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Biomedical subjects

F X Pi-Sunyer

Publications and source records attributed to F X Pi-Sunyer.

At least 55 records · Page 3Linked to original sources
PubMed1998

Organ-tissue mass measurement allows modeling of REE and metabolically active tissue mass.

Investigators have expressed interest in the associations between resting energy expenditure (REE) and body mass for over a century. Traditionally, descriptive models using regression analysis are applied, linking REE with metabolically active compartments such as body cell mass (BCM) and fat-free body mass (FFM). Recently developed whole body magnetic resonance imaging (MRI) and echocardiography methods now allow estimation of all major organs and tissue volumes in vivo. Because measured values are available for REE, BCM, and FFM content of individual organs and tissues, it should now be possible to develop energy expenditure-body composition estimation models based on MRI-measured organ-tissue volumes. Specifically, the present investigation tested the hypothesis that in vivo estimation of whole body REE, BCM, and FFM is possible using MRI- and echocardiography-derived organ volumes combined with previously reported organ-tissue metabolic rates and chemical composition. Thirteen subjects (5 females, 8 males) had REE, BCM, and FFM measured by indirect calorimetry, whole body 40K counting, and dual-energy X-ray absorptiometry, respectively. Models developed from estimated and measured variables were highly correlated, with no significant differences between those estimated and measured [e.g., calculated vs. measured REE: r = 0.92, P < 0. 001; (mean +/- SD) 6,962 +/- 1,455 and 7,045 +/- 1,450 kJ/day, respectively (P = not significant)]. Strong associations were observed between REE, individual or combined organ weights, BCM, and FFM that provide new insights into earlier observed metabolic phenomona. The present approach, the first to establish an energy expenditure-body composition link with a mechanistic model in vivo, has the potential to greatly expand our knowledge of energy expenditure-body size relationships in humans.

Adolescent↗
PubMed1998

Synergistic effects of feeding and dexamethasone on serum leptin levels.

The objectives of this study were to determine the time course of the stimulatory effect of dexamethasone on serum leptin and whether it depends on food intake. Dexamethasone (4mg) was administered I.V. over 1 minute to healthy human volunteers (n=8) under fasting and feeding conditions (2000 kcal given at three meals over 7 hours). At 10 hours, serum leptin levels were increased only in the fed subjects (delta leptin 10.6+/-1.6 vs -2.4+/-1.9 ng/ml, p=0.01, n=8). To assess the interactive effect of food and dexamethasone on serum leptin, a subgroup (n=4) was studied under 4 conditions: 1) dexamethasone/fast; 2) dexamethasone/food; 3) saline/fast; 4) saline/food. Serum leptin declined from baseline under the fasting conditions, with or without dexamethasone. Feeding prevented the drop in serum leptin. In the dexamethasone/food condition, leptin levels rose from baseline after 7 hours and doubled after 10 hours (p<0.05). The rise in serum leptin was significantly greater in the food/dexamethasone condition compared to all other conditions (p<0.05). In summary, dexamethasone has no independent effect on serum leptin in the absence of food intake. Rather, dexamethasone appears to potentiate the food-induced increase in serum leptin. This synergism may be mediated by insulin and/or other factors associated with food ingestion.

Adult↗
PubMed1997

Energy balance: role of genetics and activity.

It is clear from the above discussion that much remains to be learned about both energy intake and energy expenditure. Obesity in humans is not likely to be caused by one gene, as it is in certain rodent models of obesity, such as the ob/ob mouse and the fa/fa rat. It is likely to be a polygenic condition in which numerous genes interact with each other and the environment to express the obesity phenotype. It is likely that genes that affect energy intake as well as genes that affect energy expenditure are involved. The role of leptin as a putative factor in signaling the extent of the fat mass to the central nervous system and controlling both food intake and energy expenditure is unclear at this time. The genetics of energy expenditure are also not clear at this time. There are mechanisms of nutrient partitioning, such as respiratory quotient and lipoprotein lipase activity, that are being discovered to be important. In addition, insulin sensitivity is likely to play a role in the etiology of obesity. Much more investigation will be required before we have a clearer picture of how the above-named factors interact, what the genetic contribution to this is, and how important each factor is to the overall phenotypic expression of obesity.

Animals↗
PubMed1997

Nutritional management of cardiovascular risk factors. A randomized clinical trial.

BACKGROUND: Adherence to dietary recommendations for disease management is often hindered by the complexity of incorporating them into the daily diet. Nutrition and cardiovascular scientists and food technologists collaborated to develop a prepared meal plan that meets national dietary guidelines for cardiovascular risk reduction. OBJECTIVE: To assess the clinical effects of this plan, which incorporates all National Academy of Sciences National Research Council recommended dietary allowances for vitamins, minerals, and macronutrients, compared with a patient-selected American Heart Association Step I and Step II diet plan. METHODS: This multicenter, randomized, parallel-intervention trial was conducted at 10 medical centers in the United States and Canada and involved 560 men and women with hypertension, dyslipidemia, or diabetes. Following calculation of prescriptions to meet individual nutritional requirements based on the Harris-Benedict equation, participants were randomized to the Campbell's Center for Nutrition and Wellness (CCNW) plan, which is composed of prepackaged breakfast, lunch, and dinner meals provided to participants, or a nutritionist-guided American Heart Association Step I and Step II diet, in which participants self-selected foods to meet their nutrition prescription for 10 weeks. MAIN OUTCOME MEASURES: Blood pressure (BP); lipid, glucose, glycosylated hemoglobin (HbA1c), and insulin levels; body weight; dietary intake; and quality of life. RESULTS: Patients' BP, lipid levels, carbohydrate metabolism, weight, and quality of life (P < or = .001 for all findings except low-density lipoprotein-high-density lipoprotein ratio, P = .25) all improved on both nutrition plans. Mean differences (+/-SD) between baseline and treatment clinical values for the CCNW and the self-selected diet groups (between-group P values), respectively, were as follows: systolic BP, -6.4 +/- 9.2 mm Hg and -4.6 +/- 9.0 mm Hg (P = .02); diastolic BP, -4.2 +/- 5.7 mm Hg and -3.0 +/- 5.1 mm Hg (P = .006); cholesterol, -0.32 +/- 0.58 mmol/L and -0.27 +/- 0.56 mmol/L (-12.4 +/- 22.5 mg/dL and -10.4 +/- 21.9 mg/dL) (P = .30); glucose, -0.65 +/- 1.88 mmol/L and -0.75 +/- 2.03 mmol/L (-11.7 +/- 34.0 mg/dL and -13.5 +/- 36.6 mg/dL) (P = .10); and HbA1c, -0.4% +/- 0.8% and -0.3% +/- 0.7% (P = .66). Weight loss with the CCNW and self-selected plans, respectively, was as follows: men, -4.5 +/- 3.6 kg and -3.5 +/- 3.3 kg; and women, -4.8 +/- 3.0 kg and -2.8 +/- 2.8 kg. Quality of life was significantly improved for daily and work activities (P < .05) and nutritional health perceptions (P < .05) with the CCNW plan relative to the self-selected group. Overall nutrient intake and compliance were both significantly (P < .001) better with the CCNW plan. CONCLUSIONS: Nutritionally balanced meals that meet the recommendations of national health organizations improved multiple risk factors for patients with cardiovascular disease. The CCNW plan resulted in greater clinical benefits, nutritional completeness, and compliance than the self-selected diet. The CCNW is a comprehensive nutrition plan, convenient for both prescription and practice, and appears viable for effecting favorable dietary changes in patients at high risk for cardiovascular disease.

Adult↗
PubMed1997

Body mass index and all-cause mortality among people age 70 and over: the Longitudinal Study of Aging.

OBJECTIVES: To assess the relationship between body mass index (BMI; kg/m2) and mortality in a large nationally representative sample of US adults over age 70 years. DESIGN: Prospective longitudinal cohort study, the Longitudinal Study of Aging (LSOA). Subjects were all those 7260 black and white people (2769 men, 4491 women) initially interviewed in 1984 for whom height and weight were available. These subjects were followed through to 1990. MEASUREMENTS: Measurements included self-reported height and weight, date of death if subjects died, sex, age, race, measures of socio-economic status, number of living first degree relatives, and responses to questions asking whether the subject had retired due to poor health, had difficulty eating, worried about their health, and felt their health was worse than during the prior year. Smoking status was not assessed. RESULTS: When analyzed via Cox proportional hazard regression, the relationship between BMI and mortality, represented by means of hazard ratio, was clearly U-shaped for both men and women. The base of the curves was fairly wide suggesting that a broad range of BMIs are well tolerated by older adults. The minimum mortality (estimated from the fitted proportional hazard models) occurred at a BMI of approximately 31.7 for women and 28.8 for men. The results were essentially unchanged, if analyses were weighted, if various disease states were controlled for, and if apparently unhealthy subjects were excluded. CONCLUSIONS: The finding of the relatively high BMI (27-30 for men, 30-35 for women) associated with minimum hazard in persons older than seventy years supports some previously documented findings and opposes others and, if confirmed in future research, has implications for public health and clinical recommendations.

Aged↗
PubMed1997

Dietary compliance and cardiovascular risk reduction with a prepared meal plan compared with a self-selected diet.

Noncompliance with therapeutic diets remains a major obstacle to achieving improvements in cardiovascular disease (CVD) morbidity and mortality. This study compared dietary compliance and CVD risk factor response to two dietary interventions designed to treat hypertension, dyslipidemia, and diabetes mellitus. In a multicenter trial, 560 adults were randomly assigned to either a self-selected, mixed-food plan (n = 277), or a nutrient-fortified prepared meal plan (n = 283); each was designed to provide 15-20% of energy from fat, 55-60% from carbohydrate, and 15-20% from protein. Nutrient intake was estimated from 3-d food records collected biweekly throughout the 10-wk intervention. Compliance was determined by evaluating the participants' ability to meet specific criteria for energy intake [+/-420 kJ (100 kcal) from the midpoint of the prescribed energy range], fat intake (< 20%, < 25%, or < 30% of energy from total fat), and the National Cholesterol Education Program/American Heart Association Step 1 and 2 diet recommendations. Compliance with energy, fat, and Step 1 and 2 criteria was better in participants who followed the prepared meal plan than in those who followed the self-selected diet (P < 0.0001). Compliant participants in both groups achieved greater reductions in body weight, systolic and diastolic blood pressure, and total and low-density-lipoprotein cholesterol than noncompliant participants (P < 0.05). In general, better endpoint responses were observed with lower fat intakes regardless of group assignment. The prepared meal plan is a simple and effective strategy for meeting the many nutrient recommendations for CVD risk reduction and improving dietary compliance and CVD endpoints.

Adult↗
PubMed1997

Resting metabolic rate in obese, premenopausal black women.

In the United States, obesity is more prevalent in black than in non-Hispanic white women. Because low resting metabolic rate (RMR) has been suggested as a risk factor for weight gain, we compared RMR in 22 black and 20 white obese [body mass index (BMI; in kg/m2) range: 28.9-48.6 and 26.9-44.1, respectively], weight-stable, premenopausal, nondiabetic women. RMR was measured on two or three different occasions within a 1-wk period. The black and white groups did not differ significantly in age, degree of fitness, BMI, fat mass, or fat-free mass (FFM). In each group, RMR was predicted independently by FFM but not by age, degree of fitness, body fat mass, or body fat distribution. The slopes of the equations predicting RMR from FFM in black and white groups were not significantly different. However, the black women had significantly lower RMRs than the white women after adjustment for FFM measured by five body-composition models: dual-photon X-ray absorptiometry (DXA), hydrodensitometry, total body water, a three-compartment model, a four-compartment model, as well as for the absolute total-body potassium content as a measure of metabolically active FFM. By each analysis, the black women had significantly lower (P < 0.01) FFM-adjusted RMR than the white women; this difference ranged from 671 to 889 kJ/d depending on the body-composition method used to estimate FFM. This could contribute to the difference in the prevalence of obesity in the populations represented by these groups.

Adipose Tissue↗
PubMed1997

Thermic effect of food during each phase of the menstrual cycle.

The effect of the menstrual cycle on the thermic effect of food (TEF) was examined in eight healthy, normal-weight [mean +/- SD: 56.1 +/- 5.6 kg and body mass index (in kg/m2) 21.3 +/- 1.8] women aged 22-38 y. Their lean body mass and fat mass were 39.4 +/- 2.7 kg and 16.9 +/- 6.5 kg, respectively. TEF was measured on 4 separate days selected to match the four phases of a menstrual cycle: early follicular, follicular, luteal, and late luteal. The volunteers consumed a 3138-kJ liquid meal (54.5% carbohydrate, 14.0% protein, and 31.5% fat) on each test day. Resting metabolic rate was measured for 55 min before the meal and every 30 min after the start of the meal for 205 min. Although resting metabolic rate remained unchanged, there was a significant difference (P < 0.01 by ANOVA) in mean (+/- SEM) values for TEF among the four phases of the cycle: 0.94 +/- 0.05 kJ/min during the early follicular phase, 0.86 +/- 0.09 kJ/min during the follicular phase, 0.70 +/- 0.10 kJ/min during the luteal phase, and 0.76 +/- 0.07 kJ/min during the late luteal phase. TEF decreased significantly (P < 0.025 by paired t test) during postovulation (average of luteal and late luteal phases), when it was 0.73 +/- 0.07 kJ/min, compared with preovulation (average of early follicular and follicular phases), when it was 0.90 +/- 0.06 kJ/min. In conclusion, TEF decreased during the luteal phase of the menstrual cycle, possibly as a result of impairment of glucose uptake and slower transit of food through the upper gastrointestinal tract.

Adult↗
PubMed1997

Bioimpedance analysis: evaluation of leg-to-leg system based on pressure contact footpad electrodes.

Conventional single frequency bioimpedance analysis (BIA) systems require technician placement of arm and leg gel electrodes, a suitable location for recumbent measurements, and a separate measurement of body weight. The aim of this study was to evaluate a new single frequency 50 KHz leg-to-leg bioimpedance analysis (BIA) system combined with a digital scale that employs stainless steel pressure-contact foot pad electrodes for standing impedance and body weight measurements. Healthy adults were evaluated for 1) electrode validity and 2) potential for body component estimation. Pressure-contact foot-pad electrode measured impedance was highly correlated with (N = 9, r = 0.99, P < 0.001) impedance measured using conventional gel electrodes applied to the plantar surface of both lower extremities; mean (+/-SD) impedance was systematically higher by about 15 ohms for pressure contact electrodes (526 +/- 56 ohms vs 511 +/- 59 ohms; P < 0.001). Second, the relationship between stature-adjusted leg-to-leg impedance (H2/Z) measured by the new system and two body composition components (total body water by 3H2O dilution (N = 144); and fat-free body mass, by underwater weighing and dual x-ray absorptiometry (N = 231)) was modeled using multiple regression analysis. Correlation coefficients for H2/Z alone versus body composition components were lower for leg-to-leg BIA than for arm-to-leg BIA; correlation coefficients and SEEs became similar for the leg-to-leg and arm-to-leg BIA systems with addition of three covariates (age, gender, and waist/hip circumference ratio) to regression models. The leg-to-leg pressure contact electrode BIA system has overall performance characteristics for impedance measurement and body composition analysis similar to conventional arm-to-leg gel electrode BIA and offers the advantage of increased speed and ease of measurement.

Absorptiometry, Photon↗
PubMed1997

Visceral fat and race-dependent health risks in obese nondiabetic premenopausal women.

Our previous finding that a waist-to-hip ratio (WHR) >0.85 was not associated with similar health risks in black, compared with white, obese premenopausal non-diabetic women of similar fatness is attributed to either 1) a different relationship between WHR and visceral adiposity or 2) differences in the relationship between visceral adiposity and the metabolic abnormalities of obesity. We measured visceral (VAT) and subcutaneous adipose tissue (SCAT) areas at midwaist in 25 black and 25 white obese nondiabetic pre-menopausal women with similar BMI, percentage body fat, and wide range of WHR (0.7-0.95 for black women and 0.7-0.9 for white women) and then compared insulin sensitivity index (SI), glucose and insulin areas under the 2-h curve (AUCs) during an oral glucose tolerance test (OGTT), and blood lipids in the two groups before and after adjustments for total body and visceral adiposity. After adjusting for total body fat mass (FM), obese black women had significantly less VAT (by 32 cm2) and lower VAT/SCAT for any given WHR. The regression equations predicting the SI the glucose and insulin AUCs, and the triglyceride and HDL cholesterol levels from regional adipose tissue measurements (VAT, SCAT, or VAT/SCAT) and from total body fat (FM or percentage body fat) had slopes that were not significantly different for black and white women. LDL cholesterol levels were independently related to VAT in black but not in white women. The black women had a similar SI insulin AUC, and triglyceride levels but significantly lower glucose AUC and higher HDL cholesterol levels (P < 0.001), after adjusting for VAT and FM. Regression analysis of the pooled data showed that high VAT and high VAT/SCAT, but not SCAT, predicted lower SI higher glucose and insulin AUCs during OGTT, and higher triglyceride levels, independent of total adiposity. We conclude that while increases in VAT and VAT/SCAT adversely affect metabolism in both black and white obese premenopausal women, similar levels of total body and visceral adiposity are associated with different metabolic risk factors in these groups.

Adipose Tissue↗
PubMed1997

The role of viscous soluble fiber in the metabolic control of diabetes. A review with special emphasis on cereals rich in beta-glucan.

Recent recommendations for the dietary management of diabetes mellitus state that diet needs to be individualized so that there is improved glucose and lipid control in the patient. In a majority of individuals with diabetes, this is best done with a diet that is low in fat and high in carbohydrate, particularly that of cereal origin. However, symptoms of hyper- and hypoglycemia must be averted. Most cereal products, however, tend to have a high glycemic index Cereals such as Prowashonupana barley or fractions of oat bran are particularly high in the soluble fiber beta-glucan, which when taken with a meal increases the viscosity of the meal bolus once it has reached the small intestine, where the absorption of nutrients occurs. This high viscosity delays absorption. A 50% reduction in glycemic peak can be achieved with a concentration of 10% beta-glucan in a cereal food. A significant lowering of plasma LDL cholesterol concentrations can also be anticipated with the daily consumption of > or = 3 g of beta-glucan. Diabetic individuals can benefit from diets that are high in beta-glucan, which, as a component of oats and barley, can be incorporated into breakfast cereals and other products.

Blood Glucose↗
PubMed1996

Weight and non-insulin-dependent diabetes mellitus.

I review the effect of weight on the prevalence of non-insulin-dependent diabetes mellitus (NIDDM) and of its associated conditions. Weight loss decreases morbidity in diabetic patients. The effect of weight loss on mortality also is favorable, although the number of reports in which this has been studied is small. The recommendation is made that the persons with NIDDM who have a body mass index (BMI, in kg/m2) > 25 should try to lose weight to at least that level. Those with BMIs between 20 and 25 should make every effort to maintain their present weight throughout life.

Body Mass Index↗
PubMed1996

Improved quality of life in patients with generalized cardiovascular metabolic disease on a prepared diet.

Current dietary recommendation for cardiovascular disease risk reduction and recommended dietary allowances (RDAs) were used to develop a nutritionally complete prepackaged prepared meal plan specifically designed to reduce the risk of cardiovascular disease. In the current study we tested patient acceptance of the diet as defined by measures of quality of life. In a randomized, parallel-design, multicenter clinical trial, 77 persons with hypertension, diabetes mellitus, dyslipidemia, or a combination of two or more of these conditions were recruited and randomly assigned to either a prepared meal plan (n = 39) or a comparable self-selected diet (n = 38) for 10 wk. The prepared meal plan met both the RDAs for all essential micronutrients and the dietary recommendations of national health organizations for macronutrients, cholesterol, sodium, and fiber. The prescribed self-selected diet was matched for macronutrients. Quality of life, as measured by a battery of instruments, was the major endpoint. Individuals consuming the prepared meal plan had significant improvements in mental health (P < 0.01), general perceived health (P < 0.005), daily activities (P < 0.05), work performance (P < 0.005), affect (P < 0.01), and nutritional health perceptions (P < 0.001), and reductions in nutrition hassles based on a standardized questionnaire (P < 0.001). The self-selected-diet group had significant improvements in nutritional health perceptions (P < 0.001) and affect (P < 0.001). There were significant improvements in weight (P < 0.001), blood pressure (P < 0.001), cholesterol (P < 0.002), low-density lipoproteins (P < 0.001), glucose (P < 0.014), and glycated hemoglobin (Hb A(1c) (P < 0.004) that were comparable in both groups. In summary, this study shows that a nutritionally complete diet, whether prepackaged or self-selected, improves multiple risk factors for cardiovascular disease. The prepackaged prepared meal plan had the added benefit of a greater improvement in quality of life.

Blood Glucose↗
PubMed1996

Glycemic effect of a single high oral dose of the novel sweetener sucralose in patients with diabetes.

OBJECTIVE: To examine the effect of a single high oral dose of the novel noncaloric sweetener sucralose on short-term glucose homeostasis in patients with IDDM or NIDDM. RESEARCH DESIGN AND METHODS: A total of 13 IDDM and 13 NIDDM patients with glycosylated hemoglobin levels < 10% completed this double-blind cross-over study. After an overnight fast, patients were administered opaque capsules containing either 1,000 mg sucralose or cellulose placebo, followed by a standardized 360-kcal liquid breakfast. Plasma glucose and serum C-peptide levels were measured over the next 4 h. RESULTS: Regardless of the type of diabetes, areas under the curves for changes of plasma glucose and serum C-peptide levels after sucralose administration were not significantly different from those after placebo. During test meals with sucralose, one episode of symptomatic hypoglycemia occurred in each of three IDDM patients, but these episodes were not considered the result of sucralose administration. CONCLUSIONS: The present results support the conclusion that sucralose consumption does not adversely affect short-term blood glucose control in patients with diabetes.

Administration, Oral↗
PubMed1996

Obesity and risk of gallstone development on a 1200 kcal/d (5025 Kj/d) regular food diet.

OBJECTIVE: Previous studies report a greatly increased risk of gallstone formation in obese persons during periods of caloric restriction on very low calorie formula diets. The aim of the present study was to assess the risk of gallstone development in moderately obese patients losing weight on a prescribed 1200 kcal/d (5025 Kj/d) regular food diet. DESIGN AND SUBJECTS: A consecutive sample of 70 men and women (body mass index > 25 kg/m2) (mean +/- SD, 28.9 +/- 2.8 kg/m2) responding to an announcement of an outpatient weight loss program in a major metropolitan research and teaching hospital were enrolled in a meal replacement program which prescribed 1200 kcal/d (5025 Kj/d) consisting of regular foods with approximately 20 g/d fat (15% of kcal) for 16 weeks. RESULTS: Participants who completed the study (n = 34) lost a mean of 5.1 +/- 3.6 kg (p < 0.001) (range, +2.7 kg to -12.5 kg; 6.7 +/- 5.0% of body weight, range +/-3.1% to -17.0%; 0.36 +/- 0.25 kg/week) with no clinically significant adverse effects. There were no discernible new gallstones as measured by ultrasonography during the study period. Liver enzyme blood concentrations did not change significantly after 16 weeks except for alkaline phosphatase, which decreased by 4.5 mu/l from a mean initial level of 72.7 mu/l (p < 0.05). CONCLUSION: Weight loss over 16 weeks on a 1200 kcal/d (5025 Kj/d) regular food/approx 20 g/d fat (15% of kcal) diet was not accompanied by a high rate of gallstone formation in moderately obese persons.

Adult↗