Original article Weight cycling is associated with body weight excess and abdominal fat accumulation: A cross-sectional study q Emanuele Cereda a, f, * , Alexis Elias Malavazos b, f , Riccardo Caccialanza a , Mariangela Rondanelli c, f , Giuseppe Fatati d, f , Michela Barichella e a Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy b U.O. di Diabetologia e Malattie Metaboliche, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy c Ambulatorio di Dietologia, Dipartimento di Scienze Sanitarie Applicate e Psicocomportamentali, Sezione di Nutrizione, Azienda di Servizi alla Persona di Pavia, Università degli Studi di Pavia, Pavia, Italy d U.O. di Dietetica e Nutrizione Clinica, Azienda Ospedaliera “S.Maria”, Terni, Italy e Servizio di Dietetica e Nutrizione Clinica, Istituti Clinici di Perfezionamento, Milano, Italy article info Article history: Received 12 May 2011 Accepted 22 June 2011 Keywords: Weight cycling Body mass index (BMI) Waist circumference Central fat mass Weight management summary Background & aims: To investigate the association between history of multiple weight loss diets followed by weight regain, namely weight cycling (WCy), and both body weight excess and abdominal fat accumulation. Methods: A one-day cross-sectional survey (“Obesity-Day”) including 914 participants (605F:309M). Anthropometric variables (body mass index [BMI], waist circumference [WC] and waist-to-height ratio [WtHR]), covariates and WCy (5 intentional weight loss episodes of 5 kg followed by rapid return to pre-diet or higher body weight) were assessed by a self-administered questionnaire, interview and physical examination. Results: Data on central fat accumulation (by WC and WtHR) were available in a representative sub-group (n ¼ 600). WCy was reported by 119 participants (13.0%) of total population and by 79 (13.2%) of those with available data on central fat accumulation. At multivariable linear regressions WCy was indepen- dently associated with higher BMI (P ¼ .004), WC (P ¼ .011) and WtHR (P ¼ .008). Sensitivity analyses, performed after excluding those being on a diet at the time of assessment, confirmed these findings. Conclusions: A history of WCy appears related to body weight excess and abdominal fat accumulation. These findings support the importance of designing adequate weight loss programs to achieve long-term weight maintenance and to prevent undesirable and unhealthy weight accumulation. Ó 2011 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved. 1. Introduction Obesity is a widespread problem with important implications on health. 1e4 Contributing to several chronic disorders, it is indeed responsible of high costs for Public Health Systems which in turn are continuously struggling against this by designing effective resolution programs. 5e8 The main determinant of overweight/obesity-related health complications is indeed the adipose tissue (AT). However, not the whole body fat exerts adverse effect on health status. It is well known that AT localized in the abdominal region, particularly visceral AT, is more directly involved in the pathophysiology of chronic degenerative disorders particularly through insulin resistance and related complications. 9e13 Accordingly, beside the body mass index (BMI), simple anthropometric surrogates of body fat distribution, such as waist circumference (WC) or the waist-to-height ratio (WtHR), have been introduced in clinical practice to improve risk prediction. BMI has been initially intro- duced to account for exceeding whole body adiposity but it shows limited accuracy, particularly at higher degrees of obesity. Thus, it is a less reliable parameter for describing intra-abdominal fat accumulation when compared to other well-tailored proxy indicators. 14e16 With this background, overweight and obese patients should be enforced to obtain weight loss. Actually, dietary programs coupled q Abstract accepted for presentation to: 33th ESPEN Congress 2011, to be held in Gothenburg, Sweden. * Corresponding author. Tel.: þ39 0382 501615; fax: þ39 0382 502801. E-mail address: e.cereda@smatteo.pv.it (E. Cereda). f The ADI Lombardia Study Group, for further details see statement of authorship in Appendix. Contents lists available at ScienceDirect Clinical Nutrition journal homepage: http://www.elsevier.com/locate/clnu 0261-5614/$ e see front matter Ó 2011 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved. doi:10.1016/j.clnu.2011.06.009 Clinical Nutrition 30 (2011) 718e723