[Clinical analysis of eating disorders: therapeutic implications].
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Clinical Protocols↗
Biomedical subjects
B Guy-Grand
Publications and source records attributed to B Guy-Grand.
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.
Adipose Tissue↗
Hepatic lipase activity during oral and parenteral 17 beta-estradiol replacement therapy: high-density lipoprotein increase may not be antiatherogenic.
OBJECTIVE: Hepatic lipase activity is involved in the removal of cholesterol and phospholipid from plasma high-density lipoprotein (HDL) to the liver. Changes in hepatic lipase are responsible for some lipoprotein modifications observed during estrogen administration (i.e., increased HDL levels). The aim of this study was to compare the effects of alternative routes of administration of estrogen on hepatic lipase activity and lipoprotein metabolism. DESIGN, PATIENTS: The effects of oral and parenteral estradiol (E2) replacement therapy on post-heparin hepatic lipase were studied in the short-term (6 weeks) in postmenopausal women. INTERVENTIONS: Ten patients received 2 mg/d or oral micronized E2 and 10 patients 3 mg/d of percutaneous E2. RESULTS: Both treatments significantly increased plasma E2 levels. Hepatic lipase decreased (-33%) significantly (P less than 0.05), and the phospholipids and free cholesterol content of HDL and HDL3 increased significantly (P less than 0.05) during oral but not during parenteral treatment. CONCLUSIONS: The short-term pharmacological effect of E2 on hepatic lipase depends on the route of administration. The inhibition of this enzyme may reduce the removal of HDL-cholesterol by the liver. The expected vascular benefits of such a pharmacological increase in HDL are questionable.
Administration, Cutaneous↗
Effect of BIM-18216, a novel cholecystokinin receptor antagonist, on food intake reduction induced by cholecystokinin.
The role of cholecystokinin (CCK) in food intake was investigated in rats by using BIM-18216, a novel CCK receptor antagonist. In rats fed 6 hr/day, BIM-18216 antagonized the reduction of food intake induced by exogenous CCK octapeptide (CCK-8; 4 micrograms/kg) in a dose-dependent manner and had a maximum effect at 1 mg/kg. BIM-18216 did not antagonize the effect of bombesin on food intake and showed some degree of specificity. BIM-18216 was not able to prevent the effect of endogenous CCK at the beginning of the feeding period. These data demonstrate that BIM-18216 is a potent CCK-specific antagonist. These results also suggest that endogenous and exogenous CCK could act by different regulating pathways.
Animals↗
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.
Adipose Tissue↗
International trial of long-term dexfenfluramine in obesity.
In a randomised, placebo-controlled, double-blind study, 822 obese patients of both sexes were given either dexfenfluramine (dF), 15 mg twice daily (404), or placebo (418) in addition to a calorie-restricted diet for 1 year. Patients in both groups lost weight significantly in the first 6 months; after 6 months dF patients had a higher cumulative mean weight loss. Dropout rates were lower in dF patients than in placebo patients, mainly because of dissatisfaction with weight loss in the latter group. More than twice as many dF patients as placebo patients achieved a given weight loss; but more dF patients than placebo patients had transient side-effects (tiredness, diarrhoea, dry mouth, polyuria, and drowsiness).
Adult↗
[Physiopathologic concept of the obesity symptom].
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Adipose Tissue↗
[Drugs acting on feeding behavior].
The pharmacology of food intake has made considerable progress due to recent developments in neurobiology and to advances in the final analysis of eating behaviour. In this way, the pharmacology of food intake has risen to the rank of a more global pharmacology of eating behaviour. It is now possible to evaluate the points of impact of catecholaminergic, serotoninergic and opioid agents in terms of central or peripheral mode of action and also in terms of behavioral sequence. Some serotoninergic and opioid agents currently under development are opening new therapeutic vistas.
Amphetamines↗
[Semiology of obesity].
Obesity is a syndrome defined simply as an excess of body fat. It is becoming increasingly clear that the condition is multifactorial and has a wide range of causes. Detailed analysis of the clinical presentation is the basis of the diagnosis of the pathophysiological mechanism at work in each individual case and a prerequisite for the determination of the therapeutic strategy. Although there is no ideal system of classification, an attentive medical, dietary and psychological examination often provides relevant information to decide what is useful, possible or even harmful for the patient.
Female↗
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.
Adipose Tissue↗
[Value of animal models for understanding human obesity].
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Animals↗
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.
Abdomen↗
[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.
Adult↗
[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.
Abdominal Muscles↗
Transdermal estradiol.
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Administration, Cutaneous↗
Hypolipidaemia in fire-eaters.
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Accidents, Occupational↗
Biological effects of estradiol-17 beta in postmenopausal women: oral versus percutaneous administration.
To determine whether the route of administration or the type of estrogen used in estrogen replacement therapy (ERT) is more important in avoiding effects on hepatic function, 24 postmenopausal women were studied before and at the end of 2 months of oral or percutaneous administration of the same estrogen, estradiol-17 beta (E2). The treatments studied were oral micronized E2, 2 mg/day (9 women); oral E2 valerate, 2 mg/day (5 women), and percutaneous E2, 3 mg/day (10 women). Specific plasma biological and biochemical markers of estrogenic action were evaluated, namely, E2, estrone (E1), LH, FSH, sex steroid binding protein (SBP), renin substrate, antithrombin activity, and lipoproteins (high density lipoprotein cholesterol, low density lipoprotein cholesterol, very low density lipoprotein triglycerides). Both oral and percutaneous administration of E2 increased plasma E2 levels up to midfollicular values and decreased LH and FSH levels into the same range. Oral administration of E2 led to substantial increases in plasma E1, SBP, renin substrate, and VLDL levels, whereas AT decreased significantly. Percutaneous administration of E2 led to a physiological plasma E1/E2 ratio and did not induce any change in hepatic proteins. These data suggest that the route of administration of E2 determines the biochemical response to ERT in postmenopausal women. SBP is the most sensitive marker of the liver action of estrogen, and triglycerides also are simple and useful markers for this effect. Percutaneous E2 therapy is an effective method of ERT, and has no measurable effects on hepatic markers of estrogen action.
Administration, Oral↗
Contraception in hypertensive women using a vaginal ring delivering estradiol and levonorgestrel.
Contraception with a vaginal ring (CVR) that delivers estradiol and levonorgestrel was used during a mean of 15.6 menstrual cycles in 12 hypertensive women. Blood pressure (BP) was measured 5 times on each visit during 2 pretreatment control cycles; during the 1st, 2nd, 4th, 6th, and from the 9th to 12th cycles of CVR use; and again after a 1-month recovery period. No significant change in BP occurred during CVR use in any of the subjects. Plasma renin substrate and antithrombin III activity did not vary significantly, which suggests the utility of administering natural estradiol via the vagina, thus avoiding the first pass effect that occurs with oral contraceptives. Significant decreases in plasma sex hormone-binding globulin, cholesterol, high density lipoprotein cholesterol, phospholipids, and triglycerides occurred, indicating an androgenic effect of levonorgestrel. We conclude that the CVR is a method of contraception that does not elevate BP in hypertensive women.
Adolescent↗