A low resting metabolic rate in late childhood is associated with weight gain in adolescence

BACKGROUND AND OBJECTIVES

Lower total energy expenditure (TEE) and resting metabolic rate (RMR) are associated with greater weight gain in Native American adults. Whether these effects exist in childhood is unclear. We hypothesized that lower energy expenditure measured in childhood would predict greater relative change in body mass index (BMI) during adolescence.

METHODS

Measurements of height, weight, body composition, RMR and TEE were completed in 181 Native American children at exams done at age 5 and 10years, with 126 children having biennial follow-up assessments of weight and height after age 10years until age 20years. TEE and RMR were adjusted for age, sex, height, fat mass and fat free mass. BMI-change was assessed using population specific and Center for Disease Control (CDC) BMI z-scores and change in the relative difference to the 95th BMI-centile.

RESULTS

Lower adjusted RMR at age 10years was associated with greater increase in population-specific and CDC BMI z-scores, greater increase in the relative difference to the 95th BMI-centile and greater weight gain (all r≤-0.22, p≤0.01). However, no association was found with adjusted RMR at age 5years and with adjusted TEE and physical activity level assessed at age 5 or 10years.

CONCLUSIONS

Lower adjusted RMR at age 10years predicted greater change in adolescent BMI z-score indicating that the effects of relatively low metabolic rate on future weight gain in this population may begin in late childhood.

Impaired glucose regulation is associated with poorer performance on the Stroop Task

BACKGROUND

Type 2 diabetes is a risk factor for development of cognitive dysfunction. Impairments in glucose regulation have been associated with poorer performance on tests of executive function and information processing speed.

METHODS

We administered the Stroop Color Word Task, where higher interference scores are indicative of decreased selective attention, to 98 non-diabetic volunteers (64 m; %fat=37 ± 12; age=36 ± 9 yrs, race=41 NA/30 C/13 H/14 AA) on our inpatient unit. After 3d on a weight maintaining diet, % body fat was measured by DXA and a 75 g oral glucose tolerance test (OGTT) was administered. Impaired glucose regulation (IGR) was defined as: fasting plasma glucose ≥ 100 and ≤ 125 mg/dL and/or 2h plasma glucose between ≥ 140 and ≤ 199 mg/dL (IGR; n=48; NGR; n=50). Total and incremental area under the curve (AUC) for insulin and glucose were calculated.

RESULTS

Stroop interference scores were not significantly associated with any measure of adiposity or insulin concentrations. Individuals with IGR had significantly higher interference scores than those with normal glucose regulation (NGR; p=0.003). Higher interference scores were significantly correlated with fasting plasma glucose concentrations (r=0.26, p=0.007) and total glucose AUC (r=0.30, p=0.02) and only trending so for iAUC and 2h plasma glucose (r=0.18, p=0.08; r=0.17, p=0.09 respectively). In separate multivariate linear models, fasting plasma glucose (p=0.002) and total glucose AUC (p=0.0005) remained significant predictors of Stroop interference scores, even after adjustment for age, sex, race, education and %fat.

CONCLUSIONS

Individuals with IGR had decreased performance on a test of selective attention. Fasting plasma glucose was more strongly associated with lower performance scores than 2h plasma glucose. Our results indicate that even mild hyperglycemia in the non-diabetic range is associated with attentional processing difficulties in a sample of younger adults. Whether these impairments precede or are induced by impaired glucose regulation is not clear.

Serum uric acid predicts both current and future components of the metabolic syndrome

BACKGROUND

Uric acid (UA) is known to be associated with excess adiposity and insulin resistance. Our aim was to investigate the relationship between UA and the factors associated with the metabolic syndrome and type 2 diabetes mellitus (T2DM), both initially and longitudinally.

METHODS

Serum UA was assessed as a potential determinant of concurrent blood pressure, serum lipids, glucose regulation measured via an oral glucose tolerance test (OGTT), acute insulin response (AIR), and insulin action (M) measured with hyperinsulinemic-euglycemic clamps in 245 participants (72% Native American, 56% male). UA was also assessed as a predictor of the above variables in 60 participants with follow-up data available (median follow-up time=11.2 years [interquartile range (IQR)=8.1, 13.6 years]. The impact of UA on the risk of T2DM was determined as 36 of the 245 participants developed T2DM after the baseline visit.

RESULTS

UA was negatively associated with both concurrent and future M, such that for every 1 mg/dL increase in serum UA, M decreased 7.6% (P<0.001) and future M decreased 6.3% (P=0.02). However, UA was not associated with AIR (P=0.7). UA concentrations were a predictor of T2DM [hazard risk ratio (HRR)=1.5; P=0.02]. UA was positively associated with both concurrent blood pressure and lipids and also predicted future increases in blood pressure and total cholesterol.

CONCLUSIONS

Not only did UA associate with concomitant insulin action, blood pressure, and lipids, it also predicted future declines in insulin action and T2DM. UA is a potential target for preventing decreases in insulin sensitivity and rises in blood pressure and cholesterol.

C-C chemokine receptor 2 (CCR2) regulates the hepatic recruitment of myeloid cells that promote obesity-induced hepatic steatosis

OBJECTIVE

Obesity induces a program of systemic inflammation that is implicated in the development of many of its clinical sequelae. Hepatic inflammation is a feature of obesity-induced liver disease, and our previous studies demonstrated reduced hepatic steatosis in obese mice deficient in the C-C chemokine receptor 2 (CCR2) that regulates myeloid cell recruitment. This suggests that a myeloid cell population is recruited to the liver in obesity and contributes to nonalcoholic fatty liver disease.

RESEARCH DESIGN AND METHODS

We used fluorescence-activated cell sorting to measure hepatic leukocyte populations in genetic and diet forms of murine obesity. We characterized in vivo models that increase and decrease an obesity-regulated CCR2-expressing population of hepatic leukocytes. Finally, using an in vitro co-culture system, we measured the ability of these cells to modulate a hepatocyte program of lipid metabolism.

RESULTS

We demonstrate that obesity activates hepatocyte expression of C-C chemokine ligand 2 (CCL2/MCP-1) leading to hepatic recruitment of CCR2(+) myeloid cells that promote hepatosteatosis. The quantity of these cells correlates with body mass and in obese mice represents the second largest immune cell population in the liver. Hepatic expression of CCL2 increases their recruitment and in the presence of dietary fat induces hepatosteatosis. These cells activate hepatic transcription of genes responsible for fatty acid esterification and steatosis.

CONCLUSIONS

Obesity induces hepatic recruitment of a myeloid cell population that promotes hepatocyte lipid storage. These findings demonstrate that recruitment of myeloid cells to metabolic tissues is a common feature of obesity, not limited to adipose tissue.

Identification of adropin as a secreted factor linking dietary macronutrient intake with energy homeostasis and lipid metabolism

Obesity and nutrient homeostasis are linked by mechanisms that are not fully elucidated. Here we describe a secreted protein, adropin, encoded by a gene, Energy Homeostasis Associated (Enho), expressed in liver and brain. Liver Enho expression is regulated by nutrition: lean C57BL/6J mice fed high-fat diet (HFD) exhibited a rapid increase, while fasting reduced expression compared to controls. However, liver Enho expression declines with diet-induced obesity (DIO) associated with 3 months of HFD or with genetically induced obesity, suggesting an association with metabolic disorders in the obese state. In DIO mice, transgenic overexpression or systemic adropin treatment attenuated hepatosteatosis and insulin resistance independently of effects on adiposity or food intake. Adropin regulated expression of hepatic lipogenic genes and adipose tissue peroxisome proliferator-activated receptor gamma, a major regulator of lipogenesis. Adropin may therefore be a factor governing glucose and lipid homeostasis, which protects against hepatosteatosis and hyperinsulinemia associated with obesity.

Unique characteristics of the geriatric diabetic population and the role for therapeutic strategies that enhance glucagon-like peptide-1 activity

PURPOSE OF REVIEW

Care for elderly diabetic patients poses a unique clinical challenge. This review highlights distinct aspects of the pathophysiology and the risks for secondary complications in the geriatric diabetic population. Based on these considerations, we discuss emerging therapeutic options based on the actions of the incretin hormone glucagon-like peptide (GLP)-1, which may be ideal for achieving glycemic control in the elderly diabetic patient.

RECENT FINDINGS

Aging is associated with diminished capacity of pancreatic beta-cells to respond to glucose. This functional decline in beta-cell insulin secretion is a major contributor to the development of diabetes in the older patient. In addition, elderly diabetics suffer from a broader range of diabetic complications than do younger diabetics, warranting aggressive glycemic control. GLP-1 is known to improve beta-cell insulin secretion, increase beta-cell mass, and suppress glucagon secretion. Recent studies investigating improved GLP-1 activity have yielded promising results, with improved glycemic control in elderly patients with type 2 diabetes and without significant risk for hypoglycemia.

SUMMARY

Elderly diabetics are a growing subset of the type 2 diabetic population with unique pathophysiologic characteristics and diabetic risk profiles. Therapeutic strategies that incorporate enhancement of GLP-1 action on beta-cells to improve beta-cell insulin secretion and glycemic control may be ideal for this distinct population and should be validated with further long-term clinical studies.

Obesity and pharmacologic therapy

Obesity is a chronic, complex, multifactorial disorder with increasing prevalence in modern society. Lifestyle modification has had limited success in treating this disorder. Currently approved pharmacologic treatments for obesity include sibutramine and orlistat, which have been associated with significantly greater weight loss than that seen with dieting alone. In addition, a greater percentage of patients who receive medical treatment achieve weight losses of more than 5% to 10% of their initial body weight. This weight loss is associated with improvements in blood pressure, insulin sensitivity, and dyslipidemia. Multiple new therapies that target several different regulatory pathways are currently in clinical trials.

Effects of leptin deficiency and short-term repletion on hepatic gene expression in genetically obese mice

By supplying most organs of the body with metabolic substrates, the liver plays a central role in maintaining energy balance. Hepatic metabolism of glucose, fatty acids, and lipoproteins is disrupted in the leptin-deficient obese (Lep(ob)/Lep(ob)) mouse, leading to hyperglycemia, steatosis, and hypercholesterolemia. Microarray expression profiles were used to identify transcriptional perturbations that underlie the altered hepatic physiology of Lep(ob)/Lep(ob) mice. A wide variety of genes involved in fatty acid metabolism are altered in expression, which suggests that both fatty acid synthesis and oxidation programs are activated in obese mice. The expression of a small subset of genes is upregulated by leptin deficiency, not modulated by caloric restriction, and markedly suppressed by short-term leptin treatment. Among these leptin-regulated genes, apolipoprotein A-IV is a strong candidate for mediating the atherogenic-resistant phenotype of Lep(ob)/Lep(ob) mice.

Osteoporosis: an unusual presentation of childhood Crohn's disease

Osteoporosis is known to be associated with Crohn's disease. We report a 12-yr-old boy without a history of steroid use, in whom severe osteoporosis and multiple collapsed vertebrae were the presenting manifestations of Crohn's disease. After treatment of the Crohn's disease, he resumed normal growth and progressed through puberty. Concomitantly, he demonstrated a substantial recovery of vertebral bone mineral density and structure. Possible pathophysiological mechanisms underlying the osteoporosis and the subsequent improvement in bone density are discussed.