Obesity: the disease of the twenty-first century

Predictors of weight loss in young adults who are over-weight or obese and have psychosocial problems: a post hoc analysis

Background

The aim of this study is in a general practice trial setting to identify predictive factors for weight loss after 1 year among young adults who are over-weight or obese and who have several psychosocial problems.

Methods

Twenty-eight general practitioners recruited 495 patients aged 20–45 years with psychosocial problems for a randomized general preventive study to increase self-efficacy to achieve a self-prioritised goal for a better life by discussions of resources and barriers for reaching the goal. The present study is a post hoc analysis of possible predictors of weight loss among all 218 patients who have over-weight or obesity. A 23-pages questionnaire was completed before and 1 year after randomization. 111 patients had a one-hour preventive health consultation with their general practitioners focused on life coaching and a follow-up consultation within 3 months, and 107 patients had no preventive consultation.

Results

Twenty-two patients stated during the preventive consultation that weight loss was a prioritised goal. They had a mean weight loss of 4.7 kgs compared with 1.6 kgs in the group without this goal and 1.6 kgs in the group without preventive consultation. In a logistic regression model, predictors of weight loss or no weight loss were a) pre-interventional consideration of weight loss within 30 days, b) having weight loss as a prioritised goal for improved quality of life, c) being female, d) being in the oldest half of participants, and e) having many psychosocial problems. In a linear regression model, the predictors together explained about 11 % of the weight loss. Important predictors were: obesity (explained 4 %), pre-interventional consideration of weight loss within 30 days (3 %), and having a preventive health consultation with weight loss as a prioritised goal (2 %).

Conclusions

Pre-interventional consideration of weight loss within 30 days and having weight loss as a prioritised goal during the health consultation were two important predictors for weight loss. By structured interventions focussing on the patients’ priorities, self-chosen goals, their resources and barriers for reaching the goals, changes may be obtained; especially in participants with many problems who often do not accept participation in procedures on risks.

ClinicalTrials gov Registration

NCT 01231256, Aug. 22. 2010.

Central and peripheral fat body mass have a protective effect on osteopenia or osteoporosis in adults and elderly?

This cross-sectional study involves randomly selected men aged 50 to 99 years and postmenopausal women. Either central fat mass or peripheral fat mass were associated to osteoporosis or osteopenia independently from fat-free body mass and other confounding factors.

INTRODUCTION

Obesity and osteoporosis are public health problems that probably share common pathophysiological mechanisms. The question if body fat mass, central or peripheral, is protective or harmful for osteoporosis or osteopenia is not completely resolved. This study aims to investigate the association between osteoporosis or osteopenia, and fat body mass (central and peripheral) independently from fat-free body mass, in men aged 50 to 99 years old and postmenopausal women randomly selected in the community.

METHODS

This is a cross-sectional investigation with a random sample of registered population in Niterói Family Doctor Program (FDP), State of Rio de Janeiro, Brazil. Bone mineral density (BMD) and fat-free mass were assessed by dual X-ray absorptiometry (DXA).

RESULTS

There was statistically significant bivariate association between bone loss with gender, age, skin color, alcohol consumption at risk dose, use of thiazide, fat-free body mass, and fat body mass (central and peripheral). In the multiple analysis of fat-free body mass, central and peripheral fat body mass showed an independent and protective effect on the presence of osteoporosis or osteopenia (p value <0.001).

CONCLUSION

Since both obesity and osteoporosis are public health problems worldwide, strategies aimed at preventing both conditions should be encouraged during aging.

The pathophysiological basis of bone tissue alterations associated with eating disorders

Anorexia nervosa (AN) and obesity are two major eating disorders present nowadays in Western countries. They are both characterized by striking body composition variations and hormonal alterations, which impact on skeletal metabolism, inducing bone tissue modifications and, thus, often cause an increased risk for fractures. AN and obesity are characterized by a severe reduction in fat mass and a high expression of it, respectively, and in both conditions hormones secreted or modulated by body fat content are important determinants of low bone density, impaired bone structure and reduced bone strength. In addition, in both AN and obesity, increased marrow adiposity, which correlates with low bone density, has been observed. This review will discuss the pathophysiological basis of bone alterations associated with AN and obesity, conditions of extreme energy deficiency and excess, respectively.

The obesity of bone

During the last decades, obesity and osteoporosis have become important global health problems, and the belief that obesity is protective against osteoporosis has recently come into question. In fact, some recent epidemiologic and clinical studies have shown that a high level of fat mass might be a risk factor for osteoporosis and fragility fractures. Several potential mechanisms have been proposed to explain the complex relationship between adipose tissue and bone. Indeed, adipose tissue secretes various molecules, named adipokines, which are thought to have effects on metabolic, skeletal and cardiovascular systems. Moreover, fat tissue is one of the major sources of aromatase, an enzyme that synthesizes estrogens from androgen precursors, hormones that play a pivotal role in the maintenance of skeletal homeostasis, protecting against osteoporosis. Moreover, bone cells express several specific hormone receptors and recent observations have shown that bone-derived factors, such as osteocalcin and osteopontin, affect body weight control and glucose homeostasis. Thus, the skeleton is considered an endocrine target organ and an endocrine organ itself, likely influencing other organs as well. Finally, adipocytes and osteoblasts originate from a common progenitor, a pluripotential mesenchymal stem cell, which has an equal propensity for differentiation into adipocytes or osteoblasts (or other lines) under the influence of several cell-derived transcription factors. This review will highlight recent insights into the relationship between fat and bone, evaluating both potential positive and negative influences between adipose and bone tissue. It will also focus on the hypothesis that osteoporosis might be considered the obesity of bone.

Agavins reverse the metabolic disorders in overweight mice through the increment of short chain fatty acids and hormones

In this study, the effects of agavins (branched fructans) along with a diet shift on metabolic parameters, short chain fatty acid (SCFA) production and gastrointestinal hormones in overweight mice were established. Male C57BL/6 mice were fed with a standard (ST) or high fat (HF) diet over the course of 5 weeks, with the objective to induce overweightness in the animals, followed by a diet shift (HF_ST) and a diet shift with agavins (HF_ST + A) or inulin (HF_ST + O) for 5 additional weeks. After the first 5 weeks, the HF group showed a 30% body weight gain and an increase in glucose, triglyceride and cholesterol concentrations of 9%, 79% and 38% respectively when compared to the ST group (P < 0.05). Only the overweight mice that received agavins or inulin in their diets reversed the metabolic disorders induced by consumption of the HF diet, reaching the values very close to those of the ST group (P < 0.05). Furthermore, the consumption of agavins or inulin led to higher SCFA concentrations in the gut and modulated hormones such as GLP-1 and leptin involved in food intake regulation (P < 0.05). These findings demonstrate that a change of diet and fructan consumption such as agavins is a good alternative to increase weight loss and to improve the metabolic disorders associated with being overweight.

The Health at Every Size paradigm and obesity: missing empirical evidence may help push the reframing obesity debate forward

A Health at Every Size (HAES) approach has been proposed to address weight bias and stigma in individuals living with obesity, and more recently articulated as a promising public health approach beyond the prevailing focus on weight status as a health outcome. The purpose of this article is to examine our understanding of HAES within the context of public health approaches to obesity, and to present strengths and limitations of the available evidence. Advancing our understanding of HAES from a public health perspective requires us to move beyond an ideological debate and give greater attention to the need for empirical studies across a range of populations. Only then can the value of HAES, as a weight-neutral, public health approach for the prevention of obesity and other chronic diseases, be fully understood.

Literature review: perceptions and management of body size among normal weight and moderately overweight people

Improved understanding of how normal weight and moderately overweight people manage their body weight and shape could be used to inform initiatives to prevent and treat obesity. This literature review offers a thorough appraisal of existing research into perceptions and management of own body size among normal weight and moderately overweight people. The studies reported in the 47 publications reviewed here address various themes based on different conceptualizations. The studies point out that normal weight and moderately overweight people are much concerned about their body size, but huge discrepancies are found between their own perceptions and study categorizations. The studies also indicate that normal weight and moderately overweight people are actively engaged in managing their body size through numerous managing strategies, and dieting is widespread. Together the studies do not form a unified and coherent research field, and there is a bias towards North American study populations. Methodological problems were identified in some publications, raising questions about generalizability of the findings. Moreover, only few studies give deeper insight into the specific perceptions and actions. Repeated studies are needed in broader and more differentiated geographical, social and cultural contexts, and longitudinal studies and more in-depth explorations are especially needed.

Automated ingestion detection for a health monitoring system

Obesity is a global epidemic that imposes a financial burden and increased risk for a myriad of chronic diseases. Presented here is an overview of a prototype automated ingestion detection (AID) process implemented in a health monitoring system (HMS). The automated detection of ingestion supports personal record keeping which is essential during obesity management. Personal record keeping allows the care provider to monitor the therapeutic progress of a patient. The AID-HMS determines the levels of ingestion activity from sounds captured by an external throat microphone. Features are extracted from the sound recording and presented to machine learning classifiers, where a simple voting procedure is employed to determine instances of ingestion. Using a dataset acquired from seven individuals consisting of consumption of liquid and solid, speech, and miscellaneous sounds, > 94% of ingestion sounds are correctly identified with false positive rates around 9% based on 10-fold cross validation. The detected levels of ingestion activity are transmitted and stored on a remote web server, where information is displayed through a web application operating in a web browser. This information allows remote users (health provider) determine meal lengths and levels of ingestion activity during the meal. The AID-HMS also provides a basis for automated reinforcement for the patient.

miR-709 inhibits 3T3-L1 cell differentiation by targeting GSK3β of Wnt/β-catenin signaling

Adipocyte differentiation is tightly regulated by altering gene expression in which microRNAs might be strong post-transcriptional regulators. In this study, we examined the roles of miR-709 in adipogenic differentiation of 3T3-L1 preadipocyte. We found that miR-709 expression was down-regulated during adipogenesis after MDI (1-methyl-3-isobutylxanthine, dexamethasone and insulin) stimulation in normal cultured 3T3-L1 cells, while up-regulated after LiCl treatment. Overexpression of miR-709 inhibited adipogenic differentiation of 3T3-L1 cells. We demonstrated that miR-709 directly targeted 3' UTR of GSK3β (glycogen synthase kinase 3 beta). Overexpression of miR-709 decreased GSK3β protein but not mRNA level. Furthermore, the inhibition of miR-709 could be counteracted by overexpression of GSK3β during 3T3-L1 adipogenic differentiation. In addition, miR-709 increased both protein and mRNA levels of β-catenin, which is the downstream effector of GSK3β in Wnt/β-catenin signaling pathway, and subsequently elevated the expression of target of β-catenin which represses adipogenesis. These data indicate that miR-709 inhibits adipocyte differentiation through targeting GSK3β and subsequently activating Wnt/β-catenin signaling pathway.

Life cycle development of obesity and its determinants in six European countries

This paper empirically examines the effect of parents' and individuals' own socioeconomic status on overweight and obesity, and investigates how this effect changes over the life cycle. The impact of individuals' health behaviours on their obesity status later in life is also studied. We use data from Denmark, Finland, France, Greece, the Netherlands and the U.K. in which 4595 individuals aged 50-65 are surveyed and where individuals' height and weight at different ages (25, 35, 45 and current age) are available. We perform "repeated cross-sections" analyses as well as dynamic probit analyses of the individuals' obesity histories. We contribute to the literature by examining the role of a variety of obesity determinants over the whole life cycle, not only over a certain portion of individuals' lives. Key findings are: (i) parents' socioeconomic status predicts obesity in early adulthood whereas the individual's own socioeconomic status as adult is more important in explaining obesity at later stages of the life cycle, (ii) changes in obesity status are associated with changes in health behaviours, (iii) obesity in late adulthood is strongly and positively correlated with overweight and obesity in younger ages, and (iv) cross-country differences in obesity and overweight largely remain after controlling for parental and childhood factors and individuals' health behaviours.

Metabolomics of Ramadan fasting: an opportunity for the controlled study of physiological responses to food intake

High-throughput screening techniques that analyze the metabolic endpoints of biological processes can identify the contributions of genetic predisposition and environmental factors to the development of common diseases. Studies applying controlled physiological challenges can reveal dysregulation in metabolic responses that may be predictive for or associated with these diseases. However, large-scale epidemiological studies with well controlled physiological challenge conditions, such as extended fasting periods and defined food intake, pose logistic challenges. Culturally and religiously motivated behavioral patterns of life style changes provide a natural setting that can be used to enroll a large number of study volunteers. Here we report a proof of principle study conducted within a Muslim community, showing that a metabolomics study during the Holy Month of Ramadan can provide a unique opportunity to explore the pre-prandial and postprandial response of human metabolism to nutritional challenges. Up to five blood samples were obtained from eleven healthy male volunteers, taken directly before and two hours after consumption of a controlled meal in the evening on days 7 and 26 of Ramadan, and after an over-night fast several weeks after Ramadan. The observed increases in glucose, insulin and lactate levels at the postprandial time point confirm the expected physiological response to food intake. Targeted metabolomics further revealed significant and physiologically plausible responses to food intake by an increase in bile acid and amino acid levels and a decrease in long-chain acyl-carnitine and polyamine levels. A decrease in the concentrations of a number of phospholipids between samples taken on days 7 and 26 of Ramadan shows that the long-term response to extended fasting may differ from the response to short-term fasting. The present study design is scalable to larger populations and may be extended to the study of the metabolic response in defined patient groups such as individuals with type 2 diabetes.

The prevalence of osteoporosis in an older population with very high body mass index: evidence for an association

BACKGROUND

Studies have demonstrated the beneficial effect of normal and high body mass index (BMI) upon risk of osteoporosis (OP). No study has investigated the prevalence of OP in an older population with a very high BMI (higher than 40 kg/m(2) ).

METHODS

Data of patients aged over 50 years that attended for a dual energy X-ray absorptiometry scan at a UK district general hospital were collated. The population was divided according to BMI increments of 5 kg/m(2) . The prevalence of OP for each BMI category was ascertained. Logistic regression analysis was used to investigate for significant associations between BMI and OP prevalence, adjusted for age, sex and number of OP risk factors.

RESULTS

Data of 10,796 study subjects were collated. Mean age was 67.34 years. Decreasing prevalence of OP was associated with increasing BMI up to 40 kg/m(2) , above which increasing BMI was associated with increasing prevalence of OP.

CONCLUSIONS

The protective effect of increasing BMI exists up to 40 kg/m(2) . A BMI higher than 40 kg/m(2) is associated with increased prevalence of OP. This finding may be attributable to reduced level of bone weight bearing in individuals with a very high BMI.

The magnolia bioactive constituent 4-O-methylhonokiol protects against high-fat diet-induced obesity and systemic insulin resistance in mice

Obesity is caused by a combination of both genetic and environmental risks. Disruption in energy balance is one of these risk factors. In the present study, the preventive effect on high-fat diet- (HFD-) induced obesity and insulin resistance in mice by Magnolia bioactive constituent 4-O-methylhonokiol (MH) was compared with Magnolia officinalis extract BL153. C57BL/6J mice were fed by normal diet or by HFD with gavage-administered vehicle, BL153, low-dose MH, and high-dose MH simultaneously for 24 weeks, respectively. Either MH or BL153 slightly inhibited body-weight gain of mice by HFD feeding although the food intake had no obvious difference. Body fat mass and the epididymal white adipose tissue weight were also mildly decreased by MH or BL153. Moreover, MH significantly lowered HFD-induced plasma triglyceride, cholesterol levels and activity of alanine transaminase (ALT), liver weight and hepatic triglyceride level, and ameliorated hepatic steatosis. BL153 only significantly reduced ALT and liver triglyceride level. Concurrently, low-dose MH improved HFD-induced hyperinsulinemia and insulin resistance. Furthermore, the infiltration of mast cells in adipose tissue was decreased in MH or in BL153 treatment. These results suggested that Magnolia bioactive constituent MH might exhibit potential benefits for HFD-induced obesity by improvement of lipid metabolism and insulin resistance.

Abdominal Fat and Sarcopenia in Women Significantly Alter Osteoblasts Homeostasis In Vitro by a WNT/ β -Catenin Dependent Mechanism

Obesity and sarcopenia have been associated with mineral metabolism derangement and low bone mineral density (BMD). We investigated whether imbalance of serum factors in obese or obese sarcopenic patients could affect bone cell activity in vitro. To evaluate and characterize potential cellular and molecular changes of human osteoblasts, cells were exposed to sera of four groups of patients: (1) affected by obesity with normal BMD (O), (2) affected by obesity with low BMD (OO), (3) affected by obesity and sarcopenia (OS), and (4) affected by obesity, sarcopenia, and low BMD (OOS) as compared to subjects with normal body weight and normal BMD (CTL). Patients were previously investigated and characterized for body composition, biochemical and bone turnover markers. Then, sera of different groups of patients were used to incubate human osteoblasts and evaluate potential alterations in cell homeostasis. Exposure to OO, OS, and OOS sera significantly reduced alkaline phosphatase, osteopontin, and BMP4 expression compared to cells exposed to O and CTL, indicating a detrimental effect on osteoblast differentiation. Interestingly, sera of all groups of patients induced intracellular alteration in Wnt/ β -catenin molecular pathway, as demonstrated by the significant alteration of specific target genes expression and by altered β -catenin cellular compartmentalization and GSK3 β phosphorylation. In conclusion our results show for the first time that sera of obese subjects with low bone mineral density and sarcopenia significantly alter osteoblasts homeostasis in vitro, indicating potential detrimental effects of trunk fat on bone formation and skeletal homeostasis.

Magnolia extract (BL153) protection of heart from lipid accumulation caused cardiac oxidative damage, inflammation, and cell death in high-fat diet fed mice

Magnolia as an herbal material obtained from Magnolia officinalis has been found to play an important role in anti-inflammation, antioxidative stress, and antiapoptosis. This study was designed to investigate the effect of Magnolia extract (BL153) on obesity-associated lipid accumulation, inflammation, oxidative stress, and apoptosis in the heart. C57BL/6 mice were fed a low- (10 kcal% fat) or high-fat (60 kcal% fat) diet for 24 weeks to induce obesity. These mice fed with high-fat diet (HFD) were given a gavage of vehicle, 2.5, 5, or 10 mg/kg body weight BL153 daily. The three doses of BL153 treatment slightly ameliorated insulin resistance without decrease of body weight gain induced by HFD feeding. BL153 at 10 mg/kg slightly attenuated a mild cardiac hypertrophy and dysfunction induced by HFD feeding. Both 5 mg/kg and 10 mg/kg of BL153 treatment significantly inhibited cardiac lipid accumulation measured by Oil Red O staining and improved cardiac inflammation and oxidative stress by downregulating ICAM-1, TNF-α, PAI-1, 3-NT, and 4-HNE. TUNEL staining showed that BL153 treatment also ameliorated apoptosis induced by mitochondrial caspase-3 independent cell death pathway. This study demonstrates that BL153 attenuates HFD-associated cardiac damage through prevention of HFD-induced cardiac lipid accumulation, inflammation, oxidative stress, and apoptosis.

Age-associated (cardio)metabolic diseases and cross-talk between adipose tissue and skeleton: endocrine aspects

Aged individuals continue to increase in number, and it is important to understand the pathophysiological mechanisms of age-related changes in order to develop interventions that could contribute to “successful aging”. Metabolic and hormonal factors, age-related changes in body composition, and a decline in physical activity are all involved in the tendency to lose muscle mass, to gain fat mass, and, also, to experience bone loss. Obesity, sarcopenia, and osteoporosis are important widespread health problems that lead to high prevalence of both mortality and morbidity. Indeed, during the last decades, obesity and osteoporosis have become a major health threat around the world. Aging increases the risk of developing obesity, sarcopenia, osteoporosis, and, also, cardiovascular diseases. A reduction of both bone and muscle mass with a corresponding increase of fat mass and inflammation and hormonal imbalance in the elderly lead to and may synergistically increase cardiovascular diseases. This review will focus on the relationship among these different medical situations, trying to clarify the cellular and molecular mechanisms.

Weight reduction improves sleep, sleepiness and metabolic status in obese sleep apnoea patients

SUMMARY

METHOD

In this prospective intervention study, 33 obese patients with obstructive sleep apnoea syndrome (OSAS) (24 men, 9 women) were consecutively enrolled for a weight reduction program at the Obesity Unit, Karolinska University Hospital. 23 of 33 patients used OSAS-device, 19 with Continuous Positive Airway Pressure and 4 with Mandibular Retaining Device. The patients were investigated with questionnaires, blood tests and ambulant nocturnal polysomnography before and after a 6-month program. Patients with OSAS-device slept without it during the sleep studies. The intervention consisted of 8 weeks low calorie diet and group meetings, followed by a day-care program of behaviour change support.

RESULTS

27 of 33 patients (82%, 21 men and 6 women) completed the study. After the intervention there were highly significant decreases (p < 0.001) in Body Mass Index from mean(S.D.) 40(5) to 34(3), apnoea-hypopnoea index from 43(24) to 26(20) and Epworth Sleepiness Scale (ESS)-score from 9(4) to 6(4). Sleep quality (arousal index, sleep efficiency, percentage deep sleep) and metabolic status (blood pressure, blood glucose levels, lipidemia) were also significantly improved. There was a significant correlation between increased percentage deep sleep and reduced ESS-score. There were no differences due to gender or use/no use of OSAS-device.

CONCLUSION

The results suggest that weight loss, induced by low calorie diet and behaviour change support, significantly improves nocturnal respiratory parameters, sleep quality, daytime sleepiness and metabolic status in obese OSAS patients after 6 months.

The Relationship Between Different Body Mass Index Categories and Chair Rise Performance in Adult Women

An important prerequisite to carry out daily activities is the sit-to-stand movement. However, in obese people, this movement is characterized by altered biomechanics, which might lead to daily life activity impairments. The aim of this study was to investigate whether there are differences in kinetic and kinematic variables between three different BMI categories when performing a specific sit-to-stand test. Thirty-six adult women (BMI = 17–45 kg/m2) performed the sit-to stand test five times consecutively and as quickly as possible. Analyses of variance were used to determine differences between three BMI groups (normal or overweight: BMI < 30 kg/m2; obese: 30 ≤ BMI < 35; severely obese: BMI ≥ 35). Peak and mean vertical sacrum velocity indicated a decrease in severely obese subjects. Obese and severely obese individuals did not show higher fatigue over the five consecutive movements. Peak force and rate of force development decreased in normal or overweight subjects. The ability to successfully complete the test decreased with a higher BMI, probably due to a reduced ability to rapidly generate a high force.

Training veterans to provide peer support in a weight-management program: MOVE!

Introduction

The Veterans Health Administration (VHA) has implemented MOVE!, a weight-management program for veterans designed to address the increasing proportion of overweight and obese veterans. The objective of our study was to determine whether peer support employing motivational interviewing (MI) could positively influence lifestyle changes, thus expanding the reach of the MOVE! program. We describe the initial evaluation of the peer training program.

Methods

We developed an MI peer counselor training program for volunteer veterans, the “Buddies” program, to provide one-on-one telephone support for veterans enrolled in MOVE!. Buddies were recruited at 5 VHA sites and trained to provide peer support for the 6-month MOVE! intervention. We used a DVD to teach MI skills and followed with 2 to 3 booster sessions. We observed training, conducted pre- and posttraining surveys, and debriefed focus groups to assess training feasibility.

Results

Fifty-six Buddies were trained. Results indicate positive receipt of the program (89% reported learning about peer counseling and 87% reported learning communication skills). Buddies showed a small improvement in MI self-efficacy on posttraining surveys. We also identified key challenges to learning MI and training implementation.

Conclusions

MI training is feasible to implement and acceptable to volunteer Buddies. Trainers must assess how effectively volunteers learn MI skills in order to enhance its effective use in health promotion.

Skeletal alterations in women affected by obesity

Obesity has always been considered a protective factor for the skeleton and for osteoporosis. However, new epidemiologic and clinical data have shown that high level of fat mass might be a risk factor for osteoporosis and fragility fractures. Further, increasing evidences seem to indicate that the different components of metabolic syndrome (i.e. hypertension, increased triglycerides, and reduced high-density lipoprotein cholesterol) are also potential risk factors for the development of low bone mineral density and osteoporosis.

Long-term supplementation of honokiol and magnolol ameliorates body fat accumulation, insulin resistance, and adipose inflammation in high-fat fed mice

SCOPE

This study investigated the effect of honokiol (HON) and magnolol (MAG), phenolic compounds in Magnolia plants, on adiposity and adiposity-related metabolic disturbances in mice fed high-fat diet (HFD), and the potential underlying mechanisms focusing on the lipid metabolism and inflammatory response.

METHOD AND RESULTS

C57BL/6J mice were fed HFD (45 kcal% fat) with or without HON (0.02%, w/w) or MAG (0.02%, w/w) for 16 wk. Despite no changes in body weight, food intake, and hepatic fat accumulation, HON and MAG significantly lowered the weight of white adipose tissue (WAT) as well as adipocyte size and protected against insulin resistance induced by HFD. These effects were associated with increases in energy expenditure and adipose fatty acid oxidation and decreases in fatty acid synthase activity and expression of genes related to fatty acid synthesis, desaturation, and uptake, as well as adipocyte differentiation in WAT. Moreover, HON and MAG significantly lowered the expression of proinflammatory genes in WAT and elevated the plasma IL-10 level. Particularly, HON significantly decreased the plasma resistin level and increased the plasma adiponectin level compared to the control group.

CONCLUSION

HON and MAG have potential as novel agents for amelioration of adiposity and associated insulin resistance and inflammation.

Effect of Green Tea Extract/Poly-γ-Glutamic Acid Complex in Obese Type 2 Diabetic Mice

BACKGROUND

The increasing prevalence of type 2 diabetes mellitus (T2DM) is associated with the rapid spread of obesity. Obesity induces insulin resistance, resulting in β-cell dysfunction and thus T2DM. Green tea extract (GTE) has been known to prevent obesity and T2DM, but this effect is still being debated. Our previous results suggested that circulating green tea gallated catechins (GCs) hinders postprandial blood glucose lowering, regardless of reducing glucose and cholesterol absorption when GCs are present in the intestinal lumen. This study aimed to compare the effect of GTE with that of GTE coadministered with poly-γ-glutamic acid (γ-PGA), which is likely to inhibit the intestinal absorption of GCs.

METHODS

The db/db mice and age-matched nondiabetic mice were provided with normal chow diet containing GTE (1%), γ-PGA (0.1%), or GTE+γ-PGA (1%:0.1%) for 4 weeks.

RESULTS

In nondiabetic mice, none of the drugs showed any effects after 4 weeks. In db/db mice, however, weight gain and body fat gain were significantly reduced in the GTE+γ-PGA group compared to nondrug-treated db/db control mice without the corresponding changes in food intake and appetite. Glucose intolerance was also ameliorated in the GTE+γ-PGA group. Histopathological analyses showed that GTE+γ-PGA-treated db/db mice had a significantly reduced incidence of fatty liver and decreased pancreatic islet size. Neither GTE nor γ-PGA treatment showed any significant results.

CONCLUSION

These results suggest that GTE+γ-PGA treatment than GTE or γ-PGA alone may be a useful tool for preventing both obesity and obesity-induced T2DM.

Green tea extract with polyethylene glycol-3350 reduces body weight and improves glucose tolerance in db/db and high-fat diet mice

Green tea extract (GTE) is regarded to be effective against obesity and type 2 diabetes, but definitive evidences have not been proven. Based on the assumption that the gallated catechins (GCs) in GTE attenuate intestinal glucose and lipid absorption, while enhancing insulin resistance when GCs are present in the circulation through inhibiting cellular glucose uptake in various tissues, this study attempted to block the intestinal absorption of GCs and prolong their residence time in the lumen. We then observed whether GTE containing the nonabsorbable GCs could ameliorate body weight (BW) gain and glucose intolerance in db/db and high-fat diet mice. Inhibition of the intestinal absorption of GCs was accomplished by co-administering the nontoxic polymer polyethylene glycol-3350 (PEG). C57BLKS/J db/db and high-fat diet C57BL/6 mice were treated for 4 weeks with drugs as follows: GTE, PEG, GTE+PEG, voglibose, or pioglitazone. GTE mixed with meals did not have any ameliorating effects on BW gain and glucose intolerance. However, the administration of GTE plus PEG significantly reduced BW gain, insulin resistance, and glucose intolerance, without affecting food intake and appetite. The effect was comparable to the effects of an α-glucosidase inhibitor and a peroxisome proliferator-activated receptor-γ/α agonist. These results indicate that prolonging the action of GCs of GTE in the intestinal lumen and blocking their entry into the circulation may allow GTE to be used as a prevention and treatment for both obesity and obesity-induced type 2 diabetes.

Negative association between trunk fat, insulin resistance and skeleton in obese women

AIM

To evaluate the potential interference of trunk fat (TF) mass on metabolic and skeletal metabolism.

METHODS

In this cross-sectional study, 340 obese women (mean age: 44.8 ± 14 years; body mass index: 36.0 ± 5.9 kg/m(2)) were included. Patients were evaluated for serum vitamin D, osteocalcin (OSCA), inflammatory markers, lipids, glucose and insulin (homeostasis model assessment of insulin resistance, HOMA-IR) levels, and hormones profile. Moreover, all patients underwent measurements of bone mineral density (BMD; at lumbar and hip site) and body composition (lean mass, total and trunk fat mass) by dual-energy X-ray absorptiometry.

RESULTS

Data showed that: (1) high TF mass was inversely correlated with low BMD both at lumbar (P < 0.001) and hip (P < 0.01) sites and with serum vitamin D (P < 0.0005), OSCA (P < 0.0001) and insulin-like growth factor-1 (IGF-1; P < 0.0001) levels; (2) a positive correlation was found between TF and HOMA-IR (P < 0.01), fibrinogen (P < 0.0001) and erythrocyte sedimentation rate (P < 0.0001); (3) vitamin D levels were directly correlated with IGF-1 (P < 0.0005), lumbar (P < 0.006) and hip (P < 0.01) BMD; and (4) inversely with HOMA-IR (P < 0.001) and fibrinogen (P < 0.0005).Multivariate analysis demonstrated that only vitamin D was independent of TF variable.

CONCLUSION

In obese women, TF negatively correlates with BMD independently from vitamin D levels. Reduced IGF-1 and increased inflammatory markers might be some important determinants that account for this relationship.

Body mass index, muscle strength and physical performance in older adults from eight cohort studies: the HALCyon programme

Objective

To investigate the associations of body mass index (BMI) and grip strength with objective measures of physical performance (chair rise time, walking speed and balance) including an assessment of sex differences and non-linearity.

Methods

Cross-sectional data from eight UK cohort studies (total N = 16 444) participating in the Healthy Ageing across the Life Course (HALCyon) research programme, ranging in age from 50 to 90+ years at the time of physical capability assessment, were used. Regression models were fitted within each study and meta-analysis methods used to pool regression coefficients across studies and to assess the extent of heterogeneity between studies.

Results

Higher BMI was associated with poorer performance on chair rise (N = 10 773), walking speed (N = 9 761) and standing balance (N = 13 921) tests. Higher BMI was associated with stronger grip strength in men only. Stronger grip strength was associated with better performance on all tests with a tendency for the associations to be stronger in women than men; for example, walking speed was higher by 0.43 cm/s (0.14, 0.71) more per kg in women than men. Both BMI and grip strength remained independently related with performance after mutual adjustment, but there was no evidence of effect modification. Both BMI and grip strength exhibited non-linear relations with performance; those in the lowest fifth of grip strength and highest fifth of BMI having particularly poor performance. Findings were similar when waist circumference was examined in place of BMI.

Conclusion

Older men and women with weak muscle strength and high BMI have considerably poorer performance than others and associations were observed even in the youngest cohort (age 53). Although causality cannot be inferred from observational cross-sectional studies, our findings suggest the likely benefit of early assessment and interventions to reduce fat mass and improve muscle strength in the prevention of future functional limitations.

Relationship between Weight, Body Mass Index, and Bone Mineral Density in Men Referred for Dual-Energy X-Ray Absorptiometry Scan in Isfahan, Iran

Objective. Although several studies have investigated the association between body mass index (BMI) and bone mineral density (BMD), the results are inconsistent. The aim of this study was to further investigate the relation between BMI, weight and BMD in an Iranian men population. Methods. A total of 230 men 50-79 years old were examined. All men underwent a standard BMD scans of hip (total hip, femoral neck, trochanter, and femoral shaft) and lumbar vertebrae (L2-L4) using a Dual-Energy X-ray Absorptiometry (DXA) scan and examination of body size. Participants were categorised in two BMI group: normal weight <25.0 kg/m(2) and overweight and obese, BMI ≥ 25 kg/m(2). Results. Compared to men with BMI ≥ 25, the age-adjusted odds ratio of osteopenia was 2.2 (95% CI 0.85, 5.93) and for osteoporosis was 4.4 (1.51, 12.87) for men with BMI < 25. It was noted that BMI and weight was associated with a high BMD, compatible with a diagnosis of osteoporosis. Conclusions. These data indicate that both BMI and weight are associated with BMD of hip and vertebrae and overweight and obesity decreased the risk for osteoporosis. The results of this study highlight the need for osteoporosis prevention strategies in elderly men as well as postmenopausal women.

Phenolic compounds from maté (Ilex paraguariensis) inhibit adipogenesis in 3T3-L1 preadipocytes

Leaves of Ilex paraguariensis are used to prepare a tea known as maté which is a common beverage in several South American countries. The ethanol extract was fractionated to identify the compounds responsible for the anti-adipogenic activity in 3T3-L1 cells. Extracts of both fresh and dried maté leaves were subjected to column chromatography using molecular permeation to obtain the saponin (20 % yields) and the polyphenol extracts (40 % yields) from the fresh and dried leaves. The phenolic content was determined using high-performance liquid chromatography analysis and the Folin-Ciocalteau method. Also, maté extracts (50 μg/ml to 1,000 μg/ml) did not display citotoxicity using MTT. The polyphenol extract from the dried leaves was the most effective (50 μg/ml) in the inhibition of triglyceride accumulation in 3T3-L1 adipocytes, and rutin (100 μg/ml) likely accounted for a large portion of this activity. Additionally, maté extracts had a modulatory effect on the expression of genes related to the adipogenesis as PPARγ2, leptin, TNF-α and C/EBPα.

Preventive and improvement effects of exercise training and supplement intake in white adipose tissues on obesity and lifestyle-related diseases

Recent increases in the number of obese individuals and individuals suffering from lifestyle-related diseases, such as type 2 diabetes, that accompany obesity have become a serious social problem. White adipose tissue (WAT) is more than a mere organ for storage of energy; it is also a highly active metabolic and endocrine organ that secretes physiologically active substances collectively known as adipokines, including tumor necrosis factor-α and adiponectin. Dysregulated expression of adipokines in WAT that is hypertrophied by obesity has been closely associated with the phenomenon of insulin resistance. Therefore, WAT is currently considered to be one of the tissues that promote lifestyle-related diseases. Reduction of excess WAT that results from obesity is seen as an important strategy in preventing and improving lifestyle-related diseases. This review shows that exercise training as well as intake of supplements, such as polyphenols, is one strategy for this, because this regimen can result in reduction of WAT mass, which affects the expression and secretory response of adipokines.

Changes in Body Mass Index across Age Groups in Iranian Women: Results from the National Health Survey

Background. To investigate the associations between some factors with weight gain across age groups in Iranian women. Methods. Proportional odds model was used to estimate the probability of BMI categorized as a function of education, economic index, workforce, smoking, marital status, and place of residence adjusted for age, using data from the “National Health Survey in Iran” database. It included 14176 women aged 20–69 years. Results. For all covariates, age was directly associated with overweight and obesity before 60 years of age. Among women aged 20–40 years, the rates of change in probabilities of overweight and obesity were highest. Among women, being inactive, with high economic index, married, being nonsmoker, in an urban residence, with lower educational attainment, all increased the probabilities of overweight and obesity. Conclusions. Women aged 20–40 years gained weight faster than other groups. They may need additional information and more support on how to reduce their risk for weight gain through positive health behaviors.

(-)-Secoisolariciresinol attenuates high-fat diet-induced obesity in C57BL/6 mice

Flaxseed lignan, secoisolariciresinol has been reported to possess health benefits. We previously synthesized each stereoisomer of secoisolariciresinol and found that (-)-secoisolariciresinol reduces lipid accumulation and induces adiponectin production in 3T3-L1 adipocytes. Here we show the effects of (-)-secoisolariciresinol on high-fat diet-induced obesity in C57BL/6 male mice. Oral administration of (-)-secoisolariciresinol for 28 consecutive days significantly suppressed the gain of body weight. Increased serum adiponectin level and decreased gene expression of fatty acid synthase and sterol regulatory element-binding protein-1c in liver, which are related to fatty acid synthesis, were observed in the mice orally administered with (-)-secoisolariciresinol. In addition, subcutaneous injection of (-)-secoisolariciresinol also significantly suppressed the gain of body weight. Serum leptin levels were significantly increased by treating with (-)-secoisolariciresinol or (-)-enterolactone. Subcutaneous injection of (-)-secoisolariciresinol, (-)-enterolactone, or (-)-enterodiol promoted gene expression of acyl-CoA oxidase, carnitine palmitoyl transferase-1, and peroxisome proliferator-activated receptor α, which are related to β-oxidation. Overall results suggest that (-)-secoisolariciresinol exerts a suppressive effect on the gain of body weight of mice fed a high-fat diet by inducing gene expression of adiponectin, resulting in the altered expression of various genes related to the synthesis and β-oxidation of fatty acids.

Breast vs. bottle: differences in the growth of Croatian infants

The aim of the paper was to compare the growth of rural Croatian infants with 2000 Centers for Disease Control and Prevention (CDC) growth standards and to evaluate the potential preventive influence of breastfeeding on the development of obesity in infancy. Two hundred three infant-mother pairs from Baranja, an Eastern region of Croatia, were enrolled into this study. Retrospective evaluation of infants' medical charts was used to obtain anthropometric data recorded at the birth, 1, 3, 6, 9 and 12 months of age. Infant feeding mode was self-reported by mothers. Breastfed infants gained the least weight of all observed groups. Up to 6 months of age, formula fed infants had the highest weight gain and after 6 months of age, mixed milk fed infants had the highest weight gain. At 12 months of age, 6.4% of all study infants and 7.6% of mixed milk fed infants were at risk of overweight, while the same risk for the group of breastfed infants was 4%. Most of the study infants achieved higher values of body mass and length than the child growth standards. Exclusively breastfed infants, in comparison with other study groups (formula fed infants, mixed milk fed infants and cow's milk fed infants), had lower weight-for-length z-scores during the first year, which suggests that breastfeeding may have a preventive impact on obesity development.

Is obesity in women protective against osteoporosis?

The belief that obesity is protective against osteoporosis has recently come into question. The latest epidemiologic and clinical studies have shown that a high level of fat mass might be a risk factor for osteoporosis and fragility fractures. Further, increasing evidence seems to indicate that different components of the metabolic syndrome, ie, hypertension, increased triglycerides, reduced high-density lipoprotein cholesterol, are also potential risk factors for the development of low bone mineral density and osteoporosis. This review considers both the older and more recent data in the literature in order to evaluate further the relationship between fat tissue and bone tissue.

Associação entre aspectos psicossociais e excesso de peso referido em adultos de um município de médio porte do Sul do Brasil

Estudo transversal de base populacional, com 1.100 adultos de São Leopoldo, Rio Grande do Sul, Brasil, investigou a associação entre aspectos psicossociais e excesso de peso. Entrevistas estruturadas foram realizadas utilizando-se questionário padronizado e pré-testado. Dados antropométricos foram referidos pelos participantes, e excesso de peso foi definido pelo índice de massa corporal (IMC) > 25kg/m². Aspectos psicossociais incluíram qualidade de vida (WHO-8:EUROHIS) e apoio social (Medical Outcomes Study). A análise dos dados foi realizada com regressão de Poisson modificada. Após ajuste para variáveis sociodemográficas e comportamentais, as prevalências de excesso de peso foram 19% (RP = 1,19; IC95%: 1,03-1,38) e 12% (RP = 1,12; IC95% 0,96-1,31) mais elevadas em pessoas com, respectivamente, baixa qualidade de vida e baixo apoio sócial, quando comparadas àquelas com níveis altos ou moderados nestas características. Os achados sugerem que aspectos psicossociais podem apresentar influência no excesso de peso, indicando, assim, a necessidade da atuação interdisciplinar em programas e ações para o controle de peso.

Towards automated ingestion detection: swallow sounds

Obesity is a worldwide epidemic and is a cause of many major chronic diseases. In most cases, obesity is a result of an imbalance between food intake and calories burned. Steps toward automated ingestion detection are being made. In order to automate the process of capturing ingestion, a method for detecting, analyzing, and recording sounds related to ingestion is being developed. In this paper, preliminary swallow sound analysis is presented and compared with various other noises captured from a throat mounted microphone. Initial frequency analysis indicates a stronger presence at high frequency intervals for swallow sounds in relation to other captured sounds such as voice. Comparisons show that a single high-pass filter can offer similar results as wavelet decomposition. Two simple methods for event detection are given.

Anti-metabolic syndrome and immunostimulant activities of Egyptian fenugreek seeds in diabetic/obese and immunosuppressive rat models

Preliminary trials have suggested possible hypoglycaemic, hypolipidaemic and immunomodulatory properties of the fenugreek plant. Here, we evaluated and compared the efficacy of Egyptian fenugreek seed powder (FSP, 0·5 and 1·0 g/kg body weight) in alleviating the experimentally induced metabolic syndrome (in type 1 diabetic and obese rat models) and experimentally induced immunosuppression and delay in burn-healing (in cyclophosphamide (CP)-treated rats). FSP significantly alleviated (P < 0·05-0·001) most signs of the metabolic syndrome resulting from experimentally induced type 1 diabetes and obesity by 40-76 and 56-78 %, respectively, including hyperglycaemia, hyperlipidaemia, elevation in atherogenic indices, impairment of liver functions, severe changes in body weight and oxidative stress. Besides, FSP (especially the high dose) completely modulated the immunosuppressive activity of CP including leucopenia (resulting from neutropenia and lymphopenia), decrease in weights and cellularity of lymphoid organs, serum γ-globulin level, delayed type of hypersensitivity response and delay in the skin-burning healing process. FSP decreased the immunosuppressive activity of CP by 57-108 %. These beneficial effects of FSP were dose dependent in most cases, and FSP doses used here were considered safe in general. FSP was more efficient in alleviating the signs of the metabolic syndrome in the obese animals (over 9 %) than in the type 1 diabetic animals. Moreover, the immunostimulant activity of fenugreek seeds exceeded their anti-metabolic syndrome activity by 15-24 %. In conclusion, fenugreek seeds may be useful not only as a dietary adjunct for the control of the metabolic syndrome in diabetic/obese patients, but also as an immunostimulant in immunocompromised patients such as those under chemotherapeutic interventions.

Childhood, adolescent and early adult body mass index in relation to adult mortality: results from the British 1946 birth cohort

BACKGROUND

Adult body mass index (BMI) has been consistently related to mortality, but little is known about the impact of earlier life BMI on adult mortality. The aim is to investigate the impact of childhood, adolescent and early adult BMI on premature adult all-cause mortality.

METHODS

The British 1946 cohort study was used to assess the association of BMI in childhood, adolescence and adulthood with mortality 26-60 years (332 deaths). 4462 (83%) respondents were available for analysis at age 26 years. Splines were used in Cox regression to model the associations between BMI and mortality.

RESULTS

In both genders, adult BMI from 20 years onwards showed a consistent U-shaped relationship with adult mortality (overall p value <0.05 for BMI at ages 20, 26 and 36 years). In women, a similar relationship was observed for adolescent BMI at 15 years (p=0.02); the HR comparing women with low BMI (2 SDs below mean) versus mean BMI was 2.96 (95% CI 1.26 to 6.97). The corresponding HR for women with BMI 2 SDs above the mean was 1.97 (0.95 to 4.10). BMI in childhood was generally not associated with adult mortality except female BMI at 4 years where a U-shaped relationship was observed (p=0.02); HR for BMI 2 SDs below mean versus mean was 2.13 (0.97 to 4.70) and the corresponding HR for 2 SDs above the mean was 1.67 (0.85 to 3.28). This association was not attenuated by subsequent BMI change or mediators.

CONCLUSIONS

High and low BMI from early adulthood were related to adult premature mortality suggesting that promoting a normal weight in early adulthood could prevent premature mortality.

Social influence and obesity

PURPOSE OF REVIEW

To review a selection of research published in the last 12 months on the role of social influence in the obesity epidemic.

RECENT FINDINGS

Recent papers add evidence to previous work linking social network structures and obesity. Social norms, both eating norms and body image norms, are identified as one major source of social influence through networks. Social capital and social stress are additional types of social influence.

SUMMARY

There is increasing evidence that social influence and social network structures are significant factors in obesity. Deeper understanding of the mechanisms of action and dynamics of social influence, and its link with other factors involved in the obesity epidemic, is an important goal for further research.

Studies on the antiobesity effect of zinc-α2-glycoprotein in the ob/ob mouse

OBJECTIVE

To investigate the mechanism of the lipid depletion by zinc-α(2)-glycoprotein (ZAG).

DESIGN

Studies were conducted in the ob/ob mouse, or on isolated adipocytes from these animals or their lean counterparts.

RESULTS

Treatment of these animals for 15 days with ZAG (100  μg, intravenously, daily) resulted in a reduction of body weight of 6.55  g compared with phosphate-buffered saline-treated controls, without a change in food or water intake, but with a 0.4 °C rise in rectal temperature. ZAG-treated mice had a 30% reduction in carcass fat mass and a twofold increase in weight of brown adipose tissue. Epididymal adipocytes from ZAG-treated mice showed an increased expression of ZAG and hormone-sensitive lipase (HSL), and this was maintained for a further 3 days in the absence of ZAG. There was an increased lipolytic response to isoproterenol, which was retained for 3 days in vitro in the absence of ZAG. Expression of HSL was also increased in subcutaneous and visceral adipose tissue, as was also adipose triglyceride lipase (ATGL). There was a rapid loss of labelled lipid from epididymal adipose tissue of ZAG-treated mice, but not from the other depots, reflecting the difference in sensitivity to lipolytic stimuli. The increased expression of HSL and ATGL may involve the extracellular signal-regulated kinase (ERK) pathway, as the active (phospho) form was upregulated in all adipose depots after ZAG administration, whereas in vitro studies showed induction of HSL and ATGL by ZAG to be attenuated by PD98059, an inhibitor of the ERK pathway.

CONCLUSION

These results suggest that ZAG not only induces direct lipolysis, but also sensitizes adipose tissue to other lipolytic stimuli.

Regulatory challenges for new drugs to treat obesity and comorbid metabolic disorders

Obesity is a major cause of morbidity and mortality through cardio- and cerebrovascular diseases and cancer. The metabolic consequences of obesity include dyslipidaemia, hypertension, proinflammatory atherogenesis, pre-diabetes and Type 2 diabetes. For a significant proportion of patients, pharmacotherapy to tackle obesity is required as adjunctive support to diet, exercise and lifestyle modification. To this end, the pharmaceutical industry is pursuing many novel drug targets. Although this view is probably not justified, the recent tribulations of rimonabant have created a perception that the regulatory bar for the approval of antiobesity drugs has been raised. Although >5% of placebo-subtracted weight loss maintained over 1 year is the primary efficacy end-point, it is improvements in cardiovascular risk factors that the Food and Drug Administration (FDA) and European Medicines Agency (EMEA) require to grant approval. Safety aspects are also critical in this indication. Many companies are now switching development of their antiobesity drug candidates into other metabolic disorders. Type 2 diabetes is accepted by the industry and FDA, but not EMEA, as the most appropriate alternative. On the other hand, improvements in plasma lipids produced by antiobesity drugs are moderate compared with established therapies, suggesting dyslipidaemia is not a viable development option. Metabolic Syndrome is not accepted by FDA or EMEA as a discrete disease and the agencies will not licence antiobesity drugs for its treatment. The regulatory environment for antiobesity drugs and the spectrum of indications for which they can be approved could change dramatically if positive data for sibutramine emerge from the SCOUT outcome trial.

The association between self perceptions of psychological well-being and overweight in Brazilian children

Our objective was to estimate the prevalence and test the association between psychological well-being and overweight in children. We conducted a cross-sectional study using anthropometrical measures and interviews with 1048 6-10-year-old school children from a Brazilian town. Overweight was assessed by the body mass index and included obesity. Psychological data of children and their parents were collected using a face scale. Poisson regression models were used to test the associations and to obtain unadjusted and adjusted prevalence ratios (PR). The prevalence of overweight was of 15.3% (95% CI: 13.2-17.6) and of only obesity was 3.8% (2.8-5.2). After controlling for age, sex, school type and parental overweight, the prevalence of overweight was 52% and 44% higher in children who reported a psychological dissatisfaction in themselves and in their mothers when compared with those with positive self perception (PR = 1.52 95% CI = 1.02-2.28; P = 0.038) and (PR = 1.44 95% CI = 1.00-2.09; P = 0.049), respectively. The study suggests that actions aiming weight control of children should take into account psychological aspects of children and their families.

Prediabetes and prehypertension in disease free obese adults correlate with an exacerbated systemic proinflammatory milieu

Background

Obesity is a pro-inflammatory state frequently associated with widespread metabolic alterations that include insulin resistance and deregulation of blood pressure (BP). This cascade of events in some measure explains the susceptibility of obese adults for co-morbid conditions like diabetes mellitus and hypertension.

Hypothesis

We hypothesized that an elevated systemic proinflammatory burden correlates with dysglycemia and deregulated blood pressure.

Methods

We analyzed the screening anthropometric and laboratory measures from healthy disease free obese adults (n = 35; women (W) 27, men (M) 8) in a weight loss study.

Results

Healthy obese normoglycemic (fasting serum glucose: FSG <100 mg/dL) women and men compared with healthy obese with prediabetes (FSG 100-125 mg/dL) had no significant differences for age (Mean ± SD: 52 ± 12 vs. 56 ± 9 y), weight (95 ± 11 vs. 99 ± 13 kg), or waist circumference (108 ± 10 vs. 108 ± 11 cm). Normoglycemic group (n = 24; W = 19, M = 5) had normal FSG 92 ± 4 mg/dL, HbA1c 5.4 ± 0.3%, BP 118/75 mm Hg, but had elevated high sensitivity C-reactive protein (hs CRP) 3.7 ± 3 mg/L and fibrinogen 472 ± 76 mg/dL. The group with prediabetes (n = 11; W = 8, M = 3) with significantly higher FSG (106 ± 3 mg/dL; p < 0.0001), HbA1c (5.9 ± 0.5%; p < 0.002), had prehypertension (BP: 127/80 mm Hg) and significantly higher hs CRP (16.9 ± 9 mg/; p < 0.0001) and fibrinogen (599 ± 95 mg/dL; p < 0.0002).

Conclusions

In otherwise healthy disease free obese adults, a higher degree of systemic inflammation is associated with prediabetes and prehypertension.

Prevalence of obesity and body mass index correlates in a representative sample of Cretan school children

OBJECTIVE

This study aimed to estimate the prevalence of overweight and obesity and investigate associated factors in a representative sample of Cretan school children.

METHODS

As part of a cross-sectional study in children aged 10-12 years (n = 481, 48% boys) in 27 (urban and rural) schools in Crete, Greece, the rates of overweight and obesity were estimated and multiple logistic regression was used to explore the relationship between several factors and body mass index (BMI).

RESULTS

It was shown that 28% and 13% of children were overweight and obese, respectively. Factors affecting children's BMI classification included: gender (95% CI: 0.21 to 0.56); birth weight (95% CI: 1.33 to 3.46); parental overweight or obesity (95% CI: 1.11 to 6.5 and 95% CI: 4.37 to 30.7 for one and both overweight or obese parents, respectively), paternal educational level (95% CI: 0.89 to 3.48 and 95% CI: 1.49 to 6.13 for low and high educational level, respectively); and cardiovascular fitness levels (95% CI: 0.87 to 0.92).

CONCLUSION

The combined prevalence of overweight and obesity was alarmingly high in the current population (41%); several physiological, behavioural and social factors were shown to affect children's BMI status. These findings highlight the extent of the child obesity problem in Crete and support the need for actions to be taken at a national level to tackle the obesity epidemic.

Factors related to obesity among Iranian men: results from the National Health Survey

OBJECTIVE

To our knowledge, only a few Iranian studies have investigated factors associated with obesity among men. The aims of the present study were to explore the associations between sociodemographic factors, smoking and obesity in Iranian men and compare these associations between Iranian men and women.

DESIGN

We used data from the National Health Survey in Iran. A generalised estimating equations model included 11,697 men and 14,854 women aged 20-69 years (12,850 households). Body weight and height were objectively measured. BMI was calculated as kg/m2, and subjects were classified into obese (BMI >or= 30 kg/m2) and non-obese (BMI < 30 kg/m2).

RESULTS

Among men, adjusted obesity OR were 0.62 (95 % CI 0.52, 0.74), 1.09 (95 % CI 0.90, 1.32), 1.003 (95 % CI 1.00, 1.007) and 0.57 (95 % CI 0.40, 0.81) for smokers, married, economic index and active workforce groups, respectively. Using low education as the reference group, the obesity OR for men were 1.06 (95 % CI 0.89, 1.26) and 0.75 (95 % CI 0.57, 0.99) for the moderate and high education groups, respectively. Using rural as the reference group, the obesity OR was 1.87 (95 % CI 1.56, 2.26) for urban men.

CONCLUSIONS

Our findings may point towards a better understanding of the social and cultural mechanisms of obesity in Iranian men. The above sociodemographic factors are large contributors to obesity and provide the greatest opportunity for actions and interventions designed for prevention and treatment.

Is obesity protective for osteoporosis? Evaluation of bone mineral density in individuals with high body mass index

BACKGROUND

Obese individuals often present comorbidities while they appear protected against the development of osteoporosis. However, few and contradictory data are now available on skeletal modifications in obese patients. The aim of this study was to characterise bone mineral density (BMD) in overweight (BMI > 25 < 29.9) and obese (BMI > 30) patients.

METHODS

We selected 398 patients (291 women, 107 men, age 44.1 + 14.2 years, BMI 35.8 + 5.9 kg/m(2)) who underwent clinical examination, blood tests and examination of body composition. Subjects with chronic conditions or taking medications interfering with bone metabolism, hormonal and nutritional status and recent weight loss were excluded.

RESULTS

Interestingly, 37% (n = 146) of this population showed a significantly lower than expected lumbar BMD: 33% (n = 98) of women showed a T-score -1.84 +/- 0.71, and 45% (n = 48) of men showed a T-score -1.88 +/- 0.64. When the population was divided into subgroups based on different BMI, it was noted that overweight (BMI > 25 < 29.9) was neutral or protective for BMD, whereas obesity (BMI > 30) was associated with a low bone mass, compatible with a diagnosis of osteoporosis. No differences were observed in hormones and lipid profiles among subgroups.

CONCLUSIONS

Our results indicate that a subpopulation of obese patients has a significant low lumbar BMD than expected for age. Thus, a careful characterisation of skeletal metabolism might be useful in all obese individuals to avoid fragility fractures later in life.

Levelling off of prevalence of obesity in the adult population of Sweden between 2000/01 and 2004/05

BACKGROUND

The escalating global epidemic of obesity is of worldwide concern because of its association with several chronic diseases and premature mortality. Some subgroups seem to be more affected than others. The aim of this study was to examine whether the mean BMI (adjusted for age) and the prevalence of obesity (adjusted for all the explanatory variables) changed between 2000/01 and 2004/05 in different subgroups of the Swedish population.

METHODS

This study compared two cross-sectional, nationwide random samples of persons aged 16 to 84 years: the first from 2000/01 (5515 men, 5838 women) and the second from 2004/05 (4681 men, 4821 women). After stratification by gender, a logistic regression model was applied to analyse possible changes in mean BMI and the prevalence of obesity between 2000/01 and 2004/05.

RESULTS

Total mean BMI remained almost unchanged between 2000/01 and 2004/05 for both men and women. The prevalence of obesity increased slightly in both men and women, but not significantly (from 9.7 to 10.8% and from 9.6 to 10.2%, respectively). The prevalence of obesity in 2004/05 was especially high in some subgroups: men aged 45-54 (14.3%) or 55-64 (16.5%), women aged 65-74 (15.9%) or 75-84 (16.8%), men and women of middle educational level (15.6% and 14.4%, respectively), male former smokers (13.4%), and men from small towns or rural areas (13.1%).

CONCLUSIONS

Although the mean BMI and obesity were almost unchanged in the Swedish adult population between 2000/01 and 2004/05, obesity levels in Sweden remained unacceptably high, especially in certain subgroups. Primary and secondary intervention actions should strive to decrease the prevalence of obesity in Sweden.

Bariatric psychology, psychological aspects of weight loss surgery

Obesity is the 'disease of the 21st century' and results in physical and psychosocial co-morbidities as well as poor quality of life (QoL). In contrast to the nonsurgical treatment of obesity, bariatric surgery is treatment of choice for morbid obesity. Since improved QoL and enhanced psychosocial functioning are important goals of bariatric surgery, success following bariatric surgery should not only include weight loss and improvement or cure of co-morbid conditions, but also improvements in eating behavior, psychosocial variables, and QoL. Unfortunately, bariatric surgery does not lead to identical results in every patient. Patients who fail to adjust their eating behavior and lifestyle after bariatric surgery may experience adverse reactions. Compliance and adjustment may be attributed largely to psychological factors, implying that the operation on its own represents only one element in bariatric surgery. Considering the role of psychosocial factors in the outcomes of bariatric surgery and the impact of the operation on the psychological and social situation, mental health professionals should be a part of the process of evaluation and treatment of bariatric surgery patients. In the Netherlands, between 2000 and 2005, bariatric surgery has increased tremendously, and most Dutch hospitals have a multidisciplinary selection process.

The Addition of a Video Game to Stationary Cycling: The Impact on Energy Expenditure in Overweight Children

INTRODUCTION: The prevalence of obesity in children has reached epidemic proportions with over 37% of children aged 6-11 years in the U.S. being classified as "at risk for overweight" or "overweight." Utilization of active video games has been proposed as one possible mechanism to help shift the tide of the obesity epidemic. PURPOSE: The purpose of this study was to determine if riding a stationary bike that controlled a video game would lead to significantly greater energy expenditure than riding the same bike without the video game connected. METHODS: Twenty children, 7-14 years old, with a BMI classification of "at risk for overweight" or "overweight" participated in this study. Following familiarization, energy expenditure was evaluated while riding a stationary bike for 20 minutes. One test was performed without the addition of a video game and one test with the bike controlling the speed of a car on the video game. RESULTS: Oxygen consumption and energy expenditure were significantly elevated above baseline in both conditions. Energy expenditure was significantly higher while riding the bike as it controlled the video game (4.4 ± 1.2 Kcal·min(-1)) than when riding the bike by itself (3.7 ± 1.1 Kcal·min(-1)) (p<0.05). Perceived exertion was not significantly different between the two sessions (p>0.05). CONCLUSION: Using a stationary bike to control a video game led to greater energy expenditure than riding a stationary bike without the video game and without a related increase in perceived exertion.