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1.  Behavioral Self-Regulation and Weight-Related Behaviors in Inner-City Adolescents: A Model of Direct and Indirect Effects 
Childhood obesity (Print)  2011;7(4):306-315.
Background
This study examined the association of two distinct self-regulation constructs, effortful control and dysregulation, with weight-related behaviors in adolescents and tested whether these effects were mediated by self-efficacy variables.
Methods
A school-based survey was conducted with 1771 adolescents from 11 public schools in the Bronx, New York. Self-regulation was assessed by multiple indicators and defined as two latent constructs. Dependent variables included fruit/vegetable intake, intake of snack/junk food, frequency of physical activity, and time spent in sedentary behaviors. Structural equation modeling examined the relation of effortful control and dysregulation to lifestyle behaviors, with self-efficacy variables as possible mediators.
Results
Study results showed that effortful control had a positive indirect effect on fruit and vegetable intake, mediated by self-efficacy, as well as a direct effect. Effortful control also had a positive indirect effect on physical activity, mediated by self-efficacy. Dysregulation had direct effects on intake of junk food/snacks and time spent in sedentary behaviors.
Conclusions
These findings indicate that self-regulation characteristics are related to diet and physical activity and that some of these effects are mediated by self-efficacy. Different effects were noted for the two domains of self-regulation. Prevention researchers should consider including self-regulation processes in programs to improve health behaviors in adolescents.
PMCID: PMC3522174  PMID: 23243551
2.  Health Effects of Low-Carbohydrate Diets: Where Should New Research Go? 
Current diabetes reports  2013;13(2):271-278.
There has been considerable debate about the metabolic effects of restricting carbohydrate intake in weight and diabetes management. However, the American Diabetes Association has noted that weight and metabolic improvements can be achieved with low carbohydrate, low fat (implicitly higher carbohydrate), or a Mediterranean style diet (usually an intermediate level of carbohydrate). Our paper addresses variability in the definition for low or restricted carbohydrate, the effects of carbohydrate restriction on diabetes-related health outcomes, strategies for restricting carbohydrate intake, and potential genetic variability in response to dietary carbohydrate restriction. Issues for future research are also addressed.
doi:10.1007/s11892-012-0357-5
PMCID: PMC3595318  PMID: 23266565
diabetes; diet; nutrition; low carbohydrate; eating patterns; available carbohydrate; genetic variability; Paleolithic diet; nutrition guidelines; insulin resistance; gut hormones; health effects; diabetes; research
3.  Sleep and Cardiometabolic Function in Obese Adolescent Girls with Polycystic Ovary Syndrome 
Sleep medicine  2012;13(10):1307-1312.
Objective
To compare the polysomnography findings and cardiometabolic function among adolescent girls with PCOS and matched female and male controls.
Method
Retrospective chart review of electronic medical records of 28 girls with PCOS (age: 16.8±1.9 yrs, BMI Z-score 2.4±0.4), 28 control females (age: 17.1±1.8, BMI Z-score 2.4±0.3) and 28 control males (age: 16.6±1.6, BMI Z-score 2.5±0.5) in a tertiary care center.
Results
The prevalence of obstructive sleep apnea (OSA) was higher in girls with PCOS compared to control females (16/28 (57%) vs. 4/28(14.3%), p<0.01), however, was comparable to that of the control males (16/28(57%) vs. 21/28(75%), p=0.4). Girls with PCOS had a significantly higher prevalence of insulin resistance compared to control females and control males (20/28 (71.4%) vs. 9/22 (41.0%) (p=0.04) vs. 8/23 (34.8%) (p=0.01). Among girls with PCOS, those with OSA had significantly higher proportions of metabolic syndrome (9/16 (56.3% ) vs. 1/12 (8.3%) p=0.03), higher insulin resistance (13/16 (81.3%) vs. 5/12 (41.6%), p=0.03), elevated daytime systolic blood pressure (128.4±12.8 vs. 115.6±11.4, p<0.01), lower HDL (38.6±8.7 vs. 49±10.9, p=0.01) and elevated triglycerides (149.7±87.7 vs. 93.3±25.8, p=0.03) compared to those without OSA.
Conclusions
We report a higher prevalence of OSA and metabolic dysfunction in a selected group of obese girls with PCOS referred with sleep related complaints compared to BMI matched control girls without PCOS. We also report higher prevalence of cardiometabolic dysfunction in girls with PCOS and OSA compared to girls with PCOS without OSA.
doi:10.1016/j.sleep.2012.07.002
PMCID: PMC3509263  PMID: 22921588
AHI: Apnea hypopnea index; HDL: High density lipoprotein; HOMA-IR: Homeostatic model assessment a measure of Insulin resistance; MetS: Metabolic syndrome; OSA: Obstructive sleep apnea; PCOS: Polycystic ovary syndrome; TG: Triglyceride
4.  Associations of Obesity and Asthma with Functional Exercise Capacity in Urban Minority Adolescents 
Pediatric pulmonology  2012;47(11):1061-1069.
Summary
Purpose
To examine the independent association of asthma and obesity and of their coexistence with functional exercise capacity among urban adolescents.
Methods
One hundred and eighteen Hispanic and African American adolescents including 33 obese asthmatics, 18 normal-weight asthmatics, 38 obese non-asthmatics and 29 normal-weight non-asthmatics underwent anthropometric measures, 6 minute walk test (6MWT) as measure of functional exercise capacity and spirometry as measure of pulmonary function. The 6 minute walk distance (6MWD) was compared between the four study groups. The association of 6MWD with measures of lower airway obstruction, and measures of adiposity was assessed.
Results
The 6MWD was lower among the obese groups with the least distance covered by the obese asthmatic group (p=0.02). In the obese asthmatic group, there was a negative correlation between 6MWD and body mass index (BMI) (r= −0.35, p= 0.03) but no association was noted with percent-predicted Forced Expiratory Volume in the 1st second (FEV1) (r=0.07, p=0.70). Conversely, the 6MWD correlated with FEV1 among normal-weight asthmatics (r=0.45, p=0.04) and normal-weight non-asthmatics (r=0.4, p=0.03) but was not associated with BMI in either of the two groups. After adjusting for age, height, gender and ethnicity, BMI was noted to be a significant predictor (β −2.76, 95% CI −4.77- −0.76, p<0.01)) of the 6MWD among the obese while percent predicted FEV1 (β 1.87, 95%CI 0.28–3.45, p=0.02) was a significant predictor among the normal-weight participants.
Conclusions
Our findings suggest that among urban minority obese asthmatic adolescents, functional exercise capacity was associated with obesity, rather than pulmonary function.
doi:10.1002/ppul.22547
PMCID: PMC3389560  PMID: 22467360
Asthma; Obesity; Functional Exercise Capacity; Adolescents
5.  Considering Options for Attenuating Postmeal Glucose Excursions 
Diabetes Care  2010;33(12):2709-2710.
doi:10.2337/dc10-1653
PMCID: PMC2992216  PMID: 21115773
6.  High Prevalence of Obesity Among Inner-City Adolescent Boys in the Bronx, New York: Forgetting Our Boys 
Preventing Chronic Disease  2010;8(1):A23.
We examined sex differences in overweight and obesity in a sample of 1,619 inner-city adolescents. Participants were enrolled from 11 public schools in the Bronx, New York. The prevalence of overweight and obesity was 21.7% and 22.5%, respectively; prevalence of obesity was significantly higher among adolescent boys than adolescent girls (24.9 vs 20.1%). Childhood obesity is a public health concern in the United States, and the higher prevalence of obesity in adolescent boys requires additional attention.
PMCID: PMC3044034  PMID: 21159235
7.  Comparative Study of the Effects of a 1-Year Dietary Intervention of a Low-Carbohydrate Diet Versus a Low-Fat Diet on Weight and Glycemic Control in Type 2 Diabetes 
Diabetes Care  2009;32(7):1147-1152.
OBJECTIVE
To compare the effects of a 1-year intervention with a low-carbohydrate and a low-fat diet on weight loss and glycemic control in patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS
This study is a randomized clinical trial of 105 overweight adults with type 2 diabetes. Primary outcomes were weight and A1C. Secondary outcomes included blood pressure and lipids. Outcome measures were obtained at 3, 6, and 12 months.
RESULTS
The greatest reduction in weight and A1C occurred within the first 3 months. Weight loss occurred faster in the low-carbohydrate group than in the low-fat group (P = 0.005), but at 1 year a similar 3.4% weight reduction was seen in both dietary groups. There was no significant change in A1C in either group at 1 year. There was no change in blood pressure, but a greater increase in HDL was observed in the low-carbohydrate group (P = 0.002).
CONCLUSIONS
Among patients with type 2 diabetes, after 1 year a low-carbohydrate diet had effects on weight and A1C similar to those seen with a low-fat diet. There was no significant effect on blood pressure, but the low-carbohydrate diet produced a greater increase in HDL cholesterol.
doi:10.2337/dc08-2108
PMCID: PMC2699720  PMID: 19366978
8.  Self-Control Constructs Related to Measures of Dietary Intake and Physical Activity in Adolescents 
Purpose
To test self-regulation concepts in relation to dietary intake and physical activity patterns in adolescence, which we predicted to be influenced by components of a self-control model.
Methods
A survey was conducted with a multiethnic sample of 9th grade public school students in a metropolitan area (N = 539). Confirmatory analysis tested the measurement structure of self-control. Structural equation modeling tested the association of self-control constructs with measures of fruit and vegetable intake, saturated-fat intake, physical activity, and sedentary behavior.
Results
Confirmatory analysis of 14 indicators of self-control showed best fit for a two-factor structure, with latent constructs of good self-control (planfulness) and poor self-control (impulsiveness). Good self-control was related to more fruit and vegetable intake, more participation in sports, and less sedentary behavior. Poor self-control was related to more saturated-fat intake and less vigorous exercise. These effects were independent of gender, ethnicity, and parental education, which themselves had relations to diet and exercise measures. Multiple-group modeling indicated that effects of self-control were comparable across gender and ethnicity subgroups.
Conclusions
Self-control concepts are relevant for patterns of dietary intake and physical activity among adolescents. Attention to self-control processes may be warranted for prevention programs to improve health behaviors in childhood and adolescence.
doi:10.1016/j.jadohealth.2007.06.013
PMCID: PMC2190087  PMID: 18023783
self-control; diet; exercise; adolescents; gender; ethnicity

Results 1-8 (8)