclude that obesity and metabolic dysfunction are inseparable and that healthy obesity is best viewed only as a state of relative health but not of absolute health .

INTRODUCTION Obesity is a top public health priority but interventions to reverse the condition have had limited success . About one-in-three obese adults are free of metabolic risk factor clustering and are considered ' healthy ' , and much attention has focused on the implication s of this state for obesity management .

We argue that despite inconsistencies in the definition , patterns across studies clearly show that healthy obesity is a state of intermediate disease risk . Expert commentary : Given the current state of population -level evidence , we conclude that obesity and metabolic dysfunction are inseparable and that healthy obesity is best viewed only as a state of relative health but not of absolute health .

INTRODUCTION Obesity is a top public health priority but interventions to reverse the condition have had limited success . About one-in-three obese adults are free of metabolic risk factor clustering and are considered ' healthy ' , and much attention has focused on the implication s of this state for obesity management .

Effects of Exercise Amount and Intensity on Abdominal Obesity and Glucose Tolerance in Obese Adults

Editors ' Notes Context Whether there is added benefit from performing the same amount of exercise at a higher intensity is unclear . Contribution In this 24-week study , participants r and omly assigned to complete the same total amount of exercise at higher or lower intensities had similar reductions in waist circumference and weight . High-intensity exercise alone improved 2-hour glucose tolerance and led to the greatest increase in cardiorespiratory fitness . Caution The importance of improved 2-hour glucose tolerance in participants without diabetes is unclear . Implication For the same amount of exercise , higher-intensity exercise may not result in greater reduction in waist circumference or weight but may provide benefits in glucose tolerance and cardiorespiratory fitness . The high prevalence of obesity and associated type 2 diabetes mellitus among adults presents a major public health challenge ( 1 ) . Physical inactivity is a significant determinant of obesity , and most adults in the United States are inactive ( 2 ) . Although progress has been made to eluci date the effects of exercise as a strategy for reducing obesity and related glucose tolerance , the specific exercise exposures required to achieve optimal benefit continue to be the source of considerable uncertainty and debate . Implicit within current guidelines for physical activity and health is the observation that 75 minutes of weekly high-intensity exercise is equivalent to 150 minutes of weekly lower-intensity exercise ( 3 , 4 ) . Therefore , guidelines suggest that there are no added health benefits of high-intensity exercise other than the shorter time frame needed to expend the appropriate amount of energy . Thus , the benefits of engaging in high-intensity exercise are attributed to the greater amount of energy expenditure per unit of time and do not relate to intensity per se ( 3 ) . The scientific committee report from which current guidelines were developed recognized that many unanswered issues exist in response to the question of how much of what type of activity is appropriate for a given health outcome , and acknowledged that future investigations need to evaluate the effects of exercise intensity at fixed amounts of energy expenditure . We therefore performed a r and omized clinical trial to investigate the separate effects of habitual exercise differing in amount and intensity on abdominal obesity and glucose tolerance . We studied abdominally obese adults because they are at substantially increased risk for morbidity ( 5 ) and mortality ( 6 ) and because it is estimated that 60 % of men and 45 % of women between the ages of 35 and 65 years in the United States are abdominally obese ( 7 ) . Methods Setting and Participants Details of the trial design and methods are published ( 8) . We conducted a 24-week , single-center , parallel-group , r and omized , controlled trial between 2009 to 2013 . Potential participants were excluded if they reported a history of heart disease , stroke , or any condition that would prevent them from engaging in exercise ; were already engaging in 2 or more planned exercise sessions per week ; or were diabetic . All participants provided informed consent before participation . The study was approved by the Queen 's University Health Sciences Research Ethics Board , Kingston , Ontario , Canada . Interventions Participants were r and omly assigned to 1 of the following groups : control ( no exercise ) or 5 sessions per week of low-amount , low-intensity exercise ( LALI ) ( 180 and 300 kcal/session for women and men , respectively , at 50 % of maximum oxygen consumption [ V̇o 2peak ] ) ; high-amount , low-intensity exercise ( HALI ) ( 360 and 600 kcal/session for women and men , respectively , at 50 % of V̇o 2peak ) ; or high-amount , high-intensity exercise ( HAHI ) ( 360 and 600 kcal/session for women and men , respectively , at 75 % of V̇o 2peak ) . Exercise Interventions All participants performed walk/jog exercise consistent with consensus recommendations on a treadmill for the time required to achieve the desired amount of exercise ( energy expenditure in kilocalories per session , relative to V̇o 2peak ) 5 times per week for 24 weeks . Using the heart rate and V̇o 2 data obtained from the baseline exercise test , we assigned the target heart rate associated with a V̇o 2peak of approximately 50 % ( LALI and HALI ) and approximately 75 % ( HAHI ) for each participant . At these exercise intensities , the energy expenditure targets ( exercise amount ) for women and men , respectively , were 180 and 300 kcal for the LALI group and 360 and 600 kcal for the HALI and HAHI groups . Follow-up exercise tests to measure V̇o 2peak were performed at weeks 4 , 8 , and 16 to verify the relationship between heart rate and V̇o 2 . Continual adjustment of the heart rateV̇o 2 relationship accounted for improvement in cardiorespiratory fitness ( CRF ) , which alters the time required to achieve the prescribed exercise amount ( for example , energy expenditure ) . Heart rate was monitored continuously for all exercise participants at every session to ensure adherence to the prescribed exercise intensity . All exercise sessions were supervised , and all exercise participants were asked not to engage in any structured exercise outside of the supervised sessions . Nonexercise Control Group Participants in the control group were asked to maintain their level of physical activity throughout the trial and received diet composition advice similar to that received in the exercise groups . Daily Physical Activity Unsupervised physical activity was monitored using ActiGraph GT3X accelerometers for 1-week periods at baseline and at 8 , 16 , and 25 weeks . Participants were required to wear the accelerometer for at least 4 days each period . Established accelerometer cut points were used to estimate physical activity and sedentary time ( 9 ) . Dietary Regimen During a 1-week baseline period , participants were instructed to maintain baseline body weight by monitoring their calorie intake and recording their daily consumption of self-selected foods . During the intervention , participants were instructed to maintain the calorie intake targets measured during baseline . All participants were prescribed a balanced diet and were asked to su bmi t daily dietary intake records during the intervention . Two weeks of records for all groups were analyzed using a computerized program to assess the accuracy of self-reported records . Outcomes and Follow-up Primary outcome variables were waist circumference ( WC ) , which was measured at the superior edge of the iliac crest ( 10 ) at baseline and at 8 ( exercise groups only ) , 16 , and 24 weeks , and 2-hour glucose level , which was measured in response to a 2-hour , 75-g oral glucose tolerance test between 36 and 48 hours after the last exercise session at baseline and at 16 and 24 weeks ( 8) . Secondary outcomes included CRF ( V̇o 2peak ) assessed by using st and ard open-circuit spirometry techniques with a mass flow sensor ( SensorMedics ) during a grade d exercise test in which participants walked on a treadmill at a self-selected speed at 0 elevation for 3 minutes , after which the incline was increased every 2 minutes until the participant stopped voluntarily . Levels of glucose , triglycerides , high- and low-density lipoprotein cholesterol , and insulin and blood pressure were measured using established procedures ( 8) . The Matsuda index ( an indication of insulin sensitivity ) was calculated as follows : ( 10000/[{fasting glucose levelfasting insulin level}{mean glucose levelmean insulin level during the oral glucose tolerance test}]1/2 ) ( 11 ) . There were separate assessment and intervention personnel , and all assessment personnel were blinded to participant r and omization assignment . Sample Size and Power Sample size was determined for WC and 2-hour glucose level on the basis of reduction after treatment . Previous trials suggested that exercise-induced weight loss of approximately 6 % was associated with WC reductions of 6.9 cm ( SD , 2.6 ) in men ( 12 ) and 6.5 cm ( SD , 2.6 ) in women ( 13 ) . For 2-hour glucose level , mean reductions of 0.70 mmol/L ( SD , 1.9 ) ( 12.6 mg/dL [ SD , 34.2 ] ) and 0.94 mmol/L ( SD , 0.7 ) ( 16.9 mg/dL [ SD , 12.6 ] ) were seen in men and women , respectively ( 12 , 13 ) . The sample size calculation incorporated the larger SDs for WC and 2-hour glucose level . The sample -size formula ( equation 13 of Overall and Doyle [ 14 ] ) relevant to the repeated- measures analysis of variance design was applied . The formula is based on a simple 2-group comparison of the pretreatment and posttreatment outcome changes , and it accounts for the correlation between the pretreatment and posttreatment outcome variables . With a correlation of 0.7 between pretreatment and posttreatment glucose tolerance and WC , and allowance for a dropout rate of 30 % , a sample of 40 men or women with 28 completers in each treatment group gives more than 85 % power to detect a mean difference of 2 cm in WC and a mean difference of 1.9 mmol/L ( 34.2 mg/dL ) in glucose tolerance between any 2 treatment groups . R and omization Participants were r and omly assigned to the 4 groups using the method of permuted blocks , with r and om block sizes of 4 , 8 , or 12 within strata . R and omization was stratified by sex and age , with a fifth stratum for the few couples participating to ensure that they were r and omly assigned to the same treatment . The computer-generated r and omization list was maintained by an independent statistician otherwise uninvolved in the study and was concealed from study personnel until the time of r and omization . After baseline data collection , the study coordinator contacted the statistician by e-mail to obtain treatment assignment . Statistical Analysis Analyses were done on an intention-to-treat basis ( 15 ) . All r and omly assigned participants were included in the analyses . Differences in continuous and categorical variables between dropouts and participants who completed the study were examined by using a 2-tailed t test and a chi-square test , respectively . For WC , 2-hour glucose level ,

We argue that despite inconsistencies in the definition , patterns across studies clearly show that healthy obesity is a state of intermediate disease risk . Expert commentary : Given the current state of population -level evidence , we conclude that obesity and metabolic dysfunction are inseparable and that healthy obesity is best viewed only as a state of relative health but not of absolute health .

INTRODUCTION Obesity is a top public health priority but interventions to reverse the condition have had limited success . About one-in-three obese adults are free of metabolic risk factor clustering and are considered ' healthy ' , and much attention has focused on the implication s of this state for obesity management .

We argue that despite inconsistencies in the definition , patterns across studies clearly show that healthy obesity is a state of intermediate disease risk . Expert commentary : Given the current state of population -level evidence , we conclude that obesity and metabolic dysfunction are inseparable and that healthy obesity is best viewed only as a state of relative health but not of absolute health .

INTRODUCTION Obesity is a top public health priority but interventions to reverse the condition have had limited success . About one-in-three obese adults are free of metabolic risk factor clustering and are considered ' healthy ' , and much attention has focused on the implication s of this state for obesity management .

Subcutaneous adipose tissue remodeling during the initial phase of weight gain induced by overfeeding in humans.

CONTEXT Deciphering the early processes occurring in adipose tissue during weight gain is a major issue for underst and ing the development of fat mass and obesity . Experimental overfeeding in humans is a unique situation to tackle these events . OBJECTIVE Our aim was to identify the pathways involved in sc adipose tissue remodeling during the initial phase of weight gain . RESEARCH DESIGN AND METHODS Forty-four healthy men were involved in an overfeeding protocol with a lipid-enriched diet ( + 760 kcal/d ) for 2 months . Subcutaneous abdominal adipose tissue biopsies were taken for histology , transcriptomics , and Western blotting in the basal state , after 14 d , and at the end of the protocol . RESULTS Overfeeding significantly increased body weight ( + 2.5 kg ) and fat mass . Reorganization of gene expression patterns occurred in adipose tissue with an up-regulation of numerous genes involved in lipid metabolism and storage , followed by clusters of genes related to angiogenesis and extracellular matrix remodeling . Histological examination showed increased microvascular density and connective tissue deposition after 56 d of overfeeding , with no changes in the number of macrophages or inflammatory cells . Inhibition of the canonical Wnt/β-catenin signaling pathway and induction of the renin-angiotensin system might be implicated in the remodeling of sc adipose tissue . CONCLUSIONS We characterize the coordinated and time-dependent processes that occur in human adipose tissue during the early phase of weight gain in healthy subjects and identify pathways representing potential targets in pathologies of adipose development , including obesity

We argue that despite inconsistencies in the definition , patterns across studies clearly show that healthy obesity is a state of intermediate disease risk . Expert commentary : Given the current state of population -level evidence , we conclude that obesity and metabolic dysfunction are inseparable and that healthy obesity is best viewed only as a state of relative health but not of absolute health .

INTRODUCTION Obesity is a top public health priority but interventions to reverse the condition have had limited success . About one-in-three obese adults are free of metabolic risk factor clustering and are considered ' healthy ' , and much attention has focused on the implication s of this state for obesity management .

We argue that despite inconsistencies in the definition , patterns across studies clearly show that healthy obesity is a state of intermediate disease risk . Expert commentary : Given the current state of population -level evidence , we conclude that obesity and metabolic dysfunction are inseparable and that healthy obesity is best viewed only as a state of relative health but not of absolute health .

INTRODUCTION Obesity is a top public health priority but interventions to reverse the condition have had limited success . About one-in-three obese adults are free of metabolic risk factor clustering and are considered ' healthy ' , and much attention has focused on the implication s of this state for obesity management .

The joint effects of physical activity and body mass index on coronary heart disease risk in women.

BACKGROUND Physical activity and body mass index ( calculated as weight in kilograms divided by height in meters squared ) independently alter the risk of coronary heart disease ( CHD ) ; however , their combined effect on CHD is not established . Our objective was to study the combined association of physical activity and body mass index on CHD . METHODS Prospect i ve cohort study of 38,987 women free of cardiovascular disease , cancer , and diabetes at baseline in the Women 's Health Study , with 10.9 mean years of follow-up . Weight , height , and recreational activities were reported on entry . Body mass index was categorized as normal weight ( < 25 ) , overweight ( 25 to < 30 ) , and obese ( > or = 30 ) . Active was defined as 1000 kilocalories or more expended on recreational activities weekly . Six joint body weight-physical activity categories were defined . The main outcome measure was the occurrence of incident CHD during follow-up , defined as a cardiovascular event including nonfatal myocardial infa rct ion , coronary artery bypass graft , percutaneous transluminal coronary angioplasty , or CHD death . RESULTS A total of 948 cases of incident CHD occurred during follow-up . Higher body mass index and physical inactivity were individual predictors of CHD . In joint analyses , compared with active normal-weight individuals , the multivariate-adjusted hazard ratios ( 95 % confidence intervals ) were 1.54 ( 1.14 - 2.08 ) for overweight-active ; 1.87 ( 1.29 - 2.71 ) for obese-active ; 1.08 ( 0.84 - 1.39 ) for normal weight-inactive ; 1.88 ( 1.46 - 2.42 ) for overweight-inactive ; and 2.53 ( 1.94 - 3.30 ) for obese-inactive . Increasing levels of walking also result ed in significant reductions in CHD risk for overweight and obese individuals . CONCLUSIONS The risk of CHD associated with elevated body mass index is considerably reduced by increased physical activity levels . However , the risk is not completely eliminated , reinforcing the importance of being lean and physically active

We argue that despite inconsistencies in the definition , patterns across studies clearly show that healthy obesity is a state of intermediate disease risk . Expert commentary : Given the current state of population -level evidence , we conclude that obesity and metabolic dysfunction are inseparable and that healthy obesity is best viewed only as a state of relative health but not of absolute health .

INTRODUCTION Obesity is a top public health priority but interventions to reverse the condition have had limited success . About one-in-three obese adults are free of metabolic risk factor clustering and are considered ' healthy ' , and much attention has focused on the implication s of this state for obesity management .

We argue that despite inconsistencies in the definition , patterns across studies clearly show that healthy obesity is a state of intermediate disease risk . Expert commentary : Given the current state of population -level evidence , we conclude that obesity and metabolic dysfunction are inseparable and that healthy obesity is best viewed only as a state of relative health but not of absolute health .

INTRODUCTION Obesity is a top public health priority but interventions to reverse the condition have had limited success . About one-in-three obese adults are free of metabolic risk factor clustering and are considered ' healthy ' , and much attention has focused on the implication s of this state for obesity management .

Assessing Causality in the Association between Child Adiposity and Physical Activity Levels: A Mendelian Randomization Analysis

Here , Timpson and colleagues performed a Mendelian R and omization analysis to determine whether childhood adiposity causally influences levels of physical activity . The results suggest that increased adiposity causes a reduction in physical activity in children ; however , this study does not exclude lower physical activity also leading to increasing adiposity . Please see later in the article for the Editors '

We argue that despite inconsistencies in the definition , patterns across studies clearly show that healthy obesity is a state of intermediate disease risk . Expert commentary : Given the current state of population -level evidence , we conclude that obesity and metabolic dysfunction are inseparable and that healthy obesity is best viewed only as a state of relative health but not of absolute health .

INTRODUCTION Obesity is a top public health priority but interventions to reverse the condition have had limited success . About one-in-three obese adults are free of metabolic risk factor clustering and are considered ' healthy ' , and much attention has focused on the implication s of this state for obesity management .

We argue that despite inconsistencies in the definition , patterns across studies clearly show that healthy obesity is a state of intermediate disease risk . Expert commentary : Given the current state of population -level evidence , we conclude that obesity and metabolic dysfunction are inseparable and that healthy obesity is best viewed only as a state of relative health but not of absolute health .

INTRODUCTION Obesity is a top public health priority but interventions to reverse the condition have had limited success . About one-in-three obese adults are free of metabolic risk factor clustering and are considered ' healthy ' , and much attention has focused on the implication s of this state for obesity management .

Reduction in Obesity and Related Comorbid Conditions after Diet-Induced Weight Loss or Exercise-Induced Weight Loss in Men

In 1997 , the World Health Organization published a l and mark document recognizing obesity as a worldwide disease that poses a serious threat to public health ( 1 ) . Persons who are overweight or obese have substantially increased risk for morbidity from numerous chronic disorders , such as diabetes ( 2 , 3 ) , hypertension ( 4 , 5 ) , and cardiovascular disease ( 6 , 7 ) . Obesity-related health risk is greater when excess fat is deposited in the abdomen region because this phenotype is a stronger predictor of cardiovascular disease and type 2 diabetes mellitus than general obesity is ( 8 - 11 ) . This may be partially explained by excess accumulation of visceral fat , an independent correlate of insulin resistance ( 9 - 11 ) and dyslipidemia ( 8 , 9 ) . These observations highlight the need to identify appropriate treatment strategies to prevent and reduce obesity and suggest that the effectiveness of these treatments would be enhanced if abdominal obesity , particularly visceral fat , was substantially reduced . Diet restriction remains the most common method of obesity reduction ( 12 ) . Despite the observation that low levels of physical activity are a major cause of obesity ( 13 ) , increased physical activity alone is not thought to be a useful strategy for obesity reduction . Some reports have suggested that physical activity in obese adults results in only modest weight loss ( approximately 1 to 2 kg ) independent of the effects of diet restriction ( 14 ) . However , these conclusions are drawn from studies in which individual energy intake and expenditure were not rigorously controlled or accurately measured ( 15 - 17 ) . Moreover , in most studies , the negative energy balance induced by exercise was modest enough that substantial weight loss was not expected ( 15 - 17 ) . Currently , no compelling evidence supports the observation that exercise alone is not a useful method for reducing total or abdominal obesity . It is well known that a single exercise session is associated with a significant improvement in insulin-stimulated glucose uptake ( 18 , 19 ) . It is also clear that weight loss is associated with an improvement in insulin action ( 20 - 24 ) . It is unclear , however , whether regular exercise improves glucose metabolism after the short-term effects of exercise and changes in body fat distribution are considered . Segal and colleagues ( 25 ) controlled for the confounding effect of the last exercise session and body composition changes and found that exercise had no independent effect on insulin sensitivity ( 25 ) . Given the established importance of insulin resistance as an antecedent to both cardiovascular disease and type 2 diabetes mellitus ( 26 ) , it is important to clarify whether exercise improves insulin action independent of fat loss . We performed a r and omized , controlled trial to determine the independent effect of diet-induced or exercise-induced weight loss on obesity and insulin resistance in moderately obese men . We also evaluated whether exercise without weight loss was associated with reductions in abdominal obesity and insulin resistance . Methods Participants Participants were recruited from Kingston , Ontario , Canada , a typical suburban region , through the general media . We selected men with a body mass index greater than 27 kg/m2 and a waist circumference greater than 100 cm whose weight had been stable ( 2 kg ) for 6 months before study entry . Participants were nonsmokers who consumed an average of fewer than two alcoholic beverages per day , had a sedentary lifestyle , and took no medications known to affect the principal outcome measures . All participants had a preparticipation medical examination that included screening for normal glucose tolerance and plasma lipid profile . A computer program was used to r and omly assign eligible men to one of the following four groups : control , diet-induced weight loss , exercise-induced weight loss , and exercise without weight loss ( Figure 1 ) . Of the 101 participants who were r and omly assigned to groups , 34 chose not to participate because they were dissatisfied with their assigned group , 5 were diabetic or dyslipidemic , and 3 were relocated because of job transfers . Those who chose not to participate and those who completed the trial were similar with regard to anthropometric variables . In addition , those who completed the trial were similar to those who did not in each group ( P > 0.10 ) . Baseline characteristics among groups were similar for all participants ( Table 1 ) . All participants gave fully informed written consent . The study was conducted in accordance with the ethical guidelines of Queen 's University . The participants did not receive monetary compensation . Figure 1 . Flow of participants through the study . Table 1 . Selected Anthropometric , Magnetic Resonance Imaging , and Metabolic Variables before Treatment and 3 Months after Treatment Diet and Exercise Regimen During the baseline period , daily energy requirements for all participants were determined by estimating resting energy expenditure and multiplying the obtained value by a factor of 1.5 ( 27 ) . All participants followed a weight maintenance diet ( 55 % to 60 % carbohydrate , 15 % to 20 % protein , and 20 % to 25 % fat ) for a 4- to 5-week baseline period . During this period , body weight was monitored to determine the accuracy of the prescribed energy requirement , which was adjusted accordingly to maintain body weight . Controls were asked to maintain body weight throughout the 12-week treatment period . Participants in the diet-induced weight loss group were asked to reduce the isocaloric diet by 700 kcal/d during the treatment period to achieve a weekly weight loss of approximately 0.6 kg . To lose the same amount of weight , participants in the exercise-induced weight loss group were asked to maintain the isocaloric diet for the duration of the treatment period and to perform exercise that expended 700 kcal/d . Participants assigned to exercise without weight loss were asked to maintain body weight . Therefore , they consumed enough calories to compensate for the energy expended during the daily exercise sessions ( approximately 700 kcal ) . At the end of the treatment period , isocaloric requirements were determined and prescribed for a 2-week weight stabilization period . All participants were free-living and consumed self-selected foods . No vitamins or other nutritional supplements were prescribed . Each person participated in a series of weekly 1-hour seminars in which a dietitian taught proper food selection and preparation . Participants were told that the composition of the maintenance and energy-reduced diets should be approximately 55 % to 60 % carbohydrate , 15 % to 20 % protein , and 20 % to 25 % fat . Participants kept and analyzed daily , detailed food records for the duration of the study period ( approximately 20 weeks ) ; the study dietitian also review ed these records . For the 2-week period during which doubly labeled water measurements were acquired ( weeks 6 and 7 ) , the diet records were analyzed by using a computerized program ( Food Processor , Esha Research , Salem , Oregon ) . Participants in both exercise groups performed daily exercise ( brisk walking or light jogging ) on a motorized treadmill for the duration of the 12-week trial . The length of each exercise session was determined by the time required to expend 700 kcal . Participants were asked to exercise at an intensity not greater than 70 % of their peak oxygen uptake ( Vo 2 ) ( approximately 80 % of maximal heart rate ) . Energy expenditure was determined by using the heart rate and oxygen consumption data that were obtained from the pretreatment grade d exercise test and were adjusted according to the results of two subsequent tests performed at weeks 4 and 8 . During each session , heart rate was monitored every 5 minutes by using an automated heart rate monitor ( Polar Oy , Kempele , Finl and ) . All exercise sessions were by appointment and were supervised . Peak Vo 2 was determined by using a grade d treadmill test and st and ard open-circuit spirometry techniques ( SensorMedics , Yorba Linda , California ) . Energy Expenditure Total energy expenditure for 14 days was measured by using a two-point doubly labeled water method ( 28 ) . Deuterium enrichment was analyzed by using a 903 deuterium dual-inlet isotope ratio mass spectrometer ( VG Isogas , Cheshire , United Kingdom ) . Oxygen-18 was determined by using a SIRA 12 isotope ratio mass spectrometer ( VG Isogas ) . Total energy expenditure was calculated by using the DeWeir formula ( 29 ) . After an overnight stay in the hospital , resting metabolic rate was measured at 7:00 a.m. by using indirect calorimetry with a modified mask system ( Teem 100 , Aerosport , Inc. , Ann Arbor , Michigan ) . Values were obtained for 30 minutes , and the last 25 minutes were used to determine resting metabolic rate . Resting systolic and diastolic blood pressure were measured when the participant was supine . Magnetic Resonance Imaging and Anthropometric Measurements Whole-body data from magnetic resonance imaging ( approximately 45 equidistant images ) were obtained with a General Electric 1.5-Tesla magnet ( Milwaukee , Wisconsin ) by using an established protocol described in detail elsewhere ( 30 ) . Once acquired , the data were transferred to a st and -alone work station ( Silicon Graphics , Mountain View , California ) for analysis with specially design ed computer software ( Tomovision , Inc. , Montreal , Canada ) , the procedures for which are described elsewhere ( 31 ) . For adipose tissue ( fat ) and skeletal muscle , volume units ( L ) were converted to mass units ( kg ) by multiplying the volumes by the assumed constant density for fat ( 0.92 kg/L ) and fat-free skeletal muscle ( 1.04 kg/L ) ( 32 ) . All anthropometric circumference measurements were obtained by using st and ard procedures described elsewhere ( 30 ) . Insulin Sensitivity and Glucose Tolerance Participants consumed a weight-maintenance diet consisting of at least 200 g of carbohydrate for a minimum of 4 days and were asked to avoid strenuous physical activity for 3 days before insulin

We argue that despite inconsistencies in the definition , patterns across studies clearly show that healthy obesity is a state of intermediate disease risk . Expert commentary : Given the current state of population -level evidence , we conclude that obesity and metabolic dysfunction are inseparable and that healthy obesity is best viewed only as a state of relative health but not of absolute health .

INTRODUCTION Obesity is a top public health priority but interventions to reverse the condition have had limited success . About one-in-three obese adults are free of metabolic risk factor clustering and are considered ' healthy ' , and much attention has focused on the implication s of this state for obesity management .

We argue that despite inconsistencies in the definition , patterns across studies clearly show that healthy obesity is a state of intermediate disease risk . Expert commentary : Given the current state of population -level evidence , we conclude that obesity and metabolic dysfunction are inseparable and that healthy obesity is best viewed only as a state of relative health but not of absolute health .

INTRODUCTION Obesity is a top public health priority but interventions to reverse the condition have had limited success . About one-in-three obese adults are free of metabolic risk factor clustering and are considered ' healthy ' , and much attention has focused on the implication s of this state for obesity management .

Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies

Summary Background The main associations of body-mass index ( BMI ) with overall and cause-specific mortality can best be assessed by long-term prospect i ve follow-up of large numbers of people . The Prospect i ve Studies Collaboration aim ed to investigate these associations by sharing data from many studies . Methods Collaborative analyses were undertaken of baseline BMI versus mortality in 57 prospect i ve studies with 894 576 participants , mostly in western Europe and North America ( 61 % [ n=541 452 ] male , mean recruitment age 46 [ SD 11 ] years , median recruitment year 1979 [ IQR 1975–85 ] , mean BMI 25 [ SD 4 ] kg/m2 ) . The analyses were adjusted for age , sex , smoking status , and study . To limit reverse causality , the first 5 years of follow-up were excluded , leaving 66 552 deaths of known cause during a mean of 8 ( SD 6 ) further years of follow-up ( mean age at death 67 [ SD 10 ] years ) : 30 416 vascular ; 2070 diabetic , renal or hepatic ; 22 592 neoplastic ; 3770 respiratory ; 7704 other . Findings In both sexes , mortality was lowest at about 22·5–25 kg/m2 . Above this range , positive associations were recorded for several specific causes and inverse associations for none , the absolute excess risks for higher BMI and smoking were roughly additive , and each 5 kg/m2 higher BMI was on average associated with about 30 % higher overall mortality ( hazard ratio per 5 kg/m2 [ HR ] 1·29 [ 95 % CI 1·27–1·32 ] ) : 40 % for vascular mortality ( HR 1·41 [ 1·37–1·45 ] ) ; 60–120 % for diabetic , renal , and hepatic mortality ( HRs 2·16 [ 1·89–2·46 ] , 1·59 [ 1·27–1·99 ] , and 1·82 [ 1·59–2·09 ] , respectively ) ; 10 % for neoplastic mortality ( HR 1·10 [ 1·06–1·15 ] ) ; and 20 % for respiratory and for all other mortality ( HRs 1·20 [ 1·07–1·34 ] and 1·20 [ 1·16–1·25 ] , respectively ) . Below the range 22·5–25 kg/m2 , BMI was associated inversely with overall mortality , mainly because of strong inverse associations with respiratory disease and lung cancer . These inverse associations were much stronger for smokers than for non-smokers , despite cigarette consumption per smoker varying little with BMI . Interpretation Although other anthropometric measures ( eg , waist circumference , waist-to-hip ratio ) could well add extra information to BMI , and BMI to them , BMI is in itself a strong predictor of overall mortality both above and below the apparent optimum of about 22·5–25 kg/m2 . The progressive excess mortality above this range is due mainly to vascular disease and is probably largely causal . At 30–35 kg/m2 , median survival is reduced by 2–4 years ; at 40–45 kg/m2 , it is reduced by 8–10 years ( which is comparable with the effects of smoking ) . The definite excess mortality below 22·5 kg/m2 is due mainly to smoking-related diseases , and is not fully explained . Funding UK Medical Research Council , British Heart Foundation , Cancer Research UK , EU BIOMED programme , US National Institute on Aging , and Clinical Trial Service Unit ( Oxford , UK )

We argue that despite inconsistencies in the definition , patterns across studies clearly show that healthy obesity is a state of intermediate disease risk . Expert commentary : Given the current state of population -level evidence , we conclude that obesity and metabolic dysfunction are inseparable and that healthy obesity is best viewed only as a state of relative health but not of absolute health .

INTRODUCTION Obesity is a top public health priority but interventions to reverse the condition have had limited success . About one-in-three obese adults are free of metabolic risk factor clustering and are considered ' healthy ' , and much attention has focused on the implication s of this state for obesity management .

We argue that despite inconsistencies in the definition , patterns across studies clearly show that healthy obesity is a state of intermediate disease risk . Expert commentary : Given the current state of population -level evidence , we conclude that obesity and metabolic dysfunction are inseparable and that healthy obesity is best viewed only as a state of relative health but not of absolute health .

INTRODUCTION Obesity is a top public health priority but interventions to reverse the condition have had limited success . About one-in-three obese adults are free of metabolic risk factor clustering and are considered ' healthy ' , and much attention has focused on the implication s of this state for obesity management .

Associations of Cardiorespiratory Fitness and Obesity With Risks of Impaired Fasting Glucose and Type 2 Diabetes in Men

OBJECTIVE —The purpose of this study was to examine the associations of cardiorespiratory fitness ( hereafter fitness ) and various obesity measures with risks of incident impaired fasting glucose ( IFG ) and type 2 diabetes . RESEARCH DESIGN AND METHODS —This was a prospect i ve cohort study of 14,006 men ( 7,795 for the analyses of IFG ) , who did not have an abnormal electrocardiogram or a history of heart attack , stroke , cancer , or diabetes . RESULTS —Of the men , 3,612 ( 39,610 person-years ) and 477 ( 101,419 person-years ) developed IFG and type 2 diabetes , respectively . Compared with the least fit 20 % in multivariate analyses , IFG and type 2 diabetes risks in the most fit 20 % were 14 and 52 % lower , respectively ( both P < 0.001 ) . Men with BMI ≥30.0 kg/m2 , waist girth > 102.0 cm , or percent body fat ≥25 had 2.7- , 1.9- , and 1.3-fold higher risks for type 2 diabetes , respectively , compared with those for nonobese men ( all P < 0.01 ) , and the results for IFG were similar . In the combined analyses , obese unfit ( least fit 20 % ) men had a 5.7-fold higher risk for type 2 diabetes compared with normal-weight fit ( most fit 80 % ) men . We observed similar trends for the joint associations of BMI and fitness with IFG and those of waist girth or percent body fat and fitness with both IFG and type 2 diabetes . CONCLUSIONS —Low fitness and obesity increased the risks of IFG and type 2 diabetes by approximately similar magnitudes . When considered simultaneously , fitness attenuated but did not eliminate the increased risks of IFG and type 2 diabetes associated with obesity , and the highest risk was found in obese and unfit men

We argue that despite inconsistencies in the definition , patterns across studies clearly show that healthy obesity is a state of intermediate disease risk . Expert commentary : Given the current state of population -level evidence , we conclude that obesity and metabolic dysfunction are inseparable and that healthy obesity is best viewed only as a state of relative health but not of absolute health .

INTRODUCTION Obesity is a top public health priority but interventions to reverse the condition have had limited success . About one-in-three obese adults are free of metabolic risk factor clustering and are considered ' healthy ' , and much attention has focused on the implication s of this state for obesity management .

We argue that despite inconsistencies in the definition , patterns across studies clearly show that healthy obesity is a state of intermediate disease risk . Expert commentary : Given the current state of population -level evidence , we conclude that obesity and metabolic dysfunction are inseparable and that healthy obesity is best viewed only as a state of relative health but not of absolute health .

INTRODUCTION Obesity is a top public health priority but interventions to reverse the condition have had limited success . About one-in-three obese adults are free of metabolic risk factor clustering and are considered ' healthy ' , and much attention has focused on the implication s of this state for obesity management .

Relationship of physical activity vs body mass index with type 2 diabetes in women.

CONTEXT Physical inactivity and body mass index ( BMI ) are established independent risk factors in the development of type 2 diabetes ; however , their comparative importance and joint relationship with diabetes are unclear . OBJECTIVE To examine the relative contributions and joint association of physical activity and BMI with diabetes . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study of 37 878 women free of cardiovascular disease , cancer , and diabetes with 6.9 years of mean follow-up . Weight , height , and recreational activities were reported at study entry . Normal weight was defined as a BMI of less than 25 ; overweight , 25 to less than 30 ; and obese , 30 or higher . Active was defined as expending more than 1000 kcal on recreational activities per week . MAIN OUTCOME MEASURE Incident type 2 diabetes , defined as a new self-reported diagnosis of diabetes . RESULTS During the follow-up , 1361 cases of incident diabetes occurred . Individually , BMI and physical activity were significant predictors of incident diabetes . Compared with normal-weight individuals , the multivariate-adjusted hazard ratio ( HR ) was 3.22 ( 95 % confidence interval [ CI ] , 2.69 - 3.87 ) for overweight individuals and 9.09 ( 95 % CI , 7.62 - 10.8 ) for obese individuals . For overall activity ( kilocalories expended per week ) , compared with the least active first quartile , the multivariate-adjusted HRs were 0.91 ( 95 % CI , 0.79 - 1.06 ) for the second quartile , 0.86 ( 95 % CI , 0.74 - 1.01 ) for the third , and 0.82 ( 95 % CI , 0.70 - 0.97 ) for the fourth ( P for trend = .01 ) . In the combined analyses , overweight and obese participants , whether active or inactive , had significantly elevated risks , compared with normal-weight active individuals . The multivariate-adjusted HRs were 1.15 ( 95 % CI , 0.83 - 1.59 ) for normal-weight inactive , 3.68 ( 95 % CI , 2.63 - 5.15 ) for overweight active , 4.16 ( 95 % CI , 3.05 - 5.66 ) for overweight inactive , 11.5 ( 95 % CI , 8.34 - 15.9 ) for obese active , and 11.8 ( 95 % CI , 8.75 - 16.0 ) for obese inactive participants . CONCLUSIONS Although BMI and physical inactivity are independent predictors of incident diabetes , the magnitude of the association with BMI was greater than with physical activity in combined analyses . These findings underscore the critical importance of adiposity as a determinant of diabetes

We argue that despite inconsistencies in the definition , patterns across studies clearly show that healthy obesity is a state of intermediate disease risk . Expert commentary : Given the current state of population -level evidence , we conclude that obesity and metabolic dysfunction are inseparable and that healthy obesity is best viewed only as a state of relative health but not of absolute health .

INTRODUCTION Obesity is a top public health priority but interventions to reverse the condition have had limited success . About one-in-three obese adults are free of metabolic risk factor clustering and are considered ' healthy ' , and much attention has focused on the implication s of this state for obesity management .