The epidemiology of obesity: the size of the problem

The impact of height during childhood on the national prevalence rates of overweight

BACKGROUND

It is known that height and body mass index (BMI) are correlated in childhood. However, its impact on the (trend of) national prevalence rates of overweight and obesity has never been investigated. The aim of our study is to investigate the relation between height and national prevalence rates of overweight and obesity in childhood between 1980, 1997, and 2009, and to calculate which fixed value of p (2.0,2.1, …,3.0) in kg/m(p) during childhood is most accurate in predicting adult overweight.

METHODS AND FINDINGS

Cross-sectional growth data of children from three Dutch nationwide surveys in 1980, 1997, and 2009, and longitudinal data from the Terneuzen Birth Cohort and the Harpenden Growth Study were used. Relative risks (RR) and 95% confidence intervals (CI) were calculated. Our study showed that tall (>1 standard deviation (SD)) girls aged 5.0-13.9 y were more often overweight (RR = 3.5,95%CI:2.8-4.4) and obese (RR = 3.9,95%CI:2.1-7.4) than short girls (<-1 SD). Similar results were found in boys aged 5.0-14.9 y (RR = 4.4,95%CI:3.4-5.7 and RR = 5.3,95%CI:2.6-11.0). No large differences were found in the other age groups and in comparison with children with an average stature. Tall boys aged 2.0-4.9 y had a significantly higher positive trend in overweight between 1980 and 1997 compared to short boys (RR = 4.0,95%CI:1.38-11.9). For other age groups and in girls, no significant trends were found. The optimal Area Under the Curve (AUC) to predict adult overweight was found for p = 2.0.

CONCLUSIONS AND SIGNIFICANCE

Tall girls aged 5.0-13.9y and tall boys aged 5.0-14.9y have much higher prevalence rates of overweight and obesity than their shorter peers. We suggest taking into account the impact of height when evaluating trends and variations of BMI distributions in childhood, and to use BMI to predict adult overweight.

Continuing decrease in coronary heart disease mortality in Sweden

Background

Deaths from coronary heart disease (CHD) have been decreasing in most Western countries over the last few decades. In contrast, a flattening of the decrease in mortality has been recently reported among younger age groups in some countries. We aimed to determine whether the decrease in CHD mortality is flattening among Swedish young adults.

Methods

We examined trends in CHD mortality in Sweden between 1987 and 2009 among persons aged 35 to 84 years using CHD mortality data from the Swedish National Register on Cause of Death. Annual percent changes in rates were examined using Joinpoint software.

Results

Overall, CHD mortality rates decreased by 67.4% in men and 65.1% in women. Among men aged 35–54 years, there was a modest early attenuation from a marked initial decrease. In the oldest women aged 75–84 years, an attenuation in the mortality decrease was observed from 1989 to 1992, followed by a decrease, as in all other age groups.

Conclusions

In Sweden, coronary heart disease deaths are still falling. We were unable to confirm a flattening of the decline in young people. Death rates continue to decline in men and women across all age groups, albeit at a slower pace in younger men since 1991. Continued careful monitoring of CHD mortality trends in Sweden is required, particularly among young adults.

Clustering of children's obesity-related behaviours: associations with sociodemographic indicators

BACKGROUND/OBJECTIVES

Research suggests obesity-related behaviours cluster together in children and adolescents, but how these cluster patterns differ by sociodemographic indicators remains unclear. Furthermore, few studies examining clustering of behaviours have included younger children or an objective measure of physical activity (PA) and sedentary behaviour. Therefore, the aim of this study was to examine clustering patterns of diet, PA and sedentary behaviour in 5- to 6- and 10- to 12-year-old children, and their cross-sectional associations with sociodemographic indicators.

SUBJECTS/METHODS

In this cross-sectional study, data from the baseline wave (2002/2003) of the Health Eating and Play study (HEAPS) were used. Questionnaires were completed by parents of Australian children aged 5-6 (n=362) and 10-12 years (n=610). Children wore accelerometers for up to 7 days. K-medians cluster analysis identified groups of children with similar diet, PA and sedentary behaviours. Chi-square tests assessed cluster differences by gender, maternal education and marital status.

RESULTS

For each age group, three reliable and meaningful clusters were identified and labelled 'most healthy', 'energy-dense (ED) consumers who watch TV' and 'high sedentary behaviour/low moderate-to-vigorous PA (MVPA)'. Clusters varied by sociodemographic indicators. For example, a higher proportion of older girls comprised the 'high sedentary behaviour/low MVPA' cluster (χ(2)=22.4, P<0.001). Among both age groups, the 'ED consumers who watch TV' cluster comprised more children with lower educated mothers (younger children: χ(2)=34.9, P<0.001; older children: χ(2)=27.3, P<0.001).

CONCLUSIONS

Identification of cluster patterns of obesity-related risk factors in children, and across sociodemographic groups may assist the targeting of public health initiatives, to those most in need.

Lifestyle interventions for the treatment of non-alcoholic fatty liver disease

The burden of non-alcoholic fatty liver disease (NAFLD) worldwide is a significant clinical and public health issue, affecting approximately one third of the Western population. This review assesses the effect and impact lifestyle interventions have on the treatment of this common condition. We review studies comparing the effect of calorie restriction and exercise programs, as well as comparison of lifestyle intervention with pharmaceutical intervention. Both calorie restriction and exercise programs are shown to be beneficial in improving features of metabolic syndrome and surrogate markers of NAFLD. The paucity of studies using histological improvement hinders the ability to conclude a benefit on improvement of histological NAFLD, although this is shown in a small number of studies. There is a need to extend the intervention period to show a sustained improvement with intervention as most studies have a follow up period of 12 months of less.

Improved antenatal detection of congenital anomalies in women with pre-gestational diabetes: population-based cohort study

AIMS

To compare antenatal detection of congenital anomaly in women with and without pre-gestational diabetes and their pregnancy outcomes in a regional cohort study.

METHODS

Data from a total of 7148 singleton pregnancies with a congenital anomaly delivered between 1 January 1996 and 31 December 2008 were extracted from the Northern Diabetes in Pregnancy and Northern Congenital Abnormality Surveys. Antenatal ultrasound detection rates of congenital anomaly in pregnancies complicated by major non-chromosomal congenital anomaly and resulting in live birth, stillbirth, late miscarriage (20-23 weeks of gestation) or termination of pregnancy for a congenital anomaly, were compared between women with and without diabetes (120 and 7028, respectively).

RESULTS

A significantly higher rate of antenatal detection of congenital anomalies was observed in women with diabetes compared with women without diabetes (50.8 vs. 38.6%, respectively; relative risk 1.32; 95% CI 1.10-1.57; P = 0.003). Cardiovascular anomalies were the only group with a significantly higher antenatal detection rate in women with diabetes (31.8 vs. 10.4%; relative risk 3.05; 95% CI 1.95-4.76; P < 0.00001). This difference remained after excluding cases of ventricular septal defect (52.2 vs. 16.3%; relative risk 3.20; 95% CI 2.13-4.80; P < 0.0001). Among women with diabetes, male fetal sex was the only factor associated with a higher antenatal detection rate. There were no differences in the rates of termination of pregnancy, late miscarriage, stillbirth or infant death between groups.

CONCLUSIONS

Antenatal detection of cardiovascular anomalies was higher in women with diabetes, suggesting that recommendations for enhanced cardiovascular scanning may improve detection. Greater awareness of the increased risk of anomalies in other organ systems is needed.

The protective effect of the obesity-associated rs9939609 A variant in fat mass- and obesity-associated gene on depression

Candidate gene and genome-wide association studies have not identified common variants, which are reliably associated with depression. The recent identification of obesity predisposing genes that are highly expressed in the brain raises the possibility of their genetic contribution to depression. As variation in the intron 1 of the fat mass- and obesity-associated (FTO) gene contributes to polygenic obesity, we assessed the possibility that FTO gene may contribute to depression in a cross-sectional multi-ethnic sample of 6561 depression cases and 21,932 controls selected from the EpiDREAM, INTERHEART, DeCC (depression case-control study) and Cohorte Lausannoise (CoLaus) studies. Major depression was defined according to DSM IV diagnostic criteria. Association analyses were performed under the additive genetic model. A meta-analysis of the four studies showed a significant inverse association between the obesity risk FTO rs9939609 A variant and depression (odds ratio=0.92 (0.89, 0.97), P=3 × 10(-4)) adjusted for age, sex, ethnicity/population structure and body-mass index (BMI) with no significant between-study heterogeneity (I(2)=0%, P=0.63). The FTO rs9939609 A variant was also associated with increased BMI in the four studies (β 0.30 (0.08, 0.51), P=0.0064) adjusted for age, sex and ethnicity/population structure. In conclusion, we provide the first evidence that the FTO rs9939609 A variant may be associated with a lower risk of depression independently of its effect on BMI. This study highlights the potential importance of obesity predisposing genes on depression.

Antiobesity effect of caraway extract on overweight and obese women: a randomized, triple-blind, placebo-controlled clinical trial

Caraway (Carum carvi L.), a potent medicinal plant, is traditionally used for treating obesity. This study investigates the weight-lowering effects of caraway extract (CE) on physically active, overweight and obese women through a randomized, triple-blind, placebo-controlled clinical trial. Seventy overweight and obese, healthy, aerobic-trained, adult females were randomly assigned to two groups (n = 35 per group). Participants received either 30 mL/day of CE or placebo without changing their diet or physical activity. Subjects were examined at baseline and after 90 days for changes in body composition, anthropometric indices, and clinical and paraclinical variables. The treatment group, compared with placebo, showed a significant reduction of weight, body mass index, body fat percentage, and waist-to-hip ratio. No changes were observed in lipid profile, urine-specific gravity, and blood pressure of subjects. The results suggest that a dietary CE with no restriction in food intake, when combined with exercise, is of value in the management of obesity in women wishing to lower their weight, BMI, body fat percentage, and body size, with no clinical side effects. In conclusion, results of this study suggest a possible phytotherapeutic approach for caraway extract in the management of obesity. This trial is registered with NCT01833377.

Potential water saving through changes in European diets

This study quantifies the water footprint of consumption (WFcons) regarding agricultural products for three diets - the current diet (REF), a healthy diet (HEALTHY) and a vegetarian diet (VEG) - for the four EU zones WEST, NORTH, SOUTH and EAST. The WFcons related to the consumption of agricultural products (4265l per capita per day or lcd) accounts for 89% of the EU's total WFcons (4815lcd). The effect of diet has therefore an essential impact on the total WFcons. The current zonal WFcons regarding agricultural products is: 5875lcd (SOUTH), 4053lcd (EAST), 3761lcd (WEST) and 3197lcd (NORTH). These differences are the result of different consumption behaviours as well as different agricultural production methods and conditions. From the perspective of a healthy diet based on regional dietary guidelines, the intake of several product groups (sugar, crop oils, animal fats and meat) should be decreased and increased for others (vegetables, fruit). The WFcons regarding agricultural products for the alternative diets are the following: HEALTHY 4110lcd (-30%) and VEG 3476lcd (-41%) for SOUTH; HEALTHY 3606lcd (-11%) and VEG 2956lcd (-27%) for EAST; HEALTHY 2766lcd (-26%) and VEG 2208lcd (-41%) for WEST; HEALTHY 3091lcd (-3%) and VEG 2166lcd (-32%) for NORTH. Both the healthy and vegetarian diets thus result - consistent for all zones - in substantial WFcons reductions. The largest reduction takes place for the vegetarian diet. Indeed, a lot of water can be saved by EU citizens by a change in their diet.

Long-term multiple intragastric balloon treatment--a new strategy to treat morbid obese patients refusing surgery: prospective 6-year follow-up study

BACKGROUND

Morbid obesity is an increasing health problem. Dietary intervention often fails in the medium to long term, and surgery is the gold standard. Intragastric balloon is a valuable treatment in the short-term, and multiple balloon treatment has been shown to be effective in the medium term. The aim of this study was to investigate the efficacy of multiple balloon treatment in the long-term (6 years) in terms of weight loss, influence on co-morbidities, and quality of life in patients refusing surgery.

METHODS

Eighty-three patients with body mass index (BMI)>40, good candidates for surgery but refusing it, were enrolled in a clinical treatment protocol involving multiple intragastric balloon placement. After removing the first balloon, a second balloon was placed when the patients had regained ≥ 50% of the weight loss achieved with previous balloon. Weight, co-morbidities parameters, and quality of life test were recorded during a follow-up of 72 months.

RESULTS

All patients experienced a second balloon placement; 22.2% had a third device placed and 1 patient had a fourth device placed. At 76 months follow-up, mean BMI was 37.6 kg/m(2) (P < .001); weight cycling periods were observed. Significant difference was recorded in the presence of co-morbidities at baseline (80% of the patients) and follow-up (30%) (P = .02). Quality of life test in the follow-up indicated better scores than those at baseline (P < . .001).

CONCLUSION

Despite the weight cycling, in patients refusing surgery, multiple intragastric balloon is the recommended treatment, allowing the patients to achieve a good weight loss, better control of co-morbidities, and better quality of life than at baseline.

A gut microbiota-targeted dietary intervention for amelioration of chronic inflammation underlying metabolic syndrome

Chronic inflammation induced by endotoxin from a dysbiotic gut microbiota contributes to the development of obesity-related metabolic disorders. Modification of gut microbiota by a diet to balance its composition becomes a promising strategy to help manage obesity. A dietary scheme based on whole grains, traditional Chinese medicinal foods, and prebiotics (WTP diet) was designed to meet human nutritional needs as well as balance the gut microbiota. Ninety-three of 123 central obese volunteers (BMI ≥ 28 kg m(-2) ) completed a self-controlled clinical trial consisting of 9-week intervention on WTP diet followed by a 14-week maintenance period. The average weight loss reached 5.79 ± 4.64 kg (6.62 ± 4.94%), in addition to improvement in insulin sensitivity, lipid profiles, and blood pressure. Pyrosequencing of fecal samples showed that phylotypes related to endotoxin-producing opportunistic pathogens of Enterobacteriaceae and Desulfovibrionaceae were reduced significantly, while those related to gut barrier-protecting bacteria of Bifidobacteriaceae increased. Gut permeability, measured as lactulose/mannitol ratio, was decreased compared with the baseline. Plasma endotoxin load as lipopolysaccharide-binding protein was also significantly reduced, with concomitant decrease in tumor necrosis factor-α, interleukin-6, and an increase in adiponectin. These results suggest that modulation of the gut microbiota via dietary intervention may enhance the intestinal barrier integrity, reduce circulating antigen load, and ultimately ameliorate the inflammation and metabolic phenotypes.

Physical inactivity, insulin resistance, and the oxidative-inflammatory loop

Epidemiological data indicate that physical inactivity, a main factor of global energetic imbalance, is involved in the worldwide epidemic of obesity and metabolic disorders such as insulin resistance. Although the complex pathogenesis of insulin resistance is not fully understood, literature data accumulated during the past decades clearly indicate that the activation of the oxidative-inflammatory loop plays a major role. By activating the oxidative-inflammatory loop in insulin-sensitive tissues, fat gain and adipose tissue dysfunction likely contribute to induce insulin resistance during chronic and prolonged physical inactivity. However, in the past years, evidence has emerged showing that early insulin resistance also occurs after very short-term exposure to physical inactivity (1-7 days) without any fat gain or energetic imbalance. The possible role of liver disturbances or endothelial dysfunction is suggested, but further studies are necessary to really conclude. Inactive skeletal muscle probably constitutes the primary triggering tissue for the development of early insulin resistance. In the present review, we discuss on the current knowledge about the effect of physical inactivity on whole-body and peripheral insulin sensitivity, and how local inflammation and oxidative stress arising with physical inactivity could potentially induce insulin resistance. We assume that early muscle insulin resistance allows the excess nutrients to shift in the storage tissues to withstand starvation through energy storage. We also consider when chronic and prolonged, physical inactivity over an extended period of time is an underestimated contributor to pathological insulin resistance and hence indirectly to numerous chronic diseases.

Obesity in the ageing man

As the population is ageing globally, both ageing and obesity are recognized as major public health challenges. The aim of this narrative review is to present and discuss the current evidence on the changes in body composition, energy balance and endocrine environment that occur in the ageing man. Obesity in the ageing man is related to changes in both body weight and composition due to alterations in energy intake and total energy expenditure. In addition, somatopenia (decreased GH secretion), late-onset hypogonadism (LOH), changes in thyroid and adrenal function, as well as changes in appetite-related peptides (leptin, ghrelin) and, most importantly, insulin action are related to obesity, abnormal energy balance, redistribution of the adipose tissue and sarcopenia (decreased muscle mass). A better understanding of the complex relationship of ageing-related endocrine changes and obesity could lead to more effective interventions for elderly men.

Brief communication: Body mass index, body adiposity index, and percent body fat in Asians

Human obesity is a growing epidemic throughout the world. Body mass index (BMI) is commonly used as a good indicator of obesity. Body adiposity index (BAI = hip circumference (cm)/stature (m)(1.5) - 18), as a new surrogate measure, has been proposed recently as an alternative to BMI. This study, for the first time, compares BMI and BAI for predicting percent body fat (PBF; estimated from skinfolds) in a sample of 302 Buryat adults (148 men and 154 women) living in China. The BMI and BAI were strongly correlated with PBF in both men and women. The correlation coefficient between BMI and PBF was higher than that between BAI and PBF for both sexes. For the linear regression analysis, BMI better predicted PBF in both men and women; the variation around the regression lines for each sex was greater for BAI comparisons. For the receiver operating characteristic (ROC) analysis, the area under the ROC curve for BMI was higher than that for BAI for each sex, which suggests that the discriminatory capacity of the BMI is higher than the one of BAI. Taken together, we conclude that BMI is a more reliable indicator of PBF derived from skinfold thickness in adult Buryats.

Co-agonist of glucagon and GLP-1 reduces cholesterol and improves insulin sensitivity independent of its effect on appetite and body weight in diet-induced obese C57 mice

Dual agonism of glucagon and glucagon-like peptide-1 (GLP-1) receptors reduce body weight without inducing hyperglycemia in rodents. However, the effect of a co-agonist on insulin sensitivity and lipid metabolism has not been thoroughly assessed. Diet-induced obese (DIO) mice received 0.5 mg·kg(-1) of co-agonist or 2.5 mg·kg(-1) of glucagon or 8 μg·kg(-1) of exendin-4 by subcutaneous route, twice daily, for 28 days. A separate group of mice was pair-fed to the co-agonist-treated group for 28 days. Co-agonist treatment reduced food intake and reduced body weight up to 28 days. In addition, it reduced leptin levels and increased fibroblast growth factor 21 (FGF21) levels in plasma, when compared with control and pair-fed groups. Co-agonist treatment decreased triglyceride levels in serum and liver and reduced serum cholesterol, mainly due to reduction in low-density lipoprotein (LDL) cholesterol. These changes were not seen with pair-fed controls. Co-agonist treatment improved glucose tolerance and increased insulin sensitivity, as observed during glucose and insulin-tolerance test, hyperinsulinemic clamp, and reduced gluconeogenesis, as observed in pyruvate-tolerance test. The effects on insulin sensitivity and lipid levels are mostly independent of the food intake or body weight lowering effect of the co-agonist.

Chronic moderate sleep restriction in older long sleepers and older average duration sleepers: a randomized controlled trial

Epidemiologic studies have consistently shown that sleeping <7 h and ≥8 h is associated with increased mortality and morbidity. The risks of short sleep may be consistent with results from experimental sleep deprivation studies. However, there has been little study of chronic moderate sleep restriction and little evaluation of older adults who might be more vulnerable to negative effects of sleep restriction, given their age-related morbidities. Moreover, the risks of long sleep have scarcely been examined experimentally. Moderate sleep restriction might benefit older long sleepers who often spend excessive time in bed (TIB) in contrast to older adults with average sleep patterns. Our aims are: (1) to examine the ability of older long sleepers and older average sleepers to adhere to 60 min TIB restriction; and (2) to contrast effects of chronic TIB restriction in older long vs. average sleepers. Older adults (n = 100) (60-80 years) who sleep 8-9 h per night and 100 older adults who sleep 6-7.25 h per night will be examined at 4 sites over 5 years. Following a 2-week baseline, participants will be randomized to one of two 12-week treatments: (1) a sleep restriction involving a fixed sleep-wake schedule, in which TIB is reduced 60 min below each participant's baseline TIB; and (2) a control treatment involving no sleep restriction, but a fixed sleep schedule. Sleep will be assessed with actigraphy and a diary. Measures will include glucose tolerance, sleepiness, depressive symptoms, quality of life, cognitive performance, incidence of illness or accident, and inflammation.

Non-viral factors contributing to hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is a major cause of cancer death worldwide, accounting for over half a million deaths per year. The geographic pattern of HCC incidence is parallel to exposure to viral etiologic factors. Its incidence is increasing, ranging between 3% and 9% annually depending on the geographical location, and variability in the incidence rates correspond closely to the prevalence and pattern of the primary etiologic factors. Chronic infections with hepatitis B viruses or hepatitis C viruses have both been recognized as human liver carcinogens with a combined attributable fraction of at least 75% of all HCC cases. Multiple non-viral factors have been implicated in the development of HCC. Increased body mass index and diabetes with subsequent development of non-alcoholic steatohepatitis represent significant risk factors for HCC. Other non-viral causes of HCC include iron overload syndromes, alcohol use, tobacco, oral contraceptive, aflatoxin, pesticides exposure and betel quid chewing, a prevalent habit in the developing world. Wilson disease, α-1 antitrypsin deficiency, Porphyrias, autoimmune hepatitis, Schistosoma japonicum associated with positive hepatitis B surface antigen, and thorotrast-ray are also contributing hepatocellualar carcinoma. In addition, primary biliary cirrhosis, congestive liver disease and family history of liver cancer increase the risk of HCC incident. In conclusion, clarification of relevant non-viral causes of HCC will help to focus clinicians on those risk factors that are modifiable. The multilevel preventative approach will hopefully lead to a reduction in incidence of non-viral HCC, and a decrease in the patient morbidity and mortality as well as the societal economic burden associated with HCC.

Non-viral factors contributing to hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is a major cause of cancer death worldwide, accounting for over half a million deaths per year. The geographic pattern of HCC incidence is parallel to exposure to viral etiologic factors. Its incidence is increasing, ranging between 3% and 9% annually depending on the geographical location, and variability in the incidence rates correspond closely to the prevalence and pattern of the primary etiologic factors. Chronic infections with hepatitis B viruses or hepatitis C viruses have both been recognized as human liver carcinogens with a combined attributable fraction of at least 75% of all HCC cases. Multiple non-viral factors have been implicated in the development of HCC. Increased body mass index and diabetes with subsequent development of non-alcoholic steatohepatitis represent significant risk factors for HCC. Other non-viral causes of HCC include iron overload syndromes, alcohol use, tobacco, oral contraceptive, aflatoxin, pesticides exposure and betel quid chewing, a prevalent habit in the developing world. Wilson disease, α-₁ antitrypsin deficiency, Porphyrias, autoimmune hepatitis, Schistosoma japonicum associated with positive hepatitis B surface antigen, and thorotrast-ray are also contributing hepatocellualar carcinoma. In addition, primary biliary cirrhosis, congestive liver disease and family history of liver cancer increase the risk of HCC incident. In conclusion, clarification of relevant non-viral causes of HCC will help to focus clinicians on those risk factors that are modifiable. The multilevel preventative approach will hopefully lead to a reduction in incidence of non-viral HCC, and a decrease in the patient morbidity and mortality as well as the societal economic burden associated with HCC.

The association between neighborhood greenness and weight status: an observational study in Perth Western Australia

BACKGROUND

Few studies have examined the relationship between weight status and objectively measured neighborhood greenness and no study has examined this relationship across the different stages of adulthood. This research was an investigation of weight status and neighborhood greenness using objectively measured satellite remote sensing for a large population representative sample.

METHOD

Cross-sectional study of 10,208 young adults (16-24 years), mid-age adults (25-64 years) and older adults (65+ years) from a population representative sample for the period 2004-2009 in Perth, Western Australia. Neighborhood greenness was ascertained for a 1600m road network service area around each participant's address using the mean and standard deviation of the Normalized Difference Vegetation Index (NDVI) obtained from remote sensing. Multiple logistic regression was used to assess associations with weight status (overweight-or-obese, obese) adjusted for socio-demographics and health-related behaviors.

RESULTS

The adjusted odds ratio (OR) comparing obesity in the highest to the lowest tertile of mean greenness was 0.78 (95% CI 0.69-0.89). For the same comparison, the OR for overweight-or-obese was similar, 0.84 (95% CI 0.76-0.92). The OR comparing obesity in the highest to lowest tertile of variation in greenness was 0.75 (95% CI 0.66-0.85). For the same comparison, the OR for overweight-or-obese was similar, 0.75 (95% CI 0.68-0.82).

CONCLUSION

Higher levels and greater variation of neighborhood greenness are associated with lower odds of obesity among adults of all ages. Research examining neighborhood characteristics correlated with variability in greenness will help better understand these relationships.

Omeprazole improves the anti-obesity and antidiabetic effects of exendin-4 in db/db mice (-4 db/db)*

BACKGROUND

In addition to its glucoregulatory actions, exendin-4, a stable glucagon-like peptide-1 receptor agonist, exhibits protective effects in the pancreas and anti-obesity effects. Suitable combination treatment with other anti-obesity or pancreas protective agents would be an effective approach to optimize these additional effects. In the present study, we investigated the effects of the addition of omeprazole, a proton pump inhibitor, to exendin-4 in db/db mice, an experimental model of obesity and type 2 diabetes.

METHODS

The effects repeated dose treatment for 14 days with exendin-4 (8 μg/kg, s.c.) and omeprazole (30 mg/kg, s.c.) on glycemic control, food intake, and body weight were determined in obese and hyperglycemic db/db mice. The effects of these treatments on plasma gastrin, ghrelin, and leptin levels were determined, along with effects on nausea-like symptoms. The pancreatic effects of the repeated dose treatment were assessed by measuring %HbA1c in the circulation as well as pancreatic insulin and glucagon content and glucokinase activity.

RESULTS

Combination treatment resulted in significant decreases in plasma leptin and ghrelin levels after repeated dosing. Omeprazole improved the anorectic and body weight-lowering effects and reversed the inhibitory effect of exendin-4 on gastrin levels after repeated dose treatment. The 14-day combination treatment significantly reduced glucose excursion and improved insulin levels, with a concomitant decrease in %HbA1c levels. It also improved glucokinase activity and pancreatic insulin content, with a significant decrease in glucagon content.

CONCLUSIONS

Combined treatment with omeprazole with exendin-4 reduces food intake and body weight gain, most likely through changes in plasma ghrelin and leptin levels, and improves pancreatic insulin and glucagon content by improving glucokinase activity.

GUCY2C: at the intersection of obesity and cancer

Guanylyl cyclase C (GUCY2C) has canonical centrality in defense of key intestinal homeostatic mechanisms, encompassing fluid and electrolyte balance, epithelial dynamics, antitumorigenesis, and intestinal barrier function. Recent discoveries expand the homeostatic role of GUCY2C to reveal a novel gut-brain endocrine axis regulating appetite, anchored by hypothalamic GUCY2C which is responsive to intestine-derived uroguanylin. Thus, GUCY2C may represent a new target for anti-obesity pharmacotherapy. Moreover, the coincident regulation of energy balance and tumor suppression by a single hormone receptor system suggests that the GUCY2C axis might contribute to the established relationship between obesity and colorectal cancer. This confluence suggests that hormone supplementation to reconstitute GUCY2C signaling may be an elegant strategy to reverse both pathophysiologic processes.

Treadmill desks: A 1-year prospective trial

OBJECTIVE

Sedentariness is associated with weight gain and obesity. A treadmill desk is the combination of a standing desk and a treadmill that allow employees to work while walking at low speed.

DESIGN AND METHODS

The hypothesis was that a 1-year intervention with treadmill desks is associated with an increase in employee daily physical activity (summation of all activity per minute) and a decrease in daily sedentary time (zero activity). Employees (n = 36; 25 women, 11 men) with sedentary jobs (87 ± 27 kg, BMI 29 ± 7 kg/m(2) , n = 10 Lean BMI < 25 kg/m(2) , n = 15 Overweight 25 < BMI < 30 kg/m(2) , n = 11 Obese BMI > 30 kg/m(2) ) volunteered to have their traditional desk replaced with a treadmill desk to promote physical activity for 1 year.

RESULTS

Daily physical activity (using accelerometers), work performance, body composition, and blood variables were measured at Baseline and 6 and 12 months after the treadmill desk intervention. Subjects who used the treadmill desk increased daily physical activity from baseline 3,353 ± 1,802 activity units (AU)/day to, at 6 months, 4,460 ± 2,376 AU/day (P < 0.001), and at 12 months, 4,205 ± 2,238 AU/day (P < 0.001). Access to the treadmill desks was associated with significant decreases in daily sedentary time (zero activity) from at baseline 1,020 ± 75 min/day to, at 6 months, 929 ± 84 min/day (P < 0.001), and at 12 months, 978 ± 95 min/day (P < 0.001). For the whole group, weight loss averaged 1.4 ± 3.3 kg (P < 0.05). Weight loss for obese subjects was 2.3 ± 3.5 kg (P < 0.03). Access to the treadmill desks was associated with increased daily physical activity compared to traditional chair-based desks; their deployment was not associated with altered performance. For the 36 participants, fat mass did not change significantly, however, those who lost weight (n = 22) lost 3.4 ± 5.4 kg (P < 0.001) of fat mass. Weight loss was greatest in people with obesity.

CONCLUSIONS

Access to treadmill desks may improve the health of office workers without affecting work performance.

Assessment of the knowledge of GPS considering the surgical treatment of obesity

Bariatric surgery is currently the only effective treatment option for morbidly obese patients. There has been observed a considerable disproportion between the number of procedures conducted in Poland and the number of patients requiring such treatment. There are no studies assessing bariatric knowledge among general practitioners who play crucial role in polish health care system. The aim of the study was to assess the knowledge of general practitioners regarding bariatric surgery.

MATERIAL AND METHODS

An anonymous questionnaire conducted among 282 general practitioners in 2010-2011 during local educational conferences. The questionnaire consisted of 10 questions relating to fundamental issues of bariatric surgery.

RESULTS

Only one twelfth (8.1%) of the general practitioners questioned knows the indications for bariatric surgery, can apply them, and has epidemiological awareness. 61.5% of general practitioners know the surgical procedures used for the treatment of obesity, whereas 58% of them show the knowledge of surgical technique in which they are performed. Only 23% of general practitioners were aware that bariatric surgery decreases cancer risk. 92% of the participants noticed a necessity of education regarding the surgical treatment of obesity.

CONCLUSIONS

Bariatric knowledge among general practitioners is not adequate to scientific research results published during the last years. Most general practitioners who participated in our study are aware of that and are awaiting for educational programmes focused on this issue.

Neurobehavioural correlates of body mass index and eating behaviours in adults: a systematic review

The worldwide increase in obesity has spurred numerous efforts to understand the regulation of eating behaviours and underlying brain mechanisms. These mechanisms can affordably be studied via neurobehavioural measures. Here, we systematically review these efforts, evaluating neurocognitive tests and personality questionnaires based on: (a) consistent relationship with obesity and eating behaviour, and (b) reliability. We also considered the measures' potential to shed light on the brain mechanisms underlying these individual differences. Sixty-six neurocognitive tasks were examined. Less than 11%, mainly measures of executive functions and food motivation, yielded both replicated and reliable effects. Several different personality questionnaires were consistently related to BMI. However, further analysis found that many of these questionnaires relate closely to Conscientiousness, Extraversion and Neuroticism within the Five-Factor Model of personality. Both neurocognitive tests and personality questionnaires suggest that the critical neural systems related to individual differences in obesity are lateral prefrontal structures underpinning self-control and striatal regions implicated in food motivation. This review can guide selection of the highest yield neurobehavioural measures for future studies.

The future of inpatient diabetes management: glucose as the sixth vital sign

Diabetes is an ever increasing health problem in our society. Due to associated small and large vessel conditions, patients with diabetes are two- to four-fold more likely to require hospitalization than nondiabetic individuals. Furthermore, hyperglycemia in hospitalized patients results in increased susceptibility to wound infections, worse outcomes postcardiac and cerebrovascular events, longer hospital length of stay and increased inpatient mortality. Several studies suggest that tight control of glucose levels yields improvement in these factors. Conversely, other studies have suggested increased mortality after tight glucose management, perhaps as a result of an increased incidence of hypoglycemic events. The most reasonable approach to control of hyperglycemia is to normalize glucose levels as much as possible without triggering hypoglycemia. In the hospital, insulin therapy of hyperglycemia is preferred due to the ability to flexibly manage glucose levels without side effects associated with many alternative antidiabetic agents. Due to the increasing burden of inpatient diabetes, and the detrimental effects of both hyper and hypoglycemia, the authors predict that blood-glucose levels will become the sixth vital sign to be frequently monitored in hospitalized patients and controlled in a narrow range. The future is in the use of insulin pumps controlled by continuous glucose monitors. This technology is complex and has not yet become standard. The development of future inpatient diabetes care will depend on adaptation of hospital systems to advance the new technology.

The impact of patatin-like phospholipase domain-containing protein 3 polymorphism on hepatocellular carcinoma prognosis

BACKGROUND

The single nucleotide polymorphism (SNP) rs738409 in patatin-like phospholipase domain-containing protein 3 (PNPLA3) is associated with hepatic fat accumulation and disease progression in patients with non-alcoholic fatty liver disease and alcoholic liver disease (ALD). This study was conducted to determine whether PNPLA3 rs738409 SNPs affect development and prognosis of hepatocellular carcinoma (HCC) in patients with various liver diseases.

METHODS

We enrolled 638 consecutive Japanese patients newly diagnosed with HCC between 2001 and 2010: 72 patients with hepatitis B virus (HBV), 462 with hepatitis C virus (HCV), and 104 with non-B non-C (NBNC).

RESULTS

NBNC patients exhibited large tumors of advanced TNM stages at HCC diagnosis, and had significantly poorer prognosis than HBV or HCV patients (P < 0.001 and <0.001, respectively; log-rank test). The G/G genotype of PNPLA3 rs738409 SNP had significantly higher distribution in NBNC patients (P < 0.001) and was significantly associated with higher body mass index (BMI) and an increased aspartate aminotransferase to platelet ratio index. No significant differences were observed in survival with differences in PNPLA3 SNP genotypes among the patients, although ALD patients with the G/G genotype of PNPLA3 SNP and low BMI had significantly poorer survival than those with high BMI (P = 0.028).

CONCLUSIONS

The G/G genotype of PNPLA3 rs738409 SNP was more frequently distributed, and associated with BMI and fibrosis among NBNC-HCC patients but not among HBV or HCV patients. These genotypes might affect HCC prognosis in ALD patients, but not in HBV, HCV, or NAFLD patients.

Blood lead is significantly associated with metabolic syndrome in Korean adults: an analysis based on the Korea National Health and Nutrition Examination Survey (KNHANES), 2008

Background

Although an association between low-level environmental heavy metal exposure and the incidence of metabolic syndrome (MS) has been hypothesized, little research on this topic has been conducted on a population-wide level.

Methods

We analyzed MS status and whole blood lead, mercury, cadmium, manganese, and creatinine-adjusted urine arsenic concentrations in 1,405 subjects, ≥ 20 years of age, who were registered for the Korea National Health and Nutrition Examination Survey, 2008.

Results

Various demographic and biochemical parameters were associated with MS and blood heavy metal status. After adjusting for these variables, lead was the only heavy metal that was significantly associated with MS. Lead concentrations in subjects with MS were significantly higher than those in subjects without MS (p = 0.015). The prevalence of MS and a moderate/high risk for cardiovascular disease, as determined by Framingham risk score, also increased significantly according to the logarithmic transformation of the lead quartile (p < 0.001). The odds ratios and 95% confidence intervals for MS were 1.56 (0.90–2.71), 1.63 (0.94–2.83), and 2.57 (1.46–4.51) for the second, third, and fourth quartiles of the log-transformed lead quartile, respectively, as compared with those of the lowest quartile after multiple adjustments for confounding factors. Serum triglyceride level was the only MS diagnostic component significantly associated with lead level in a multiple linear regression analysis (p = 0.006).

Conclusions

These findings suggest that a higher prevalence of MS is associated with higher blood lead levels in the Korean population.

Clinical utility of phentermine/topiramate (Qsymia™) combination for the treatment of obesity

Qsymia™ (Vivus Inc, Mountain View, CA, USA), a combination of phentermine and delayed-release topiramate, has been available in the US since September 2012 for the treatment of obesity. Phentermine is an anorexigenic agent, which is approved for the short-term treatment of obesity, while topiramate is approved for nonweight loss indications - seizure disorders and migraine prophylaxis. The amount of weight loss achieved with combination therapy is of a greater magnitude than what could be achieved with either agent alone. Adverse events that occur with the combination therapy are in line with the known side effect profiles of the constituent drugs; teratogenicity, a slight increase in heart rate, psychiatric and cognitive adverse effects, and metabolic acidosis are concerns.

Global obesity: trends, risk factors and policy implications

The worldwide increase in obesity and related chronic diseases has largely been driven by global trade liberalization, economic growth and rapid urbanization. These factors continue to fuel dramatic changes in living environments, diets and lifestyles in ways that promote positive energy balance. Nutritional transitions in low-income and middle-income countries are typically characterized by increases in the consumption of animal fat and protein, refined grains, and added sugar. This change is coupled with reductions in physical activity owing to more mechanized and technologically driven lifestyles. Given the high costs of obesity and comorbidities in terms of health-care expenditure and quality of life, prevention strategies are paramount, particularly in low-income and middle-income countries that must manage coexisting infectious diseases and undernutrition in addition to the obesity epidemic. As countries become increasingly urbanized, undernutrition and obesity can exist side by side within the same country, community or household, which is a particular challenge for health systems with limited resources. Owing to the scope and complexity of the obesity epidemic, prevention strategies and policies across multiple levels are needed in order to have a measurable effect. Changes should include high-level global policies from the international community and coordinated efforts by governments, organizations, communities and individuals to positively influence behavioural change.

G protein-coupled estrogen receptor in energy homeostasis and obesity pathogenesis

Obesity and its related metabolic diseases have reached a pandemic level worldwide. There are sex differences in the prevalence of obesity and its related metabolic diseases, with men being more vulnerable than women; however, the prevalence of these disorders increases dramatically in women after menopause, suggesting that sex steroid hormone estrogens play key protective roles against development of obesity and metabolic diseases. Estrogens are important regulators of several aspects of metabolism, including body weight and body fat, caloric intake and energy expenditure, and glucose and lipid metabolism in both males and females. Estrogens act in complex ways on their nuclear estrogen receptors (ERs) ERα and ERβ and transmembrane ERs such as G protein-coupled estrogen receptor. Genetic tools, such as different lines of knockout mouse models, and pharmacological agents, such as selective agonists and antagonists, are available to study function and signaling mechanisms of ERs. We provide an overview of the evidence for the physiological and cellular actions of ERs in estrogen-dependent processes in the context of energy homeostasis and body fat regulation and discuss its pathology that leads to obesity and related metabolic states.

Obesity and burns

The population of overweight patients presenting to burn facilities is expected to increase significantly over the next decades due to the global epidemic of obesity. Excess adiposity mediates alterations to key physiological responses and poses challenges to the optimal management of burns. The purpose of this study is to document the general epidemiological aspects of thermal injuries in the obese population, outline relevant physiological aspects associated with obesity, and draw attention to topics relating to the management, rehabilitation, and prognosis of burns in this emerging subpopulation of patients.

Lipidomic and metabolomic analyses reveal potential plasma biomarkers of early atheromatous plaque formation in hamsters

AIMS

Atherosclerosis is the main pathological process contributing to cardiovascular disease, with diet being the most important factor involved. Although the lipidome of atheromatous plaque has been studied previously, the use of comparative lipidomics and metabolomics in plasma in early atherogenesis could lead to the discovery of plasma biomarkers that allow not only disease prediction but also measurement of disease progression.

METHODS AND RESULTS

High-throughput techniques, such as liquid chromatography/mass spectrometry, allowed us to compare the circulating and aortic lipidome and plasma metabolome in order to look for new molecular targets involved in atherogenesis. To achieve this objective, we chose the hamster (Mesocricetus auratus) as the best small animal model for diet-induced early atherosclerosis, because its lipoprotein metabolism is similar to that of humans. The results revealed the existence of several, previously unreported, changes in lipid and amino-acid metabolism, the peroxisome proliferator-activated receptor γ pathway, and oxidative and endoplasmic reticulum stress, also involving cell senescence. Furthermore, as a proof of concept in the modelling of dietary influences in atherogenesis, we have measured the effect of a potential anti-atherogenic polyphenol extract on the reported pathways. Our results support a previously unknown role for taurocholic acid as a potential plasma biomarker of early atheromatous plaque formation.

CONCLUSION

The use of comparative liquid chromatography/mass spectrometry-based lipidomics and metabolomics allows the discovery of novel pathways in atherogenesis, as well as new potential plasma biomarkers, which could allow us to predict disease in its early stages and measure its progression.

The vagus nerve and the inflammatory reflex--linking immunity and metabolism

The vagus nerve has an important role in regulation of metabolic homeostasis, and efferent vagus nerve-mediated cholinergic signalling controls immune function and proinflammatory responses via the inflammatory reflex. Dysregulation of metabolism and immune function in obesity are associated with chronic inflammation, a critical step in the pathogenesis of insulin resistance and type 2 diabetes mellitus. Cholinergic mechanisms within the inflammatory reflex have, in the past 2 years, been implicated in attenuating obesity-related inflammation and metabolic complications. This knowledge has led to the exploration of novel therapeutic approaches in the treatment of obesity-related disorders.

Do we need anti-obesity drugs?

The increasing global prevalence of obesity urgently requires an implementation of efficient preventive and therapeutic measures. Weight loss and its maintenance should be considered one of the most important strategies to reduce the incidence of obesity-related co-morbidities such as diabetes and cardiovascular diseases. Lifestyle modification focused on diet and physical activity represents the essential component of any kind of weight management. However, only an intensive lifestyle intervention can be efficient in terms of long-term weight loss. Anti-obesity drugs affect different targets in the central nervous system or peripheral tissues and improve regulatory and metabolic disturbances that contribute to the development of obesity. Anti-obesity medications provide modest additional fat loss to that achieved by lifestyle modification alone, reduce visceral fat stores, improve programme adherence, weight loss maintenance, diminish obesity-related health risks and improve a quality of life. Anti-obesity drugs do play a role in weight management. Their replacement with placebo is followed by weight regain. Due to adverse events, several anti-obesity drugs were withdrawn from the market over the past few years and currently only orlistat remains available for long-term obesity management. Drug withdrawals, failure of clinical trials with several new anti-obesity compounds as well as inappropriate demands of drug regulating agencies concerning the study protocol led to scepticism about the perspectives in the pharmacotherapy of obesity. However, recently developed anti-obesity medications such as gut hormone analogues and drug combinations provided encouraging results in terms of weight loss, safety and improvement of cardio-metabolic health risks.

The relationship between income and weight control strategies among Canadian adults

OBJECTIVE

The goal of this study was to examine use of weight control strategies in Canadian adults and the role of income as a barrier to using these strategies.

METHODS

Data from the Canadian Community Health Survey cycle 4.1 on health behaviour change was used for this study. Analysis was restricted to adults (18+ years) residing in the 10 provinces of Canada. Respondents were categorized as having used weight control strategies in their lifestyle if they responded that they increased exercise, improved/modified their eating habits, or lost weight in the previous 12 months, as the primary means of health improvement. An adjusted household income ratio divided into deciles was used as a measure of income. Multivariable logistic regression was used to examine the relationship between income and weight control strategies adjusting for known confounders.

RESULTS

Of the 103,990 respondents analyzed, 60% were overweight or obese and 45% reported using weight control strategies in the previous 12 months. Age, sex, ethnicity, having a regular doctor, education, and income were all significantly associated with using weight control strategies in the multivariable model. Results that included all two- and three-way interactions between sex, weight category, and income found that lower income was significantly associated with using fewer weight control strategies--more so for obese men and normal weight women.

CONCLUSION

Efforts must be made to create equal access to services and food products that promote weight reduction or control strategies given the rising prevalence of adult obesity in Canada.

Effects of meal preparation training on body weight, glycemia, and blood pressure: results of a phase 2 trial in type 2 diabetes

BACKGROUND

Modest reductions in weight and small increases in step- related activity (e.g., walking) can improve glycemic and blood pressure control in type 2 diabetes mellitus (DM2). We examined changes in these parameters following training in time- efficient preparation of balanced, low- energy meals combined with pedometer- based step count monitoring.

METHODS

Seventy- two adults with DM2 were enrolled in a 24- week program (i.e., 15 three- hour group sessions). They prepared meals under a chef's supervision, and discussed eating behaviours/nutrition with a registered dietitian. They maintained a record of pedometer- assessed step counts. We evaluated changes from baseline to 24 weeks in terms of weight, step counts, hemoglobin A1c (HbA1c, glycemic control), blood pressure, and eating control ability (Weight Efficacy Lifestyle WEL Questionnaire). 53 participants (73.6%) completed assessments.

RESULTS

There were improvements in eating control (11.2 point WEL score change, 95% CI 4.7 to 17.8), step counts (mean change 869 steps/day, 95% CI 198 to 1,540), weight (mean change -2.2%; 95% CI -3.6 to -0.8), and HbA1c (mean change -0.3% HbA1c, 95% CI -0.6 to -0.1), as well as suggestion of systolic blood pressure reduction (mean change -3.5 mm Hg, 95% CI -7.8 to 0.9). Findings were not attributable to medication changes. In linear regression models (adjusted for age, sex, ethnicity, insulin use, season), a -2.5% weight change was associated with a -0.3% HbA1c change (95% CI -0.4 to -0.2) and a -3.5% systolic blood pressure change (95% CI -5.5 to -1.4).

CONCLUSIONS

In this 'proof of concept' study, persistence with the program led to improvements in eating and physical activity habits, glycemia reductions, and suggestion of blood pressure lowering effects. The strategy thus merits further study and development to expand the range of options for vascular risk reduction in DM2.

Changing spectrum of diabetes mellitus in children: challenges with initial classification

OBJECTIVE

To determine the frequency of initial misclassification of diabetes mellitus (DM) in children and to compare the presenting features of DM1, DM2, and the misclassified cases.

RESULTS

A total of 206 patients fulfilled the inclusion criteria. Of them, 74.75% had DM1 and 25.25% had DM2. Ten percent of studied patients had a subsequent change in classification. The mean HbA1c of the DM2 patients, who were initially misclassified, was 13.35% (SD = 1.96). The mean HbA1c of DM2 patients with correct initial classification was 8.83% (SD = 3.01). Diabetes ketoacidosis (DKA) was seen in 59.44% of DM1 and 23.91% of DM2 patients. Of the DM2 patients who were initially misclassified, 58.82% had presented in DKA as opposed to only 6.45% of patients who were correctly classified.

CONCLUSION

The initial classification of DM frequently requires revision (10% in this study). The misclassification is highest among DM2 patients who initially present with higher HbA1c and DKA.

Blockade of adipocyte differentiation by cordycepin

BACKGROUND AND PURPOSE

Cordyceps militaris has the potential to suppress differentiation of pre-adipocytes. However, the active entities in the extract and the underlying mechanisms of its action are not known. Hence, we investigated whether and how cordycepin (3'-deoxyadenosine), a constituent of C. militaris, inhibits adipogenesis.

EXPERIMENTAL APPROACH

Differentiation of 3T3-L1 pre-adipocytes and pre-adipocytes in primary cultures was induced by Insulin, dexamethasone and IBMX, and these were used as in vitro models of adipogenesis. The effects of cordycepin on adipogenesis were examined with particular focus on the regulation of CCAAT/enhancer-binding protein β (C/EBPβ) and PPARγ.

KEY RESULTS

Cordycepin suppressed the lipid accumulation and induction of adipogenic markers that occurred on differentiation of pre-adipocytes and also blocked the down-regulation of a pre-adipocyte marker. This anti-adipogenic effect was reversible and mediated by an adenosine transporter, but not A₁, A₂ or A₃ adenosine receptors. This effect of cordycepin was not reproduced by other adenosine-related substances, including ATP, ADP and adenosine. Early induction of the adipogenic C/EBPβ-PPARγ pathway was suppressed by cordycepin. Blockade of mTORC1 via inhibition of PKB (Akt) and activation of AMP kinase was identified as the crucial upstream event targeted by cordycepin. In addition to its negative effect on adipogenesis, cordycepin suppressed lipid accumulation in mature adipocytes.

CONCLUSIONS AND IMPLICATIONS

These results suggest that the anti-adipogenic effects of cordycepin occur through its intervention in the mTORC1-C/EBPβ-PPARγ pathway. Cordycepin, by blocking both adipogenesis and lipid accumulation, may have potential as a therapeutic agent for effective treatment of obesity and obesity-related disorders.

Early postnatal low-protein nutrition, metabolic programming and the autonomic nervous system in adult life

Protein restriction during lactation has been used as a rat model of metabolic programming to study the impact of perinatal malnutrition on adult metabolism. In contrast to protein restriction during fetal life, protein restriction during lactation did not appear to cause either obesity or the hallmarks of metabolic syndrome, such as hyperinsulinemia, when individuals reached adulthood. However, protein restriction provokes body underweight and hypoinsulinemia. This review is focused on the regulation of insulin secretion and the influence of the autonomic nervous system (ANS) in adult rats that were protein-malnourished during lactation. The data available on the topic suggest that the perinatal phase of lactation, when insulted by protein deficit, imprints the adult metabolism and thereby alters the glycemic control. Although hypoinsulinemia programs adult rats to maintain normoglycemia, pancreatic β-cells are less sensitive to secretion stimuli, such as glucose and cholinergic agents. These pancreatic dysfunctions may be attributed to an imbalance of ANS activity recorded in adult rats that experienced maternal protein restriction.

Regulation of appetite to treat obesity

Obesity has escalated into a pandemic over the past few decades. In turn, research efforts have sought to elucidate the molecular mechanisms underlying the regulation of energy balance. A host of endogenous mediators regulate appetite and metabolism, and thereby control both short- and long-term energy balance. These mediators, which include gut, pancreatic and adipose neuropeptides, have been targeted in the development of anti-obesity pharmacotherapy, with the goal of amplifying anorexigenic and lipolytic signaling or blocking orexigenic and lipogenic signaling. This article presents the efficacy and safety of these anti-obesity drugs.

Variação do diâmetro da artéria braquial em crianças obesas: presente e futuro

OBJETIVO: Revisão da literatura acerca do uso da medida da variação do diâmetro da artéria braquial por ultrassonografia de alta resolução (dilatação mediada por fluxo) como preditor de risco para doença cardiovascular em crianças e adolescentes obesos. FONTES DE DADOS: Levantamento de publicações indexadas no Medline/PubMed de trabalhos publicados entre 2002 e 2011, rastreadas com a combinação dos descritores: "endothelium", "child", "ultrasonography" e "obesity", além de estudos e textos clássicos sobre o tema. Foram encontradas 54 publicações e 32 delas foram incluídas na presente revisão do tema. SINTESE DOS DADOS: O estudo da disfunção endotelial tem sido empregado como preditor de risco para doenças cardiovasculares, tais como aterosclerose e doença cardíaca coronariana, visto que a lesão endotelial é um importante evento na fisiopatologia de tais doenças. CONCLUSÕES: A dilatação mediada por fluxo da artéria braquial mostra-se importante como ferramenta diagnóstica e prognóstica na avaliação da função endotelial de crianças e adolescentes com excesso de peso por ser um método não invasivo, com boa aplicabilidade quanto ao custo, à inocuidade e ao benefício.