Relationships between endogenous steroid hormone, sex hormone-binding globulin and lipoprotein levels in men: contribution of visceral obesity, insulin levels and other metabolic variables

Excess visceral adipose tissue (AT) and hyperinsulinemia are important correlates of an altered lipoprotein profile. It has also been reported that testosterone, adrenal C19 steroids and sex hormone-binding globulin (SHBG) concentrations are associated with plasma lipoprotein levels. The aim of the present study was to investigate the relative contributions of endogenous steroid hormone and SHBG levels, of visceral AT accumulation measured by computed tomography, and of fasting insulin and free fatty acid (FFA) concentrations to the variation of plasma lipoprotein levels in men. For this purpose, plasma concentrations of testosterone, dehydroepiandrosterone (DHEA), androstene-3beta,17beta-diol (delta5-DIOL), androstenedione (delta4-DIONE), estrone and estradiol, as well as SHBG levels were determined in a sample of 76 men covering a wide range of body fatness values. Higher testosterone levels were associated with a more favorable lipoprotein profile as it showed significant correlations with triglyceride (TG), total cholesterol and LDL-cholesterol (LDL-C) concentrations (r= -0.25, -0.25 and -0.27, respectively; P < 0.05). Higher plasma adrenal C19 steroid levels were also associated with a favorable lipoprotein profile as DHEA, delta4-DIONE and delta5-DIOL levels were negatively correlated with total cholesterol (r = -0.24, -0.33 and -0.24, respectively; P < 0.05) and LDL-C (r = -0.23, -0.31 and -0.28, respectively; P < 0.05). SHBG levels were negatively correlated with TG concentrations (r = -0.33; P < 0.005) whereas delta5-DIOL, testosterone and SHBG were negatively correlated with apolipoprotein B levels (-0.32 < or = r < or = -0.43; P < 0.005). Statistical adjustment for visceral AT area, fasting insulin, fasting free fatty acid (FFA) levels and total body fat mass eliminated most of the correlations between steroid and lipoprotein levels, while SHBG remained significantly correlated with lipoprotein concentrations after such adjustments. Multivariate analyses revealed that SHBG, delta4-DIONE, delta5-DIOL and metabolic variables all contributed to the variance in plasma lipoprotein concentrations (from 10 to 29% of explained variance). Visceral AT, fasting FFA and insulin levels as well as SHBG concentrations appeared to be independent correlates of lipoprotein concentrations. Thus, metabolic and anthropometric variables examined in the present study could have represented important confounding factors in previous studies which have examined the relationship of steroid hormones to plasma lipoprotein concentrations.

Segregation analysis of abdominal visceral fat: the HERITAGE Family Study

A major gene hypothesis for abdominal visceral fat (AVF) level, both before and after adjustment for total body fat mass, was investigated in 86 white families who participated in the HERITAGE Family Study. In this study, sedentary families were tested for a battery of measures (baseline), endurance exercise trained for 20 weeks, and then remeasured again. The baseline measures reported here are unique in that the variance due to a potentially important environmental factor (activity level) was limited. AVF area was assessed at L4 to L5 by the use of computerized tomography scan, and total body fat mass was assessed with underwater weighing. For fat mass, a putative locus accounted for 64% of the variance, but there was no evidence of a multifactorial component (i.e., no polygenic and/or common familial environmental effects). For AVF area, both a major gene effect accounting for 54% of the variance and a multifactorial component accounting for 17% of the variance were significant. However, after AVF area was adjusted for the effects of total level of body fat, the support for a major gene was reduced. In particular, there was a major effect for fat mass-adjusted AVF area, but it was not transmitted from parents to offspring (i.e., the three transmission probabilities were equal). The importance of this study is twofold. First, these results confirm a previous study that suggested that there is a putative major locus for AVF and for total body fat mass. Second, the findings from the HERITAGE Family Study suggest that the factors underlying AVF area in sedentary families may be similar to those in the population at large, which includes both sedentary and active families. Whether the gene(s) responsible for the high levels of AVF area is the same as that which influences total body fat content remains to be further investigated.

Identification of an obesity quantitative trait locus on mouse chromosome 2 and evidence of linkage to body fat and insulin on the human homologous region 20q

Chromosomal synteny between the mouse model and humans was used to map a gene for the complex trait of obesity. Analysis of NZB/BINJ x SM/J intercross mice located a quantitative trait locus (QTL) for obesity on distal mouse chromosome 2, in a region syntenic with a large region of human chromosome 20, showing linkage to percent body fat (likelihood of the odds [LOD] score 3.6) and fat mass (LOD score 4.3). The QTL was confirmed in a congenic mouse strain. To test whether the QTL contributes to human obesity, we studied linkage between markers located within a 52-cM region extending from 20p12 to 20q13.3 and measures of obesity in 650 French Canadian subjects from 152 pedigrees participating in the Quebec Family Study. Sib-pair analysis based on a maximum of 258 sib pairs revealed suggestive linkages between the percentage of body fat (P < 0.004), body mass index (P < 0.008), and fasting insulin (P < 0.0005) and a locus extending approximately from ADA (the adenosine deaminase gene) to MC3R (the melanocortin 3 receptor gene). These data provide evidence that a locus on human chromosome 20q contributes to body fat and insulin in a human population, and demonstrate the utility of using interspecies syntenic relationships to find relevant disease loci in humans.

Visceral fat in relation to health: is it a major culprit or simply an innocent bystander?

The aim of this review is to look critically at the widely accepted notion that visceral fat accumulation is the main determinant of obesity related diseases. Most of the epidemiological evidence is based on anthropometric indicators of fatness and fat distribution and their implications for visceral fat accumulation may not be unequivocal. In most cross-sectional studies in which visceral fat is associated with the level of risk factors or presence of disease, no adjustment is made for potential confounders. There are potential confounders at different levels of the causal chains linking visceral fat to health. Firstly, there are aspects of body composition or fat depots associated with visceral fat accumulation such as total body fat or total subcutaneous fat. Total and subcutaneous fat are, by themselves, potentially strong determinants for metabolic disturbances and disease. Secondly, there are behavioural factors (for example smoking, alcohol consumption, physical activity, dietary habits) which have been found to be associated with both the amount of visceral fat and health outcomes. Thirdly, there are hormonal mechanisms (adrenal and gonadal steroids as well as growth hormone) which may affect both the accumulation of visceral fat as well as the development of diseases. Finally, even if associations between visceral fat and risk factors or presence of diseases would be firmly established, the causality of the observed associations may not always be easy to interpret. Prospective studies are needed with appropriate control of potential confounding variables. It is concluded that, based on the current evidence, it is difficult to quantify the independent contribution of visceral fat to the development of a variety of chronic diseases.

Physical activity, fibrinogen plasma level and gene polymorphisms in postmenopausal women

The relations between habitual physical activity (PA), fibrinogen gene polymorphisms and plasma fibrinogen were investigated in 191 postmenopausal women. Subjects who reported PA at least 4 times/week had lower fibrinogen level (3.19 g/l; 95% CI 3.10; 3.27) than women reporting PA 2-3 times/week (3.43 g/l; 3.29; 3.58) or sedentary subjects (3.64 g/l; 3.33; 3.94). There were no differences in plasma fibrinogen across the alpha-fibrinogen (RsaI, TaqI) or beta-fibrinogen (MnlI, BclI, HindIII) genotypes, the frequencies of which were in a Hardy-Weinberg equilibrium. An interaction between RsaI, which was in complete linkage disequilibrium with TaqI, and PA on plasma fibrinogen was observed, even after adjustments for BMI, smoking and medication (p = 0.024). Among women homozygous for the common RsaI allele, the physically most active had lower fibrinogen level (p <0.001) compared to the physically less active subjects. These results suggest that, in postmenopausal women, the relation between physical activity and plasma fibrinogen is modulated by genetic variation in the alpha-fibrinogen gene.

Familial aggregation of obesity, candidate genes and quantitative trait loci

This brief review covers the findings reported in 1996 and in the first 2 months of 1997 on the genetic epidemiology and the molecular markers of human obesity. Although relatively little new evidence has been published on the heritability and other genetic epidemiology characteristics of obesity and fat topography, more has been reported on candidate genes, positional candidate genes and quantitative trait loci. Two recent genome-wide scans have revealed that several molecular markers on different chromosomes were linked to obesity-related phenotypes. Little support for a role for specific candidate genes can be found at this time. A large number of rodent quantitative trait loci have been uncovered so far but they have not yet been systematically tested in human populations.

Time course of training-induced changes in maximal exercise of short duration in men and women

The purpose of the present study was to test the hypothesis that gender differences are present in the extent and time course of exercise training-induced changes in maximal 10- and 90-s performance test. Thirty-six sedentary subjects (19 women and 17 men) were submitted to 15 weeks of training involving both continuous and interval ergocycle exercise sessions, while 13 other subjects (5 women and 8 men) served as a control group. Maximal power output after 10 s (P10) and 90s (P90) of cycling exercise was measured before and at each 5-week interval of the 15-week training period in both groups. Significant (p < 0.01) training-induced increases in performance were noted after 5 weeks, 10 weeks and 15 weeks of training for P10, and after 5 and 10 weeks for P90 in both genders. P10 and P90 were significantly increased in both genders (about 25% in men and 35% in women) following the 15-week training program and overall absolute increases were not statistically different between men and women. Slight increases (about 5%) in performance tests were observed in control subjects, but only during the first 5-week interval. P10 and P90 of women expressed as a percentage of that of men remained the same throughout the 15-week program. No significant relationship between pre-training values of P10 and their responses to training was found in men and women. In conclusion, results of the present study indicate that women have the same capacity to increase maximal short-term performance in response to training in comparison to men.

In the early stage of major burns, is there a correlation between survival, interleukin-6 levels and oxygen delivery and consumption?

The correlation between haemodynamic and oxymetric parameters, and circulating cytokines has been little studied for the early phase of extensive burns. The aim of this prospective study was to evaluate survival, looking at variations in cardiac index (CI), oxygen delivery (DO2I) and consumption (VO2I) indexed to the body surface area (BSA), and circulating interleukin-6 (IL6) levels in the acute stage of major burns. Over a 12-month period, all patients admitted within 6 h of extensive thermal injury with total burn surface area (TBSA) of over 60 per cent, necessitating standardized resuscitation and mechanical ventilation, were included. Routine intensive care monitoring, including pulmonary and femoral artery catheters, was set up. During the first 3 days post-injury haemodynamic and oxymetric profiles were recorded every 6 h. Circulating IL6 samples were taken within 6 h of admission, then daily (at 24, 48 and 72 h). A comparison of the results in survivors (S) and non-survivors (NS) at those previously determined times was made. Ten consecutive patients were studied. Six patients survived (Age = 33 +/- 10 years; TBSA = 76 +/- 11 per cent) and four died (Age = 40 +/- 14 years; TBSA = 77 +/- 13 per cent). Similar initial hypovolemic profiles were found in both groups. From 24 h, a hyperdynamic status was observed which increased until 72 h. This hyperkinetic evolution was more marked in the survivors (CI: 4.6 +/- 2.0 for NS and 6.9 +/- 1.51 min-1 m-2 for S; SVRI: 2125 +/- 1288 for NS and 918 +/- 232 dyne s cm-5 m2 for S at 72 h). DO2I and VO2I were always higher in the survivors. DO2I and VO2I increased from admission to 72 h in the survivors whereas a significant drop in DO2I and VO2I occurred in the non-survivors at 48 h (DO2I:536 +/- 222 for NS and 1228 +/- 268 ml min-1 m-2 for S; VO2I:120 +/- 50 for NS and 251 +/- 56 ml min-1 m-2 for S (P < 0.01)). Plasma IL6 revealed abnormal values with consistent peaks at 24-48 h in the survivors (respectively 17,411 +/- 24,542 and 10,746 +/- 11,802 pg ml-1) and only moderate peaks in the non-survivors (865 +/- 652 and 912 +/- 485 pg ml-1). Finally, CI, DO2I, VO2I and circulating IL6 were always higher, and SVRI lower, in the survivors than in the non-survivors. The ability to increase DO2 and to optimize VO2 during the 'turning point' of 48 h seems to improve the prognosis of critically burned patients: the role of IL6 in this systemic inflammatory response is discussed.

Acute and chronic effects of exercise on leptin levels in humans

The acute (single bout of exercise) and chronic (exercise training) effects of exercise on plasma leptin were investigated in 97 sedentary adult men (n = 51) and women (n = 46) participating in the HERITAGE Family Study. Exercise training consisted of a standardized 20-wk endurance training program performed in the laboratory on a computer-controlled cycle ergometer. Maximal oxygen uptake, body composition assessed by hydrostatic weighing, and fasting insulin level were also measured before and after training. Pre- and posttraining blood samples were obtained before and after completion of a maximal exercise test on the cycle ergometer. Exercise training resulted in significant changes in maximal oxygen uptake (increase in both genders) and body composition (reduction of fat mass in men and increase in fat-free mass in women). There were considerable interindividual differences in the leptin response to acute and chronic effects of exercise, some individuals showing either increase or reduction in leptin, others showing almost no change. On average, leptin levels were not acutely affected by exercise. After endurance training was completed, leptin levels decreased significantly in men (from 4.6 to 3.9 ng/ml; P = 0.004) but not in women. However, after the training-induced changes in body fat mass were accounted for, the effects of exercise training were no longer significant. Most of the variation observed in leptin levels after acute exercise or endurance training appears to be within the confidence intervals of the leptin assay. We conclude that there are no meaningful acute or chronic effects of exercise, independent of the amount of body fat, on leptin levels in humans.

Fat gain in female swimmers

The association between diet and body composition was investigated in 6 elite female swimmers subjected to a 13-month nutritional supervision and in 11 female untrained subjects matched for fat-free mass. The impact of a 2-month interruption of training on diet and body composition was also studied in the swimmers. A positive correlation was observed between the percentage of dietary energy as fat and percent body fat in the untrained subjects (r = 0.68, p < 0.05). When values of the swimmers were incorporated in the regression analysis, the correlation coefficient remained the same. Following detraining for 2 months, a 4.8-kg body weight gain, including 4.3 kg fat mass, was observed. The energy equivalent of these morphological changes was 170 MJ and corresponded to about the amount of energy that would have been normally expended during this detraining period. In conclusion, these results suggest that the association between diet and body composition is not altered by exercise training, and that body fat gain occurs in response to detraining, perhaps to promote the restoration of energy and fat balance.

Endurance training with constant energy intake in identical twins: changes over time in energy expenditure and related hormones

The effects of exercise training and of its interaction with the genotype on components of energy expenditure and related hormones were examined in young male monozygotic twins. Energy intake was maintained at the pretraining level for a 93-day training period. The estimated net energy deficit induced by training was 244 MJ and was associated with a 5-kg body weight loss that was almost entirely explained by body fat loss. Resting metabolic rate (RMR) was significantly decreased by 8% after training despite the preservation of fat-free mass (FFM). Accordingly, plasma norepinephrine (NE) concentrations, NE appearance rate, and plasma levels of triiodothyronine (T3), free T3, and total thyroxine (T4) were lower after training. The energy cost of standardized exercise was also reduced after the training program. A modest to significant within-twin-pair resemblance was observed for absolute changes in the RMR, thermic effect of food, energy cost of exercise, NE clearance, and plasma concentrations of thyroid hormones. These results suggest that when exercise training is associated with a substantial negative energy balance, energy expenditure and levels of related hormones are decreased, and this effect is partly accounted for by heredity.

Genetic influences on the response of body fat and fat distribution to positive and negative energy balances in human identical twins

This article summarizes a series of intervention studies conducted with pairs of young adult male identical twins and designed to determine whether there is any evidence for genotype x overfeeding or genotype x negative energy balance interaction effects in the changes in body weight, body composition, fat distribution, computerized tomography-assessed abdominal visceral fat, resting metabolic rate and thermic response to a standardized meal of mixed composition brought about by chronic exposure to appropriate experimental treatments. These studies demonstrated that individual differences in response to chronic alterations in energy balance are common. The comparison of the heterogeneity in response between the pairs of twins in contrast to the variance within pairs revealed that members of the same twin pair are significantly more alike than individuals who are not genetically related by descent. The intrapair resemblance in response was particularly strong for the changes in body mass, body composition, subcutaneous fat distribution and abdominal visceral fat. In contrast, the results of two long-term intervention studies showed that variations in resting metabolic rate following exposure to chronic overfeeding or negative energy balance induced by exercise were accounted for primarily by the changes in body mass. Finally, the thermic response to food was not modified by any of the experimental treatments. On the basis of these observations, we conclude that there are individuals at risk of gaining weight and body fat or who are resistant to weight loss. These differences in susceptibility to chronic overfeeding or in sensitivity to negative energy balance seem to be largely explained by genetic factors whose exact nature remains to be determined.

Regional variation in adipose tissue insulin action and GLUT4 glucose transporter expression in severely obese premenopausal women

Insulin action and GLUT4 expression were examined in adipose tissue of severely obese premenopausal women undergoing gastrointestinal surgery. Fat samples were taken from three different anatomical regions: the subcutaneous abdominal site, the round ligament (deep abdominal properitoneal fat), and the greater omentum (deep abdominal intraperitoneal fat). The stimulatory effect of insulin on glucose transport and the ability of the hormone to inhibit lipolysis were determined in adipocytes isolated from these three adipose depots. Insulin stimulated glucose transport 2-3 times over basal rates in all adipocytes. However, round ligament adipose cells showed a significantly greater responsiveness to insulin when compared to subcutaneous and omental adipocytes. Round ligament fat cells also displayed the greatest sensitivity and maximal antilipolytic response to insulin. We also investigated whether regional differences in fat cell insulin-stimulated glucose transport were linked to a differential expression of the GLUT4 glucose transporter. GLUT4 protein content in total membranes was 5 and 2.2 times greater in round ligament adipose tissue than in subcutaneous and omental fat depots, respectively. Moreover, GLUT4 mRNA levels were 2.1 and 3 times higher in round ligament than in subcutaneous or omental adipose tissues, respectively. Adipose tissue GLUT4 protein content was strongly and negatively associated (r = -0.79 to -0.89, p < 0.01) with the waist-to-hip ratio but not with total adiposity. In conclusion, these results demonstrate the existence of site differences in adipose tissue insulin action in morbidly obese women. The greater insulin effect on glucose transport in round ligament adipocytes was associated with a higher expression of GLUT4 when compared to subcutaneous abdominal and omental fat cells. Moreover, despite the regional variation in GLUT4 expression, an increased proportion of abdominal fat was found to be associated with lower levels of GLUT4 in all adipose regions investigated.

Variation in plasma fibrinogen over one year: relationships with genetic polymorphisms and non-genetic factors

We analyzed plasma fibrinogen level in relation to genetic polymorphisms in the alpha- and beta-fibrinogen gene loci. Furthermore, the association of other CVD risk markers with fibrinogen was studied twice, with a time interval of one year in 50 to 60 year old men (n = 183). DNA polymorphisms were detected by PCR and digestion with Taq I (alpha-fibrinogen), Hind III and Bcl I (beta-fibrinogen) restriction enzymes. The correlation coefficient between fibrinogen measurements was 0.48 (p < 0.001). Blood leucocytes and waist-to-hip circumference ratio were the strongest correlates of fibrinogen level in both examinations, and the changes in leucocyte count and plasma fibrinogen correlated positively (r = 0.40, p < 0.001). In Eastern Finnish men, the Taq I, Hind III or Bcl I restriction fragment length polymorphisms of the alpha- or beta-fibrinogen gene loci did not associate with fibrinogen level, either cross-sectionally or longitudinally.

Androstane-3alpha,17beta-diol glucuronide as a steroid correlate of visceral obesity in men

Plasma levels of androstane-3alpha,17beta-diol glucuronide (3alpha-DIOL-G) and androsterone glucuronide (ADT-G) as well as testosterone and adrenal C19 steroid concentrations were measured in a sample of 80 men in whom visceral adipose tissue (AT) accumulation was also determined by computed tomography. Plasma 3alpha-DIOL-G concentrations showed significant positive correlations with total body fat mass (r = 0.31; P < 0.05) and percent body fat (r = 0.28; P < 0.05). Furthermore, plasma 3alpha-DIOL-G levels were significantly associated with visceral adipose tissue accumulation (r = 0.41; P < 0.0005) as well as fasting plasma insulin (r = 0.35; P < 0.005) and glycemic and insulinemic responses to an oral glucose load (r = 0.39; P < 0.0005 and r = 0.32; P < 0.005, respectively). However, associations between 3alpha-DIOL-G and plasma glucose-insulin homeostasis indexes were no longer significant after adjustment for visceral AT area. ADT-G levels were not significantly associated with any of the adiposity variables. Subjects matched for abdominal sc AT area but with either low or high levels of visceral AT area showed significant differences in 3alpha-DIOL-G concentrations (P < 0.05), whereas subjects with low or high levels of abdominal sc AT but similar levels of visceral AT had similar 3alpha-DIOL-G concentrations. Among men with high testosterone levels, subjects with reduced 3alpha-DIOL-G concentrations had lower visceral adipose tissue accumulation than subjects with increased 3alpha-DIOL-G levels. The present results indicate that plasma 3alpha-DIOL-G, but not ADT-G, is a steroid correlate of visceral obesity. Excess visceral adipose tissue and/or concomitant alterations in insulin levels or in vivo insulin action could be responsible for the increased 3alpha-DIOL-G formation observed in this condition.

Abdominal visceral fat is associated with a BclI restriction fragment length polymorphism at the glucocorticoid receptor gene locus

Several investigations have suggested that body fat distribution is influenced by nonpathologic variations in the responsiveness to cortisol. Genetic variations in the glucocorticoid receptor (GRL) could therefore potentially have an impact on the level of abdominal fat. A restriction fragment length polymorphism (RFLP) has previously been detected with the BclI restriction enzyme in the GRL gene identifying two alleles with fragment lengths of 4.5 and 2.3 kb. This study investigates whether abdominal fat areas measured by computerized tomography (CT) are associated with this polymorphism in 152 middle-aged men and women. The less frequent 4.5-kb allele was found to be associated with a higher abdominal visceral fat (AVF) area independently of total body fat mass (4.5/4.5 vs. 2.3/2.3 kb genotype; men: 190.7 +/- 30.1 vs. 150.7 +/- 33.3 cm2, p = 0.04; women: 132.7 +/- 37.3 vs. 101.3 +/- 34.5 cm2, p = 0.06). However, the association with AVF was seen only in subjects of the lower tertile of the percent body fat level. In these subjects, the polymorphism was found to account for 41% (p = 0.003) and 35% (p = 0.007), in men and women, respectively, of the total variance in AVF area. The consistent association between the GRL polymorphism detected with BclI and AVF area suggests that this gene or a locus in linkage disequilibrium with the BclI restriction site may contribute to the accumulation of AVF.

Body composition by DEXA in older adults: accuracy and influence of scan mode

Dual energy x-ray absorptiometry (DEXA) measures bone mineral content (BMC), bone mineral density (BMD), fat-free mass (FFM), and provides estimates of percent body fat. Changes in scan mode geometry (pencil beam vs array) may impact these measures and body composition estimates using multi-compartment models. Forty-one adults, ages 59-79 yr, were scanned in each mode and also underwent hydrostatic weighing and measurement of total body water (tritiated water dilution). The effect of scan mode on measurement of DEXA BMC, BMD, FFM, and percent body fat (DEXA %Fat) was examined. The effect of scan mode on percentage body fat determined by a 4-compartment body composition model (4 Comp %Fat) and comparison of DEXA %Fat and 4 Comp %Fat were also examined. BMC and DEXA %Fat were greater (1.3% and 3.9%, respectively, P < 0.01), and BMD and FFM were lower (1.1% and 1.9%, respectively, P < 0.01) with the array scan mode. The 4 Comp %Fat was significantly greater (0.2%) when the array scan mode measurements of total body bone mineral were used; however, these differences were physiologically inconsequential. Comparison between DEXA %Fat and 4 Comp %Fat measures revealed a total error of +/-5.0% in the older adults examined. These results indicate significant scan mode differences in total body BMC, BMD, FFM, and DEXA %Fat measurements and demonstrate the importance of using a single DEXA scan mode for clinical investigation, particularly with longitudinal studies. For all investigations with DEXA, the scan mode should be reported. Furthermore, the error associated with using DEXA alone to estimate percent fat in an older population suggests that this technique is unacceptable in a research setting.

Reproducibility of anthropometric and body composition measurements: the HERITAGE Family Study

OBJECTIVE

To determine the reproducibility of anthropometric and body composition measures using the HERITAGE Family Study protocol.

DESIGN

Anthropometric and body composition measures were obtained on three separate days within a 3-wk period at each of the four HERITAGE Clinical Centers.

SUBJECTS

Sixty men and women representative of the HERITAGE subject population, 15 from each of four Clinical Centers.

MEASUREMENTS

Anthropometric measures included eight skinfolds, three girths and one length; and body composition measures included stature, mass, hydrostatic weight, residual volume, and body density, from which relative fat, fat mass and fat-free mass were estimated.

RESULTS

Reproducibility as determined by technical error, coefficient of variation, and intraclass correlations was very high for the total sample. For example, intraclass correlations for the total sample generally ranged from 0.95-0.99 for the anthropometric measures, and from 0.97-1.00 for the body composition measures. The results across Clinical Centers were in close agreement with each other and with the pooled data.

CONCLUSIONS

The reproducibility of anthropometric and body composition measures using the HERITAGE Family Study protocol is sufficiently high that it should be possible to detect small changes in any of these measures and to determine the genetic basis of these changes consequent to a 20 wk endurance training program.

Suggestive linkages between markers on human 1p32-p22 and body fat and insulin levels in the Quebec Family Study

A single-gene rodent mutation (diabetes) and a quantitative trait locus (dietary obese 1) mapped to the mid portion of mouse chromosome 4 have been related to obesity and/or insulin levels. Synteny relationships place their putative human homologs on 1p31 and 1p35-p31, respectively. In 137 sibships of adult brothers and sisters from the Québec Family Study, genetic linkages between seven microsatellite markers from 1p32-p22 and various obesity- and diabetes-related quantitative phenotypes were examined using single locus sibpair linkage analysis. Suggestive linkages were observed between markers D1S476 and body mass index (p = 0.05), fat mass (p = 0.02), the sum of six skinfolds (p = 0.02), the insulin area after an oral glucose tolerance test (p = 0.02), and between the neighboring marker D1S200 and body mass index (p = 0.03), and fat mass (p = 0.009). Suggestive linkages were also observed between the more telomeric markers D1S193 and body mass index (p = 0.03), and between the neighboring marker D1S197 and fasting insulin level (p = 0.05). No linkage was observed with the trunk to extremity skinfolds ratio. These linkages suggest that human homologs of the mouse diabetes or dietary obese 1 and/or other genes in this interval on chromosome 1 play a role in the regulation of body mass, body composition, and insulin levels, but not of subcutaneous fat distribution.

The MspI polymorphism of the apolipoprotein A-II gene as a modulator of the dyslipidemic state found in visceral obesity

The aim of the present study was to examine the effect of variation at the apolipoprotein (apo) A-II gene locus on lipoprotein levels in visceral obesity. A total of 145 sedentary men, free from metabolic disorders requiring pharmacotherapy, were classified into two groups on the basis of their apo A-II-MspI genotype determined by the polymerase chain reaction: 1) 43 M1 carriers or M1M2, including two M1M1 homozygotes and 41 M1M2 heterozygotes, and 2) 102 M2M2 homozygotes for the presence of a MspI restriction site. The two genotypic groups did not differ for body mass index (BMI, expressed in kg/m2), body fat mass, visceral adipose tissue (AT) accumulation, as well as for insulin, glucose and free fatty acids levels measured in the fasting state and in response to an oral glucose tolerance test. In addition, 65 and 63% of M1 carriers had plasma HDL2 cholesterol levels and a HDL2/HDL3 cholesterol ratio below the 50th percentile of their distributions compared with 45%(P < 0.05) and 46%(P = 0.06), respectively, in M2M2 homozygotes. When subjects were further divided on the basis of visceral AT accumulation (below and above a value of 130 cm2), M1 carriers with low levels of visceral AT were characterized by high plasma HDL cholesterol and HDL2 cholesterol concentrations as well as by a higher HDL2/HDL3 ratio, compared with M1 carriers with high levels of visceral AT (> 130 cm2), or with M2M2 homozygotes with either a high or a low accumulation of visceral AT. Furthermore, M1 carriers with high levels of visceral AT showed a trend for lower plasma HDL2 cholesterol levels and were characterized by a significantly lower HDL2/HDL3 cholesterol ratio compared with the other three groups. No difference in HDL and HDL2 cholesterol levels and in the HDL2/HDL3 cholesterol ratio was noted when M2 homozygotes with lower versus higher levels of visceral AT were compared. The contribution of hyperinsulinemia was also examined by dividing subjects on the basis of the 50th percentile of the integrated insulin response to an oral glucose challenge. Significantly lower plasma HDL2 cholesterol levels and a reduced HDL2/HDL3 cholesterol ratio were noted among M1 carriers with high plasma insulin responses compared with M1 carriers with low insulin responses. Among M2M2 homozygotes, no difference was noted in plasma HDL cholesterol and in HDL2 cholesterol concentrations between men with low versus high insulin responses to the oral glucose load. These results suggest that the apo A-II-MspI polymorphism could modulate plasma HDL cholesterol levels among visceral obese, insulin-resistant men.

Glucose metabolism in identical twins discordant for obesity. The critical role of visceral fat

Obesity, especially intraabdominally deposited fatness, is associated with reduced insulin sensitivity. However, it is not well established whether this association is confounded by genetic factors. We studied 23 monozygous twin pairs (14 female, 9 male), 33-59 yr old, who had, on the average, 18 kg intrapair difference in body weight. A 75-g oral glucose tolerance test with glucose and insulin measurements at 30-min intervals was performed, and fat distribution was determined with magnetic resonance imaging. The pairs were divided into two groups by the gender-specific median of the abdominal visceral fat area (AVF) in the obese co-twins. In the high-AVF pairs, the mean area under curve (AUC) for glucose (mmol x min/L) was 758 vs. 968 (P = 0.001), AUC for insulin (mU x min/L) was 4320 vs. 8741 (P = 0.001), and insulin sensitivity index (mg x L x L/mmol x mU x min) was 71.5 vs. 45.9 (P < 0.001) in the lean and obese co-twins, respectively. In the low AVF pairs, the mean AUC for glucose was 669 vs. 706 (not significant), AUC for insulin was 3323 vs. 4241 (not significant), and the sensitivity index was 85.2 vs. 73.7 (P = 0.04) in the lean and obese co-twins, respectively. In subjects who are genetically identical but who are discordant for body mass, only those who differ most in visceral fat level are characterized by major alterations in insulin sensitivity and glucose tolerance.

Negative energy balance with exercise in identical twins: plasma glucose and insulin responses

The effects of long-term (93 days) negative energy balance on plasma glucose and insulin were investigated by means of exercise with constant energy intake in seven pairs of young sedentary male identical twins. Results showed a significant decrease in fasting (-24%, P < 0.02) and postprandial insulin (-16%, P < 0.05). Fasting and postprandial plasma glucose and glucagon were not modified. Mean glucose disposal rate measured during a euglycemic-hyperinsulinemic clamp performed in five twin pairs was increased by 34% (P = 0.13). No significant intrapair similarity was found for the responses of fasting and postprandial insulin levels and of glucose disposal rate. Changes in glucose disposal rate were significantly greater in high compared with low losers for computerized tomography-measured abdominal visceral fat (3.0 +/- 1.1 vs. 0.3 +/- 0.5 mg x kg(-1) x min(-1), P < 0.05) despite similar losses in total body fat. We conclude that 1) a long-term negative energy balance generated by exercise training significantly reduces plasma insulin levels, whereas insulin sensitivity tends to be improved; 2) training-induced changes in insulin sensitivity are associated with changes in abdominal visceral fat; and 3) data from this experiment conducted with a small number of twin pairs suggest that the genotype does not seem to be a major determinant of the changes in insulin levels and sensitivity brought about by negative energy balance with exercise.

Energy and macronutrient balances for humans in a whole body metabolic chamber without control of preceding diet and activity level

OBJECTIVE

To examine the relationships between 24 h energy and macronutrient balances in a whole body metabolic chamber subsequent to periods when subjects maintained their normal food intake and physical activity levels.

SUBJECTS

Thirteen males and 17 females were studied for two 24 h sessions while consuming an estimated isocaloric diet with a food quotient of 0.85.

MEASUREMENTS

Energy expenditure and macronutrient oxidation rates were measured twice for 24 h in whole body indirect calorimeter.

RESULTS

Positive and significant correlations were evident between energy and lipid balances (r = 0.38, P < 0.05 and r = 0.54, P < 0.01, respectively) and differences between the two sessions for energy and lipid balances were also significantly correlated (r = 0.40, P < 0.05). Accounting for carbohydrate or protein balances improved the strength of each of these associations.

CONCLUSION

These results indicate that for subjects in a small but significant positive energy balance, with uncontrolled diet and activity preceding their metabolic chamber sessions, that 24 h energy balance is positively correlated with lipid balance. Accounting for associations between lipid, carbohydrate, protein and energy balances, improved the strength of the association between 24 h lipid and energy balances. The implications of these results are that in these conditions modifications to lipid balance are important for weight maintenance.