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Absence of linkage of obesity and energy metabolism to markers flanking homologues of rodent obesity genes in Pima Indians.

The homologues of single genes that cause obesity in rodents are suggested as candidate genes for modulation of body composition in humans. Among these genes are the four mouse mutations-diabetes (db), obesity (ob), tubby (tub), and yellow agouti (Ay). Variation in the human counterparts to these genes (OB, DB, TUB, and ASP, respectively) may contribute to human obesity, which is thought to have a substantial genetic component. To initially assess the potential contribution of these genes to human obesity, we examined polymorphic DNA markers that, by virtue of syntenic relationships to appropriate regions of the mouse genome, should be closely linked to the human counterparts of these genes. Using combined data from 716 Pima Indians comprising 217 nuclear families, we have tested a number of polymorphic microsatellite markers (three at DB, two at OB, five at TUB, and three at ASP) for sib-pair linkage to BMI, percentage body fat, resting metabolic rate, 24-h energy expenditure, and 24-h respiratory quotient. No significant linkages were found in an analysis of all sibships or in an analysis restricted to discordant sib pairs.

Adipose Tissue↗

Phenotype of the obese Koletsky (f) rat due to Tyr763Stop mutation in the extracellular domain of the leptin receptor (Lepr): evidence for deficient plasma-to-CSF transport of leptin in both the Zucker and Koletsky obese rat.

The obese phenotypes of the diabetes (db) mouse and fatty fa) rat are due to functional null mutations of the leptin receptor (Lepr). The recessive mutation in the Koletsky (f) obese rat maps to the same genetic intervals as db and fa and fails to complement the fa mutation. Comparison of the sequence of brain Lepr cDNA from +/+ and f/f animals reveals a T2349A transversion resulting in a Tyr763Stop nonsense mutation in the gene just before the transmembrane domain. Virtual absence of Lepr mRNA in whole brain from f/f animals is consistent with the presence of a null mutation. The predicted reduced cerebrospinal fluid (CSF) transport of leptin in both f/f and fa/fa mutants is reflected in the approximately 10-fold lower ratio of CSF/plasma leptin concentration in the obese versus lean animals. However, equivalent CSF leptin concentration between lean and obese rats (fa/fa, f/f) indicates that leptin can enter the CSF through a non-Lepr-mediated mechanism, which may be saturated at normal physiological plasma leptin concentration.

Animals↗

Convergent validity of the Larocque Obesity Questionnaire and self-reported behavior during obesity treatment.

A validation study of the Larocque Obesity Questionnaire designed for use in obesity treatment was performed. Unlike other measures of obesity, this questionnaire includes scales measuring general emotional state as well as eating behavior. Subscales measured uncontrolled eating, physical stress responses, depression, and perfectionism. Subjects were 458 women and 79 men in treatment for obesity by general practitioners. The subscales showed acceptable internal consistency and related in predictable ways to measures of eating behavior, depression, self-criticism, stress, physical complaints and weight-control motivation. Subjects in the heaviest weight category (Body Mass Index > or = 40) showed higher scores on Stress Response and Depression subscales. There were no significant sex differences, after controlling for weight. All four subscales showed significant improvement after 5 wk., which indicates their sensitivity to changes during treatment.

Adolescent↗

Evaluation of obesity. Who are the obese?

Obesity has become increasingly prevalent in westernized countries, and in the United States it has reached epidemic proportions. The risks linked to obesity--such as cardiovascular disease, hypertension, and type 2 diabetes--make this condition one that deserves time and recognition by primary care physicians. Here, Dr Bray reviews the characteristics that define overweight and obesity, the factors that contribute to the pathogenesis of obesity, and current approaches to its management.

Absorptiometry, Photon↗

[The latest in the diagnosis and treatment of obesity: Is still there a place for the conservative treatment of obesity?].

In Chile and other countries the actual prevalence of obesity is reaching 30% in selected populations (low income women). Nowadays bariatric surgery appears to be the treatment of choice. However, it is only indicated in selected patients and is not the first line treatment, since it does not prevent or reduce the appearance of this condition, a crucial challenge in its clinical management. The contemporary medical management of obesity should include changes in lifestyle habits and diet together with a behavioral therapy. However, this optimal management requires a multidisciplinary team. A challenge for contemporary medicine is to design efficient interventional strategies to change lifestyles among the obese. These interventions are the only way to reduce the adverse health consequences of obesity.

Bariatric Surgery↗

[Dietary habits in obese individuals before ambulatory obesity treatment].

Resting energy expenditure, using indirect calorimetry, and food habits by the food frequency questionnaire, were measured in randomly selected 200 obese people (body weight 102 +/- 23 kg, age 41 +/- 15 yrs) during their first appointment in the Centre for obesity treatment. All were educated in low calorie diet (LCD = 5 MJ) regime at the same way. After 30 months the obese people from the highest and the lowest quartile according to the percentage of weight loss (derived as a percentage of their initial body weight) were compared. There was not found any statistical difference in frequency of particular commodities intake, only higher probability of good weight reduction was confirmed in obese with higher body weight (p < 0.003) and higher resting energy expenditure (p < 0.02) on the beginning of the LCD treatment. This study has demonstrated that food habits assessed according food frequency questionnaire has not predictive value to distinguish between successful or non-successful compliance with very low calorie diet.

Adult↗

[Treatment of morbid obesity with laparoscopic, adjustable gastric banding. Results after two years of experiences with a new surgical method for severe obesity].

INTRODUCTION: In the last decade, laparoscopic, adjustable silicone gastric banding for morbid obesity has gained widespread use, owing to two important improvements: The surgical procedure can be performed laparoscopically and the weight loss can be regulated by adjusting the silicone band by a simple percutaneous technique. MATERIAL AND METHODS: Over a 2-year period, we followed up 33 patients admitted to the clinic for morbid obesity. Sixteen patients preferred the conventional diet treatment (1), seven patients underwent an operation (2), and ten patients were motivated for operation, but were found to be unfit and were treated by diet (3). RESULTS: The excess loss of body weight was 25% in group 1, 60% in group 2, and 0% in group 3. CONCLUSION: Laparoscopic, adjustable gastric banding can help the severely obese patients when diets and pharmacological treatment have failed. The resulting loss of weight is highly dependent on careful follow-up by a professional obesity team.

Adult↗

[Multidisciplinary management of the obese patient: example from the Obesity Center at the University of Liege].

Obesity is a mulfactorial disease whose prevalence is progressively increasing. Ideally, it requires a multidisciplinary management by medical doctors, dieticians, psychologists and kinetherapists. The new "Centre de l'Obésité" at the University of Liège aims at fulfilling such objectives with: 1) a first outpatient visit including the simultaneous participation of an endocrinologist, a dietician and a psychologist; 2) a structured and individualized programme of physical rehabilitation; 3) an individualized management of obese subjects as in-(hospital) and/or outpatients, using medical and/or surgical approaches; and 4) an opportunity to benefit of other specialized medical advices, if necessary, in order to increase both the efficacy and safety of the treatment. Owing to the increasing importance of obesity and the well-known difficulties to succeed in treating it, general practitioners should consider this new centre as a valuable help rather than a competitive structure for the management of their patients, especially those with severe or morbid obesity.

Counseling↗

The obese Göttingen minipig as a model of the metabolic syndrome: dietary effects on obesity, insulin sensitivity, and growth hormone profile.

The objective of the study reported here was to induce obesity in the female Göttingen minipig to establish a model of the human metabolic syndrome. Nine- to ten-month-old female Göttingen minipigs received a high-fat high-energy (HFE) diet or a low-fat, low-energy (LFE) diet. The energy contents derived from fat were 55 and 13 %, respectively. After 5 weeks, animals were subjected to dual energy x-ray absorptiometry (DEXA) scanning, intravenous glucose tolerance testing (IVGTT), and 6-h growth hormone profile recording. After treatment, mean body weight of pigs of the LFE group was 21.0 +/- 0.4 kg, and was 26.8 +/- 0.2 kg in pigs of the HFE group (P < 0.0001). The DEXA scanning indicated that the fat content of the LFE group was 10.0 +/- 1.2 % versus 15.2 +/- 0.7 % in the HFE group (P < 0.003). Triglycerides concentration was significantly (P < 0.05) increased in pigs of the HFE group (0.24 +/- 0.03 mM), compared with that in pigs of the LFE group (0.13 +/- 0.04 mM). Preprandial plasma glucose and insulin concentrations were not affected, but insulin area under the curve during IVGTT was significantly high in the obese animals. Growth hormone (GH) secretion was low in both groups of pigs. The obese minipig shares some of the metabolic impairments seen in obese humans, and may thus serve as a model of the metabolic syndrome.

Absorptiometry, Photon↗

[Differential indications for ambulatory group therapy of obesity--exemplified by "interdisciplinary therapy of obesity"].

The article deals with reflections about the differential indication for out-patient group therapy treatment of patients suffering from a considerable overweight by the example of the "Interdisciplinary therapy of obesity". First the conception of the "Interdisciplinary therapy of obesity" is presented. Within the context of evaluation of the therapy program, especially the results of a long-term follow-up study and the special conditions for severely obese people are dealt with. Empirical results and clinical experiences build the foundations to work out differential indication criteria like therapy motivation, degree of overweight and degree of psychological strain. On this basis modifications of the therapy program are suggested in the form of three different kinds of treatment, taking into account the clinically different groups of obese people.

Adolescent↗

Does adipose tissue cellularity or the age of onset of obesity influence the response to short-term inpatient treatment of obese women?

Thirty-three obese women were admitted as inpatients to a metabolic ward and had an average intake of 3.35 MJ (800 kcal) daily for three weeks. Fat biopsies were taken at three subcutaneous sites and average fat cell mass (CM) and apparent fat cell number (FCN) were calculated. There was no significant correlation between adipose tissue cellularity (CM or FCN) and total weight loss or resting metabolic rate, provided due allowances were made for the severity of obesity in each case. Neither was there any significant correlation between short-term weight loss and the age of onset of obesity. Resting metabolic rate, and not adipose tissue cellularity or age of onset of obesity, is a better indicator of short-term weight loss under controlled inpatient conditions.

Abdominal Muscles↗

Prevalence of obesity in patients with acute hepatitis; is severe obesity a risk factor for fulminant hepatitis in Japan?

BACKGROUND/AIMS: The prevalence of obesity in acute convalescent hepatitis and fulminant hepatitis has not been reported. The aim of this study was to investigate whether obesity affected the disease severity in Japanese patients with acute hepatitis. METHODOLOGY: 31 non-severe acute hepatitis (NS-AH) and 24 severe acute hepatitis and 14 fulminant hepatitis patients (S-AH) between January 1995 and December 2001 were analyzed retrospectively. Height and weight were used to calculate the body mass index (BMI) in these 69 patients. RESULTS: Mean height, weight and BMI were not significantly different between S-AH and NS-AH patients. Two severely obese (BMI greater than 35kg/m2) patients had developed S-AH. CONCLUSIONS: Severe obesity may be one of the prognostic factors in acute hepatitis. Further studies are needed.

Acute Disease↗

[Clinical features, hormonal profile, and metabolic abnormalities of obese women with obese polycystic ovary syndrome].

OBJECTIVE: To investigate and analyze the clinical presentation, hormonal profile, and metabolic abnormalities of obese women with polycystic ovary syndrome (PCOS). METHODS: The data of the anthropometric measurements, clinical manifestations of hyperandrogenism, serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol (E(2)), testosterone (T), prolactin (PRL), dehydro-epiandrosterone sulfate (DHEAS), sex-hormone-binding globulin (SGBG), and 17-oxyhydroprogesterone (17-OHP), fasting plasma glucose (FPG) and fasting insulin (FINS) detected after oral glucose tolerance test (OGTT), serum lipid levels, including total cholesterol (Chol), triglycerides (TG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL), homeostasis model assessment (HOMA) and area under curve (AUC) so as to assess the insulin resistance (IR), free androgen index (FAI) to estimate the extent of hyperandrogenism, HOMA IS and DeltaI(30)/DeltaG(30) used to assess the function of islet beta cells, were collected from 192 women with PCOS, aged 24 +/- 6, that were divided into 2 groups according to the body mass index (BMI): Group A (n = 70) with the BMI > or = 25 kg.m(-2) and Group B (n = 122) with the BMI < 2 5 kg.m(-2), and 65 age-matched bilateral tubal block factor infertile women served as controls that were divided into 2 groups as well: Group C (n = 25) with the BMI > or = 25 kg.m(-2); and Group D (n = 79) with the BMI < 25 kg.m(-2), and underwent a cross-sectional study. RESULTS: (1) Clinical phenotype: The presence of obesity was 36.46% (70/192) of which 80.00% (56/70) was central obesity. The incidence of acanthosis nigricans was 17.18% (33/192), 35.71% in Group A and 6.56% in Group B. (P < 0.01). Groups A and C showed increased frequency of acanthosis nigricans compared with Group B. The value of FAI of Group A was 3.40 +/- 1.84, significantly higher than those of Group B (1.75 +/- 1.20) and Group C (1.65 +/- 0.90), (both P < 0.01). The LH/FSH ratio of Group B was 2.41 +/- 1.13, significantly higher than those of Groups A, C, and D (all P < 0.01). (2) Hormonal profile: The IR rate was 43.23% in the 192 patients, 82.86% in Group A and 20.49% in Group B. The LH and LH/FSH ratio were significantly higher in Group B than in Groups A, C, and D (all P < 0.01); T level was higher in Groups A and B than in Group C and D (all P < 0.05). SHBG was lower in Group A (108.70 +/- 81.35 nmol.L(-1)) and Group C (150.34 +/- 106.23 nmol.L(-1)) compared with Group B (192.49 +/- 98.30 nmol.L(-1)) and Group D (231.84 +/- 90.09 nmol.L(-1)) (P < 0.01 and P < 0.05). FAI level was 3.40 +/- 1.84 in Group A, significantly higher than those of Groups B (1.75 +/- 1.20), C (1.65 +/- 0.90), and D (0.84 +/- 0.45) (all P < 0.01). The FINS, TG, and HOMA IR of Groups A and C were all significantly higher than those of Groups B and D (all P < 0.01). The OGTT GAUC was significantly higher than those of Groups B, C, and D (P = 0.006, 0.028, and 0.031 respectively). (3) Metabolic profile: The prevalence of IR was 43.23% (83/192) with a higher prevalence rate in Group A (82.76%, 58/70) compared with Group B (20.49%, 25/122). The values of FINS, HOMA IR, GAUC, IAUC, and TG were all higher in Group A than in Group B (all P < 0.01). BMI and WHR were positively correlated with FAI and HOMA-IR (all P < 0.01), whereas negatively correlated with LH/FSH ratio (r = -0.345, -0.260, P < 0.01). There were no significant differences in HOMA-IS and DeltaI(30)/DeltaG(30) among these groups (all P > 0.05). CONCLUSION: Obese PCOS women have more severe hyperandrogenism, IR and hyperinsulinism than normal-weight PCOS women, which may have some health implications later in life.

Adolescent↗

Successful weight loss following obesity surgery and the perceived liability of morbid obesity.

Patients (n = 47) who lost 45 kg (100 lb) or more and who successfully maintained weight loss for at least three years following gastric restrictive surgery for morbid obesity viewed their previous morbidly obese state as having been extremely distressful. In spite of the strong proclivity for people to evaluate their own worst handicap as less disabling than other handicaps, patients said they would prefer to be normal weight with a major handicap (deaf, dyslexic, diabetic, legally blind, very bad acne, heart disease, one leg amputated) than to be morbidly obese. All patients said they would rather be normal weight than a morbidly obese multi-millionaire.

Adult↗

Introduction: obesity: diet composition, energy expenditure, and treatment of the obese patient.

The association of obesity with increased risks for developing hypertension, diabetes, cardiovascular disease, and cancer has made it a complex health problem. Exacerbating the problem is the realization that there are multiple factors, both physiological and psychological, that interact to induce obesity, as well as a myriad of components that may be useful in the curtailment of obesity. The aim of this symposium is to provide a wider understanding of the elements behind the development and reduction of obesity.

Adipose Tissue↗

Glucose, insulin and C-peptide secretion in obese and non obese women with polycystic ovarian disease.

Plasma glucose, immunoreactive insulin (IRI) and C-peptide responses during oral glucose tolerance testing (OGTT) were evaluated in 10 non obese women with polycystic ovarian disease (NOB-PCOD) and 10 obese women with polycystic ovarian disease (OB-PCOD). Mean plasma glucose response at 120 minutes in OB-PCOD showed impaired glucose tolerance. Also in this group, 1 patient had frank diabetes mellitus, whilst 3 other patients had impaired glucose tolerance 1 NOB-PCOD patient had impaired glucose tolerance. Mean plasma glucose levels and mean incremental glucose areas were higher in the OB-PCOD at all time intervals and reached statistical significance at 60 and 90 minutes. Mean plasma IRI levels were also higher in OB-PCOD at all time intervals, and reached statistically significant higher levels at 0, 60 and 90 minutes. Mean serum C-peptide valves were also higher at all time intervals in OB-PCOD. The relationship between acanthosis nigricans, obesity and PCOD was also analysed. It is evident from this study that obesity has a significant negative impact on the overall carbohydrate status in women with PCOD.

Blood Glucose↗

[Obesity and hyperlipoproteinemia. I. Changes in lipid levels in obese persons].

The authors investigated changes in serum lipid levels in 115 obese men and 172 obese women. The body mass index (BMI) of the subjects was 29-50 kg/m2. The group was subdivided by sex and age as follows: 15-18 years, 19-25 years, 26-35 years, 36-55 years. It was revealed that with advancing age and increasing body weight the mean tiacylglycerol levels in men increased from 1.74 mmol/l to 4.40 mmol/l, in women from 1.37 mmol/l to 1.84 mmol/l. The mean levels of total serum cholesterol increased in men from 4.58 mmol/l to 6.82 mmol/l, in women from 5.09 mmol/l to 5.96 mmol/l. In the rise of serum cholesterol in men the LDL and VLDL fractions participated, in women mainly the LDL fraction. Conversely the HDL fraction declined in men from 1.60 mmol/l to 1.20 mmol/l, in women from 1.71 mmol/l to 1.26 mmol/l. The mean value of the atherogenic index in men increased from 2.88 to 5.68, in women from 2.99 to 4.73. The results indicate the adverse changes of serum lipid levels in obese subjects which appear in men already after the age of 25 years, in women 10-20 years later. The authors discuss the causes of hyperlipoproteinaemia and the risk of atherosclerosis in obesity.

Adolescent↗

[Obesity and hyperlipoproteinemia. II. The effect of a low energy diet on lipid levels in the blood of obese persons].

In 287 obese men and women with BMI values of 29-50 kg/m2, divided by sex and age, the effect of a low-energy diet on triacylglycerol (TG), total cholesterol (TC) and HDL-cholesterol (HDL-C) serum levels was investigated. On a diet of 2500 kJ/day (4 weeks) and 4000-7000 kJ/day (6 weeks) the body weight declined by 10-11% from the initial value. There was a significant drop of TG in obese men above 25 years and in obese women above 35 years of age. The mean TC values did not change significantly after weight reduction. The mean HDL-C levels increased significantly after weight reduction, as compared with initial values in both sexes in the groups aged 26-35 years. In this group there was also an increase of the relative ratio of HDL-C in TC and the value of the atherogenic index declined. The authors draw attention to the fact that with regard to preserving normal blood lipid levels, in particular in obese men, it is necessary to reduce or normalize body weight in the course of the third decade.

Adolescent↗