Healthy obesity as an intermediate state of risk: A critical review

Introduction: Obesity is a top public health priority but interventions to reverse the condition have had limited success. About 1-in-3 obese adults are free of metabolic risk factor clustering and are considered ‘healthy', and much attention has focused on the implications of this state for obesity management. Areas covered: We searched for individual studies, systematic reviews, and meta-analyses which examined correlates and outcomes of metabolically healthy obesity. We discuss the key roles of fat distribution and physical activity in determining healthy vs. unhealthy obesity and report a greatly increased risk of incident type 2 diabetes associated with healthy obesity vs. healthy normal-weight, among other outcomes. 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. We recommend that weight loss through energy restriction be a stand-alone target in addition to increased physical activity for minimising risk of future disease

An experimental test of all theories with predictive power beyond quantum theory

According to quantum theory, the outcomes of future measurements cannot (in general) be predicted with certainty. In some cases, even with a complete physical description of the system to be measured and the measurement apparatus, the outcomes of certain measurements are completely random. This raises the question, originating in the paper by Einstein, Podolsky and Rosen, of whether quantum mechanics is the optimal way to predict measurement outcomes. Established arguments and experimental tests exclude a few specific alternative models. Here, we provide a complete answer to the above question, refuting any alternative theory with significantly more predictive power than quantum theory. More precisely, we perform various measurements on distant entangled photons, and, under the assumption that these measurements are chosen freely, we give an upper bound on how well any alternative theory could predict their outcomes. In particular, in the case where quantum mechanics predicts two equally likely outcomes, our results are incompatible with any theory in which the probability of a prediction is increased by more than ~0.19. Hence, we can immediately refute any already considered or yet-to-be-proposed alternative model with more predictive power than this.Comment: 13 pages, 4 figure

Testing nonlocality over 12.4 km of underground fiber with universal time-bin qubit analyzers

We experimentally demonstrate that the nonlocal nature of time-bin entangled photonic qubits persists when one or two qubits of the pair are converted to polarization qubits. This is possible by implementing a novel Universal Time-Bin Qubit Analyzer (UTBA), which, for the first time, allows analyzing time-bin qubits in any basis. We reveal the nonlocal nature of the emitted light by violating the Clauser-Horne-Shimony-Holt inequality with measurement bases exploring all the dimensions of the Bloch sphere. Moreover, we conducted experiments where one qubit is transmitted over a 12.4 km underground fiber link and demonstrate the suitability of our scheme for use in a real-world setting. The resulting entanglement can also be interpreted as hybrid entanglement between different types of degrees of freedom of two physical systems, which could prove useful in large scale, heterogeneous quantum networks. This work opens new possibilities for testing nonlocality and for implementing new quantum communication protocols with time-bin entanglement.Comment: 6 pages, 5 figure

Masculinity in Adolescent Males’ Early Romantic and Sexual Heterosexual Relationships

There is a need to understand better the complex interrelationship between the adoption of masculinity during adolescence and the development of early romantic and sexual relationships. The purpose of this study was to describe features of adolescent masculinity and how it is expressed in the contexts of early to middle adolescent males’ romantic and sexual relationships. Thirty-three 14- to 16-year-old males were recruited from an adolescent clinic serving a community with high sexually transmitted infection rates and were asked open-ended questions about their relationships—how they developed, progressed, and ended. Participants described a high degree of relationally oriented beliefs and behaviors related to romantic and sexual relationships, such as a desire for intimacy and trust. The males also described a more limited degree of conventionally masculine beliefs and behaviors. These beliefs and behaviors often coexisted or overlapped. Implications for the clinical care of similar groups of adolescents are described

Tropical Forests Of Oceania. Anthropological Perspectives

The tropical forests of Oceania are an enduring source of concern for indigenous communities, for the migrants who move to them, for the states that encompass them within their borders, for the multilateral institutions and aid agencies, and for the non-governmental organisations that focus on their conservation. Grounded in the perspective of political ecology, contributors to this volume approach forests as socially alive spaces produced by a confluence of local histories and global circulations. In doing so, they collectively explore the multiple ways in which these forests come into view and therefore into being. Exploring the local dynamics within and around these forests provides an insight into regional issues that have global resonance. Intertwined as they are with cosmological beliefs and livelihoods, as sites of biodiversity and Western desire, these forests have been and are still being transformed by the interaction of foreign and local entities. Focusing on case studies from Papua New Guinea, the Solomon Islands and the Gambier Islands, this volume brings new perspectives on how Pacific Islanders continue to creatively engage with the various processes at play in and around their forests

Improving risk estimates for metabolically healthy obesity and mortality using a refined healthy reference group

Objective: We aimed to re-examine mortality risk estimates for metabolically healthy obesity by using a ‘stable’ healthy non-obese referent group. Design: prospective cohort study. Methods: Participants were 5,427 men and women (aged 65.9 ± 9.4 years, 45.9% men) from the English Longitudinal Study of Ageing. Obesity was defined as body mass index ≥ 30 kg/m2 (vs. non-obese as below this threshold). Based on blood pressure, HDL-cholesterol, triglycerides, glycated haemoglobin, and C-reactive protein, participants were classified as ‘healthy’ (0 or 1 metabolic abnormality) or ‘unhealthy’ (≥ 2 metabolic abnormalities). Results: 671 deaths were observed over an average follow up of 8 years. When defining the referent group based on 1 clinical assessment, the unhealthy non-obese (Hazard ratio = 1.22; 95% CI, 1.01, 1.45) and unhealthy obese (1.29; 1.05, 1.60) were at greater risk of all-cause mortality compared to the healthy non-obese, yet no excess risk was seen in the healthy obese (1.14; 0.83, 1.52). When we re-defined the referent group based on 2 clinical assessments, effect estimates were accentuated and healthy obesity was at increased risk of mortality (2.67; 1.64, 4.34). Conclusion: An unstable healthy referent group may make ‘healthy obesity’ appear less harmful by obscuring the benefits of remaining never obese without metabolic dysfunction

Metabolically healthy obesity and risk of incident type 2 diabetes: a meta-analysis of prospective cohort studies

The risk of type 2 diabetes among obese adults who are metabolically healthy has not been established. We systematically searched Medline (1946–August 2013) and Embase (1947–August 2013) for prospective studies of type 2 diabetes incidence (defined by blood glucose levels or self-report) among metabolically healthy obese adults (defined by body mass index [BMI] and normal cardiometabolic clustering, insulin profile or risk score) aged ≥18 years at baseline. We supplemented the analysis with an original effect estimate from the English Longitudinal Study of Ageing (ELSA), with metabolically healthy obesity defined as BMI ≥ 30 kg m−2 and <2 of hypertension, impaired glycaemic control, systemic inflammation, adverse high-density lipoprotein cholesterol and adverse triglycerides. Estimates from seven published studies and ELSA were pooled using random effects meta-analyses (1,770 healthy obese participants; 98 type 2 diabetes cases). The pooled adjusted relative risk (RR) for incident type 2 diabetes was 4.03 (95% confidence interval = 2.66–6.09) in healthy obese adults and 8.93 (6.86–11.62) in unhealthy obese compared with healthy normal-weight adults. Although there was between-study heterogeneity in the size of effects (I2 = 49.8%; P = 0.03), RR for healthy obesity exceeded one in every study, indicating a consistently increased risk across study populations. Metabolically healthy obese adults show a substantially increased risk of developing type 2 diabetes compared with metabolically healthy normal-weight adults. Prospective evidence does not indicate that healthy obesity is a harmless condition

Nonthermal Bremsstrahlung and Hard X-ray Emission from Clusters of Galaxies

We have calculated nonthermal bremsstrahlung (NTB) models for the hard X-ray (HXR) tails recently observed by BeppoSAX in clusters of galaxies. In these models, the HXR emission is due to suprathermal electrons with energies of about 10-200 keV. Under the assumption that the suprathermal electrons form part of a continuous spectrum of electrons including highly relativistic particles, we have calculated the inverse Compton (IC) extreme ultraviolet (EUV), HXR, and radio synchrotron emission by the extensions of the same populations. For accelerating electron models with power-law momentum spectra (N[p] propto p^{- mu}) with mu <~ 2.7, which are those expected from strong shock acceleration, the IC HXR emission exceeds that due to NTB. Thus, these models are only of interest if the electron population is cut-off at some upper energy <~1 GeV. Similarly, flat spectrum accelerating electron models produce more radio synchrotron emission than is observed from clusters if the ICM magnetic field is B >~ 1 muG. The cooling electron model produces vastly too much EUV emission as compared to the observations of clusters. We have compared these NTB models to the observed HXR tails in Coma and Abell 2199. The NTB models require a nonthermal electron population which contains about 3% of the number of electrons in the thermal ICM. If the suprathermal electron population is cut-off at some energy above 100 keV, then the models can easily fit the observed HXR fluxes and spectral indices in both clusters. For accelerating electron models without a cutoff, the electron spectrum must be rather steep >~ 2.9.Comment: Accepted for publication in the Astrophysical Journal. 10 pages with 5 embedded Postscript figures in emulateapj.sty. An abbreviated abstract follow

Examining associations between physical activity and cardiovascular mortality using negative control outcomes

Background: The purpose of a negative control is to reproduce a condition that cannot involve the hypothesized causal mechanism, but does involve the same sources of bias and confounding that may distort the primary association of interest. Observational studies suggest physical inactivity is a major risk factor for cardiovascular disease (CVD) although potential sources of bias, including reverse causation and residual confounding, make it difficult to infer causality. The aim was to employ a negative control outcome to explore the extent to which the association between physical activity and CVD mortality is explained by confounding. Methods: The sample comprised 104,851 participants (aged 47 ± 17 yrs; 45.4% male) followed up over mean [SD] 9.4±4.5 years, recruited from The Health Survey for England and the Scottish Health Surveys. Results: There were 10,309 deaths, of which 3,109 were attributed to CVD, and 157 to accidents (negative control outcome). Accidental death was related to age, male sex, smoking, longstanding illness and psychological distress, with some evidence of social patterning. This confounding structure was similar to that seen with CVD mortality, suggesting that our negative control outcome was appropriate. Physical activity (per SD unit increase in MET-hr-wk) was inversely associated with CVD (HR=0.75; 95% CI, 0.70, 0.80); the point estimate between physical activity and accidental death was in the same direction but of lesser magnitude (HR=0.86; 0.69, 1.07). A linear dose-response pattern was observed for physical activity and CVD but not with the negative control. Conclusions: Inverse associations between physical activity and risk of CVD mortality are likely causal but of a smaller magnitude than commonly observed. Negative control studies have potential to improve causal inference within the physical activity field