Adapted educational health program among deprived subjects with prediabetes

AIMS

Assess the feasibility and benefit of a health educational program on global metabolic status in prediabetic deprived subjects.

DESIGN

Case control study.

METHODS

693 subjects (466 men, 227 women), aged 16 to 95 years with prediabetes and low socioeconomic status, consulting at the IPC Center were included between September 2015 and June 2016. Subjects were invited to participate in 4 workshops (2 nutrition, 2 physical activities). One year after their inclusion (visit 1), they were offered a second health check-up (visit 2). Participants were classified into 3 groups: 1) Intervention group (INTG, N=133): complete process 2) Control group (CG, N=415): Only a second health check-up, no workshop participation; 3) Abandoned group (AG, N=145). All groups were compared.

RESULTS

After considered confounding factors, fasting blood glucose and SBP levels variation between visit 1 and visit 2 differed significantly between the CG and INTG. In the INTG with higher diminution of fasting glucose, 90% reported eating healthy food since nutrition workshop and 51%. reached objectives (The same trend was observed for physical activity.

CONCLUSION

An educational program among deprived prediabetic tended to limit fasting glucose increment, improve metabolic status and encourage healthy lifestyle despite difficulties in convincing subjects to participate.

Onset of exercise and diet program in obese women: metabolic and anorexigenic responses related to weight loss and physical capacities

Perturbations of energy balance induce compensatory processes that may alter expected weight loss. In obese patients, our aim was to investigate the relationships that occurred between fasting plasma concentrations of anorexigenic peptides and metabolic parameters, appetite, physical capacity, and weight loss in the 5 first days of a program associating exercise and caloric reduction. Thirteen obese women were monitored from day 1 to day 5 with 2 exercise sessions in day 2 and day 4. We measured, in a fasted state, changes in body weight, hunger ratings, and plasma concentrations of fatty acids, triglycerides, leptin, insulin, amylin, peptide YY, and insulin-resistance index. Physical performance was assessed by a 6-min walking test. The program resulted in significantly reduced body weight (0.75±0.4 kg; p=0.001), of plasma concentrations of triglycerides, insulin, amylin, peptide YY, and the insulin-resistance index, and also increased fatty acids (p<0.05). Hunger ratings were increased (p<0.05). Program-induced changes in fatty acids, leptin, and insulin concentrations were related to physical performance (r(2)=0.45, 0.59, and 0.52; p<0.05, respectively) and to weight loss (r(2)=0.65, 0.57, 0.55; p<0.05, respectively). Five days of diet and exercise induced weight loss, improved lipid profile, and decreased insulin resistance while hunger ratings increased. Subjects with higher physical capacity lost more weight, presented higher increases in fatty acids and lower changes of leptin and insulin concentrations suggesting a better metabolic flexibility. To reduce the compensatory responses that can occur with energy imbalances, our study supports to account for individual activity level before prescribing weight-loss program associating diet and exercise.

L'ultrasonographie à haute fréquence et le celluscore : un progrès dans l'évaluation objective du phénomène de cellulite

As they usually do not have any serious effect on health condition, cellulite phenomenons are not considered as potentially hazardous by general practitioners; unfortunately they involve almost all the feminine population after the forties and may really induce bad side effects either psychological or physical whatever the confusing origin of that cutaneous deformation: heredity, nutrition, circulatory and hormonal diseases etc. Trying to appreciate in a more scientific way this superficial skin disorder, we have developed a computerised questionnaire which can be combined with the finest upto date way of skin exploration, high frequency ultrasonography. It seems possible to consider now cellulite as the result of various disorders which can be separate into fibrotic or retentional phenomenons (surrounding superficial fat tissues) and the direct adipocyte reaction (adiposis). We hope to be able in the future to extend the treatment of cellulite beyond the limits of liposuction which seems until today the only way to bring some improvement to that phenomenon in spite of the very delicacy of the surgical approach.

[Body composition and left ventricular geometry]

Left ventricular mass and cardiac output are, particularly in obesity, correlated with fat free body mass. We assessed the relationship between ventricular geometry and fat body mass in treated hypertensives with or without normalization of blood pressure We investigated 175 patients (age: 57 +/- 15 years, M/F: 111/64, Mean blood pressure (MBP): 111 +/- 18 mmHg, BMI: 27.02 +/- 3.70 kg/m2: 20.3-39.6 kg/m2) with measure of body composition (impedancemetry Analycor2) and echographic left ventricular mass (adjusted to height2.7: mass2.7). Multiple correlation with adjustment to age and MBP were performed in men (M) and in women (W). Mass2.7 is correlated with fat mass percentage in men (R partial R: 5.6, p=0.02). LV diastolic diameter is correlated with fat free body mass while interventricular septum is correlated with fat body mass but only in men. In summary, in hypertensives not selected on BMI or BP, fat body mass is weakly correlated to ventricular wall thickness in men, probably mediated by sympathetic tone, while fat free body mass is related to ventricular volume in both gender probably through the water volume particularly in vascular bed. In conclusion, both components of body composition are differently, and weakly, linked to ventricular geometry in hypertensive patients.

Effects of atorvastatin on aortic pulse wave velocity in patients with hypertension and hypercholesterolaemia: a preliminary study

As statins may contribute to plaque stabilisation, it is important to evaluate whether these drugs may modify arterial stiffness. In 23 patients, aged 32-70 years, with hypertension and hypercholesterolaemia, a double-blind randomised study vs placebo was performed to evaluate whether atorvastatin was able to modify aortic stiffness, measured from aortic pulse wave velocity (PWV), after a 12-week treatment. The results revealed that atorvastatin did not change blood pressure, significantly lowered (P<0.003; <0.002) plasma total and LDL cholesterol, and increased aortic PWV by +8% (vs -2% under placebo) (P<or=0.05). The percentage changes in plasma total and LDL cholesterol and in PWV were significantly and negatively correlated, independent of blood pressure level. The finding of increased aortic PWV after 12-week statin treatment agrees with studies in monkeys, indicating that, at the early phase of hypolipidaemic diet but not later, aortic PWV increases transiently as a consequence of the significant reduction of lipid vascular content. In conclusion, the present results support the possibility that statins might contribute to a change in arterial stiffness independent of blood pressure level, and suggest that long-term studies in humans are needed to evaluate the contribution of arterial elasticity to statin-induced vascular remodelling.

[Hypertension and obesity]

Hypertension is often associated with corpulence, an increased total and abdominal fatty mass. The fact of being corpulent exposes to the risk of error of measurement of the blood pressure which may be overestimated by 10 to 16 mmHg and lead to the unnecessary prescription of antihypertensive drugs. In order to analyse the nature of the corpulence, it is useful to define the condition as an increase in fatty and/or lean body mass. It is also useful to quantify the distribution of body fat. Hypertensive patients of increased corpulence, obese (BMI > 30) with an abdominal distribution of adipose tissue, have an increased risk of cardiovascular morbidity-mortality, especially from coronary artery disease: their cardiovascular risk factors consist not only of hypertension and corpulence, but also of metabolic abnormalities and the haemodynamic consequences of corpulence, that is to say diabetes, hypertriglyceridaemia, hypercholesterolaemia, left ventricular hypertrophy and increased glomerular filtration. In hypertension with increased corpulence, the nutritional objective is to decrease the corpulence, decrease the fatty mass without reducing the lean mass. Therefore, it is important to proceed by a progressive, even small, loss of weight with a realistic target because loss of weight is beneficial for the hypertension and its complications (cardiovascular and renal), all other risk factors and for cardiovascular mortality.

Dehydroepiandrosterone (DHEA), DHEA sulfate, and aging: contribution of the DHEAge Study to a sociobiomedical issue

The secretion and the blood levels of the adrenal steroid dehydroepiandrosterone (DHEA) and its sulfate ester (DHEAS) decrease profoundly with age, and the question is posed whether administration of the steroid to compensate for the decline counteracts defects associated with aging. The commercial availability of DHEA outside the regular pharmaceutical-medical network in the United States creates a real public health problem that may be resolved only by appropriate long-term clinical trials in elderly men and women. Two hundred and eighty healthy individuals (women and men 60-79 years old) were given DHEA, 50 mg, or placebo, orally, daily for a year in a double-blind, placebo-controlled study. No potentially harmful accumulation of DHEAS and active steroids was recorded. Besides the reestablishment of a "young" concentration of DHEAS, a small increase of testosterone and estradiol was noted, particularly in women, and may be involved in the significantly demonstrated physiological-clinical manifestations here reported. Bone turnover improved selectively in women >70 years old, as assessed by the dual-energy x-ray absorptiometry (DEXA) technique and the decrease of osteoclastic activity. A significant increase in most libido parameters was also found in these older women. Improvement of the skin status was observed, particularly in women, in terms of hydration, epidermal thickness, sebum production, and pigmentation. A number of biological indices confirmed the lack of harmful consequences of this 50 mg/day DHEA administration over one year, also indicating that this kind of replacement therapy normalized some effects of aging, but does not create "supermen/women" (doping).

Plasma insulin, plasminogen activator inhibitor, and ankle-brachial systolic blood pressure ratio in overweight hypertensive subjects

BACKGROUND

In hypertensive subjects, the ratio between ankle and brachial systolic blood pressure (ABI) has been shown to be an independent risk factor for cardiovascular diseases, particularly in the elderly. Plasma insulin may be an important interconnecting factor explaining this observation.

PURPOSE

In a population of middle-aged subjects with essential hypertension and moderate overweight, we identified whether the decrease in the ABI ratio was associated with the clinical and biochemical factors involved in resistance to insulin. Patients with diabetes and/or arteriosclerosis obliterans of the lower limbs were excluded from the population. Subjects were or were not on antihypertensive therapy.

RESULT

On the basis of univariate correlations, the ABI ratio was found to be significantly and negatively associated not only with the degree of abdominal fat distribution, but also with the usual biological features of resistance to insulin: plasma triglycerides and cholesterol; plasma glucose and insulin; and plasminogen activator inhibitor (PAI) antigen. In a multivariate analysis in subjects with untreated hypertension, the ABI ratio was significantly and negatively associated with only three variables: age, plasma insulin and PAI antigen. In treated hypertensive subjects, only the role of age and insulin remained significant.

CONCLUSION

Since the alterations of the ABI ratio may be considered as a marker of the changes in the structure and function of arteries of the lower limbs, the study provides evidence that plasma insulin and PAI antigen, independently of the presence of significant atherosclerotic occlusive lesions, are susceptible to alter the pressure wave transmission in conduit arteries of the lower limbs.

Increased arterial distensibility in postmenopausal hypertensive women with and without hormone replacement therapy after acute administration of the ACE inhibitor moexipril

Menopause and essential hypertension are associated with a decreased compliance and distensibility of the arteries. ACE inhibitors have been shown to improve arterial distensibility. Hormone replacement therapy (HRT), especially estrogens, could have a positive influence through their atheroprotective, vasodilative, and blood pressure-lowering effect. The vascular interactions of HRT and ACE inhibitors, like moexipril hydrochloride, have not been investigated so far. This trial was intended to assess the effect of combined sequential HRT for 25 days on acute changes in arterial distensibility after a single oral dose of 15 mg moexipril hydrochloride in postmenopausal women with borderline to mild essential hypertension. This study had a monocentric, randomized, parallel-group design, and was open for moexipril, and double-blind, and placebo-controlled for HRT. Assessment of arterial distensibility was by automatic noninvasive measurement of the carotid-femoral pulse wave velocity (PWV). The PWV and the pulse pressure decreased significantly after a single oral dose of 15 mg moexiprill. An influence of HRT on the changes in the PWV and pulse pressure could not be seen. The plasma concentrations of renin increased and of aldosterone decreased after moexipril administration. Arterial function improves after acute administration of 15 mg moexipril in postmenopausal women with mild to moderate essential hypertension. The changes in PWV and pulse pressure are of similar magnitude in women with and without HRT.

Plasma leptin and hunger ratings in healthy humans

Leptin, the ob gene product, is considered as a signal involved in the regulation of energy stores through centrally mediated effects on ingestive behavior and metabolism. To investigate the relationships between appetite-related sensations and circulating leptin in humans, 12 healthy male volunteers were served two test lunches (1200 kcal, 38% carbohydrate, 50% fat, 12% protein) with comparable palatability but resulting in different postprandial hunger ratings, and plasma leptin concentrations were monitored during 8 h after meal ingestion. Whereas postprandial hunger ratings (assessed by visual analog scales) and plasma insulin patterns differed significantly between meals, no significant difference in postprandial plasma leptin concentrations was observed between the two meals. A moderate but significant increase in mean plasma leptin was found over time. We conclude that postprandial plasma leptin concentrations do not significantly differ between two meals inducing different effects on hunger subjective feelings. These data are in agreement with a role for leptin in the regulation of energy balance as a long-term adiposity-related signal rather than a short-term meal-related factor.

A polymorphism in the 5' untranslated region of the human ob gene is associated with low leptin levels

OBJECTIVE

To search the human ob gene for mutations and evaluate their role in massive obesity.

DESIGN

Direct mutation screening of the gene and case-control association study. Multivariate analyses for evaluation of differences in clinical parameters.

SUBJECTS

Primary mutation screening: 24 morbidly obese subjects (body mass index (BMI) > 40 kg/m2). Association study: 395 unrelated morbidly obese subjects (BMI > 40 kg/m2), 121 lean, non-diabetic control individuals, 72 women of a random sample with an average BMI 32.5 kg/m2.

RESULTS

We report the finding of a DNA variant in exon 1 of the human ob gene (A --> G substitution, base + 19). This variant showed a prevalence of 62% in our study population. Association analyses under different genetic models (dominant, co-dominant, recessive) showed no significant evidence for an association of this variant with BMI. However, obese individuals homozygous for the G-allele showed significantly lower leptin concentrations compared to obese patients either heterozygous or homozygous for the A-allele after correction for BMI.

CONCLUSION

Recent linkage studies have shown evidence for linkage of the hsob locus with obesity. Our study provides further evidence that a defect in the ob gene in linkage disequilibrium with the G-allele of exon 1 might be involved in obesity by affecting leptin concentrations.

[Arterial hypertension, non-drug treatment and cardiovascular risk]

Four non-drug measures have been shown to be effective on reduction of blood pressure: low-salt diet, weight loss, reduction of alcohol consumption and sports activity. Other measures, mainly dietary (increased potassium intake, DASH diet), may also be effective. The two limits to non-drug treatment of HT are the absence of demonstrated benefit in terms of cardiovascular morbidity-mortality, and the difficulty to ensure good patient compliance with this type of often constraining measure. However, these non-drug measures could probably decrease the overall level of cardiovascular risk. The main drawback, related to the required modification of the patient's lifestyle, is poor compliance with these measures. Compliance can be improved by various methods which share in common their time-consuming nature.

Plasma insulin and ankle on brachial systolic blood pressure ratio in overweight men with hypertension

BACKGROUND

Hypertension is often associated with multiple metabolic abnormalities included in the insulin resistance syndrome. In hypertensive individuals, the ratio between ankle and brachial systolic blood pressure (ABI) is considered to be an independent cardiovascular risk factor. Insulin resistance has not been studied in relation to ABI ratio in men with essential hypertension and who are moderately overweight.

OBJECTIVE

To identify whether a decrease in the ABI ratio is associated with the degree of abdominal obesity and, hence, with the biochemical characteristics of resistance to insulin.

METHODS

In 166 overweight men with mild-to-moderate essential hypertension, insulinaemia was measured using radioimmunoassay. The ABI ratio was measured by using a pressure cuff of appropriate diameter, a standard mercury sphygmomanometer and a Doppler probe. Patients with diabetes or arteriosclerosis obliterans of the lower limbs, or both, were excluded from the study.

RESULTS

The ABI ratio was significantly associated with the degree of abdominal obesity, but also with plasma triglycerides and cholesterol, low high-density lipoprotein cholesterol, plasma glucose and insulin. In a multiple regression analysis, the ABI ratio was significantly and negatively associated with only two variables: age and plasma insulin. This result was independent of age and drug treatment of hypertension.

CONCLUSION

Because alterations in the ABI ratio may be considered markers of the changes in the structure and function of the arteries of lower limbs, the study provides evidence that plasma insulin, independently of atherosclerotic occlusive lesions, can significantly influence the status of conduit arteries of the lower limbs.

Weight gain at the time of menopause

The menopause is associated with changes in body composition: a decline in bone mineral content, a decrease in collagen synthesis, a loss of lean body mass and an increase in total and abdominal fat mass. Oestrogen deficiency seems to play a role in the menopause-related changes in body composition, but life styles (diet, exercise, smoking habits, alcohol consumption) are also involved. The time course of the decrease in lean mass deserves attention since it could justify specific actions, i.e. exercising or hormonal treatment, early during the perimenopausal period. A decrease in fat-free mass may be responsible for a decrease in energy expenditure favouring weight gain if the calorie intake is not reduced.

How the degree of unsaturation of dietary fatty acids influences the glucose and insulin responses to different carbohydrates in mixed meals

The association of fats with carbohydrates results in a lower glucose response but the influence of the nature of the dietary fatty acids has not been investigated clearly. We examined the effect of the degree of dietary fatty acid unsaturation on the postprandial glucose and insulin responses to a mixed meal. Eight young normolipidemic men consumed four different meals in random order. The meals differed in the nature of their oils and in the type of their main carbohydrates. The meals contained either a high ratio of monounsaturated to polyunsaturated n-6 fatty acids (MUFA) or a low ratio (PUFA) and either potatoes or parboiled rice. Proteins and saturated and polyunsaturated n-3 fatty acid contents were not different among meals. Blood samples were collected every 30 min for 3 h after the test meal. The glucose response was significantly lower 30 min after the parboiled rice-PUFA meal than after parboiled rice-MUFA or potato-MUFA (P < 0.05) meals. The insulin response was lower after parboiled rice-PUFA than after potato-MUFA (P < 0.05) meals. Similarly, an effect of fat appeared after 30 min. Glucose responses (F = 1.4, P < 0.01) and insulin responses (F = 5.3, P < 0.05) to both carbohydrates were significantly lower with dietary PUFA compared with dietary MUFA. In conclusion, the degree of dietary fatty acid unsaturation (18:1 compared with 18:2) may influence the glucose and insulin responses to mixed meals.

Menopause, fat and lean distribution in obese women

OBJECTIVES

Whether menopause per se influences fat distribution independently of the effect of aging remains controversial. The lack of consistency in the menopause related changes in body fat distribution may be the result of differences in the methods for measuring fat distribution or in the characteristics of the women studied. The aim of this cross sectional study in obese women was to compare total body composition and regional fat and lean distribution, in premenopausal, perimenopausal and postmenopausal women.

METHODS

Body composition was assessed by dual energy X-ray absorptiometry (DEXA) in premenopausal (n = 26), perimenopausal (n = 24) and postmenopausal (n = 73) obese women with no intercurrent diseases.

RESULTS

It was shown that postmenopausal obese (n = 73) women had a higher proportion of total fat mass in the trunk and a lower proportion of total fat and lean mass in the femoral and leg regions than premenopausal women after adjustment for age and total fat mass. In the same analysis, perimenopausal women had a lower proportion of total fat in the leg and femoral regions and of total lean in the femoral region than premenopausal women; they had a regional body composition similar to that of postmenopausal women.

CONCLUSION

The present data indicate that in obese women, post menopause and perimenopause are associated with differences in fat and lean distribution, independently of age and total fat.

Microalbuminuria and body fat distribution in obese subjects

The aim of this work was to evaluate the prevalence of microalbuminuria in an obese population and to study the relation between albumin excretion rate (AER), various clinical (body mass index, adipose tissue distribution) nutritional (macronutrient intake) and metabolic parameters. A cross-sectional study was carried out, and AER was evaluated in 182 obese subjects (BMI > 27) with no medication, no intercurrent disease, no cardiac, pulmonary or endocrinological disorders (including diabetes and hypertension) and also in 31 control subjects at the outpatient clinic of the department of Nutrition, Hôtel Dieu, Paris, France. The following were measured: BMI, waist/hip ratio (WHR), urinary AER, blood glucose, insulin and C peptide levels, cholesterol (CT), triglycerides, HDL cholesterol (HDL-CT), apoprotein A1 and B. In the obese population, 18 subjects (9.9%) were found to have an increased AER: 13 subjects (7.1%) with microalbuminuria (AER between 30 to 300 mg/24 h) and five with AER over 300 mg/24 h. AER was normal in all control subjects but one, who was found to have microalbuminuria. Log AER was positively correlated to WHR (P < 0.001), blood pressure (P < 0.05), cholesterol (P < 0.05), Apo B levels (P < 0.01) and with fasting Insulin levels and protein intake (P < 0.001). Positive association between log AER and protein intake, insulin levels, Apo B and blood pressure were found independently of BMI and WHR. It is suggested that abdominal obesity may be associated with incipient nephropathy in some obese subjects without diabetes and hypertension. Microalbuminuria may be included among metabolic abnormalities connected with abdominal-type excess weight distribution.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cardiovascular consequences of obesity associated with arterial hypertension]

Hypertensive obese subjects run an increased cardiovascular risk. Their predominantly abdominal obesity is often associated with hypertriglyceridaemia and insulin-resistant diabetes, and their cardiovascular status is characterized by cardiac hyperdynamics and hypervolaemia responsible for left ventricular hypertrophy and dilatation. Insulin resistance and subsequent hyperinsulinaemia are thought to explain the obesity-hypertension association, the cardiovascular effects observed and the metabolic and cardiovascular complications which might result from this situation. Successful control of both arterial pressure and overweight should contribute to regression of the left ventricular hypertrophy. Simultaneous treatment of abnormalities in carbohydrate and lipid metabolism is also necessary to prevent cardiovascular complications.

Relationships between 3-y longitudinal changes in body mass index, waist-to-hip ratio, and metabolic variables in an active French female population

Three-year longitudinal changes in body mass index (BMI), waist-to-hip ratio (WHR), and metabolic variables were examined in 209 active French women. For the entire group, a weak but significant positive association was found between change in BMI and change in WHR. However, analysis of covariance according to the degree of abdominal fat distribution showed a heterogeneity of this association that was confined to women with abdominal fat distribution. Changes in BMI were positively associated with changes in total cholesterol (P less than 0.05), triglycerides (P less than 0.10), and blood pressure (P less than 0.001), whereas changes in WHR were associated with changes in triglycerides (P less than 0.05) and diastolic blood pressure (P less than 0.10). These longitudinal results suggest that a more favorable body-fat pattern and metabolic profile might be achieved by reducing weight, or at least by preventing weight gain, particularly in women with high abdominal-fat distribution.

Skinfold and body circumferences as measures of body fat patterning in a French female active population: relationships with the metabolic risk profile

Body mass index (BMI), various anthropometric indices of abdominal fat distribution and some metabolic variables (blood lipids, fasting glucose, blood pressure) were measured in 408 French-born women from an occupational population who volunteered for the study. The aim of the study was to determine the best index for describing the relationships between the body fat pattern and the metabolic risk profile. The four age-adjusted circumference ratios (waist/hip, waist/thigh, xiphoid/hip, xiphoid/thigh) showed similar associations with the metabolic variables whereas the three age-adjusted skinfold ratios (epigastric/thigh, mesogastric/thigh, hypogastric/thigh) tended to be more weakly associated with the metabolic variables, particularly with apolipoprotein (Apo) B and fasting glucose. Multiple regression analyses showed that age-adjusted BMI was significantly related to high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, Apo A and Apo B, and blood pressure, independently of abdominal fat distribution. After controlling for the effects of BMI, the waist/thigh ratio remained significantly associated to triglyceride, Apo B, fasting glucose, and systolic blood pressure, whereas the waist/hip ratio and the mesogastric/thigh skinfold ratio were significantly related only to triglyceride and systolic blood pressure independently of BMI. With the exception of triglyceride and fasting glucose, the degree of association between the metabolic variables and the abdominal fat distribution tended to be weaker than that observed with the BMI. These results emphasize the importance of the global corpulence in the levels of metabolic variables. However, all indices of abdominal fat distribution were, to varying degrees, independently associated with an unfavorable metabolic profile. Among them, the waist/thigh circumference ratio seems to be a useful indicator of the body fat pattern in women.

Hormonal influences on the relationships between body fatness, body fat distribution, lipids, lipoproteins, glucose and blood pressure in French working women

The independent associations between overall obesity, body fat distribution, lipids, lipoproteins, glucose, blood pressure and some hormonal factors (sex hormone-binding globulin (SHBG), corticosteroid binding globulin (CBG) and fasting insulin) were cross-sectionally examined in 205 French working women. After adjustment for age, overall adiposity assessed by body mass index (BMI) was significantly associated with most metabolic parameters, whereas regional adiposity assessed by the waist-hip ratio (WHR) was significantly associated only with triglyceride, systolic and diastolic blood pressure. Blood pressure, glucose but not triglyceride, were also negatively and significantly correlated with SHBG and positively with fasting insulin. Negative independent associations were found between SHBG and both BMI and WHR, whereas CBG was positively associated only with WHR. Fasting insulin was no longer related to WHR after adjustment for BMI. After controlling for the effect of SHBG or insulin, the associations between triglyceride, blood pressure and both BMI and WHR were not substantially modified. After adjustment for BMI and WHR, fasting insulin was independently associated with both HDL cholesterol and diastolic blood pressure. In conclusion, in these French women, hormonal factors under study appeared to have little influence on the relationships between body fatness, body fat distribution, metabolic variables and blood pressure.

[Regional hemodynamics of the forearm. Comparison between obese and non-obese hypertensive patients]

Forearm hemodynamics using pulsed Doppler flowmetry were studied in 83 men: 15 non-obese and 8 obese normotensive subjects; and 30 non-obese and 30 obese hypertensive patients. Mean ages were similar in the four subgroups. The blood pressure of normotensives and hypertensives was identical in obese and non-obese subjects. Blood flow expressed in ml/mn was significantly higher in obese subjects whether normotensive or hypertensive. However, when blood flow was expressed per unit liter of forearm volume, it was similar in the four subgroups. Forearm vascular resistance, whether expressed as absolute of normalized values, was significantly higher (p less than 0.001) in non-obese hypertensives. When obese and non-obese hypertensives were compared, the former were characterized by higher values of blood velocity and blood flow, and lower values of vascular resistance, whether absolute or normalized values were used. The present study shows that: (i) forearm vascular resistance in hypertensives is increased exclusively in non-obese subjects, and (ii) obese hypertensives, when compared with non-obese hypertensives, are characterized by a hyperkinetic forearm circulation.

Regional differences in adipose tissue lipoprotein lipase activity in relation to body fat distribution and menopausal status in obese women

Adipose tissue lipoprotein lipase (LPL) activity was determined in the abdominal and femoral regions in 25 pre- and 25 post-menopausal obese women, matched for body mass index and fat distribution. LPL activity was not different in pre- and post-menopausal women. Regional differences of the same magnitude were observed in pre- and post-menopausal women with femoral obesity. Such differences were not found in women with abdominal obesity either pre- or post-menopausal. Furthermore the abdominal/femoral ratio of LPL activity was positively correlated (P less than 0.05) to waist/hip ratio, independently of age, body mass index, fat cell size ratio and menopausal status. These data indicate that in obese women the regional differences in LPL activity are related to body fat distribution. The menopausal status does not seem to be a sufficient and necessary condition to abolish the typical female regional differences in LPL activity in adipose tissue from obese women.

Regional variations in cholesterol-esterase activity in rat adipocytes

Cholesterol esterase and lipoprotein lipase activities were examined in different fat depots in adult male rats. Both were significantly higher in the retroperitoneal and epididymal regions than in the subcutaneous abdominal depots.

[Relation between adipose tissue distribution and and circulating lipids in obese women]

Adipose tissue distribution was determined in 50 pre--or post--menopausal women by measuring the waist/hip and arm/thigh circumference ratios and the brachial-femoral adipo-muscular ratio. These three ratios correlated with plasma triglycerides levels irrespective of the women's age and degree of obesity. Total cholesterol, LDL-cholesterol and HDL-cholesterol were related to age and not to weight or adipose tissue distribution. Compared to pre-menopausal women with the same weight excess, post-menopausal women had a more android type of body fat distribution and higher plasma triglycerides and total cholesterol values. The influences of age and menopause are difficult to separate, since the three distribution ratios are age-related. The correlation between plasma triglycerides and adipose tissue distribution in obese women reflects the metabolic consequences of an abdominal predominance of fat.

[Influence of the distribution of body fat on vascular risk]

The metabolic and cardiovascular complications of obesity are dependent upon the distribution of body fat excess: predominantly abdominal or "android" obesity is more pathogenic than "gynoid" obesity which predominates in the lower part of the body. Adipose tissue overloads localized to the abdomen are associated with hypermortality from vascular diseases, even in patients who are not overweight. The metabolic characteristics of abdominal adipocytes, which have increased lipolytic capacity, might account for this situation, as they would facilitate hyperinsulinism, insulin resistance and such-metabolic disturbances as arterial hypertension, diabetes mellitus and dyslipidemia. Androgens seem to play a key role in the development of obesity morphotypes. These notions have important practical applications: an excess of body fat is not necessarily pathogenic; as regards vascular and metabolic risks, body fat distribution seems to be more important than overweight.

Extracellular and interstitial fluid volume in obesity with and without associated systemic hypertension

Fluid volumes and cardiac and renal hemodynamics were investigated in 44 obese men, 22 with normal blood pressure and 22 with sustained essential hypertension. For the same degree of obesity hypertensive patients had a higher value in extracellular (p less than 0.05) and interstitial fluid (p less than 0.01) volumes than normotensive subjects, while plasma volume, total body water, body cellular water, cardiac output, renal blood flow and glomerular filtration rate were similar. For the same level of blood pressure, the expansion of extracellular and interstitial fluid volume paralleled the degree of obesity. Thus, obese patients with hypertension have an absolute increase in extracellular and interstitial fluid volumes. The increase was related both to the degree of overweight and to the mechanisms of hypertension.

Adipose tissue cellularity and hemodynamic indexes in obese patients with hypertension

Fat-cell weight, fat-cell number, and hemodynamic indexes were determined in 25 obese men with sustained elevation of BP. Fat-cell weight (and not fat-cell number) was positively correlated with overweight (r = .51) and mean arterial pressure (MAP) (r = .57) in basal conditions. After body weight reduction, BP decreased significantly through a decrease in cardiac index due to a predominant decrease in heart rate. Simultaneously, fat-cell weight decreased significantly. The ratio between the change in BP and the change in body weight, ie, the ability to decrease pressure per unit weight loss, was positively related to the level of initial BP (r = .80) and reached a plateau above 120 mm Hg of the initial MAP. We suggest that, in patients with obesity and hypertension, high BP is associated with hypertrophic obesity, and after body weight reduction, the simultaneous decrease in BP, heart rate, and fat-cell weight could be mediated by neurogenic mechanisms.

Biological membranes are rich in low-frequency motion

Using 13C cross-polarization NMR techniques, we have found that the effect of protein on the dynamics of the hydrocarbon interior of a series of biological membranes is to depress the intensity of motion on the nanosecond timescale (i.e., T1 becomes longer) and to enhance the intensity of motion on the timescale of tens of microseconds (i.e., T1p becomes shorter.)

Intravascular volume, extracellular fluid volume, and total body water in obese and nonobese hypertensive patients

Intraarterial blood pressure, plasma volume, extracellular and interstitial (IFV) fluid volumes, and total and intracellular (IBV) body water were evaluated in 50 men: 16 obese hypertensive patients, 16 nonobese hypertensive patients, and 18 normal subjects of similar age. In obese hypertensive subjects, the IBW/IFV ratio was significantly increased (p less than 0.01) in comparison with both control subjects and nonobese hypertensive patients. After body weight reduction, blood pressure (p less than 0.01), heart rate (p less than 0.05), and the IBW/IFV ratio (p less than 0.01) significantly decreased. The decrease in the ratio was due to an absolute increase in the interstitial fluid volume, related to a shift of fluid volume from the intracellular to the interstitial space. Thus, obese hypertensive patients have an increased water cell content, causing an altered partition between the intracellular and the interstitial spaces.