Overweight and obesity: Key components of cardiometabolic risk

Short-term Intensive Lifestyle Therapy in a Worksite Setting Improves Cardiometabolic Health in People With Obesity

Context

The Pritikin Program, which provides intensive lifestyle therapy, has been shown to improve cardiometabolic outcomes when provided as a residential program.

Objective

The purpose of the present study was to conduct a short-term, randomized, controlled trial to evaluate the feasibility and clinical efficacy of treatment with the Pritikin Program in an outpatient worksite setting.

Methods

Cardiometabolic outcomes were evaluated in people with overweight/obesity and ≥2 metabolic abnormalities (high triglycerides, low high-density lipoprotein (HDL) cholesterol, high blood pressure, HbA1c > 5.7%), before and after they were randomized to 6 weeks of standard care (n = 26) or intensive lifestyle therapy, based on the Pritikin Program (n = 28). Participants in the lifestyle intervention group were provided all food as packed-out meals and participated in group nutrition, behavioral education, cooking classes, and exercise sessions 3 times per week at a worksite location.

Results

Compared with standard care, intensive lifestyle therapy decreased body weight (-5.0% vs -0.5%), HbA1c (-15.5% vs +2.3%), plasma total cholesterol (-9.8% vs +7.7%), low-density lipoprotein cholesterol (-10.3% vs +9.3%) and triglyceride (-21.7% vs +3.0%) concentrations, and systolic blood pressure (-7.0% vs 0%) (all P values < .02), and increased exercise tolerance (time to exhaustion walking on a treadmill by +23.7% vs +4.5%; P < .001).

Conclusion

This study demonstrates the feasibility and clinical effectiveness of short-term, intensive outpatient lifestyle therapy in people with overweight/obesity and increased risk of coronary heart disease when all food is provided and the intervention is conducted at a convenient worksite setting.

Group Lifestyle Intervention With Mobile Health for Young Adults With Serious Mental Illness: A Randomized Controlled Trial

OBJECTIVE

Evidence-based lifestyle interventions tailored to young adults with serious mental illness are needed to reduce their cardiometabolic risk. This study evaluated the effectiveness of a group lifestyle intervention ("PeerFIT") enhanced with mobile health (mHealth) compared with one-on-one mHealth coaching (basic education supported by activity tracking [BEAT]) for young adults with serious mental illness who were overweight or obese.

METHODS

Participants were young adults ages 18-35 years with serious mental illness and a body mass index ≥25 kg/m², who were randomly assigned to PeerFIT or BEAT. Research staff collected data at baseline and at 6 and 12 months. Main outcomes were clinically significant changes from baseline in weight (≥5% weight loss), cardiorespiratory fitness (CRF; increase of >50 m on the 6-minute walk test), and cardiovascular disease (CVD) risk reduction (clinically significant weight loss or CRF improvement).

RESULTS

Participants were 150 young adults with a mean ± SD body mass index of 37.1±7.4. Intent-to-treat analyses revealed no significant between-group difference for weight-loss, CRF, or CVD outcomes at 6 and 12 months. Participants in both conditions achieved clinically significant CVD risk reduction, weight loss, and CRF from baseline to 6 and 12 months, and all these improvements were statistically significant (p<0.01).

CONCLUSION

The PeerFIT group lifestyle intervention was not superior to one-on-one mHealth coaching in achieving clinically significant changes in weight, CRF, and CVD risk reduction. Although both interventions improved outcomes, low-intensity mHealth coaching may be a more scalable approach for addressing modifiable cardiometabolic risk factors among young adults with serious mental illness.

Obesity is associated with a higher Torque Teno viral load compared to leanness

INTRODUCTION

Obesity affects a rising proportion of the population and is an important risk factor for unfavorable outcomes in viral disease including severe acute respiratory syndrome coronavirus 2- associated diseases. Torque Teno virus (TTV) is a ubiquitous and apathogenic virus which reflects the immune function of its host. The aim of this study was to investigate the association between obesity and TTV load - an indirect marker of compromised viral immune response.

METHODS

TTV was quantified by TTV R-GENE^® PCR in a total of 89 participants of which 30 were lean (BMI <25 kg/m²) and 59 were obese (BMI >30 kg/m²). For 38 subjects, follow-up was available after bariatric surgery.

RESULTS

TTV load was higher in individuals with obesity (median 2.39, IQR: 1.69-3.33 vs. 1.88, IQR 1.08-2.43 log10 copies/mL; p = 0.027). Multivariable linear modeling revealed an independent association between TTV load and obesity. TTV was positively correlated with waist-to-hip ratio and inversely with 25OH vitamin D levels. Interleukin 6 and fasting insulin resistance were confounders of the association between TTV and obesity, while age was an effect modifier. TTV load increased by 87% (95% CI 2-243%) in the year following bariatric surgery.

DISCUSSION

A higher TTV load in obese individuals may reflect compromised immune function and thus might serve for risk stratification of unfavorable outcomes during infectious disease, including coronavirus disease 2019, in this population. Our data warrant further analysis of TTV-based risk assessment in obese individuals in the context of infectious disease-associated outcomes.

In Men With Obesity, T2DM Is Associated With Poor Trabecular Microarchitecture and Bone Strength and Low Bone Turnover

INTRODUCTION

Obesity and type 2 Diabetes (T2D) are both associated with greater bone mineral density (BMD) but increased risk of fractures. The effect of the combination of both conditions on bone metabolism, microarchitecture, and strength in the obese population remains unknown.

METHODS

Data from 112 obese men were collected. Bone turnover and biochemical markers were measured by enzyme-linked immunosorbent assay, body composition and BMD at all sites were assessed by dual energy X-ray absorptiometry, whereas bone microarchitecture and strength (stiffness and failure load) were measured by high-resolution peripheral computed tomography. Data were compared among metabolically healthy obese (MHO) and metabolically unhealthy obese (MUHO) with and without T2D and between obese without and with T2D.

RESULTS

Compared to MHO and MUHO without T2D, MUHO with T2D had significantly lower levels of osteocalcin ((7.49 ± 3.0 and 6.03 ± 2.47 vs 4.24 ± 2.72 ng/mL, respectively, P = 0.003) and C-terminal telopeptide of type I collagen (CTx) (0.28 ± 0.10 and 0.29 ± 0.13 vs 0.21 ± 0.15 ng/mL, respectively, P = 0.02). Dividing our subjects simply into those with and without T2D showed that obese men with T2D had significantly lower levels of osteocalcin (P = 0.003) and CTx (P = 0.005), greater trabecular separation at the tibia and radius (P = 0.03 and P = 0.04, respectively), and lower tibial failure load and stiffness (both P = 0.04), relative to obese men without T2D.

CONCLUSION

In men, the combination of obesity and T2D is associated with reduced bone turnover and poorer trabecular bone microarchitecture and bone strength compared to those who are obese but without T2D, suggesting worse bone disease.

The association between cardiorespiratory fitness, liver fat and insulin resistance in adults with or without type 2 diabetes: a cross-sectional analysis

Background

Exercise-induced improvements in cardiorespiratory fitness (CRF) often coincide with improvements in insulin sensitivity and reductions in liver fat content. However, there are limited data concerning the relationship between CRF and liver fat content in adults with varying degrees of metabolic dysfunction.

Methods

The aim of this study was to examine the association between CRF, liver fat content, and insulin resistance in inactive adults with obesity and with or without type 2 diabetes (T2D), via cross-sectional analysis. CRF was determined via a graded exercise test. Liver fat content was assessed via proton magnetic resonance spectroscopy and insulin resistance was assessed via homeostatic model of insulin resistance (HOMA-IR). A partial correlation analysis, controlling for age and gender, was performed to determine the association between CRF, demographic, cardiometabolic, and anthropometric variables. Independent t tests were performed to compare cardiometabolic outcomes between participants with T2D and participants without T2D.

Results

Seventy-two adults (46% male) with a mean age of 49.28 ± 10.8 years, BMI of 34.69 ± 4.87 kg/m², liver fat content of 8.37 ± 6.90%, HOMA-IR of 3.07 ± 2.33 and CRF of 21.52 ± 3.77 mL/kg/min participated in this study. CRF was inversely associated with liver fat content (r = − 0.28, p = 0.019) and HOMA-IR (r = − 0.40, p < 0.001). Participants with T2D had significantly higher liver fat content (+ 3.66%, p = 0.024) and HOMA-IR (+ 2.44, p < 0.001) than participants without T2D. Participants with T2D tended to have lower CRF than participants without T2D (− 1.5 ml/kg/min, p = 0.094).

Conclusion

CRF was inversely associated with liver fat content and insulin resistance. Participants with T2D had lower CRF than those without T2D, however, the difference was not statistically significant. Further longitudinal studies are required to elucidate the relationship between CRF and the progression of obesity-related diseases such as T2D.

Registration: ACTRN12614001220651 (retrospectively registered on the 19th November 2014) and ACTRN12614000723684 (prospectively registered on the 8th July 2014).

Supplementary Information

The online version contains supplementary material available at 10.1186/s13102-021-00261-9.

Effects of Different Resistance Training Frequencies on Body Composition, Cardiometabolic Risk Factors, and Handgrip Strength in Overweight and Obese Women: A Randomized Controlled Trial

BACKGROUND

Resistance training improves health in obese and overweight people. However, it is not clear what is the optimal weekly resistance training frequency and the most efficacious training protocol on body composition, cardiometabolic risk factors, and handgrip strength (HS). The aim of this study was to determine the effects of a supervised structured 24 week resistance training program on obese and overweight women.

METHODS

Forty-five women (BMI 37.1 ± 6.3 kg/m²; age 56.5 ± 0.7 years) were randomly assigned to one of two groups: A group with a high weekly training frequency of three times a week (HIGH) and a group that performed it only once a week (LOW). Cardiometabolic risk factors, anthropometric and HS measures were taken before and after the intervention period.

RESULTS

A significant (p < 0.05) group by time interaction was observed for body weight, body mass index, waist circumference, fat mass, plasma glucose, plasma insulin, homeostatic model assessment, and for dominant and absolute HS. Additionally, only the HIGH group saw increased HS and decreased total cholesterol and LDL-cholesterol after the intervention period (p < 0.05). The observed increase in HS was associated with an improved insulin resistance sensitivity (absolute handgrip strength: r = -0.40, p = 0.007; relative handgrip strength: r = -0.47, p = 0.001) after training, which constitutes an essential element for cardiovascular health.

CONCLUSIONS

The results suggest that high weekly frequency training give greater benefits for weight loss and cardiometabolic risk factors improvement than a training program with a training session of once a week. Furthermore, the improvement of HS can be achieved with a high weekly frequency training.

Body Fat Percentage in Relation to Lung Function in Individuals with Normal Weight Obesity

Accumulating evidence indicates the association between obesity and lung function. However, no previous study has examined whether obesity affects lung function in normal weight participants with high body fat. We hypothesized that subjects with normal weight obesity (NWO) were inversely associated with lung function in Taiwan. The study sample was composed of participants who attended health examinations at the Tri-Service General Hospital from 2010 to 2016. A total of 7801 eligible participants who were classified as NWO were divided into quartiles by percentage body fat (PBF), which was measured by bioelectrical impedance analysis (BIA). A multivariable linear regression was performed to assess the association between PBF quartiles and pulmonary function. The relationship between PBF and the presence of obstructive and restrictive lung diseases was analyzed by a logistic regression. PBF quartiles were closely associated with reduced forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) in all adjusted models. This relationship remained significant in the male population, and a dose-dependent effect was observed. Increased PBF was associated with increased risks for the presence of restrictive lung diseases. These results presented a novel finding that body fat exhibited an inverse association with pulmonary function in NWO subjects. More comprehensive management of subjects with normal weight but high body fat, which might contribute to metabolic dysfunction and impaired pulmonary function, is needed.

Methyl dehydroabietate counters high fat diet-induced insulin resistance and hepatic steatosis by modulating peroxisome proliferator-activated receptor signaling in mice

The aim of this study was to investigate the therapeutic effects of methyl dehydroabietate (mDA) on adipocyte differentiation in 3T3-L1 preadipocytes and obesity characteristics induced by high-fat diet (HFD) in mice. Adipocyte differentiation in 3T3-L1 cells was evaluated after 14 days of incubation with mDA. mDA enhanced adipocyte differentiation in 3T3-L1 cells. For the in vivo evaluation, five-week-old male C57BL/6J mice were fed HFD or normal CE-2 diet (control) for eight weeks. During the experimental period, mice were administered mDA (50 mg/kg, p.o.) as an olive oil emulsion (containing 10% ethanol), and body weights were measured weekly. At the end of the experiment, the mice were euthanized after 16 h fasting period, and plasma samples were collected. The liver, kidney, and epididymal adipose tissues were collected and weighed. It significantly decreased body weight, adipose tissue weight, and plasma levels of glucose, insulin, leptin, and pro-inflammatory cytokines compared with that in the HFD group, and markedly reduced the impairment in glucose tolerance in obese mice. Furthermore, mDA reduced HFD-induced adipocyte hypertrophy and the formation of hepatic lipid droplets. Moreover, it induced the expression of proliferator-activated receptor alpha (PPARα) in the liver and PPARγ in the adipose tissues. Our findings demonstrate that mDA reduces obesity-induced glucose and insulin tolerance by inducing PPAR expression.

Parental Correlates of Body Weight Status Among High School Students in Tehran

This study aimed to determine the parental correlates of body weight status among adolescents in Tehran. The participants were 465 high school students and their parents who resided in Tehran. Body weight and height of the students were measured, and body mass index (BMI)-for-age and body weight status of the students were determined according to the world health organization growth reference (2007). Parents of the students completed a self-administered questionnaire including socio-demographic information, self-reported parental body weight and height, and parental perception of student's body weight status. About half of the parents had an incorrect perception about body weight status of their children with higher rates of underestimation than overestimation. The percentage of parents who correctly perceived body weight status of the students decreased from 100.0% in severe thinness group to 14.0% in obese group. There were no significant associations between marital status, occupation, and education of parents and BMI-for-age of the students. While, both BMI of mother and BMI of father were significantly associated with students' BMI-for-age (r = 0.29 and r = 0.27, respectively; P < 0.05). A great number of parents had incorrect perception regarding body weight status of their offspring; this was true specifically for parents of overweight and obese students. Both parental BMI and parental perception regarding students' body weight status were associated with students' BMI-for-age, indicating the need for parental involvement in weight management programs targeting adolescents.

Association Between Physical Activity Intensity and Physical Capacity Among Individuals Awaiting Bariatric Surgery

BACKGROUND

Physical activity is a routine component of the lifestyle modification program implemented prior to bariatric surgery, and one of the goals is to improve patients' physical capacity. However, the physical activity intensity recommended to meet that goal is unknown.

OBJECTIVE

This study aimed to assess the association between time spent at different physical activity intensities and physical capacity in patients awaiting bariatric surgery.

MATERIALS AND METHODS

A total of 39 women and 13 men were recruited. The primary outcome was physical capacity measured using six objective tests: 6-min walk, chair stand, sit and reach, unipodal balance (eyes open and eyes closed), and hand grip strength tests. The primary exposure variable was physical activity intensity (i.e., sedentary, light, moderate, and vigorous) measured by accelerometers.

RESULTS

The average body mass index was 46.3 ± 5.4 kg/m². Only 6% of total time was spent at moderate to vigorous intensity, while 71% of the time was spent sedentary. When adjusted for body mass index, age, and sex, four of the six physical capacity tests were significantly associated with moderate intensity physical activity β(SE): 6-min walk 9.7 (2.7), chair stand 0.3 (0.1), balance (eyes open) 1.8 (0.7), and hand grip strength 1.2 (0.4), and only the 6-min walk was associated with sedentary activity 1.7 (0.7).

CONCLUSION

These results suggest that physical capacity is associated with time spent at moderate intensity in individuals awaiting bariatric surgery. The next step is to study if an increase in time spent at moderate intensity will translate to improvements in physical capacity.

Simultaneous HPLC-APCI-MS/MS quantification of endogenous cannabinoids and glucocorticoids in hair

Hair matrix could retrospectively record association of endogenous cannabinoids (e.g. 2-arachidonoyl glycerol, 2-AG and N-arachidonoyl-ethanolamine, AEA) and glucocorticoids (e.g. cortisol and cortisone) in a myriad of physiological functions. However, depending on the extraction conditions, the spontaneous isomerization of 2-AG to 1-arachidonoylglycerol (1-AG) and the possible rearrangement of O-arachidonoyl ethanolamine (OAEA) to AEA in various sample matrices could be major obstacles encountered in the detection of both 2-AG and AEA. This study aimed to develop a novel method for simultaneous quantification of 2-AG, AEA, cortisol and cortisone in hair. Methanol was used as the incubation solution and an acidic mixture of deionized water and methanol were utilized as mobile phase in order to avert possible rearrangements of both OAEA and 2-AG. The analyses were performed on a high-performance liquid chromatography tandem mass spectrometer with atmosphere pressure chemical ionization in positive mode. The method showed good linearity in the range of 3.0-250pg/mg for AEA, 15.0-1250pg/mg for 2-AG and 1-250pg/mg for cortisol and cortisone. Limit of detection was 1.5pg/mg for AEA, 6.0pg/mg for 2-AG and 0.5pg/mg for cortisol and cortisone. For all four analytes, intra and inter-day coefficients of variation were less than 20% and recovery above 90%. Population analyses in 473 hair samples established that 2-AG was significantly correlated with AEA. 2-AG was significantly and positively correlated with cortisol and cortisone. There was a significant positive correlation of AEA with cortisol, but not with cortisone. Obese participants showed a significantly higher concentration of cortisone and 2-AG. Males showed significantly higher 2-AG and cortisone levels but significantly lower AEA levels than females.

Administration of granulocyte-colony stimulating factor accompanied with a balanced diet improves cardiac function alterations induced by high fat diet in mice

Background/Objectives

High fat diet (HFD) is a major contributor to the development of obesity and cardiovascular diseases due to the induction of cardiac structural and hemodynamic abnormalities. We used a model of diabetic cardiomyopathy in C57Bl/6 mice fed with a HFD to investigate the effects of granulocyte-colony stimulating factor (G-CSF), a cytokine known for its beneficial effects in the heart, on cardiac anatomical and functional abnormalities associated with obesity and type 2 diabetes.

Methods

Groups of C57Bl/6 mice were fed with standard diet (n = 8) or HFD (n = 16). After 36 weeks, HFD animals were divided into a group treated with G-CSF + standard diet (n = 8) and a vehicle control group + standard diet (n = 8). Cardiac structure and function were assessed by electrocardiography, echocardiography and treadmill tests, in addition to the evaluation of body weight, fasting glicemia, insulin and glucose tolerance at different time points. Histological analyses were performed in the heart tissue.

Results

HFD consumption induced metabolic alterations characteristic of type 2 diabetes and obesity, as well as cardiac fibrosis and reduced exercise capacity. Upon returning to a standard diet, obese mice body weight returned to non-obese levels. G-CSF administration accelerated the reduction in of body weight in obese mice. Additionally, G-CSF treatment reduced insulin levels, diminished heart fibrosis, increased exercise capacity and reversed cardiac alterations, including bradycardia, elevated QRS amplitude, augmented P amplitude, increased septal wall thickness, left ventricular posterior thickening and cardiac output reduction.

Conclusion

Our results indicate that G-CSF administration caused beneficial effects on obesity-associated cardiac impairment.

The association of body size in early to mid-life with adult urinary 6-sulfatoxymelatonin levels among night shift health care workers

Background

Adult body mass index (BMI) has been associated with urinary melatonin levels in humans; however, whether earlier-life body size is associated with melatonin, particularly among night shift workers, remains unknown.

Methods

We evaluated associations of birth weight, body shape (or somatotype) at ages 5 and 10, BMI at age 18 and adulthood, weight change since age 18, waist circumference, waist to hip ratio, and height with creatinine-adjusted morning urinary melatonin (6-sulfatoxymelatonin, aMT6s) levels among 1,343 healthy women (aged 32–53 at urine collection, 1996–1999) in the Nurses’ Health Study (NHS) II cohort. Using multivariable linear regression, we computed least-square mean aMT6s levels across categories of body size, and evaluated whether these associations were modified by night shift work.

Results

Adult BMI was inversely associated with aMT6s levels (mean aMT6s levels = 34 vs. 50 ng/mg creatinine, comparing adult BMI ≥30 vs. <20 kg/m²; P_trend <0.0001); however, other measures of body size were not related to aMT6s levels after accounting for adult BMI. Night shifts worked prior to urine collection, whether recent or cumulatively over time, did not modify the association between adult BMI and aMT6s levels (e.g., P_interaction = 0.72 for night shifts worked within two weeks of urine collection).

Conclusions

Our results suggest that adult BMI, but not earlier measures of body size, is associated with urinary aMT6s levels in adulthood. These observations did not vary by night shift work status, and suggest that adult BMI may be an important mechanism by which melatonin levels are altered and subsequently influence chronic disease risk.

Effect of excessive water intake on body weight, body mass index, body fat, and appetite of overweight female participants

Objective:

Drinking plenty of water is commonly recommended in weight loss regimens; however, very limited scientific evidence is available to justify this. Here we studied the effect of drinking 1.5 L of water, over and above the usual intake on body weight, body mass index (BMI), body fat, and appetite score in overweight female participants.

Materials and Methods:

The study was done on 50 overweight female participants, who were instructed to drink 500 mL of water, three times a day 30 min before breakfast, lunch, and dinner. The 1.5 L water intake was over and above their daily water intake and was continued for 8 consecutive weeks. Body weight, BMI, body fat, and appetite score was measured pre and post-study; and the values were compared by paired t-test using Statistical Packages for Social Sciences (SPSS) version 14.0.1.

Results:

All the parameters tested were lower after 8 weeks: body weight (pre-study 65.86 ± 3.614 kg vs post-study 64.42 ± 3.704 kg; P < 0.01); BMI (pre-study 26.7002 ± 0.9423 vs post-study 26.1224 ± 1.0632; P < 0.01); sum of skinfold thickness (pre-study 79.626 ± 10.385 mm vs post-study 76.578 ± 10.477 mm; P < 0.01); and the appetite score (pre-study 36.880 ± 4.170 vs post-study 34.673 ± 3.845; P < 0.01).

Conclusions:

Our study establishes the role of drinking 1.5 L of excessive water in weight reduction, body fat reduction, and appetite suppression in overweight female participants.

Obesity impairs vasodilatation and blood flow increase mediated by endothelial nitric oxide: an overview

Obesity dramatically increases the risk of development of cardiovascular and metabolic diseases. Endothelial dysfunction induced by obesity is an important risk factor that impairs blood flow controls in various organs. Impaired endothelial function occurs early in life in obese children. Obesity-induced endothelial dysfunction is associated with decreased nitric oxide (NO) production due to impaired endothelial NO synthase activity and expression and increased production of superoxide anion and the endogenous NOS inhibitor ADMA, together with increased vasoconstrictor factors, such as endothelin-1 and sympathetic nerve activation. Decreased endothelial progenitor cells are also involved in endothelial cell senescence in obese individuals. Insulin resistance and diabetes mellitus augment obesity-induced endothelial dysfunction. Adipokines liberated from adipose tissues play roles in modulating endothelial function; adiponectin and ghrelin have beneficial effects on endothelial cells. Effects of leptin on endothelial function are controversial. Decreased body weight by physical exercise, dietary interventions, and bariatric surgery are effective measures that reverse endothelial dysfunction; however, the weight control is not only the reason for improving of endothelia function. Pharmacological therapies with β-adrenoceptor antagonists, resveratolol, anti-obesity agents, nifedipine, and NADPH oxidase inhibitors may also be effective; however, these treatments have to be utilized under the basis of exercise and dietary controls.

Effect of 'water induced thermogenesis' on body weight, body mass index and body composition of overweight subjects

CONTEXT

Drinking lots of water is commonly suggested as a part of weight loss regimens. However, only few systematic studies have addressed this notion. In this study, the effect of drinking 1500 ml of water, over and above the daily water intake on body weight, body mass index (BMI) and body composition of overweight subjects was assessed.

AIM

To evaluate the role of drinking excessive water in weight reduction and body fat reduction of overweight subjects.

SETTINGS AND DESIGN

This study was conducted on 50 overweight girls for eight weeks, during which they were instructed to drink 500 ml of water, three times a day, half an hour before breakfast, lunch and dinner, which was over and above their daily water intake.

MATERIAL AND METHODS

Body weight was measured in kilograms (kgs). BMI was calculated as weight in kilograms, which was divided by the square of height in metres. Body composition score was calculated as a sum of skin fold thickness in millimetres at three different sites, which was measured by using skin fold calipers. Pre and post-study body weight, body mass index and body composition scores were measured.

STATISTICAL ANALYSIS

SPSS, version 14.0.1 and paired t-test were used to find out the statistical significance of the results.

RESULTS

The mean values of the pre-study and post-study body weight, body mass index and body composition scores were 65.86 kg and 64.42 kg, 26.7002 and 26.1224 and 79.626 mm and 76.578 mm respectively. All the three results were highly significant statistically.

CONCLUSIONS

The decrease in body weight, body mass index and body composition scores of overweight subjects at the end of study period establishes the role of water induced thermogenesis in weight reduction of overweight subjects.

Behavior and weight correlates of weight-control efforts in Australian women living in disadvantage: The READI study

Background

With increasing obesity rates worldwide, more and more people are actively attempting to lose weight or avoid weight gain, but relatively little is known about what specific behaviors comprise these efforts and which, if any, are associated with better weight control over time.

Methods

This paper reports relationships between body weight, weight-control efforts and related behaviors over a three-year period in 1,634 Australian women. The women were purposefully recruited from 80 disadvantaged neighborhoods in Victoria, Australia. Weight loss efforts were categorized as trying to lose weight, trying to prevent weight gain and no weight-control efforts. Behavioral correlates examined included different kinds of physical activity and consumption of a number of specific foods types.

Results and discussion

Self-reported body weight at baseline was higher in women trying to lose weight. Frequency of consumption of low energy density foods was positively associated with reported weight-control efforts, as was frequency of reported total and leisure-time physical activity. Longitudinal associations between changes in weight-control efforts and changes in behaviors were consistent with the cross-sectional findings. At three-year follow up, however, weight-control efforts were not associated with change in body weight. More detailed analyses of specific food choices suggested that part of the explanation of no effect of reported weight-control efforts and weight over time might be that people are not as well-informed as they should be about the energy density of some common foods. In particular, those reporting engagement in weight-control efforts reported reducing consumption of carbohydrate-containing foods such as bread and potatoes more than is justified by their energy content, while they reported increasing consumption of some high energy density foods (e.g., cheese and nuts).

Conclusion

It is tentatively concluded that women living in disadvantaged neighborhoods understand messages about weight-control (more activity and foods with lower fat and lower energy density) but that some foods eaten more by women engaged in weight control may reduce the effectiveness of these efforts.

Effects of reduced weight maintenance and leptin repletion on functional connectivity of the hypothalamus in obese humans

Treating obesity has proven to be an intractable challenge, in part, due to the difficulty of maintaining reduced weight. In our previous studies of in-patient obese subjects, we have shown that leptin repletion following a 10% or greater weight loss reduces many of the metabolic (decreased energy expenditure, sympathetic nervous system tone, and bioactive thyroid hormones) and behavioral (delayed satiation) changes that favor regain of lost weight. FMRI studies of these same subjects have shown leptin-sensitive increases in activation of the right hypothalamus and reduced activation of the cingulate, medial frontal and parahippocampal gryi, following weight loss, in response to food stimuli. In the present study, we expanded our cohort of in-patient subjects and employed psychophysiological interaction (PPI) analysis to examine changes in the functional connectivity of the right hypothalamus. During reduced-weight maintenance with placebo injections, the functional connectivity of the hypothalamus increased with visual areas and the dorsal anterior cingulate (dorsal ACC) in response to food cues, consistent with higher sensitivity to food. During reduced-weight maintenance with leptin injections, however, the functional connectivity of the right hypothalamus increased with the mid-insula and the central and parietal operculae, suggesting increased coupling with the interoceptive system, and decreased with the orbital frontal cortex, frontal pole and the dorsal ACC, suggesting a down-regulated sensitivity to food. These findings reveal neural mechanisms that may underlie observed changes in sensitivity to food cues in the obese population during reduced-weight maintenance and leptin repletion.

Effect of weight loss on the rate of muscle protein synthesis during fasted and fed conditions in obese older adults

Although weight loss ameliorates many of the metabolic abnormalities associated with obesity, there has been reluctance to prescribe weight loss in obese, older individuals because of the fear that it will cause debilitating loss of muscle mass and impair physical function. To gain insight into the mechanisms responsible for the weight loss-induced changes in muscle mass, we measured the rate of muscle protein synthesis (by using stable isotope labeled tracer methodology) during basal, postabsorptive conditions and during mixed meal ingestion in eight obese, older adults: (i) before weight loss therapy, (ii) ~3 months after starting the weight loss intervention (i.e., during the active weight loss phase), when subjects had lost ~7% of their initial body weight, and (iii) after they had lost ~10% of their body weight and maintained this new body weight for ~6 months (~12 months after starting the weight loss intervention). The basal muscle protein fractional synthesis rate (FSR) was not affected by weight loss. Mixed meal ingestion stimulated the rate of muscle protein synthesis, and the anabolic response (i.e., increase in the protein synthesis rate above basal values) was greater (P < 0.05) during negative energy balance and active weight loss at 3 months (0.033 ± 0.012%·per hour, mean ± s.e.m.) than during weight maintenance before and at 12 months of weight loss therapy (0.003 ± 0.003 and 0.008 ± 0.012%·per hour, respectively). We conclude that during dietary calorie restriction and weight loss in older adults, the rate of muscle protein synthesis is not impaired. Thus, the loss of muscle mass must be mediated predominately by adverse effects of dietary calorie restriction on muscle proteolysis.

Drug treatment of obesity in cardiovascular disease

Obesity is a significant health problem worldwide and is associated with a number of co-morbidities including type 2 diabetes mellitus, hypertension, dyslipidemia, obstructive sleep apnea, and cardiovascular disease. A number of different pathophysiologic mechanisms including increased inflammation, oxidative stress, and insulin resistance have been associated with initiation and progression of atherosclerotic disease in obese individuals. Lifestyle modifications have provided modest results in weight reduction and the focus of interest has now shifted towards drug development to treat severely obese individuals with a body mass index (BMI) >30 kg/m(2) or those with a BMI >27 kg/m(2) who have additional co-morbidities. Different regimens focusing on dietary absorption or acting centrally to control hunger and food intake have been developed. However, their weight loss effect is, in most cases, modest and this effect is lost once the medication is discontinued. In addition, long-term use of these drugs is limited by significant side effects and lack of long-term safety and efficacy data. Orlistat is the only US FDA-approved medication for long-term use. A number of new medications are currently under investigation in phase III trials with promising preliminary results. This review comments on available anti-obesity pharmacologic regimens, their weight-loss benefit, and their impact on cardiovascular risk factors.

Impact of obesity on orthopaedics

The prevalence of obesity among children and adults is increasing worldwide. There are substantial health risks and financial costs associated with the obesity epidemic that impact the practice of orthopaedic surgery. Patients with increased body mass index are more prone to sustaining distal extremity injuries than are those with a normal body mass index. Obese individuals are more likely than nonobese individuals to seek treatment for osteoarthritis of the knee.

The association between circulating secreted protein acidic and rich in cysteine (SPARC) and glycosylated haemoglobin (HbA(1c)) during lifestyle-modified weight reduction intervention in obese male subjects

The physiological role and clinical relevance of circulating secreted protein acidic and rich in cysteine (SPARC, or osteonectin) is still poorly understood. This study investigated the correlation between circulating SPARC and metabolic variables, including glucose and glycosylated haemoglobin (HbA(1c)), during a diet and exercise modified weight reduction intervention programme. Changes in plasma SPARC levels and several metabolic variables were analysed in asymptomatically obese, nondiabetic, male subjects before and after weight reduction intervention. Body mass index and blood pressure, serum cholesterol and HbA(1c) levels were all significantly reduced after weight reduction intervention. Multiple regression analysis demonstrated that changes in SPARC levels were significantly and positively correlated with HbA(1c). The relationship between SPARC and HbA(1c) may merit further investigation with regard to its association with postprandial or long-term glucose variation in obese male subjects.

Antiobesity effects of Chinese black tea (Pu-erh tea) extract and gallic acid

The antiobesity effects of Chinese black tea (Pu-erh tea) and of gallic acid (GA) were investigated using in vitro and in vivo assays. Chinese black tea extract (BTE) and GA inhibited pancreatic lipase activity in a dose-dependent manner in vitro; the IC(inhibitory concentration)(50) values were 101.6 and 9.2 µg/mL, respectively. Black tea extract (50, 100 mg/kg body weight (b.w.)) and GA (15, 45 mg/kg b.w.) significantly suppressed the elevation of blood triglyceride after oral administration of a corn oil emulsion (8 mL oil/kg b.w.) to male ddY mice. Moreover, the antiobesity effects of BTE and GA were also evaluated in a mouse model of diet-induced obesity. Female ddY mice were divided into seven groups; normal diet (ND) group, high fat diet (HFD) group, BTE (0.2% and 0.6% of diets) groups, and GA (0.007%, 0.02% and 0.1% of diets) groups; the experimental groups were fed the test diets for 12 weeks. The BTE 0.6% and GA 0.1% groups showed significant suppression of weight gain. The weight of parametrial adipose tissue was strongly correlated with the body weight. These results suggest that GA contributes to the antiobesity effect of BTE as an active constituent by inhibiting pancreatic lipase activity.

Anti-obesity potential of Clerodendron glandulosum.Coleb leaf aqueous extract

ETHNOPHARMACOLOGICAL RELEVANCE

Clerodendron glandulosum.Coleb leaf aqueous extract (CG) is traditionally used by people of North-East India to alleviate symptoms of diabetes, obesity and hypertension. Previous study from our laboratory have documented anti-diabetic and anti-hypertensive properties of CG extract but, till date there are no pharmacological studies available on its anti-obesity potential. This inventory investigates the underlining molecular mechanism/s of CG induced regulation of in vivo HFD induced obesity and in vitro adipocyte differentiation.

AIM

To evaluate effects of CG extract on (i) expression of genes regulating visceral adiposity and (ii) in vitro adipocyte differentiation and LEP release.

MATERIALS AND METHODS

Body weight, lee index, plasma lipids and LEP, mRNA expression of PPARγ-2, SREBP1c, FAS, CPT-1 and LEP in epididymal adipose tissue of control and experimental groups were evaluated. Also, potential of CG extract on in vitro adipocyte differentiation and LEP release was assessed.

RESULTS

Supplementation of CG extract to HFD fed mice significantly prevented HFD induced increment in bodyweight, lee index, plasma lipids and LEP, visceral adiposity and adipocyte hypertrophy. Also, CG extract supplementation resulted in down regulation of PPARγ-2, SREBP1c, FAS and LEP expression along with up-regulation of CPT-1 in epididymal adipose tissue compared to HFD fed mice. In vitro study recorded significant anti-adipogenic effect of CG extract that resulted in decreased adipogenesis, TG accumulation, LEP release, G3PDH activity along with higher glycerol release without significantly altering viability of 3T3L1 pre-adipocytes.

CONCLUSIONS

Clerodendron glandulosum.Coleb extract prevents adipocyte differentiation and visceral adiposity by down regulation of PPARγ-2 related genes and Lep expression thus validating its traditional therapeutic use in controlling obesity.

Opposing effects of chronic stress and weight restriction on cardiovascular, neuroendocrine and metabolic function

Chronic stress is associated with dysregulation of energy homeostasis, but the link between the two is largely unknown. For most rodents, periods of chronic stress reduce weight gain. We hypothesized that these reductions in weight are an additional homeostatic challenge, contributing to the chronic stress syndrome. Experiment #1 examined cardiovascular responsivity following exposure to prolonged intermittent stress. We used radio-telemetry to monitor mean arterial pressure and heart rate in freely moving, conscious rats. Three groups of animals were tested: chronic variable stress (CVS), weight-matched (WM), and controls. Using this design, we can distinguish between effects due to stress and effects due to the changing body weight. WM, but not CVS, markedly reduced basal heart rate. Although an acute stress challenge elicited similar peak heart rate, WM expedited the recovery to baseline heart rate. The data suggest that CVS prevents the weight-induced attenuation of cardiovascular stress reactivity. Experiment #2 investigated hypothalamic-pituitary-adrenal axis and metabolic hormone reactivity to novel psychogenic stress. WM increased corticosterone area under the curve. CVS blunted plasma glucose, leptin, and insulin levels in response to restraint. Experiment #3 tested the effects of WM and CVS on PVN oxytocin and corticotrophin-releasing hormone mRNA expression. CVS increased, while WM reduced PVN CRH mRNA expression, whereas both CVS and WM reduced dorsal parvocellular PVN oxytocin mRNA. Overall, the data suggest that weight loss is unlikely to account for the deleterious effects of chronic stress on the organism, but in fact produces beneficial effects that are effectively absent or indeed, reversed in the face of chronic stress exposure.

The relationship between urinary 8-hydroxydeoxyguanosine and metabolic risk factors in asymptomatic subjects

OBJECTIVE

The aim of this study was to investigate the relationship between metabolic risk factors and oxidative stress using urinary 8-hydroxydeoxyguanosine (8-OHdG), a recently utilized biological marker, in asymptomatic subjects.

METHODS

Ninety subjects (males/females = 30/60; mean age = 52 years), who were nonsmoking, nondiabetic and not on any medicine, were enrolled in the study. The body mass index, blood pressure, total cholesterol, triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and glucose as well as urinary 8-OHdG and creatinine were measured.

RESULTS

The median level of 8-OHdG was 9.3 ng/mg creatinine (interquartile range: 5.8-23.2). TG (Pearson's correlation: r = 0.262, p = 0.013) and HDL-C (r = -0.259, p = 0.014) showed a significant correlation with 8-OHdG. A multiple linear regression analysis adjusted for all the variables revealed that only TG had an independently significant and positive correlation with 8-OHdG (β = 0.231, p = 0.046).

CONCLUSION

The data in this population suggest that, among metabolic risk factors, hypertriglyceridemia may be weakly but significantly associated with hyperoxidative stress as assessed by 8-OHdG.

Vegetarian diets and public health: biomarker and redox connections

Vegetarian diets are rich in antioxidant phytochemicals. However, they may not act as antioxidants in vivo, and yet still have important signaling and regulatory functions. Some may act as pro-oxidants, modulating cellular redox tone and oxidizing redox sensitive sites. In this review, evidence for health benefits of vegetarian diets is presented from different perspectives: epidemiological, biomarker, evolutionary, and public health, as well as antioxidant. From the perspective of molecular connections between diet and health, evidence of a role for plasma ascorbic acid as a biomarker for future disease risk is presented. Basic concepts of redox-based cell signaling are presented, and effects of antioxidant phytochemicals on signaling, especially via redox tone, sulfur switches and the Antioxidant Response Element (ARE), are explored. Sufficient scientific evidence exists for public health policy to promote a plant-rich diet for health promotion. This does not need to wait for science to provide all the answers as to why and how. However, action and interplay of dietary antioxidants in the nonequilibrium systems that control redox balance, cell signaling, and cell function provide rich ground for research to advance understanding of orthomolecular nutrition and provide science-based evidence to advance public health in our aging population.

Peroxisome proliferator-activated receptors, metabolic syndrome and cardiovascular disease

Metabolic syndrome (MetS) is a constellation of risk factors including insulin resistance, central obesity, dyslipidemia and hypertension that markedly increase the risk of Type 2 diabetes (T2DM) and cardiovascular disease (CVD). The peroxisome proliferators-activated receptor (PPAR) isotypes, PPARα, PPARδ/ß and PPARγ are ligand-activated nuclear transcription factors, which modulate the expression of an array of genes that play a central role in regulating glucose, lipid and cholesterol metabolism, where imbalance can lead to obesity, T2DM and CVD. They are also drug targets, and currently, PPARα (fibrates) and PPARγ (thiazolodinediones) agonists are in clinical use for treating dyslipidemia and T2DM, respectively. These metabolic characteristics of the PPARs, coupled with their involvement in metabolic diseases, mean extensive efforts are underway worldwide to develop new and efficacious PPAR-based therapies for the treatment of additional maladies associated with the MetS. This article presents an overview of the functional characteristics of three PPAR isotypes, discusses recent advances in our understanding of the diverse biological actions of PPARs, particularly in the vascular system, and summarizes the developmental status of new single, dual, pan (multiple) and partial PPAR agonists for the clinical management of key components of MetS, T2DM and CVD. It also summarizes the clinical outcomes from various clinical trials aimed at evaluating the atheroprotective actions of currently used fibrates and thiazolodinediones.

A hassle a day may keep the pathogens away: The fight-or-flight stress response and the augmentation of immune function

Stress is known to suppress or dysregulate immune function and increase susceptibility to disease. Paradoxically, the short-term fight-or-flight stress response is one of nature's fundamental defense mechanisms that galvanizes the neuroendocrine, cardiovascular, and musculoskeletal systems into action to enable survival. Therefore, it is unlikely that short-term stress would suppress immune function at a time when it may be critically required for survival (e.g., in response to wounding and infection by a predator or aggressor). In fact, studies have shown that stress can enhance immune function under certain conditions. Several factors influence the direction (enhancing versus suppressive) of the effects of stress on immune function: (1) DURATION: acute or short-term stress experienced at the time of activation of an immune response enhances innate and adaptive immune responses. Chronic or long-term stress can suppress or dysregulate immune function. (2) Leukocyte distribution: compartments (e.g., skin), that are enriched with immune cells during acute stress show immuno-enhancement, while those that are depleted of leukocytes (e.g., blood), show immuno-suppression. (3) The differential effects of physiologic versus pharmacologic stress hormones: Endogenous hormones in physiological concentrations can have immuno-enhancing effects. Endogenous hormones at pharmacologic concentrations, and synthetic hormones, are immuno-suppressive. (4) Timing: immuno-enhancement is observed when acute stress is experienced during the early stages of an immune response while immuno-suppression may be observed at late stages. The type of immune response (protective, regulatory/inhibitory, or pathological) that is affected determines whether the effects of stress are ultimately beneficial or harmful for the organism. Arguments based on conservation of energy have been invoked to explain potential adaptive benefits of stress-induced immuno-suppression, but generally do not hold true because most mechanisms for immuno-suppression expend, rather than conserve, energy. We propose that it is important to study, and if possible, to clinically harness, the immuno-enhancing effects of the acute stress response that evolution has finely sculpted as a survival mechanism, just as we study its maladaptive ramifications (chronic stress) that evolution has yet to resolve.

Stimulant-induced changes in smoking and caloric intake: influence of rate of onset

Rate-of-onset modulates the subject-rated effects of stimulants. Results of two studies from our laboratory demonstrate that immediate-release methylphenidate increases smoking and decreases caloric intake. Whether rate-of-onset influences the effects of methylphenidate on smoking and eating is unknown. The present experiment examined the influence of a range of doses of immediate- (7.5-30 mg) and sustained-release (18-72 mg) methylphenidate as well as placebo on smoking and eating. Eight cigarette smokers participated. A double-dummy drug administration procedure was used to maintain the double blind because immediate-release methylphenidate produces peak plasma concentrations 1.5-2 h and the sustained-release formulation produces peak plasma concentrations 6-8 h after oral administration. Smoking and eating were assessed for 4 h across the predicted peak effects of both methylphenidate formulations. Measures of smoking included total cigarettes, puffs, and carbon monoxide levels. Snacks and decaffeinated beverages were available ad libitum and caloric intake was monitored during the four-hour smoking session. Immediate- and sustained-release methylphenidate increased smoking and decreased caloric intake. The effects of methylphenidate generally did not vary as a function of formulation. The results of this study may have important implications for the treatment of disorders that require stimulant medications. Smoking should be monitored in patients that are prescribed stimulant medications, regardless of the formulation type.