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Biomedical subjects

L Van Gaal

Publications and source records attributed to L Van Gaal.

At least 37 records · Page 2Linked to original sources

Mutation analysis of the MEN1 gene in Belgian patients with multiple endocrine neoplasia type 1 and related diseases.

Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant disorder characterized by tumors in parathyroids, enteropancreatic endocrine tissues, anterior pituitary, and other tissues. The gene for MEN1 has recently been cloned and shown to code for a 610-amino acid protein of enigmatic function which probably acts as a tumor suppressor. Several mutations causing the MEN1 phenotype have been recently identified. In order to determine the spectrum of MEN1 gene mutations in a sample of 25 Belgian patients, we have systematically screened the 10 exons and adjacent sequences of the MEN1 gene by means of an automatic sequencing protocol. Twelve different mutations were identified including nonsense, frameshift, splicing, and missense mutations. Two of these mutations (D172Y and 357del4) occurred more than once. A missense mutation was also found in a kindred with familial hyperparathyroidism. We observed no significant correlation between the nature or position of mutation and the clinical status. We have also detected 6 intragenic polymorphisms and DNA sequence variants and have analyzed their frequencies in our population.

Belgium↗

Carbohydrate-induced thermogenesis in obese women. Effect of insulin and catecholamines.

Results of studies on diet-induced thermogenesis in obese persons are contradictory. A number of factors have been postulated to mediate the obligatory and facultative component of thermogenesis. This study was designed to investigate some further factors mediating the carbohydrate-induced thermogenesis in obese women. In 13 obese women, thermogenic responses to glucose and fructose were compared and related to subsequent hormonal changes. The thermogenic effect after fructose ingestion was significantly (p<0.006) higher in comparison with glucose, despite lower values for both glucose and insulin concentrations. Carbohydrate oxidation was significantly higher after fructose (81+/-7 E% vs 62+/-10 E% p<0.01) while oxidation of fat was lower (10+/-9 E% vs 21+/-12 E% p<0.01). These effects may partly be due to the de novo lipogenesis and/or to changes in cellular metabolism. No clear relationship could be found between thermogenesis and the activity of the sympathetic nervous system, as expressed by urinary catecholamine levels. These results indicate that not insulin but the cellular rate of carbohydrate metabolism is responsible for the thermogenic response to different carbo-nutrients.

Adult↗

Are leptin levels dependent on body fat distribution in obese men and women?

Leptin levels are strongly related to total body fat. It is however not yet clear if leptin is also related to visceral fat accumulation or not. In this study, we investigated whether leptin is also associated with body fat distribution and if this association is different in men and women. Leptin was measured in 143 obese subjects (118 women and 25 men) with a body mass index (BMI) greater than 28. Also weight, skinfolds, waist-to-hip ratio (WHR), fat mass by bioimpedance analysis (BIA) were measured, and abdominal visceral and subcutaneous fat were determined by CT scan. Leptin levels were significantly related with BMI, with fat mass (in kg and percentage body fat) as measured by BIA and skinfolds, and with total abdominal fat mass and subcutaneous fat measured by CT scan. No association was found with visceral fat, waist circumference or WHR. In men and women separately, however, a correlation with visceral fat existed. After correction for total body fat, the correlation remained significant only with subcutaneous fat in women. Multiple regression analyses pointed out that percentage body fat was the most important determinant of leptin for all subjects, while for women subcutaneous fat was the most important parameter, and for men alone total abdominal fat. These results suggest that subcutaneous fat seems to be an important factor related to leptin levels.

Adipose Tissue↗

Effects of initial BMI and on-treatment weight change on the lipid-lowering efficacy of fibrates.

OBJECTIVE: To assess the effects of BMI at baseline and on-treatment weight change on the lipid-lowering efficacy of diet plus fibric acid derivatives (fibrates) in hypercholesterolemic adults. SUBJECTS: 6003 participants in a Belgian General Practitioners Trial, an open-label, prospective study conducted in a primary care setting. MEASURES: Effect of initial BMI, on-treatment weight change, or lipid values at baseline on percentage changes in low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG). Multiple linear regression models, including initial BMI, on-treatment weight change, age, gender, and baseline lipid values, were fitted to control the influences exerted by these variables on each other. RESULTS: Reductions in LDL-C after diet plus fibrate treatment for 12 weeks were inversely related to initial BMI and to TG levels at baseline, and were positively associated with baseline LDL-C concentrations and with on-treatment weight change (P < 0.001 for all analyses). Decreases in TG related negatively with initial BMI (P = 0.012), and positively with weight loss (P = 0.011) and TG at baseline (P < 0.001). Increases in HDL-C were negatively associated with initial BMI (P = 0.012) and with baseline TG (P < 0.001). CONCLUSIONS: The LDL-C lowering efficacy of fibrates is inversely related to initial BMI, and is positively associated with on-treatment weight loss.

Body Mass Index↗

The use of multi-frequency impedance to determine total body water and extracellular water in obese and lean female individuals.

OBJECTIVE: To validate the assessment of total body water (TBW) and extracellular water (ECW) by multi-frequency bioelectrical impedance. SUBJECTS: Twenty-five overweight but otherwise healthy subjects and 20 lean subjects. DESIGN: Cross-sectional. MEASUREMENTS: TBW and ECW were determined by dilution techniques. Prediction equations from the literature were used to calculate TBW and ECW from measured impedance at 100 and 50 kHz or 1 and 5 kHz, respectively. In 18 of the obese subjects, impedance was also measured with the electrodes placed at proximal sites. RESULTS: In lean and obese subjects, significant correlations were observed between the impedance index (H2/Z) at high frequencies with TBW (r = 0.90, P < 0.001 in lean and r = 0.80, P < 0.001 in obese subjects) and at low frequencies with ECW (r = 0.87, P < 0.001 and r = 0.77, P < 0.001 respectively). Proximal placement of electrodes slightly improved the correlation between the impedance index and TBW (from r = 0.83 to r = 0.90 at 50 kHz and from r = 0.85 to r = 0.90 at 100 kHz) and ECW (from r = 0.77 to r = 0.83 at 1 kHz and from r = 0.79 to r = 0.85 at 5 kHz). The association of ECW and TBW with H2/Z was different for obese and lean subjects: in obese subjects a given amount of TBW or ECW corresponded with a lower index. An equation consisting only of the impedance index could predict TBW and ECW with small mean errors in lean (1.3 and 0.8 kg respectively) and obese subjects (0.1 and 0.0 kg respectively). Applying a more specific equation, including other subject characteristics, resulted in larger prediction errors in obese subjects, illustrating the population specificity of prediction equations. Furthermore an association was observed of the prediction bias of TBW and ECW with TBW (r = 0.48, P < 0.01) and ECW (r = 0.70, P < 0.001) respectively, and with body water distribution (r = -0.38 and r = 0.33 respectively, P < 0.05). TBW and ECW were also associated with weight (r = 0.76 and r = 0.71 respectively, P < 0.001) and body mass index (BMI) (r = 0.54 and r = 0.53 respectively, P < 0.001). CONCLUSION: It appeared from this study that the accuracy of TBW and ECW estimation with the impedance technique is dependent on the absolute amount of TBW and ECW. A higher amount of TBW and ECW in obese subjects may contribute to a difference in prediction error between lean and obese individuals.

Adult↗

Role of hepatic arterial embolisation in the treatment for metastatic insulinoma. Report of two cases and review of the literature.

Malignant insulinomas are very rare. They have typical clinical and biochemical characteristics that allow an early detection and distinction from other sorts of islet cell carcinoma. As a result a curative resection can occasionally be managed. Nevertheless, for more advanced stages the same treatment options as for other metastatic neuroendocrine tumours must be considered: palliative surgery, medical treatment, chemotherapy and hepatic arterial (chemo-) embolisation. Especially the last kind of treatment has recently gained interest. We report two cases of metastatic insulinoma treated in this way. In the first case we are able to record an unusually long survival through the single use of sequential embolisation, following palliative resection of the primary tumour. In the second case we describe the current way to use this technique, i.e. in combination with chemotherapy. We argue that it might be more important in the treatment of metastatic insulinoma to combine hepatic arterial embolisation with other types of local or systemic therapy, rather than the choice of this most efficient technique on its own.

Adult↗

Usefulness of fluoxetine in obese non-insulin-dependent diabetics: a multicenter study.

Weight reduction is essential in the management of most non-insulin-dependent diabetics, but this therapeutical goal is difficult to obtain. In this double-blind parallel study, 82 non-insulin-dependent diabetics, moderately obese (BMI = 30 - 39 kg/m2), were given for an 8-week period either placebo (P) or fluoxetine (F), a specific serotonin reuptake inhibitor, in addition to their usual antidiabetic treatment. Thirty-nine of them received 60 mg fluoxetine a day and 43 were given the placebo. At admission, both groups had similar weight excess, metabolic control and serum lipid values. In comparison with the P-treated subjects, those treated with fluoxetine (F) lost more weight after 3 weeks (-1.9 vs. -0.7 kg, p < -0.0009) and after 8 weeks (-3.1 vs. -0.9 kg, p < 0.0007). Fasting blood glucose decreased in group F after 3 weeks (-1.5 vs -0.4 mmol/L, p < 0.003) and after 8 weeks (-1.7 vs. -0.02 mmol/L, p < 0.0004). HbAlc decreased from 8.5% to 7.7% in group F and from 8.6% to 8.3% in group P (p = 0.057). Mean triglyceride level was also reduced in group F after 8 weeks (p = 0.042). Fasting C-peptide did not change in either group, but fasting insulin values decreased in group F after 3 weeks (p < 0.02) and after 8 weeks (p < 0.05). The insulin/C-peptide molar ratio decreased significantly in group F after 3 weeks (p < 0.04) and after 8 weeks (p < 0.05) in comparison with group P. The drug was generally well tolerated and no major side effects were reported. In conclusion, the addition of fluoxetine to the usual oral hypoglycemic agent therapy might be beneficial in obese non-insulin-dependent diabetics, at least on a short-term basis.

Adolescent↗

Effects of pravastatin on lipid levels, in vitro oxidizability of non-HDL lipoproteins and microalbuminuria in IDDM patients.

The effects of pravastatin on plasma lipid levels, in vitro oxidizability of the non-HDL fraction, metabolic control, urinary albumin excretion, and four serum enzymes (SGPT, SGOT, GT and CPK) were studied in 20 insulin-dependent diabetic patients (IDDM) with incipient nephropathy. The patients were divided into two groups and the study was carried out by a crossover design. After 12 weeks pravastatin treatment (20 mg daily), plasma cholesterol, LDL-cholesterol and apolipoprotein B (Apo B) decreased by 22, 19 and 15%, respectively. The thiobarbituric acid reactive substances (TBARS) formation and the oxidation lagtime of the non-HDL fraction during the in vitro incubation with copper were not changed before and after treatment. The HbA1c and blood glucose levels, urinary albumin excretion, SGOT, SGPT and GT were not influenced by pravastatin treatment. CPK activity was elevated after 12 weeks of pravastatin treatment, and this elevation persisted even after the 12 weeks placebo period. So, pravastatin could be used as an effective drug for IDDM patients with incipient nephropathy, but close monitoring of the CPK activity is recommended.

Adult↗

Lipid and lipoprotein changes after long-term weight reduction: the influence of gender and body fat distribution.

OBJECTIVES: This study was designed: 1) to evaluate the effect of weight loss on body fat distribution, 2) to determine whether indices of body fat distribution can be considered as a prognostic indicator for the ability to lose weight and 3) to evaluate whether a change of body fat distribution is associated with changes in plasma glucose, lipids and lipoproteins in both sexes in order to evaluate a gender difference. METHODS: 63 obese subjects (41 women and 22 men) were treated on an outpatient basis with an energy-reduced, protein-enriched low calorie diet (3150-4200 kJ/day) for a 6-month period. They were divided in different groups according to gender and body fat distribution using the waist-to-hip circumference ratio. RESULTS: Body fat topography can be altered by dieting, but not by more than it increases when a person gains weight. Body fat distribution seems to be a significant prognostic indicator for the ability to lose weight in women but not in men. Although body weight and the waist-to-hip circumference decreased significantly, no relationships were found between percent decrease in these parameters and percent changes in plasma glucose, lipids and lipoproteins. CONCLUSION: We conclude that an important caloric deficit may lead to a series of metabolic improvements but that gender and the type of fat distribution are important confounding factors in the prediction of metabolic success.

Adult↗

A rapid and simple method for measuring the susceptibility of low-density-lipoprotein and very-low-density-lipoprotein to copper-catalyzed oxidation.

Much evidence has accumulated to suggest a role for the oxidation of low-density-lipoprotein (LDL) and very low-density-lipoprotein (VLDL) in the pathogenesis of atherosclerosis. The susceptibility of lipoprotein to copper-catalyzed oxidation is often used to evaluate its oxidizability. A method was developed which isolates the non-high-density lipoprotein (non-HDL) fraction and removes EDTA by a dextran-magnesium precipitation method. The oxidizability of this fraction is evaluated by monitoring the fluorescence and measuring thiobarbituric acid reactive substances (TBARS) at different intervals of incubation. Those parameters reflect apolipoprotein B (apo B) modification and lipid degradation during LDL and VLDL oxidation. Our assay is sensitive enough to study factors which can influence the oxidizability of LDL and VLDL. The method is simple, rapid and can be easily conducted in a routine laboratory.

Catalysis↗

Insulin antibodies before and 1 year after the change-over from U40 to U100 insulin preparations in Belgium.

In 1991, Belgium realized, on a national level, a change-over from U40 to U100 insulin. We took advantage of this evolution to investigate the consequences of changing the concentration of insulin. The patients' weight, daily insulin dosis, insulin binding-capacity of plasma and glycated hemoglobin HbA1c were registered before, and after the change of concentration. Overall, none of these parameters underwent an obvious change, except for the percentage of insulin binding that significantly decreased after the adaptation. Especially in the range of 40% or more insulin binding, the decrease becomes very pronounced. In conclusion, changing the insulin concentration from U40 to U100, did not lead to any harmful clinical consequence. On the contrary, a positive influence of this adaptation, in terms of decreased amount of insulin antibodies was suggested. Probably this decrease is not clinically relevant, since neither the glycated hemoglobin, nor the total daily insulin dose underwent a similar change.

Adult↗

Impact of obesity on resting metabolic rate and glucose-induced thermogenesis in non-insulin dependent diabetes mellitus.

Previous studies have shown that patients with non-insulin dependent diabetes mellitus (NIDDM) have a higher metabolic rate (RMR) and lower thermogenesis in comparison with persons with normal glucose tolerance. It is not clear whether this impairment is due to the diabetic state per se or to the association of the diabetic and obese state. The impact of obesity on RMR and glucose-induced thermogenesis (GIT) was studied in seven non-obese and 12 obese men with NIDDM; the results are compared with a group of six obese men with normal glucose tolerance. RMR was significantly higher for the obese subjects (P < 0.02) but this difference disappeared after correction for fat-free mass. Mean GIT was significantly lower (P < 0.01) in the diabetic patients, whether they were obese or non-obese. The results of this study indicate that for patients with NIDDM, the impact of obesity on both RMR and GIT is rather limited. On the other hand, a significant influence of glucose tolerance on GIT in obese patients could be demonstrated.

Adipose Tissue↗

Fluoxetine therapy in obese diabetic and glucose intolerant patients.

A double-blind placebo-controlled trial was conducted, involving 97 obese diabetic and glucose intolerant patients receiving either 60 mg fluoxetine daily (47 patients) or a placebo (50 patients); a similar calorie-restricted diet was prescribed to all patients. Weight loss was significantly higher in the fluoxetine-treated patients, whose diabetic status improved. Drop-out rate was not significantly different for both groups of patients.

Blood Glucose↗

Magnesium and obesity: influence of gender, glucose tolerance, and body fat distribution on circulating magnesium concentrations.

Obesity is characterized by a high risk for glucose intolerance and cardiovascular disease. Since magnesium deficiency or depletion have often been associated with both pathologies, is of interest to study magnesium status in severely obese subjects before any form of treatment. Negative magnesium balances have been described in overweight persons submitted to total starvation, hypocaloric diets, and obesity surgery. For this reason 80 non-diabetic obese men and 118 age-matched obese women were studied. Serum and erythrocyte magnesium concentrations were significantly higher in the male population but the mean values were not suggestive of a magnesium deficit before any form of treatment was started. Since metabolic abnormalities and cardiovascular risk are greater in patients with upper body fat distribution (UBFD) both sexes were subdivided according to "waist-to-hip" circumference ratio. No difference could be shown in the obese men but in women, UBFD subjects showed higher basal insulin levels and increased erythrocyte magnesium concentration as compared to those with classical gynoid fat distribution. A 75 g oral glucose tolerance test enabled the subjects to be subdivided into those with normal or impaired glucose tolerance (IGT). The IGT group in both sexes was older and more obese. Mean values of serum magnesium and erythrocyte magnesium were not decreased despite the more pronounced insulin resistance in the IGT group. However a significant negative correlation was found between fasting blood sugar/insulinaemia and erythrocyte magnesium, showing that this middle-aged obese population can maintain normal circulating levels of magnesium, in contrast to type II diabetics or older subjects where for other reasons (urinary losses or decreased intake) magnesium status is interfered with.

Adipose Tissue↗