Diagnosis and prevalence of obesity

Body Mass Index Distribution in Female Child, Adolescent and Adult Inpatients with Anorexia Nervosa-A Retrospective Chart Review

BACKGROUND

The variation in body mass index (BMI) of inpatients with anorexia nervosa has not been analyzed across the age span. A positive correlation between BMI and age has been reported in adolescent inpatients aged 15 years and younger that levels off at 15 to 18 years. BMIs standardized for age and sex (standard deviation scores, SDSs) were negatively correlated with age in these inpatients aged 8 to 18 years.

METHODS

The aims of the current retrospective study were threefold: first, to confirm the relationships of BMI, BMI-SDS and age in adolescent inpatients in a larger sample; second, to systematically assess the relationship of BMI, BMI-SDS, body height-SDS and age in adult inpatients at the time of referral; and third, to assess body height-SDSs and age to evaluate stunting.

RESULTS

We included 1001 girls (aged 12-17.9 years) and 1371 women (aged 18-73 years) admitted to inpatient treatment between 2014 and 2021. Mean BMI at admission was 14.95 kg/m2 (SD = 1.43; range 10.67-18.47) in adolescents and 14.63 kg/m2 (SD = 2.02; range 8.28-18.47) in adults. None of the adolescent patients but 20 adults had very low BMI values below 10 kg/m2. Adolescents showed a small but significant positive correlation between age and BMI (r = 0.12; p = 2.4 × 10-4). In adults, BMI was not correlated with age (r = -0.03; p = 0.3). BMI-SDSs was negatively correlated with age in adolescents and less so in adults (r = -0.35; p < 0.001 and r = -0.09; p = 0.001). Curve fit analyses for all patients indicated that there was a quadratic (age × age) relationship between age and BMI-SDS. Height correlated positively with BMI in adult (r = 0.1; p < 0.001) and adolescent (r = 0.09 p = 0.005) patients and we detected no evidence for stunting.

CONCLUSIONS

In conclusion, the BMI of inpatients seems to be relatively stable across the age span with mean values between 14 and 15 kg/m2. BMI values initially increase with age in younger patients, drop between ages 18 and 23 and then slowly decline with age.

Combination Therapy: A New Tool for the Management of Obesity

Obesity is a chronic lifestyle issue with devastating results. Behavioral changes are one of the initial lines of management strategies for obesity, but they are not very efficient management strategies. Many people also use surgical intervention to maintain a healthy weight, now considered to be the most common and effective obesity management. Chemically synthesized medicines fill the gap between lifestyle interventions and minimally invasive surgical management of obesity. The most common issue associated with monotherapy without side effects is its moderate effectiveness and higher dose requirement. Combination therapy is already used for many serious and complicated disease treatments and management and has shown efficacy as well. Generally, we use two or more medicines with different mechanisms of action for a better effect. The commonly used combination therapy for obesity management includes low-dose phentermine and prolonged and slow-releasing mechanism topiramate; naltrexone, and bupropion. Phentermine with inhibitors of Na-glucose cotransporter-2 or glucagon-like peptide-1 (GLP-1) agonists with gastric hormone or Na-glucose cotransporter-2 are two more viable combo therapy. This combination strategy aims to achieve success in bariatric surgery and the scientific community is working in this direction.

Thoracic adipose tissue contributes to severe virus infection of the lung

OBJECTIVE

Obesity is an independent risk factor for severe influenza virus and COVID-19 infections. There might be an interplay between adipose tissue and respiratory pathogens, although the mechanism is unknown. Proinflammatory factors secreted by the adipose tissue are often discussed to serve as indirect contributor to virus infection. However, the direct potential of adipose tissue to serve as a viral niche has not yet been investigated.

METHODS

Two murine obesity models (DIO and ob/ob) were infected with influenza A virus (IAV) and monitored for 3 weeks. p.i. Lung and adipose tissue were harvested, and the viral load was analysed. Direct replication of IAV in vitro was investigated in human derived primary adipocytes and macrophages. The indirect impact of the secretory products of adipocytes during infection was analysed in a co-culture system with lung fibroblasts. Moreover, lung and adipose tissue was harvested from deceased patients infected with SARS-CoV-2 omicron variant. Additionally, replication of SARS-CoV-2 alpha, delta, and omicron variants was investigated in vitro in adipocytes and macrophages.

RESULTS

Both murine obesity models presented high IAV titers compared to non-obese mice. Interestingly, adipose tissue adjacent to the lungs was a focal point for influenza virus replication in mice. We further detected IAV replication and antiviral response in human adipocytes. Co-cultivation of adipocytes and lung fibroblasts led to increased IL-8 concentration during infection. Though we observed SARS-CoV-2 in the thoracic adipose tissue of COVID-19 patients, no active replication was found in adipocytes in vitro. However, SARS-CoV-2 was detected in the macrophages and this finding was associated with increased inflammation.

CONCLUSIONS

Our study revealed that thoracic adipose tissue contributes to respiratory virus infection. Besides indirect induction of proinflammatory factors during infection, adipocytes and macrophages within the tissue can directly support viral replication.

Trends in adults' energy imbalance gaps over two decades in Belgium using system dynamics modelling

BACKGROUND

The energy imbalance gap (EIG) represents the average daily difference between energy intake and energy expenditure. The maintenance energy gap (MEG) captures the increased energy intake needed to maintain a higher average bodyweight compared with an initial distribution of bodyweight. This study quantified the dynamics of the EIG and MEG over time and across different genders/regions/BMI groups for Belgian adults.

METHODS

A validated system dynamics model was adapted to estimate the trends/dynamics of the EIG among different subpopulations over two decades in Belgium. The model was calibrated using data from the six Belgian national Health Interview Surveys (1997, 2001, 2004, 2008, 2013, 2018).

RESULTS

EIG was negative for all BMI groups among Belgian females in 2018, implying the start of a decrease in prevalence of overweight/obesity in this subpopulation. However, this was not the case among Belgian males. Flemish and Walloon males had positive EIGs across BMI groups in 2018, however, Brussels' males showed negative EIGs across BMI groups. Flemish and Brussels' females showed negative EIGs across all BMI groups in 2018, while Walloon females showed positive EIGs across almost all BMI groups. According to the MEG, Belgian men consumed (and expended) on average 59 kcal/day more in 2018 than in 1997 to maintain their heavier body weight. The MEG for Belgian women was 46 kcal/day in 2018, triple the MEG in 2004.

CONCLUSIONS

The detailed heterogeneous trends of the EIG describe the obesity patterns for different subpopulations in Belgium and could be used to model the differential effects of specific nutrition policies targeting energy intake.

The Inflammatory Profile of Obesity and the Role on Pulmonary Bacterial and Viral Infections

Obesity is a globally increasing health problem, entailing diverse comorbidities such as infectious diseases. An obese weight status has marked effects on lung function that can be attributed to mechanical dysfunctions. Moreover, the alterations of adipocyte-derived signal mediators strongly influence the regulation of inflammation, resulting in chronic low-grade inflammation. Our review summarizes the known effects regarding pulmonary bacterial and viral infections. For this, we discuss model systems that allow mechanistic investigation of the interplay between obesity and lung infections. Overall, obesity gives rise to a higher susceptibility to infectious pathogens, but the pathogenetic process is not clearly defined. Whereas, viral infections often show a more severe course in obese patients, the same patients seem to have a survival benefit during bacterial infections. In particular, we summarize the main mechanical impairments in the pulmonary tract caused by obesity. Moreover, we outline the main secretory changes within the expanded adipose tissue mass, resulting in chronic low-grade inflammation. Finally, we connect these altered host factors to the influence of obesity on the development of lung infection by summarizing observations from clinical and experimental data.

Trends in Energy Imbalance Gap and Body Weight Status in the Japanese Adult Population: A System Dynamics Approach

Background

The double burden of malnutrition is a growing public health problem in Japan. We estimated the dynamics of the energy imbalance gap (EIG) (average daily difference between energy intake and expenditure) to explain trends in the prevalence of underweight, overweight, and obese Japanese adults.

Methods

We used individual-level data on body height and weight from the National Health and Nutrition Surveys from 1975 to 2015. We calibrated a validated system dynamics model to estimate the EIG for Japanese adults aged 20 to 74 years by survey year, sex, and weight status classified by the body mass index (BMI).

Results

The overall EIG for men increased from 2.3 kcal/day in 1975 to 4.7 kcal/day in 1987 and then decreased to 2.3 kcal/day in 2015. The overall EIG for women consistently decreased from 4.3 kcal/day in 1975 to −0.5 kcal/day in 2015. By BMI class, the EIG for men with a BMI of <30 kg/m² began to decrease around 1990, indicating a deceleration in the prevalence of overweight and obese men. The EIG consistently decreased for women with a BMI of <25 kg/m² and reached negative values from the late 2000s to early 2010s, indicating a gradual decrease in the prevalence of overweight and obese women.

Conclusions

The dynamics of the EIG were different across sex and weight groups. Public health interventions should target a further decrease in the EIG for normal-weight, overweight, and obese men and a stop in the decreasing trends of the EIG in underweight and normal-weight women.

Three Decades of New Zealand Adults Obesity Trends: An Estimation of Energy Imbalance Gaps Using System Dynamics Modeling

OBJECTIVE

The energy imbalance gap (EIG) captures the average daily excess energy intake and governs the speed of change in body mass. This study quantifies the dynamics of the EIG over time and across different ethnic, sex, and weight groups in New Zealand.

METHODS

A novel method in system dynamics was used to estimate the trends/dynamics of the EIG among Pacific, Māori, Asian, and European/other men and women over the past 3 decades in New Zealand. The model was calibrated using data from the national New Zealand Health Survey (1988-2014/15).

RESULTS

All ethnic/sex subpopulations except European/other women and Pacific men showed a drop in their EIGs starting in early to mid-2000. For European/other subpopulations, the EIG was positive in 2014/15 but lower than it was in previous years, meaning that the prevalence of obesity still increased but at a slower pace. For the Pacific subpopulation, increasing trends of the EIG across all BMI classes in 2014/15 implied that obesity prevalence for this subpopulation increased at a rate faster than before. Among Asian women, almost all BMI classes showed a negative EIG in 2012 to 2014/15, implying decreasing prevalence of obesity in this subpopulation. Māori populations with obesity showed a negative EIG in 2014/15.

CONCLUSIONS

The detailed heterogeneous trends of the EIG explain the obesity patterns for different ethnic, sex, and BMI subgroups in New Zealand and suggest the need for customizing targets/policy interventions for different subpopulations.

Phenotype of obesity and gastroesophageal reflux disease in the context of comorbidity in patients with cardiovascular diseases

The relevance of studying such problems as gastroesophageal reflux disease (GERD) and obesity is caused by their high prevalence in the developed countries of the world. Epidemiological data indicate that obesity is a significant risk factor for developing GERD due to increased intra-abdominal pressure and gastroesophageal gradient, slowing of gastric evacuation and formation of hiatal hernia. Abdominal obesity increases the likelihood of complications of GERD: erosive esophagitis, Barrett's esophagus and adenocarcinoma. This fact is connected with humoral influences: increased production of pro-inflammatory cytokines and leptin, and decreased secretion of adiponectin. Treatment of comorbid patients requires higher dosages and longer courses of antisecretory medicines, and an additional prescription of ursodeoxycholic acid.

Cardiovascular Disease Risk Factors and Obesity Levels in Korean Adults: Results from the Korea National Health and Nutrition Examination Survey, 2007-2015

Objectives

The increase in the obesity rate in adult males in Korea is higher than countries in the Organization for Economic Co-operation and Development and other Asian countries. We examined the trends and prevalence of major risk factors for cardiovascular disease by evaluating the weight status amongst adults from 2007 to 2015.

Methods

The study included 37,402 adults, who participated in the Korea National Health and Nutrition Examination Survey. The prevalence trends of cardiovascular disease risk factors were estimated for each body mass index group.

Results

From 2007 to 2015, significant increases in the prevalence of hypertension, diabetes, and hypercholesterolemia were observed in normal weight adults (0.03 percentage point (%p), 0.06%p, and 0.13%p, respectively). Amongst the overweight and obese adults, a significant increase in the prevalence of hypercholesterolemia was observed, During this period, the prevalence of smoking decreased amongst obese adults and no significant changes in drinking habits and physical activity were noted across all body mass index groups.

Conclusion

The prevalence of obesity in Korean adults is increasing, and it is necessary to implement interventions to prevent further weight gain and obesity-associated cardiovascular disease.

The Evaluation of Relationship Between Body Mass Index and Nasal Geometry Using Objective and Subjective Methods

INTRODUCTION

It is known that obesity causes obstructive sleep apnea syndrome by increasing upper airway resistance. Also, obese patients are admitted to the ear, nose, and throat clinic very often because of nasal obstruction complaint. The aim of this study is to identify the change and relation among body mass index (BMI), nasal resistance, reduction in nasal ariflow, nasal anatomy, and patients' subjective complaints.

MATERIAL AND METHOD

A total of 67 patients admitted to our clinic between August 2013 and January 2014 were included in the study.The study group comprised 33 patients who had a chief complaint-nasal obstruction and the other group consisted of 34 patients who had no complaint and nasal pathology. Both the groups were checked with acoustic rhinometry (AR), active anterior rhinomanometer, nasal obstruction symptom evaluation (NOSE), and visual analog study (VAS) questionnaire.

RESULTS

There is a significant statistical correlation between the body mass increase and VAS and NOSE score increase (P < 0.05). But the authors did not find any statistically significant relation between BMI and total inspiratory and expiratory MR and MF measured by anterior active rhinomanometer and left and right nasal cavity MCA, and volume measured by acoustic rhinometery (P > 0.05).

CONCLUSIONS

Contrary to belief, obesity does not change the nasal resistance, airflow, and anatomy but it can cause subjective nasal complaints.

PROPOSAL OF A REVISIONAL SURGERY TO TREAT NON-INSULINOMA HYPERINSULINEMIC HYPOGLICEMIA POSTGASTRIC BYPASS

Background :

Hyperinsulinemic hypoglicemia with severe neuroglycopenic symptoms has been identified as a late and rare complication in patients submitted to Roux-en-Y gastric bypass. However, the potential gravity of its manifestations requires effective treatment of this condition. The absence of treatment makes it necessary to develop more effective clinical or surgical methods.

Aim :

To present one surgical option to revisional surgery in the treatment of hyperinsulinemic hypoglicemia

Methods :

The procedure consists in reconstituting alimentary transit through the duodenum and proximal jejunum, while keeping the restrictive part of the gastric bypass. As an additional strategy to maintain weight loss, is realized gastric fundus resection, aiming to suppress ghrelin production more effectively.

Results :

It was used in three patients with successful results in one year of follow-up.

Conclusion :

The procedure to reconstruct the food transit through the duodenum and proximal jejunum, keeping the restrictive component of gastric bypass in the treatment of hyperinsulinemic hypoglycemia showed good initial results and validated its application in other cases with this indication.

Modeling US adult obesity trends: a system dynamics model for estimating energy imbalance gap

OBJECTIVES

We present a system dynamics model that quantifies the energy imbalance gap responsible for the US adult obesity epidemic among gender and racial subpopulations.

METHODS

We divided the adult population into gender-race/ethnicity subpopulations and body mass index (BMI) classes. We defined transition rates between classes as a function of metabolic dynamics of individuals within each class. We estimated energy intake in each BMI class within the past 4 decades as a multiplication of the equilibrium energy intake of individuals in that class. Through calibration, we estimated the energy gap multiplier for each gender-race-BMI group by matching simulated BMI distributions for each subpopulation against national data with maximum likelihood estimation.

RESULTS

No subpopulation showed a negative or zero energy gap, suggesting that the obesity epidemic continues to worsen, albeit at a slower rate. In the past decade the epidemic has slowed for non-Hispanic Whites, is starting to slow for non-Hispanic Blacks, but continues to accelerate among Mexican Americans.

CONCLUSIONS

The differential energy balance gap across subpopulations and over time suggests that interventions should be tailored to subpopulations' needs.

The Role of Low-calorie Sweeteners in Diabetes

As the incidence and prevalence of type 2 diabetes continue to rise, the identification of components that contribute to or are associated with this disease has become a priority. One of the main factors that has been linked to type 2 diabetes is excessive weight gain, and reduction in weight has been recommended for both diabetes prevention and management. Low-calorie sweeteners (LCS) provide an alternative to added sugars and may facilitate weight loss or maintenance by limiting caloric intake. Considerable attention has been given to the role of LCS and their relationship to type 2 diabetes. Research suggests that LCS can serve an important role in diabetes prevention and management. Substituting sugars with LCS provides patients with type 2 diabetes considerable flexibility in their health goals and personal dietary preferences.

Plasma levels of resistin and ghrelin before and after treatment in patients with hyperthyroidism

OBJECTIVE

To investigate ghrelin and resistin concentrations in patients with hyperthyroidism before and after restoration to a euthyroid state and to correlate the 2 peptides with anthropometric and insulin resistance parameters.

METHODS

The study included hyperthyroid patients and euthyroid healthy participants as a control group. Hyperthyroid patients were evaluated at the start of the study and after normalization of thyroid function with appropriate antithyroid drugs. Anthropometric parameters, insulin resistance parameters (fasting blood glucose, fasting insulin, and homeostasis model assessment-insulin resistance), thyroid function tests, and measurement of ghrelin and resistin were assessed in patients and control participants.

RESULTS

The study included 40 hyperthyroid patients (32 women and 8 men, aged 26-42 years) and 30 euthyroid healthy participants (20 women and 10 men, aged 25-43 years) as a control group. In hyperthyroid patients, serum resistin levels and insulin resistance parameters were higher and plasma ghrelin levels were lower than in control participants (P<.001), and all normalized after treatment. Ghrelin levels were correlated only with insulin resistance parameters, but no correlations with any anthropometric or laboratory data were found. Resistin levels did not correlate with any clinical or laboratory data of hyperthyroid patients.

CONCLUSION

In hyperthyroid patients, resistin was increased and ghrelin was decreased, they were not related to anthropometric parameters, and they normalized after treatment of hyperthyroidism.

Bone Mineral Density and Factors influencing Bone Mineral Density in College Women

PURPOSE

The purpose of this study was to identify the levels of bone mineral density (BMD) and to explain the factors influencing BMD among female college students in Korea.

METHODS

A cross-sectional study was conducted with 144 college women. Lifestyle factors were determined by self-report questionnaire. Body composition was measured by body composition analyzer and bone mineral density was measured by ultrasound bone densitometry. Data were analyzed using SPSS for windows, version 19.0.

RESULTS

The mean BMD at calcaneus site was 0.56 g/cm2 (mean T-score=-0.22). The incidence of osteopenia was 21.5%. Factors predicting BMD were menarche age (r=-.22, p=.009) and height (r=-.18, p=.030) with 7% of explained variance.

CONCLUSION

These results suggest that health care professionals need to provide young women with program that is intended to affect their intention toward osteoporosis preventive behavior change.

Diagnostic issues in eating disorders and obesity

A thorough understanding of weight related issues is required for the assessment of patients with obesity and eating disorders. Body weight adjusted for height is used for the diagnosis of both anorexia nervosa (AN) and obesity. For AN, the DSM IV A criterion refers to 85 % of expected weight as a guideline, for overweight and obesity BMI cut-offs are commonly used. Because the BMI distribution changes during childhood and adolescence, the 85(th) and 95(th) BMI centiles are used in the USA to classify children as at risk of overweight and obesity, respectively. 85 % of expected weight is approximately equivalent to the 10(th) BMI centile.

The distributions and correlates of serum albumin levels in institutionalised individuals with intellectual and/or motor disabilities

The serum albumin level is a widely accepted indicator of nutritional status in healthy adults and elderly individuals. However, there are few data regarding the distribution and correlates of serum albumin levels in individuals with intellectual and/or motor disabilities. We conducted a cross-sectional study at a public facility for individuals with intellectual and/or motor disabilities in Ibaraki prefecture, Japan. Health check-up data obtained in 2001 from 477 individuals with intellectual disability (286 males, average age 40.6 (SD 12.3) years; 191 females, average age 45.1 (SD 11.6) years) were retrospectively reviewed. With the exception of men with cerebral palsy, the serum albumin level was nearly normally distributed. The mean was 44 (SD 3.6) g/l for males and 44 (SD 3.6) g/l for females with intellectual disability, 43 (SD 3.2) g/l in males and 44 (SD 2.6) g/l for females with cerebral palsy, 41 (SD 2.7) g/l for males and 42 (SD 3.7) g/l for females with Down's syndrome, and 42 (SD 4.5) g/l for males and 41 (SD 3.2) g/l for females with severe motor and intellectual disabilities. Only six of 474 individuals (1.3 %) had a serum albumin <or= 35 g/l. Low serum albumin was related to age, use of anticonvulsants and/or major tranquilisers, use of other medications, high C-reactive protein (CRP), high zinc sulfate turbidity test (ZTT), low serum Hb and low serum Fe among men; among women, high CRP and high ZTT were related to low serum albumin. The present study found an unexpectedly low incidence of low serum albumin among institutionalised individuals with intellectual and/or motor disabilities. Low serum albumin was associated with age, medications and inflammation in men, as well as inflammation in women.

The emerging pandemic of obesity and diabetes: are we doing enough to prevent a disaster?

Obesity is growing into a global epidemic and alarming trends are seen in Asian countries. Although obesity is defined by body mass index (BMI), waist circumference has emerged as a more specific marker of metabolic risk. BMI and waist circumference thresholds vary between ethnicities and values are lower for Asian populations. Asians are at an increased risk of developing diabetes and early death from cardiovascular complications at lower levels of BMI and waist circumference. Obesity, especially central obesity is strongly associated with development and worsening of type 2 diabetes. The developing countries may find it difficult to face a surge in diabetes with early death and loss of productivity. Therefore, early action to contain an epidemic of obesity should be considered an urgent global priority.

The metabolic effects of antipsychotic medications

OBJECTIVES

To review current evidence for the hypothesis that treatment with antipsychotic medications may be associated with increased risks for weight gain, insulin resistance, hyperglycemia, dyslipidemia, and type 2 diabetes mellitus (T2DM) and to examine the relation of adiposity to medical risk.

METHODS

We identified relevant publications through a search of MEDLINE from the years 1975 to 2006, using the following primary search parameters: "diabetes or hyperglycemia or glucose or insulin or lipids" and "antipsychotic." Meeting abstracts and earlier nonindexed articles were also reviewed. We summarized key studies in this emerging literature, including case reports, observational studies, retrospective database analyses, and controlled experimental studies.

RESULTS

Treatment with different antipsychotic medications is associated with variable effects on body weight, ranging from modest increases (for example, less than 2 kg) experienced with amisulpride, ziprasidone, and aripiprazole to larger increases during treatment with agents such as olanzapine and clozapine (for example, 4 to 10 kg). Substantial evidence indicates that increases in adiposity are associated with decreases in insulin sensitivity in individuals both with and without psychiatric disease. The effects of increasing adiposity, as well as other effects, may contribute to increases in plasma glucose and lipids observed during treatment with certain antipsychotics.

CONCLUSION

Treatment with certain antipsychotic medications is associated with metabolic adverse events that can increase the risk for metabolic syndrome and related conditions such as prediabetes, T2DM, and cardiovascular disease.

An epidemiological study on anemia among institutionalized people with intellectual and/or motor disability with special reference to its frequency, severity and predictors

Background

To examine the type, frequency, severity, and predictors of anemia and its relationship with co-morbid conditions among institutionalized people with intellectual and/or motor disability.

Methods

We conducted a cross-sectional study at a public facility for people with intellectual and/or motor disability in Ibaraki prefecture, Japan. Health checkup data obtained in 2001 from 477 people with intellectual disability (male: 286, average age 40.6 ± 12.3; female: 191, average age 45.1 ± 11.6) were retrospectively reviewed.

Results

The prevalence of anemia among male participants was higher than in female participants for each disability category (intellectual disability, 41.1%, 4.2%; cerebral palsy, 37.5%, 4.8%; Down's syndrome, 15.0%, 0%; severe motor and intellectual disabilities, 61.9%, 16.7%). Most participants with anemia (93.8 – 100%) showed a normocytic normochromic anemia pattern. Multivariate analysis revealed that factors related to an increase in frequency included sex (male), low body mass index (BMI), use of anticonvulsants or major tranquilizers, and a high zinc sulfate turbidity test (ZTT) value. No clinically diagnosed co-morbid condition was found to be related to the presence of anemia.

Conclusion

A high frequency of mild normocytic normochromic anemia in institutionalized people with intellectual and/or motor disability was observed, particularly among males. Medications and chronic inflammation may increase the risk of anemia.

Post-Operative Obesity and Cachexia Are Risk Factors for Morbidity and Mortality After Heart Transplant: Multi-Institutional Study of Post-Operative Weight Change

BACKGROUND

The relationship between post-heart transplant cachexia and obesity with subsequent morbidity and mortality has not yet been reported. Therefore, the purposes of this study were to: (1) describe change in body mass index (BMI) from before transplant through 5 years after transplant; (2) identify risk factors for increased BMI at 1 year post-transplant; and (3) determine whether post-transplant BMI is associated with post-transplant morbidity and mortality.

METHODS

Patients (n = 3,540) were from a non-random sample having received a heart transplant between January 1, 1996 and December 31, 2001 at 33 institutions of the Cardiac Transplant Research Database (CTRD). Patients were divided into groups using cut-offs for categories of BMI. Data were assessed according to frequencies, measures of central tendency, Pearson correlations, chi-square tests, multiple regression and stratified actuarial analyses with log-rank tests for comparisons. The level of statistical significance was set at p = 0.05.

RESULTS

The number of obese patients increased significantly from immediately before heart transplant to 5 years later (17% vs 38%) (p < 0.0001). Risk factors for increased BMI at 1 year after heart transplant (explaining 56% of variance) included increased BMI at transplant, younger age, black race, non-ischemic etiology of heart disease, Status I at time of transplant and non-use of mycophenolate mofetil. Patients who were underweight or obese at 1 year post-transplant were at greater risk for rejection over time than patients who were of normal weight or overweight (p = 0.009).

CONCLUSIONS

Both demographic and clinical factors are related to increased BMI at 1 year after heart transplantation. Post-transplant cachexia and obesity are risk factors for poor clinical outcomes after heart transplantation.

Metabolic risk during antipsychotic treatment

BACKGROUND

Compared with the general population, individuals with schizophrenia demonstrate an increased prevalence of obesity, type 2 diabetes mellitus (T2DM), and cardiovascular disease (CVD). Increased adiposity is associated with decreases in insulin sensitivity, leading to an increased risk of hyperglycemia and hyperlipidemia. Antipsychotic medications can increase adiposity, and a range of evidence from case reports, observational studies, retrospective database analyses, and controlled experimental studies (including randomized clinical trials) suggests that treatment with antipsychotic medications may be associated with an increased risk for insulin resistance, hyperglycemia, dyslipidemia, and T2DM.

OBJECTIVE

This article reviews current evidence for the hypothesis that treatment with antipsychotic medications may be associated with increased risks for weight gain, insulin resistance, hyperglycemia, dyslipidemia, and T2DM, and examines the relationship of adiposity to medical risk.

METHODS

Relevant publications were identified through a search of MEDLINE from 1975 to the present using the primary search parameters "diabetes or hyperglycemia or glucose or insulin or lipids" and "antipsychotic." Meeting abstracts and earlier nonindexed articles concerning antipsychotic-associated weight gain and metabolic disturbance were also reviewed. Key studies in this emerging literature were summarized, including case reports, observational studies, retrospective database analyses, and controlled experimental studies.

RESULTS

Individual antipsychotic medications are associated with different degrees of treatment-induced increases in body weight and adiposity, ranging from modest effects (<2 kg) with amisulpride, ziprasidone, and aripiprazole to clinically significant increases with olanzapine (4-10 kg). In addition to strong evidence concerning the effect of adiposity on insulin sensitivity in nonpsychiatric populations, increased adiposity in patients with schizophrenia has been associated with decreases in insulin sensitivity; this and other effects may contribute to increases in plasma glucose concentrations and lipid levels.

CONCLUSION

Metabolic changes in psychiatric patients who receive antipsychotic agents can contribute to the development of the metabolic syndrome and increase the risk for T2DM and CVD.

Perfil do obeso classe III do ambulatório de obesidade de um hospital universitário de Salvador, Bahia

Foram avaliados retrospectivamente 316 obesos classe III (91% mulheres), consecutivamente atendidos num ambulatório de obesidade de um hospital universitário em Salvador, Bahia, durante oito anos. A idade média±DP dos pacientes foi de 37±10 anos e o índice de massa corpórea (IMC) de 47±6kg/m2. Metade deles apresentava obesidade desde a infância ou puberdade e 82% tinha história familiar de obesidade. Hipertensão arterial foi constatada em 66%, diabetes mellitus em 13,9%, intolerância à glicose em 16,8%, aumento dos níveis de colesterol total e triglicérides ( > ou = 200mg/dl) em 33,5% e 8%, respectivamente, HDL-colesterol baixo (<40mg/dl) em 39,9% e LDL-colesterol elevado ( > ou = 100mg/dl) em 66,7%. Após tratamento com dieta hipocalórica e aumento da atividade física, observou-se perda de peso maior ou igual a 5 e10% em relação ao peso inicial, em 60 (26,6%) e 28 (12,4%) dos 225 pacientes que retornaram a consulta, num período médio de 20±17 meses. Concluindo, a obesidade classe III é uma doença de difícil tratamento e de elevada freqüência de fatores de risco cardiovascular mesmo em pacientes jovens.

Ureteroscopic treatment of renal calculi in morbidly obese patients: a stone-matched comparison

OBJECTIVES

To report a matched comparison of morbidly obese (MO) patients and normal weight (NW) patients who underwent ureteroscopic (URS) treatment of renal calculi. Shock wave lithotripsy and percutaneous nephrostolithotomy may be precluded in MO patients, and URS treatment offers a minimally invasive alternative.

METHODS

We retrospectively reviewed the charts of patients who underwent URS at our institution between 1997 and 2000. Fifty-four patients underwent URS treatment solely for renal calculi. Sixteen MO patients underwent 18 procedures. Thirty-eight NW patients, who underwent 39 procedures, were matched to the MO patients by stone location and size. Stones were categorized by location and size, less than 10 mm or 10 mm or greater. The factors and outcomes assessed were stone length, operative time, presence of a ureteral stent, success, and complications.

RESULTS

The overall success rate was 83% (15 of 18 procedures) for MO patients and 67% (26 of 39 procedures) for NW patients, but this difference was not significant (P = 0.23). The difference in the success rate for renal calculi 10 mm or greater (100% versus 38%) approached significance (P = 0.09). This may be related to other distinctions between the groups. URS treatment was often a salvage therapy in the NW group after other modalities failed. No significant differences were found between the other outcomes.

CONCLUSIONS

URS treatment of renal calculi when matched for location and size is as successful and no more morbid in MO than in NW patients. URS treatment of renal calculi is a safe and effective first-line treatment for renal calculi in MO patients.

Body mass index in male and female children with infantile autism

Morphometry, the measurement of forms, is an ancient practice. Recently, evidence has grown to support the notion that aberrant neurodevelopment may play a role in the pathophysiology of autism. Is the body, like the brain, affected by abnormal development in these patients? The aim of this study was to evaluate body mass index (BMI) of children with infantile autism, by comparing the BMI of 117 children with infantile autism with the corresponding BMI percentiles in an age- and sex-matched reference population. The BMI distribution of the male, but not female, children with infantile autism was significantly lower than that of the age-matched reference population. There was no evidence that BMI was associated with intelligence or socioeconomic status among children with infantile autism.

Nutritional status by socioeconomic level in an urban sample from Bilbao (Basque Country)

Anthropometry, records of food intake, and bioelectric impedance were gathered from a sample of 297 adults of both sexes who lived in marginal districts in the town of Bilbao and benefited from a program of social assistance. This survey aimed to determine present nutritional status and to ascertain the relationship between food intake and nutritional conditions. A comparative evaluation of anthropometry and food intake was then carried out using a reference from the Basque Country and a control sample from the same area but from better-off nutritional and socioeconomic conditions. Males from low socioeconomic status (SES) displayed lower heights and weights compared to the local reference and control sample. They showed higher skinfold thickness than males in the local reference but lower thicknesses than those in the control sample. All anthropometric variables, except height, were higher in women of low socioeconomic status compared to the local reference and control sample. Low socioeconomic males had lower estimated percentage of body fat than the control sample, while females showed the opposite pattern. On the other hand, estimates of food intake in males did not reveal great differences among samples from different socioeconomic backgrounds, while low SES females had greater intakes of food than the better-off control sample. Estimated zinc intake showed differences by SES in both sexes.

Body composition and energy expenditure after weight loss following bariatric surgery

OBJECTIVES

To assess the effectiveness of biliopancreatic diversion (BPD) in the treatment of morbid obesity and to evaluate how the procedure affects body weight.

SUBJECTS

Fourteen morbidly obese subjects studied before and 30 months after BPD and fifteen healthy volunteers matched for age, sex and height (controls).

METHODS

Comparison of the following parameters were made in the study groups before surgery and 30 months after BPD and with those of the controls group: fat mass, fat-free mass, non-protein substrate oxidation, basal metabolic rate, plasma glucose, insulin and free fatty acid concentrations.

RESULTS

Obese subjects lost 60.38+/-10.71 kg of weight during 18 months following surgery and then remained stable for another 12 months, when this study was performed. Weight loss was substantially due to a loss of fat mass (FM: 60.13+/-13.01 kg before and 19.02+/-8.61 kg after BPD; p<0.001). FM were not statistically different between post-obese subjects and controls; however, post-obese patients retained significantly more fat free mass (FFM) than controls. Subsequently, basal metabolic rates of post-obese subjects were higher than those of the control group (p<0.05). Fasting non-protein respiratory quotient (npRQ) was significantly lower before BPD than 30 months after the surgery (0.798+/-0.04 vs. 0.90+/-0.048, p<0.001), suggesting that, while obese, patients oxidized more lipids than carbohydrates. Moreover, fasting and two-hour plasma glucose and insulin concentrations decreased significantly after BPD to values comparable to those of the control group.

CONCLUSION

Weight loss in obese patients after BPD is mainly due to lipid malabsorption, but increased energy expenditure associated with retaining a high FFM in physically active post-obese subjects may also play a role, enabling them to maintain long-term reduced body weights.

Factors associated with fetal macrosomia in offspring of gestational diabetic women

OBJECTIVE

To determine whether there is a relationship between birthweight and interval between 1-h and 3-h glucose tolerance test (GTT) as well as other factors.

METHODS

We performed a retrospective analysis of our computerized diabetes database for the years 1992-1997. Ninety-four women with gestational diabetes fulfilled the inclusion criteria (i.e., singleton gestation, term delivery, absence of medical conditions, and known interval between 1-h and 3-h GTT). They were evaluated based on prepregnancy body mass index (BMI), mean glucose values, interval between diagnostic testing, and gestational age of 3-h GTT.

RESULTS

Subjects with GDM had a mean glucose value of 96.8 mg/dl and average prepregnancy BMI of 29.3 kg/m2. When GDM subjects with and without macrosomic infants were compared, mean glucose values (97.4 vs. 96.6 mg/dl) and mean interval (18.1 vs. 17.0 days) between diagnostic testing did not significantly differ. However, maternal prepregnancy BMI was higher in the group of women who gave birth to macrosomic infants (32.2 vs. 28.22 kg/m2, P = 0.008). Using stepwise multiple regression, maternal prepregnancy BMI was the only variable found to be predictive of macrosomia.

CONCLUSION

We were unable to show a statistical relationship between interval of diagnostic testing and rate of macrosomia. However, we demonstrated a clear relationship between maternal BMI and infant birthweight.

Are preoperative obesity and cachexia risk factors for post heart transplant morbidity and mortality: a multi-institutional study of preoperative weight-height indices. Cardiac Transplant Research Database (CTRD) Group

BACKGROUND

The relationship between pre-transplant body weight and post-transplant outcome has only recently been identified using a single, indirect measure of weight (percent ideal body weight [PIBW]). The literature is equivocal regarding which index is the better indicator of body weight. The purpose of this study was to determine (1) if pre-heart transplant body weight, measured by body mass index (BMI) and PIBW, is associated with post-heart transplant morbidity and mortality and (2) if patient gender, age, and etiology of heart disease affect this association.

METHODS

The sample included 4,515 patients who received a heart transplant from January 1, 1990-December 31, 1995 at 38 institutions participating in the Cardiac Transplant Research Database (CTRD). Patients were divided into groups according to their BMI and PIBW. Data were described using frequencies, measures of central tendency, Pearson correlation coefficients, stratified actuarial analyses and log rank tests for comparisons, and a multivariable risk factor analysis in the hazard domain.

RESULTS

For all patients (n = 4,515), being <80% or >140% of IBW before heart transplant was a risk factor for increased mortality after heart transplant. The association between pre-heart transplant PIBW and post-heart transplant survival was affected by gender, age, and etiology of heart disease. In males, a higher PIBW was a significant risk factor for death early after transplant (p = .0003). Although not significant, there was a trend for a higher PIBW being a risk factor for death in females throughout the post transplant period (p = .07). No differences in cause of death were found for PIBW and BMI. In male and female recipients <55 years, being overweight pre-heart transplant was a risk factor for infection. In patients with pre-transplant ischemic heart disease, the greatest risk for infection was found in patients who were >140% of IBW. Pre-heart transplant BMI and PIBW were not associated with acute rejection or cardiac allograft arteriopathy after transplant.

CONCLUSIONS

In conclusion, being cachectic or obese preoperatively is associated with decreased survival in all patients after heart transplantation. Being obese preoperatively is associated with increased infection after heart transplant in males and females <55 years and in patients with ischemic heart disease. Of the 2 indices of body weight used in this study, percent ideal body weight appears to be the better predictor of future morbidity and mortality following heart transplantation.

Current concepts in the pharmacological management of obesity

The pharmacological management of obesity has gained increasing attention as new weight loss treatments are approved and a significant proportion of the public strives to lose weight. Obesity is associated with a high mortality rate, multiple chronic medical conditions, and carries an enormous financial burden. Obesity is a multifactorial condition, most often due to an imbalance in energy intake and expenditure. Despite the greater focus on management of obesity, weight loss remains a difficult goal to achieve. Obesity is a chronic medical condition that may require long term treatment, therefore the risks and benefits of all pharmacological agents must be carefully considered. Noradrenergic appetite suppressants (ie. phenyl-propanolamine, phentermine) result in weight loss but stimulatory effects limit their use. The serotonergic agents (fenfluramine, dexfenfluramine) were effective weight loss drugs, but were voluntarily withdrawn from the US market last year because of cardiovascular and pulmonary complications. The combination noradrenergic/serotonergic agent sibutramine is indicated for the management of obesity, particularly in the presence of other cardiovascular risk factors. Modest weight loss is achieved with sibutramine, although weight gain is significant after discontinuation. In addition, long term safety data are not yet available. The thermogenic combination of ephedrine plus caffeine is minimally effective, and adverse effects are usually transient. Other thermogenic agents, such as beta3-agonists, are still under investigation. Agents may alter digestion through lipase inhibition (orlistat) or fat substitution (olestra). Orlistat decreases systemic absorption of dietary fat, decreasing body weight and cholesterol. Olestra is a fat substitute that has been incorporated into snack foods. Olestra substitution for dietary fat has not been studied as a weight loss strategy, although olestra has no caloric value and may be beneficial. The use of orlistat and olestra may be limited by gastrointestinal adverse effects. Finally, the manipulation of leptin and neuropeptide Y are under investigation for the treatment of obesity. Pharmacological agents should be used as an aid to a structured diet and exercise regimen in the treatment of obesity. Weight loss agents may result in initial weight loss, but sustained weight loss is not always achieved even with continuation of treatment. The effect of weight loss obtained while using pharmacotherapeutic agents on morbidity and mortality has not been established. Therefore, diet and exercise should be the focus of any weight loss programme. There is a continued need for safe and effective pharmacotherapeutic agents for the treatment of obesity.

Low body mass indices in adolescents with obsessive-compulsive disorder

The aim of this study was to evaluate the growth of adolescents with obsessive-compulsive disorder (OCD). Body heights and body mass indices (BMIs; expressed in kg m(-2)) of 51 adolescent patients with OCD were compared with the corresponding anthropometric variables in age- and sex-matched psychiatric controls and in a general population sample, respectively. In accordance with a previous epidemiologically based investigation, body heights and weights were found to be reduced, especially in male patients with OCD. The body mass indices of the patients with OCD were significantly lower than those of age-matched control patients and population controls. However, some of the parameters were also reduced in male psychiatric controls, indicating that the reductions are not entirely specific for adolescent OCD. The results suggest a neuroendocrine dysfunction in adolescent OCD. The low body mass index indicates that psychiatric disorders other than anorexia nervosa are associated with underweight during adolescence.

Binge/purge symptoms and comorbidity in adolescents with eating disorders

OBJECTIVE

To identify the diagnostic subtypes of eating disorders (EDs), the psychiatric comorbid diagnoses, and associated specific and nonspecific psychopathology in a series of 120 adolescents undergoing standardized assessment for an ED.

METHOD

Consecutive patients referred to our large pediatric hospital for ED assessment completed a semistructured diagnostic interview for children and adolescents. The following self-report scales were administered to assess specific and nonspecific psychopathology: the Children's Depression Inventory (CDI), the Brief Symptom Inventory (BSI), the Eating Disorder Inventory 2 (EDI-2), and the Family Assessment Measure (FAM-III) of family functioning.

RESULTS

Female subjects with a mean age of 14.5 years and a mean body mass index (BMI) of 18.1 comprised 93% of the sample. The restrictive subtypes of anorexia nervosa (AN) (43%) and eating disorder not otherwise specified (EDNOS) (16%) were the most common diagnoses. Patients with restricting symptoms (R) could be grouped together because they were more similar to each other with respect to self-report symptoms of psychopathology than they were to patients with binge/purge (B/P) symptoms and vice versa. Patients with R endorsed significantly fewer subjective symptoms, both ED-specific and nonspecific, and rated their families functioning better than did B/P patients. Comorbid, current major depressive disorders and dysthymic disorders occurred in 66% of subjects, but depressive, dysthymic, and oppositional disorders occurred in 96% of those with B/P symptoms. Severity of the CDI was the best single discriminator between R and B/P subjects.

CONCLUSIONS

Adolescents with EDs in the early stage of their illness are similar to adults with EDs in the following ways: they meet the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for subtypes of EDs (excluding amenorrhea) and commonly have comorbid psychiatric disorders, especially depressive disorders. Patients with B/P symptoms can be distinguished from restricting subjects because they endorse significantly more ED-specific and nonspecific psychopathology and have a higher frequency of comorbid Axis I diagnoses (especially depressive disorders) than restricting patients. Oppositional defiant disorder (ODD) occurs more commonly in adolescents with EDs associated with B/P symptoms.

Diabetes mellitus and eating disorders: a multicenter study on the comorbidity of the two diseases

Because diet is a key issue in the treatment of diabetes mellitus, it is assumed that these patients are prone to eating disorders. In a multicenter study, we have therefore assessed the prevalence of eating disorders in 662 patients with insulin dependent diabetes mellitus (IDDM) (n = 340) and non-insulin-dependent diabetes mellitus (NIDDM) (n = 322). A two-stage study combining self-rating questionnaires and a standardized interview was carried out. We found a prevalence of eating disorders of 5.9% (lifetime prevalence of 10%), irrespective of gender and type of diabetes; 4.1% of the whole sample reported intentional insulin undertreatment or omission. When patients were stratified according to IDDM and NIDDM, there was no difference in the prevalence of all eating disorders (point prevalence 5.5% vs. 6.5%, lifetime prevalence 10.0% vs. 9.9%). Prevalence of bulimia nervosa (BN) was more frequent in IDDM patients (point prevalence 1.5% vs. 0.3%, lifetime prevalence 3.2% vs. 1.9%) and binge eating (BED) was more frequent in NIDDM patients (point prevalence 1.8% vs. 3.7%, lifetime prevalence 2.6% vs. 5.9%). We conclude that eating disorders seem to be equally frequent in IDDM and NIDDM patients. However, there might be different features of eating disorders in both types of diabetes.

Acarbose treatment in obesity: a controlled study

Acarbose is an alpha-glucosidase inhibitor which reversibly inhibits oligosaccharidase and disaccharidase at the brush border of the small intestine. The aim of this study was to observe its effectiveness in the treatment of obesity.

METHODS

Two groups of 25 obese women were put on a 15 kcal/kg/day low-calorie diet for 12 weeks. One group (the study group) received 150 mg/day acarbose for the first 2 weeks and 300 mg/day acarbose for the remaining 10 weeks. The second group (controls) received no additional treatment. Body weight, BMI, skinfold thickness, serum lipids, OGTT, and insulin and C-peptide responses to OGTT were assessed before and after the study.

RESULTS

Body weight, BMI and skinfold thickness decreased significantly in both groups. Basal insulin and triglyceride levels in the study group, total and LDL cholesterol and triglyceride levels in the control group decreased significantly. No difference was found between the two groups when these decrements were compared, but the triglyceride level fell more in the control group.

CONCLUSION

Additional acarbose therapy is not more beneficial than low-calorie diet therapy alone.

[The relationship between place of birth and certain health characteristics in Ontario]

The relationship between place of birth and some health characteristics of the population of Ontario was investigated using data from the 1990 Ontario Health Survey. Adult respondents were categorized according to their region, sub-region, and country of birth. Multiple logistic and linear regression analyses indicated that immigrants were less frequently obese than were Canadian-born respondents (odds ratio [OR] = 0.75, confidence interval [CI] 0.63, 0.90), and Asians particularly so (OR = 0.56, CI 0.34, 0.91). Asians also more often had a low body mass index (OR = 3.40, CI 2.11, 5.50). Immigrants less frequently reported a health problem (OR = 0.74, CI 0.62, 0.88) than did respondents born in Canada, but they perceived their health less positively. Place of birth influences some health characteristics of the Ontario population. The differences observed need to be investigated further to develop health services adapted to the needs of the multi-cultural population of Ontario.

Food acquisition habits, nutrient intakes, and anthropometric data of Havasupai adults

OBJECTIVE

To describe the dietary patterns, anthropometric data, and food sources of Havasupai adults (> or = 18 years old) and determine the effect of age and gender.

DESIGN

Dietary intakes (one 24-hour recall), anthropometric measures (body mass index [BMI], waist-to-hip ratio [WHR]) and demographic data, including sites of food purchases, were obtained. Food sources of selected nutrients were calculated from diet recalls.

SETTING/SUBJECTS

92 adults (60 women, 32 men) from the Havasupai Reservation, Supai, Ariz.

STATISTICAL ANALYSES

Descriptive statistics were generated for demographic data. Nutrient intakes, BMI, and WHR were compared across gender and age groups ("Younger" [18 to 59 years old] vs "older" [> or = 60 years old]) by one-way analysis of variance. Two-tailed t tests identified significant differences in selected food practices by age group.

RESULTS

Diets were moderately high in fat (35% of energy), saturated fat (12%), and sugar (14%); intakes of zinc, calcium, vitamin A, vitamin B-6, and folate were frequently inadequate (less than two thirds of the Recommended Dietary Allowance). Of the 92 subjects, 76 (83%) were obese (BMI > or = 27). Fifty-four of the 60 women (90%) and 24 of the 32 men (75%) exhibited abdominal obesity (no age effect). Thirty-nine of the subjects (42%) consumed at least one food item purchased off the reservation on the day of the recall; the remaining 53 subjects (58%) consumed only food purchased or acquired on the reservation. Older Havasupai were significantly more dependent on the tribal store and other village food sources than were younger adults. Food sources of key nutrients did not differ by age or gender.

APPLICATIONS

The dietary patterns of isolated populations may be shaped by the unique limitations of their food sources as well as by factors such as age and gender. Individual and community-wide efforts to improve nutrient intakes and food patterns must recognize these geographic limitations. For populations such as the Havasupai, cooperative marketing and health promotion efforts between tribal officials, health care providers, and managers of the cafe and tribal store could improve the availability and consumption of a wider range of health-promoting foods.

Partial eating disorders in a community sample of female adolescents

OBJECTIVES

To evaluate the validity of two definitions of partial eating disorders, the Eating Attitudes Test (EAT) and a combination of the EAT and relevant criteria of the DSM-III-R, and to examine their association with factors related to anorexia nervosa and bulimia nervosa.

METHOD

Questionnaires on eating behaviors, depression, obsessionality, and impulsivity were distributed to 534 female high school students. Demographic, psychosocial, and physical parameters and the subjects' height and weight were also recorded.

RESULTS

EAT scores revealed maladaptive behaviors in 18% of the subjects: the combination of the EAT and DSM-III-R criteria identified 20.8% of the subjects as having partial anorexia nervosa and 11.3% as having partial bulimia nervosa. Both definitions were significantly associated with risk factors for clinical eating disorders: high weight, weight fluctuations, dieting, menstrual disturbances, high level of depression and obsessionality, and preoccupation with eating in the family. Partial bulimics fared worse on most of these parameters. Partial anorectics were not more psychologically distressed than normal subjects.

CONCLUSIONS

The validity of both definitions of partial eating disorders is supported by their similar and significant associations with known risk factors for the development of the clinical syndromes. Partial bulimics are similar to patients with bulimia nervosa in the level of many eating-related disturbances and in depression, obsessionality, and impulsivity. Partial anorectics, like anorectic patients in clinical settings, tend to minimize their problems. The relevance of partial eating disorders to the later development of the full-blown clinical entity is still not established.

Low body weight in male children and adolescents with schizoid personality disorder or Asperger's disorder

This study explored the hypothesis that body weight is reduced in male children and adolescents with schizoid personality disorder or Asperger's disorder. The body weights of 33 consecutively admitted male subjects with one of these disorders were retrospectively assessed with percentiles for the body mass index (BMI). The mean percentile (+/- SD) for the BMI was 31.6 +/- 27.6 and differed significantly from the expected value of 50 (P<0.001). Ten subjects had a BMI of < or = 10th age percentile. Post hoc comparisons revealed that BMI percentiles were (a) reduced to a similar extent in patients with schizoid personality disorder and Asperger's disorder and (b) reduced to a greater extent in patients with abnormal eating behaviour. During childhood and adolescence both diagnoses are associated with an increased risk of being underweight. Population-based BMI percentiles are useful for detecting associations between specific psychopathological syndromes and body weight.

Role of nutrition planning in the treatment for obesity

The most sensible eating plans are those that involve a wide selection of foods with a modest percentage of kilocalories as fat. The dietary pyramid developed by the US Government is an excellent basis for the construction of an eating plan for life. Patients should be encouraged to develop healthy eating habits that they can maintain indefinitely, as the early inevitable consequence of finishing a diet is regain of any weight that has been lost when the patient goes back to their old eating habits. The unfortunate fact is that individuals with the disease of obesity must behave differently than those who do not. This usually means that obese persons must eat differently than lean persons, and they must do this for their entire lives. Food is a critical part of the social fabric of our society. The physician, usually in combination with a knowledgeable and empathetic dietitian or other nutritional education resource, can help obese patients choose the series of compromises in eating plans and activity levels that can be maintained for life but still allow a reasonable quality of life.

Obesity in Bahraini adults

In this study the prevalence of obesity and the demographic factors associated with it were analysed on 290 adult Bahraini individuals, of whom 137 were males and 153 were females. The overweight and obesity prevalence rates, using the Body Mass Index (BMI) as a criterion, were 26% and 16% in males and 29% and 31% in females, respectively. The prevalence of underweight (BMI < 20) was 16.8% and 11.8% in the males and females respectively. The mean body fat percentage of females, calculated from the skinfold measurements, was 35%; the fat percentage of males was 18.6%. Bahraini women had greater fat deposition in the subscapular region than the amount reported for American women. Females and males living in urban areas had a greater tendency to be obese than those residing in rural areas. Marriage, ownership of a car as well as a large family ( > 7 members) were positively associated with obesity; unmarried women were more likely to be underweight than married women. The educational level was not associated with obesity in either the males or females. The age of adult females was not found to be associated with obesity, whereas in males the incidence of obesity was more frequent among those who were 50 years of age and above than under 50 years of age. Family monthly income was not associated with the incidence of obesity. The high prevalence of overweight and obesity in the women reported in this study and the difference in the distribution of body fat suggest that genetics may be a determinant factor of this disorder in Bahrainis but certainly social factors are also important.