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Background: In the US, Europe, and throughout the world, abdominal obesity prevalence is increasing. Depressive symptoms may contribute to abdominal obesity through the consumption of diets high in energy density. Purpose: To test dietary energy density ([DED]; kilocalories/gram of food and beverages consumed) for an independent relationship with abdominal obesity or as a mediator between depressive symptoms and abdominal obesity. Methods: This cross-sectional study included 87 mid-life, overweight adults; 73.6% women; 50.6% African-American. Variables and measures: Beck Depression Inventory-II (BDI-II) to measure depressive symptoms; 3-day weighed food records to calculate DED; and waist circumference, an indicator of abdominal obesity. Hierarchical regression tested if DED explained waist circumference variance while controlling for depressive symptoms and consumed food and beverage weight. Three approaches tested DED as a mediator. Results: Nearly three-quarters of participants had abdominal obesity, and the mean waist circumference was 103.2 (SD 14.3) cm. Mean values: BDI-II was 8.67 (SD 8.34) which indicates that most participants experienced minimal depressive symptoms, and 21.8% reported mild to severe depressive symptoms (BDI-II ≥ 14); DED was 0.75 (SD 0.22) kilocalories/gram. Hierarchical regression showed an independent association between DED and waist circumference with DED explaining 7.0% of variance above that accounted for by BDI-II and food and beverage weight. DED did not mediate between depressive symptoms and abdominal obesity. Conclusions: Depressive symptoms and DED were associated with elevated waist circumference, thus a comprehensive intervention aimed at improving depressive symptoms and decreasing DED to reduce waist circumference is warranted.

Purpose The purpose of this study was to explore potential factors affecting the self-management behaviors of Korean immigrants with type 2 diabetes mellitus (KIT2Ds). Methods A qualitative descriptive design guided this study. Semistructured interviews lasting 45 to 60 minutes were conducted with 20 KIT2Ds in the participants’ preferred language; in all cases, this was Korean. Each interview was audiotaped, transcribed, and analyzed using conventional content analysis. Data analysis was performed in two steps. The data written in Korean were initially analyzed by 3 bilingual researchers. A qualitative researcher then participated in the analysis to refine the findings for presentation to an English-speaking audience while staying true to the data and preserving the nuanced Korean meanings. Results The mean age of the sample was 64. 5 ± 11.6 years (9 men and 11 women). The mean years of staying in the United States and age at diabetes mellitus diagnosis were 23.6 ± 9.7 years and 52.5 ± 12.3 years, respectively. Three major ideas were identified: (1) issues on treatment regimen related to medications and diet, (2) resources that helped or hindered ability to manage diabetes, and (3) the physician-patient relationship. Conclusions Important cultural nuances need to be addressed to better prepare KIT2Ds to manage their diabetes more effectively. A culture-specific program should extend beyond a diabetes self-management education delivered in Korean language. Rather, content and education methods need to consider acculturation effects on diabetes management behaviors. Article NotesThis study was supported by a Sigma Theta Tau International / American Association of Diabetes Educator Foundation Collaborative Grant for 2011 (principal investigator: E. S. Cha). We thank Sunhee Kim, MD, Cosmo Health Care; Ms HyeYoung Kim, Center for Pan Asian Community Service; translators; and study participants. © 2012 The Author(s)

Simultaneous adherence with multiple self-care instructions among heart failure (HF) patients is not well described. Patient-reported adherence to 8 recommendations related to exercise, alcohol, medications, smoking, diet, weight, and symptoms was assessed among 308 HF patients using the Medical Outcomes Study Specific Adherence Scale questionnaire (0=“never” to 5=“always,” maximum score=40). A baseline cumulative score of ≥32/40 (average ≥80%) defined good adherence. Clinical events (death/transplantation/ventricular assist device), resource utilization, functional capacity (6-minute walk distance), and health status (Kansas City Cardiomyopathy Questionnaire [KCCQ]) were compared among patients with and without good adherence. The mean follow-up was 2.0±1.0 years, and adherence ranged from 26.3% (exercise) to 89.9% (medications). A cumulative score indicating good adherence was reported by 35.7%, whereas good adherence with every behavior was reported by 9.1% of patients. Good adherence was associated with fewer hospitalizations (all-cause 87.8 vs 107.6; P=.018; HF 29.6 vs 43.8; P=.007) and hospitalized days (all-cause 422 vs 465; P=.015; HF 228 vs 282; P

ObjectivesTo assess the effects of a home-based aerobic and resistance training program on the physical function of adults with New York Heart Association (NYHA) class II and III patients and systolic heart failure (HF).DesignRandomized controlled trial.SettingHome based.ParticipantsStable patients (N=24; mean age, 60±10y; left ventricular ejection fraction, 25%±9%; 50% white; 50% women) with New York Heart Association (NYHA) classes II and III (NYHA class III, 58%) systolic heart failure (HF).InterventionA 12-week progressive home-based program of moderate-intensity aerobic and resistance exercise. Attention control wait list participants performed light stretching and flexibility exercises.Main Outcome MeasuresA 10-item performance-based physical function measure, the Continuous Scale Physical Functional Performance test (CS-PFP10), was the major outcome variable and included specific physical activities measured in time to complete a task, weight carried during a task, and distance walked. Other measures included muscle strength, HRQOL (Minnesota Living With Heart Failure Questionnaire, Epworth Sleepiness Scale), functional capacity (Duke Activity Status Index), and disease severity (brain natriuretic peptide) levels.

Background and Purpose: Prevalence of adolescent obesity has increasedworldwide. Although diet and exercise patterns are major determinants ofweight, recent studies with adults and children have shown that total amountof sleep is inversely associated with body mass index (BMI). The purpose ofthis study was to examine associations among total sleep time (TST), hunger,satiety, food cravings, and caloric intake in a sample of healthy adolescents.Design-Methods: Participants were recruited from the community and a localhigh school. Demographic data such as sleeping habits, pubertal status, foodcravings, caloric intake, physical activity, height, and weight were collectedbetween October 2006 and April 2007. Participants also completed a 7-daysleep-hunger-satiety diary. Descriptive and parametric procedures were usedfor data analyses (α=.05).Findings: The sample (N=85) included 56% females (n=48), 76% AfricanAmerican (n=65) adolescents. Mean age was 15.6±1.4 years and mean BMIwas 24.3±5.4 kg/m2. Mean reported 7-day cumulative nocturnal sleep was52.9 (±6.0) hours; mean reported cumulative daytime sleep (or napping) was3.7 (±3.4) hours. Multiple regression analyses showed age, gender, and racewere associated with feelings of hunger, satiety, total food cravings and caloricintake. A greater total food-cravings score was associated with increased daytimesleep.Conclusions: These findings indicate an unexpected association between increaseddaytime sleep and eating behaviors that potentially lead to obesity.Longitudinal studies using objective measures of sleep, appetite regulation, andcaloric intake are needed to better understand relationships between appetiteand sleep in adolescents from varying racial and gender groups.Clinical Relevance: By carefully considering adolescent sleep (especially daytimesleep), race, and gender, clinicians and school health nurses in the US andother countries are in a unique position to develop novel approaches to preventand reduce obesity.