Expenditure and storage of energy in man

Platform for the interdisciplinary study of cardiovascular, metabolic and neurovascular diseases (PICMAN) protocol

Through extensive multisystem phenotyping, the central aim of Project PICMAN is to correlate metabolic flexibility to measures of cardiometabolic health, including myocardial diastolic dysfunction, coronary and cerebral atherosclerosis, body fat distribution and severity of non-alcoholic fatty liver disease. This cohort will form the basis of larger interventional trials targeting metabolic inflexibility in the prevention of cardiovascular disease. Participants aged 21-72 years with no prior manifest atherosclerotic cardiovascular disease (ASCVD) are being recruited from a preventive cardiology clinic and an existing cohort of non-alcoholic fatty liver disease (NAFLD) in an academic medical centre. A total of 120 patients will be recruited in the pilot phase of this study and followed up for 5 years. Those with 10-year ASCVD risk ≥ 5% as per the QRISK3 calculator are eligible. Those with established diabetes mellitus are excluded. Participants recruited undergo a detailed assessment of health behaviours and physical measurements. Participants also undergo a series of multimodality clinical phenotyping comprising cardiac tests, vascular assessments, metabolic tests, liver and neurovascular testing. Blood samples are also being collected and banked for plasma biomarkers, 'multi-omics analyses' and for generation of induced pluripotent stem cells (iPSC). Extensive evidence points to metabolic dysregulation as an early precursor of cardiovascular disease, particularly in Asia. We hypothesise that quantifiable metabolic inflexibility may be representative of an individual in his/her silent, but high-risk progression towards insulin resistance, diabetes and cardiovascular disease. The platform for interdisciplinary cardiovascular-metabolic-neurovascular diseases (PICMAN) is a pilot, prospective, multi-ethnic cohort study.

Genistein-mediated thermogenesis and white-to-beige adipocyte differentiation involve transcriptional activation of cAMP response elements in the Ucp1 promoter

Genistein is an isoflavone present in soybeans and is considered a bioactive compound due to its widely reported biological activity. We have previously shown that intraperitoneal genistein administration and diet supplementation activates the thermogenic program in rats and mice subcutaneous white adipose tissue (scWAT) under multiple environmental cues, including cold exposure and high-fat diet feeding. However, the mechanistic insights of this process were not previously unveiled. Uncoupling protein 1 (UCP1), a mitochondrial membrane polypeptide responsible for dissipating energy into heat, is considered the most relevant thermogenic marker; thus, we aimed to evaluate whether genistein regulates UCP1 transcription. Here we show that genistein administration to thermoneutral-housed mice leads to the appearance of beige adipocyte markers, including a sharp upregulation of UCP1 expression and protein abundance in scWAT. Reporter assays showed an increase in UCP1 promoter activity after genistein stimulation, and in silico analysis revealed the presence of estrogen (ERE) and cAMP (CRE) response elements as putative candidates of genistein activation. Mutation of the CRE but not the ERE reduced genistein-induced promoter activity by 51%. Additionally, in vitro and in vivo ChIP assays demonstrated the binding of CREB to the UCP1 promoter after acute genistein administration. Taken together, these data elucidate the mechanism of genistein-mediated UCP1 induction and confirm its potential applications in managing metabolic disorders.

The elusive cephalic phase insulin response: triggers, mechanisms, and functions

The cephalic phase insulin response (CPIR) is classically defined as a head receptor-induced early release of insulin during eating that precedes a postabsorptive rise in blood glucose. Here we discuss, first, the various stimuli that elicit the CPIR and the sensory signaling pathways (sensory limb) involved; second, the efferent pathways that control the various endocrine events associated with eating (motor limb); and third, what is known about the central integrative processes linking the sensory and motor limbs. Fourth, in doing so, we identify open questions and problems with respect to the CPIR in general. Specifically, we consider test conditions that allow, or may not allow, the stimulus to reach the potentially relevant taste receptors and to trigger a CPIR. The possible significance of sweetness and palatability as crucial stimulus features and whether conditioning plays a role in the CPIR are also discussed. Moreover, we ponder the utility of the strict classical CPIR definition based on what is known about the effects of vagal motor neuron activation and thereby acetylcholine on the β-cells, together with the difficulties of the accurate assessment of insulin release. Finally, we weigh the evidence of the physiological and clinical relevance of the cephalic contribution to the release of insulin that occurs during and after a meal. These points are critical for the interpretation of the existing data, and they support a sharper focus on the role of head receptors in the overall insulin response to eating rather than relying solely on the classical CPIR definition.

United States Dietary Trends Since 1800: Lack of Association Between Saturated Fatty Acid Consumption and Non-communicable Diseases

We reviewed data on the American diet from 1800 to 2019. Methods: We examined food availability and estimated consumption data from 1800 to 2019 using historical sources from the federal government and additional public data sources. Results: Processed and ultra-processed foods increased from <5 to >60% of foods. Large increases occurred for sugar, white and whole wheat flour, rice, poultry, eggs, vegetable oils, dairy products, and fresh vegetables. Saturated fats from animal sources declined while polyunsaturated fats from vegetable oils rose. Non-communicable diseases (NCDs) rose over the twentieth century in parallel with increased consumption of processed foods, including sugar, refined flour and rice, and vegetable oils. Saturated fats from animal sources were inversely correlated with the prevalence of NCDs. Conclusions: As observed from the food availability data, processed and ultra-processed foods dramatically increased over the past two centuries, especially sugar, white flour, white rice, vegetable oils, and ready-to-eat meals. These changes paralleled the rising incidence of NCDs, while animal fat consumption was inversely correlated.

Prevention of Obesity and Metabolic Syndrome in Children

In recent decades, the prevalence of overweight and obesity has become increasingly common such that it is now the major nutritional problem worldwide. Obesity occurs when dietary energy intake exceeds energy expenditure and has arisen in many societies due to an increasingly "obesogenic" environment in which physical activity has declined and yet children continue to be exposed to unhealthy, energy-dense diets. Additional risks for the development of obesity also include psychological issues and genetic factors. Obesity has many adverse health consequences including development of insulin resistance, Type 2 diabetes, and the metabolic syndrome. There are also important genetic influences on the likelihood of developing insulin resistance. Given the limited success of therapeutic interventions to treat obesity and the metabolic syndrome, there has been an increased interest in preventative strategies. These are likely to be most successful when targeting the young and will require a combination of approaches which will need inter-disciplinary collaborations across health and local government to target families, schools, and local environments to facilitate behavior changes which influence young people's eating behaviors and habitual levels of physical activity.

Natural Dietary Products and Their Effects on Appetite Control

Natural dietary products have been thoroughly studied for their effects of antiadipogenesis to prevent and treat obesity for decades. Nevertheless, in the past few years appetite control for the treatment of obesity has attracted much attention as a new target. Homeostatic control of energy intake involves a complex system that conveys peripheral signals to the central nervous system where multiple signals are integrated and then provide feedback to regulate satiation. This perspective aims at elucidating the neuronal mechanisms of food intake and energy balance as well as providing an alternative pathway of controlling weight using natural dietary products.

Brown and Beige Adipose Tissue: Therapy for Obesity and Its Comorbidities?

Overweight and obesity are global health problems placing an ever-increasing demand on health care systems. Brown adipose tissue (BAT) is present in significant amounts in adults. BAT has potential as a fuel for oxidation and dissipation as heat production, which makes it an attractive target for obesity therapy. BAT activation results in increased energy expenditure via thermogenesis. The role of BAT/beige adipocyte activation on whole body energy homeostasis, body weight management/regulation, and whole body glucose and lipid homeostasis remains unproven. This paper reviews knowledge on brown/beige adipocytes in energy expenditure and how it may impact obesity therapy and its comorbidities.

Prevalence of obesity and overweight and associated factors among financial institution workers in Accra Metropolis, Ghana: a cross sectional study

BACKGROUND

Certain professions are associated with low physical activity. Workers in such professions spend the most part of their adult working lives less engaged in physical activity if they don't consciously exercise outside of working hours. This increases their risk of obesity and its associated diseases. This study determined the prevalence of obesity and overweight and associated factors among workers of a financial institution in Accra Metropolis, Ghana.

METHODS

A cross-sectional study was conducted among 180 workers of a financial institution in Accra using the World Health Organization's STEPS (STEPwise approach) instrument for non-communicable disease risk factor surveillance. Relevant sociodemographic information were recorded and BMI was computed for each respondent.

RESULTS

The overall prevalence of obesity and overweight among the bank workers was 55.6 % (17.8 % obese and 37.8 % overweight). After adjusting for other variables, physical activity (OR = 0.34, 95 % CI = 0.13-0.89, p = 0.03), alcohol consumption (OR = 3.00, 95 % CI = 1.35, 6.68, p = 0.007), marital status (OR = 2.74, 95 % CI = 0.96-7.85, p = 0.04), sex (OR = 2.78, 95 % CI = 1.23-6.33, p = 0.01), and age (OR = 1.10, 95 % CI = 1.01-1.20, p = 0.036) were significantly associated with obesity and overweight.

CONCLUSION

Being physically inactive, consumption of alcohol, being married and a female, in addition to old age, increase the risk of obesity and overweight significantly. These factors should inform policy makers in developing strategies to reduce the burden of obesity and overweight among this category of workers.

Replication of Interactions between Genome-Wide Genetic Variants and Body Mass Index in Fasting Glucose and Insulin Levels

The genetic regulation of glucose and insulin levels might be modified by adiposity. With regard to the genetic factors that are altered by adiposity, a large meta-analysis on the interactions between genetic variants and body mass index with regard to fasting glucose and insulin levels was reported by the Meta-Analyses of Glucose- and Insulin-related trait Consortium (MAGIC), based on European ancestry. Because no replication study has been performed in other ethnic groups, we first examined the link between reported single-nucleotide polymorphisms (SNPs) and fasting glucose and insulin levels in a large Korean cohort (Korean Genome and Epidemiology Study cohort [KoGES], n = 5,814). The MAGIC study reported 7 novel SNPs for fasting glucose levels and 6 novel SNPs for fasting insulin levels. In this study, we attempted to replicate the association of 5 SNPs with fasting glucose levels and 5 SNPs with fasting insulin levels. One SNP (rs2293941) in PDX1 was identified as a significant obesity-modifiable factor in Koreans. Our results indicate that the novel loci that were identified by MAGIC are poorly replicated in other ethnic groups, although we do not know why.

Calorie shifting diet versus calorie restriction diet: a comparative clinical trial study

BACKGROUND

Finding new tolerable methods in weight loss has largely been an issue of interest for specialists. Present study compared a novel method of calorie shifting diet (CSD) with classic calorie restriction (CR) on weight loss in overweight and obese subjects.

METHODS

Seventy-four subjects (body mass index ≥25; 37) were randomized to 4 weeks control diet, 6 weeks CSD or CR diets, and 4 weeks follow-up period. CSD consisted of three phases each lasts for 2 weeks, 11 days calorie restriction which included four meals every day, and 4 h fasting between meals follow with 3 days self-selecting diet. CR subjects receive determined low calorie diet. Anthropometric and metabolic measures were assessed at different time points in the study.

RESULTS

Four weeks after treatment, significant weight, and fat loss started (6.02 and 5.15 kg) and continued for 1 month of follow-up (5.24 and 4.3 kg), which was correlated to the restricted energy intake (P < 0.05). During three CSD phases, resting metabolic rate tended to remain unchanged. The decrease in plasma glucose, total cholesterol, and triacylglycerol were greater among subjects on the CSD diet (P < 0.05). Feeling of hunger decreased and satisfaction increased among those on the CSD diet after 4 weeks (P < 0.05).

CONCLUSIONS

The CSD diet was associated with a greater improvement in some anthropometric measures, Adherence was better among CSD subjects. Longer and larger studies are required to determine the long-term safety and efficacy of CSD diet.

Skeletal muscle as a target of LXR agonist after long-term treatment: focus on lipid homeostasis

The liver X receptors (LXR)α and LXRβ are transcription factors belonging to the nuclear receptor family, which play a central role in metabolic homeostasis, being master regulators of key target genes in the glucose and lipid pathways. Wild-type (WT), LXRα(-/-), and LXRβ(-/-) mice were fed a chow diet with (treated) or without (control) the synthetic dual LXR agonist GW3965 for 5 wk. GW3965 raised intrahepatic triglyceride (TG) level but, surprisingly, reduced serum TG level through the activation of serum lipase activity. The serum TG reduction was associated with a repression of both catecholamine-stimulated lipolysis and relative glucose incorporation into lipid in isolated adipocytes through activation of LXRβ. We also demonstrated that LXRα is required for basal (nonstimulated) adipocyte metabolism, whereas LXRβ acts as a repressor of lipolysis. On the contrary, in skeletal muscle (SM), the lipogenic and cholesterol transporter LXR target genes were markedly induced in WT and LXRα(-/-) mice and to a lesser extent in LXRβ(-/-) mice following treatment with GW3965. Moreover, TG content was reduced in SM of LXRβ(-/-) mice, associated with increased expression of the main TG-lipase genes Hsl and Atgl. Energy expenditure was increased, and a switch from glucose to lipid oxidation was observed. In conclusion, we provide evidence that LXR might be an essential regulator of the lipid balance between tissues to ensure appropriate control of the flux of fuel. Importantly, we show that, after chronic treatment with GW3965, SM becomes the target tissue for LXR activation, as opposed to liver, in acute treatment.

Duodenal lipid sensing activates vagal afferents to regulate non-shivering brown fat thermogenesis in rats

Previous evidence indicates that duodenal lipid sensing engages gut-brain neurocircuits to determine food intake and hepatic glucose production, but a potential role for gut-brain communication in the control of energy expenditure remains to be determined. Here, we tested the hypothesis that duodenal lipid sensing activates a gut-brain-brown adipose tissue neuraxis to regulate thermogenesis. We demonstrate that direct administration of lipids into the duodenum increases brown fat temperature. Co-infusion of the local anesthetic tetracaine with duodenal lipids abolished the lipid-induced increase in brown fat temperature. Systemic administration of the CCKA receptor antagonist devazepide blocked the ability of duodenal lipids to increase brown fat thermogenesis. Parenchymal administration of the N-methyl-d-aspartate receptor blocker MK-801 directly into the caudomedial nucleus of the solitary tract also abolished duodenal lipid-induced activation of brown fat thermogenesis. These findings establish that duodenal lipid sensing activates a gut-brain-brown fat axis to determine brown fat temperature, and thereby reveal a previously unappreciated pathway that regulates thermogenesis.

What causes the insulin resistance underlying obesity?

PURPOSE OF REVIEW

The association between obesity and insulin resistance is an area of much interest and enormous public health impact, with hundreds of articles being published in the last year focused on the possible mechanisms that underlie this association. The purpose to this review is to highlight some of the key recent literature with emphasis on emerging concepts.

RECENT FINDINGS

The specific link between visceral adipose tissue accumulation and insulin resistance continues to be discerned. Visceral adiposity is correlated with accumulation of excess lipid in liver, and results in cell autonomous impairment in insulin signaling. Visceral adipose tissue is also prone to inflammation and inflammatory cytokine production, which also contribute to impairment in insulin signaling. The expansion of visceral adipose tissue and excess lipid accumulation in liver and muscle may result from limited expandability of subcutaneous adipose tissue, due to the properties of its extracellular matrix and capacity for capillary growth.

SUMMARY

Recent studies underscore the need to better understand the mechanisms linking visceral adiposity with liver fat accumulation, the mechanisms by which ectopic fat accumulation cause insulin resistance, and the mechanisms by which the size of adipose tissue depots is determined.

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.

Gastric bypass increases energy expenditure in rats

BACKGROUND & AIMS

Mechanisms underlying weight loss maintenance after gastric bypass are poorly understood. Our aim was to examine the effects of gastric bypass on energy expenditure in rats.

METHODS

Thirty diet-induced obese male Wistar rats underwent either gastric bypass (n = 14), sham-operation ad libitum fed (n = 8), or sham-operation body weight-matched (n = 8). Energy expenditure was measured in an open circuit calorimetry system.

RESULTS

Twenty-four-hour energy expenditure was increased after gastric bypass (4.50 +/- 0.04 kcal/kg/h) compared with sham-operated, ad libitum fed (4.29 +/- 0.08 kcal/kg/h) and sham-operated, body weight-matched controls (3.98 +/- 0.10 kcal/kg/h, P < .001). Gastric bypass rats showed higher energy expenditure during the light phase than sham-operated control groups (sham-operated, ad libitum fed: 3.63 +/- 0.04 kcal/kg/h vs sham-operated, body weight-matched: 3.42 +/- 0.05 kcal/kg/h vs bypass: 4.12 +/- 0.03 kcal/kg/h, P < .001). Diet-induced thermogenesis was elevated after gastric bypass compared with sham-operated, body weight-matched controls 3 hours after a test meal (0.41% +/- 1.9% vs 10.5% +/- 2.0%, respectively, P < .05). The small bowel of gastric bypass rats was 72.1% heavier because of hypertrophy compared with sham-operated, ad libitum fed rats (P < .0001).

CONCLUSIONS

Gastric bypass in rats prevented the decrease in energy expenditure after weight loss. Diet-induced thermogenesis was higher after gastric bypass compared with body weight-matched controls. Raised energy expenditure may be a mechanism explaining the physiologic basis of weight loss after gastric bypass.

Regulation of the hypothalamic thyrotropin releasing hormone (TRH) neuron by neuronal and peripheral inputs

The hypothalamic-pituitary-thyroid (HPT) axis plays a critical role in mediating changes in metabolism and thermogenesis. Thus, the central regulation of the thyroid axis by Thyrotropin Releasing Hormone (TRH) neurons in the paraventricular nucleus of the hypothalamus (PVN) is of key importance for the normal function of the axis under different physiological conditions including cold stress and changes in nutritional status. Before the TRH peptide becomes biologically active, a series of tightly regulated processes occur including the proper folding of the prohormone for targeting to the secretory pathway, its post-translational processing, and targeting of the processed peptides to the secretory granules near the plasma membrane of the cell ready for secretion. Multiple inputs coming from the periphery or from neurons present in different areas of the brain including the hypothalamus are responsible for the activation or inhibition of the TRH neuron and in turn affect the output of TRH and the set point of the axis.

Obesity and thyroid function

A moderate elevation of thyrotropin (TSH) concentrations, which is associated with triiodothyronine (T3) values in or slightly above the upper normal range, is frequently found in obese humans. These alterations seem rather a consequence than a cause of obesity since weight loss leads to a normalization of elevated thyroid hormone levels. Elevated thyroid hormone concentrations increase the resting energy expenditure (REE). The underlying pathways are not fully understood. As a consequence of the increased REE, the availability of accumulated energy for conversion into fat is diminished. In conclusion, the alterations of thyroid hormones in obesity suggest an adaptation process. Since rapid weight loss is associated with a decrease of TSH and T3, the resulting decrease in REE may contribute towards the difficulties maintaining weight loss. Leptin seems to be a promising link between obesity and alterations of thyroid hormones since leptin concentrations influence TSH release.

Maintenance of resting energy expenditure after weight loss in premenopausal women: potential benefits of a high-protein, reduced-calorie diet

The number of contemporary diet plans promoting high protein intakes for weight management has increased dramatically. Complementing this dietary approach with increased physical activity has proven to be beneficial. Recent studies have suggested that protein intakes in excess of the current Recommended Dietary Allowance (0.8 g/kg) may be of metabolic benefit during weight loss. This investigation assessed changes in resting energy expenditure and substrate oxidation in overweight and obese premenopausal women in response to a weight loss intervention that combined a high-protein, reduced-calorie diet with increased physical activity. Thirty-nine overweight and obese premenopausal women (age, 30.9 +/- 1.5 years; body mass index, 30.2 +/- 0.5 kg/m2) participated in a 10-week weight loss program in which they ate a reduced-calorie diet for which protein provided 30% of total energy and approximated 1.4 g/kg. Subjects incrementally increased physical activity (ie, steps walking) throughout the diet intervention period. Resting energy expenditure, substrate oxidation, and body composition were assessed before (PRE) and after (POST) the 10-week weight loss program. Subjects experienced a 5% decrease in body weight, with significant decreases in both fat mass (PRE, 35.5 +/- 1.2 kg; POST, 32.4 +/- 1.1 kg; P < .0001) and fat-free mass (PRE, 44.6 +/- 0.7 kg; POST, 43.6 +/- 0.7 kg; P < .0001). Changes in body weight or body composition did not alter resting energy expenditure. Protein oxidation increased (PRE, 18% +/- 1%; POST, 20% +/- 1%; P < .05) and fat oxidation decreased (PRE, 37% +/- 3%; POST, 30% +/- 3%; P < .05) after the 10-week intervention. These findings illustrate that a weight loss intervention combining consumption of a high-protein, reduced-calorie diet with increased physical activity promotes weight loss without negatively impacting resting energy expenditure in this population of women.

Thyroid hormone as a determinant of energy expenditure and the basal metabolic rate

It has long been accepted that thyroid hormone is an important determinant of overall energy expenditure and the basal metabolic rate. Indeed, regulating thermogenesis is one of the major tasks of thyroid hormone in adult humans. A wealth of data have demonstrated the effects of thyroid hormone on cellular processes involved with energy expenditure, yet in spite of this body of work it remains unclear which 3,3'-triiodothyronine-responsive energetic processes are most relevant for the determination of the basal metabolic rate. Recently, a novel metabolic role for thyroid hormone has been recognized based on the observation that bile acids can activate local production of thyroid hormone via induction of the type 2 deiodinase. Nevertheless, more work must be done before it can be fully explained how thyroid hormone determines the metabolic rate.

Dairy proteins and the regulation of satiety and obesity

Over the past decade there has been growing scientific evidence and public acceptance of the role that dietary protein plays in regulation of satiety, feed intake and obesity-related disorders. Dietary protein appears to suppress food intake and delay the return of hunger more than fats or carbohydrates in a manner not due to energy content alone. Also, high-protein diets support the maintenance of muscle mass when subjects reduce their energy intake, ensuring primarily adipose tissue loss. Some protein sources, particularly dairy, contain specific peptides or proteins that may elicit direct effects on satiety. The major proteins present in milk include β-lactalbumin, α-lactoglobulin, immunoglobulins, bovine serum albumin, and the various caseins. In addition, processed whey contains glycomacropeptide, which stimulates pancreatic and gastrointestinal secretion of hormones involved in satiety to a greater extent than whey alone. In the context of the literature, we show that a glycomacropeptide-rich whey protein isolate decreases feed intake and weight gain to a greater extent than a soy protein isolate in obese pigs. Also, insulin sensitivity is improved in pigs consuming high-protein diets, with these effects being independent of protein source. While, high-protein diets may decrease calcium balance and bone strength, it appears that these effects are attenuated by dairy proteins and dairy sources of calcium. These findings suggest that high-protein diets, and in particular those that contain whey proteins, may reduce hunger and food intake, thereby reducing fat deposition and improving insulin sensitivity.

Are all calories created equal? Emerging issues in weight management

The global prevalence of overweight and obesity is growing. Correction of the problem through dietary intervention has been disappointing and has prompted research into variations of diet composition or pattern to promote negative energy balance. Limited research suggests that selected approaches, such as low-carbohydrate diets, augment weight loss and offer an advantage over conventional low-fat diets. This has led to the hypothesis that although in theoretical terms a calorie is a calorie, in practice this is not the case. Support for such views and plausible mechanisms exist. Although any advantage may augment weight management, reported discrepancies between theoretical and observed effects are small. Thus, energy-restricted diets should be based primarily on energy intake and expenditure.

Thyroid hormones in the pathogenesis and treatment of obesity

Thyroid hormones (TH) are potent modulators of adaptive thermogenesis and can potentially contribute to development of obesity. The decrease of T(3) in association with reduction of calorie intake is centrally regulated via decreases in leptin and melanocortin concentrations and peripherally via a decrease in deiodinase activity, all aimed at protein and energy sparing. The use of TH in the treatment of obesity is hardly justified except in cases of elevated thyrotropin (TSH) with low/normal T(3) and T(4) and/or a low T(3) or T'(3)/T(4) or a high TSH/T(3) ratio. TH treatment with small doses of T(3) can also be exceptionally applied in obese patients resistant to dietary therapy who are taking beta-adrenergic blockers or with obesity developed after cessation of cigarette smoking and with hyperlipidemia and a concomitant high thryrotropin/T(3) ratio. Supplementation with Se(2+) and Zn(2+) may be tried along with more severe calorie restriction to prevent decline of T(3).

Metabolic assessment of female chronic dieters with either normal or low resting energy expenditures

BACKGROUND

Chronic dieting syndrome can have negative physiologic and psychological consequences. Metabolic differences between female chronic dieters with normal and with low resting energy expenditures (REEs) have not been fully examined.

OBJECTIVE

To determine whether differences existed between 2 groups (n = 15/group) of female chronic dieters aged 21-49 y with either normal (>/=100% of predicted) and with low (</=85% of predicted) REEs based on the equation of Mifflin et al.

DESIGN

The sample was a nonrandomized convenience sample and the 2 groups were compared in an observational study design. Body composition, aerobic fitness, physical activity, glucose and insulin responses, leptin and thyroid hormone status, dietary intake, and dietary restraint were measured.

RESULTS

Both groups were similar with respect to age, height, weight, and body mass index. The normal-REE group had a higher lean body mass and insulin response to a test meal, higher thyroxine and reverse triiodothyronine concentrations, and lower dietary restraint. Within both groups, leptin decreased significantly from baseline to 2 h after an oral-glucose-tolerance test. The groups did not differ significantly with respect to dietary intake, aerobic fitness, or physical activity.

CONCLUSIONS

Differences in insulin response were associated with higher ratios of abdominal to gluteal body fat in the normal-REE group. Leptin response appears to be due to normal diurnal variations in leptin production rather than a direct response to food consumption. It appears that a normal REE does not necessarily predict positive metabolic health among chronic dieters.

Towards a molecular understanding of adaptive thermogenesis

Obesity results when energy intake exceeds energy expenditure. Naturally occurring genetic mutations, as well as ablative lesions, have shown that the brain regulates both aspects of energy balance and that abnormalities in energy expenditure contribute to the development of obesity. Energy can be expended by performing work or producing heat (thermogenesis). Adaptive thermogenesis, or the regulated production of heat, is influenced by environmental temperature and diet. Mitochondria, the organelles that convert food to carbon dioxide, water and ATP, are fundamental in mediating effects on energy dissipation. Recently, there have been significant advances in understanding the molecular regulation of energy expenditure in mitochondria and the mechanisms of transcriptional control of mitochondrial genes. Here we explore these developments in relation to classical physiological views of adaptive thermogenesis.

Neuroendocrine control of growth hormone secretion

The secretion of growth hormone (GH) is regulated through a complex neuroendocrine control system, especially by the functional interplay of two hypothalamic hypophysiotropic hormones, GH-releasing hormone (GHRH) and somatostatin (SS), exerting stimulatory and inhibitory influences, respectively, on the somatotrope. The two hypothalamic neurohormones are subject to modulation by a host of neurotransmitters, especially the noradrenergic and cholinergic ones and other hypothalamic neuropeptides, and are the final mediators of metabolic, endocrine, neural, and immune influences for the secretion of GH. Since the identification of the GHRH peptide, recombinant DNA procedures have been used to characterize the corresponding cDNA and to clone GHRH receptor isoforms in rodent and human pituitaries. Parallel to research into the effects of SS and its analogs on endocrine and exocrine secretions, investigations into their mechanism of action have led to the discovery of five separate SS receptor genes encoding a family of G protein-coupled SS receptors, which are widely expressed in the pituitary, brain, and the periphery, and to the synthesis of analogs with subtype specificity. Better understanding of the function of GHRH, SS, and their receptors and, hence, of neural regulation of GH secretion in health and disease has been achieved with the discovery of a new class of fairly specific, orally active, small peptides and their congeners, the GH-releasing peptides, acting on specific, ubiquitous seven-transmembrane domain receptors, whose natural ligands are not yet known.

Role of nonexercise activity thermogenesis in resistance to fat gain in humans

Humans show considerable interindividual variation in susceptibility to weight gain in response to overeating. The physiological basis of this variation was investigated by measuring changes in energy storage and expenditure in 16 nonobese volunteers who were fed 1000 kilocalories per day in excess of weight-maintenance requirements for 8 weeks. Two-thirds of the increases in total daily energy expenditure was due to increased nonexercise activity thermogenesis (NEAT), which is associated with fidgeting, maintenance of posture, and other physical activities of daily life. Changes in NEAT accounted for the 10-fold differences in fat storage that occurred and directly predicted resistance to fat gain with overfeeding (correlation coefficient = 0.77, probability < 0.001). These results suggest that as humans overeat, activation of NEAT dissipates excess energy to preserve leanness and that failure to activate NEAT may result in ready fat gain.

The effect of oral contraceptive agents on the basal metabolic rate of young women

The use of oral contraceptive agents by women may be a factor that contributes to the observed inter-individual variability in the BMR. We, therefore, measured the BMR, body build and composition in two groups of young women and also assessed their self-reported level of physical activity. One group had been using oral contraceptive agents for a period of 6 months or more (OCA, n 24), while the other group had never used oral contraceptives (NOCA, n 22). There were no significant differences in age, body build or composition. The absolute BMR in the groups were not significantly different when compared using an unpaired t test (OCA: 5841 (SD 471) v. NOCA: 5633 (SD 615) kJ/d). However, using an analysis of covariance, with either body weight or a combination of fat and fat free mass as covariates, the OCA group had a BMR almost 5% higher than that of the NOCA group (OCA: 5871 v. NOCA: 5601 kJ/d; P = 0.002). When those subjects with high self-reported levels of physical activity were excluded, the difference in BMR between the two groups persisted (P = 0.001). An ANOVA of oral contraceptives use and phase of menstrual cycle showed significant differences in BMR with use of oral contraceptives (P = 0.004) but no difference in BMR between phases of the menstrual cycle. In conclusion, the use of oral contraceptive agents deserves consideration when conducting and analysing data from studies on energy metabolism in young women, as it results in a significantly higher BMR.

Aging, fat oxidation and exercise

Aging is characterized by deleterious changes in body composition and in fat distribution. The mechanisms that determine the aging-associated changes in body composition are not well defined, but the evidence suggests that the loss of fat-free mass is at least partially attributable to physical inactivity. The increase in fat mass may be the result of alterations in fatty acid metabolism. Indeed, fat oxidation is decreased in elderly individuals in several physiological conditions: a) at rest, b) during exercise, and c) in response to meal ingestion (after weight loss). These defects are related in part to loss of fat-free mass, but may also be the consequence of estrogen loss (in women) and/or a decrease in the intrinsic capacity of muscle for fat oxidation, and are amenable to partial correction by exercise training. Special emphasis should be placed in future studies upon the role of steroid hormone in the regulation of fatty acid metabolism in elderly individuals (especially women), as well as therapeutic interventions that may increase the quantity of the fat-free mass and/or fat oxidation.

Diet-induced thermogenesis and satiety in humans after full-fat and reduced-fat meals

Diet-induced thermogenesis was measured during and after a full-fat lunch, an identical but reduced-fat, reduced-energy lunch, and an iso-energetic reduced-fat lunch in 32 normal-weight men and women, age 35-55. Hunger and satiety were scored during and after the lunches, and their relationship to diet-induced thermogenesis was assessed. Diet-induced thermogenesis was relatively higher after the reduced-fat, reduced-energy lunch compared to the full-fat lunch (6.7% vs. 5.2%; p < 0.05). The respiratory quotients were significantly lower after the full-fat lunch than after the 2 reduced-fat lunches (p < 0.05). After the iso-energetic reduced-fat lunch, hunger scores were significantly reduced and satiety scores significantly increased (p < 0.05) until 1800 h. compared to the other 2 lunches. Satiety scores were positively related to the magnitude of diet-induced thermogenesis expressed as an absolute increase in metabolic rate during and after the meal. We conclude that hunger and satiety scores, substrate utilization, and diet-induced thermogenesis showed clear and different short-term responses to diets that differed with respect to the percentage energy from fat and/or the energy content of the meal.

Predictive equations for basal metabolic rate in Chinese adults: a cross-validation study

OBJECTIVE

To develop predictive equations for basal metabolic rate (BMR) in healthy Chinese adults and to evaluate factors that may influence BMR.

DESIGN

Measuring the BMR of Chinese adults by indirect calorimetry. Selected subjects were randomly assigned to a validation sample and a cross-validation sample. The validation sample was used to develop predictive equations that were cross-validated using the other sample.

SUBJECTS

Two hundred twenty-three healthy Chinese adults (102 men and 121 women) participated in the study. Their ages ranged from 20 to 78 years old (mean = 43.8 +/- 14.3 years).

MEASURES

BMR was measured by indirect calorimetry. Body composition was assessed by skinfold fat thicknesses, bioelectrical impedance analysis, and urinary creatinine excretion.

STATISTICAL ANALYSES PERFORMED

Student's t test, Pearson correlation coefficients, linear regression analyses, and the best subset were used for statistical analyses.

RESULTS

The better-fitting equation for predicting BMR in Chinese adults is BMR = 13.88 x weight (kg) + 4.16 x height (cm) - 3.43 x age (years) - 112.40 x sex (men = 0; women = 1) +54.34. Men had higher BMR values than women because men had greater fat-free mass, body cell mass, and muscle mass. BMR correlated best with body composition, which correlated highly with anthropometric measurements. Therefore, accurate determination of body weight and body height are beneficial in predicting a person's BMR. All of the currently available predictive equations overestimated BMR (P = .0001) for healthy Chinese adults. The equations developed in this study predict BMR more accurately for Chinese adults.

APPLICATIONS

The equations developed in this study are recommended for clinical use in healthy Chinese adults who are within normal limits for body weight.

The role of exercise in weight loss

Aerobic exercise has traditionally been viewed as a critical component of most weight-reduction programs. The resulting weight loss from the exercise alone, however, is often disappointing. Researchers too frequently fail to take into account the normal energy expenditure associated with living; the degree of obesity; the intensity and duration of the exercise itself; the activity during the recovery period; food intake before and after the exercise; and the age, gender, and training status of the individuals. Nor do they consider variations in baseline resting metabolic rates. In this article, the authors explore the effect of the intensity of aerobic exercise on weight loss, emphasizing the inability of many obese individuals to maintain an intensity level sufficient to produce significant weight loss. Aerobic exercise should be emphasized for its health benefits rather than as a short-term method of enhancing weight loss.

Overfeeding-induced obesity in rats: insulin sensitivity and autonomic regulation of metabolism

The metabolic consequences of the development of obesity and the underlying mechanisms were investigated. For this purpose, male rats were overfed for 5 weeks through long-term gastric catheters. Permanent cardiac cannulas implanted before the overfeeding period allowed frequent blood sampling and infusions without disturbing the rats. Hyperalimented rats became grossly obese, displayed elevated basal plasma norepinephrine (NE) concentrations, and developed hyperinsulinemia and insulin insensitivity, but remained normoglycemic and preserved normal intravenous (IV) glucose tolerance. During physical exercise (ie, 15 minutes of swimming), obese rats displayed exaggerated increases in blood glucose concentrations, whereas plasma free fatty acid (FFA) responses were blunted. These alterations were probably due to decreased NE release by the sympathetic nervous system during exercise and to altered tissue responsivity to adrenergic stimulation. The latter was demonstrated by infusions of catecholamines in the resting state. Responses to mild stress were increased in obese animals, as indicated by increased responses of plasma epinephrine (E) and corticosterone during handling and first contact with water. The results of the present study indicate that overfeeding induces changes in the sympathetic control of metabolism and insulin secretion. Whereas elevated NE levels in the basal state probably reflect increased energy expenditure, the pattern of nutrient mobilization during exercise is directed toward sparing of fats.

Reduced metabolic efficiency in patients with Crohn's disease

Malnutrition is frequently seen in patients with inflammatory bowel disease, and parenteral or enteral nutrition is considered essential in this patient group. However, many patients with Crohn's disease have difficulties in gaining weight in response to overfeeding, suggesting reduced energy retention. Substrate utilization and nutrient balances as well as changes in body composition were followed in 10 patients with Crohn's disease immediately in the course of remission on low-dose steroid treatment, during an eight-day period of continuous enteral nutrition at constant (protocol 1:1.5-fold basal energy expenditure) and increasing (protocol 2:0.5- to 2.0-fold basal energy expenditure) nutrient supply. Energy, substrate, and nitrogen balances all became positive in response to overfeeding. However, fat was predominantly oxidized at an infusion rate of 1.2 g/kg body wt/day, whereas carbohydrates and proteins were effectively stored. A positive energy balance was reached at an energy infusion rate exceeding 31 kcal/kg body wt/day and corresponding substrate supplies of 1.6, 1.7, and 1.1 g/kg body wt/day for carbohydrates, fat, and protein, respectively. Nitrogen balance normalized at a supply of 0.14 g/kg body wt/day, which also reduced myofibrillar protein breakdown. Considering the relative contributions made by these nutrients in the diets, an accumulation of carbohydrates and protein but a depletion in fat became evident from nutrient balances. In fact, body weight increased by 0.12 kg/day, which was explained by an increased extracellular (+0.18 kg/day) and body cell mass (+0.04 kg/day) at reduced fat mass (-0.10 kg/day). Concomitantly, plasma T3 and insulin secretion both increased, whereas sympathetic nervous system activity decreased with overfeeding. This is contrary to data observed in healthy subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Abnormal polyunsaturated lipid metabolism in the obese Zucker rat, with partial metabolic correction by gamma-linolenic acid administration

Below-normal proportions of phospholipid (PL) arachidonic acid (20:4 omega 6) have been reported in serum from obese humans and in liver from obese Zucker rats. This implies an abnormality of 20:4 omega 6 formation from linoleic acid (18:2 omega 6), possibly in the delta 6 desaturase step, or alternatively an abnormality in the catabolism or distribution of arachidonate. We previously speculated that a reduced proportion of 20:4 omega 6 in hepatic PL could contribute to the etiology of genetic obesity. Providing 18:3 omega 6 would bypass delta 6 desaturase and possibly normalize hepatic PL 20:4 omega 6. Therefore weanling Zucker rats were given free access to a defined diet (11% of energy as soy oil) and gavaged daily with 100 microL of either black currant oil concentrate ([BCO] 8% 18:2 omega 6 and 70% 18:3 omega 6) or soy oil ([Soy] 55% 18:2 omega 6 and < 0.1% 18:3 omega 6). Groups of eight lean and eight obese animals were randomized to receive Soy or BCO in a 2 x 2 design; 10 obese and 10 lean rats were fed a stock diet (nongavaged reference). All groups of lean rats had identical weight gain; food intake for Soy lean and BCO lean did not differ. The obese reference animals and Soy obese animals did not differ in weight gain. However, BCO obese animals ate less food (P < .06), gained less weight (P < .0001), and had lower percent body fat (P < .05) compared with the Soy obese animals. The fatty acid constituents from serum, liver, and adipose tissue showed marked differences between lean and obese animals. Hepatic PL 20:4 omega 6 was lower in Soy obese than in lean (P < .002), but was normalized by BCO gavage (diet effect, P < .007). The paucity of hepatic PL 20:4 omega 6 was not due to reduced desaturase activity, as the proportions of other desaturase products (20:3 omega 6, 20:3 omega 9, 20:5 omega 3) were significantly elevated in Soy obese rat liver and serum. Serum and hepatic cholesteryl ester 20:4 omega 6 levels were elevated in obese versus lean rats (P < .02 and P < .0001), indicating abnormal arachidonate distribution in the obese Zucker rat. Because BCO selectively reduced weight gain and percent body fat in obese Zucker rats, our results imply a role for abnormal omega 6 fatty acid metabolism in the etiology of Zucker obesity.(ABSTRACT TRUNCATED AT 400 WORDS)

Energy metabolism in response to overfeeding in young adult men

The effect of overfeeding on energy metabolism was evaluated in four young adult men of normal weight. Subjects were fed a hypocaloric diet for 8 days followed by an 8-day hypercaloric diet to maximize differences in the metabolic response to the two diets. Energy intake during the hypocaloric and hypercaloric phases was 1.32 and 2.26 times resting metabolic rate (RMR), respectively. Additional calories during hypercaloric feeding were provided as 1,659 +/- 40 kcal/d carbohydrate and lipid. Total daily energy expenditure (TDEE) was measured by the doubly labeled water technique and RMR by indirect calorimetry. Nonresting energy expenditure (NREE) was calculated as the difference between TDEE and RMR. During the 8-day hypocaloric diet period, energy intake was approximately 340 kcal/d less than the measured rate of TDEE (2,384 +/- 219 kcal/d) and the subjects lost 0.8 +/- 0.3 kg body weight. During the 8-day hypercaloric diet period, TDEE increased by 425 +/- 103 kcal/d (P = .03), which dissipated 25% +/- 5% of the increased energy intake. One fourth of the increase in TDEE was caused by an increase in RMR (110 +/- 24 kcal/d, P = .02) and the remainder by an increase in NREE (316 +/- 103 kcal/d, P = .05). These results demonstrate that only a small portion of excess energy intake is dissipated by an increase in energy expenditure. NREE can be an important component of the increase in energy metabolism during overfeeding.

Meal-induced thermogenesis in obese children with or without familial history of obesity

Resting metabolic rate (RMR) and the thermic effect of a meal (TEM) were measured in a group of 26 prepubertal children divided into three groups: (1) children with both parents obese (n = 8, group OB2); (2) children with no obese parents and without familial history of obesity (n = 8, OB0); and (3) normal body weight children (n = 10, C). Average RMR was similar in OB2 and OB0 children (4785 +/- 274 kJ/day vs 5091 +/- 543 kJ/day), but higher (P < 0.05) than in controls (4519 +/- 322 kJ/day). Adjusted for fat-free mass (FFM) mean RMRs were comparable in the three groups of children (4891 +/- 451 kJ/day vs 5031 +/- 451 kJ/day vs 4686 +/- 451 kJ/day in OB2, OB0, and C, respectively). The thermic response to the mixed meal was similar in OB2, OB0 and C groups. The TEM calculated as the percentage of RMR was lower (P < 0.05) in obese than in control children: 10.2% +/- 3.1% vs 10.9% +/- 4.3% vs 14.0% +/- 4.3% in OB2, OB0, and C, respectively. The similar RMR as absolute value as well as adjusted for FFM, and the comparable thermic effect of food in the obese children with or without familial history of obesity, failed to support the view that family history of obesity can greatly influence the RMR and the TEM of the obese child with obese parents.

Thermic effect of a meal. 2. Role in chronic undernutrition

The thermic effect of a standard liquid meal (TEM; energy 2.5 MJ; containing (g/kg) protein 100, fat 150, carbohydrate 750; volume 350 ml) was measured in a chronically undernourished (UN; n 9) group of human subjects and was compared with results from two control groups, one normal weight (NW)-for-height (BMI greater than 20; n 10) and the other underweight (UW)-for-height (BMI less than 18, n 10), using a ventilated-hood system over a period of 6 h after ingestion of the meal. Results indicated that the UN subjects had lower values for body-weight, height, percentage fat and fat-free mass (FFM) compared with those of either control group. Basal metabolic rates were lowest in the UN group in absolute terms; however, there were no significant differences among groups on an analysis of covariance (ANACOVA) with FFM as the covariate. TEM responses in the UN group were significantly higher when expressed either in absolute terms or as a percentage of the energy density of the meal. The post-meal total energy output was significantly lower (P less than 0.05) in the UW and UN groups as compared with the NW group in absolute terms; however, on adjusting for differences in FFM (by ANACOVA) there were no significant differences among groups. This would suggest that in the chronically undernourished thermogenic responses to a meal are unlikely to contribute towards any energy saving and may not constitute a part of any adaptive response to the undernourished state.

Thyroid emergencies

Thyroid storm is a rapid decompensation of severe hyperthyroidism which can best be described by the three criteria of hyperthermia, tachycardia and altered mental state with severe agitation. There has to be a precipitating factor such as infection, iodine contamination, surgery or even I-131 treatment. Severe hyperthyroidism not fulfilling the criteria of thyroid storm can also be an indication for emergency treatment, particularly in the elderly with heart disease. Suppressed serum TSH and elevated free T4 levels are essential to confirm the diagnosis. When rapidly available, radioiodine uptake of the thyroid can be useful. Therapy aims at rapidly reducing the active circulating hormone pool, hypermetabolic state, tachycardia, and finally hormone synthesis. Thyroid secretion can be blocked by ioipanoic acid or ipodate while hypermetabolic state can be reduced with beta-blockers or calcium channel-blockers. Treatment of hyperthyroidism in patients with iodine contamination is a real therapeutic challenge. Myxoedema coma, a complication of severe hypothyroidism, is defined by hypothermia (rectal temperature less than 36 degrees C), bradycardia, slow mentation, precipitating factor such as infection or drug overdose, and increased serum creatine phosphokinase levels. Diagnosis of severe hypothyroidism should be confirmed by serum measurements of TSH and free T4. Treatment consists of general supporting measures including rewarming, correction of serum electrolyte disturbances, and adequate alimentation. Thyroid hormone treatment should initially be aggressive using either 300-400 micrograms of T4 or 20-40 micrograms of T3 intravenously. Cortisone therapy may be added. Patients should be under close monitoring as arrhythmias and myocardial infarction are frequent complications of myxoedema coma and/or its treatment with thyroid hormones.

Role of dietary fat in calorie intake and weight gain

This paper reviews the literature on the role of dietary fat in calorie intake and body weight gain in humans and laboratory animals. An overview of 40 animal studies which compared growth on high-fat (HF) and high-carbohydrate (HC) solid/powdered diets indicated that the HF diet elicited greater weight gain in 33 out of 40 studies. Enhanced growth on the HF diet was often, but not exclusively, attributable to greater caloric intake. Additional evidence for the growth-enhancing effect of HF diets emerges from "diet option" and "supermarket" feeding studies in rats, and experimental and epidemiological studies in humans. Three principal factors that contribute to the different responses to HF and HC diets are (a) caloric density, (b) sensory properties and palatability, and (c) postabsorptive processing. It is concluded that both calorie intake and metabolic energy expenditure are biased towards weight gain when a HF diet is consumed, and that the high caloric density of high-fat diets plays a primary role in weight gain. Humans may be biologically predisposed to gain weight when a HF diet is consumed.

Saturated fat intake and insulin resistance in men with coronary artery disease. The Stanford Coronary Risk Intervention Project Investigators and Staff

BACKGROUND

To determine whether there is an association between diet and plasma insulin concentration that is independent of obesity, we studied the relation of dietary composition and caloric intake to obesity and plasma insulin concentrations in 215 nondiabetic men aged 32-74 years with angiographically proven coronary artery disease.

METHODS AND RESULTS

After adjusting for age, the intake of saturated fatty acids and cholesterol were positively correlated (p less than 0.05) with body mass index (r = 0.18, r = 0.16), waist-to-hip circumference ratio (r = 0.21, r = 0.22), and fasting insulin (r = 0.26, r = 0.23). Carbohydrate intake was negatively correlated with body mass index (r = -0.21), waist-to-hip ratio (r = -0.21), and fasting insulin (r = -0.16). Intake of monounsaturated fatty acids did not correlate significantly with body mass index or waist-to-hip circumference ratio but did correlate positively with fasting insulin (r = 0.24). Intake of dietary calories was negatively correlated with body mass index (r = -0.15). In multivariate analysis, intake of saturated fatty acids was significantly related to elevated fasting insulin concentration independently of body mass index.

CONCLUSIONS

These cross-sectional findings in nondiabetic men with coronary artery disease suggest that increased consumption of saturated fatty acids is associated independently with higher fasting insulin concentrations.

Molecular mapping of obesity genes

Advances in molecular genetics have made it possible to clone mutant genes from mammals. This capability should facilitate efforts to determine the genetic factors that control food intake and body composition. In order to identify these genetic factors, we have been making use of mouse mutations that cause obesity. The basic premise of this approach is to take advantage of the mouse as a genetic system for the analysis of genetically complex disorders and to then apply that information to the study of human disease. This paper reviews: (1) current concepts concerning the control of body weight in man and other mammals; (2) the biologic characteristics of the mouse obesity mutations; (3) our progress in the use of positional cloning techniques to clone the mouse obese (ob) and diabetes (db) genes; (4) an approach to polygenic obesity in mice; and (5) the possible relevance of the mouse obesity mutations to human obesity.

Changes in body composition and energy expenditure after six weeks' growth hormone treatment

Changes in body composition and energy expenditure were assessed in 15 children after six weeks of human growth hormone (hGH) treatment. Body composition measurements were made by stable isotope labelled water (H2(18)O) dilution, bioelectrical impedance, and skinfold thickness techniques. Energy expenditure was assessed both by indirect ventilated hood calorimetry (resting energy expenditure) and the stable isotope doubly labelled water (2H2(18)O) technique (free living daily total energy expenditure). Mean increases in weight of 0.96 kg and fat free mass of 1.37 kg and a mean decrease in fat mass of 0.41 kg were observed. Significant increases both in resting energy expenditure and free living daily energy expenditure were detected. Absolute changes in fat mass and resting energy expenditure were correlated. The data suggest (i) that the increase in the fat free mass is the most significant early clinical measure of hGH response and (ii) that hGH increases the metabolic activity of the fat free mass. Monitoring such changes may be predictive of the efficacy of hGH in promoting growth.