The importance of clinical research: the role of thermogenesis in human obesity

Pterostilbene Enhances Thermogenesis and Mitochondrial Biogenesis by Activating the SIRT1/PGC-1α/SIRT3 Pathway to Prevent Western Diet-Induced Obesity

SCOPE

Sirtuin 1/peroxisome proliferator-activated receptor gamma co-activator 1 alpha (SIRT1/PGC-1α) pathway activation is known to promote thermogenesis and mitochondrial biogenesis. Pterostilbene (PSB) and pinostilbene (PIN), the methylated analogs of resveratrol, are potential candidates to enhance thermogenesis and mitochondrial biogenesis.

METHOD AND RESULTS

A model of Western diet-induced obesity in mice is designed. Either PSB or PIN is supplemented in the diet for 16 weeks. Both samples can significantly reduce body weight gain but only PSB can decrease inguinal adipose tissue weight. Besides, both samples can promote lipolysis but only PSB supplementation activates the SIRT1/PGC-1α/SIRT3 pathway to enhance mitochondrial biogenesis and thermogenesis in the inguinal adipose tissue. In addition, although both samples exert a modulatory effect on gut microbiota but significant increments in fecal isobutyric acid, valeric acid, and isovaleric acid are only observed in the PSB group, functioning as gut microbial metabolites.

CONCLUSION

Overall, these findings suggest PSB and PIN as potential candidates for the improvement of obesity and gut microbiota dysbiosis. With its higher stability, PSB exerts a greater effect than PIN by promoting thermogenesis and mitochondrial biogenesis via SIRT1 activation.

Seasonal decrease in thermogenesis and increase in vasoconstriction explain seasonal response to N6 -cyclohexyladenosine-induced hibernation in the Arctic ground squirrel (Urocitellus parryii)

Hibernation is a seasonal phenomenon characterized by a drop in metabolic rate and body temperature. Adenosine A₁ receptor agonists promote hibernation in different mammalian species, and the understanding of the mechanism inducing hibernation will inform clinical strategies to manipulate metabolic demand that are fundamental to conditions such as obesity, metabolic syndrome, and therapeutic hypothermia. Adenosine A₁ receptor agonist-induced hibernation in Arctic ground squirrels is regulated by an endogenous circannual (seasonal) rhythm. This study aims to identify the neuronal mechanism underlying the seasonal difference in response to the adenosine A₁ receptor agonist. Arctic ground squirrels were implanted with body temperature transmitters and housed at constant ambient temperature (2°C) and light cycle (4L:20D). We administered CHA (N⁶ -cyclohexyladenosine), an adenosine A₁ receptor agonist in euthermic-summer phenotype and euthermic-winter phenotype and used cFos and phenotypic immunoreactivity to identify cell groups affected by season and treatment. We observed lower core and subcutaneous temperature in winter animals and CHA produced a hibernation-like response in winter, but not in summer. cFos-ir was greater in the median preoptic nucleus and the raphe pallidus in summer after CHA. CHA administration also resulted in enhanced cFos-ir in the nucleus tractus solitarius and decreased cFos-ir in the tuberomammillary nucleus in both seasons. In winter, cFos-ir was greater in the supraoptic nucleus and lower in the raphe pallidus than in summer. The seasonal decrease in the thermogenic response to CHA and the seasonal increase in vasoconstriction, assessed by subcutaneous temperature, reflect the endogenous seasonal modulation of the thermoregulatory systems necessary for CHA-induced hibernation. Cover Image for this issue: doi: 10.1111/jnc.14528.

Physical activity, energy expenditure and sedentary parameters in overfeeding studies - a systematic review

BACKGROUND

It has been proposed that compensations in physical activity, energy expenditure and sedentary parameters can occur as a result of overfeeding studies in order to maintain body weight; however, the evidence has not yet been systematically reviewed.

METHODS

The current study systematically reviewed the literature on this subject to determine the common tools used in overfeeding studies and to explore whether overfeeding produces changes in physical activity, energy expenditure and sedentary parameters. Eight electronic databases were searched to identify experimental studies using keywords pertaining to overfeeding, exercise, physical activity and sedentariness. Articles included healthy adults (aged 18-64 years) participating in an overfeeding study that examined at least one parameter of sedentary, energy expenditure or physical activity. Of 123 full-text articles reviewed, 15 met the inclusion criteria.

RESULTS

The common tools used in overfeeding studies were doubly labeled water (n = 6), room calorimeter (n = 4), accelerometer (n = 7), pedometer (n = 3), radar sensor (n = 4) and survey (n = 1). Parameters partaining to energy expenditure increased between 7 to 50% with different overfeeding duration. Physical activity parameters, such as number of steps and spontaneous activity, increased or decreased significantly in three studies, while five studies showed no significant change. Sedentary parameters were examined by only one study and its results were not significant after 3 days of overfeeding. Methodological issues existed concerning the small number of studies, disparities in sedentary and physical activity parameters and various definitions of free-living experimental conditions and physical activity limits.

CONCLUSIONS

There is actually a use of many tools and a large variation of parameters for physical activity in overfeeding studies. Contradictory findings showed changes in physical activity parameters following overfeeding and limited findings support the absence of changes in sedentariness. While energy expenditure parameters are more numerous and all show an increase after an overfeeding period, further studies are required to confirm changes in physical activity and sedentary parameters.

Metabolic Adaptation in Obesity and Type II Diabetes: Myokines, Adipokines and Hepatokines

Obesity and type II diabetes are characterized by insulin resistance in peripheral tissues. A high caloric intake combined with a sedentary lifestyle is the leading cause of these conditions. Whole-body insulin resistance and its improvement are the result of the combined actions of each insulin-sensitive organ. Among the fundamental molecular mechanisms by which each organ is able to communicate and engage in cross-talk are cytokines or peptides which stem from secretory organs. Recently, it was reported that several cytokines or peptides are secreted from muscle (myokines), adipose tissue (adipokines) and liver (hepatokines) in response to certain nutrition and/or physical activity conditions. Cytokines exert autocrine, paracrine or endocrine effects for the maintenance of energy homeostasis. The present review is focused on the relationship and cross-talk amongst muscle, adipose tissue and the liver as secretory organs in metabolic diseases.

The 2012 CDA-CIHR INMD young investigator award lecture: dysfunction of adipose tissues and the mechanisms of ectopic fat deposition in type 2 diabetes

Ectopic fat deposition in skeletal muscles, liver, heart, and other tissues has been closely linked with the development of lean tissues' insulin resistance and progression toward type 2 diabetes mellitus. Mechanisms of overexposure of these tissues to fatty acids include increased de novo lipogenesis, impaired fatty acid oxidation and increased fatty acid flux to these organs. White adipose tissues are the main organs responsible for the regulation of circulating fatty acids. It has been clearly demonstrated that pre-diabetes individuals and individuals with diabetes display impaired adipose tissue dietary fatty acid storage that may lead to increased circulating flux and exaggerated lean tissue fatty acid exposure. Additionally, brown adipose tissue depots are less metabolically active in individuals with type 2 diabetes. We have developed a series of novel in vivo investigative tools using positron emission tomography to comprehensively assess postprandial interorgan fatty acid partitioning and white and brown adipose tissue metabolism in subjects with pre-diabetes and type 2 diabetes. Our findings shed new lights into the sophisticated mechanisms that regulate fatty acid partitioning and energy homeostasis during the development of type 2 diabetes. New links between abnormal dietary fatty acid metabolism and early myocardial metabolic and functional defects are now being uncovered in humans with the hope to find novel ways to predict and avoid the devastating complications of diabetes.

Adaptive thermogenesis in human body weight regulation: more of a concept than a measurable entity?

According to Lavoisier, 'Life is combustion'. But to what extent humans adapt to changes in food intake through adaptive thermogenesis--by turning down the rate of heat production during energy deficit (so as to conserve energy) or turning it up during overnutrition (so as to dissipate excess calories)--has been one of the most controversial issues in nutritional sciences over the past 100 years. The debate nowadays is not whether adaptive thermogenesis exists or not, but rather about its quantitative importance in weight homoeostasis and its clinical relevance to the pathogenesis and management of obesity. Such uncertainties are likely to persist in the foreseeable future primarily because of limitations to unobtrusively measure changes in energy expenditure and body composition with high enough accuracy and precision, particularly when even small inter-individual variations in thermogenesis can, in dynamic systems and over the long term, be important in the determining weight maintenance in some and obesity and weight regain in others. This paper reviews the considerable body of evidence, albeit fragmentary, suggesting the existence of quantitatively important adaptive thermogenesis in several compartments of energy expenditure in response to altered food intake. It then discusses the various limitations that lead to over- or underestimations in its assessment, including definitional and semantics, technical and methodological, analytical and statistical. While the role of adaptive thermogenesis in human weight regulation is likely to remain more a concept than a strictly 'quantifiable' entity in the foreseeable future, the evolution of this concept continues to fuel exciting hypothesis-driven mechanistic research which contributes to advance knowledge in human metabolism and which is bound to result in improved strategies for the management of a healthy body weight.

AFestschriftfor Roland L. Weinsier: Nutrition Scientist, Educator, and Clinician1

Roland L. Weinsier, M.D., Dr.P.H., devoted himself to the fields of nutrition and obesity for more than 35 years. He contributed outstanding work related to the treatment of obesity through dietary and lifestyle change; metabolic/energetic influences on obesity, weight loss, and weight regain; body composition changes accompanying weight loss and regain; the health benefits and risks of weight loss; nutrition education for physicians; and nutrition support of sick patients. He served on the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) National Task Force on Prevention and Treatment of Obesity, as Chair of the University of Alabama at Birmingham's Department of Nutrition Sciences, and as Founder and Director of its NIDDK-funded Clinical Nutrition Research Center. He was a long-time and active member of NAASO, serving in the roles of Councilor, Publications Committee Chair, Continuing Medical Education Course Director, Public Relations Committee Chair, and Membership Committee Co-Chair, to name just a few. He was well respected as a staunch defender of NAASO's scientific integrity in these roles. Sadly, Roland Weinsier died on November 27, 2002. He will be missed and remembered by many as a revered and beloved teacher, mentor, healer, and scholar.

Transcultural diabetes nutrition therapy algorithm: the Asian Indian application

India and other countries in Asia are experiencing rapidly escalating epidemics of type 2 diabetes (T2D) and cardiovascular disease. The dramatic rise in the prevalence of these illnesses has been attributed to rapid changes in demographic, socioeconomic, and nutritional factors. The rapid transition in dietary patterns in India-coupled with a sedentary lifestyle and specific socioeconomic pressures-has led to an increase in obesity and other diet-related noncommunicable diseases. Studies have shown that nutritional interventions significantly enhance metabolic control and weight loss. Current clinical practice guidelines (CPGs) are not portable to diverse cultures, constraining the applicability of this type of practical educational instrument. Therefore, a transcultural Diabetes Nutrition Algorithm (tDNA) was developed and then customized per regional variations in India. The resultant India-specific tDNA reflects differences in epidemiologic, physiologic, and nutritional aspects of disease, anthropometric cutoff points, and lifestyle interventions unique to this region of the world. Specific features of this transculturalization process for India include characteristics of a transitional economy with a persistently high poverty rate in a majority of people; higher percentage of body fat and lower muscle mass for a given body mass index; higher rate of sedentary lifestyle; elements of the thrifty phenotype; impact of festivals and holidays on adherence with clinic appointments; and the role of a systems or holistic approach to the problem that must involve politics, policy, and government. This Asian Indian tDNA promises to help guide physicians in the management of prediabetes and T2D in India in a more structured, systematic, and effective way compared with previous methods and currently available CPGs.

Control and physiological determinants of sympathetically mediated brown adipose tissue thermogenesis

Brown adipose tissue (BAT) represents a remarkable heat-producing tissue. The thermogenic potential of BAT is conferred by uncoupling protein 1, a protein found uniquely in brown adipocytes. BAT activity and capacity is controlled by the sympathetic nervous system (SNS), which densely innervates brown fat depots. SNS-mediated BAT thermogenesis is essentially governed by hypothalamic and brainstem neurons. BAT activity is also modulated by brain energy balance pathways including the very significant brain melanocortin system, suggesting a genuine involvement of SNS-mediated BAT thermogenesis in energy homeostasis. The use of positron emission tomography/computed tomography scanning has revealed the presence of well-defined BAT depots in the cervical, clavicular, and paraspinal areas in adult humans. The prevalence of these depots is higher in subjects exposed to low temperature and is also higher in women compared to men. Moreover, the prevalence of BAT decreases with age and body fat mass, suggesting that BAT could be involved in energy balance regulation and obesity in humans. This short review summarizes recent progress made in our understanding of the control of SNS-mediated BAT thermogenesis and of the determinants of BAT prevalence or detection in humans.

Elucidation of thrifty features in adult rats exposed to protein restriction during gestation and lactation

Since the introduction of the thrifty phenotype hypothesis, the potential traits of thrift have been described in increasingly broad terms but biochemical and behavioral evidence of thrift has not been well demonstrated. The objective of our studies was to use a rodent model to identify features of thrift programmed by early life protein restriction. Robust programming of thrifty features requires a thrifty nutritional environment during the entire window of developmental plasticity. Therefore, pregnant rats were exposed to a low protein diet throughout the window of developmental plasticity spanning the period of gestation and lactation and its effects on energy acquisition, storage and expenditure in the adult offspring were examined. Maternal protein restriction reduced birth weight and produced long term reductions in body and organ weights in the offspring. Low protein offspring demonstrated an increased drive to seek food as evidenced by hyperphagia that was mediated by changes in plasma leptin and ghrelin levels. Hyperphagia was accompanied by increased efficiency in converting caloric intake into body mass. The higher feed efficiency was mediated by greater insulin sensitivity. Energy expenditure of low protein offspring in locomotion was not affected either in the light or dark phase. However, low protein offspring exhibited higher resting and basal metabolic rates as evidenced by higher core body temperature in the fed and fasted states. The increased thermogenesis was not mediated by thyroid hormones but by an increased sympathetic nervous system drive as reflected by a lower areal bone mineral density and bone mineral content and lower plasma adiponectin and triglyceride levels. Elevated thermogenesis in the low protein offspring possibly offsets the effects of hyperphagia, minimizes their chances of weight gain, and improves survivability. This constellation of metabolic features in the low protein offspring will maximize survival potential in a post natal environment of nutritional scarcity and constitute a thrifty phenotype.

Relation of body composition to daily physical activity in free-living Japanese adult women

The objective of the present study was to investigate the relationship between the indices of body size such as BMI, fat-free mass index (FFMI, FFM/height2), fat mass index (FMI, FM/height2), and body fat percentage (%BF), and physical activities assessed by the doubly-labelled water (DLW) method and an accelerometer in free-living Japanese adult women. We conducted a cross-sectional study in 100 female subjects ranging in age from 31 to 69 years. Subjects were classified in quartiles of BMI, FFMI, FMI and %BF. Daily walking steps and the duration of light to vigorous physical activity were simultaneously assessed by an accelerometer for the same period as the DLW experiment. Only physical activity-related energy expenditure (PAEE)/FFM and PAEE/body weight (BW) decreased in the highest quartile of BMI. Physical activity level, PAEE/FFM and PAEE/BW decreased in the highest quartile of FMI and %BF, whereas they were not different among quartiles of FFMI. Daily walking steps and the duration of moderate- and vigorous-intensity physical activities decreased or tended to decrease in the highest quartile of FMI and %BF, but did not differ among quartiles of FFMI and BMI. These results clearly showed that Japanese adult women with higher fat deposition obviously had a low level of physical activities assessed by both the DLW method and accelerometry, but those with larger BMI had lower PAEE/FFM and PAEE/BW only. Our data suggest that the relationship between obesity and daily physical activities should be discussed using not only BMI but also FMI or %BF.

Influence of resting energy expenditure on weight gain in adolescents taking second-generation antipsychotics

BACKGROUND & AIMS

Weight gain is an undesirable side effect of second-generation antipsychotics (SGAs). We performed this study to examine the influence of SGAs on resting energy expenditure (REE) and the relationship of REE to weight gain in adolescent patients.

METHODS

Antipsychotic-naïve or quasi-naïve (<72 h of exposure to antipsychotics) adolescent patients taking olanzapine, quetiapine, or risperidone in monotherapy were followed up for one year. We performed a prospective study (baseline, 1, 3, 6, and 12 months after treatment) based on anthropometric measurements, bioelectrical impedance analysis, and indirect calorimetry (Deltatrac™ II MBM-200) to measure REE. We also analyzed metabolic and hormonal data and adiponectin concentrations.

RESULTS

Forty-six out of the 54 patients that started treatment attended at least 2 visits, and 16 completed 1 year of follow-up. Patients gained 10.8 ± 6.2 kg (60% in the form of fat mass) and increased their waist circumference by 11.1 ± 5.0 cm after 1 year of treatment. The REE/kg body mass ratio decreased (p = 0.027), and the REE/percentage fat-free mass (FFM) ratio increased (p = 0.007) following the fall in the percentage of FFM during treatment. Weight increase was significantly correlated with the REE/percentage FFM ratio at all the visits (1-3-6-12 months) (r = 0.69, p = 0.004 at 12 months).

CONCLUSIONS

SGAs seem to induce a hypometabolic state (reflected as decreased REE/kg body mass and increased REE/percentage FFM). This could explain, at least in part, the changes in weight and body composition observed in these patients.

The role of the myosin ATPase activity in adaptive thermogenesis by skeletal muscle

Resting skeletal muscle is a major contributor to adaptive thermogenesis, i.e., the thermogenesis that changes in response to exposure to cold or to overfeeding. The identification of the “furnace” that is responsible for increased heat generation in resting muscle has been the subject of a number of investigations. A new state of myosin, the super relaxed state (SRX), with a very slow ATP turnover rate has recently been observed in skeletal muscle (Stewart et al. in Proc Natl Acad Sci USA 107:430–435, 2010). Inhibition of the myosin ATPase activity in the SRX was suggested to be caused by binding of the myosin head to the core of the thick filament in a structural motif identified earlier by electron microscopy. To be compatible with the basal metabolic rate observed in vivo for resting muscle, most myosin heads would have to be in the SRX. Modulation of the population of this state, relative to the normal relaxed state, was proposed to be a major contributor to adaptive thermogenesis in resting muscle. Transfer of only 20% of myosin heads from the SRX into the normal relaxed state would cause muscle thermogenesis to double. Phosphorylation of the myosin regulatory light chain was shown to transfer myosin heads from the SRX into the relaxed state, which would increase thermogenesis. In particular, thermogenesis by myosin has been proposed to play a role in the dissipation of calories during overfeeding. Up-regulation of muscle thermogenesis by pharmaceuticals that target the SRX would provide new approaches to the treatment of obesity or high blood sugar levels.

[Advances in pathophysiological concepts of obesity]

Obesity is defined as an increase in fat mass, which reflects the inefficiency of the system regulating energy homeostasis to resist against the pressure of environmental and genetic factors. Obesity constitutes itself into several phases to reach a real pathology of adipose tissue, seat of large functional alterations. There is a continuum of obesity forms, from purely genetic forms to purely environmental forms. Within this continuum, genetic and environmental determinants interaction is the rule. The role of gut flora has become a new interesting line of research in the pathophysiology of obesity.

Diet, nutrition and the prevention of type 2 diabetes

Objectives:

The overall objective of this study was to evaluate and provide evidence and recommendations on current published literature about diet and lifestyle in the prevention of type 2 diabetes.

Design:

Epidemiological and experimental studies, focusing on nutritional intervention in the prevention of type 2 diabetes are used to make disease-specific recommendations. Long-term cohort studies are given the most weight as to strength of evidence available.

Setting and subjects:

Numerous clinical trials and cohort studies in low, middle and high income countries are evaluated regarding recommendations for dietary prevention of type 2 diabetes. These include, among others, the Finnish Diabetes Prevention Study, US Diabetes Prevention Program, Da Qing Study; Pima Indian Study; Iowa Women's Health Study; and the study of the US Male Physicians.

Results:

There is convincing evidence for a decreased risk of diabetes in adults who are physically active and maintain a normal body mass index (BMI) throughout adulthood, and in overweight adults with impaired glucose tolerance who lose weight voluntarily. An increased risk for developing type 2 diabetes is associated with overweight and obesity; abdominal obesity; physical inactivity; and maternal diabetes. It is probable that a high intake of saturated fats and intrauterine growth retardation also contribute to an increased risk, while non-starch polysaccharides are likely to be associated with a decreased risk. From existing evidence it is also possible that omega-3 fatty acids, low glycaemic index foods and exclusive breastfeeding may play a protective role, and that total fat intake andtransfatty acids may contribute to the risk. However, insufficient evidence is currently available to provide convincing proof.

Conclusions:

Based on the strength of available evidence regarding diet and lifestyle in the prevention of type 2 diabetes, it is recommended that a normal weight status in the lower BMI range (BMI 21–23) and regular physical activity be maintained throughout adulthood; abdominal obesity be prevented; and saturated fat intake be less than 7% of the total energy intake.

Evolving resistance to obesity in an insect

Failure to adapt to a changing nutritional environment comes at a cost, as evidenced by the modern human obesity crisis. Consumption of energy-rich diets can lead to obesity and is associated with deleterious consequences not only in humans but also in many other animals, including insects. The question thus arises whether animals restricted over multiple generations to high-energy diets can evolve mechanisms to limit the deposition of adverse levels of body fat. We show that Plutella xylostella caterpillars reared for multiple generations on carbohydrate-rich foods (either a chemically defined artificial diet or a high-starch Arabidopsis mutant) progressively developed the ability to eat excess carbohydrate without laying it down as fat, providing strong evidence that excess fat storage has a fitness cost. In contrast, caterpillars reared in carbohydrate-scarce environments (a chemically defined artificial diet or a low-starch Arabidopsis mutant) had a greater propensity to store ingested carbohydrate as fat. Additionally, insects reared on the low-starch Arabidopsis mutant evolved a preference for laying their eggs on this plant, whereas those selected on the high-starch Arabidopsis mutant showed no preference. Our results provide an experimental example of metabolic adaptation in the face of changes in the nutritional environment and suggest that changes in plant macronutrient profiles may promote host-associated population divergence.

Within- and between-individual variability in estimated energy expenditure and habitual physical activity among young adults

OBJECTIVE

To examine the within- and between-individual variability in the estimated total energy expenditure (TEE) and habitual physical activity (PA) in free-living young adults. We were specifically interested in the day-to-day variation.

DESIGN

Cross-sectional.

SETTING

University.

SUBJECTS

A total of 277 (125 males, 152 females) participants aged 18-24 years.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Subjects recorded their daily PA with the Bouchard 3-day diary. Descriptive statistics for TEE, moderate-to-vigorous physical activity (MVPA), inactivity (IA), and activity energy expenditure (AEE) were calculated and presented as a frequency distribution. Within- and between-individual variability were tested by RMANOVA and also presented as the coefficient of variation (CV).

RESULTS

Mean values for TEE, MVPA, AEE, and IA were comparable between males and females; however, considerable between-individual variability existed. Only MVPA showed a significant difference between sexes (P<0.05), due to slightly greater vigorous PA in males compared to females (8.0 and 6.8 kcal/kg/day, respectively; P=0.12). Results from the RMANOVA revealed no significant day-to-day variability in any TEE or PA variable and the CVs were not significantly different between males and females. TEE and IA displayed mean CVs of approximately 12% while mean CVs for AEE and MVPA approximated 32 and 84%, respectively.

CONCLUSIONS

Results from this study suggest (1) a limited day-to-day variability in TEE and (2) a large degree of between-individual variation for TEE and PA exist. This study highlights the importance of understanding the variability associated with TEE, which is important for PA measurement and proper PA and nutritional recommendations.

SPONSORSHIP

None.

The Financial Reality of Overeating

OBJECTIVE

Obesity has been linked to frequency of meals eaten outside the home and the associated large portion sizes. These large portions, which have been shown to promote overeating, are often offered for a small additional cost which may appear economical to the consumer. The aim of this study was to calculate additional costs from medical, gasoline, and increased caloric needs that result from weight gain attributable to overeating and thus provide consumers with added incentive not to upsize their meal, or overeat in general.

METHODS

The effects and costs of overeating were estimated for men and women with a BMI of 22.5, 27.5, and 32.5 by conducting a Pubmed search for relevant literature combined with US statistics obtained from open Federal and other websites.

RESULTS

Among fast food restaurants, the average upsized meal increases energy content of the meal from 927 to 1324 kcal at an added cost of Dollar 0.67. Because the regular meal is already 37% of a 2500 kcal diet, the extra energy of upsizing is likely to be in excess of need and thus potentially stored as 36 grams of added adipose tissue. This hypothesized weight gain predicts an average increase auto fuel cost by Dollar 0.05 for both men and women, maintenance food cost by Dollar 0.36 and Dollar 0.35 for men and women, respectively, and health care cost from Dollar 0.82 to Dollar 6.64.

CONCLUSIONS

These calculated costs exceed the value of upsized meals and may provide motivation to some consumers not to upsize their meals. The same rationale can be applied to other environments notorious for encouraging overeating. Thus, this information could be presented to individuals along with other more well publicized health risks and consequences during weight control counseling.

PPAR delta: a dagger in the heart of the metabolic syndrome

Obesity is a growing threat to global health by virtue of its association with insulin resistance, glucose intolerance, hypertension, and dyslipidemia, collectively known as the metabolic syndrome or syndrome X. The nuclear receptors PPARalpha and PPARgamma are therapeutic targets for hypertriglyceridemia and insulin resistance, respectively, and drugs that modulate these receptors are currently in clinical use. More recent work on the less-described PPAR isotype PPARdelta has uncovered a dual benefit for both hypertriglyceridemia and insulin resistance, highlighting the broad potential of PPARdelta in the treatment of metabolic disease. PPARdelta enhances fatty acid catabolism and energy uncoupling in adipose tissue and muscle, and it suppresses macrophage-derived inflammation. Its combined activities in these and other tissues make it a multifaceted therapeutic target for the metabolic syndrome with the potential to control weight gain, enhance physical endurance, improve insulin sensitivity, and ameliorate atherosclerosis.

Obesity: the protein leverage hypothesis

The obesity epidemic is among the greatest public health challenges facing the modern world. Regarding dietary causes, most emphasis has been on changing patterns of fat and carbohydrate consumption. In contrast, the role of protein has largely been ignored, because (i) it typically comprises only approximately 15% of dietary energy, and (ii) protein intake has remained near constant within and across populations throughout the development of the obesity epidemic. We show that, paradoxically, these are precisely the two conditions that potentially provide protein with the leverage both to drive the obesity epidemic through its effects on food intake, and perhaps to assuage it. We formalize this hypothesis in a mathematical model. Some supporting epidemiological, experimental and animal data are presented, and predictions are made for future testing.

RESISTANCE TO EXCESSIVE BODYWEIGHT GAIN IN RISPERIDONE-INJECTED RATS

1. The present study was carried out to explain the resistance of rats injected subcutaneously with risperidone, the atypical antipsychotic drug, for 21 consecutive days at 0.1 mg/kg per day (a dose equivalent to the one used for patients) to result in an excessive bodyweight despite the increase in diet-uptake in rats against risperidone-induced decrease in body temperature. 2. Rectal temperature measurements were made in 8-week-old male Sprague-Dawley rats maintained under standard laboratory conditions using a 12 h daylight cycle. A s.c. injection of risperidone (0.05 mg/kg) produced hypothermia in rats, which was observed during the daily injection for 21 consecutive days. 3. Sera, white and brown adipose tissues, skeletal muscle and liver were extracted from 8-week-old male Sprague-Dawley rats injected subcutaneously with risperidone (0.01 or 0.1 mg/kg per day) or a vehicle for 21 consecutive days. Serum levels of lipids, ketones and thyroid hormone were measured. The mRNA expression levels in these tissues and organs of the genes encoding the substances involved in heat production and/or lipid metabolism were investigated by using quantitative real-time polymerase chain reaction amplification. 4. Serum nonesterified fatty acid levels in risperidone 0.1 mg/kg per day s.c. injected rats were significantly lower than those in vehicle-injected ones. Serum beta-hydroxybutyrate levels in risperidone-injected rats tended to decrease compared with those in vehicle-injected ones. The serum level of neither triiodothyronine nor thyroxine was affected by risperidone s.c. injection at the doses examined, although their values were within normal limits. 5. Risperidone injection (0.1 mg/kg per day) for 21 consecutive days upregulated mRNA expressions in white adipose tissue of uncoupling protein 3 which dissipates energy as heat; peroxisome proliferator-activated receptor (PPAR) gamma coactivator 1alpha which activates mitochondrial biogenesis to expand the oxidative machinery; and PPARalpha which is necessary for the fat-depletion of adipocytes for thermogenesis. The mRNA of lipogenic enzymes (acetyl-CoA carboxylase alpha, fatty-acid synthase and glycerol-3-phosphate acyltransferase), hormone sensitive lipase and beta1-adrenoceptor were also enhanced in white adipose tissue by the injection of 0.1 mg/kg per day risperidone. 6. These findings suggest that the materials for heat generation in white adipose tissue would be readily supplied, which in turn would reduce a storage of lipids in white adipose tissue resulting in the lower rate of bodyweight gain of rats.

Non-exercise activity thermogenesis (NEAT)

Non-exercise activity thermogenesis (NEAT) is the energy expended for everything we do that is not sleeping, eating or sports-like exercise. NEAT can be measured by one of two approaches. The first approach is to measure or estimate total NEAT. Here, total daily energy expenditure is measured and from it, the basal metabolic rate-plus-thermic effect of food is subtracted. The second approach is the factoral approach whereby the components of NEAT are quantified and total NEAT calculated by summing these components. The amount of NEAT that humans perform represents the product of the amount and types of physical activities and the thermogenic cost of each activity. The factors that impact a human's NEAT are readily divisible in biological factors such as weight, gender and body composition and environmental factors such occupation or dwelling within a "concrete jungle." The impact of these factors combined explains the substantial variance in human NEAT. The variability in NEAT might be viewed as random and unprogrammed but human data contradict this thesis. It appears that changes in NEAT accompany experimentally induced changes in energy balance and may be important in the physiology of weight change. NEAT and a sedentary lifestyle may thus be of profound importance in obesity.

Nonexercise activity thermogenesis (NEAT): environment and biology

Nonexercise activity thermogenesis (NEAT) is the energy expended for everything that is not sleeping, eating, or sports-like exercise. It includes the energy expended walking to work, typing, performing yard work, undertaking agricultural tasks, and fidgeting. NEAT can be measured by one of two approaches. The first is to measure or estimate total NEAT. Here, total daily energy expenditure is measured, and from it "basal metabolic rate-plus-thermic effect of food" is subtracted. The second is the factoral approach, whereby the components of NEAT are quantified, and total NEAT is calculated by summing these components. The amount of NEAT that humans perform represents the product of the amount and types of physical activities and the thermogenic cost of each activity. The factors that impact a human's NEAT are readily divisible into environmental factors, such as occupation or dwelling within a "concrete jungle," and biological factors such as weight, gender, and body composition. The combined impact of these factors explains the substantial variance in human NEAT. The variability in NEAT might be viewed as random, but human and animal data contradict this. It appears that changes in NEAT subtly accompany experimentally induced changes in energy balance and are important in the physiology of weight change. Inadequate modulation of NEAT plus a sedentary lifestyle may thus be important in obesity. It then becomes intriguing to dissect mechanistic studies that delineate how NEAT is regulated into neural, peripheral, and humoral factors. A scheme is described in this review in which NEAT corresponds to a carefully regulated "tank" of physical activity that is crucial for weight control.

Non-exercise activity thermogenesis

Non-exercise activity thermogenesis (NEAT) is the energy expended that is not from sleeping, eating or sports-like exercise. It ranges from the energy expended walking to work, typing, performing yard work, undertaking agricultural tasks and fidgeting. NEAT can be measured by one of two approaches. The first approach is to measure or estimate total NEAT. Here, total daily energy expenditure is measured and from it is subtracted BMR + thermic effect of food. The second is the factoral approach whereby the components of NEAT are quantified and total NEAT calculated by summing these components. The amount of NEAT that human subjects perform represents the product of the amount and types of physical activities and the thermogenic cost of each activity. The factors that affect the NEAT of a human subject are readily divisible into biological factors, such as weight, gender and body composition, and environmental factors, such as occupation or dwelling within a 'concrete jungle'. The combined impact of these factors explains the substantial variance in human NEAT. The variability in NEAT might be viewed as random but human data contradict this perception. It appears that changes in NEAT subtly accompany experimentally-induced changes in energy balance and are important in the physiology of weight change. NEAT and sedentariness may thus be important in obesity. It then becomes intriguing to dissect mechanistic studies that delineate how NEAT is regulated by neural, peripheral and humoral factors. NEAT may be a carefully-regulated 'tank' of physical activity that is crucial for weight control.

Non-exercise activity thermogenesis (NEAT)

Non-exercise activity thermogenesis (NEAT) is the energy expended for everything we do that is not sleeping, eating or sports-like exercise. It ranges from the energy expended walking to work, typing, performing yard work, undertaking agricultural tasks and fidgeting. Even trivial physical activities increase metabolic rate substantially and it is the cumulative impact of a multitude of exothermic actions that culminate in an individual's daily NEAT. It is, therefore, not surprising that NEAT explains a vast majority of an individual's non-resting energy needs. Epidemiological studies highlight the importance of culture in promoting and quashing NEAT. Agricultural and manual workers have high NEAT, whereas wealth and industrialization appear to decrease NEAT. Physiological studies demonstrate, intriguingly, that NEAT is modulated with changes in energy balance; NEAT increases with overfeeding and decreases with underfeeding. Thus, NEAT could be a critical component in how we maintain our body weight and/or develop obesity or lose weight. The mechanism that regulates NEAT is unknown. However, hypothalamic factors have been identified that specifically and directly increase NEAT in animals. By understanding how NEAT is regulated we may come to appreciate that spontaneous physical activity is not spontaneous at all but carefully programmed.

betaAR signaling required for diet-induced thermogenesis and obesity resistance

Excessive caloric intake is thought to be sensed by the brain, which then activates thermogenesis as a means of preventing obesity. The sympathetic nervous system, through beta-adrenergic receptor (betaAR) action on target tissues, is likely the efferent arm of this homeostatic mechanism. To test this hypothesis, we created mice that lack the three known betaARs (beta-less mice). beta-less mice on a Chow diet had a reduced metabolic rate and were slightly obese. On a high-fat diet, beta-less mice, in contrast to wild-type mice, developed massive obesity that was due entirely to a failure of diet-induced thermogenesis. These findings establish that betaARs are necessary for diet-induced thermogenesis and that this efferent pathway plays a critical role in the body's defense against diet-induced obesity.

Leptin potentiates thermogenic sympathetic responses to hypothermia: a receptor-mediated effect

Leptin contributes to the regulation of thermogenesis. In rodents, sympathetic nerve activity efferent to interscapular brown adipose tissue (IBAT-SNA) is involved. On the basis of the hypotheses that 1) leptin acutely potentiates hypothermia-induced increases in IBAT-SNA; 2) this action of leptin is specific to IBAT-SNA, i.e., it does not occur with renal sympathetic nerve activity (R-SNA); and 3) this effect of leptin depends on intact and functional leptin receptors, we measured IBAT-SNA and R-SNA in anesthetized lean and diet-induced obese Sprague-Dawley and in obese Zucker rats, randomly assigned to low-dose leptin or vehicle. Before the start of leptin or vehicle and 5 min, 90 min, and 180 min after, hypothermia (30 degrees C) was induced. Compared with vehicle, leptin did not significantly alter baseline R-SNA or IBAT-SNA. In lean Sprague-Dawley rats, hypothermia-induced increases in IBAT-SNA were significantly augmented by leptin but not by vehicle. In obese Sprague-Dawley rats, leptin did not potentiate hypothermia-induced increases in IBAT-SNA. In Zucker rats, IBAT-SNA did not increase with hypothermia and leptin was not able to induce sympathoactivation with cooling. Changes in R-SNA during hypothermia were not significantly modified by leptin in either group. Thus, low-dose leptin, although not altering baseline SNA, acutely enhances hypothermia-induced sympathetic outflow to IBAT in lean rats. This effect is specific for thermogenic SNA because leptin does not significantly alter the response of R-SNA to hypothermia. The effect depends on intact and functional leptin receptors because it occurs neither in rats with a leptin receptor defect nor in rats with acquired leptin resistance.

Human obesity: an evolutionary approach to understanding our bulging waistline

The unique worldwide spread of the human species and the remarkably long post-reproductive survival show that our genome permits excellent adaptation to vastly different environments. Moreover, the main scourges of later age, namely malignant growths and atherosclerosis, appear in humans later than in shorter-living animals. In recent years, excess weight and obesity have become mass phenomena with a pronounced upward trend in all developed countries. However, despite the detrimental effects of being overweight, these populations live longer than ever, which in part may be explained by the availability of better medical treatment. The prevalence and predicted further spread of obesity can be understood in the light of evolution. In all animal species energy metabolism is asymmetric with energy accumulation ('thrifty genotype') being the necessary condition of survival during hard times. For humans, which are no different to other animals in this respect, this genetic programming was necessary for survival because during the course of history, including the recorded history in the more developed Middle East, Europe or China, there was never a long period of uninterrupted food abundance, whereas famines were regular and frequent. Therefore fat accumulation, when food was available, meant survival at times of shortage, while the possible detrimental effects of overindulgence in food and being overweight expressed in unrealistically old age were irrelevant. It is the central, mostly intra-abdominal fat (in both humans and animals) that is more medically important than the subcutaneous truncal fat, and the accumulation of both types of fat is conditioned by high food consumption; therefore it is a historic novelty for human populations. In contrast, lower-body fat in human females is unique in the animal kingdom: it is much less metabolically active, it is of much lower pathologic significance than central fat, and it is programmed to be mobilized mostly during pregnancy and lactation. In view of all this, norms of desired weight should be based on hard mortality and morbidity statistics and not on theoretical, esthetic or fashion considerations. By this criterion, the upper limit of desirable weight is likely to be body mass index (BMI) 27 or 28, but specified for different populations (sex, race, ethnic origin); moreover, with aging, the detrimental effects of obesity diminish and finally disappear. Risks of other pathologies related to obesity (e.g. diabetes, hypertension and coronary disease) are also population-specific. However, total fatness, measured by BMI, is insufficiently sensitive as a risk factor, and fat distribution (upper-body versus low-body type, as reflected by waist circumference and waist:hip ratio) plays at least as prominent a role. Therefore the detailed norms, not yet available, should take into account both general obesity and fat distribution and be specific for different populations. Since long-term weight loss in adults is rarely achievable, public health measures should be aggressively directed at the prevention of obesity from childhood.