Endocrine and metabolic aberrations in men with abdominal obesity in relation to anxio-depressive infirmity

Evaluating the Reproducibility of Physiological Stress Detection Models

Recent advances in wearable sensor technologies have led to a variety of approaches for detecting physiological stress. Even with over a decade of research in the domain, there still exist many significant challenges, including a near-total lack of reproducibility across studies. Researchers often use some physiological sensors (custom-made or off-the-shelf), conduct a study to collect data, and build machine-learning models to detect stress. There is little effort to test the applicability of the model with similar physiological data collected from different devices, or the efficacy of the model on data collected from different studies, populations, or demographics. This paper takes the first step towards testing reproducibility and validity of methods and machine-learning models for stress detection. To this end, we analyzed data from 90 participants, from four independent controlled studies, using two different types of sensors, with different study protocols and research goals. We started by evaluating the performance of models built using data from one study and tested on data from other studies. Next, we evaluated new methods to improve the performance of stress-detection models and found that our methods led to a consistent increase in performance across all studies, irrespective of the device type, sensor type, or the type of stressor. Finally, we developed and evaluated a clustering approach to determine the stressed/not-stressed classification when applying models on data from different studies, and found that our approach performed better than selecting a threshold based on training data. This paper's thorough exploration of reproducibility in a controlled environment provides a critical foundation for deeper study of such methods, and is a prerequisite for tackling reproducibility in free-living conditions.

Stress detection using ECG and EMG signals: A comprehensive study

BACKGROUND AND OBJECTIVE

In recent years, stress and mental health have been considered as important worldwide concerns. Stress detection using physiological signals such as electrocardiogram (ECG), skin conductance (SC), electromyogram (EMG) and electroencephalogram (EEG) is a traditional approach. However, the effect of stress on the EMG signal of different muscles and the efficacy of combination of the EMG and other biological signals for stress detection have not been taken into account yet. This paper presents a comprehensive review of the EMG signal of the right and left trapezius and right and left erector spinae muscles for multi-level stress recognition. Also, the ECG signal was employed to evaluate the efficacy of EMG signals for stress detection.

METHODS

Both EMG and ECG signals were acquired simultaneously from 34 healthy students (23 females and 11 males, aged 20-37 years). Mental arithmetic, Stroop color-word test, time pressure, and stressful environment were employed to induce stress in the laboratory.

RESULTS

The accuracies of stress recognition in two, three and four levels were 100%, 97.6%, and 96.2%, respectively, obtained from the distinct combination of feature selection and machine learning algorithms.

CONCLUSIONS

The comparison of stress detection accuracies resulted from EMG and ECG indicators demonstrated the strong ability and the effectiveness of EMG signal for multi-level stress detection.

Continuous Detection of Physiological Stress with Commodity Hardware

Timely detection of an individual's stress level has the potential to improve stress management, thereby reducing the risk of adverse health consequences that may arise due to mismanagement of stress. Recent advances in wearable sensing have resulted in multiple approaches to detect and monitor stress with varying levels of accuracy. The most accurate methods, however, rely on clinical-grade sensors to measure physiological signals; they are often bulky, custom made, and expensive, hence limiting their adoption by researchers and the general public. In this article, we explore the viability of commercially available off-the-shelf sensors for stress monitoring. The idea is to be able to use cheap, nonclinical sensors to capture physiological signals and make inferences about the wearer's stress level based on that data. We describe a system involving a popular off-the-shelf heart rate monitor, the Polar H7; we evaluated our system with 26 participants in both a controlled lab setting with three well-validated stress-inducing stimuli and in free-living field conditions. Our analysis shows that using the off-the-shelf sensor alone, we were able to detect stressful events with an F1-score of up to 0.87 in the lab and 0.66 in the field, on par with clinical-grade sensors.

Wearable-Based Affect Recognition-A Review

Affect recognition is an interdisciplinary research field bringing together researchers from natural and social sciences. Affect recognition research aims to detect the affective state of a person based on observables, with the goal to, for example, provide reasoning for the person's decision making or to support mental wellbeing (e.g., stress monitoring). Recently, beside of approaches based on audio, visual or text information, solutions relying on wearable sensors as observables, recording mainly physiological and inertial parameters, have received increasing attention. Wearable systems enable an ideal platform for long-term affect recognition applications due to their rich functionality and form factor, while providing valuable insights during everyday life through integrated sensors. However, existing literature surveys lack a comprehensive overview of state-of-the-art research in wearable-based affect recognition. Therefore, the aim of this paper is to provide a broad overview and in-depth understanding of the theoretical background, methods and best practices of wearable affect and stress recognition. Following a summary of different psychological models, we detail the influence of affective states on the human physiology and the sensors commonly employed to measure physiological changes. Then, we outline lab protocols eliciting affective states and provide guidelines for ground truth generation in field studies. We also describe the standard data processing chain and review common approaches related to the preprocessing, feature extraction and classification steps. By providing a comprehensive summary of the state-of-the-art and guidelines to various aspects, we would like to enable other researchers in the field to conduct and evaluate user studies and develop wearable systems.

High-protein meal challenge reveals the association between the salivary cortisol response and metabolic syndrome in police officers

OBJECTIVES

Policing is considered a high-stress occupation and officers have elevated cardiovascular morbidity and mortality. To investigate a potential connection, we evaluated the association between salivary cortisol response to a high-protein meal challenge and the metabolic syndrome (MetSyn), a subclinical disorder associated with increased cardiovascular risk.

METHODS

Cross-sectional data were from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Study (2004-2009). MetSyn was defined as having ≥3 components: abdominal obesity, hypertension, elevated triglycerides, reduced high-density lipoprotein cholesterol, and glucose intolerance. Officers provided five saliva samples for cortisol analysis, one before challenge (high-protein shake) and four at 15-min intervals thereafter, where the usual response is increase. Regression models were used to examine trends in mean number of MetSyn components across quartiles of area under the curve (AUC) salivary cortisol. Patterns of mean cortisol response were assessed by MetSyn status using repeated-measures analysis of covariance.

RESULTS

Prevalence of MetSyn was 25.7% among 373 officers (74.0% male). The mean count of MetSyn components decreased (1.89, 1.75, 1.55, 1.37; P < 0.01) across increasing quartiles of AUC salivary cortisol. Mean salivary cortisol decreased from baseline (5.55, 4.58, 4.47, 4.79, 4.75 nmol/l) in officers with MetSyn and increased (5.08, 5.82, 5.92, 5.82, 5.60 nmol/l) in their counterparts. The test for interaction between MetSyn status and time of saliva collection was statistically significant (P < 0.001).

CONCLUSIONS

Reduced cortisol response to a high-protein meal challenge may be associated with MetSyn. Future longitudinal studies could provide useful evidence for planning intervention studies on cardiovascular risk among police officers.

cStress: Towards a Gold Standard for Continuous Stress Assessment in the Mobile Environment

Recent advances in mobile health have produced several new models for inferring stress from wearable sensors. But, the lack of a gold standard is a major hurdle in making clinical use of continuous stress measurements derived from wearable sensors. In this paper, we present a stress model (called cStress) that has been carefully developed with attention to every step of computational modeling including data collection, screening, cleaning, filtering, feature computation, normalization, and model training. More importantly, cStress was trained using data collected from a rigorous lab study with 21 participants and validated on two independently collected data sets - in a lab study on 26 participants and in a week-long field study with 20 participants. In testing, the model obtains a recall of 89% and a false positive rate of 5% on lab data. On field data, the model is able to predict each instantaneous self-report with an accuracy of 72%.

Are We There Yet? Feasibility of Continuous Stress Assessment via Wireless Physiological Sensors

Stress can lead to headaches and fatigue, precipitate addictive behaviors (e.g., smoking, alcohol and drug use), and lead to cardiovascular diseases and cancer. Continuous assessment of stress from sensors can be used for timely delivery of a variety of interventions to reduce or avoid stress. We investigate the feasibility of continuous stress measurement via two field studies using wireless physiological sensors - a four-week study with illicit drug users (n = 40), and a one-week study with daily smokers and social drinkers (n = 30). We find that 11+ hours/day of usable data can be obtained in a 4-week study. Significant learning effect is observed after the first week and data yield is seen to be increasing over time even in the fourth week. We propose a framework to analyze sensor data yield and find that losses in wireless channel is negligible; the main hurdle in further improving data yield is the attachment constraint. We show the feasibility of measuring stress minutes preceding events of interest and observe the sensor-derived stress to be rising prior to self-reported stress and smoking events.

Ghrelin influences novelty seeking behavior in rodents and men

Recent discoveries indicate an important role for ghrelin in drug and alcohol reward and an ability of ghrelin to regulate mesolimbic dopamine activity. The role of dopamine in novelty seeking, and the association between this trait and drug and alcohol abuse, led us to hypothesize that ghrelin may influence novelty seeking behavior. To test this possibility we applied several complementary rodent models of novelty seeking behavior, i.e. inescapable novelty-induced locomotor activity (NILA), novelty-induced place preference and novel object exploration, in rats subjected to acute ghrelin receptor (growth hormone secretagogue receptor; GHSR) stimulation or blockade. Furthermore we assessed the possible association between polymorphisms in the genes encoding ghrelin and GHSR and novelty seeking behavior in humans. The rodent studies indicate an important role for ghrelin in a wide range of novelty seeking behaviors. Ghrelin-injected rats exhibited a higher preference for a novel environment and increased novel object exploration. Conversely, those with GHSR blockade drastically reduced their preference for a novel environment and displayed decreased NILA. Importantly, the mesolimbic ventral tegmental area selective GHSR blockade was sufficient to reduce the NILA response indicating that the mesolimbic GHSRs might play an important role in the observed novelty responses. Moreover, in untreated animals, a striking positive correlation between NILA and sucrose reward behavior was detected. Two GHSR single nucleotide polymorphisms (SNPs), rs2948694 and rs495225, were significantly associated with the personality trait novelty seeking, as assessed using the Temperament and Character Inventory (TCI), in human subjects. This study provides the first evidence for a role of ghrelin in novelty seeking behavior in animals and humans, and also points to an association between food reward and novelty seeking in rodents.

Family functioning and its clinical correlates in overweight and obese patients

AIM

Our aim is to evaluate the differences in family functioning and anxiety between normal, overweight, and obese subjects.

METHOD

Overweight and obese patients were selected from the outpatient clinic of internal medicine department of a university hospital. Patients were classified into three groups as normal weight (N=82), overweight (N=33) and obese (N=50) patients. The normal weight group included healthy subjects. The individuals were examined by the same psychiatrist (MA). Beck Anxiety Inventory and Family Assessment Device were applied to all groups.

RESULTS

When compared to normal weight patients, obese and overweight patients had significantly higher anxiety scores and higher scores in general functions, problem solving, communication, roles, affective responsiveness, and behavior control dimensions which reflect increased dysfunctions in their families. The total level of dysfunction that patients experience was predicted by alcohol dependence in the family during childhood period, any medical disorder in the current family, anxiety level and body mass index.

CONCLUSION

When treating them clinicians should keep in mind that families of obese and overweight patients may have higher levels of dysfunctions.

The relationships of leptin, adiponectin levels and paraoxonase activity with metabolic and cardiovascular risk factors in females treated with psychiatric drugs

OBJECTIVES

The aim of this study was to investigate serum leptin, adiponectin and paraoxonase1 levels in adult females receiving pharmacotherapy for various psychiatric disorders.

METHODS

The study group consisted of 32 obese females (mean age 40.53 +/- 11.00 years, mean body mass index 35.44 +/- 5.33 kg/m(2)) who were receiving treatment for psychiatric disorders, and the control group included 22 obese females (mean age 35.95 +/- 9.16 years, mean body mass index 30.78 +/- 3.33 kg/m(2)) who were free of psychiatric disorders. Analyses were performed using a bioelectrical impedance device. Fasting blood samples were obtained for complete blood count and various biochemical tests, including determination of leptin, adiponectin and paraoxonase1 activity.

RESULTS

Body mass index, waist and hip circumference, body fat percentage, fasting blood glucose, insulin, glycosylated hemoglobin, homeostasis model assesement of insulin resistance, alanine transaminase, aspartate tarnsaminase, and leptin levels were significantly higher in the study group than in controls. Although body weight was positively correlated with leptin levels in both groups, body weight was negatively correlated with adiponectin levels in the control group and positively correlated with adiponectin levels in the study group. In the study group, body mass index and hip circumference correlated positively with leptin levels, hip circumference correlated positively with adiponectin levels, and waist to hip ratio correlated positively with paraoxonase levels. In the control group, body mass index as well as waist and hip circumferences were positively correlated with leptin levels. Weight, body mass index, and hip circumference were also negatively correlated with the adiponectin/leptin ratio in the control group.

CONCLUSION

This study indicates a higher risk for obesity-related disorders, particularly metabolic syndrome, diabetes and cardiovascular disease, in patients treated with psychiatric drugs.

The Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Pilot Study: Methods and Participant Characteristics

PURPOSE

The Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study is one of the first population-based studies to integrate psychological, physiological, and subclinical measures of stress, disease, and mental dysfunction. This pilot study was undertaken to establish a methodology and descriptive results for a larger police study.

METHODS

A stratified sample of 100 officers was randomly selected from the Buffalo, NY Police Department. Salivary cortisol served as a stress biomarker. Flow mediated dilation (FMD) and carotid intima-media thickness (IMT) were performed with ultrasound. Dual Energy X-Ray Absorptiometry (DEXA) and anthropometric measures assessed body composition. Self-report measures of depression and posttraumatic stress disorder (PTSD) were obtained.

RESULTS

Recruitment attained for the study was 100%. Seventy-five percent showed a cortisol increase upon awakening, 90% a negative diurnal slope, and 77% an increased cortisol response after a high protein lunch challenge. Dexamethasone suppression was evident. FMD showed an increase in mean brachial artery diameter of 3.2% in men and 3.9% in women, and mean IMT was lower (male=0.67 mm; female=0.62 mm) compared to populations of similar age. For males, the mean body-mass index (BMI) was 29.8 kg/m2 and total body fat 23.4%. For females, the mean BMI was 26.7 kg/m2 and total body fat 31.5%. For all officers, 16% met criteria for depression; 36% reported elevated PTSD symptoms.

CONCLUSIONS

Compared to populations of similar age, police officers had slightly lower FMD, lower carotid IMT, elevated BMI, and higher reported rates of depression and PTSD. Standardized physiological and psychological data collection and descriptive results confirmed that the methodology of the study is feasible in a working police population.

Influence of Long-Term Exposure to an Air-conditioned Environment on the Diurnal Cortisol Rhythm

In the present study, the influence of the long-term use of air-conditioning in summer on the cortisol rhythm was examined by measuring the rhythm in subjects who had been exposed to air-conditioning for a short [S] or long [L] time. Investigations were conducted twice in July and September. Atmospheric temperature and relative humidity near the subjects were measured for three days in each season. Saliva samples for cortisol analysis were collected every 2 hours during the daytime beginning at 8:00 h with subsequent sampling times at 10:00, 12:00, 14:00, 16:00, 18:00, 20:00 and 22:00 h. A questionnaire on sleep and duration of air-conditioning use was also undertaken. Ambient mean temperature was higher in the S group (mean+/-SD; 30.8+/-1.2 degrees C in July, 28.0+/-0.8 degrees C in September) than in the L group (28.0+/-1.2 degrees C in July, 27.3+/-1.0 degrees C in September) (p<0.01), while mean relative humidity did not differ. There were no differences in bedtime, waking time and sleeping hours either between groups or months. Diurnal patterns of salivary cortisol rhythm in July and September were similar in the S group, but the L group had a delayed rise of morning cortisol secretion in September compared with July. These results suggest that long-term exposure to an air-conditioned environment might adversely affect the human cortisol rhythm.

Depressão, ansiedade, competência social e problemas comportamentais em crianças obesas

A obesidade infantil alcança índices preocupantes e sua ocorrência na população brasileira tem adquirido grande significância na área da saúde, principalmente devido ao impacto que causa na vida das crianças, trazendo conseqüências físicas, sociais, econômicas e psicológicas. Neste artigo enfatiza-se a depressão, a ansiedade, a competência social e os problemas comportamentais, dentre os múltiplos fatores relacionados à obesidade infantil. São discutidos estudos que mostram estes fatores como causa ou como conseqüência da obesidade infantil, apesar de não haver consenso na área. Porém, a ocorrência concomitante de depressão, ansiedade e déficits de competência social com obesidade infantil demonstra a relevância deste tema. Uma maior difusão desse conhecimento e a proliferação desses estudos são importantes para proporcionar um atendimento e intervenção adequados a essa população.

Depressão, ansiedade e competência social em crianças obesas

Obesidade infantil alcança índices preocupantes, e sua ocorrência na população brasileira tem adquirido grande significância na área da saúde, principalmente devido ao impacto que causa na vida das crianças, trazendo conseqüências físicas, sociais, econômicas e psicológicas. Neste artigo dá-se ênfase à depressão, ansiedade e competência social, dentre os múltiplos fatores relacionados à obesidade infantil. Discutem-se aqui estudos que mostram estes fatores como causa ou como conseqüência da obesidade infantil, apesar de não haver consenso na área. Porém, a ocorrência concomitante de depressão, ansiedade e déficits de competência social com obesidade infantil demonstra a relevância deste tema. Uma maior difusão deste conhecimento bem como a proliferação destes estudos são importantes para proporcionar um atendimento e intervenção adequada a essa população.

Diurnal cycles of salivary cortisol in older adults

Cortisol has a well-documented circadian pattern. However, recent studies have demonstrated that individual variation in diurnal cortisol patterns occurs in young adult populations. Since older adults experience altered sleep-wake cycles and changes in circadian rhythmicity, we may see even greater variations in diurnal cortisol patterns in older adults. This study examined salivary cortisol patterns in 48 community dwelling older adults. Participants (mean age 76+/-6) collected saliva every 2 h over a three-day period. Cortisol was assayed by using RIA. Cortisol cycles were defined as inconsistent, typical or flat based on the slopes of two sequential daily cortisol patterns. Demographic, physical, psychological and behavioral measures were tested for group differences using t-tests and chi-square analyses. Forty-eight percent of the sample had inconsistent cycles, 50% had typical cycles and 2% had flat cycles. This sample had a higher percentage of inconsistent cycles and fewer flat cycles than reported for young adults (p=0.008) (Psychoneuroendocrinology 22 (1997) 89). Those with inconsistent cycles were younger and reported higher caffeine and food intake than those with typical cycles. This study demonstrates that normal diurnal rhythms of cortisol can be maintained in older adults, while day-to-day variation may increase.

Chronic episodic disorders in women

Chronic episodic disorders, such as depressive disorders, IBS, migraine, and FMS, have important commonalities, including cormorbidities, an absence of classic anatomic pathology in the tissues, a lack of objective findings on physical examination, and a lack of abnormal findings by routine laboratory and radiologic tests. These CED are more prevalent in women (perhaps due to changes in estrogen levels), are generally worsened by stress (with resultant hyperactivity of the HPA axis), and often improve with aerobic exercise and common classes of medications affecting serotonin function, such as antidepressants. Thus, an increased understanding of the CED may result in improved treatment and functioning of many patients.

Depression and obesity

The prevalence of depression (10%) and overweight (65%) indicates that there is a probability that they will co-occur, but are they functionally related? This report used the moderator/mediator distinction to approach this question. Moderators, such as severity of depression, severity of obesity, gender, socioeconomic status (SES), gene-by-environment interactions and childhood experiences, specify for whom and under what conditions effects of agents occur. Mediators, such as eating and physical activity, teasing, disordered eating and stress, identify why and how they exert these effects. Major depression among adolescents predicted a greater body mass index (BMI = kg/m(2)) in adult life than for persons who had not been depressed. Among women, obesity is related to major depression, and this relationship increases among those of high SES, while among men, there is an inverse relationship between depression and obesity, and there is no relationship with SES. A genetic susceptibility to both depression and obesity may be expressed by environmental influences. Adverse childhood experiences promote the development of both depression and obesity, and, presumably, their co-occurrence. As most knowledge about the relationship between these two factors results from research devoted to other topics, a systematic exploration of this relationship would help to elucidate causal mechanisms and opportunities for prevention and treatment.

The Pro12Ala PPARgamma2 gene missense mutation is associated with obesity and insulin resistance in Swedish middle-aged men

BACKGROUND

A missense mutation in exon B of the adipocyte-specific isoform peroxisome proliferator-activated receptor-gamma2 (PPARgamma2) has recently been described, leading to the substitution of proline to alanine at codon 12, which causes a reduction in the transcriptional activity of PPARgamma2. The Pro12Ala PPARgamma2 polymorphism has been variably associated with obesity, insulin sensitivity, and dyslipidemia.

AIMS AND METHODS

In the present study, we addressed the hypothesis that the Pro12Ala variant is associated with obesity and estimates of insulin, glucose, and lipid metabolism as well as circulating hormones including salivary cortisol in 284 unrelated Swedish men born in 1944. The subjects were genotyped by using PCR amplification of exon B of the PPARgamma2 gene followed by digestion with the restriction enzyme BstUI.

RESULTS

Tests for differences between the PPARgamma2 genotypes revealed that the PPARgamma2 Ala homozygotes (n = 6) had higher body mass index (P = 0.022), abdominal sagittal diameter (P = 0.038), and nearly 3 times higher fasting insulin levels (P < 0.001) as well as higher HOMA insulin-resistance index (P = 0.011) compared to the PPARgamma2 Pro homozygotes (n = 186). This association was independent of body mass and fat distribution. In addition, subjects with the Ala/Ala genotype had lower total cholesterol (P = 0.012) as well as a trend toward lower high- and low-density lipoprotein cholesterol (P = 0.071 and P = 0.095) compared to the other PPARgamma2 genotypes.

CONCLUSION

In summary, these findings both confirm and expand the current notion that the PPARgamma2 gene might play a role in the etiology of obesity and that genetic variability in PPARgamma2 is associated with variations in body fat mass and insulin sensitivity.

Obesity-depression associations in the population

This article summarizes data on the relationship between obesity and depression in the population. Both obesity and depression are increasingly prevalent and associated with numerous health complications including hypertension, coronary heart disease, and increased mortality. There does not appear to be a simple or single association between these disorders. Meta-analytic studies suggest no statistically significant relationship, although pooling all subjects may mask important variables that moderate or mediate potential covariations. Sociodemographic, psychosocial, and genetic factors may render certain obese individuals more prone to depression or vice versa. Physiological and behavioral variables that link obesity and depression have received limited study. There are likely multiple obesity-depression covariations in the population, rather than a single pattern of association. There is a need for longitudinal and mechanistic studies to understand casual pathways and greater collaboration between depression and obesity specialists.

5-HT2A receptor gene promoter polymorphism in relation to abdominal obesity and cortisol

OBJECTIVE

There is considerable evidence that cortisol secretion is associated with obesity. The regulation of the 5-hydroxytryptamine receptor 2A (5-HT2A) gene might play an essential role because it is involved in the control of cortisol secretion. Therefore, we examined the potential impact of the 5-HT2A -1438G/A promoter polymorphism on obesity and estimates of insulin, glucose, and lipid metabolism as well as circulating hormones, including salivary cortisol, in 284 unrelated Swedish men born in 1944.

RESEARCH METHODS AND PROCEDURES

The subjects were genotyped by using polymerase chain reaction amplification of the promoter region of the gene for 5-HT2A followed by digestion of the reaction product with the restriction enzyme MspI.

RESULTS

The frequencies were 0.39 for allele -1438A and 0.61 for allele -1438G. Homozygotes for the -1438G allele had, in comparison with -1438A/A subjects, higher body mass index, waist-to-hip ratio, and abdominal sagittal diameter. Moreover, cortisol escape from 0.25-mg dexamethasone suppression was found in subjects with the -1438A/G genotype. Serum leptin, fasting insulin, and glucose, as well as serum lipids, were not different across the -1438G/A genotype groups.

DISCUSSION

From these results, we suggest the possibility that an abnormal production rate of the 5-HT2A gene product might lead to the development of abdominal obesity. The pathophysiology could involve stress factors that destabilize the serotonin-hypothalamic-pituitary-adrenal system in those with genetic vulnerability in the serotonin receptor gene.

Links between body mass index, total body fat, cholesterol, high-density lipoprotein, and insulin sensitivity in patients with obesity related to depression, anger, and anxiety

OBJECTIVE

Define links between psychosocial parameters and metabolic variables in obese females before and after a low-calorie diet.

METHOD

Nine female obese patients (age 36.1 +/- 7.1 years, body mass index [BMI] > 30 kg/m2) were investigated before and after a 6-week low-calorie diet accompanied by behavior therapy. Blood lipids, insulin sensitivity (Bergman protocol), fat distribution (by dual-energy X-ray absorptiometry [DEXA]), as well as psychological parameters such as depression, anger, anxiety, symptom load, and well-being, were assessed before and after the dieting period.

RESULTS

The females lost 9.6 +/- 2.8 kg (p < .0001) of body weight, their BMI was reduced by 3.5 +/- 0.3 kg/m2 (p < .0001), and insulin sensitivity increased from 3.0 +/- 1.8 to 4.3 +/- 1.5 mg/kg (p = .05). Their abdominal fat content decreased from 22.3 +/- 5.5 to 18.9 +/- 4.5 kg (p < .0001). In parallel, psychological parameters such as irritability (p < .05) and cognitive control (p < .0001) increased, whereas feelings of hunger (p < .05), externality (p < .05), interpersonal sensitivity (p < .01), paranoid ideation (p < .05), psychoticism (p < .01), and global severity index (p < .01) decreased. Prospectively, differences in body fat (percent) were correlated to nervousness (p < .05). Waist-to-hip ratio (WHR) differences were significantly correlated to sociability (p < .05) and inversely to emotional instability (p < .05), whereas emotional instability was inversely correlated to differences in insulin sensitivity (p < .01).

DISCUSSION

Weight reduction may lead to better somatic risk factor control. Women with more nervousness and better sociability at the beginning of a diet period may lose more weight than others.

Increased abdominal obesity in subjects with a mutation in the 5-HT(2A) receptor gene promoter

In the present study, we examined the potential impact of the 5-HT(2A) -1438G/A promoter polymorphism on obesity and estimates of insulin, glucose, and lipid metabolism as well as circulating hormones, including salivary cortisol, in 284 unrelated Swedish men born in 1944. The subjects were genotyped by using PCR amplification of the promoter region of the gene for 5-HT(2A) followed by digestion with the restriction enzyme MspI. The frequencies were 0.39 for allele -1438A and 0.61 for allele -1438G. Homozygotes for the -1438G allele had, in comparison with -1438A/A subjects, higher body mass index (BMI), waist-to-hip ratio (WHR), and abdominal sagittal diameter. Moreover, cortisol escape from 0.25 mg dexamethasone suppression was found in subjects with the -1438A/G genotype. Serum leptin, fasting insulin and glucose, as well as serum lipids were not different across the -1438G/A genotype groups. From these results, we suggest the possibility that an abnormal production rate of the 5-HT(2A) gene product might lead to the development of abdominal obesity. The pathophysiology could involve stress factors that destabilize the serotonin-hypothalamic-pituitary-adrenal systems in those with genetic vulnerability in the serotonin receptor gene.

A C-1291G polymorphism in the alpha2A-adrenergic receptor gene (ADRA2A) promoter is associated with cortisol escape from dexamethasone and elevated glucose levels

OBJECTIVES

The objective of the current study was to examine the potential impact of a C right arrow G substitution at position -1291 of the alpha2A-adrenergic receptor gene (ADRA2A) promoter on obesity and estimates of insulin, glucose, and lipid metabolism as well as circulating hormones, including salivary cortisol in 284 unrelated Swedish men born in 1944.

MAIN OUTCOME MEASURES

The subjects were genotyped by using PCR amplification of the promoter region of the ADRA2A gene followed by digestion with the restriction enzyme MspI.

RESULTS

The frequencies were 0.23 for allele C and 0.77 for allele G. The observed genotype frequencies were 45.8 and 54.2% for C/G and G/G, respectively. Heterozygotes (n=121) had significantly (P=0.009) higher salivary cortisol levels after 0.5 mg dexamethasone compared with G/G homozygotes (n=143). Fasting glucose was found to be significantly (P=0.017) higher in heterozygotes than in G/G homozygotes. The latter group had also a borderline significantly (P=0.080) higher mean diastolic blood pressure. These results were all adjusted for the potential confounding effect of body mass index (BMI) and waist-to-hip ratio (WHR). Other measurements such as BMI, WHR, abdominal sagittal diameter, total testosterone, insulin-like growth factor I, serum leptin, fasting insulin and serum lipids were not different across the ADRA2A genotype groups.

CONCLUSIONS

In conclusion, we have shown that an C --> G polymorphism at position -1291 of the ADRA2A gene is associated with a subnormal cortisol response to dexamethasone, elevated glucose levels and perhaps increased diastolic blood pressure. The pathophysiology could involve an altered density of the alpha2A-AR that destabilizes the sympathetic-hypothalamic-pituitary-adrenal systems in those with genetic vulnerability in the alpha2A-adrenergic receptor gene promoter.

Relationship between socio-economic and cultural status, psychological factors and body fat distribution in middle-aged women living in Northern Italy

This study analyses the relationships between body fat distribution and socioeconomic and psychological factors in a cohort of 426 healthy middle-aged women living in Virgilio, Mantua (Northern Italy). The information concerning their occupational, social and psychological conditions and smoking habits were obtained by means of questionnaires. Psychological factors were investigated using the Italian version of the Illness Behaviour Questionnaire and the Symptom Questionnaire. Anthropometric measurements, body mass index (BMI) (kg/m2), waist/hip ratio (WHR) and clinical/hormonal menopausal status were also collected for each subject. The women reported significantly higher or lower psychological factor scores (symptoms of conversion: p=0.005; perception of disease: p=-0.018; denial: p=0.021; hostility: p=0.57; and laxity: p=0.047) as their WHR increased, thus indicating some concern about their health. In a multiple regression model, their WHR and waist circumference (W) significantly correlated with symptoms of conversion (p=0.005 and p=0.029), and W was also significantly related to the perception of disease (p=0.043). There was a significant inverse correlation between the WHR and educational level (p<0.001). The prevalence of partners who were entrepreneurs or self-employed also decreased as WHR increased (p<0.001). Furthermore, the number of women living in the centre of town significantly diminished, whereas those living in the suburbs or in the country significantly increased (p=0.005). However, using age, BMI and menopausal status as covariates, only the partner's work significantly and negatively correlated with the WHR (p=0.029). These results are consistent with the hypothesis that psychological and socio-economic handicaps are associated with a higher prevalence of abdominal fatness in middle-aged women living in Northern Italy

Rationale and design of the St. Francis Heart Study: a randomized clinical trial of atorvastatin plus antioxidants in asymptomatic persons with elevated coronary calcification

Early detection of asymptomatic subjects who are at risk for future cardiovascular events may allow for earlier medical treatment in order to prevent disease progression and future events. Electron-beam computed tomography accurately identifies people with increased coronary calcification, which is correlated with increased coronary plaque mass, increased likelihood of obstructive coronary disease, and increased likelihood of future cardiovascular events. The St. Francis Heart Study is a single-center combination study of men and women 50-70 years old that includes a natural history study of the relation between calcium scores and cardiovascular events (n = 5582), the association of calcium scores with traditional and nontraditional coronary disease risk factors (n = 1160), and a randomized clinical trial designed to assess the benefit of combination treatment with atorvastatin, vitamin C, and vitamin E, as compared to placebos, in subjects with elevated age- and gender-adjusted coronary calcification (n = 1007). Mean follow-up duration will be 4 years. The study is proceeding on schedule with anticipated completion by August 2002. It should provide important information regarding the benefits of treating asymptomatic men and women who have elevated coronary artery calcium, using cholesterol reduction and antioxidant therapy. The article describes the design of the St. Francis Heart Study.

Treatment of abdominally obese men with a serotonin reuptake inhibitor: a pilot study

OBJECTIVE

To investigate the effects of a selective serotonin reuptake inhibitor (SSRI) on the neuroendocrine and autonomic nervous system perturbations found in abdominal obesity.

DESIGN

Treatment for 6 months with citalopram and for 6 months with placebo using a double-blind, cross-over design, with a 2-month wash-out period between treatment periods.

SUBJECTS

Sixteen healthy men, 45-60 years, moderately obese and with an abdominal fat distribution.

MEASUREMENTS

Anthropometry, three different depression rating scales, serum lipids, testosterone, IGF-I, oral glucose tolerance test (OGTT), pituitary stimulation with corticotropin releasing hormone (CRH), arithmetic stress test, and excretion of cortisol and metoxycatecholamines in urine, collected during 24 h.

RESULTS

Cortisol concentrations in the morning were low before treatment, indicating a perturbed function of the hypothalamic-pituitary-adrenal (HPA) axis. After treatment with citalopram morning cortisol concentrations rose to normal. Cortisol concentrations after stimulation with CRH or stress were elevated by citalopram treatment, but urinary cortisol excretion was unchanged. The glucose concentrations after OGTT (120 min) tended to be reduced, with unchanged insulin concentrations, whilst other metabolic values did not change during treatment. Heart rate after administration of CRH, and during laboratory stress test, decreased by treatment with citalopram. Diurnal urinary excretion of metoxycatecholamines tended to decrease. Neither body mass index nor waist/hip circumference ratio decreased. Depression scores were within normal limits before treatment and did not change.

CONCLUSION

The results of this pilot study indicate improvements in the regulation of neuroendocrine-autonomic systems as well as metabolism in abdominal obesity during treatment with an SSRI.

Do stress reactions cause abdominal obesity and comorbidities?

'Stress' embraces the reaction to a multitude of poorly defined factors that disturb homeostasis or allostasis. In this overview, the activation of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system have been utilized as objective measurements of stress reactions. Although long-term activation of the sympathetic nervous system is followed by primary hypertension, consequences of similar activation of the HPA axis have not been clearly defined. The focus of this overview is to examine whether or not repeated activation of these two stress centres may be involved in the pathogenesis of abdominal obesity and its comorbidities. In population studies adrenal hormones show strong statistical associations to centralization of body fat as well as to obesity. There is considerable evidence from clinical to cellular and molecular studies that elevated cortisol, particularly when combined with secondary inhibition of sex steroids and growth hormone secretions, is causing accumulation of fat in visceral adipose tissues as well as metabolic abnormalities (The Metabolic Syndrome). Hypertension is probably due to a parallel activation of the central sympathetic nervous system. Depression and 'the small baby syndrome' as well as stress exposure in men and non-human primates are followed with time by similar central and peripheral abnormalities. Glucocorticoid exposure is also followed by increased food intake and 'leptin resistant' obesity, perhaps disrupting the balance between leptin and neuropeptide Y to the advantage of the latter. The consequence might be 'stress-eating', which, however, is a poorly defined entity. Factors activating the stress centres in humans include psychosocial and socioeconomic handicaps, depressive and anxiety traits, alcohol and smoking, with some differences in profile between personalities and genders. Polymorphisms have been defined in several genes associated with the cascade of events along the stress axes. Based on this evidence it is suggested that environmental, perinatal and genetic factors induce neuroendocrine perturbations followed by abdominal obesity with its associated comorbidities.

Quality of life, overweight, and body fat distribution in middle-aged men

Measurements of obesity [body mass index (BMI)] and body fat distribution [waist-to-hip ratio (WHR)] were analyzed in 284 51-year-old men in relation to items about social, mental, and physical well-being from the Göteborg Quality of Life Instrument. Overweight participants (BMI > or = 25) reported a better home-family situation, appetite, and self-esteem, but decreased physical fitness and more pain in the legs compared with their leaner counterparts. Men with abdominal obesity (WHR > or = 1.0) experienced impaired health and physical fitness and lower self-esteem compared with those with WHR < 1.0. The abdominally obese participants were more often exhausted and experienced depressive symptoms. Abdominal pain was more frequent among those with WHR > or = 1.0. Overweight and abdominal obesity seem differently associated with social, mental, and physical well-being in men. Impaired quality of life may be causally related to the development of abdominal obesity; the mechanism involved might be increased cortisol secretion, which can redistribute body fat to central adipose tissue depots.

Relationships between personality disorders and anthropometry, hormones and metabolism in women

This study sought to examine the potential influence of personality disorders (PD) on anthropometry, hormones and metabolism in women. In a population sample of women born in 1956 (no.=270), estimates of PD:s by Structured Clinical Interview for DSM-III-R, Axis II, were correlated with anthropometric, endocrine, and metabolic factors. The PD:s were grouped into three thematic clusters: cluster A (characterized by oddness or eccentricity), cluster B (characterized by self-centeredness, emotionality, and erratic behavior) and cluster C (characterized by anxiety and fear). Subjects with cluster A PD:s had significantly increased body mass index (BMI, kg/m2) and abdominal sagittal diameter (cm) as well as lower salivary cortisol after dexamethasone (DEX) compared to controls. Subjects with cluster B also had a significantly higher abdominal sagittal diameter and significantly lower salivary cortisol levels after DEX than controls. In addition, subjects with cluster B PD:s had decreased levels of ACTH, and significantly higher concentrations of lactate and triglycerides, while high-density lipoprotein (HDL) cholesterol was significantly lower compared to controls. A significantly higher waist/hip ratio was seen among subjects with cluster C PD:s. In addition, these subjects had higher levels of insulin, glucose, lactate, triglycerides, total cholesterol and low-density lipoprotein (LDL) cholesterol than controls. Moreover, IGF-I and HDL cholesterol were significantly decreased in the former group. These results suggest that PD:s are involved in the development of obesity and abdominal fat accumulation in women, with different endocrine and metabolic profiles depending on the type of PD.

Polymorphisms of the beta2-adrenergic receptor gene (ADRB2) in relation to cardiovascular risk factors in men

OBJECTIVE

To investigate the effect of polymorphisms in codon 16 (Arg16Gly) and codon 27 (Gln27Glu) of the beta2-adrenergic receptor gene (ADRB2) on anthropometric, endocrine, metabolic and haemodynamic variables.

DESIGN

A cross-sectional study.

SUBJECTS

A subgroup of 284 Swedish men from a population sample of 1040 at the age of 51 years.

MAIN OUTCOME MEASURES

Genotype examination of ADRB2 polymorphisms in codon 16 and codon 27 with polymerase chain reaction and restriction fragment length polymorphism. Anthropometric measurements included body mass index, waist-to-hip ratio and abdominal sagittal diameter. Endocrine measurements included blood levels of testosterone, insulin-like growth factor I, and leptin plus salivary cortisol. Overnight fasting values of serum insulin, blood glucose, triglycerides, total, low and high density lipoprotein cholesterol, as well as blood pressure and resting heart rate, were also determined.

RESULTS

Polymorphisms were frequent in both codon 16 and codon 27. The Arg16Gly genotype showed significant relationships to elevated central distribution of body fat and to systolic blood pressure, whilst the Glu27Glu genotype was associated with elevated leptin and triglyceride levels but not to other measurements, including obesity variables.

CONCLUSIONS

We conclude that only a few cardiovascular risk factors are associated with DNA sequence variation in the ADRB2 in Swedish men.

The role of antidepressants in the treatment of abdominal obesity

The pathophysiology of abdominal obesity is unclear and controversial. Recent evidence now suggests that inadequate cortisol secretion is associated with abnormalities in glucose, insulin and lipid metabolism, including hypertension, bringing the importance of the hypothalamic-pituitary-adrenal (HPA) axis in the pathogenesis of abdominal obesity to the forefront. In addition, abnormal gonadal steroid concentrations and impaired plasma growth hormone levels accompany the abdominally obese state. Since the reproductive and growth axes are inhibited at many levels by various components of the HPA axis, increasing cortisol levels results in further depression of testosterone and growth hormone concentrations. Over the last decade, antidepressant (serotoninergic) drugs have proved useful as equalizers of HPA axis hyperactivity. Such therapy may interrupt the vicious circle of a hyperactive HPA axis leading to increasing abdominal obesity and endocrine perturbations that, in turn, leads to progressive accumulation of abdominal fat. Additionally, preliminary results indicate that serotoninergic agents decrease abdominal fat mass with improvements in related risk factors.

A glucocorticoid receptor gene marker is associated with abdominal obesity, leptin, and dysregulation of the hypothalamic-pituitary-adrenal axis

OBJECTIVE

Abdominal obesity has a key role in the pathogenesis of prevalent and serious diseases and has been shown to be associated with an altered hypothalamic-pituitary-adrenal (HPA) axis function, which is regulated by endocrine feedback mediated via hippocampal glucocorticoid receptors (GR).

RESEARCH METHODS AND PROCEDURES

We examined the HPA axis function by repeated salivary samples for the assessment of cortisol, as well as other endocrine, anthropometric, metabolic, and circulatory variables in middle-aged Swedish men (n = 284). With the restriction enzyme BclI, variants of the GR gene (GRL) locus were identified and two alleles with fragment lengths of 4.5 and 2.3 kilobases (kb) were detected.

RESULTS

The observed frequencies were 40.1% for the 2.3- and 2.3-kb, 46.2% for the 4.5- and 2.3-kb, and 13.7% for the 4.5- and 4.5-kb genotypes. The larger allele (4.5 and 4.5 kb) was associated with elevated body mass index (BMI; p < 0.001), waist-to-hip circumference ratio (p = 0.015), abdominal sagittal diameter (p = 0.002), leptin (p < 0.001), and systolic blood pressure (borderline, p = 0.058). The 4.5- and 4.5-kb allele was associated with leptin after adjustment for BMI. Moreover, salivary cortisol values, particularly after stimulation by a standardized lunch (p = 0.040 to 0.086), were elevated in the men with the larger allele.

DISCUSSION

These results indicate that there is an association between a deficient GR function, defined as a poor feedback regulation of the HPA axis activity, and a polymorphic restriction site at the GR gene locus. An abnormal control of HPA axis function due to genetic alterations may contribute to the pathogenesis of abdominal obesity.

Obesity: a disease or a biological adaptation?

The increase in obesity prevalence is problematic as this condition is associated with health complications such as diabetes and cardiovascular diseases, more particularly when the excess body fat is stored in the deep abdominal region. On the other hand, obesity facilitates the maintenance of body homeostasis probably because of an increased hormonal gradient which favours the regulation of energy balance, to give but one example. The regulation potential of excess body fat is particularly apparent in the reduced-obese state where a reduction of energy expenditure, fat oxidation and some immune system markers, as well as an increase in appetite, stress vulnerability and circulating and adipose tissue organochlorines have been observed. These constitute another category of risk factors which can certainly favour the accumulation of body fat to reestablish body homeostasis on other fronts. Under such conditions, obesity is perceived by the physiologist as a necessary biological adaptation rather than a disease. For health professionals, this emphasizes the importance to seek a reasonable compromise between the favourable reduction of risk to develop metabolic complications by body weight loss and the physiological vulnerability which is also generated by such an intervention.

Food-induced cortisol secretion in relation to anthropometric, metabolic and haemodynamic variables in men

OBJECTIVE

To assess the relationships between the regulation of diurnal and food-induced cortisol secretion and anthropometric, metabolic and haemodynamic variables in middle-aged men.

SUBJECTS AND METHOD

Salivary cortisols were collected repeatedly (n = 7) over an ordinary working day (8a.m. to 11 p.m.) in a randomly selected population of 284 men, aged 51 y. A standardized lunch was provided, and an overnight low-dose dexamethasone suppression test was performed. These measurements were correlate with the anthropometric factors-body mass index, BMI, (kg/m2), waist-to-hip ratio (WHR) and abdominal sagittal diameter; the metabolic factors-fasting insulin and glucose as well as their ratio, and triglycerides; and the haemodynamic factors-systolic and diastolic blood pressures and heart rate.

RESULTS

As reported previously two principal types of salivary cortisol secretory patterns can be singled out, one characterized by high morning cortisol levels, a normal circadian rhythm and feedback regulation (dexamethasone) along with a brisk cortisol response to lunch, and another, found in a limited number of men, characterized by low morning cortisols, the absence of a circadian rhythm, a relative resistance to dexamethasone inhibition and a poor lunch-induced cortisol response. The normal cortisol secretory pattern showed negative associations with BMI (P< 0.05), WHR (P< 0.01), and blood pressures (P< 0.001). After stimulation by food intake, negative relationships were found with all obesity measurements, insulin, insulin/glucose ratio, triglycerides, blood pressures and heart rate (all P < 0.001). These results suggest that normally regulated cortisol is associated with a favourable somatic health. In contrast, after food intake cortisol secretion, based on an abnormal cortisol secretory pattern, showed consistent positive associations with obesity measurements, insulin, glucose and insulin/glucose ratio, triglycerides, blood pressures and heart rate (all P < 0.001).

CONCLUSIONS

A normal HPA axis regulation is associated with excellent health anthropometric, metabolic and haemodynamic variables, particularly visible after the physiological stimulus of food intake. This is, however, not the case in men with perturbed HPA axis function where associations in these somatic variables become exaggerated by food intake. We have previously reported that perceived stress-related cortisol is associated with abnormalities in the variables mentioned above, both with a normal and, particularly, with an abnormal function of the HPA axis. It is thus apparent that perceived stress and food intake show separate associations to somatic variables with a normally functioning HPA axis, while with an abnormal regulation of this axis both perceived stress and food intake exaggerate associations to abnormal somatic variables.

The hypothalamic-pituitary-adrenal axis activity as a predictor of cardiovascular disease, type 2 diabetes and stroke

OBJECTIVES

The hypothalamic-pituitary-adrenal (HPA) axis, the mediator of cortisol, plays a central role in the homeostatic processes. In this study, we addressed the potential impact of HPA axis activity on established anthropometric, metabolic and haemodynamic risk factors for cardiovascular disease (CVD), type 2 diabetes mellitus and stroke.

DESIGN

A cross-sectional study.

SUBJECTS

A subgroup of 284 men from a population sample of 1040 at the age of 51 years.

MAIN OUTCOME MEASURES

Anthropometric measurements included body mass index (BMI, kg m-2), waist/hip circumference ratio (WHR) and abdominal sagittal diameter (D). Overnight fasting values of blood glucose, serum insulin, triglycerides, total, low (LDL) and high density (HDL) lipoprotein cholesterol, as well as resting heart rate and blood pressure, were also determined. By using repeated diurnal salivary cortisol measurements during everyday conditions, methods were developed to characterize the status of the HPA axis, and set in relation to the anthropometric, metabolic and haemodynamic measurements.

RESULTS

In bivariate analyses, risk factors intercorrelated in clusters of anthropometric (BMI, WHR, D), metabolic (insulin, glucose and their ratio, triglycerides, cholesterol [total and LDL], HDL cholesterol [negative]) and haemodynamic (systolic and diastolic blood pressure and heart rate) measurements. This was also the case in the two-dimensional scaling analysis, where, however, HDL separated out. A normal HPA axis status, characterized by high variability and morning cortisol values, as well as a clear response to a standardized lunch and dexamethasone suppression test, was then introduced by a statistical weighting procedure. This did not essentially change the results of either the bivariate correlation matrix or the two-dimensional scaling analysis. A similar introduction of a pathological HPA axis, characterized by low variability and morning cortisol values, a poor lunch-induced cortisol response and a blunted dexamethasone suppression of cortisol, changed the results markedly. Now strong and consistent correlations were found not only within but also between different clusters of risk factors, which also congregated into one distinct cluster, again except for HDL cholesterol.

CONCLUSIONS

These results disclose the prospect of an overriding function of a pathological HPA axis on other, established risk factors for CVD, type 2 diabetes and stroke. Its close association to HPA axis dysfunction may explain the previously reported powerful risk indication of abdominal obesity for the diseases mentioned. The HPA axis abnormality has been reported to be a characteristic consequence of frequently repeated or chronic environmental stress challenges.

Effects of troglitazone on fat distribution in the treatment of male type 2 diabetes

We investigated the efficacy of additional administration of 400 mg troglitazone (+T), which became available as a treatment for type 2 diabetes following the demonstration of its ability to reduce insulin resistance, in combination with diet (D + T) or sulfonylurea (S + T) therapy. Body fat area as determined by computed tomographic (CT) scanning at the umbilical level, as well as several clinical and biochemical parameters of glycemic control and lipid metabolism, were compared before and after 3 months of additional treatment with troglitazone. The body mass index (BMI) tended to increase in both groups (22.7 +/- 0.6 v 23.2 +/- 0.6 kg/m2 in D + T, nonsignificant [NS]; 22.2 +/- 0.5 v 22.3 +/- 0.5 kg/m2 in S + T, NS), while it tended to decrease in the control group (only diet therapy, 23.6 +/- 0.6 v 23.1 +/- 0.8 kg/m2, NS). Mean blood pressure ([BP] 96 +/- 3 v 89 +/- 4 mm Hg, P < .05) decreased significantly in the D + T group. Changes in the glycemic and lipid profile and leptin did not reach statistical significance. The D + T group showed a significant decline in immunoreactive insulin ([IRI] 12.4 +/- 1.2 v 8.0 +/- 1.0 microU/mL, P < .05), reflecting markedly reduced insulin resistance, as well as a significant increase in plasma insulin-like growth factor-1 ([IGF-1] 175.7 +/- 14.2 v 189.8 +/- 12.6 ng/mL, P < .05). A slight weight gain was associated with a tendency for subcutaneous fat to increase, while visceral fat decreased in both troglitazone-treated groups. The decrease in the visceral to subcutaneous fat ratio (V/S ratio) was statistically significant in the D + T group (1.09 +/- 0.11 v 0.94 +/- 0.09, P < .05), while the V/S ratio in the control group did not change. A notable finding of this study is the difference in the response to troglitazone between subcutaneous and visceral adipose tissue. It is suggested that troglitazone may exert beneficial effects by reducing visceral fat.

Anxiety, depression, hunger and body composition: III. Their relationships in obese patients

The present paper explores the relationships between anxiety, depression, hunger sensation and body composition in obese patients (OP). The aim is to detect whether or not there are abnormalities in these relationships in OP as compared to clinically healthy subjects (CHS). The study was performed on 22 CHS (2 M, 20 W; mean age = 24 +/- 2 years; mean body mass index = 21 +/- 2 kg/m2) and 48 OP (4 M, 44 W; mean age = 40 +/- 17 years; mean body mass index = 32 +/- 7 kg/m2). Anxiety and depression were found to be correlated, negatively, with the relative lean body mass, and, positively, with the fat body mass in OP but not in CHS. These findings corroborate the idea that anxiety and depression can reach an abnormal expression when obesity shows its worst loss in lean body mass and its highest expansion in adipocyte mass. As hunger sensation was found not to correlate with either anxiety or depression in OP, the opinion is expressed that the impairment of anxio-depressive integrity is a corollary of obesity rather than a primary affective disorder leading to obesity via an enhanced food intake.

Personality disorders in relation to anthropometric, endocrine and metabolic factors

Subjects with abdominal obesity show several signs of a perturbed regulation of the hypothalamic-pituitary-adrenal (HPA) axis. This is known to occur after chronic, submissive stress. Perceived environmental stress is depending on personality characteristics. Therefore, personality disorders (PD:s) were examined in relation to HPA axis status, other endocrine and metabolic variables as well as anthropometry. Men (no.=284) aged 51 years, recruited in similar subgroups of low, median and high waist/hip circumference ratio (WHR) from a sample of 1302 men. Measurements of personality disorders by Structured Clinical Interview for DSM-III-R, Axis II (SCID II), body mass index (BMI, weight, kg/height2, m2), WHR and abdominal sagittal diameter (D), dexamethasone suppression test (0.5 mg, salivary measurements of cortisol), insulin-like growth factor I (IGF-I), testosterone and metabolic variables. Men with cluster A (paranoid, schizotypal, schizoid) PD showed an increased BMI, WHR and D, independent of dexamethasone suppression. Testosterone was decreased in these men in relation to a blunted dexamethasone suppression. BMI, WHR and D were increased in men with cluster B (borderline, histrionic, narcissistic) and cluster C (avoidant, dependent, obsessive compulsive, passive aggressive) PD, only in relation to a blunted dexamethasone suppression. Furthermore, IGF-I was low in cluster B. Metabolic variables were differently associated to clusters of PD but generally followed obesity. Path-analytic models suggested that cluster B and C PD were followed by blunted dexamethasone suppression and obesity. Men with cluster A PD showed centralized body fat distribution, independently of dexamethasone suppression. In contrast, men with impulsive (cluster B) and anxious (cluster C) personality disorders seem often to have abdominal obesity only in combination with a blunted dexamethasone suppression test, suggesting a HPA axis disturbance. These results suggest that PD:s are involved in the development of abdominal obesity in men, with different endocrine and metabolic profiles depending on the type of PD. This might hypothetically be due to frequent exposure and/or an increased sensitivity to environmental stress factors, caused by aberrant personalities.