The metabolic syndrome in obese postmenopausal women: relationship to body composition, visceral fat, and inflammation

Sarcopenia, a neurogenic syndrome?

Sarcopenia is an aging-associated condition, which is currently characterized by the loss of muscle mass and muscle strength. However, there is no consensus regarding its characterization hitherto. As the world older adult population is on the rise, the impact of sarcopenia becomes greater. Due to the lack of effective treatments, sarcopenia is still a persisting problem among the global older adults and should not be overlooked. As a result, it is vital to investigate deeper into the mechanism underlying the pathogenesis of sarcopenia in order to develop more effective therapeutic interventions and to inscribe a more uniform characterization. The etiology of sarcopenia is currently found to be multifactorial, and most of the pharmacological researches are focused on the muscular factors in aging. Although the complete mechanism underlying the development of sarcopenia is still waiting to be elucidated, we propose in this article that the primary trigger of sarcopenia may be neurogenic in origin based on the intimate relationship between the nervous and muscular system, namely, the motor neuron and its underlying muscle fibers. Both of them are affected by the cellular environment and their physiological activity.

Metabolic effects of adjunctive aripiprazole in clozapine-treated patients with schizophrenia

OBJECTIVE

This study examined the effects of adjunctive aripiprazole therapy on metabolism in clozapine-treated patients with schizophrenia.

METHOD

In an 8-week randomized, double-blind, placebo-controlled study, subjects received either aripiprazole (15 mg/day) or placebo. At baseline and week 8, metabolic parameters were assessed by the frequently sampled intravenous glucose tolerance test, nuclear magnetic resonance spectroscopy and whole-body dual-energy X-ray absorptiometry (DXA).

RESULTS

Thirty subjects completed the study (16 in the aripiprazole group and 14 in the placebo group). Glucose effectiveness measured by the frequently sampled intravenous glucose tolerance test improved significantly in the aripiprazole group (0.003 ± 0.006 vs. -0.005 ± 0.007/min, P = 0.010). The aripiprazole group showed significant reductions in both plasma low-density lipoprotein (LDL) levels (-15.1 ± 19.8 vs. 4.4 ± 22.5 mg/dl, P = 0.019) and LDL particle numbers (-376 ± 632 vs. -36 ± 301 nm, P = 0.035). Further, there was a significant reduction in the lean mass (-1125 ± 1620 vs. 607 ± 1578 g, P = 0.011) measured by whole-body DXA scan in the aripiprazole group. All values were expressed as mean ± standard deviation, aripiprazole vs. placebo.

CONCLUSION

Adjunctive therapy with aripiprazole may have some metabolic benefits in clozapine-treated patients with schizophrenia.

Central adiposity and decreased heart rate variability in postmenopause: a cross-sectional study

OBJECTIVE

To investigate the impact of waist circumference (WC) on heart rate variability in 87 apparently healthy, postmenopausal women.

METHODS

In this cross-sectional study, time- and frequency-domain heart rate variability indices were determined at rest and during sympathetic stimulation with mental stress. Patients were stratified according to WC ≥ or < 88 cm. The mean (± standard deviation) age was 55 ± 5 years. The median time since menopause was 6 (range 1-22) years. Age and time since menopause were similar.

RESULTS

The mean body mass index was 27.12 ± 4.49 kg/m². Metabolic syndrome was diagnosed in 26 (29.5%) participants. Thirty-eight participants (43.6%) had hypertension. Women with WC ≥ 88 cm had higher body mass index, glucose and insulin (both fasting and after a 75-g oral glucose tolerance test), HOMA, triglycerides, and free androgen index (p < 0.05). The metabolic syndrome was more frequent in women with WC ≥ 88 cm (24.13% vs. 5.74%; p < 0.01). At rest, women with WC ≥ 88 cm presented lower vagal modulation, expressed by a reduction in the mean of all normal RR intervals (mean RR) (p < 0.01) and root mean square of successive differences of adjacent RR intervals (rMSSD) (p < 0.05) than women with WC < 88 cm. Mental stress significantly increased sympathetic modulation in both groups, expressed by reduction in high frequency (HF), increase in low frequency (LF) and LF/F ratio, and reduction in mean RR and rMSSD.

CONCLUSIONS

Less favorable metabolic profile and lower cardiac vagal modulation with preserved sympathetic responsiveness were found in participants with WC ≥ 88 cm, suggesting that central adiposity may be associated with decreased heart rate variability in apparently healthy, postmenopausal women.

Low-calorie diet induced weight loss may alter regulatory hormones and contribute to rebound visceral adiposity in obese persons with a family history of type-2 diabetes

PURPOSE

To examine potential detrimental long-term effects of acute diet-induced weight loss on visceral adiposity, insulin resistance, cortisol, and adipokines in obese individuals at risk for type-2 diabetes.

DATA SOURCES

Anthropometric measures (height, weight, waist circumference), self-report instruments, abdominal computed tomography (CT) scan, and blood samples (glucose, insulin, interleukin-6, leptin, adiponectin) were obtained from a convenience sample of 20 participants at baseline, after a 28-day low-calorie diet (800 kcal/day) intervention, and again 6 months later.

CONCLUSIONS

Fifteen of 20 participants completed the 28-day diet intervention and had a mean weight loss of 15 pounds. Comparison between baseline, postdiet, and 6-month data, demonstrated that although participants had significant improvements after the diet, they regained fat mass, particularly in the visceral area.

IMPLICATIONS FOR PRACTICE

Clinicians may need to revise recommendations for using low-calorie diets to achieve weight loss. Diet-induced weight cycling may contribute to dysregulation of metabolism and have long-term detrimental consequences for accumulation of visceral adipose tissue. The likelihood of success is low, with high dropout rates, and those patients who achieve weight loss are very likely to regain it. Thus, the perceived short-term benefits of calorie-restricted diets in this population likely do not outweigh the potential long-term detrimental effects.

Relationships among body mass index, longitudinal body composition alterations, and survival in patients with locally advanced pancreatic cancer receiving chemoradiation: a pilot study

CONTEXT

In pancreatic cancer, the presence of obesity or weight loss is associated with higher mortality.

OBJECTIVES

To explore the relationships among body mass index, longitudinal body composition alterations, and clinical outcomes in pancreatic cancer patients.

METHODS

Records of 41 patients with inoperable locally advanced pancreatic cancer who participated in a prospective chemoradiation study were reviewed. Body composition was analyzed from two sets of computed tomography images obtained before and after radiation treatment (median interval 104 days).

RESULTS

Median age was 59 years and 56% of patients were female. Twenty-four (59%) patients were either overweight (22%) or obese (37%). Sarcopenia was present in 26 (63%) patients. At follow-up, weight loss was experienced by 33 (81%) patients. The median losses (%) before and after treatment were weight 5% (P<0.001), skeletal muscle (SKM) 4% (P=0.003), visceral adipose tissue (VAT) 13% (P<0.001), and subcutaneous adipose tissue 11% (P=0.002). SKM loss positively correlated with age (P=0.03), baseline body mass index (P<0.001), and VAT (P=0.04) index. Obese patients experienced higher losses in weight (P=0.009), SKM (P=0.02), and VAT (P=0.02). Median survival was 12 months. In univariate analysis, age, baseline obesity, sarcopenic obesity, and losses (%) in weight, SKM, and VAT were associated with worse survival. In multivariate analysis, only age (hazard ratio=1.033, P=0.04) and higher VAT loss (hazard ratio=2.6 and P=0.03) remained significant.

CONCLUSION

Our preliminary findings suggest that obese patients experience higher losses in weight, SKM, and VAT, which may contribute to poorer survival in these patients.

Regulation of adipose tissue energy availability through blood flow control in the metabolic syndrome

Maintenance of blood flow rate is a critical factor for tissue oxygen and substrate supply. The potentially large mass of adipose tissue deeply influences the body distribution of blood flow. This is due to increased peripheral resistance in obesity and the role of this tissue as the ultimate destination of unused excess of dietary energy. However, adipose tissue cannot grow indefinitely, and the tissue must defend itself against the avalanche of nutrients provoking inordinate growth and inflammation. In the obese, large adipose tissue masses show lower blood flow, limiting the access of excess circulating substrates. Blood flow restriction is achieved by vasoconstriction, despite increased production of nitric oxide, the vasodilatation effects of which are overridden by catecholamines (and probably also by angiotensin II and endothelin). Decreased blood flow reduces the availability of oxygen, provoking massive glycolysis (hyperglycemic conditions), which results in the production of lactate, exported to the liver for processing. However, this produces local acidosis, which elicits the rapid dissociation of oxyhemoglobin, freeing bursts of oxygen in localized zones of the tissue. The excess of oxygen (and of nitric oxide) induces the production of reactive oxygen species, which deeply affect the endothelial, blood, and adipose cells, inducing oxidative and nitrosative damage and eliciting an increased immune response, which translates into inflammation. The result of the defense mechanism for adipose tissue, localized vasoconstriction, may thus help develop a more generalized pathologic response within the metabolic syndrome parameters, extending its effects to the whole body.

Stem cell activation in adults can reverse detrimental changes in body composition to reduce fat and increase lean mass in both sexes

Detrimental changes in body composition are often associated with declining levels of testosterone. Here, we evaluated the notion that multipotent mesenchymal stem cells, that give rise to both fat and muscle tissue, can play a significant role to alter existing body composition in the adult. Transgenic mice with targeted androgen receptor (AR) overexpression in stem cells were employed. Wild-type littermate and AR-transgenic male and female mice were gonadectomized and left untreated for 2 months. After the hypogonadal period, mice were then treated with 5α-dihydrotestosterone (DHT) for 6 weeks. After orchidectomy (ORX), wild-type males have reduced lean mass and increased fat mass compared to shams. DHT treatment was beneficial to partially restore body composition. In wild-type females, ovariectomy (OVX) produced a similar change but there was no improvement with DHT. In targeted AR transgenic mice, DHT treatment increased lean and reduced fat mass to sham levels. In contrast to wild-type females, DHT treatment in female transgenic mice significantly ameliorated the increased fat and decreased lean mass changes that result after OVX. Our results show that DHT administration reduces fat mass and increases lean mass in wild-type males but not females, indicating that wild-type females are not as sensitive to androgen treatment. Because both male and female transgenic mice are more responsive than wild-type, results suggest that body composition remains linked to stem cell fate in the adult and that targeted androgen signaling in stem cells can play a significant role to reverse detrimental changes in body composition in both sexes.

Relationship between fat mass and serum high-sensitivity C-reactive protein levels in prevalent hemodialysis patients

BACKGROUND/AIMS

Little is known about the relationship between fat mass distribution and chronic inflammation in dialysis patients, in whom chronic inflammation is related to morbidity and mortality.

METHODS

The fat and lean masses (truncal and nontruncal) of 452 hemodialysis patients (age: 64 ± 11 years; hemodialysis duration: 89 ± 77 months; 37% diabetics) were measured by dual X-ray absorptiometry and their association with high-sensitivity C-reactive protein (hsCRP) was examined.

RESULTS

The fat mass of the high hsCRP group (n = 106) was significantly higher than that of the normal hsCRP group (n = 346; p < 0.05); there were no significant differences in lean mass between the two groups. Truncal fat mass of the former group was significantly greater than that of the latter (p < 0.05), but there was no significant difference in nontruncal fat mass between the two groups. In multiple regression analysis, truncal fat mass (β = 0.227, p < 0.01) was significantly and independently associated with serum hsCRP levels after adjustment for age, gender and serum albumin (R(2) = 0.137, p < 0.01), whereas nontruncal fat mass was not.

CONCLUSION

Fat mass, particularly truncal fat mass, but not lean body mass, was significantly associated with serum hsCRP levels. The results suggest that truncal fat mass exhibits a distinct effect on chronic inflammation in hemodialysis patients.

Prepregnancy obesity: determinants, consequences, and solutions

Obesity among women of childbearing age is of paramount importance because of its association with multiple adverse health outcomes for the mother and fetus once a woman becomes pregnant. Obesity is more prevalent among women of lower socioeconomic status and of color who often times lack health insurance. This health disparity that exists within a framework of repeating cycle of risk emphasizes the urgency for accelerating the discovery of solutions for the obesity problem among women of childbearing age.

Relationship of C-reactive protein with components of the metabolic syndrome in a Tunisian population

BACKGROUND

C-reactive protein (CRP) is an independent risk factor of diabetes and cardiovascular disease and it is proposed as a component of metabolic syndrome (MS). This study was undertaken to investigate the relationship between CRP and various characteristics of the MS in a sample of the Tunisian population

METHODS

One hundred and forty nine patients with MS and 152 controls, aged 35-70 years were recruited. Waist circumference (WC), blood pressure, HDL-cholesterol (HDL-C), triglycerides (TG), glucose, insulin and CRP were measured. Insulin resistance was assessed by homeostasis model assessment of insulin resistance (HOMA-IR). MS was defined by NCEP-ATPIII report

RESULTS

CRP levels were significantly higher in MS group (4.41±3.73 mg/L vs. 2.68±2.59 mg/L, p<0.001) compared to without MS group. For both sexes, CRP increased as the number of MS components increased (p=0.015 for men and p<0.001) after adjustment for age, smoking, alcohol intake and, for women, menopause. There were statistically significant positive correlations for log CRP with WC, log TG, and log HOMA-IR in both sexes adjusted for confounding factors listed above. A significant negative correlation was found between HDL-C and log CRP only in women. In both sexes, WC was identified, by multiple linear regression models, as significant independent predictor of CRP level variability. HDL-C showed also a significant contribution only in women

CONCLUSIONS

The present study provides evidence that CRP levels are elevated in MS subjects. In addition, WC and HDL-C are significant predictors of the CRP elevation.

Effects of high-fat diet on plasma lipids, adiposity, and inflammatory markers in ovariectomized C57BL/6 mice

OBJECTIVE

We hypothesized that a high-fat (HF) diet aggravates ovariectomy-related complications. To test this hypothesis, ovariectomized (OVX) mice were fed a HF diet, and we investigated the lipid metabolism, adipose tissue remodeling, adipokines, and inflammatory cytokines.

METHODS

To investigate the situation in a mouse model of ovariectomy, OVX and SHAM C57BL/6 mice fed a HF diet (60% fat) or standard chow (SC, 10% fat) were monitored for 18 wk. We evaluated daily food intake and weekly body weight. Mice were killed at 30 wk of age. Blood samples and adipose tissue were collected for biochemical, histologic, and molecular analysis.

RESULTS

OVX groups showed atrophied uterus compared to the SHAM groups, ensuring the success of surgically induced menopause. Despite lower food intake, OVX-HF mice gained about 52% more weight and had heavier total body fats, especially in relation to ovarian fat pad (372%)-a visceral fat which is associated with increased pathogenicity in obesity, and showed larger adipocytes (30%) when compared to OVX-SC mice. Biochemical analysis showed that the OVX-HF mice had increased levels of serum total cholesterol (51%), greater serum triglycerides (158%), lower serum adiponectin (40%), and higher plasma leptin (323%) than OVX-SC mice. The obese group (OVX-HF) also had higher IL-6 levels than both SHAM-HF (241%) and OVX-SC mice (870%).

CONCLUSION

OVX C57BL/6 mice fed HF diet had greater adipose fat pad, larger adipocytes, and increased inflammatory markers, reinforcing the idea that a HF diet aggravates the complications of ovariectomy-associated inflammation.

The relationship between perceived sense of control and visceral adipose tissue - the North Texas Healthy Heart Study

Background

The purpose of this study was to assess the relationship between one's sense of control and visceral adipose tissue.

Methods

This cross-sectional study recruited 571 subjects (45 years and older) who were asymptomatic of CHD from Fort Worth, Texas from 2006 to 2008. Subjects completed a questionnaire, body measurements, a multi-slice computed tomography scan to assess for visceral adipose tissue (VAT) centered at the L4L5 spinal interspace, and serum chemistries. The natural log of L4L5 VAT (lnVAT) was used in all analyses to achieve normality of the data with final analyses including 506 participants. Linear regression was used to estimate unadjusted and adjusted beta-coefficients and standard errors for the association between sense of control and lnVAT.

Results

A total of 506 participants were used in the data after adjusting for normality of the data. An increase in sense of control was associated with a decrease in lnVAT in the unadjusted (p < 0.001) and adjusted (p = 0.03) models. Other factors significantly associated with lnVAT in the adjusted model include age, BMI, male gender, non-Hispanic African American, and diet.

Conclusions

Sense of control remained as an independent factor associated with visceral adiposity despite adjusting for traditional cardiovascular risk factors, including BMI. Future studies should focus on establishing a causal relationship between sense of control and visceral adiposity.

Pro-inflammatory cytokine levels in postmenopausal women with the metabolic syndrome

BACKGROUND

Prevalence of the metabolic syndrome (METS) and its components significantly increase after the menopause. Related increased cardiovascular risk may partially be explained by a pro-inflammatory state.

OBJECTIVE

To assess pro-inflammatory cytokine serum levels in postmenopausal women with and without the METS.

METHODS

Serum of 90 postmenopausal women who previously participated in a METS screening programme was analysed for tumour necrosis factor-alpha (TNF-α) and interleukin 6 (IL-6). Cytokine levels were compared among those with and without the syndrome, and for each of its components. Linear relationships were also assessed between cytokine levels and several continuous variables including each diagnostic METS criteria and menopausal symptoms assessed with the Menopause Specific Quality of Life tool (MENQOL).

RESULTS

For all studied women mean age was 55.1 ± 7.3 years with 63.3% having abdominal obesity, 15.6% hyperglycaemia, 58.9% high triglycerides, 44.4% hypertension and 25.6% high total cholesterol levels. Women with the METS (n = 45) significantly had higher body mass index values, and higher rates of abdominal obesity, hyperglycaemia, hypertriglyceridemia, hypertension and lower HDL-C levels. Cytokine levels did not differ among women with or without the METS; however, independent of METS diagnosis those with abdominal obesity displayed significantly higher IL-6 levels and those with hypertension higher levels of both cytokines. Levels of both cytokines positively correlated with age and time since menopause, IL-6 positively correlating with waist circumference values and TNF-α positively with both systolic and diastolic blood pressure levels. A significant positive correlation was also found between the number of positive METS criteria (0-5) and both cytokine levels. Cytokine levels did not correlate with vasomotor and psycho-social MENQOL scores.

CONCLUSION

Pro-inflammatory cytokine levels in this postmenopausal series positively correlated with age, time since the menopause, abdominal circumference, blood pressures levels and the number of positive METS diagnostic criteria. There is a need for more research in this regard.

Weight loss and low-intensity exercise for the treatment of metabolic syndrome in obese postmenopausal women

BACKGROUND

The prevalence of the metabolic syndrome (MetSyn) approaches 50% in postmenopausal women. This study examines the efficacy of lifestyle modification for the treatment of MetSyn and its associated risk for cardiovascular disease and diabetes in this population.

METHODS

This prospective controlled study examines the effects of a 6-month weight loss and low-intensity exercise program (WL+LEX) on body composition (dual-energy X-ray absorptiometry and abdominal computed tomography scans), fasting glucose and lipid levels, cytokines, and blood pressure in postmenopausal women with and without MetSyn.

RESULTS

WL+LEX reduced body weight (MetSyn: -5% vs non-MetSyn: -7%) and fat mass (-11% vs -15%) and increased VO(2max) (+2% vs +3%) in both MetSyn (N = 35) and non-MetSyn (N = 41) groups. Constituents of MetSyn decreased comparably in both groups. Fifteen (45%) MetSyn participants responded (R) by converting to non-MetSyn, 18 remained MetSyn (NR), and 2 had missing data. Reduction in fat mass (-15% vs -8%, p = .02) was greater in R than NR, but there were no between-group differences in changes in VO(2max), cytokines, or other variables. The decrease in the number of MetSyn criteria was greater in R than in NR (-27 vs -13, p < .0001) due to decreases in blood pressure (p < .01), glucose (p = .02), and with a trend for triglyceride (p = .07). Reductions in fat mass best predicted resolution of MetSyn (p = .04).

CONCLUSIONS

Women who lose more fat are more likely to lower blood pressure, glucose, and triglyceride levels to resolve MetSyn. Thus, a WL+LEX program effectively treats postmenopausal women with MetSyn.

Lean body mass, interleukin 18, and metabolic syndrome in apparently healthy Chinese

OBJECTIVE

We aimed to investigate how lean body mass is related to circulating Interleukin 18 (IL-18) and its association with metabolic syndrome (MetS) among apparently healthy Chinese.

METHODS

A population-based sample of 1059 Chinese men and women aged 35-54 years was used to measure plasma IL-18, glucose, insulin, lipid profile, inflammatory markers and high-molecular-weight (HMW)-adiponectin. Fat mass index (FMI) and lean mass index (LMI) were measured by dual-energy X-ray absorptiometry. MetS was defined by the updated National Cholesterol Education Program Adult Treatment Panel III criteria for Asian-Americans.

RESULTS

Circulating IL-18 was positively correlated with LMI after adjustment for FMI (correlation coefficient = 0.11, P<0.001). The association with the MetS (odds ratio 3.43, 95% confidence interval 2.01-5.85) was substantially higher in the highest than the lowest quartile of IL-18 after multiple adjustments including body mass index. In the stratified multivariable regression analyses, the positive association between IL-18 and MetS was independent of tertiles of FMI, inflammatory markers and HMW-adiponectin, but significantly interacted with tertile of LMI (P for interaction = 0.010).

CONCLUSION

Elevated plasma IL-18 was associated with higher MetS prevalence in apparently healthy Chinese, independent of traditional risk factors, FMI, inflammatory markers and HMW-adiponectin. More studies are needed to clarify the role of lean mass in IL-18 secretion and its associated cardio-metabolic disorders.

The physical ability of elderly female Japanese patients with cerebrovascular disease correlates with telomere length in their peripheral blood leukocytes

BACKGROUND AND AIMS

The telomere length of peripheral blood leukocytes has been reported to be inversely correlated with many kinds of pathophysiological conditions. However, correlations between telomere length in peripheral blood leukocytes and patients' physical ability are not known.

METHODS

To address this problem, the physical ability of patients with cerebrovascular disease admitted to the chronic disease ward of Kyushu University Hospital was assessed with the Barthel index (BI) and the telomere length of their peripheral blood leukocytes was determined.

RESULTS AND CONCLUSIONS

Women exhibited a significant correlation between the Barthel score and the expression of long telomeres (>9.4 Kb), in contrast with men who revealed no such correlation. The physical ability of older women was positively correlated with the lengths of their somatic telomeres. Among the BI items, the scores of more difficult physical performances tended to correlate with the presence of terminal restriction fragments longer than 9.4 Kb.

Evidence for resistance training as a treatment therapy in obesity

Over the last decade, investigators have paid increasing attention to the effects of resistance training (RT) on several metabolic syndrome variables. Evidence suggests that skeletal muscle is responsible for up to 40% of individuals' total body weight and may be influential in modifying metabolic risk factors via muscle mass development. Due to the metabolic consequences of reduced muscle mass, it is understood that normal aging and/or decreased physical activity may lead to a higher prevalence of metabolic disorders. The purpose of this review is to (1) evaluate the potential clinical effectiveness and biological mechanisms of RT in the treatment of obesity and (2) provide up-to-date evidence relating to the impact of RT in reducing major cardiovascular disease risk factors (including dyslipidaemia and type 2 diabetes). A further aim of this paper is to provide clinicians with recommendations for facilitating the use of RT as therapy in obesity and obesity-related metabolic disorders.

Body fat distribution and inflammation among obese older adults with and without metabolic syndrome

The protective mechanisms by which some obese individuals escape the detrimental metabolic consequences of obesity are not understood. This study examined differences in body fat distribution and adipocytokines in obese older persons with and without metabolic syndrome. Additionally, we examined whether adipocytokines mediate the association between body fat distribution and metabolic syndrome. Data were from 729 obese men and women (BMI ≥ 30 kg/m(2)), aged 70-79 participating in the Health, Aging and Body Composition (Health ABC) study. Thirty-one percent of these obese men and women did not have metabolic syndrome. Obese persons with metabolic syndrome had significantly more abdominal visceral fat (men: P = 0.04; women: P < 0.01) and less thigh subcutaneous fat (men: P = 0.09; women: P < 0.01) than those without metabolic syndrome. Additionally, those with metabolic syndrome had significantly higher levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and plasminogen activator inhibitor-1 (PAI-1) than individuals without metabolic syndrome. Per standard deviation higher in visceral fat, the likelihood of metabolic syndrome significantly increased in women (odds ratio (OR): 2.16, 95% confidence interval (CI): 1.59-2.94). In contrast, the likelihood of metabolic syndrome decreased in both men (OR: 0.56, 95% CI: 0.39-0.80) and women (OR: 0.49, 95% CI: 0.34-0.69) with each standard deviation higher in thigh subcutaneous fat. These associations were partly mediated by adipocytokines; the association between thigh subcutaneous fat and metabolic syndrome was no longer significant in men. In summary, metabolically healthy obese older persons had a more favorable fat distribution, characterized by lower visceral fat and greater thigh subcutaneous fat and a more favorable inflammatory profile compared to their metabolically unhealthy obese counterparts.

Waist circumference as the predominant contributor to the micro-inflammatory response in the metabolic syndrome: a cross sectional study

BACKGROUND

The metabolic syndrome (MetS) is associated with the presence of low grade inflammation. Our aim was to analyze the inter-relations between each of the components of the metabolic syndrome (MetS) and four inflammatory markers, namely high sensitivity C-reactive protein (hs-CRP), the erythrocyte sedimentation rate, the concentration of fibrinogen and the white blood cell count.

METHODS

We have analyzed data collected between September 2002 and June 2009 in the Tel-Aviv medical center inflammation survey (TAMCIS). We recruited both apparently healthy individuals and individuals presenting with atherothrombotic risk factors. All participants were enrolled during their routine annual health check-up and gave their written informed consent. This is a cross sectional study in which we have fitted linear regression models using inflammatory markers as the dependant variables and adjust them according to the different components of the MetS and multiple other confounders.

RESULTS

Included were 12,072 individuals of whom there were 7,760 men at a mean (S.D.) age of 44 (11) years, and 4,312 women aged 44 (11) years. A significant correlation was noted between most components of the MetS and all inflammatory markers, the most significant one being with hs-CRP. In the multi-adjusted regression analysis, waist was the factor that best explained the variability of hs-CRP, in both women and men. It also remained a significant variable for the other inflammatory markers.

CONCLUSIONS

From amongst the various components of the MetS, waist circumference appears to exert the most influence upon the presence and intensity of the micro-inflammatory response.

Adipocytokines and the metabolic syndrome among older persons with and without obesity: the InCHIANTI study

OBJECTIVES

Adipose tissue-derived inflammation may contribute to metabolic alterations and eventually to the metabolic syndrome (MetS). The purpose of this study was to: (1) examine the role of adipocytokines in the association between obesity and the MetS and (2) to determine whether the association is different in obese and non-obese persons.

DESIGN

Cross-sectional population-based InCHIANTI study.

SUBJECTS

A total of 944 community-dwelling adults aged 65 years and older living in Tuscany, Italy.

MEASUREMENTS

Obesity was defined as body mass index > or =30 kg/m2 and MetS as > or =3 of the ATP-III criteria. Circulating levels of C-reactive protein, interleukin (IL)-6, IL-1 receptor antagonist (IL-1ra), IL-18, tumour necrosis factor (TNF)-alpha R1, adiponectin, resistin and leptin were measured. Additionally, insulin resistance was determined using the homeostasis model assessment (HOMA-IR).

RESULTS

The prevalence of the MetS was 32%. Both overall and abdominal obesity were significantly associated with the MetS after adjusting for inflammatory cytokines, adipokines and lifestyle factors. After adjusting for multiple confounders and HOMA-IR, IL-1ra, TNF-alpha R1 and adiponectin (P < 0.05) remained significantly associated with the MetS. Having multiple cytokines in the highest tertile increased the likelihood of having the MetS in both obese (P for trend 0.002) and non-obese persons (P for trend 0.001) independent of insulin resistance.

CONCLUSIONS

Non-obese and obese individuals who develop an intense pro-inflammatory state may be more prone to develop the MetS than those with lower levels of inflammation.

Racial differences in body fat distribution among reproductive-aged women

We examined the influence of race/ethnicity on body fat distribution for a given body mass index (BMI) among reproductive-aged women. Body weight, height, and body fat distribution were measured with a digital scale, wall-mounted stadiometer, and dual-energy x-ray absorptiometry, respectively, on 708 healthy black, white, and Hispanic women 16 to 33 years of age. Multiple linear regression was used to model the relationship between race/ethnicity and different body fat distribution variables after adjusting for BMI, age at menarche, and demographic and lifestyle variables. For a given BMI, white women had the highest total fat mass (FM(total)), trunk fat mass (FM(trunk)), and leg fat mass (FM(leg)), whereas Hispanic women had the highest percentage of FM(trunk) (%FM(trunk)) and trunk-to-limb fat mass ratio (FMR(trunk-to-limb)). Conversely, black women had the lowest FM(total), FM(trunk), percentage body fat mass (%FM), %FM(trunk), and FMR(trunk-to-limb), and the highest percentage of FM(leg). The %FM was similar in whites and Hispanics and lower in blacks. The race x BMI interactions were significant for almost all of the body fat distribution variables. Increasing in differences with increasing BMI were apparent between blacks and whites in FM(trunk), %FM(trunk), FMR(trunk-to-limb), %FM(leg), and %FM, and between blacks and Hispanics in FM(trunk), %FM(trunk), FMR(trunk-to-limb), and FM(leg). In summary, the distribution of body fat for a given BMI differs by race among reproductive-aged women. These findings raise questions regarding universally applied BMI-based guidelines for obesity and have implications for patient education regarding individual risk factors for cardiovascular disease and metabolic complications.

Gender differences relating to metabolic syndrome and proinflammation in Finnish subjects with elevated blood pressure

Fasting insulin, adiponectin, high-sensitivity C-reactive protein (hs-CRP), and interleukin-1 receptor antagonist (IL-1Ra) were determined in 278 men and 273 women with blood pressure > or = 130 and/or > or = 85 mmHg and/or with antihypertensive medication. Metabolic syndrome (MetS) with the National Cholesterol Education Program (NCEP) criteria was observed in 35% of men and 34% of women. Men with MetS had lower hs-CRP and IL-1Ra than women. The absolute gender difference in adiponectin was smaller and those in IL-1Ra and hs-CRP were greater in subjects with MetS compared to those without. After adjustment with body mass index the association between insulin and the odd's ratio (OR) for MetS remained significant in both genders, in females also the association between the OR for MetS and adiponectin. There are gender differences in subjects with elevated blood pressure and MetS with respect to inflammatory markers and the relationship between adiponectin levels and MetS.

Body mass index is a major determinant of abdominal fat accumulation in pre-, peri- and post-menopausal women

OBJECTIVE

To investigate the role of menopause, body mass index (BMI) and aging on body fat distribution in women.

DESIGN

In this population-based cross-sectional study, 335 women (126 in pre-menopause, 75 in peri-menopause and 134 in post-menopause according to Stages of Reproductive Aging Workshop criteria) were evaluated for body mass composition and fat distribution by dual X-ray absorptiometry procedure. A sub-group of 79 women with similar age and BMI was extracted from the sample to examine the relative influence of BMI in body fat distribution.

RESULTS

ANCOVA analysis of total sample showed an age-independent increase of total fat mass (p < 0.001) and percentage on total weight (p < 0.001), arms fat mass (p < 0.01), legs fat mass percentage on total fat (p < 0.05) and trunk fat mass (p < 0.001) and percentage (p < 0.05) in peri- and post- with respect to pre-menopausal women. In the sub-sample including age and BMI matched women the difference of regional fat parameters among menopausal status was no more statistically significant.

CONCLUSION

BMI, and not age, is the main determinant of the increase of body fat mass (total and abdominal) observed during the menopausal transition.

Depressive symptoms and increased visceral fat in middle-aged women

OBJECTIVE

To examine whether depressive symptoms are differentially associated with visceral adipose tissue (VAT), which is more metabolically active and confers greater cardiovascular risk than subcutaneous fat (SAT). Prior research has shown an association between depression and central adiposity. Mechanisms underlying the association between depression and increased cardiovascular risk remain poorly understood. Central adiposity is one potential pathway.

METHODS

We investigated the cross-sectional association between depressive symptoms, assessed by the Center for Epidemiological Studies Depression Scale (CES-D), and VAT and SAT, assessed by computed tomography, in a sample of 409 middle-aged women (44.7% African-Americans, 55.3% Whites; mean age = 50.4 years) participating in the Chicago site of the Study of Women's Health Across the Nation (SWAN).

RESULTS

With adjustments for age, race, total percent fat, and sex hormone binding globulin (SHBG), each 1-point higher score on the CES-D was associated with 1.03-cm(2) greater VAT (p < .001). Women with a CES-D score of >or=16, indicative of clinically relevant depressive symptomatology, had 24.5% more VAT than women with lower CES-D scores (p < .001). Further adjustment for Framingham Risk Score and physical activity did not alter the findings, and associations did not vary by race. Associations were strongest in obese and overweight women. Depressive symptoms were unrelated to SAT.

CONCLUSIONS

Increased visceral fat may be one pathway by which depression contributes to excess risk for cardiovascular disease and diabetes. Further research is needed to examine whether depressive symptoms influence accumulation of VAT over time.

Whole-body skeletal muscle mass is not related to glucose tolerance or insulin sensitivity in overweight and obese men and women

The relationship between skeletal muscle mass, visceral adipose tissue, insulin sensitivity, and glucose tolerance was examined in 214 overweight or obese, but otherwise healthy, men (n = 98) and women (n = 116) who participated in various exercise and (or) weight-loss intervention studies. Subjects had a 75 g oral glucose tolerance test and (or) insulin sensitivity measures by a 3 h hyperinsulinemic-euglycemic clamp technique. Whole-body skeletal muscle mass and visceral adipose tissue were measured using a multi-slice magnetic resonance imaging protocol. Total body skeletal muscle mass was not associated with any measure of glucose metabolism in men or women (p > 0.10). These observations remained independent of age and total adiposity. Conversely, visceral adipose tissue was a significant predictor of various measures of glucose metabolism in both men and women with or without control for age and (or) total body fat (p < 0.05). Although skeletal muscle is a primary site for glucose uptake and deposition, these findings suggest that unlike visceral adipose tissue, whole-body skeletal muscle mass per se is not associated with either glucose tolerance or insulin sensitivity in overweight and obese men and women.

Insulin resistance, serum adiponectin, and proinflammatory markers in young subjects with the metabolic syndrome

Insulin resistance is the underlying metabolic abnormality in the metabolic syndrome. The low-grade chronic inflammation may be associated with metabolic risk factors and atherogenesis. The aim of our study was to establish the link between the metabolic syndrome, as defined by the National Cholesterol Education Program (NCEP) criteria, and insulin sensitivity, serum adiponectin, and parameters of chronic inflammation in young subjects. The group of 223 subjects (mean age, 25.86 +/- 5.49 years; body mass index, 28.04 +/- 6.91 kg/m2) was studied. Oral glucose tolerance test, euglycemic hyperinsulinemic clamp, and estimation of serum adiponectin and proinflammatory factors were performed. The NCEP-defined metabolic syndrome was present in 49 subjects (21.97%). The higher the number of NCEP criteria fulfilled was, the bigger were the decrease in insulin sensitivity (P < .0001) and adiponectin (P < .0001) and the increase in fasting and postload insulin (both Ps < .0001), C-reactive protein (P < .0001), interleukin 18 (P < .0001), interleukin 6 (P < .0001), and soluble tumor necrosis factor-alpha receptors sTNFR1 (P < .0001) and sTNFR2 (P < .0001) observed. Multiple regression analysis revealed that adiponectin and inflammatory factors predicted NCEP score independent of insulin sensitivity (all adjusted beta values between .16 and .32, all Ps < .01). Young subjects with metabolic syndrome demonstrate an increased inflammatory response and lower adiponectin concentration.

Insulin and free oestradiol are independent risk factors for benign prostatic hyperplasia

The aetiology of benign prostatic hyperplasia (BPH) remains unclear. The objective of the present study was to test the insulin, oestradiol and metabolic syndrome hypotheses as promoters of BPH. The design was a risk factor analysis of BPH in which the total prostate gland volume was related to endocrine and anthropometric factors. The participants studied were 184 representative men, aged 72-76 years, residing in Göteborg, Sweden. Using a multivariate analysis, BPH as measured by the total prostate gland volume correlated statistically significantly with fasting serum insulin (beta=0.200, P=0.028), free oestradiol (beta=0.233, P=0.008) and lean body mass (beta=0.257, P=0.034). Insulin and free oestradiol appear to be independent risk factors for BPH, confirming both the insulin and the oestradiol hypotheses. Our findings also seem to confirm the metabolic syndrome hypothesis. The metabolic syndrome and its major endocrine aberration, hyperinsulinaemia, are possible primary events in BPH.

The metabolic syndrome is associated with circulating adipokines in older adults across a wide range of adiposity

BACKGROUND

Circulating levels of adipokines are elevated with adiposity and are closely linked with the clustering of traditional metabolic risk factors for cardiovascular disease. The purpose of this study was to examine the relationship of metabolic syndrome to several adipokines and the role of total and visceral adiposity in influencing this relationship in older adults.

METHODS

A cross-sectional analysis was conducted including 1914 individuals aged 70-79 years without cardiovascular disease or type 2 diabetes. The metabolic syndrome was defined by the updated Adult Treatment Panel III criteria. Circulating levels of leptin, adiponectin, plasminogen activator inhibitor type 1 (PAI-1), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), and C-reactive protein (CRP) were measured. Body composition and abdominal visceral fat area were determined.

RESULTS

Both the presence of metabolic syndrome and the number of metabolic syndrome components were associated with higher levels of leptin, PAI-1, IL-6, TNF-alpha, and CRP and with lower levels of adiponectin (all p <.0001). The odds ratios for the prevalence of metabolic syndrome associated with adipokines were attenuated after adjustment for total fat mass and/or visceral fat area, but remained significant. Levels of leptin, PAI-1, IL-6, and TNF-alpha were higher (all p <.05 to p <.0001), and adiponectin was lower (all p <.0001), in persons with, compared to those without, metabolic syndrome within each tertile of percent body fat.

CONCLUSION

The metabolic syndrome is associated with adipokines in older adults across a wide range of adiposity, including in those with low or normal overall fatness.

Contribution of the lean body mass to insulin resistance in postmenopausal women with visceral obesity: a Monet study

Some insulin-resistant obese postmenopausal (PM) women are characterized by an android body fat distribution type and higher levels of lean body mass (LBM) compared to insulin-sensitive obese PM women. This study investigates the independent contribution of LBM to the detrimental effect of visceral fat (VF) levels on the metabolic profile. One hundred and three PM women (age: 58.0+/-4.9 years) were studied and categorized in four groups on the basis of their VF (higher vs. lower) and lean BMI (LBMI=LBM (kg)/height (m2); higher vs. lower). Measures included: fasting lipids, glucose homeostasis (by euglycemic/hyperinsulinemic clamp technique and 2-h oral glucose tolerance test (OGTT)), C-reactive protein (CRP) levels, fat distribution (by computed tomography (CT) scan), and body composition (by dual-energy X-ray absorptiometry). Women in the higher VF/higher LBMI group had lower glucose disposal and higher plasma insulin levels compared to the other groups. They also had higher plasma CRP levels than the women in the lower VF/lower LBMI group. VF was independently associated with insulin levels, measures of glucose disposal, and CRP levels (P<0.05). LBMI was also independently associated with insulin levels, glucose disposal, and CRP levels (P<0.05). Finally, significant interactions were observed between LBMI and VF levels for insulin levels during the OGTT and measures of glucose disposal (P<0.05). In conclusion, VF and LBMI are both independently associated with alterations in glucose homeostasis and CRP levels. The contribution of VF to insulin resistance seems to be exacerbated by increased LBM in PM women.

Relationship between the metabolic syndrome and physical activity energy expenditure: a MONET study

The purpose of this cross-sectional study was to examine the association between the metabolic syndrome (MetS) and physical activity energy expenditure (PAEE) in overweight and obese sedentary postmenopausal women. The study population consisted of 137 overweight and obese sedentary postmenopausal women (age, 57.7 ± 4.8 years; BMI, 32.4 ± 4.6 kg·m–2). Subjects had the MetS if 3 out of the following 5 criteria were met: visceral fat > 130 cm2, high-density lipoprotein (HDL) cholesterol < 1.29 mmol·L–1, fasting triglycerides ≥ 1.7 mmol·L–1, blood pressure ≥ 130/85 mmHg, and fasting glucose ≥5.6 mmol·L–1. We measured (i) body composition (by dual-energy X-ray absorptiometry); (ii) visceral fat (by computed tomography); (iii) insulin sensitivity (using the hyperinsulinemic-euglycemic clamp); (iv) plasma lipids, fasting glucose, and insulin, as well as 2 h glucose during an oral glucose tolerance test; (v) resting blood pressure; (vi) peak oxygen consumption (VO2 peak); (vii) PAEE (using doubly labeled water); and (viii) lower-body muscle strength (using weight-training equipment). Forty-two women (30.7%) had the MetS in our cohort. Individuals without the MetS had significantly higher levels of PAEE (962 ± 296 vs. 837 ± 271 kcal·d–1; p < 0.05), VO2 peak (18.2 ± 3.0 vs. 16.7 ± 3.2 mL·min–1·kg–1; p < 0.05), and insulin sensitivity, as well as significantly lower levels of 2 h glucose and central lean body mass. No differences in total energy expenditure, resting metabolic rate, and muscle strength between groups were observed. Logistic regression analysis showed that 2 h glucose (odds ratio (OR): 1.50 (95% CI 1.17–1.92)), central lean body mass (OR: 1.17 (95% CI 1.05–1.31)), and PAEE (OR: 0.998 (95% CI 0.997–1.000)), but not VO2 peak and (or) muscle strength, were independent predictors of the MetS. Lower levels of PAEE and higher levels of 2 h glucose, as well as central lean body mass, are independent determinants of the MetS in our cohort of overweight and obese postmenopausal women.

Correlation between the rate of weight loss and changes in body composition in obese postmenopausal women after 5 weeks: a pilot study

Approximately 25% of weight lost during restrictive diets (without exercise) is lean body mass (LBM). No study has yet investigated the impact of the rate of weight loss (RWL) on LBM and fat mass (FM). The purpose of this study was to investigate the relationships between the RWL and body composition in older obese women. Twenty obese postmenopausal women aged between 51 and 74 years enrolled in a 5 week dietary weight loss intervention. Subjects were characterized according to their RWL (low RWL < 0.74 kg·week–1 (n = 9) vs. high RWL ≥ 0.74 kg·week–1 (n = 11)). Total and trunk FM and LBM (by dual-energy X-ray absorptiometry) were measured before and after weight loss. A significant correlation was observed between the RWL (kg·week–1) and changes in LBM (kg·week–1) (r = 0.75; p = 0.0002). However, no association was observed with changes in FM (kg·week–1) (r = 0.40; p = 0.08). Both groups showed a similar decrease in FM (low RWL, –2.7 ± 0.9 kg,; high RWL, –3.2 ± 0.8 kg; p = 0.38), whereas losses in LBM were significantly higher in the high RWL than in the low RWL group (–1.6 ± 1.2 kg vs. –0.4 ± 1.1 kg; p = 0.05). An RWL > 0.74 kg·week–1 was associated with a greater loss of LBM, but had no extra benefits on FM after a 5 week weight loss program. Current guidelines, which recommend RWL up to 0.91 kg·week–1, might not be optimal to prevent decreases in LBM in postmenopausal women when no exercise is added.

Visceral fat, waist circumference, and BMI: impact of race/ethnicity

OBJECTIVE

BMI and waist circumference are used to define risk from excess body fat. Limited data in women suggest that there may be racial/ethnic differences in visceral adipose tissue (VAT) at a given BMI or waist circumference. This study tested the hypothesis that racial/ethnic differences exist in both men and women in the relationship of anthropometric measures of body composition and computed tomography (CT)-determined VAT or subcutaneous adipose tissue (SAT).

METHODS AND PROCEDURES

Subjects included 66 African American, 72 Hispanic, and 47 white men and women, aged > or =45. Waist circumference and BMI were measured using standard methods. Total abdominal and L4L5 VAT and SAT were measured using CT.

RESULTS

Among both men and women, groups did not differ in waist circumference or BMI. White men had greater L4L5 VAT than African-American men, and both white and Hispanic men had greater total VAT than African-American men. Among women, Hispanics and whites had greater L4L5 VAT than African Americans, and Hispanics had greater total VAT than African Americans. The slope of the linear relationship between BMI or waist circumference and VAT was lower in African Americans than in Hispanics and/or whites.

DISCUSSION

Middle-aged and older African-American men and women had lower VAT despite similar BMI and waist circumference measurements. Altered relationships between anthropometric measures and VAT may have implications for defining metabolic risk in different populations. Different waist circumference or BMI cutoff points may be necessary to adequately reflect risk in different racial/ethnic groups.

Waist circumference is the main determinant of elevated C-reactive protein in metabolic syndrome

BACKGROUND

Metabolic syndrome (MetS) is known to increase the risk of cardiovascular disease. C-reactive protein (CRP) has been reported to be elevated in subjects with MetS. However, which component of MetS contributes mostly to the elevation has not been studied in detail.

METHODS

We studied 628 apparently healthy Japanese subjects (men 262, women 366, age 19-85 years). Body mass index, waist circumference (WC), blood pressure, lipids, glucose, insulin and CRP were measured. MetS was defined according to the National Cholesterol Education Program's Adult Treatment Panel III report.

RESULTS

In partial correlation analysis, WC showed the strongest correlation with CRP among the variables related to MetS. CRP increased as the number of MetS components increased. The mean CRP value adjusted for demographic variables was higher in subjects with MetS than those without MetS, and further adjustments with variables related to MetS revealed that the significant difference between the two groups disappeared only when further adjustment was made for WC. In multiple linear regression analysis, the independent variable that most strongly explained the CRP level was WC, which was followed by HDL-cholesterol. Finally, comparison of the CRP levels in groups stratified by abdominal obesity and the number of MetS components revealed that those with abdominal obesity tended to show higher CRP levels compared with those without abdominal obesity regardless of the number of MetS components other than WC.

CONCLUSIONS

Subjects with MetS showed higher levels of CRP and the main determinant of the CRP elevation was WC.

Gaining weight and components of metabolic syndrome in the period of menopause

INTRODUCTION Menopause induces redistribution of fat mass and development of abdominal obesity, increasing risk for metabolic syndrome (MS) by 60%. Related cardiovascular diseases become a leading cause of morbidity and mortality in women after fifty years of age. OBJECTIVE The aim of this study was to investigate the influence of gaining weight on components of MS in the menopause. METHOD The study included 50 obese women, BMI=31.92? 5.83 kg/m2, age 54.40?3.64, time since menopause 5.90?5.46 years, and 37 normal weight women, BMI=23.50?2.13 kg/m2, age 53.92?3.95, time since menopause 5.96?4.92 years. Both groups were divided according to the presence of MS into two subgroups. Anthropometric characteristics and blood pressure were measured. Blood was taken at 8 am for the following: fasting glucose, triglycerides, cholesterol, HDL, LDL, apolipoprotein A (ApoA), apolipoprotein B (ApoB), lipoprotein(a) (Lp(a)), C-reactive protein (CRP), fibrinogen, FSH, LH, prolactin, oestrogen, progesterone, testosterone and sex hormonebinding globulin (SHBG). RESULTS 66% of obese women had MS compared with 22% normal weight women. Significant differences between groups were found for the following: weight, BMI, waist, hip circumference, waist/hip ratio, diastolic blood pressure, Lp(a), FSH, LH, prolactin (all p<0.01) and fasting glucose (p<0.05). Obese women with and without MS were significantly diverse for the following: waist/hip ratio, systolic blood pressure and fasting glucose (all p<0.01); age, BMI, waist circumference, triglycerides, HDL, Lp(a) and SHBG (all p<0.05). Normal weight women with and without MS had significantly different values of waist/hip ratio, systolic, diastolic blood pressure, triglycerides (all p<0.01); HDL and testosterone (p<0.05). Significant differences were found between obese and normal weight women with MS in anthropometric characteristics, ApoA, Lp(a), fibrinogen (all p<0.01) and FSH (p<0.05). CONCLUSION Abdominal obesity significantly increases incidence of MS as a cluster of cardiovascular risk factors in the menopause.

Effect of a weight loss intervention on anthropometric measures and metabolic risk factors in pre- versus postmenopausal women

BACKGROUND

The present study examines changes in body weight, fat mass, metabolic and hormonal parameters in overweight and obese pre- and postmenopausal women who participated in a weight loss intervention.

METHODS

Seventy-two subjects were included in the analysis of this single arm study (premenopausal: 22 women, age 43.7 +/- 6.4 years, BMI 31.0 +/- 2.4 kg/m2; postmenopausal: 50 women, age 58.2 +/- 5.1 years, BMI 32.9 +/- 3.7 kg/m2). Weight reduction was achieved by the use of a meal replacement and fat-reduced diet. In addition, from week 6 to 24 participants attended a guided exercise program. Body composition was analyzed with the Bod Pod(R). Blood pressures were taken at every visit and blood was collected at baseline and closeout of the study to evaluate lipids, insulin, cortisol and leptin levels.

RESULTS

BMI, fat mass, waist circumference, systolic blood pressure, triglycerides, glucose, leptin and cortisol were higher in the postmenopausal women at baseline. Both groups achieved a substantial and comparable weight loss (pre- vs. postmenopausal: 6.7 +/- 4.9 vs 6.7 +/- 4.4 kg; n.s.). However, in contrast to premenopausal women, weight loss in postmenopausal women was exclusively due to a reduction of fat mass (-5.3 +/- 5.1 vs -6.6 +/- 4.1 kg; p < 0.01). In premenopausal women 21% of weight loss was attributed to a reduction in lean body mass. Blood pressure, triglycerides, HDL-cholesterol, and glucose improved significantly only in postmenopausal women whereas total cholesterol and LDL-cholesterol were lowered significantly in both groups.

CONCLUSION

Both groups showed comparable weight loss and in postmenopausal women weight loss was associated with a pronounced improvement in metabolic risk factors thereby reducing the prevalence of metabolic syndrome.

Abdominal obesity exhibits distinct effect on inflammatory and anti-inflammatory proteins in apparently healthy Japanese men

Background

Since visceral fat tissue is known to release various inflammatory and anti-inflammatory cytokines, abdominal obesity may play a key role in the inflammation associated with metabolic syndrome (MetS). However, few studies have determined precise relationships of abdominal obesity with inflammatory markers in MetS. To clarify the importance of abdominal obesity in sub-clinical inflammation, we examined the changes of inflammatory markers in clustering of MetS components with or without abdominal obesity.

Methods

Subjects consisted of 326 apparently healthy Japanese men (age: 30 to 59 years) who underwent health examination in the Osaka University Health Care Center. MetS components were assessed and serum levels of high sensitive C-reactive protein (hs-CRP), interleukin (IL)-6 and adiponectin were examined in all subjects.

Results

Subjects with abdominal obesity (waist circumference ≥ 85 cm) showed higher serum hs-CRP and IL-6 levels and a lower adiponectin level than those without abdominal obesity. Serum levels of hs-CRP and IL-6 significantly increased in association with clustering of MetS components in the subjects with abdominal obesity, but not in those without abdominal obesity. On the other hand, serum adiponectin level exhibited a little change with clustering of MetS components in the subjects with abdominal obesity. Significant negative correlation between adiponectin and hs-CRP was observed in the subjects with abdominal obesity, however this correlation was not detected in obese subjects defined by body mass index ≥ 25.

Conclusion

Inflammatory status is not exaggerated by clustering of MetS components in the subjects without abdominal obesity. Abdominal obesity may exhibit distinct effect on inflammatory and anti-inflammatory proteins and modulate inflammatory network in MetS.

Can EGCG Reduce Abdominal Fat in Obese Subjects?

OBJECTIVE

To evaluate metabolic effects of epigallocatechin gallate (EGCG) supplementation when combined with a program of regular aerobic exercise in overweight/obese post-menopausal women.

METHODS

Thirty-eight overweight or obese postmenopausal women exercised at moderate intensity, viz. walking three times per week for 45 min at 75% of age-predicted maximum heart rate (HR), and took a 150 mg capsule of EGCG (Teavigo) or placebo (lactose) twice daily for 12 weeks. Blood parameters (lipids, glucose and insulin), blood pressure, heart rate, arterial function and anthropometry were assessed at 0, 6 and 12 wk. At wk 0 and 12, body composition was assessed by dual energy X-ray absorptiometry (DXA) and abdominal fat was assessed by DXA and computed tomography (CT).

RESULTS

Waist circumference (p < 0.01), total body fat (p < 0.02), abdominal fat (by DXA) (p < 0.01) and intra abdominal adipose tissue (by CT) (p < 0.01) were reduced in both treatment groups, with no difference between placebo and Teavigo. Teavigo significantly decreased resting HR (p < 0.01) and reduced plasma glucose in subjects with impaired glucose tolerance (p < 0.05).

CONCLUSIONS

Moderate consumption of EGCG can improve the health status of overweight individuals undergoing regular exercise by reducing HR and plasma glucose concentrations. Loss of body fat, however, may require a higher intake of EGCG, other catechins or addition of metabolic stimulants.

Assortative mating for obesity

BACKGROUND

Assortative mating is the nonrandom mating of individuals with respect to phenotype and cultural factors. Previous studies of assortative mating for obesity have indicated that it may have contributed to the obesity epidemic. However, those studies all used body mass index or skinfold thicknesses to measure obesity and did not always account for potential confounding factors.

OBJECTIVE

We aimed to assess the level of assortative mating for obesity by using dual-energy X-ray absorptiometry to characterize body composition.

DESIGN

This was a cross-sectional study of 42 couples.

RESULTS

Raw spousal correlations showed assortative mating for age, weight, body mass index, lean mass, and fat mass. Removing the effect of age on fat mass strengthened the spousal correlation (r = 0.405). Social homogamy did not appear to be important, because in this sample there was no significant effect of area of origin on age-corrected fat and lean tissue masses for either sex. Regional body-composition analysis showed that subjects with disproportionately large arms (both fat and lean) assortatively mated with partners with the same trait. However, both men and women with high lean tissue in their arms assortatively mated with partners that had a disproportionately low fat content in their legs.

CONCLUSIONS

These data confirm that assortative mating for obesity exists when dual-energy X-ray absorptiometry is used to evaluate adiposity. We hypothesize that assortative mating may have contributed to the obesity epidemic because the time course of obesity development has shifted progressively earlier, allowing singles in their late teens and early twenties to more easily distinguish partners with obese and lean phenotypes.

Platelet and White Blood Cell Counts Are Elevated in Patients With the Metabolic Syndrome

Platelet and white blood cell counts are higher among some insulin-resistant patients and may contribute to atherothromboembolic complications. Metabolic syndrome patients are insulin resistant, often hypertensive, and at high cardiovascular disease risk, yet the relationship of platelets to the metabolic syndrome is unknown. Platelet and white blood cell counts were obtained from 135 volunteers who had measurements of blood pressure, fasting triglycerides, high-density lipoprotein cholesterol, and glucose. A body mass index >30 kg/m2 served as a surrogate for increased waist circumference. Subjects were subdivided into three groups by the number of metabolic syndrome criteria, i.e., no metabolic syndrome risk factor (MS-0; n = 40), one or two metabolic syndrome risk factors (MS1-2; n = 61), and three to five metabolic syndrome risk factors (MS3-5; n = 34). Platelet counts were increased significantly from 226+/-8 to 257+/-8 and 276+/-10 (x10(3)/mm3) in the MS-0, MS1-2, and MS3-5 groups, respectively (p < 0.01), after adjustment for age, gender, ethnicity, total cholesterol, and low-density lipoprotein cholesterol. White blood cell counts were also increased across the three groups (5.4+/-0.2, 6.2+/-0.2, and 6.6+/-0.3 [x10(3)/mm3]; p < 0.01) after multivariate adjustment. Compared with patients with zero to two metabolic syndrome risk factors, metabolic syndrome patients have higher platelet and white blood counts, which may serve as markers of a prothrombotic and proinflammatory state and contributors to atherothromboembolic risk.

Clinical aspects of obesity in the gynecological endocrinologicaly practice

Obesity is epidemic of 21st century, its visceral form is associated with increased risk for type 2 diabetes, cardiovascular disease, hypertension and increased mortality due to consequences of the disease. This type of obesity is a common diagnostic and therapeutic problem in gynecological practice. This especially concerns polycystic ovary disease, in which this type of obesity with its metabolic consequences is one of the important factors in etiology and additionally may lead to remote metabolic and cardiovascular problems. Another group of women in which this type of obesity plays an important role are climacteric women in whom redistribution of adipose tissue with increase in visceral fat deposit occurs. On the basis of current viewpoints and own experiences, the authors propose a diagnostic-therapeutic algorithm in women with visceral obesity and polycystic ovary disease or climacteric period. In case with cardiovascular risk factors (waist circumference over than 80cm, serum triglycerides over 1.7mmol/l, HDL cholesterol lower than 1.0mmol/l, blood pressure over 130/85mmHg and fast serum glucose levels over 100mg/dl) the therapeutic model focuses on the recognize risk factors. It must be considered that diet and physical activity play a very important role in the therapy.

Index of central obesity - A novel parameter

Waist circumference (WC) is globally used as a parameter to quantify central obesity, the key culprit in insulin resistance and related disorders. Hitherto globally in various definitions of metabolic syndrome and risk scores, WC is used to quantify central obesity. For defining central obesity, which is a single entity numerous WC cutoffs have been suggested, separately for males and females and various races. We believe that this difference is amenable to differences in their average heights. To quantify proportion of visceral fat in the total body fat, WC alone is not sufficient. We hereby hypothesize that Index of central obesity (ICO) defined by us, as a ratio of WC and height is a better parameter of central obesity. If ICO is used in place of WC we may do away with various WC cutoffs and may have a single cutoff applicable to all races and both genders. Using average heights of various countries and their respective WC cutoffs suggested by IDF consensus definition for defining metabolic syndrome (MS) we derived their ICO cutoffs mathematically. The ICO cutoffs obtained ranged from 0.51 to 0.58 among males and 0.47 to 0.54 among females. The range has narrowed down compared to wide range of cutoffs for WC i.e. 90-102 cm for males and 80-88 cm for females. To test superiority of ICO over WC even among people of same race and same gender we conducted a pilot study in which, we compared two subjects with same WC and body mass index (BMI), though they differed in their stature. Body fat distribution was compared on DEXA and oral glucose tolerance was tested. Percentage of total body fat contributed by truncal fat was 36.11% in taller subject (Dr. P) and 46.31% in the shorter one (Mr. P). On investigation Dr P had normal glucose tolerance while Mr. P was diagnosed to be diabetic. These differences unexplained by identical WC and BMI could be explained by difference in their ICO (0.557 vs 0.645). ICO has a potential to be a better parameter of central obesity. It may obviate the need for numerous WC cutoffs and may even be applicable to children where existing parameters are not useful.

Weight increase and overweight are associated with DNA oxidative damage in skeletal muscle

BACKGROUND AND AIMS

Weight maintenance within normal standards is recommended for prevention of conditions associated with oxidative injury. To compare oxidative damage in a post mitotic tissue, between adults differing in long-term energy balance.

METHODS

During hernia surgery, a sample of skeletal muscle was obtained in 17 non-obese adults. Subjects were divided into two groups according to their self-reported weight change: weight maintainers (WM) reported <4kg increase, and weight gainers (WG) reported >5kg increment. Muscle immunohistochemistry for 8-hydroxy-deoxyguanosine (8OHdG), 4-Hydroxy-2-nonenal (4HNE), and TNF-alpha, as markers of oxidative injury and inflammation, were performed. As known positive controls for oxidative injury, we included 10 elderly subjects (66-101yr). Anthropometric measures and blood samples for clinical laboratory and serum cytokines (TNF-alpha and IL-6) were obtained.

RESULTS

8OHdG was higher in WG compared with WM (149.1+/-16.2 versus 117.8+/-29.5, P=0.03), and was associated with anthropometric indicators of fat accumulation. 4HNE was similar in WG compared with WM (10.9+/-7.6 versus 9.8+/-6.3) but noticeably higher in elderly subjects (21.5+/-15.3, P=0.059). TNF-alpha protein in WG was higher compared with WM (114.0+/-41.7 versus 70.1+/-23.3, P=0.025), and was associated with weight increase.

CONCLUSIONS

Moderate self-reported weight increase, and body fat accumulation, suggesting long-term positive energy balance is associated with muscle DNA oxidative injury and inflammation.

Accurate quantification of visceral adipose tissue (VAT) using water-saturation MRI and computer segmentation: Preliminary results

PURPOSE

To describe and evaluate the accuracy of water-saturation MRI and a computer segmentation program for quantification of visceral adipose tissue (VAT).

MATERIALS AND METHODS

MRI was performed on five patients with whole-volume coverage of the abdomen using two different sequences: 1) a T1-weighted spoiled gradient-echo breath-hold sequence (non-water-saturation) and 2) a T1-weighted spoiled gradient-echo water-saturation breath-hold sequence (water-saturation). The computer segmentation program analyzed the data and calculated VAT volumes (cm3) from both sequences. The data from one patient were additionally processed with the use of a manual technique. The intrastudy reproducibility of the proposed method using the water-saturation MRI sequence and the computer segmentation technique was tested by repeated measures of the automated system analysis (x 10) on MRI data from a single subject to calculate variability.

RESULTS

VAT volumes measured by the water-saturation MRI sequences were consistently greater than those measured by the non-water-saturation sequences. Comparison of VAT volumes derived from the water-saturation images and measured by the computer segmentation technique vs. the manual technique showed good correlation (K = 0.8), with a significant time-saving benefit associated with the automated method (5 minutes vs. 1 hour). There was poor correlation between VAT volume measurement calculated by the manual technique and the computer segmentation technique using non-water-saturation images. The reproducibility of the computer segmentation technique using data derived from water-saturation images was high, with a low variability (+/- 5%).

CONCLUSION

The results obtained demonstrate that the proposed method may be able to provide accurate quantification of VAT in a highly reproducible and efficient manner.

Impact of sex-specific body composition on cardiovascular risk factors: the Hong Kong Cardiovascular Risk Factor Study

The aim of the study was to analyze the effects of sex-specific distribution of adiposity, particularly emphasizing the independent contribution of waist and hip circumferences relative to body mass index (BMI), on cardiovascular risk factors in a Chinese population. Blood pressure and anthropometric and biochemical parameters were measured in 2510 population-based Chinese subjects. The relative contributions of waist and hip circumferences to the presence of cardiovascular risk factors were determined. The Chinese men were significantly larger than women, with greater BMI and central adiposity. Waist and hip circumferences were both positively associated with the presence of hypertension, dyslipidemia, and diabetes. However, after adjustment for BMI and age, hip circumference exhibited a significant dose-dependent inverse relationship with dyslipidemia and diabetes in women, but not men. Sex-specific differences exist. After adjustment for age and BMI, hip circumferences independently and inversely contribute to cardiovascular risk in women, but not in men. Increasing adjusted waist circumference was associated with increased risk of hypertension and diabetes in Chinese and dyslipidemia in women only.