Health hazards of obesity

The Diagnosis and Management of Cardiometabolic Risk and Cardiometabolic Syndrome after Spinal Cord Injury

Individuals with spinal cord injuries (SCI) commonly present with component risk factors for cardiometabolic risk and combined risk factors for cardiometabolic syndrome (CMS). These primary risk factors include obesity, dyslipidemia, dysglycemia/insulin resistance, and hypertension. Commonly referred to as "silent killers", cardiometabolic risk and CMS increase the threat of cardiovascular disease, a leading cause of death after SCI. This narrative review will examine current data and the etiopathogenesis of cardiometabolic risk, CMS, and cardiovascular disease associated with SCI, focusing on pivotal research on cardiometabolic sequelae from the last five years. The review will also provide current diagnosis and surveillance criteria for cardiometabolic disorders after SCI, a novel obesity classification system based on percent total body fat, and lifestyle management strategies to improve cardiometabolic health.

Association between soup consumption and obesity: A systematic review with meta-analysis

This systematic review aimed to determine the correlation between soup consumption and obesity. The observational studies on the association of soup consumption to obesity-related parameters were screened by database search. From 1873 identified articles, 7 cross-sectional studies were included in the review. All studies indicated a significant inverse correlation between soup consumption and obesity. The meta-analysis of the studies of which outcome is odds ratio for obesity revealed that soup consumption is significantly related to lower odds ratio of obesity in combined data (n=45292, OR: 0.85, 95% CI: 0.79-0.91, p<0.0001), suggesting that soup consumption was inversely correlated with a risk of obesity.

Food and nutrient provision in preschools: Comparison of public and private preschools

BACKGROUND

A balanced diet is important for ensuring health and development in childhood. As preschool is the main place of childcare, the meals that they provide have a critical influence on children's dietary intake.

AIM

The objectives of this study were to evaluate the nutrition status of preschool meals and to compare the food and nutrient content in public and private preschool meals.

METHODS

This was a cross-sectional study of 12 randomly sampled, public and private preschools in Taichung City, Taiwan. The background questionnaires, which included the meal budget and provision status of preschool meals, were completed either by the principals or supervisors of the preschools. The food and nutrition levels of preschool meals were assessed by weighing the actual food provided to the preschool children. In addition, preschool menus were collected to evaluate the meals and food served.

RESULTS

Overall, the mean calcium provision of preschools was lower than half the daily dietary reference intake (DRI), and the mean sodium was higher than half the DRI. The mean energy, carbohydrate, protein, fat, iron and vitamins B1, B2 and C supplied by the public preschools were significantly higher than those in the private preschools. In addition, the whole grains, meat, vegetables, fruits, oil and nuts supplied in public preschools were significantly higher than those found in private preschools.

CONCLUSIONS

The mean energy and macronutrient provision of public preschools were significantly higher than those found in private preschools. Meal quality and nutrient levels offered in public preschools were generally higher than those found in private preschools.

Temporal relationship between body mass index and triglyceride-glucose index and its impact on the incident of hypertension

BACKGROUND AND AIMS

Obesity and insulin levels can influence each other by metabolism. However, their temporal sequences and influence on hypertension are generally unknown, especially in Chinese adults. Recently, some scholars have proposed that triglycerides-glucose index (TyG) is an important indicator of insulin resistance. The study aims to describe the relationship between body mass index (BMI) and TyG index and its impact on hypertension.

METHODS AND RESULTS

A total of 4081 adults (56.33% women) without antihypertensive, hypoglycemic or lipid-lowering medications were selected for the present study. Measurements of BMI and TyG index were obtained twice from 2012 to 2017. Cross-lagged panel analysis was used to describe the temporal sequences between BMI and TyG index, and the effect of their temporal relationship patterns on hypertension was explored through mediation analysis. After adjusting for confounding factors (age, sex, ethnicity et al.), the cross-lagged path coefficient from baseline BMI to follow-up TyG (ρ₂ = 0.135, P < 0.001) was significantly greater than the path coefficient from baseline TyG to follow-up BMI (ρ₁ = 0.043, P < 0.001), and P < 0.001 for the difference between ρ₁ and ρ₂. Furthermore, the sensitivity analyses between women and men revealed identical findings. In addition, TyG index mediation effect on BMI-hypertension was estimated to be 38.45% (P < 0.001) in total population, 25.24% in women and 57.35% in men.

CONCLUSION

These results provided evidence that the temporal relationship between BMI and insulin resistance is reciprocal and a higher BMI precedes hyperinsulinemia in Chinese adults. This relationship plays an essential role in the development of hypertension, while there is a difference between women and men.

Serum ICAM-1 level and ICAM-1 gene 1462A>G (K469E) polimorphism on microalbuminuria in nondiabetic, nonhypertensive and normolipidemic obese patients: Genetical background of microalbuminuria in obesity

BACKGROUND

A growing body of evidence suggest that obese individuals are under risk of renal parenchymal disorders when compared to nonobese counterparts. Microalbuminuria is the early marker of renal involvement. Although most of obese patients carries multiple risk factors for microalbuminuria, some obese individuals without risk factor may progress to microalbuminuria. The present study was performed to examine the role of ICAM-1 gene 1462A>G (K469E) polymorphism on microalbuminuria in obese subjects without diabetes mellitus, hypertension, hiperlipidemia and older age.

METHODS

Ninety eight obese and 96 nonobese individuals without a comorbidity enrolled into the study. Serum ICAM-1 level was measured by enzyme linked immunoabsorbent assay (ELISA) method. ICAM-1 gene 1462A>G (K469E) polymorphism was examined by restriction fragment length polymorphism-polymerase chain reaction (RFLP-PCR). Nepholometric method was used to examine urinary albumin loss, and microalbuminuria was measured by albumin to creatinine ratio.

RESULTS

Obese individuals had significantly higher microalbuminuria and proteinuria level compared to nonobese subjects (p: 0.043 and p: 0.011; respectively). GG genotype of ICAM-1 carriers have significantly higher microalbuminuria compared to individuals with AA or AG genotype carriers (p: 0.042). Serum ICAM-1 level was significantly correlated with creatinine and microalbuminuria (p: 0.002 and p: 0.03; respectively). Logistic regression analysis indicated a 7.39 fold increased risk of microalbuminuria in individuals with GG genotype of ICAM-1 gene 1462A>G (K469E) polymorphism.

CONCLUSIONS

GG genotype of ICAM-1 gene K469E polymorphism is associated with increased microalbuminuria in obese individuals without another metabolic risk factor.

Liraglutide 3.0 mg for Weight Management: A Population Pharmacokinetic Analysis

BACKGROUND AND OBJECTIVES

This analysis used a population pharmacokinetic approach to identify covariates that influence plasma exposure of liraglutide 3.0 mg, a glucagon-like peptide-1 (GLP-1) receptor agonist approved for weight management in overweight and obese individuals.

METHODS

Samples for pharmacokinetic analysis were drawn at weeks 2, 12 and 28 of the phase IIIa SCALE Obesity and Prediabetes (N = 2339) and SCALE Diabetes (N = 584) trials. Dose proportionality of liraglutide in obese subjects was investigated using data from a phase II dose-finding study (N = 331).

RESULTS

Dose-proportional exposure of liraglutide up to and including 3.0 mg was confirmed. Body weight and sex influenced exposure of liraglutide 3.0 mg, while age ≥70 years, race, ethnicity and baseline glycaemic status did not. Compared with a reference subject weighing 100 kg, exposure of liraglutide 3.0 mg was 44 % lower for a subject weighing 234 kg (90 % CI 41-47), 41 % higher for a subject weighing 60 kg (90 % CI 37-46), and 32 % higher (90 % CI 28-35) in females than males with the same body weight. Neither injection site nor renal function significantly influenced exposure of liraglutide 3.0 mg (post hoc analysis).

CONCLUSION

Population pharmacokinetics of liraglutide up to and including 3.0 mg daily in overweight and obese adults demonstrated dose-proportional exposure, and limited effect of covariates other than sex and body weight. These findings were similar to those previously observed with liraglutide up to 1.8 mg in subjects with type 2 diabetes mellitus. Further analysis of exposure-response relationship and its effect on dose requirements is addressed in a separate publication.

Oxidized tea polyphenols prevent lipid accumulation in liver and visceral white adipose tissue in rats

BACKGROUND

Tea polyphenols are the prominent component in tea. After the fermentation process, tea polyphenols are oxidized by polyphenol oxidase to form oxidized tea polyphenols (OTPs). OTPs contain a significant amount of hydrophobic phenyl groups that can bind with non-aqueous materials. Here, we determined whether OTPs can bind with lipids and reduce fat uptake and assessed the effect of OTPs on decreasing obesity and alleviating hyperlipidaemia and other metabolic syndromes.

METHODS

Rats were divided into three groups: control, high-fat diet (HFD) and OTP groups. The control and HFD groups were fed a chow diet and a high-fat diet, respectively, for 12 weeks; the OTP group was fed a high-fat diet for 6 weeks and then a high-fat diet containing 2 % OTP for 6 weeks. The serum and excrement triglyceride (TAG) and total cholesterol (CHOL) concentrations were determined, and liver tissue and white adipose tissue were collected to detect the expression levels of genes involved in lipid metabolism.

RESULTS

Our results revealed that OTPs failed to decrease the serum concentrations of TAG and CHOL. OTPs alleviated the accumulation of lipids in the liver tissue and changed the expression levels of the regulators of lipid metabolism, i.e., peroxisome proliferation-activated receptors (ppars), compared with the rats fed a high-fat diet alone. We also observed a significantly decreased reduction of weight in the visceral white adipose, enhanced regulation of fatty acid β-oxidation by PPARα and enhanced biosynthesis of mitochondria in the visceral white adipose of the OTP rats compared with the HFD rats. Additionally, OTPs promoted the excretion of lipids.

CONCLUSION

Our results suggest that OTPs alleviate the accumulation of lipids in liver and visceral white adipose tissue and promote lipid excretion in rats in vivo.

Early severe vasomotor menopausal symptoms are associated with diabetes

OBJECTIVE

The purpose of this study was to investigate associations between profiles of vasomotor menopausal symptoms (VMS) during the menopausal transition with the prevalence of diabetes.

METHODS

VMS and diabetes were measured at baseline and 3-year intervals for 15 years in 4,895 women in the Australian Longitudinal Study on Women's Health who were aged 45 to 50 years at baseline in 1996. Latent class analysis and generalized estimating equation models for binary repeated measures were performed. The VMS profiles were labeled as mild, moderate, early severe, and late severe.

RESULTS

The prevalence of diabetes in the total group was 9.0%. Compared with mild VMS, the odds of diabetes were higher in those with a late severe profile (though not statistically significant; adjusted odds ratio, 1.28; 95% CI, 0.97-1.68) and in those with an early severe profile (adjusted odds ratio, 1.67; 95% CI, 1.20-2.32). Adjustment for body mass index attenuated this association, but the odds of diabetes were still significantly higher in women with an early severe profile than in women with mild VMS (odds ratio, 1.55; 95% CI, 1.11-2.17). The moderate profile was not associated with diabetes.

CONCLUSIONS

Women with an early severe VMS profile are more likely to have diabetes across a period of 15 years. This association is not explained by body mass index or other potential confounders. Our findings imply that the predictive value of VMS for diabetes may vary with the timing of VMS relative to menopause.

Joint effects of physical activity and BMI on risk of hypertension in women: a longitudinal study

INTRODUCTION

There is debate as to whether physical activity counteracts the adverse effect of weight on health outcomes. We investigated how physical activity modifies the effect of body mass index (BMI) on hypertension risk.

METHODS

BMI, physical activity, and hypertension were measured at baseline and at three-year interval for 14 years (from 1996 to 2010), in 10,339 participants in the Australian Longitudinal Study on Women's Health. Generalised estimating equation models for binary repeated measures were performed to determine the individual and joint effects of BMI and physical activity on incident hypertension.

RESULTS

At baseline (mean age 47.6 ± 1.5 SD), 57% were healthy weight, 28% overweight, and 14% obese. Increasing BMI and decreasing physical activity were associated with increased risk of hypertension. Physical activity attenuated the positive association between weight and risk of hypertension, especially for obese women. Compared to healthy weight high active women, risk of hypertension in obese high active women was 3.4 times greater (OR 3.43, 95% CI 2.68, 4.39) and in obese inactive women 4.9 times greater (OR 4.91, 95% CI 3.92, 6.13).

CONCLUSIONS

Both physical activity and maintenance of a healthy body weight are associated with lower risk of hypertension. Physical activity reduced but did not remove the effect of obesity on hypertension risk.

Prevalence of functional gastrointestinal disorders according to Rome III criteria in Italian morbidly obese patients

The relationship between GI symptoms and obesity has yet to be completely clarified.

AIM

To determine in a morbidly obese southern Italy adult population the prevalence of Functional Gastrointestinal Disorders (FGID) and its association with the presence of a Binge Eating (BE) behavior pattern.

METHODS

Consecutive obese patients eligible for bariatric surgery and 100 Healthy Controls (HC) were recruited. All participants were questioned and scored for the presence of FGID according to Rome III criteria and for the presence or the frequency-intensity of a number of upper and lower GI symptoms. BE behavior pattern was assessed.

RESULTS

One-hundred obese patients met the inclusion criteria. The prevalence of FGID was similar between obese patients and HC. There was a significant association between obese patients with BE behavior and postprandial distress syndrome (P = 0.04). Moreover, a significantly higher frequency-intensity score for epigastric fullness (1.23 ± 0.45 versus 0.35 ± 0.13, P = 0.01) was found in obese patients with BE behavior compared to obese patients without.

CONCLUSIONS

Obese patients with a BE behavior pattern showed a significantly higher prevalence of postprandial distress syndrome. A greater knowledge of the GI symptoms associated with obesity along with the pathophysiological mechanisms underlying will be important in the clinical management of these patients.

Prediction of Percentage Body Fat in Rural Thai Population Using Simple Anthropometric Measurements

OBJECTIVE

To develop and validate sex-specific equations for predicting percentage body fat (%BF) in rural Thai population, based on BMI and anthropometric measurements.

RESEARCH METHODS AND PROCEDURES

%BF (DXA; GE Lunar Corp., Madison, WI) was measured in 181 men and 255 women who were healthy and between 20 and 84 years old. Anthropometric measures such as weight (kilograms), height (centimeters), BMI (kilograms per meter squared), waist circumference (centimeters), hip circumference (centimeters), thickness at triceps skinfold (millimeters), biceps skinfold (millimeters), subscapular skinfold (millimeters), and suprailiac skinfold (millimeters) were also measured. The sample was randomly divided into a development group (98 men and 125 women) and a validation group (83 men and 130 women). Regression equations of %BF derived from the development group were then evaluated for accuracy in the validation group.

RESULTS

The equation for estimating %BF in men was: %BF(men) = 0.42 x subscapular skinfold + 0.62 x BMI - 0.28 x biceps skinfold + 0.17 x waist circumference - 18.47, and in women: %BF(women) = 0.42 x hip circumference + 0.17 x suprailiac skinfold + 0.46 x BMI - 23.75. The coefficient of determination (R2) for both equations was 0.68. Without anthropometric variables, the predictive equation using BMI, age, and sex was: %BF = 1.65 x BMI + 0.06 x age - 15.3 x sex - 10.67 (where sex = 1 for men and sex = 0 for women), with R2 = 0.83. When these equations were applied to the validation sample, the difference between measured and predicted %BF ranged between +/-9%, and the positive predictive values were above 0.9.

DISCUSSION

These results suggest that simple, noninvasive, and inexpensive anthropometric variables may provide an accurate estimate of %BF and could potentially aid the diagnosis of obesity in rural Thais.

Relationship between Plasma Adiponectin Levels and Metabolic Risk Profiles in Taiwanese Children

OBJECTIVE

Adiponectin, a novel adipokine with antiinflammatory and insulin-sensitizing properties, has an important role in glucose metabolism and is negatively correlated with body fat amount in adults. The purpose of this study was to evaluate the association of plasma adiponectin level with metabolic risk profiles and insulin resistance status among Taiwanese children.

RESEARCH METHODS AND PROCEDURES

We enrolled 1,248 children (608 boys and 640 girls) to ascertain their demographic, anthropometric, and cardiovascular risk factors distribution in Taipei. We measured plasma insulin, adiponectin, and leptin levels by radioimmunoassay (Linco Research Inc, St. Charles, MO). We calculated an insulin resistance index (IRI) using the Homeostasis Model Assessment model and also calculated an insulin resistance syndrome (IRS) summary score for each individual by adding the quartile ranks from the distribution of systolic blood pressure, serum triglyceride, high-density lipoprotein-cholesterol (HDL-C) (inverse), and insulin levels.

RESULTS

In general, the boys had larger BMI, higher systolic blood pressure, serum total cholesterol, and triglyceride, and lower plasma leptin and adiponectin levels than girls. Plasma adiponectin levels were correlated negatively with BMI, leptin, insulin, IRI, and IRS summary score but positively correlated with HDL-C in both boys and girls. In multivariate regression analyses, adiponectin was negatively associated with insulin (girls only), IRI (girls only), and IRS score, and positively associated with HDL-C in both genders even after adjusting for age, BMI, plasma leptin level, and other potential confounders.

DISCUSSION

These data suggest that plasma adiponectin levels were negatively associated with metabolic risk profiles that may have played a protective role in the development of insulin resistance among Taiwanese school children.

Risk Factors of Adolescent Obesity in Taiwan and Its Association with Physical activity, Blood Pressure and Waist Circumference

Purpose

This study was conducted to investigate risk factors of obesity and its associated health problems in adolescence in Taiwan.

Methods

We enrolled 559 adolescent volunteers with equal numbers of females and males in 2008. Participants were divided into two groups: obese (body mass index [BMI] ≧95th percentile) and normal-weight adolescents (BMI: 15th ∼ 85th percentile). Each of them completed a questionnaire about lifestyle and parents’ stature.

Results

Obese mother had high likelihood of having obese girls and boys (P=0.001). Obese girls spent more time in watching TV (P=0.03) and had higher frequency of having sweetened soft drinks (P=0.016) than normal-weight group. Girls spent more time in TV watching associated higher frequency of having sweetened soft drinks (P=0.012). In boys, this associated with higher frequency of eating snick (P=0.018) and larger waist circumference (P=0.011). Boys who had more frequent effective exercise had lower frequency of eating outside (P=0.01) and more services of vegetables (P=0.002). There was no relation between hypertension and adolescent physical activity. Regardless of gender, obese group had higher waist circumference and blood pressure than normal-weight group (P<0.001).

Conclusion

There was a strong association between obese mother and adolescent obesity. More physical activity in adolescents associated with healthier dietary behaviors. Obese adolescents have higher waist circumference and blood pressure.

Obesity and its diagnostic methods in Turkish children

OBJECTIVE

The application of body mass index (BMI) for obesity classification in all population studies has been questioned by the scientific community. It has been found that the bioelectrical impedance analysis (BIA) is an accurate method for screening obesity. This study was conducted to evaluate the accuracies of BMI, skinfold thickness (SFT), leptin and BIA measurements in obesity classification and to find correlations between BIA and the other indicators for obesity.

MATERIALS AND METHODS

This case-control study included 178 children of whom 90 were in the obese group and 88 in the control group. The study measured BMI, SFT, leptin level and BIA-mediated body fat percentage (BIA BFP) in each child.

RESULTS

The BMIs, leptin levels, SFTs and BIA BFPs of children in the obese group were found to be higher than those in the control group (p<0.001). The measurement of BIA BFP strongly correlated with BMI, SFT and waist circumference, whereas BIA BFP measurement showed weak-moderate correlation with leptin level.

CONCLUSION

Bioelectrical impedance analysis was found to be an accurate measure of BFP in obesity. In addition, BIA may prevent the incorrect diagnosis of obesity as determined by BMI alone, especially in boys during the pubertal period.

Are dieting-related cognitive impairments a function of iron status?

The aim of the present study was to investigate whether the impairments in cognitive function observed in unsupported dieting are related to compromised Fe status. During a non-clinical intervention, overweight participants (age: 18-45 years, BMI: 25-30 kg/m²) either participated in a commercially available weight-loss regimen (n 14), dieted without support (n 17) or acted as a non-dieting control group (n 14) for a period of 8 weeks. Measurements of cognitive function and blood chemistry were taken at a pre-diet baseline, after 1 week and 8 weeks of dieting. After 1 week, unsupported dieters displayed impaired verbal memory, executive function and slower reaction speeds than the other two groups, this difference disappearing by the end of the study. There were no significant group-related changes in blood chemistry over the course of the study, although there were group-related changes in a number of self-reported food-related cognitions. In conclusion, impaired cognition among unsupported dieters is not due to compromised Fe status and is most likely to result from psychological variables.

Association of an APOC3 promoter variant with type 2 diabetes risk and need for insulin treatment in lean persons

AIMS/HYPOTHESIS

An APOC3 promoter haplotype has been previously associated with type 1 diabetes. In this population-based study, we investigated whether APOC3 polymorphisms increase type 2 diabetes risk and need for insulin treatment in lean participants.

METHODS

In the Rotterdam Study, a population-based prospective cohort (n = 7,983), Cox and logistic regression models were used to analyse the associations and interactive effects of APOC3 promoter variants (-482C > T, -455T > C) and BMI on type 2 diabetes risk and insulin treatment. Analyses were followed by replication in an independent case-control sample (1,817 cases, 2,292 controls) and meta-analysis.

RESULTS

In lean participants, the -482T allele was associated with increased risk of prevalent and incident type 2 diabetes: OR -482CT 1.47 (95% CI 1.13-1.92), -482TT 1.40 (95% CI 0.83-2.35), p = 0.009 for trend; HR -482CT 1.35 (95% CI 0.96-1.89), -482TT 1.68 (95% CI 0.91-3.1), p = 0.03 for trend, respectively. These results were confirmed by replication. Meta-analysis was highly significant (-482T meta-analysis p = 1.1 × 10(-4)). A borderline significant interaction was observed for insulin use among participants with type 2 diabetes (-482CT*BMI p = 0.06, -455TC*BMI p = 0.02).

CONCLUSIONS/INTERPRETATION

At a population-based level, the influence of APOC3 promoter variants on type 2 diabetes risk varies with the level of adiposity. Lean carriers of the -482T allele had increased type 2 diabetes risk, while such an effect was not observed in overweight participants. Conversely, in overweight participants the -455C allele seemed protective against type 2 diabetes. The interaction of the variants with need for insulin treatment may indicate beta cell involvement in lean participants. Our findings suggest overlap in the genetic backgrounds of type 1 diabetes and type 2 diabetes in lean patients.

Relationship between obesity and other risk factors and skin disease among adult Saudi population

BACKGROUND

Obesity is accused for a wide spectrum of dermatologic diseases; no previous follow-up study has been conducted to investigate these conditions in adult male and female Saudi population.

OBJECTIVES

To describe obesity pattern using BMI and to assess the association between obesity and certain skin diseases among adult Saudi population.

MATERIALS AND METHODS

A retrospective cohort study of 2-year duration was conducted. The study sample was randomly selected from dermatology clinics at Qassim. Male cohorts were 61 obese adults and 48 nonobese adults. Female cohorts were 32 obese adults and 36 nonobese adults. Measurement of BMI, waist-hip ratio, fasting glucose, blood pressure, and dermatological examination was performed.

RESULTS

Skin disease incidence was significantly increased among exposed rather than nonexposed cohorts with a relative risk of 2.3 in male cohort and 2.3 in female cohort. Acanthosis nigricans and striae distensae incidence increased in exposed men and women with highly significant difference from nonexposed groups. Skin tag incidence significantly increased in the exposed male cohorts only but not the female cohort. Hirsutism, dry skin, pruritis, and planter keratosis all showed nonsignificant differences. The most frequently reported infections in obese men were tinea pedis (18%), intertrigo (14.7%), and bacterial folliculitis (13.1%) with significant difference. BMI was the only risk factor that regresses on skin disease occurrence in study groups.

CONCLUSION AND RECOMMENDATIONS

Our study linked incidence of acanthosis nigricans and striae distensae to obesity in both female and male adult population but showed sex difference for other skin diseases, which raised many questions and requires further longer duration follow-up studies.

Addressing the need for research on bariatric patient

During the past 3 decades numerous studies have documented the high prevalence of patient handling-related musculoskeletal injuries among healthcare workers and evaluated ergonomic interventions using mechanized equipment for lifting and moving patients. A great deal of research-based evidence now demonstrates the effectiveness of ergonomic interventions to reduce injury risk among healthcare workers who handle patients of average weights and sizes. In contrast, there is a lack of evidence-based research that evaluates ergonomic interventions for handling bariatric patients, whose extreme weights and sizes necessitate specialized handling equipment. The obesity epidemic, along with special medical and therapeutic concerns regarding bariatric patients, exacerbates healthcare workers' patient handling demands. The National Institute for Occupational Safety and Health is conducting a new study to evaluate bariatric patient handling hazards and interventions and identify evidence-based best practices for handling this population.

Effects of body weight and alcohol consumption on insulin sensitivity

Background

Obesity is a risk factor for the development of insulin resistance, which can eventually lead to type-2 diabetes. Alcohol consumption is a protective factor against insulin resistance, and thus protects against the development of type-2 diabetes. The mechanism by which alcohol protects against the development of type-2 diabetes is not well known. To determine the mechanism by which alcohol improves insulin sensitivity, we fed water or alcohol to lean, control, and obese mice. The aim of this study was to determine whether alcohol consumption and body weights affect overlapping metabolic pathways and to identify specific target genes that are regulated in these pathways.

Method

Adipose tissue dysfunction has been associated with the development of type-2 diabetes. We assessed possible gene expression alterations in epididymal white adipose tissue (WAT). We obtained WAT from mice fed a calorie restricted (CR), low fat (LF Control) or high fat (HF) diets and either water or 20% ethanol in the drinking water. We screened the expression of genes related to the regulation of energy homeostasis and insulin regulation using a gene array composed of 384 genes.

Results

Obesity induced insulin resistance and calorie restriction and alcohol improved insulin sensitivity. The insulin resistance in obese mice was associated with the increased expression of inflammatory markers Cd68, Il-6 and Il-1α; in contrast, most of these genes were down-regulated in CR mice. Anti-inflammatory factors such as Il-10 and adrenergic beta receptor kinase 1 (Adrbk1) were decreased in obese mice and increased by CR and alcohol. Also, we report a direct correlation between body weight and the expression of the following genes: Kcnj11 (potassium inwardly-rectifying channel, subfamily J, member 11), Lpin2 (lipin2), and Dusp9 (dual-specificity MAP kinase phosphatase 9).

Conclusion

We show that alcohol consumption increased insulin sensitivity. Additionally, alterations in insulin sensitivity related with obesity were coupled with alterations in inflammatory genes. We provide evidence that alcohol may improve insulin sensitivity by up-regulating anti-inflammatory genes. Moreover, we have indentified potential gene targets in energy metabolic pathways and signal transducers that may contribute to obesity-related insulin resistance as well as calorie restriction and alcohol-induced insulin sensitivity.

Prevalence of overweight and obesity in Italy (2001-2008): is there a rising obesity epidemic?

PURPOSE

To provide national, population-based estimates of the prevalence of overweight and obesity in the Italian population.

METHODS

Prevalence estimates of overweight and obesity were calculated in seven waves (2001-2008) of the cross-sectional Multipurpose Household Survey organized by the Italian National Institute of Statistics, which are representative of the general adult Italian population. Sampling weights were used to estimate prevalence figures as well as their standard errors. Mean-difference plot was used to evaluate changes in the distribution of body mass index across sex and age categories.

RESULTS

Almost half of Italian men and about 1 of 3 Italian women are overweight or obese. Between 2001 and 2008 the age-standardized prevalence of overweight (obesity) increased 1.4% (1.9%) in men and 0.4% (0.5%) in women. Mean-difference plots showed an upward shift for body mass index distribution with an increasing skewness.

CONCLUSIONS

The obesity epidemic is one of the major issues in United States and other developed countries. However, if for "epidemic" we mean that in Italy obesity is steadily increasing, then our data give little support to this interpretation. In fact, trends observed between 1983 and 2008 suggest that the rates of changes in the prevalence of overweight and/or obesity are not increasing.

Efficacy and tolerability of the association of sibutramine and orlistat for six months in overweight and obese patients

Objective. To assess the efficacy and tolerability of the association sibutramine (10-20 mg/day) and orlistat (120 mg 2-3 times a day) in the treatment of obesity in a six-month open trial. Methods. 446 overweight and obese patients who sought treatment for obesity in a private clinic were assessed every 2 weeks during a period of 3 and 6 months. Results. After 3 months, the mean weight loss was 10.5 kg (-9.8% of the initial weight, n = 263), and after 6 months, the mean weight loss was 13.9 kg (-12.8% of the initial weight, n = 97). The tolerability of such association was quite acceptable and coherent with the action mechanism of each component. Conclusions. The association of orlistat and sibutramine is quite efficient and it seems to promote a higher rate of weight loss than that reported in clinical studies performed with each drug separately.

The effects of chronic nicotine on meal patterns, food intake, metabolism and body weight of male rats

It is unclear what contribution food intake and metabolism have in causing weight loss after administering a dose of nicotine equivalent to smoking one to three packs of cigarettes per day because previous studies have been of a very short duration. To address this question, male Sprague Dawley rats were housed in computerized food intake modules and fed 45 mg pellets: Group 1 [nicotine injected with 1.4 mg/kg/day (free base), fed ad libitum]; and Group 2 [saline injected and pair-fed by computer with Group 2]; and Group 3 [saline injected (i.p.), fed ad libitum]. The rats received 4 equally spaced injections over the dark phase. Treatment consisted of: Phase 1 (nicotine or saline for 14 days), Phase 2 (all rats saline for 8 days and Phase 3 (pair-fed group "unyoked" for 6 days)). Nicotine inhibited food intake over the first 6 days. On termination of nicotine, there was no compensatory hyperphagia in either Groups 1 or 2; and their body weight was reduced starting on day 5 until day 28. In another study, rats were housed in an indirect calorimetry system. Saline or nicotine was injected for 14 days, as noted above; then all rats were injected with saline for 4 days and then no injections for 10 days to follow changes in body weight. Energy expenditure (Kcal/Kg(0.75)) was measured for 18 days. Nicotine significantly reduced food intake on 7 of 14 days of nicotine injections. The body weight of the nicotine injected rats was significantly reduced starting on day 3 until day 25. There were no differences in energy expenditures of the groups, which suggested that a decrease in food intake and not an increase in metabolism was the reason the rats lost weight after administering nicotine.

Socioeconomic status and obesity among semi-urban Nigerians

OBJECTIVE

The relation between socioeconomic status (SES) and obesity in Sub-Saharan Africa (SSA) has been inconsistent.

METHODS

This study examined the prevalence of obesity and SES/obesity relations in 1,067 adults aged 30-60 years from a semi-urban Nigerian population. A structured questionnaire validated by a pictorial selfrating ladder was used to determine the participants' SES.

RESULTS

SES was found to be inversely related (p < 0.010) to weight and BMI, respectively. The odds ratio (OR) and 95% confidence interval (CI) for obesity among lower SES individuals were OR 2.4 and CI 1.91-2.88 compared with OR 2.9 and CI 2.42-3.39 in those of the middle and higher socioeconomic strata. Among males, the OR and 95% CI for obesity among lower SES individuals were OR 1.9 and CI 1.21-2.59 compared with OR 1.7 and CI 1.00-2.39 in those of the middle and higher socioeconomic strata. Among females, the OR and 95% CI for obesity among lower SES individuals were OR 3.0 and CI 2.32-3.68 compared with OR 4.7 and CI 4.02-5.38 in those of the middle and higher socioeconomic strata.

CONCLUSION

SES was inversely associated with the risk of obesity, with a higher prevalence of obesity in the lower socioeconomic stratum of the semi-urban Nigerian population.

The joint effects of cardiorespiratory fitness and adiposity on mortality risk in men with hypertension

BACKGROUND

Whether higher cardiorespiratory fitness (CRF) attenuates the mortality risk associated with higher adiposity in adults with hypertension (HTN) is poorly understood.

METHODS

Participants were 13,155 men (mean age, 47.7 (s.d., 9.9) years) who completed a baseline health examination and maximal treadmill exercise test during 1974-2003. All men had HTN at baseline based on resting systolic blood pressure of > or =140 mm Hg or diastolic blood pressure > or =90 mm Hg. CRF was quantified as the duration of a symptom-limited maximal treadmill exercise test, and was grouped for analysis as low (lowest 20%), moderate (middle 40%), and high (upper 40%). Distributions of body mass index (BMI), waist circumference (WC), and percent body fat (%BF) were grouped according to standard clinical guidelines.

RESULTS

During a mean follow-up of 12 years, 883 deaths (355 cardiovascular disease (CVD)) were recorded. Multivariate hazard ratios (HRs) (95% confidence interval) for all-cause mortality, using low-fitness as the reference group, were 0.58 (0.48-0.69) and 0.43 (0.35-0.54) for moderate-fit and high-fit groups, respectively. We observed a similar pattern for CVD mortality. High-fit/obese men had no greater risk of all-cause (1.59 (0.95-2.67)) or CVD (1.23 (0.44-3.41)) death, high-fit/abdominal-obese men had no greater risk for all-cause (1.20 (0.80-1.78)) or CVD (0.62 (0.25-1.53)) death, and high-fit/percent body fat (%BF)-obese men had no greater risk for all-cause (1.19 (0.90-1.56)) or CVD (0.86 (0.52-1.43)) death compared with their high-fit/normal counterparts.

CONCLUSIONS

Fitness is a powerful effect modifier in the association of adiposity to mortality in men with HTN, negating the all-cause and CVD mortality risk associated with obesity.

Inter- and intra-rater reliability of neck circumference measurements in children

RATIONALE

Increased neck circumference is a risk factor for obstructive sleep apnea in adults. With rising obesity prevalence in children, it may be an important identifier of obstructive sleep apnea in children. The reliability of measuring neck circumference in children has not been systematically evaluated.

OBJECTIVE

To determine the inter- and intra-rater reliability of neck circumference measurements in children aged 2-16 years.

METHODS

Children aged 2-16 years with limb fractures were recruited. Neck circumference was measured by three investigators each using two separate unmarked paper tapes in the 2-5 year age group (N = 43), and three separate tapes in the 6-10 and 11-16 year age groups (N = 18 and 40).

RESULTS

Neck circumference measurements showed excellent inter-rater reliability for children 6-10 and 11-16 years (ICC = 0.952 and 0.989). Substantial variation was observed for the 2-5 year age group (ICC = 0.701). Good intra-rater reliability was demonstrated for the three groups (ICC range: 0.776, 0.950). Repeatability coefficients were 2.5-3.4 cm in the youngest age group and were 1.2-1.4 cm in the 6-16 year age group.

CONCLUSION

In children 6-16 years old, neck circumference shows very good inter and good intra-rater reliability. Multiple measurements are not required for precision and reliability.

The epidemiology of obesity and gastrointestinal and other diseases: an overview

The worldwide prevalence of obesity continues to increase, with devastating implications for overall health. Epidemiological trends indicate the primary contributors are environmental (e.g., increased caloric intake, lack of exercise), although the evidence is surprisingly equivocal. Increased body mass index (BMI) is associated with an increase in all-cause mortality and in diseases related to this increasing mortality rate, such as diabetes mellitus, cardiovascular disease, and cancer, including those of the gastrointestinal system. Some of these associations are even more pronounced when obesity is measured by waist-to-hip ratio, a marker of visceral adipose tissue, versus BMI. Higher BMI is related to increased risk of developing gall stones, and obese patients experience GI symptoms, such as vomiting and diarrhea, more often compared with those of normal body mass. Although the exact cause remains uncertain, these symptoms may be connected to eating habits or to changes in gastrointestinal motility.

Adipose-tissue engineering: taking advantage of the properties of human adipose-derived stem/stromal cells

Adipose tissue is now recognized as an important source of postnatal mesenchymal stem cells for regenerative medicine applications. For example, adipose-tissue engineering is an emerging approach that enables the development of autologous substitutes that could be used as an alternative to fat transplantation methods currently yielding variable outcomes for the long-term repair of soft-tissue defects. Here, we describe the production of unique tissue-engineered adipose tissues devoid of exogenous biomaterials produced from human adipose-derived stem/stromal cells. Our strategy is based on the dual self-assembly of extracellular components secreted and organized by the adipose-derived stromal cells after ascorbic acid stimulation, as well as their concomitant differentiation into adipocytes after adipogenic induction. When compared to stromal cells isolated from resected fat, lipoaspirated fat-derived cells featured an increased adipogenic potential and the enhanced ability to recreate three-dimensional adipose substitutes in vitro. These substitutes were histologically similar to native adipose tissue. They featured lipid-filled adipocytes embedded into an extracellular matrix rich in fibronectin as well as collagens I and V. On a functional level, the reconstructed adipose tissues expressed adipocyte-related transcripts and secreted adipokines typical of adipose tissue, such as leptin. Finally, the successful in vitro production of human adipose substitutes featuring an increased surface area (>30cm2) is described, reinforcing the notion that customized autologous reconstructed adipose tissues could be produced in the future to repair a wide range of soft-tissue defects.

Development and validation of a risk score for hospitalization for heart failure in patients with Type 2 diabetes mellitus

Background

There are no risk scores available for predicting heart failure in Type 2 diabetes mellitus (T2DM). Based on the Hong Kong Diabetes Registry, this study aimed to develop and validate a risk score for predicting heart failure that needs hospitalisation in T2DM.

Methods

7067 Hong Kong Chinese diabetes patients without history of heart failure, and without history and clinical evidence of coronary heart disease at baseline were analyzed. The subjects have been followed up for a median period of 5.5 years. Data were randomly and evenly assigned to a training dataset and a test dataset. Sex-stratified Cox proportional hazard regression was used to obtain predictors of HF-related hospitalization in the training dataset. Calibration was assessed using Hosmer-Lemeshow test and discrimination was examined using the area under receiver's operating characteristic curve (aROC) in the test dataset.

Results

During the follow-up, 274 patients developed heart failure event/s that needed hospitalisation. Age, body mass index (BMI), spot urinary albumin to creatinine ratio (ACR), HbA_1c, blood haemoglobin (Hb) at baseline and coronary heart disease during follow-up were predictors of HF-related hospitalization in the training dataset. HF-related hospitalization risk score = 0.0709 × age (year) + 0.0627 × BMI (kg/m²) + 0.1363 × HbA_1c(%) + 0.9915 × Log₁₀(1+ACR) (mg/mmol) - 0.3606 × Blood Hb(g/dL) + 0.8161 × CHD during follow-up (1 if yes). The 5-year probability of heart failure = 1-S₀(5)^{EXP{0.9744 × (Risk Score - 2.3961)}}. Where S₀(5) = 0.9888 if male and 0.9809 if female. The predicted and observed 5-year probabilities of HF-related hospitalization were similar (p > 0.20) and the adjusted aROC was 0.920 for 5 years of follow-up.

Conclusion

The risk score had adequate performance. Further validations in other cohorts of patients with T2DM are needed before clinical use.

Body Mass Index Affects the Need for and the Duration of Mechanical Ventilation After Thoracic Trauma

BACKGROUND

A higher body mass index (BMI) is associated with hypoxia, hypercarbia, and reduced functional residual capacity. The current study evaluates the association between BMI and the need for mechanical ventilation (MV) among patients who have sustained chest trauma.

METHODS

Demographic and clinical outcome data were collected from patients suffering blunt or penetrating thoracic traumatic injury admitted to a Level I academic trauma center between January 2001 and June 2006 (n = 3,649). Using logistic regression, the odds of being placed on MV were estimated according to BMI adjusting for the potentially confounding effects of age, mechanism of injury, severity of thoracic, head and overall injury, and pneumonia.

RESULTS

Compared with those with a normal BMI (18.5-24.9 kg/m), the odds of MV were not significantly different for underweight (BMI < 18.5 kg/m) patients (odds ratio [OR] 0.98, 95% confidence interval [CI] 0.53-1.80), but were elevated for overweight (BMI 25.0-29.9 kg/m) and obese (BMI 30+ kg/m) patients (OR 1.40, 95% CI 1.08-1.81 and OR 1.53, 95% CI 1.17-1.99, respectively).

CONCLUSIONS

Higher BMI values were positively associated with the initiation of MV. Among those patients on MV, an elevated BMI was significantly associated with a longer duration of MV. The field of acute trauma care would benefit from further evaluation of the association between BMI and MV so as to improve ventilation strategies for obese trauma patients.

Prevalence and socioeconomic risk factors of obesity among urban female students in Al-Khobar city, Eastern Saudi Arabia, 2003

The aim of this study was to determine the prevalence and the socioeconomic risk factors associated with obesity among female school-aged children and adolescents in primary and intermediate schools in Al-Khobar city, Kingdom of Saudi Arabia. This is a cross-sectional study conducted in Al-Khobar city, which is located in the eastern part of Saudi Arabia, during the period of January to March 2003. It involved 2239 female schoolchildren randomly selected from 30 regular government and private primary and preparatory schools. The students' ages ranged from 6 to 17 years, with a mean of 10.49 +/- 2.64 years. A multistage stratified random sampling technique with proportional allocation was used. Data were collected using questionnaires and anthropometric measurements. Body mass index interpretation was based on using a table of standard definitions for overweight and obesity in children (Cole's). The spss version 10 (SPSS Inc., Chicago, IL, USA) was used for data entry and analysis. A chi-squared test was used in cross-tabulation analysis to test the significance of association between body mass index and socioeconomic variables. The prevalence of overweight and obesity were 20% and 11%, respectively. The prevalence of overweight was higher among schoolchildren with father in private work (P<0.01) and the prevalence of overweight and obesity was higher among schoolchildren with highly educated mothers (P=0.008). The prevalence of overweight and obesity among female school-aged children and adolescents in the Al-Khobar city was very high. Accordingly, it is recommended that health education programmes regarding obesity should be provided to all schoolchildren, their families and teachers.

Sociodemographic variations in obesity among Ghanaian adults

Objectives:

To determine the sociodemographic associations of obesity in Ghana.

Design:

A cross-sectional descriptive study was conducted on a sample of 6300 adults aged 25 years and over who were selected by random cluster sampling.

Setting:

Two urban (high-class and low-class suburbs) and a rural community in Accra, Ghana.

Subjects and methods:

In total, 4731 (1857 males, 2874 females) subjects participated. Demographic data were obtained by a questionnaire and height and weight were determined with subjects in light clothing and without shoes.

Results:

The overall crude prevalence of overweight and obesity was 23.4 and 14.1%, respectively. The rates of overweight (27.1 vs. 17.5%) and obesity (20.2 vs. 4.6%) were higher in females than males. Obesity increased with age up to 64 years. There were more overweight and obesity in the urban high-class residents compared with the low-class residents and in urban than rural subjects. Overweight and obesity were highest among the Akan and Ga tribes and relatively low among Ewes. Subjects with tertiary education had the highest prevalence of obesity (18.8%) compared with less literate and illiterate subjects (12.5–13.8%). Subjects whose jobs were of a sedentary nature had higher levels of obesity (15%) than subjects whose jobs involved heavy physical activity (10%). Subjects who did not engage in leisure-time physical activity were more obese than those who had three or more sessions of leisure-time physical activity per week (15.3 vs. 13.5%).

Conclusions:

Overweight and obesity are common among residents in the Accra area. Older age, female gender, urban, high-class residence, sedentary occupation and tertiary education were associated with higher levels of obesity. Policies and programmes that promote healthy lifestyles may prove beneficial.

A multicenter, randomized, double-blind, placebo-controlled, dose-finding trial of a long-acting formulation of octreotide in promoting weight loss in obese adults with insulin hypersecretion

OBJECTIVE

To compare changes in weight in obese patients who received long-acting octreotide (octreotide LAR) at one of three dose levels (20, 40, or 60 mg) or placebo over 6 months and to identify the lowest dose of octreotide LAR that safely achieved optimal weight loss.

DESIGN

Randomized, double-blind, placebo-controlled trial of octreotide LAR at three dose levels.

PATIENTS

A total of 172 adults (28 men and 144 women) with at least moderate obesity (body mass index (BMI) range 30-65 kg/m2) and evidence of insulin hypersecretion were enrolled. Patients were predominantly either Caucasian (50.0%) or African American (45.3%). The mean age (38 +/- 11 year), weight (110.7 +/- 23 kg), and BMI (39.8 +/- 6.5 kg/m2) were similar across the four treatment groups.

MEASUREMENTS

Efficacy measures included weight, BMI, fasting serum glucose; triglycerides; percentage of total body fat and abdominal fat as measured by dual-energy X-ray absorptiometry; skin fold thickness; waist-to-hip circumference; leptin; percentage of carbohydrates, fat, and protein ingested; nutritional evaluation (including dietary analysis--3-day food record); quality of life (QoL; using the Impact of Weight on Quality of Life-Lite); Beck Depression Inventory; and Carbohydrate Craving Questionnaire. Safety measures included medical history, vital signs, physical examinations, hematology, blood chemistries, thyroid function tests, hemoglobin A1c, gallbladder ultrasound, electrocardiograms, and adverse events.

RESULTS

After 6 months of treatment, patients receiving 40 or 60 mg of octreotide LAR experienced statistically significant weight loss compared to baseline, with mean differences from placebo in percent weight change of -1.98 and -1.87%, respectively. This finding was accompanied by statistically significant mean decreases in BMI compared to baseline, that is, a mean decrease of 0.73 and 0.79 kg/m2 for the 40 and 60 mg treatment arms, respectively. The observed weight loss was progressive during the 6-month treatment in the two higher dose groups. The lowest dose to reach statistical significance in weight loss after 6 months' treatment was 40 mg. Post hoc analysis revealed a 3.5-3.8% weight loss at month 6 in the two higher dose groups among Caucasian patients having insulin secretion greater than the median of the cohort, defined as CIR(gp) (corrected insulin response at the glucose peak) > or = 1.43. There were no statistically significant changes in QoL scores, body fat, leptin concentration, Beck Depression Inventory, or macronutrient intake. Mean changes of blood glucose AUC(0-180 min) during an oral glucose tolerance test in patients taking octreotide LAR were 39-40 mg/dl h higher than those on placebo. A total of 7-21% of the patients taking octreotide LAR reached a 5% or greater decrease in body weight from Baseline, compared to 11% for the placebo group. This was not statistically significant. The most common adverse events included diarrhea, headache, cholelithiasis, nausea, and abdominal pain.

CONCLUSION

Octreotide LAR given at 40 or 60 mg resulted in statistically significant weight loss. A post hoc analysis stratifying patients by race and CIR(gp) indicated that Caucasian patients with the greater degree of insulin hypersecretion appeared to derive the most benefit from treatment. The observed safety profile was consistent with the known effects of octreotide from previous studies.

Barriers to obesity management: a pilot study of primary care clinicians

Background

Obesity is an increasing epidemic in both the US and veteran populations, yet it remains largely understudied in the Veteran's Health Administration (VHA) setting. The purpose of our study was to identify barriers to the effective management of obesity in VHA primary care settings.

Methods

Three focus groups of clinicians from a Veteran's Affairs Medical Center (VAMC) and an affiliated Community Based Outpatient Center (CBOC) were conducted to identify potential barriers to obesity management. The focus groups and previously published studies then informed the creation of a 47-item survey that was then disseminated and completed by 55 primary care clinicians.

Results

The focus groups identified provider, system, and patient barriers to obesity care. Lack of obesity training during medical school and residency was associated with lower rates of discussing diet and exercise with obese patients (p < 0.05). Clinicians who watched their own diets vigorously were more likely to calculate BMI for obese patients than other clinicians (42% vs. 13%, p < 0.05). Many barriers identified in previous studies (e.g., attitudes toward obese patients, lack of insurance payments for obesity care) were not prevalent barriers in the current study.

Conclusion

Many VHA clinicians do not routinely provide weight management services for obese patients. The most prevalent barriers to obesity care were poor education during medical school and residency and the lack of information provided by the VHA to both clinicians and patients about available weight management services.

Perianesthesia respiratory care of the bariatric patient

Our nation's obesity problem has reached epidemic proportions and is only projected to worsen. The morbidly obese patient is at risk for experiencing a multitude of health-related conditions. Morbidly obese patients are presenting for surgery at an increasing rate, especially with the growing popularity of weight-loss surgery. Therefore the perianesthesia nurse has to remain informed of optimal care strategies for this sometimes challenging population. The obese patient presents with distinct respiratory care considerations of which the perianesthesia nurse must be knowledgeable. This review article will specifically focus on the respiratory care of the bariatric patient presenting for surgery.

Interdigital lesions and frequency of acute dermatolymphangioadenitis in lymphoedema in a filariasis-endemic area

BACKGROUND

Lymphatic filariasis (LF) is a mosquito-borne nematode infection that causes permanent lymphatic dysfunction in virtually all infected individuals and clinical disease in a subset of these. One major sequel of infection is lymphoedema of the limbs. Lymphoedema of the leg affects an estimated 15 million persons in LF-endemic areas worldwide. Acute dermatolymphangioadenitis (ADLA) in people with filarial lymphoedema causes acute morbidity and increasingly severe lymphoedema. Episodes of ADLA are believed to be caused by bacteria, and it has been shown that entry lesions in the skin play a causative role. Clinical observations suggest that interdigital skin lesions of the feet, often assumed to be fungal, may be of particular importance.

OBJECTIVES

To investigate the epidemiology and aetiology of interdigital lesions (IDL) of the feet in filarial lymphoedema.

METHODS

The frequency and mycological aetiology of IDL in 73 patients with filarial lymphoedema were compared with 74 individuals without lymphoedema in a region of Guyana highly endemic for Wuchereria bancrofti.

RESULTS

More than 50% of patients with lymphoedema had one or more IDL (odds ratio 2.69; 95% confidence interval 1.31-5.66; P<0.005 compared with controls). The number of lesions was the strongest predictor of frequency of ADLA. Only 18% of the lesions had positive microscopy or culture for fungi (dermatophytes and Scytalidium).

CONCLUSIONS

These findings highlight the importance of interdigital entry lesions as risk factors for episodes of ADLA and have implications for the control of morbidity from filarial lymphoedema.

Dietary approaches that delay age-related diseases

Reducing food intake in lower animals such as the rat decreases body weight, retards many aging processes, delays the onset of most diseases of old age, and prolongs life. A number of clinical trials of food restriction in healthy adult human subjects running over 2-15 years show significant reductions in body weight, blood cholesterol, blood glucose, and blood pressure, which are risk factors for the development of cardiovascular disease and diabetes. Lifestyle interventions that lower energy balance by reducing body weight such as physical exercise can also delay the development of diabetes and cardiovascular disease. In general, clinical trials are suggesting that diets high in calories or fat along with overweight are associated with increased risk for cardiovascular disease, type 2 diabetes, some cancers, and dementia. There is a growing literature indicating that specific dietary constituents are able to influence the development of age-related diseases, including certain fats (trans fatty acids, saturated, and polyunsaturated fats) and cholesterol for cardiovascular disease, glycemic index and fiber for diabetes, fruits and vegetables for cardiovascular disease, and calcium and vitamin D for osteoporosis and bone fracture. In addition, there are dietary compounds from different functional foods, herbs, and neutraceuticals such as ginseng, nuts, grains, and polyphenols that may affect the development of age-related diseases. Long-term prospective clinical trials will be needed to confirm these diet-disease relationships. On the basis of current research, the best diet to delay age-related disease onset is one low in calories and saturated fat and high in wholegrain cereals, legumes, fruits and vegetables, and which maintains a lean body weight. Such a diet should become a key component of healthy aging, delaying age-related diseases and perhaps intervening in the aging process itself. Furthermore, there are studies suggesting that nutrition in childhood and even in the fetus may influence the later development of aging diseases and lifespan.

[Genetics and pathophysiology of obesity]

Obesity is one of the major health problems in developed countries. More than 35% of adults in Germany are considered to be overweight (BMI 25-29.9 kg/m(2)) and approximately 15-20% to be obese (BMI >30 kg/m(2)). Overweight and obesity result from chronic disruption of energy balance. Recent progress in understanding of appetite control and energy expenditure has elucidated a complex integrated system of energy homoeostasis. Although changes in nutritional habits and reduction of physical activity are the main characteristics leading to the strong increase in obesity, it is now recognized that obesity is not only caused by a lack of will power, but can be a consequence of metabolic defects. As obesity results from a genetic make-up favoring weight gain in an "obesigenic" environment the elucidation of the underlying molecular mechanisms might be translated in novel therapeutic options in the future.

Prevalence of obesity in Taiwan

In Taiwan, the prevalence and problem of obesity has increased significantly in recent decades and has became an important public health issue. In children (12-15 years), the prevalence of obesity (defined as body weight > 120% of mean body weight with age- and gender-specification) was 12.4%, 14.8% and 15.6% among boys and 10.1%, 11.1% and 12.9% among girls in 1980, 1986 and 1996 respectively. A survey of 1500 12-15-year-old children during 1995-1996 in Taipei city found that about 16.6% of boys and 11.1% of girls were obese, while an additional 11.6% of boys and 10.2% of girls were overweight. In adults, using the criteria defined by the Department of Health in Taiwan [overweight as (body mass index) BMI > or = 24 and obese as BMI > or = 27], the age-adjusted prevalence of obesity was 10.5% and 15.9% for men and 13.2% and 10.7% for women from 1993-1996 to 2000-2001. From these data, we found that the prevalence of obesity in Taiwan has increased steadily from 1980 to 2000 especially in children and in men.

Diet-induced obesity impairs mammary development and lactogenesis in murine mammary gland

We have developed a mouse model of diet-induced obesity that shows numerous abnormalities relating to mammary gland function. Animals ate approximately 40% more calories when offered a high-fat diet and gained weight at three times the rate of controls. They exhibited reduced conception rates, increased peripartum pup mortality, and impaired lactogenesis. The impairment of lactogenesis involved lipid accumulation in the secretory epithelial cells indicative of an absence of copius milk secretion. Expression of mRNAs for beta-casein, whey acid protein, and alpha-lactalbumin were all decreased immediately postpartum but recovered as lactation was established over 2-3 days. Expression of acetyl-CoA carboxylase (ACC)-alpha mRNA was also decreased at parturition as was the total enzyme activity, although there was a compensatory increase in the proportion in the active state. By day 10 of lactation, the proportion of ACC in the active state was also decreased in obese animals, indicative of suppression of de novo fatty acid synthesis resulting from the supply of preformed fatty acids in the diet. Although obese animals consumed more calories in the nonpregnant and early pregnant states, they showed a marked depression in fat intake around day 9 of pregnancy before food intake recovered in later pregnancy. Food intake increased dramatically in both lean and obese animals during lactation although total calories consumed were identical in both groups. Thus, despite access to high-energy diets, the obese animals mobilized even more adipose tissue during lactation than their lean counterparts. Obese animals also exhibited marked abnormalities in alveolar development of the mammary gland, which may partially explain the delay in differentiation evident during lactogenesis.