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PubMed2005

Obesity prevalence among a group of Chicago residents with disabilities.

OBJECTIVE: To examine the prevalence of overweight, obesity, and extreme obesity in a predominantly minority group of adults with disabilities. DESIGN: Cross-sectional study using secondary data analysis. SETTING: Major university medical center. PARTICIPANTS: Adults with physical and cognitive disabilities (N = 306). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Direct measures of height and weight to classify subjects into 3 obesity categories: overweight (body mass index [BMI] range, 25-29.9 kg/m2), obese (BMI range, 30-39.9 kg/m2), and extreme obesity (BMI, > or = 40 kg/m2). RESULTS: People with disabilities, regardless of sex, race and ethnicity, or age, had significantly higher rates of overweight, obesity, and extreme obesity compared with people without disabilities. Extreme obesity (BMI, > or = 40 kg/m2) was approximately 4 times higher among people with disabilities than in the general population (odds ratio = 4.08; 95% confidence interval, 3.50-4.66). There were also substantial differences in obesity prevalence among people with disabilities, using actual measurement data, compared with self-reported data from previously published data sets. CONCLUSIONS: The disparity in excess body weight between people with and without disabilities, particularly in the category of extreme obesity, along with substantial differences in obesity prevalence between actual and self-reported data, show a critical need to better understand why these differences exist.

Adult↗
PubMed2006

Phosphodiesterase 5 inhibitor ameliorates renal resistance to atrial natriuretic peptide associated with obesity and hyperleptinemia.

BACKGROUND: Abnormal neurohormonal regulation of renal sodium handling plays an important role in obesity-associated hypertension. We investigated the effect of experimental obesity on renal response to atrial natriuretic peptide (ANP). METHODS: The effect of ANP was studied in three groups of rats: (1) lean controls, (2) animals made obese by a highly palatable diet, (3) rats treated with adipose tissue hormone, leptin, for 7 days to reproduce hyperleptinemia observed in obesity. RESULTS: ANP administered at a dose of 50 pmol/kg min(-1) induced about a 3-fold lower increase in Na+ and cGMP excretion in obese and leptin-treated rats than in the control group. ANP decreased Na+,K+-ATPase activity in the renal medulla only in the control group. Natriuretic effect of exogenous cGMP was also impaired in obese and leptin-treated rats. In contrast, hydrolysis-resistant cGMP derivative, 8-bromo-cGMP exerted comparable natriuretic effects in all groups. Neutral endopeptidase inhibitor, phosphoramidon, and ANP clearance receptor antagonist, C-ANP, increased urinary ANP excretion in all groups to a similar level, but their natriuretic effect was impaired in obese and leptin-treated groups. A specific inhibitor of cGMP-degrading phosphodiesterase, zaprinast, had comparable natriuretic and Na+,K+-ATPase-lowering effects in all groups and restored normal sensitivity to ANP. CONCLUSIONS: (1) Dietary-induced obesity is accompanied by impaired natriuretic effect of ANP, (2) ANP resistance in obesity may be accounted for by increased leptin level, (3) accelerated degradation of cGMP may contribute to ANP resistance associated with obesity and hyperleptinemia, suggesting that inhibiting cGMP-specific phosphodiesterases may be useful in the treatment of obesity-associated hypertension.

3',5'-Cyclic-GMP Phosphodiesterases↗
PubMed2006

Fatty acid turnover, substrate oxidation, and heat production in lean and obese cats during the euglycemic hyperinsulinemic clamp.

Simultaneous application of the euglycemic hyperinsulinemic clamp (EHC) and indirect calorimetry was used to examine heat production, fat, and glucose metabolism in lean and obese adult neutered male and female cats. The results show that in lean insulin-sensitive cats glucose oxidation predominated during fasting, whereas lipid oxidation became more prominent in obese cats. Insulin infusion during the EHC in lean cats and obese male cats led to a large increase in glucose oxidation, glycogenesis, and lipogenesis. It also led to an increase in glucose oxidation and glycogenesis in obese female cats but it was significantly less compared to lean cats and obese males. This indicates that obese females show greater metabolic inflexibility. In obese cats of either gender, insulin caused greater suppression of non-esterified fatty acids compared to lean cats suggesting that obese cats show greater fatty acid clearance than lean cats. The heat production per metabolic size was lower in obese cats than lean cats. This would perpetuate obesity unless food intake is decreased. The higher glucose oxidation rate in obese neutered male cats suggests that they are able to replete their glycogen and lipid stores at a faster rate than females in response to insulin and it implies that they gain weight more rapidly. Further studies are needed to investigate if the different response to insulin of male cats is involved in their higher risk to develop diabetes.

Adaptation, Physiological↗
PubMed2006

Association of subclinical right ventricular dysfunction with obesity.

OBJECTIVES: The purpose of this research was to identify the determinants of right ventricular (RV) dysfunction in overweight and obese subjects. BACKGROUND: Right ventricular dysfunction in obese subjects is usually ascribed to comorbid diseases, especially obstructive sleep apnea. We used tissue Doppler imaging to identify the determinants of RV dysfunction in overweight and obese subjects. METHODS: Standard and tissue Doppler echocardiography was performed in 112 overweight (body mass index [BMI] 25 to 29.9 kg/m2) or obese (BMI >30 kg/m2) subjects and 36 referents (BMI <25 kg/m2), including 22 with obstructive sleep apnea but no obesity. Tissue Doppler was used to measure RV systolic (s(m)) and diastolic (e(m)) velocities and strain indexes. RESULTS: Obese subjects with BMI >35 kg/m2 had reduced RV function compared with referent subjects, evidenced by reduced s(m) (6.5 +/- 2.4 cm/s vs. 10.2 +/- 1.5 cm/s, p < 0.001), peak strain (-21 +/- 4% vs. -28 +/- 4%, p < 0.001), peak strain rate (-1.4 +/- 0.4 s(-1) vs. -2.0 +/- 0.5 s(-1), p < 0.001), and e(m) (-6.8 +/- 2.4 cm/s vs. -10.3 +/- 2.5 cm/s, p < 0.001), irrespective of the presence of sleep apnea. Similar but lesser degrees of reduced systolic function (p < 0.05) were present in overweight (BMI 25 to 29.9 kg/m2) and mildly obese (BMI 30 to 35 kg/m2) groups. Differences in RV e(m), s(m), and strain indexes were demonstrated between the severely versus overweight and mildly obese groups (p < 0.05). Body mass index remained independently related to RV changes after adjusting for age, log insulin, and mean arterial pressures. In obese patients, these changes were associated with reduced exercise capacity but not the duration of obesity and presence of sleep apnea or its severity. CONCLUSIONS: Increasing BMI is associated with increasing severity of RV dysfunction in overweight and obese subjects without overt heart disease, independent of sleep apnea.

Adult↗
PubMed2006

Potentially protective factors associated with healthful body mass index in adolescents with obese and nonobese parents: a secondary data analysis of the third national health and nutrition examination survey, 1988-1994.

OBJECTIVE: To identify factors potentially protective against obesity in 12- to 16-year-olds with one or two obese parents, and those with no obese parents. DESIGN: A secondary analysis of the Third National Health and Nutrition Examination Survey, 1988-1994. SUBJECTS/SETTING: A nationally representative sample of healthful weight, at-risk, or overweight adolescents with measured heights and weights (n=1,890). Subsamples with any obese parent (body mass index > or =30) and no obese parents (both with body mass index <25) were analyzed. STATISTICAL ANALYSES PERFORMED: Bivariate analyses examined the association of predictor variables (demographics, nutrient intake, and physical activity) on the outcome. Logistic regressions examined the likelihood of being healthful weight. SUDAAN software (release 7.5, 1997, Research Triangle Institute, Research Triangle Park, NC) was used to account for the sample design. RESULTS: Overall, 71% of subjects had a healthful weight, 29% were at risk or overweight. Factors associated with healthful weight included having two nonobese parents (odds ratio [OR]=5.4), only father obese (OR=4.9), only mother obese (OR=3.3), higher reading scores (OR=1.02), lower water consumption (OR=1.8), more exercise programs (OR=2.8), and higher energy intake (OR=2.0). For adolescents with any obese parent, factors potentially protective against obesity included being female (OR=2.2), higher household education (OR=1.1), lower water consumption (OR=2.0), and eating breakfast some days (OR=3.1) or everyday (OR=4.0). For adolescents with no obese parents, potentially protective factors included older age (OR=1.2), not having asthma (OR=2.6), more exercise programs (OR=6.1), and higher energy intake (OR=2.9). All P<.05. CONCLUSIONS: Interventions targeted at adolescents who are at risk because they have parents with obesity should employ a family approach focused on regular breakfast consumption.

Adolescent↗
PubMed2006

Impact of obesity in the critically ill trauma patient: a prospective study.

BACKGROUND: Obesity has risen at an epidemic rate over the past 20 years in the US. To our knowledge, there is an absence of data evaluating the impact of obesity in the critically ill trauma patient. METHODS: Prospective data were collected on 1,167 patients admitted to the ICU over a 2-year period. Obesity was defined as a body mass index (calculated as weight [kg]/height [m(2)]) of 30 or higher. Outcomes analyzed included infection rate, hospital and ICU length of stay, and mortality. Multiple logistic regression was used to evaluate outcomes between obese and nonobese patients for infection (infection versus noninfection) and mortality (deceased versus not deceased). Continuous outcomes such as hospital and ICU lengths of stay were evaluated using multiple linear regression analyses. RESULTS: Sixty-two of 1,167 (5.3%) patients were obese. The majority (71%) of injuries in the study cohort were blunt. Although the majority of patients were men (76%), women (10% versus 4%) were more likely to be obese (p < 0.001). Obese patients had a more than twofold increase in risk of acquiring a bloodstream, urinary tract, or respiratory infection, or being admitted to the ICU (p < 0.001), after statistically controlling for age and Injury Severity Score. When controlling for diabetes, gender, obesity, age, COPD, and Injury Severity Score, obese patients were 7.1 times (95% CI, 2.06-8.9) more likely to die in the hospital. CONCLUSIONS: Obesity is associated with a substantial increase in morbidity and mortality in the critically ill trauma patient. Future studies are warranted in both the prevention of infection and intensive care management of the obese trauma patient.

Adult↗
PubMed2005

Adolescent obesity is associated with high ambulatory blood pressure and increased carotid intimal-medial thickness.

OBJECTIVES: To investigate 24-hour ambulatory blood pressure, lipid profiles, and carotid artery intimal-medial thickness (IMT) in adolescents with and without obesity. STUDY DESIGN: Ambulatory blood pressure data from 93 consecutive adolescents referred to our hypertension center for possible hypertension were analyzed. Fasting serum glucose and lipid concentrations were measured in all subjects. Carotid artery IMT was also measured by B-mode ultrasound imaging in all patients. Obesity was defined as body mass index > or =95(th) percentile for age and sex. Twenty-two of the subjects were obese and 71 nonobese. RESULTS: Mean 24-hour, daytime, and nighttime systolic blood pressures were significantly higher in obese subjects compared with nonobese subjects (P < .002). Twenty-four-hour, daytime, and nighttime pulse pressures were also significantly higher in obese subjects (P < .001). The magnitude of systolic white coat effect was significantly higher in obese subjects (P < .006) and white coat hypertension was significantly more frequent in obese subjects (P < .0001). Obese subjects had higher triglycerides (P < .001) and lower HDL cholesterol (P < .01) than nonobese subjects. Finally, obese adolescents had thicker mean IMT of internal carotid arteries than nonobese adolescents (P < .005). CONCLUSIONS: Obese adolescents have higher ambulatory blood pressure and higher carotid artery IMT, possibly indicating an early course of obesity-related hypertension and carotid artery structural alterations.

Adolescent↗
PubMed2006

Prevalence of mental disorders in normal-weight and obese individuals with and without weight loss treatment in a German urban population.

OBJECTIVE: The aim of the study was to evaluate the prevalence rates of mental disorders in normal-weight individuals and obese individuals with and without weight loss treatment. METHODS: A sample of 251 participants in a conventional weight loss treatment, 153 pre-bariatric surgery patients, 174 normal-weight control participants, and 128 obese control participants not actively losing weight at the time of the investigation were examined. RESULTS: Lifetime prevalence rates of mental disorders in obese women ranged from 46.7% to 60.1% compared with 41.7% in normal-weight women and from 48.0% to 54.4% in obese men compared with 29.8% in normal-weight men. Prevalence rates of mental disorders did not differ significantly between normal-weight and obese women not currently in weight loss treatment; however, the rates were significantly lower compared with both obese treatment groups. Compared with normal-weight men, obese men not currently in weight loss treatment and obese men participating in conventional weight loss treatment showed significantly higher prevalence rates of mental disorders. CONCLUSION: Unlike obese male individuals, obese female participants not currently in weight loss treatment did not differ from normal-weight participants with regard to comorbidity of mental disorders. However, obese female participants who were engaged in weight loss treatment exhibited significantly higher prevalence rates than normal-weight participants.

Adult↗
PubMed2006

Chronic inflammation in psoriasis and obesity: implications for therapy.

A recent study has shown an indisputable relationship between psoriasis and obesity. Obesity leads to a higher risk in developing psoriasis and a poorer long-term clinical outcome of psoriasis. Furthermore, loosing weight may improve the psoriasis. A network of pro-inflammatory cytokines (especially tumour necrosis factor alpha (TNF-alpha)) is believed to play an important role in the pathophysiology of both obesity and psoriasis. The chronic low-level inflammation- as seen in obesity--may contribute to the extent of psoriatic lesions in obese patients. TNF-alpha in obesity is presumed to be derived from inflammatory cells (macrophages) in the adipose tissue and in psoriasis from activated T cells. Several drugs, such as peroxisome proliferator activated receptor (PPAR)-gamma agonists and TNF-alpha blocking agents, that target the pro-inflammatory pathways involved in both psoriasis and obesity have proven their benefit in the treatment of these entities. Furthermore, changes in levels of metabolic hormones as ghrelin and leptin in obesity may also play a role in the pathogenesis of deterioration of psoriasis by their potency to release pro-inflammatory mediators (e.g. interleukin (IL) 6 and TNF-alpha). We hypothesize that the treatment of obese psoriasis patient could be focused on reducing the obesity-induced inflammation. Reducing this obesity-induced inflammation may finally lead to a better clinical outcome. Weight loss could lead to a less inflammatory state by reducing concentrations of TNF-alpha, IL-6, leptin and improving insulin sensitivity.

Chronic Disease↗
PubMed2006

Hyperhomocysteinemia correlates with insulin resistance and low-grade systemic inflammation in obese prepubertal children.

Obesity is an independent risk factor for the development of cardiovascular disease frequently associated with hypertension, dyslipemia, diabetes, and insulin resistance. Higher homocysteine (Hcy) levels are observed in the hyperinsulinemic obese adults and suggest that Hcy could play a role in the higher risk of cardiovascular disease in obesity. We analyzed total Hcy levels in obese prepubertal children and their possible association with both metabolic syndrome and various inflammatory biomarkers and leptin. We studied 43 obese children (aged 6-9 years) and an equal number of nonobese children, paired by age and sex. The obese subjects presented significantly elevated values for insulin (P = .003), C-reactive protein (P = .033), and leptin (P < .001). No significant differences were found in Hcy levels between the obese and nonobese children. However, Hcy concentration was significantly higher in the hyperinsulinemic obese children than in the normoinsulinemic group (P = .002). Using multivariant regression analysis, in the obese group, corrected for age and sex, the homeostasis model assessment for insulin resistance (P partial = .001) and leptin (P partial = .02) are independent predictive factors for Hcy. In the control group, corrected for age and sex, the homeostasis model assessment for insulin resistance (P partial = .005) and leptin (P partial = .031) also are independent predictive factor for Hcy. Increased plasma Hcy, particularly in hyperinsulinemic obese children, may be causally involved in the pathogenesis of atherosclerosis and/or cardiovascular disease, both of which are common in obesity.

Anthropometry↗
PubMed2005

Obesity and asthma.

Obesity is an important public health problem. An increasing body of data supports the hypothesis that obesity is a risk factor for asthma. These data include numerous large cross-sectional and prospective studies performed in adults, adolescents, and children throughout the world. With few exceptions, these studies indicate an increased relative risk of asthma in the obese and overweight and demonstrate that obesity antedates asthma. Obesity appears to be a particularly important issue for severe asthma. Studies showing improvements in asthma in subjects who lose weight, as well as studies showing that obese mice have innate airway hyperresponsiveness (AHR) as well as increased responses to certain asthma triggers also suggest a causal relationship between obesity and asthma. The mechanistic basis for this relationship has not been established. It may be that obesity and asthma share some common etiology, such as a common genetic predisposition, common effects of in utero conditions, or that obesity and asthma are both the result of some other predisposing factor such as physical activity or diet. However, there are also plausible biological mechanisms whereby obesity could be expected to either cause or worsen asthma. These include co-morbidities such as gastroesophageal reflux, complications from sleep-disordered breathing (SDB), breathing at low lung volume, chronic systemic inflammation, and endocrine factors, including adipokines and reproductive hormones. Understanding the mechanistic basis for the relationship between obesity and asthma may lead to new therapeutic strategies for treatment of this susceptible population.

Animals↗
PubMed2006

Should completely intracorporeal anastomosis be considered in obese patients who undergo laparoscopic colectomy for benign or malignant disease of the colon?

BACKGROUND: The outcome of laparoscopic colectomy with completely intracorporeal anastomosis (LCIA) in obese and nonobese patients is assessed. METHODS: Forty-five consecutive patients who underwent LCIA for benign or malignant disease of the right and proximal left colon were reviewed prospectively. Obesity was defined as a body mass index of >30 kg/m(2). RESULTS: There were 24 men (53%) and 21 women (47%) with a mean age of 67 years (46-84 years). The mean body mass index was 27 kg/m(2) (16-38 kg/m(2)); 13 patients (29%) were obese. One procedure was converted to a laparoscopic-assisted colectomy. The mean operative time, estimated blood loss, and duration of stay were 218 minutes (110-420 minutes), 82 mL (50-250 mL), and 5 days (2-11 days), respectively. The mean length of the larger incision (extraction site) and the sum of all port incisions was 4 cm (3-8 cm) and 7 cm (6-10 cm), respectively. Complications occurred in 8 of 45 patients (18%), with no deaths. The mean number of harvested lymph nodes per specimen was 11 (3-30 lymph nodes). Obesity had no effect on operative time (obese patients, 232 minutes; nonobese patients, 213 minutes), incision length (obese patients, 4 cm; nonobese patients, 4 cm) estimated blood loss (obese patients, 100 mL; nonobese patients, 76 mL), complications (obese patients, 15%; nonobese patients, 19%), duration of stay (obese patients, 5 days; nonobese patients, 5 days), or number of harvested lymph nodes (obese patients, 11 lymph nodes; nonobese patients, 11 lymph nodes). There were no port-site hernias or metastases during a mean follow-up period of 5 months (1-18 months). CONCLUSIONS: LCIA can offer smaller incisions, improved cosmesis, and low conversion rates while oncologic principles are preserved. LCIA is a feasible and safe technique with equally successful outcomes in thin and obese patients.

Aged↗
PubMed2001

Can associations between free fatty acid levels and metabolic parameters determine insulin resistance development in obese Zucker rats?

Elevated levels of serum free fatty acids (FFA) may be the metabolic alteration in obesity that leads to insulin resistance (IR) and type 2 diabetes mellitus (DM). The obese Zucker rat (ZR) is a genetic model of juvenile-onset obesity and type 2 DM. Compared with its lean sibling, the obese ZR is hyperinsulinemic, hypertriglyceridemic, and, beginning at about 6 months, hyperglycemic. The obese ZR demonstrates also IR, hyperphagia, increased lipogenesis, adipocyte hypertrophy and hyperplasia, and increased serum FFA levels. This study was designed to determine if serum FFA levels in lean and obese ZRs correlate with metabolic parameters associated with altered energy metabolism and IR. We hypothesized that serum FFA levels correlate with such serum parameters such as insulin, glucose, triglyceride, and total cholesterol, as well as such tissue parameters as retroperitoneal, perirenal, and epididymal fat pad weights and liver total lipid content. Twenty lean and 20 obese ZR were age/weight matched. For 14 days each rat had ad libitum access to a single bowl diet that was 50% fat, 30% carbohydrate, and 20% protein. Body weights and caloric intakes were measured daily. After 14 days, all animals were fasted overnight and euthanized. Serum and tissue measurements were made and various parameters were correlated with FFA levels. Serum FFA levels were almost 2 times higher in the obese ZR (approximately 1 mmol/L) compared to the lean (approximately 0.6 mmol/L). Each variable measured was significantly (p < or = 0.05) greater in the obese ZR compared to the lean. There were significant correlations between serum FFA levels and certain variables when data from all ZR were plotted against serum and tissue parameters. However, within phenotypes, there were no significant correlations. Serum FFA levels predict serum and tissue parameters that accompany obesity and IR when comparing lean and obese rats. However, FFA do not predict such parameters within one phenotype.

Animals↗
PubMed1978

Insulin response in skeletal muscle and fat cells of the genetically obese Zucker rat.

Isolated fat cells derived from 10-wk-old Zucker obese rats utilized substantially greater amounts of glucose per cell in the presence or absence of insulin than those from lean rats. Initial rates of deoxyglucose or 3-0-methylglucose uptake in fat cells from Zucker obese rats were also 5--10 times greater than those observed in cells from lean rats. However, while 240 microU/ml insulin elicited a maximal response in fat cells from lean rats, this dose of hormone was only about 50% as effective as 24 microU/ml insulin in stimulating glucose metabolism or hexose transport in obese rat cells. This apparent rightward shift in the dose response-relationship could not be adequately explained on the basis of decreased insulin receptors since (125I-) insulin binding per fat cell was increased 2.5--3-fold in obesity, while receptor density on the cell surface in obesity was decreased only slightly. Soleus muscles from obese Zucker rats exhibited decreased basal rates of D(5-3H)glucose conversion to glycogen and H2O compared to those of lean controls. While the percent increase in glucose metabolism due to a supermaximal dose of insulin was similar in soleus muscles of lean and obese Zucker rats, a blunted response to a submaximal insulin dose was observed in muscles from the latter animals. This rightward shift in the dose-response relationship was also observed when deoxyglucose uptake was monitored in soleus muscles from obese rats. Binding of (1251-) insulin to soleus muscles at a medium concentration of 57 microU/ml was significantly decreased in obese compared to lean rats. We conclude that (1) fat cells do not contribute to the insulin resistance of 10-wk obese Zucer rats since glucose utilization is higher in these cells at all concentrations of insulin tested, (2) obese Zucker rat soleus muscle metabolism is defective in two respects--imparied basal glucose utilization and a rightward shift in the insulin dose-response relationship with respect to hexose transport, and (3) this latter defect involving decreased sensitivity of muscle to insulin appears to result from a marked decrease in cell surface receptors for the hormone.

Adipose Tissue↗
PubMed1997

Effects of heparin treatment on hemostatic abnormalities in obese non-insulin-dependent diabetic patients.

This study was conducted to identify the mechanisms responsible for coagulative and fibrinolytic alterations and to study the effects of a short-term treatment with low-dose heparin on hemostatic abnormalities in obese non-insulin-dependent diabetes mellitus (NIDDM) patients. Four groups of age- and sex-matched patients were studied: (1) lean nondiabetic subjects (n = 30) with a body mass index (BMI) less than 25 kg/m2 (lean control subjects), (2) obese nondiabetic subjects (n = 30) with a BMI greater than 30 kg/m2 (obese control subjects), (3) lean NIDDM patients (n = 30), and (4) obese NIDDM patients (n = 30). All subjects were tested on the following parameters: fibrinogen, factor VII, prothrombin fragment 1 + 2 (F1 + 2), thrombin-antithrombin III complexes (TAT), tissue plasminogen activator (t-PA) antigen (Ag) before and after venous occlusion (VO), and plasminogen activator inhibitor type-1 (PAI-1) activity pre- and post-VO. In addition, all these parameters were evaluated in obese NIDDM patients after 10 days of treatment with a single dose of 12,500-U/d subcutaneous calcium heparin and after a 10-day washout period. At baseline, obese nondiabetic subjects, lean NIDDM patients, and especially obese NIDDM patients displayed significantly (P < .01) higher levels of fibrinogen, factor VII, F1 + 2, TAT, t-PA(Ag) pre-VO, and PAI-1 pre- and post-VO and significantly (P < .01) lower levels of t-PA(Ag) post-VO. In obese NIDDM patients treated with heparin fibrinogen, factor VII, F1 + 2, TAT, t-PA(Ag) pre-VO, and PAI-1 pre- and post-VO levels significantly (P < .01) decreased and t-PA(Ag) post-VO levels significantly (P < .01) increased at the end of treatment. Our findings demonstrate in obese nondiabetic subjects, lean NIDDM patients, and especially obese NIDDM patients the hemostatic abnormalities contributing to an enhanced risk of thrombotic complications. We conclude that in obese NIDDM patients, short-term treatment with heparin may reduce this thrombophilic state and have a potential benefit in the progression of diabetic microvascular and macrovascular disease and needs further investigation.

Anticoagulants↗
PubMed2001

Biological influences on obesity.

Severely obese children are even more likely to have mutations in obesity genes than are severely obese adults. Thus, investigators searching for obesity genes commonly focus on children, with the result that many human obesity genes were first identified in studies of children. Although the development of obesity depends on living in an obesity-promoting environment, it also is influenced strongly by individual genetic composition. Thus, the discovery of new obesity genes provides new opportunities to identify causes of severe obesity. Finally, identification of individual causes of obesity may, in the future, provide for a safe, effective, and individualized treatment recommendation for each obese person.

Animals↗
PubMed2003

Prevalence and determinants of obesity in an urban sample of Portuguese adults.

OBJECTIVE: To evaluate the prevalence and the determinants of obesity, and the associated cardiovascular risk factors in a random sample of non-institutionalised adults. DESIGN: Cross-sectional study. SUBJECTS: A random sample of 1436 habitants of Porto (873 women and 563 men) aged 18-90 years. MEASUREMENTS: All participants answered a structured questionnaire comprising information on social, demographic, behavioural and clinical aspects. Anthropometric measures, blood pressure and fasting blood samples were obtained. Diet was assessed using a semi-quantitative food-frequency questionnaire, and physical activity was evaluated using a questionnaire exploring all professional, domestic and leisure-time activities. When the body mass index was > or =30 kg/m2, the subject was considered as 'obese'. Proportions were age adjusted for the European population. Odds ratios and 95% confidence intervals were computed using unconditional logistic regression. RESULTS: The prevalence of obesity was significantly higher in women (26.1%) than men (13.9%). Regardless of gender, obesity increased with age, decreased with education, and was more frequent in married blue-collar workers and unemployed subjects. Smoking was more prevalent in subjects of normal weight, and a higher proportion of those reporting no regular exercise were obese. In men, obesity prevalence increased with increasing quartiles of energy intake, but no such changes were found in women. Compared with subjects of normal weight, obese men showed a significantly higher prevalence of hypertension (53.3 vs 26.1%) and hypertriglyceridaemia (23.4 vs 9.0%). Also, hypertension (43.7 vs 30.7%), diabetes (7.6 vs 2.7%), hypertriglyceridaemia (27.1 vs 5.0%), and abnormal low-density lipoprotein (30.4 vs 21.4%) and high-density lipoprotein cholesterol concentration (15.0 vs 5.3%) were more frequent in obese women. CONCLUSION: Obesity is a major public health issue in urban Portuguese populations, and obese individuals have many features of metabolic syndrome. Education and relative deprivation are modifiable factors that are significantly associated with obesity. However, no clear-cut relationship was found between physical activity and energy intake.

Adolescent↗
PubMed2000

Laparoscopic nephrectomy in the markedly obese living renal donor.

OBJECTIVES: To determine whether laparoscopic living donor nephrectomy is safe and efficacious in markedly obese renal donors. METHODS: From 1996 to 1999, 431 laparoscopic living donor nephrectomies were performed. The markedly obese group consisted of 41 patients with a body mass index (BMI) greater than 35. Forty-one controls with a BMI less than 30 were matched to the obese donors by sex, age, race, and date of surgery. RESULTS: The markedly obese and control groups were closely matched in sex, race, age, serum creatinine level, creatinine clearance, HLA match to recipient, side of donated kidney, and experience level of the surgeons. The obese patients had a BMI range of 35.2 to 53.9 (mean 39.3), and the control patients had a BMI range of 18.4 to 29.0 (mean 24.3). Donor operations in the markedly obese were significantly longer by an average of 40 minutes. The greater intraoperative blood loss and longer extraction incision length seen in the markedly obese did not reach statistical significance. More and larger laparoscopic ports were used in the markedly obese. Obese donors were more likely to require conversion from laparoscopic nephrectomy to open nephrectomy than ideal-sized donors. The postoperative recovery of the gastrointestinal tract, hospitalization time, analgesic requirements, and total complications were equal in the two groups, although the obese donors' complications tended to be cardiopulmonary problems. The recipient graft function was equivalent between the two groups. CONCLUSIONS: Laparoscopic living donor nephrectomy is more difficult to perform in the markedly obese but is associated with an equivalent donor morbidity and recipient renal outcome.

Blood Loss, Surgical↗