Impact of weight loss on the metabolic syndrome

Effects of intermittent fasting on metabolism in men

This review analyzes the available literature on the impact of intermittent fasting (IF), a nutritional intervention, on different aspects of metabolism. The epidemic of metabolic disturbances, such as obesity, metabolic syndrome (MS), and diabetes mellitus type 2 has led to an increase in the prevalence of cardiovascular diseases, and affected patients might significantly benefit from modifications in nutritional habits. Recent experimental studies have elucidated some of the metabolic mechanisms involved with IF. Animal models have shown positive changes in glucose (lower plasma glucose and insulin levels) and in lipid metabolism (reduced visceral fat tissue and increased plasma adiponectin level), and an increased resistance to stress. Despite the limited number of samples studied, positive results have been reported on the impact of IF for human health. IF is reported to improve the lipid profile; to decrease inflammatory responses, reflected by changes in serum adipokine levels; and to change the expression of genes related to inflammatory response and other factors. Studies on obese individuals have shown that patient compliance was greater for IF than other traditional nutritional approaches (calorie restriction), and IF was found to be associated with low oxidative stress. Recent reports suggest that IF exerts a positive impact on the metabolic derangements commonly associated with cardiovascular diseases, and that it may be a viable and accessible intervention for most individuals. Therefore, further clinical studies are essential to test the effectiveness of IF in preventing and controlling metabolic and cardiovascular diseases.

Prevention of the metabolic syndrome in IGT subjects in a lifestyle intervention: results from the SLIM study

BACKGROUND AND AIMS

The Study on Lifestyle intervention and Impaired glucose tolerance Maastricht (SLIM), a randomized controlled trial, directed at diet and physical activity in impaired glucose tolerant subjects was effective to improve glucose tolerance and prevent type 2 diabetes. The aim of this study was to determine the effects of the SLIM lifestyle intervention on the incidence and prevalence of the metabolic syndrome (MetS) during the active intervention and four years thereafter.

METHODS AND RESULTS

MetS was diagnosed according to the NCEP ATP III criteria. At baseline, 66.4% of all participants (n = 146, age 57 ± 7 years, BMI 29.7 ± 3.6, 51.3% female) fulfilled the criteria for MetS. No significant difference in MetS prevalence was observed between the intervention (63.9%) and control group (68.9%). At the end of active intervention (average duration 4.2 ± 2.0 years), prevalence of MetS was significantly lower in the intervention group (52.6%, n = 57) compared to the control group (74.6%, n = 59) (p = 0.014). Furthermore, in participants without MetS at baseline, cumulative incidence of MetS was 18.2% in the intervention group at the end of active intervention, compared to 73.7% in the control group (Log-rank test, p = 0.011). Four years after stopping active intervention, the reduced incidence of MetS was maintained (Log-rank test, p = 0.002).

CONCLUSION

In conclusion, a combined diet-and-exercise intervention to improve glucose tolerance, not only prevented type 2 diabetes, but also reduced the prevalence of MetS and prevented MetS development, showing the long-term impact of lifestyle intervention on cardiovascular risk reduction.

Is obesity a brain disease?

That the brain is involved in the pathogenesis and perpetuation of obesity is broadly self-intuitive, but traditional evaluation of this relationship has focused on psychological and environment-dependent issues, often referred to as the "it's all in the head" axiom. Here we review evidence that excessive nutrition or caloric flux, regardless of its primary trigger, elicits a biological trap which imprints aberrant energy control circuits that tend to worsen with the accumulation of body fat. Structural and functional changes in the brain can be recognized, such as hypothalamic inflammation and gliosis, reduction in brain volume, reduced regional blood flow or diminished hippocampal size. Such induced changes collectively translate into a vicious cycle of deranged metabolic control and cognitive deficits, some of which can be traced back even to childhood or adolescence. Much like other components of the obese state, brain disease is inseparable from obesity itself and requires better recognition to allow future therapeutic targeting.

High density lipoprotein is positively correlated with the changes in circulating total adiponectin and high molecular weight adiponectin during dietary and fenofibrate treatment

OBJECTIVE

The investigation of the relationship between high density lipoprotein (HDL) and adiponectin.

DESIGN

Thirty-seven obese or overweight [body mass index ≥27 Kg/m(2)], hypertriglyceridemic patients underwent one of the following interventions for 3 months: 1) Low-calorie diet (n=19), 2) Low-calorie diet plus fenofibrate (n=18).

RESULTS

Circulating total adiponectin did not change significantly in the low-calorie diet group. However, in the subgroup of patients whose high density lipoprotein cholesterol (HDL-C) decreased over the first month of diet, a statistically significant reduction of the circulating total adiponectin was observed (p=0.010), while in the subgroup of patients whose HDL-C increased over the latter 2 months of the diet, an increase in circulating total adiponectin over the 2 months was found (p=0.043). The percentage change of HDL-C over the first month of diet was positively correlated with the percentage change of circulating total adiponectin (r=0.579, p=0.019). The percentage change of HDL-C over the 3 months of diet was positively correlated with the percentage changes of circulating total adiponectin (r=0.527, p=0.030) and high molecular weight (HMW) adiponectin (r=0.524, p=0.031). The change in circulating total adiponectin over the first month of diet was positively correlated with the HDL-C at 1 month (r=0.606, p=0.013). The change in HMW adiponectin over the 3 months of diet was positively correlated with the HDL-C at 3 months (r=0.602, p=0.011). The percentage change of circulating HMW adiponectin over the first month of fenofibrate treatment was positively correlated with the percentage change of HDL-C (r=0.594, p=0.012).

CONCLUSIONS

HDL is positively correlated with the changes in circulating adiponectin during dietary and fenofibrate treatment.

The impact of rapid weight loss on oxidative stress markers and the expression of the metabolic syndrome in obese individuals

OBJECTIVE

Obesity is linked with a state of increased oxidative stress, which plays an important role in the etiology of atherosclerosis and type 2 diabetes mellitus. The aim of our study was to evaluate the effect of rapid weight loss on oxidative stress markers in obese individuals with metabolic syndrome (MetS).

DESIGN AND METHODS

We measured oxidative stress markers in 40 obese subjects with metabolic syndrome (MetS+), 40 obese subjects without metabolic syndrome (MetS-), and 20 lean controls (LC) at baseline and after three months of very low caloric diet.

RESULTS

Oxidized low density lipoprotein (ox-LDL) levels decreased by 12% in MetS+ subjects, associated with a reduction in total cholesterol (TC), even after adjustment for age and sex. Lipoprotein associated phospholipase A₂ (Lp-PLA₂) activity decreased by 4.7% in MetS+ subjects, associated with a drop in LDL-cholesterol (LDL-C), TC, and insulin levels. Multivariate logistic regression analysis showed that a model including ox-LDL, LpPLA₂ activity, and myeloperoxidase (MPO) improved prediction of MetS status among obese individuals compared to each oxidative stress marker alone.

CONCLUSIONS

Oxidative stress markers were predictive of MetS in obese subjects, suggesting a higher oxidative stress. Rapid weight loss resulted in a decline in oxidative stress markers, especially in MetS+ patients.

A randomized, double-blind, placebo-controlled study of an oral, extended-release formulation of phentermine/topiramate for the treatment of obstructive sleep apnea in obese adults

STUDY OBJECTIVES

To evaluate safety and efficacy of phentermine 15 mg plus extended-release topiramate 92 mg for treatment of moderate to severe obstructive sleep apnea (OSA) in obese adults.

DESIGN

This phase 2, randomized, double-blind, placebo-controlled study included 2-week screening and 28-week treatment periods. Overnight polysomnography was performed at baseline, Week 8, and Week 28.

SETTING

Single-center study conducted from August 2008 to September 2009.

PARTICIPANTS

Forty-five subjects with moderate to severe OSA not receiving positive airway pressure (PAP) treatment with body mass index of 30-40 kg/m(2).

INTERVENTIONS

Subjects were randomized to receive placebo (n = 23) or phentermine 15 mg plus extended-release topiramate 92 mg (n = 22). Both groups received lifestyle-modification counseling.

MEASUREMENTS AND RESULTS

Primary endpoint, change in apnea-hypopnea index (AHI), significantly favored phentermine 15 mg plus extended-release topiramate 92 mg (-31.5 events/h, 95% CI: -40.0, -22.9) over placebo (-16.6 events/h, 95% CI: -25.0, -8.2) at Week 28 (P =0.0084). At Week 28, there was a 10.2% (95% CI: -12.7, -7.6; 10.8 kg, 95% CI: -13.5, -8.0) mean decrease in weight in the phentermine 15 mg plus extended-release topiramate 92 mg group compared with 4.3% (95% CI: -6.6, -2.0; 4.7 kg, 95% CI: -7.2, -2.2) in the placebo group (P = 0.0006) and a positive, significant (P = 0.0003) correlation between percent change in weight and change in AHI. Significant improvements in overnight oxygen saturation and reduction in blood pressure compared with placebo were observed. Phentermine 15 mg plus extended-release topiramate 92 mg was well tolerated with low adverse event rates.

CONCLUSIONS

Phentermine 15 mg plus extended-release topiramate 92 mg induced significant weight reductions and concomitant improvements in OSA and related symptoms vs placebo. This suggests weight loss mediated by phentermine 15 mg plus extended-release topiramate 92 mg may be useful in treatment of moderate to severe OSA in obese subjects unable or unwilling to comply with PAP treatment.

Promoting only the consumption of healthy foods may be an alternative stategy for treating patients with the metabolic syndrome

OBJECTIVE

To evaluate the effectiveness of two lifestyle, interventional approaches on metabolic abnormalities and eating habits of patients with metabolic syndrome.

MATERIALS/METHODS

This is a randomized controlled trial, involving a 6-month lifestyle intervention. Eighty-eight metabolic syndrome patients were randomized to one of the three groups: (i) "Increase - Decrease" group, (ii) "Increase" group, and (iii) "Minimum intervention" group. All patients received dietary and physical activity advice at baseline; patients in the first two groups also participated in individual counseling sessions. In the "Increase - Decrease" group, all recommended dietary and physical activity goals were targeted, whereas in the "Increase" group, only goals proposing an increase in dietary intake or physical activity were included. Patients received nutrition counseling through seven, one-to-one sessions, conducted every two weeks for the first 2 months, every month for the following 4 months. All participants underwent a full medical and nutritional assessment at baseline and at the end of the intervention.

RESULTS

At 6 months, BMI and waist circumference were improved in the "Increase" and the "Increase - Decrease" groups, compared to the "Minimum Intervention" group. Additionally, "Increase - Decrease" group reduced blood systolic (p=0.017), diastolic pressure (p=0.005) and glucose concentrations (p=0.015). Forty eight percent, 32%, and 19% of the patients in the "Increase - Decrease", "Increase" and "Minimum Intervention" groups, respectively, ceased to fulfill the criteria for the metabolic syndrome (p=0.031).

CONCLUSIONS

Promoting only the increase of the intake of healthy foods did not result in better outcome values compared to a conventional all-food approach.

Impact of metabolic syndrome on cognition and brain: a selected review of the literature

Metabolic syndrome (MetS), a clustering of risk factors for type 2 diabetes mellitus and cardiovascular disease, has been associated with cognitive dysfunction and brain abnormalities. This review describes the literature on the impact of MetS on brain and cognition and suggests directions for future research. A literature search for reports of MetS and cognition and brain imaging was conducted for both nonelderly adults and adolescents. No studies were found describing MetS and brain or cognition among adolescents; therefore, we also included studies investigating individual components of MetS in this age group. Most studies found associations between MetS and cognitive dysfunction. Multiple cognitive domains were affected by MetS in adults. In adolescents, the majority of findings were in executive functioning. Brain imaging literature in adults implicated MetS in ischemic stroke, white matter alterations, and altered brain metabolism. For adolescents, individual MetS factors were linked to volume losses in the hippocampus and frontal lobes. MetS negatively impacts cognitive performance and brain structure. Potential explanatory models include impaired vascular reactivity, neuroinflammation, oxidative stress, and abnormal brain lipid metabolism. We posit that insulin resistance-associated impairment in cerebrovascular reactivity is an important mechanism underlying brain deficits seen in MetS.

Dyslipidemia Management for Secondary Prevention in Women with Cardiovascular Disease: What Can We Expect From Non-pharmacologic Strategies?

Cardiovascular disease is the leading cause of death in women and the treatment of dyslipidemia is a cornerstone of secondary prevention. Pharmacologic therapy with statins can lower LDL-C by 30-50% and reduce the risk of recurrent coronary heart disease in both men and women. While significant reductions in LDL-C can be achieved with statin therapy, diet and lifestyle modification remain an essential part of the treatment regimen for cardiovascular disease. Moreover, a large proportion of the U.S. population is sedentary, overweight, and does not consume a heart-healthy diet. Non-pharmacologic treatment strategies also improve other cardiovascular risk factors and are generally easily accessible. In this review, we examine the effect of non-pharmacologic therapy on lipids as part of the secondary prevention strategy of cardiovascular disease in women.

Telephone counseling intervention improves dietary habits and metabolic parameters of patients with the metabolic syndrome: a randomized controlled trial

BACKGROUND

Patients with the metabolic syndrome (MetS) can suffer from poor metabolic parameters through lack of adherence to requisite lifestyle changes in dietary and physical activity. Usually, interventions in MetS patients are infrequent face-to-face consultations. The low frequency or absence of counseling interviews leads to a shortage of information and motivation to adhere to the recommended lifestyle changes. Telephone interventions could be an additional low-cost tool for effective interventions.

AIM

To evaluate the effectiveness of telephone intervention in improving lifestyle habits and metabolic parameters in MetS patients compared with similar face-to-face or a usual care interventions.

METHODS

Eighty-seven MetS patients recruited from the outpatient clinic of a major public hospital were randomly assigned to one of the three intervention groups: "usual care", "telephone" or "face-to-face". At the beginning of the study, all patients were provided with a hypocaloric Mediterranean-type diet. Afterwards, patients in the telephone group received 7 dietary counseling calls, patients in the face-to-face group participated in 7 one-to-one dietary counseling sessions, while patients in the usual care group received no other contact until the end of the study, 6 months later. All patients underwent full medical and nutritional evaluation at the beginning and at the end of the intervention.

RESULTS

At the end of the intervention, 42% of the participants no longer showed symptoms of MetS; the reduction rates differed significantly between the groups (p = 0.024), with those in the face-to-face and telephone group exhibiting similar rates (52% and 54%, respectively, vs. 21% in the usual care group). Between-group analysis revealed that the face-to-face group achieved the greatest improvement in metabolic parameters, while the telephone group had the greatest improvement in dietary adherence compared with the usual care group.

CONCLUSIONS

Telephone counseling is an effective way to implement behavioral counseling to improve lifestyle habits in MetS patients.

Controlled-release phentermine/topiramate in severely obese adults: a randomized controlled trial (EQUIP)

A 56-week randomized controlled trial was conducted to evaluate safety and efficacy of a controlled-release combination of phentermine and topiramate (PHEN/TPM CR) for weight loss (WL) and metabolic improvements. Men and women with class II and III obesity (BMI ≥ 35 kg/m(2)) were randomized to placebo, PHEN/TPM CR 3.75/23 mg, or PHEN/TPM CR 15/92 mg, added to a reduced-energy diet. Primary end points were percent WL and proportions of patients achieving 5% WL. Secondary end points included waist circumference (WC), systolic and diastolic blood pressure (BP), fasting glucose, and lipid measures. In the primary analysis (randomized patients with at least one postbaseline weight measurement who took at least one dose of assigned drug or placebo), patients in the placebo, 3.75/23, and 15/92 groups lost 1.6%, 5.1%, and 10.9% of baseline body weight (BW), respectively, at 56 weeks (P < 0.0001). In categorical analysis, 17.3% of placebo patients, 44.9% of 3.75/23 patients, and 66.7% of 15/92 patients, lost at least 5% of baseline BW at 56 weeks (P < 0.0001). The 15/92 group had significantly greater changes relative to placebo for WC, systolic and diastolic BP, fasting glucose, triglycerides, total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL). The most common adverse events were paresthesia, dry mouth, constipation, dysgeusia, and insomnia. Dropout rate from the study was 47.1% for placebo patients, 39.0% for 3.75/23 patients, and 33.6% of 15/92 patients. PHEN/TPM CR demonstrated dose-dependent effects on weight and metabolic variables in the direction expected to be beneficial with no evidence of serious adverse events induced by treatment.

The weight change impact on metabolic syndrome: a 17-year follow-up study

Introduction: Data on long-term patterns of weight change in relation to the development of metabolic syndrome (MetS) are scarce. The aim of the study was to evaluate the impact of weight change on the risk of MetS in men. Material and Methods: Prospective longitudinal observation (17.9 ± 8.1 years) of apparently healthy 324 men aged 18–64 years. Metabolic risk was assessed in weight gain (⩾ 2.5 kg), stable weight (> −2.5 kg and < 2.5 kg) and weight loss (⩽ −2.5 kg) groups. Adjusted relative risk (RR) of MetS was analyzed using multivariate logistic regression. Results: The prevalence of MetS over follow-up was 22.5%. There was a strong relationship between weight gain and worsening of MetS components among baseline overweight men. Long-term increase in weight was most strongly related with the risk of abdominal obesity (RR=7.26; 95% CI 2.98–18.98), regardless of baseline body mass index (BMI). Weight loss was protective against most metabolic disorders. Leisure-time physical activity (LTPA) with energy expenditure > 2000 metabolic equivalent/min/week was associated with a significantly lower risk of MetS. Conclusions: Reducing weight among overweight and maintaining stable weight among normal-weight men lower the risk of MetS. High LTPA level may additionally decrease the metabolic risk regardless of BMI.

Managing the combination of nonalcoholic fatty liver disease and metabolic syndrome

INTRODUCTION

Metabolic syndrome (MetS) and nonalcoholic fatty liver disease (NAFLD) are part of the same metabolic defect, both having insulin resistance as the main pathogenic mechanism and sharing similar outcomes (i.e., cardiovascular and liver-related mortality). The prevalence of NAFLD is expected to rise, owing to the increasing worldwide prevalence of obesity and MetS; therefore, the identification of factors responsible for disease progression is essential to devise therapeutic strategies.

AREAS COVERED

The available and potential future treatments for NAFLD in combination with MetS are reviewed in this paper, following an extensive literature search and personal experience.

EXPERT OPINION

All NAFLD patients should be evaluated for their metabolic, cardiovascular and liver-related risk. Weight loss through lifestyle intervention remains the most comprehensive and safe treatment of NAFLD and associated MetS; however, > 50% of patients fail to achieve target weight loss. Pharmacologic treatment seems to be important for these patients and for NAFLD cases with more advanced liver disease. It temporarily reverses metabolic alterations, but liver disease progresses after the treatment is stopped. Although current treatments are unsatisfactory, new drugs have been proposed and a few innovative compounds are in the pipeline of pharmaceutical companies. Before pharmacologic treatment can be routinely recommended for NAFLD, long-term randomized trials are needed, along with assessments of the safety and benefits of drugs on proper histological outcomes or validated surrogate markers. The intensive control of individual features of MetS remains mandatory.

Adipose tissue dysfunction and hypertriglyceridemia: mechanisms and management

Elevated plasma triglyceride levels, as often seen in obese subjects, are independently associated with an increased risk of cardiovascular diseases. By secreting adipokines (such as adiponectin and leptin) and other proteins (such as lipoprotein lipase and cholesteryl ester transferase protein), adipose tissue affects triglyceride metabolism. In obesity, adipocyte hypertrophy leads to many changes in adipocyte function and production of anti- and pro-inflammatory cytokines. Furthermore, free fatty acids are released into the circulation contributing to insulin resistance. Adipose tissue dysfunction will eventually lead to abnormalities in lipid metabolism, such as hypertriglyceridemia (due to increased hepatic very-low-density lipoprotein production and decreased triglyceride hydrolysis), small dense low-density lipoprotein particles, remnant lipoproteins and low high-density lipoprotein cholesterol levels, all associated with a higher risk for the development of cardiovascular diseases. The clinical implications of elevated plasma triglycerides are still a matter of debate. Understanding the pathophysiology of adipose tissue dysfunction in obesity, which is becoming a pandemic condition, is essential for designing appropriate therapeutic interventions. Lifestyle changes are important to improve adipose tissue function in obese patients. Pharmacological interventions to improve adipose tissue function need further evaluation. Although statins are not very potent in reducing plasma triglycerides, they remain the mainstay of therapy for cardiovascular risk reduction in high-risk patients.

Lifestyle modification increases circulating adiponectin concentrations but does not change vaspin concentrations

The objective of the study was to evaluate the effects of a 10-month lifestyle intervention on the components of the metabolic syndrome (MetSyn) in Koreans with MetSyn as well as on blood concentrations of adiponectin and vaspin. One hundred thirty-eight patients with MetSyn, recruited from a community health care center, were consecutively enrolled in the study; 12 patients dropped of the intervention, leaving 126 subjects (76 men and 50 women; age, 65.3 ± 9.0 years). All participants followed a 10-month lifestyle modification interventional program, including dietary counseling, advice on increasing physical activity, and recommendations to stop or limit smoking and alcohol drinking. Anthropometric and biochemical parameters related to the components of the MetSyn, including blood concentrations of adiponectin and vaspin, were assessed pre- and postintervention. At baseline, adiponectin concentrations were moderately negatively correlated to insulin concentrations and insulin resistance evaluated by the homeostasis model assessment. In response to lifestyle modification, statistically significant changes were found in systolic and diastolic blood pressure, total cholesterol, triglyceride, and insulin concentrations, as well as in homeostasis model assessment of insulin resistance. Adiponectin concentrations postintervention, compared with the preintervention levels, increased (7.2 ± 4.0 vs 6.8 ± 3.9 μg/mL, respectively; P < .05), whereas vaspin concentrations remained unchanged (0.25 ± 0.19 vs 0.26 ± 0.20 ng/mL, respectively; P = .64). A 10-month lifestyle modification program in Korean patients with MetSyn led to favorable changes in metabolic parameters and adiponectin but not vaspin concentrations.

Effect of the Mediterranean diet with and without weight loss on cardiovascular risk factors in men with the metabolic syndrome

BACKGROUND AND AIMS

No study has yet examined how weight loss modifies the impact of the Mediterranean diet (MedDiet) on cardiovascular risk factors in men with the metabolic syndrome (MetS). The objective of the study was to assess the efficacy of MedDiet, with and without weight loss, to modify the cardiometabolic risk profile of male patients with MetS.

METHODS AND RESULTS

Twenty-six men aged between 24 and 62 years with the MetS consumed a North American control diet for 5 weeks followed by a 5-week MedDiet, both under weight-maintaining conditions. Participants then underwent a 20-week weight loss period, after which they consumed the MedDiet for five weeks under weight stable conditions. Body weight was reduced by 10.2% ± 2.9% after the weight loss period (p < 0.001). All foods were provided to participants during the weight stable phases of the study. The MedDiet in the absence of weight loss decreased total plasma cholesterol (C) (-7.1%), LDL-C (-9.3%) and the total/HDL-C ratio (-6.5%) compared to the control diet (all p < 0.04). The MedDiet combined with weight loss led to reductions in systolic blood pressure (-4.7%), diastolic blood pressure (-7.7%), triglycerides (-18.2%), ApoB (-10.7%), fasting glucose (-4.2%) and insulin (-29.9%) compared to the control diet (all p < 0.001).

CONCLUSION

The MedDiet in the absence of weight loss leads to significant changes in plasma cholesterol concentrations but has little effects on other cardiometabolic risk factors associated with the MetS in men.

Exercise and diet, independent of weight loss, improve cardiometabolic risk profile in overweight and obese individuals

Diet and/or exercise are routinely advised as methods for weight loss in overweight/obese individuals, particularly those who are at high risk for cardiovascular disease and type 2 diabetes mellitus. However, physical activity and structured exercise programs rarely result in significant loss of body weight or body fat, and weight-loss diets have extraordinarily high recidivism rates. Despite only modest effects on body weight, exercise and ad libitum nutrient-dense diets for overweight/obese individuals have many health benefits, including skeletal muscle adaptations that improve fat and glucose metabolism, and insulin action; enhance endothelial function; have favorable changes in blood lipids, lipoproteins, and hemostatic factors; and reduce blood pressure, postprandial lipemia and glycemia, and proinflammatory markers. These lifestyle-induced adaptations occur independently of changes in body weight or body fat. Thus, overweight/obese men and women who are at increased risk for cardiovascular disease and type 2 diabetes as a result of sedentary lifestyle, poor diet, and excess body weight should be encouraged to engage in regular physical activity and improve their diet, regardless of whether the healthier lifestyle leads to weight loss.

Effects of lifestyle interventions on inflammatory markers in the metabolic syndrome

Metabolic syndrome (MetS) is a clustering of cardiovascular risk factors which places individuals at increased risk for cardiovascular morbidity and mortality. In addition to obesity and insulin resistance, inflammation is emerging as a potential etiologic factor of the syndrome. One hypothesis suggests that obesity contributes to insulin resistance through increased production of adipose-derived inflammatory cytokines. Currently, lifestyle change is the first line of treatment for MetS. Only recently, however, have studies begun exploring the effect of lifestyle interventions on the mediation of inflammation in individuals with MetS. This review summarizes the strongest evidence (i.e. randomized controlled trial data) for a role of lifestyle interventions (diet and/or exercise) on the improvement of inflammatory biomarkers in people with MetS. Of six studies assessed, lifestyle interventions were consistently successful at improving the inflammatory and metabolic profiles. Interestingly, improvements in the inflammatory profile were found to be largely independent of obesity. Data currently suggest that alterations in dietary composition may be the most effective lifestyle change, although there is a need for more research in this area.

Lifestyle modification in the management of the metabolic syndrome: achievements and challenges

Lifestyle modification based on behavior therapy is the most important and effective strategy to manage the metabolic syndrome. Modern lifestyle modification therapy combines specific recommendations on diet and exercise with behavioral and cognitive strategies. The intervention may be delivered face-to-face or in groups, or in groups combined with individual sessions. The main challenge of treatment is helping patients maintain healthy behavior changes in the long term. In the last few years, several strategies have been evaluated to improve the long-term effect of lifestyle modification. Promising results have been achieved by combining lifestyle modification with pharmacotherapy, using meals replacement, setting higher physical activity goals, and long-term care. The key role of cognitive processes in the success/failure of weight loss and maintenance suggests that new cognitive procedures and strategies should be included in the traditional lifestyle modification interventions, in order to help patients build a mind-set favoring long-term lifestyle changes. These new strategies raise optimistic expectations for an effective treatment of metabolic syndrome with lifestyle modifications, provided public health programs to change the environment where patients live support them.

Effect of long-term whole body vibration training on visceral adipose tissue: a preliminary report

AIM

To determine the effect of whole body vibration (WBV), combined with caloric restriction, on weight, body composition and metabolic risk factors in overweight and obese adults.

METHODS

A randomized, controlled study with a 6-month intervention period and a 6-month 'no intervention' follow-up. 61 of the 79 participants completed the study. Data were collected at baseline and at 3, 6 and 12 months in the control group (CONTROL), the diet only group (DIET), the diet plus fitness group (FITNESS) and the diet plus WBV group (VIBRATION).

RESULTS

Weight decreased significantly in all three intervention groups. Only FITNESS and VIBRATION managed to maintain a weight loss of 5% or more in the long term. Visceral adipose tissue (VAT) changed most in VIBRATION: -47.8 +/- 41.2 and -47.7 +/- 45.7 cm2 after 6 and 12 months respectively compared to CONTROL (-3.6 +/- 20.5 or +26.3 +/- 30.6 cm(2)), DIET (-24.3 +/- 29.8 or -7.5 +/- 28.3 cm(2)) and FITNESS (-17.6 +/- 36.6 or -1.6 +/- 33.3 cm(2)) (p < 0.001).

CONCLUSIONS

Combining aerobic exercise or WBV training with caloric restriction can help to achieve a sustained long-term weight loss of 5-10%. These preliminary data show that WBV training may have the potential to reduce VAT more than aerobic exercise in obese adults, possibly making it a meaningful addition to future weight loss programs.

DASH lowers blood pressure in obese hypertensives beyond potassium, magnesium and fibre

The mechanism underlying blood pressure (BP) reduction in the high fruits and vegetables arm of the Dietary Approaches to Stop Hypertension (DASH) study is unknown but may include potassium, magnesium and fibre. This study was designed to separate minerals and fibre from other components of DASH on BP in abdominally obese individuals with metabolic syndrome with pre-hypertension to stage 1 hypertension (obese hypertensives). A total of 15 obese hypertensives and 15 lean normotensives were studied on a standardized usual diet, randomized to DASH or usual diet supplemented with potassium, magnesium and fibre to match DASH, then crossed over to the complementary diet. All diets were 3 weeks long, isocaloric and matched for sodium and calcium. In obese hypertensives, BP was lower after 3 weeks on DASH than usual diet (-7.6+/-1.4/-5.3+/-1.4 mm Hg, P<0.001/0.02) and usual diet supplemented (-6.2+/-1.4/-3.7+/-1.4 P<0.005/0.06), whereas BP was not significantly different on usual and supplemented diets. BP values were not different among the three diets in lean normotensives. Small artery elasticity was lower in obese hypertensives than in lean normotensives on the usual and supplemented diets (P<0.02). This index of endothelial function improved in obese hypertensives (P<0.02) but not lean normotensives on DASH, and was no longer different from values in lean normotensives (P>0.50). DASH is more effective than potassium, magnesium and fibre supplements for lowering BP in obese hypertensives, which suggest that high fruits and vegetables DASH lowers BP and improves endothelial function in this group by nutritional factors in addition to potassium, magnesium and fibre.

Weight change over five-year periods and number of components of the metabolic syndrome in a Dutch cohort

Overweight and obesity are associated with the metabolic syndrome (MetS). We studied the association of weight change over three consecutive 5-year periods with the number of MetS components in people aged 20–59 years. 5735 participants from the Doetinchem Cohort Study were included. Weight was measured in round 1 and at each 5-year interval follow-up (round 2, 3 and 4). Weight change was defined as the absolute weight change between two consecutive measurements. The number of MetS components (assessed in round 2, 3 and 4) was based on the presence of the following components of the MetS: central obesity, raised blood pressure, reduced high density lipoprotein cholesterol and elevated glucose. Associations of weight change and the number of components of the MetS were analyzed with Generalized Estimating Equations for Poisson regression, stratified for 10-year age groups. For each age group, 1 kg weight gain was positively associated with the number of components of the MetS, independent of sex and measurement round. The association was stronger in 30–39 years (adjusted rate ratio: 1.044; 95%CI: 1.040–1.049) and smaller in older age groups. Compared to stable weight (>−2.5 kg and < 2.5 kg), weight loss (≤−2.5 kg) and weight gain (≥2.5 kg) was associated with a lower and higher rate ratio respectively, for the number of components of the MetS. Our results support the independent association of weight change with the number of MetS components with a more pronounced association in younger people.

Aspectos nutricionais em obesos antes e após a cirurgia bariátrica

OBJETIVO: Determinar perfil clínico-nutricional de pacientes obesos submetidos à cirurgia bariátrica, no HC/UFPE. MÉTODOS: Foram avaliados retrospectivamente, 205 pacientes, no período 2002/2006. A análise considerou história clínica para diabetes tipo 2 (DM 2), hipertensão arterial (HA) e síndrome metabólica (SM). O estado nutricional pré-operatório foi avaliado pelo IMC e bioquímica (hemoglobina, hematócrito, albumina, proteínas totais, triglicérides (TG), colesterol associado à lipoproteína de alta (HDLc) e baixa (LDLc) densidade e glicemia de jejum (GJ). Nos períodos pós-operatórios (6, 12, 18, 24 meses) a avaliação nutricional foi feita pelas medidas de peso, perda ponderal, percentual de perda de peso (%PP), IMC e bioquímica incluindo ferro, ferritina e transferrina. RESULTADOS: 71,2% eram do sexo feminino, idade de 38,4 ± 9,96 anos, 129,66±27,40 Kg e IMC 48,6 ± 8,9 Kg/m², no pré-operatório. Receberam o diagnóstico de SM 26,8%, HA 52,7% e DM 2 11,7%. A bioquímica revelou TG, LDLc, GJ elevados, estando normais os demais parâmetros. Evolução antropométrica demonstrou perda ponderal progressiva, atingindo aos 24 meses IMC 31,7±5,82 Kg/m² (p< 0,001) e maior %PP (36,05%). Valores de TG, LDLc e GJ atingiram a normalidade a partir do 6° mês pós-operatório: 104,4mg/dL(p=0,018), 95,5mg/dL(p=0,263) e 84,8g/dL(p=0,004), respectivamente; transferrina apresentou valores reduzidos aos 6 meses. Prevalência maior dos sintomas ocorreu no 6° mês: alopécia (19%), vômitos (18%), intolerância alimentar (12,2%). CONCLUSÃO: A Cirurgia bariátrica foi um procedimento eficaz para promover perda ponderal e sua manutenção por dois anos, assim como melhora de parâmetros bioquímicos e co-morbidades, com sintomas clínico-nutricionais reduzidos e/ou evitados por monitorização nutricional.

Weight change and incident metabolic syndrome in Iranian men and women; a 3 year follow-up study

Background

Although the association of weight gain and developing metabolic syndrome (MetS) has been reported in the Western and Asian populations, data on the gender-stratified effects of weight change (including weight loss) on incident MetS and its components in the Middle East Caucasians is still scarce.

Methods

A total of 1431 men and 2036 women aged ≥ 20 years with BMI > 18.5 kg/m² were followed over 3 years. Multivariate logistic regression analysis was used to estimate the relative risk (RR) of MetS and its components (the Adult Treatment Panel III definition) associated with gender-stratified quintiles of percent weight change. Subjects with MetS at baseline were excluded for analyzing the RR of MetS.

Results

There was 20.4% (95% CI, 19.6–21.2) age-adjusted incident MetS (18.4% male vs. 23.1% women). In men, mild weight gain (WG) predicted high waist circumference (WC) and high triglyceride; moderate WG predicted MetS (RR 2.5, 95% CI 1.4–4.3), high WC and high blood pressure (BP); large WG predicted MetS (RR 3.2, 95% CI 1.8–5.7) and its components, except for high fasting plasma glucose. In women, mild WG predicted MetS (RR 2.5, 95% CI 1.4–4.3), high WC and high BP; moderate WG predicted Mets (RR 4.6, 95% CI 2.7–8.0), high WC and high triglyceride; large WG predicted MetS (RR 6.6, 95% CI 3.8–11.3) and its components except for low HDL-cholesterol. Mild weight loss had protective effect on high WC in both genders and MetS in men (RR 0.5, 95% CI 0.26–0.97, P = 0.04).

Conclusion

Weight change showed different effects on MetS in men and women. In women, mild WG predicted MetS; however, mild weight loss was protective against MetS in men and high WC in both genders.

Management of the metabolic syndrome and type 2 diabetes through lifestyle modification

Sustainable lifestyle modifications in diet and physical activity are the initial, and often the primary, component in the management of diabetes and the metabolic syndrome. An energy-prudent diet, coupled with moderate levels of physical activity, favorably affects several parameters of the metabolic syndrome and delays the onset of diabetic complications. Weight loss, albeit not an absolute prerequisite for improvement, is a major determinant and maximizes effectiveness. Adopting a healthy lifestyle pattern requires a series of long-term behavioral changes, but evidence to date indicates low long-term adherence to diet and physical activity recommendations. This calls for greater research and public health efforts focusing on strategies to facilitate behavior modification.

Remission of metabolic syndrome following a 15-week low-calorie lifestyle change program for weight loss

OBJECTIVE

To evaluate the rate of remission of metabolic syndrome (Met Syn) among patients undergoing a brief, low-calorie lifestyle change weight loss intervention and to compare the baseline characteristics of patients who were remitted and not remitted from Met Syn at post-treatment.

RESEARCH METHODS AND PROCEDURES

Obese adults (N=36) meeting criteria for Met Syn enrolled in an outpatient fee-for-service behavioral weight loss intervention. Participants were assessed on key Met Syn variables (waist circumference, blood pressure, triglycerides, high-density lipoprotein (HDL) cholesterol and fasting blood glucose) at pre- and post-treatment.

RESULTS

The majority of patients (61%) responded to treatment after a 9.9% mean weight loss. Although Met Syn responders did not differ significantly from Met Syn non-responders on any baseline Met Syn criterion variable, responders had significantly lower baseline body mass indices (BMI; kg/m(2)) and met criteria for fewer baseline Met Syn variables. As expected, Met Syn responders, compared with Met Syn non-responders, had significantly lower post-treatment waist circumference, systolic and diastolic blood pressures, triglycerides and fasting blood glucose. Patient groups did not differ significantly on weight lost (kg or %), or on the proportion of patients losing > or =10% of initial body weight.

DISCUSSION

In a community population, Met Syn responds to weight loss through a low-calorie lifestyle intervention; for some patients, however, the recommended 10% weight loss may not be enough for Met Syn remission.

Metabolic syndrome after laparoscopic bariatric surgery

BACKGROUND

Metabolic syndrome (MS) is common among morbidly obese patients undergoing bariatric surgery. The aim of this study was to assess the impact and predictors of bariatric surgery on the resolution of MS.

METHODS

Subjects included 286 patients [age 44.0 +/- 11.5, female 78.2%, BMI 48.7 +/- 9.4, waist circumference 139 +/- 20 cm, AST 23.5 +/- 14.9, ALT 30.0 +/- 20.1, type 2 diabetes mellitus (DM) 30.1% and MS 39.2%] who underwent bariatric surgery.

RESULTS

Of the entire cohort, 27.3% underwent malabsorptive surgery, 55.9% underwent restrictive surgery, and 16.8% had combination restrictive-malabsorptive surgery. Mean weight loss was 33.7 +/- 20.1 kg after restrictive surgery (follow up period 298 +/- 271 days), 39.4 +/- 22.9 kg after malabsorptive surgery (follow-up period 306 +/- 290 days), and 28.3 +/- 14.1 kg after combination surgery (follow-up period 281 +/- 239 days). Regardless of the type of bariatric surgery, significant improvements were noted in MS (p values from <0.0001-0.01) as well as its components such as DM (p values from <0.0001-0.0005), waist circumference (p values <0.0001), BMI (p values <0.0001), fasting serum triglycerides (p values <0.0001 to 0.001), and fasting serum glucose (p values <0.0001). Additionally, a significant improvement in AST/ALT ratio (p value = 0.0002) was noted in those undergoing restrictive surgery. Multivariate analysis showed that patients who underwent malabsorptive bariatric procedures experienced a significantly greater percent excess weight loss than patients who underwent restrictive procedures (p value = 0.0451). Percent excess weight loss increased with longer postoperative follow-up (p value <0.0001).

CONCLUSIONS

Weight loss after bariatric surgery is associated with a significant improvement in MS and other metabolic factors.

Remission of metabolic syndrome: a study of 140 patients six months after Roux-en-Y gastric bypass

BACKGROUND

Metabolic Syndrome (MS) is a complex disorder characterized by a number of cardiovascular risk factors usually associated with central fat deposition and insulin resistance. Nowadays, there are many different medical treatments to MS, including bariatric surgery, which improves all risk factors. The present study aims to evaluate the influence of gastric bypass in the improvement of risk factors associated with MS, during the postoperative (6 months).

METHODS

This was a retrospective study of 140 patients submitted to gastric bypass. The sample was comprised of a female majority (79.3 %). The mean body mass index (BMI) was 44.17 kg/m2. We evaluated the weight of the subjects, the presence of diabetes mellitus and hypertension as comorbidities, as well as plasma levels of triglycerides (TG), total cholesterol and its fractions, and glycemia, in both preoperative and postoperative.

RESULTS

The percentage of excess weight loss (%EWL) was similar in men and women, with an average of 67.82 +/- 13.21%. Concerning impaired fasting glucose (> or =100 mg/dl), 41 patients (95.3%) presented normal postoperative glycemia. There has been an improvement of every appraised parameter. The mean decrease in TG level was 66.33 mg/dl (p<0.0001). Before the surgery, 47.1% were hypertensive; after it, only 15% continued in antihypertensive drug therapy (p<0.0001). Otherwise, the only dissimilar variable between sexes was the high-density lipoprotein (HDL) level.

CONCLUSION

Gastric bypass is an effective method to improve the risk factors of metabolic syndrome in the morbidly obese.

Percentage of excess BMI lost correlates better with improvement of metabolic syndrome after Roux-en-Y gastric bypass in morbidly obese subjects: anthropometric indexes and gastric bypass

BACKGROUND

The metabolic syndrome (MS) is a complex disorder characterized by a number of cardiovascular risk factors usually associated with central fat deposition and insulin resistance. Many different medical treatments are available for MS, including bariatric surgery, which improves all risk factors. The present study aimed to evaluate, at the Clinic of Gastroenterology and Obesity Surgery (Brazil), the accuracy of different anthropometric indexes and their correlation with improvement of the MS factors in the postoperative (6-month) period.

METHODS

This was a retrospective study of 140 patients who had undergone gastric bypass. Most of the patients were women (79.3%). The mean body mass index was 44.17 kg/m(2). We evaluated the weight of the subjects, the presence of diabetes mellitus and hypertension as co-morbidities, and the biochemical parameters. The anthropometric indexes tested included the percentage of excess weight loss, amount lost in kilograms, difference in the body mass index, percentage of initial weight lost, percentage of excess body mass index lost (%EBL), and percentage of initial fat mass lost.

RESULTS

The %EBL had a Spearman's correlation coefficient of 0.55 (P <.0001) for the difference between the MS factors before and after Roux-en-Y gastric bypass. The receiver operating characteristic curve for the %EBL resulted in an area under the curve of 0.846 (P = 0.0001) and a sensitivity and specificity of 100% and 61.29%, respectively, for a cutoff value of 64.55%.

CONCLUSION

The %EBL was the best method to report weight loss and the improvement in MS in morbidly obese subjects after Roux-en-Y gastric bypass.

[Can bariatric surgery cure metabolic syndrome?]

OBJECTIVES

To evaluate the impact of bariatric surgery on the metabolic syndrome (MS) and what are the criteria that contribute the most for its exclusion after surgery. The progress of leucometry was also analyzed.

METHODS AND PROCEDURES

47 obese women with MS were evaluated. All patients were operated with the Roux-en-Y vertical gastric bypass technique, with the insertion of a contention ring on the gastro-jejune anastomosis (Fobi-Capella). Patients were evaluated before and on the first year post-surgery.

RESULTS

Fasting glucose presented a relevant decrease at 3 months after surgery. After 12 months, all 20 patients who had DM2 or altered fasting glucose presented normal levels of fasting glucose and glicated hemoglobin, and none of them was using any anti-diabetic drug. Triglycerides levels were reduced by 49.2%, whereas HDL-cholesterol increased by 27.2%. Systolic and diastolic blood pressures were reduced by an average of 28.7 and 20.8 mmHg, respectively. Leucocytes counting fell from 7671/microL to 6156/microL. Fasting glucose, triglycerides, DBP, SBP and HDL-cholesterol were the variables that contributed most for the reduction of MS. At the end of the first year, elimination of MS occurred in 80.9% of the patients.

DISCUSSION

Bariatric surgery reduces resistance to insulin and consequently the cardiovascular risk factors.

The evidence for dietary prevention and treatment of cardiovascular disease

During the past few decades numerous studies have reported the atherogenic potential of saturated fatty acids, trans-fatty acids, and cholesterol, and beneficial effects of fiber, phytostanols/phytosterols, n-3 fatty acids, a Mediterranean diet, and other plant-based approaches. The purpose of this article is to provide a comprehensive and systematic review of the evidence associated with key dietary factors and risk of cardiovascular disease-an umbrella term encompassing diseases that affect the heart and blood vessels, including coronary heart disease, coronary artery disease, dyslipidemia, and hypertension-in conjunction with the work of the American Dietetic Association Evidence Analysis Library review on diet and lipids, updated with new evidence from the past 2 years. The criteria used and results cited provide scientific rationale for food and nutrition professionals and other health professionals for counseling patients. Details of these searches are available within the American Dietetic Association Evidence Analysis Library online (http://adaevidencelibrary.com). Potential mechanisms and needs for future research are summarized for each relevant nutrient, food, or food component.

Endoscopic and ultrasonographic evaluation before and after Roux-en-Y gastric bypass for morbid obesity

BACKGROUND

Esophagogastric abnormalities are recognized prior and after bariatric procedures, but frequency and severity are debated. Liver and biliary tract findings are also of clinical importance, especially gallstones and liver steatosis.

AIM

To compare pre-operative findings of hepatobiliary ultrasound and upper digestive endoscopy with post-operative results in patients submitted to open Roux-en-Y gastric bypass for morbid obesity.

METHODS

A total of 80 patients were enrolled 16.8 +/- 12.1 months after operation, all of them on routine follow-up program, and 8 were excluded. Retrospective analysis aimed at pre-operative clinical, endoscopic and ultrasonographic examinations and were prospectively repeated.

RESULTS

Pre-operative endoscopical report was available in 42 cases, and 52 examinations were performed post-operatively. Frequency of esophagitis changed from 16.7% (7/42) to 15.4% (8/52), and of gastritis from 45.2% (19/42) to 21.2% (11/52). Gastric or gastrojejunal ulcers were initially present in 4.8% (2/42) and increased to 9.6% (5/52). Post-operatively, an unusual abnormality was silastic band erosion: 7.7% (4/52). Helicobacter pylori was present in 50.0% (21/42) before and 3.5% (2/52) after operation. Ultrasonographic study had been done before intervention in 63 subjects, and 57 were executed on follow-up. Liver steatosis occurred previously in 58.7% (37/63) and in 43.9% (25/57) later on. Only 12.7% (8/63) of the patients had undergone cholecystectomy before bariatric operation, 29.1%(16/55) suffered simultaneous resection of gallbladder because of stones during Roux-en-Y gastric bypass, and an additional 26.8% (10/36) developed gallstones post-operatively.

CONCLUSIONS

Liver steatosis did not statistically improve, nor did inflammatory conditions of the upper digestive tube, despite reduction of H. pylori infections; gallbladder stones requiring intervention were common.

The prevalence of metabolic syndrome in patients with bipolar disorder

BACKGROUND

Previous studies on the prevalence of metabolic syndrome (MetS) in patients with bipolar disorder have reported rates 11% and 79% higher than in their respective general populations. This study evaluates the prevalence of MetS in a group of 194 Spanish patients with bipolar disorder.

METHODS

Naturalistic, multicentre, cross-sectional study. Patients were evaluated for presence of MetS according to modified NCEP ATP III criteria.

RESULTS

Mean age was 46.6 (SD 13.9); 49.2% were male. Forty-six percent were in remission. Patients were receiving 2.9 (SD 1.3) drugs. Overall prevalence of MetS was 22.4%. Fifty-four percent met the criterion for abdominal obesity, 36.1% for hypertriglyceridemia, 38.2% for low HDL cholesterol, 20.9% for hypertension, and 12.2% for high fasting glucose. The multivariate analysis for MetS retained only the BMI variable in the model.

LIMITATIONS

Cross-sectional study design.

CONCLUSIONS

The prevalence of MetS in patients with bipolar disorder is 58% higher than that reported for the general Spanish population. MetS is associated with BMI. Clinicians should be aware of this issue and appropriately monitor patients with bipolar disorder for MetS as part of the standard of care for these patients.

Circulating markers of inflammation and their link to indices of adiposity

BACKGROUND

Adipose tissue produces a number of inflammatory mediators. Circulating concentrations of these inflammatory markers are increasingly used as markers of local or systemic inflammation. This study compares results for 3 inflammatory adipokines measured using 2 techniques, (multiplex and ELISA), and determines the relationships with C-reactive protein (CRP), obesity, and the impact of moderate weight loss.

SUBJECTS AND METHODS

Fasting blood samples were collected at baseline and after a 24-week weight loss intervention. Interleukin 6 (IL-6), tumour necrosis factor alpha(TNF-alpha), and monocyte chemoattractant protein 1 (MCP-1) were measured using a standard ELISA technique or a new multiplex technique. A total of 54 women with complete data were included in this analysis.

RESULTS

Multiplex showed poor correlation with ELISA results, and were not significantly correlated with CRP. Using ELISA data, IL-6 and CRP were significantly correlated with body mass index (BMI) (r = 0.42 and r = 0.55), but MCP-1 and TNF-alpha were not (r = - 0.07 and r = 0.06). Changes in MCP-1, TNF-alpha, and IL-6 were not significantly different between control and weight loss groups. CRP was significantly reduced in weight loss vs. control group (p < 0.05), and change in CRP correlated with change in BMI (r = 0.31).

CONCLUSION

Circulating IL-6 and CRP, but not MCP-1 and TNF-alpha, are significantly associated with indices of adiposity in obese women. This study suggests that circulating IL-6 and CRP, but not MCP-1 and TNF-alpha, are useful markers of obesity-related inflammation.

Metabolic syndrome in youth: a cross-sectional school-based survey

AIM

To assess the prevalence of metabolic syndrome (MetS) among students attending vocational secondary school (VSE). VSE provides practice-oriented education in which young people learn a specific occupation. Previously we reported VSE to be the type of education with the highest prevalence of overweight and obesity.

METHODS

All data were collected in a cross-sectional school-based survey. Subjects were recruited from a community sample of 869 adolescents in 14 secondary schools. In this total sample all components of the metabolic syndrome were assessed in a subgroup of 506 students. MetS was defined analogous to National Cholesterol Education Program: Adult Treatment Panel III criteria, with modifications for students under 19 years of age.

RESULTS

In the subsample (n=506) 4.1% of the students had metabolic syndrome. There was a significant difference in the prevalence of metabolic syndrome among BMI categories (p<0.001). The prevalence of metabolic syndrome was higher in obese students (39.1%) than in overweight students (2.8%) and normal weight students (0.3%).

CONCLUSION

Being overweight or obese substantially increases the risk for metabolic syndrome, even in an adolescent school population.

Behavioral intervention for the treatment of obesity: strategies and effectiveness data

The obesity epidemic has been recognized in the professional and lay public as a major health problem in the United States and many other cultures. The gastroenterology literature has recently paid attention to this problem, focusing primarily on either physiological mechanisms of obesity or surgical remedies for obesity. However, behavioral strategies developed from social learning theory have been the most thoroughly tested interventions for the treatment of obesity, as well as the interventions shown most clearly to have clinical benefit. Nevertheless, descriptions of behavioral techniques and their theoretical underpinnings have been minimal in the gastroenterology literature. Here, a brief history and presentation of the theoretical underpinnings of behavioral strategies for obesity management is summarized, emphasizing some of the key components, treatment effectiveness data, and needed areas for further research. Overall, it is concluded that behavior therapy is both the most studied and most effective therapy for treating obesity at present. Gastroenterologists are encouraged to use it as a first line of treatment for most obese patients, and as a key component of therapies that involve pharmacologic and surgical components.

Psychiatric and metabolic characteristics of childhood versus adult-onset obesity in patients seeking weight management

The purpose of the study was to examine whether childhood-onset obesity differed from adult-onset obesity in lifetime prevalence of mood and eating disorders, and metabolic abnormalities, in currently obese adults seeking weight loss. A subgroup of childhood-onset obesity participants (N=44) was compared with a subgroup with adult-onset obesity (N=69) on a number of clinical and metabolic features. The results showed high lifetime prevalence rates of mood (78%) and eating (81%) disorders, and metabolic syndrome (45%), in the group as a whole. However, patients with childhood-onset obesity had a significantly higher lifetime prevalence of eating disorders in general, and of bulimia nervosa in particular, than patients with adult-onset obesity. Our results support findings of substantial comorbidity among obesity, mood and eating disorders, and metabolic syndrome in weight loss seeking populations. Early recognition and attention to eating and mood dysregulation, including, but not limited to binge eating disorder and bulimia nervosa, in some persons, might help reduce their lifetime risk for obesity.

Metabolic syndrome: pathogenesis, medical care and dental implications

BACKGROUND

The dental literature contains little information about metabolic syndrome (MetS) and its dental implications.

TYPES OF STUDIES REVIEWED

The authors conducted a MEDLINE search for the period 2000 through 2005, using the term "metabolic syndrome" to define its pathophysiology, medical treatment and dental implications.

RESULTS

MetS is the co-occurrence of abdominal obesity, hyper-triglyceridemia, reduced high-density lipoprotein cholesterol levels, hypertension and impaired fasting glucose, which results from consumption of a high-calorie diet and decreased levels of physical activity superimposed on the appropriate genetic setting. Components of MetS synergistically promote the development of atherosclerosis, resulting in myocardial infarction and stroke.

CLINICAL IMPLICATIONS

Deteriorating oral health status is associated with worsening of the atherogenic profile. Tooth loss often results in chewing difficulties because of inadequate occlusive surfaces and may lead to alterations in food selection and dietary quality. This, in turn, adversely affects body composition and nutritional status, both of which are related to vascular health. Dentists should develop treatment plans that preserve and restore the dentition, thus ensuring maximum masticatory efficiency and affording patients the optimum opportunity to consume food that will not foster atherogenesis.

Impact of weight loss on the metabolic syndrome

OBJECTIVE

To evaluate the effects of weight loss on the risk of having metabolic syndrome after 1 year of treatment with lifestyle modification alone, pharmacotherapy alone (sibutramine) or the combination of the two.

DESIGN

Randomized, controlled, 1-year clinical trial.

PATIENTS

One hundred and eighty women and 44 men, 18-65 years of age, with a body mass index of 30-45 kg/m(2), free of uncontrolled hypertension or type 1 or 2 diabetes.

INTERVENTION

Fifteen milligrams of sibutramine per day alone, lifestyle modification counseling alone, sibutramine plus lifestyle modification counseling or sibutramine plus brief lifestyle modification counseling.

MEASUREMENTS

The metabolic syndrome, as defined by the Adult Treatment Panel III.

RESULTS

Before treatment, 34.8% of the participants had the metabolic syndrome. Metabolic syndrome was more prevalent in Caucasians than African Americans (42.5 vs 20.3%; P<0.03), in males than females (65.1 vs 34.9%; P<0.002) and in older (>44 years) than younger (</=44 years) participants (47.5 vs 20.8%; P<0.0001). After 1 year of treatment, a moderate decrease in weight (8.0+/-8.7 kg) resulted in significant reductions in the prevalence of metabolic syndrome from 34.8 to 27.2% of all participants (P<0.02). Logistic regression analyses indicated that for each 1 kg of weight lost, the odds of metabolic syndrome were reduced by 8% (CI=0.89-0.97; P<0.003). Lifestyle modification either alone (P<0.04), or in combination with sibutramine (P<0.05), significantly reduced the prevalence of metabolic syndrome compared with sibutramine alone. The group effect was removed after controlling for weight loss.

CONCLUSIONS

The metabolic syndrome was prevalent in over one-third of obese individuals who sought weight loss treatment, and the prevalence differed by age, sex and ethnicity. Moderate weight loss markedly reduced the odds of metabolic syndrome in this sample.

Cardiovascular risk factors after bariatric surgery: Do patients gain more than expected from their substantial weight loss?

BACKGROUND

While it has been established that even limited weight loss (5-10%) improves obesity-associated cardiovascular risk factors, it is not known if considerable weight loss following laparoscopic adjustable silicone gastric banding (LASGB) results in a cardiovascular risk profile that is comparable, worse, or even better than that of matched control subjects.

METHODS

Cardiovascular risk factors were compared in three groups of 24 women each: an index group that had lost considerable weight following LASGB for morbid obesity (BMI>40 kg/m(2)), a control group with the same BMI that the index group achieved after weight loss, and a pre-weight loss group of women with a BMI above 40 kg/m(2). Anthropometric measures, fasting serum glucose, insulin, lipids, C-reactive protein, and homocysteine levels were determined and insulin sensitivity was estimated using a homeostasis model assessment index (HOMA-IR).

RESULTS

After bariatric surgery, the index group had a BMI of 32.0+/-0.8 kg/m(2). This resulted in a significantly better cardiovascular risk profile than that of the pre-weight loss group (BMI 42.8+/-0.6 kg/m(2)). Unexpectedly, after weight loss, the index group had significantly lower systolic blood pressure, fasting serum insulin, and HOMA-IR than the BMI-matched (32.8+/-0.9 kg/m(2)) control group. Although not significant, diastolic blood pressure, LDL-cholesterol, and CRP levels were also lower.

CONCLUSION

Considerable weight loss following bariatric surgery leads to a greater improvement in cardiovascular risk factors than might be expected from the weight loss.

Prevalence and trends of metabolic syndrome in Korea: Korean National Health and Nutrition Survey 1998-2001

BACKGROUND

Metabolic syndrome (MetS) is a major international health problem. Limited information is available about the prevalence of MetS in Asia, especially in Korea.

OBJECTIVE

To examine the prevalence and trends of MetS in a Korean population. In addition, we investigated the risk factors associated with MetS.

DESIGN AND PARTICIPANTS

A total of 7445 participants aged >/=20 years from the Korean National Health and Nutrition Survey (KNHNS) 1998 and 5964 participants from the KNHNS 2001 were included in this analysis. The KNHNS is a cross-sectional health survey of a nationally representative sample of the Korean population. The prevalence of MetS was determined using the National Cholesterol Education Program Adult Treatment Panel III criteria and the Asia-Pacific criteria for obesity based on waist circumference (APC-WC).

RESULTS

Using the ATP III criteria, the age-adjusted prevalence of MetS among Korean adults was 15.7% (13.7% male, 17.8% female) in 1998 and 14.4% (13.0% male, 16.2% female) in 2001. Using the APC-WC criteria, the prevalence was 21.6% (19.4% male, 23.9% female) in 1998 and 21.4% (20.1% male, 23.4% female) in 2001. Of the five MetS components, increasing trends were found between 1998 and 2001 in the prevalence of hypertriglyceridaemia, low high-density lipoprotein cholesterol and central obesity for both men and women. Age, sex, body mass index and a family history of diabetes were associated with MetS.

CONCLUSIONS

These results from a representative sample show that MetS is common in Korean adults. A systemic public health programme is required to prevent future increases in diabetes and cardiovascular complications.