Degree Of Weight Gain Research Articles

Secular trends in BMI in a cohort of children with Type 1 diabetes in the first-year post diagnosis

Background: Along with the global increase in the rates of overweight and obesity in the pediatric population, it is becoming more prevalent in children with type 1 diabetes. The presence of diabetes and obesity may further aggravate the long term outcome of these children. Aims: Evaluate the secular change in BMI in children during the first year after the diagnosis of type 1 diabetes and identify variables affecting this change. Methods: This is a retrospective cohort study conducted at the diabetes clinic at Shaare Zedek Medical Center. Demographic data was withdrawn from the patients' charts and included age, age at diagnosis, gender and ethnic origin. Clinical data included DKA at diagnosis, height, weight, and BMI at presentation and throughout the first year following diagnosis at several pre-determined time points. Results: The study included 167 patients, 93 males. The average BMI- Z at presentation was -0.65 and increased to 0.35 after a year from diagnosis. The most pronounced increase in BMIZ occurred as expected in the first month (0.5-0.75), but it continued during the first year. At diagnosis, 16.6% of the children were underweight, 11.8% overweight and 2.7% obese. By the end of the first year, there were more overweight 28.5%, and obese 6.3% children. The lower the BMI-Z at diagnosis, the greater the weight gain observed at all-time points throughout the year. DKA at presentation was associated with a more significant weight gain in the first year using univariate analysis. No correlation was found between the patients' gender or age at diagnosis and the degree of weight gain. Conclusions: Continuous weight gain was observed throughout the first year after the diagnosis of diabetes, with a significant increase in the rate of overweight and obesity.

Labial Frenotomy for Symptomatic Isolated Upper Lip Tie.

The benefits and challenges of successful breastfeeding for both mother and child have been well-established in the literature. While ankyloglossia, or tongue tie, alone or in combination with upper lip tie has been the focus of several previous studies, very few have directly addressed isolated symptomatic upper lip tie and the role of surgical correction for breastfeeding difficulties. Seven infants with isolated upper lip tie and breastfeeding difficultywere taken to the operating room for labial frenotomy. These infants were assessed at their follow-up visits for their degree of weight gain since their procedure. Their mothers were surveyed regarding their experiences with breastfeeding since the frenotomy was performed. In this article, we present seven infants with isolated upper lip tie and breastfeeding difficulty who were treated with labial frenotomy. Subsequently, these infants demonstrated improved weight gain, and all mothers reported increased ease of breastfeeding. These findings implicate lip tie as an underrecognized cause of breastfeeding difficulty and suggest that labial frenotomy is an effective treatment in these patients. Larger-scale randomized controlled studies are necessary to further evaluate this topic.

Heterogeneity of obesity and the main pathogenetic factors of its development (a review of resources)

Introduction. Among medical and social problems, obesity (Ob) occupies one of the leading places. This is related to the established pathogenetic connection of Ob with type 2 diabetes mellitus, arterial hypertension, acute vascular events, dementia, osteoarthritis, obstructive sleep apnea and some forms of cancer. Ob is also associated with social problems and reduced work capacity. Despite numerous studies on the study of Ob, a number of unresolved issues and controversial points of view remain. The aim – is to analyze the currently existing data on the heterogeneity of Ob and the main pathogenetic factors of its development based on the study of literary sources, mainly for a period of 10 years. Materials and methods – an electronic search was carried out in MEDLINE/PubMed, Google Scholar and Web of Science databases using the keywords "obesity", "obesity heterogeneity", "obesity etiopathogenesis" with subsequent analysis of literature sources published mainly in the last 10 years. The results. To date, there is no single universally accepted classification of Ob, and those currently used in clinical practice and during scientific research are based on one or another criterion. Such criteria include etiopathogenetic factors, type of adipose tissue deposition, degree of weight gain, etc. The use of bioimpedancemetry became the basis for the assertion about the heterogeneity of Ob with the selection of its separate forms, namely: metabolically healthy Ob; metabolic Ob with normal body weight, sarcopenic and metabolically unhealthy Ob. Despite the lack of clear diagnostic criteria for each of these forms, their differences in clinical course, pathogenetic factors of development and degree of cardiovascular risk have been established. Considering the indicated heterogeneity, the selection of the leading etiological factor of Ob remains a rather controversial and difficult issue. The exceptions, obviously, should include cases of the secondary form of this pathology, when Ob is one of the symptoms and is pathogenetically related to the underlying disease. In general, it is believed that, being hereditary, Ob is the result of the interaction between genetic, hormonal-metabolic, behavioral and environmental factors. Conclusions. Ob is a chronic multifactorial and heterogeneous disease, the individual clinical forms of which differ in the course and level of metabolic disorders. Etiopathogenetic factors of the development and progression of Ob are multifactorial and include genetic predisposition, factors of the external and internal environment, eating behavior and hormonal and metabolic shifts. According to the data obtained today regarding the heterogeneity of Ob and the pathogenetic mechanisms of its development, a new generally accepted characteristic and classification of this pathology should be accepted.

High Prevalence of Weight Gain in Childhood Brain Tumor Survivors and Its Association With Hypothalamic-Pituitary Dysfunction.

Childhood brain tumor survivors (CBTS) are at risk for developing obesity, which negatively influences cardiometabolic health. The prevalence of obesity in CBTS may have been overestimated in previous cohorts because of inclusion of children with craniopharyngioma. On the contrary, the degree of weight gain may have been underestimated because of exclusion of CBTS who experienced weight gain, but were neither overweight nor obese. Weight gain may be an indicator of underlying hypothalamic-pituitary (HP) dysfunction. We aimed to study prevalence of and risk factors for significant weight gain, overweight, or obesity, and its association with HP dysfunction in a national cohort of noncraniopharyngioma and nonpituitary CBTS. Prevalence of and risk factors for significant weight gain (body mass index [BMI] change ≥ +2.0 standard deviation score [SDS]), overweight, or obesity at follow-up, and its association with HP dysfunction were studied in a nationwide cohort of CBTS, diagnosed in a 10-year period (2002-2012), excluding all craniopharyngioma and pituitary tumors. Of 661 CBTS, with a median age at follow-up of 7.3 years, 33.1% had significant weight gain, overweight, or obesity. Of the CBTS between 4 and 20 years of age, 28.7% were overweight or obese, compared with 13.2% of the general population between 4 and 20 years of age. BMI SDS at diagnosis, diagnosis of low-grade glioma, diabetes insipidus, and central precocious puberty were associated with weight gain, overweight, or obesity. The prevalence of HP dysfunction was higher in overweight and obese CTBS compared with normal-weight CBTS. Overweight, obesity, and significant weight gain are prevalent in CBTS. An increase in BMI during follow-up may be a reflection of HP dysfunction, necessitating more intense endocrine surveillance.

1005. Comparison of Weight Changes in Treatment-Naïve, HIV-Infected Patients Receiving Integrase Inhibitor-Based Therapy Versus Protease Inhibitor-Based Therapy

BackgroundRecent data regarding integrase inhibitor (INSTI) therapy indicate possible association with weight gain. The incidence and degree of weight gain seems to vary by both patient-specific and regimen-related factors, such as nucleoside reverse transcriptase (NRTI) backbone.MethodsThis was a retrospective chart review of previously ART-naïve Indiana University Health LifeCare Clinic patients who started an INSTI- or PI-based regimens from 1/1/13 to 7/31/19. Adult patients without prior ART exposure receiving an INSTI- or PI-based regimen for at least 10 months were included. The primary objective was weight gain at 12 months after starting ART. Subgroup analyses were conducted by INSTI, PI, or NRTI backbone utilized. Statistical testing included Wilcoxon Rank-Sum Test and Chi Square analyses.ResultsThe patient population (N=162) was predominately male and African American with relative immunocompetence, generally achieving viral suppression after 12 months of ART. Patients receiving PI-based therapy were more likely to be Asian American or Hispanic (p=0.04), and to receive a tenofovir disoproxil fumarate (TDF)-based regimen (p=0.0034). No statistically significant difference in weight change was observed between INSTI- and PI-based regimens (median weight gain 5.1 kg vs 3.9 kg, p=0.52). The proportion of obese or overweight patients in the INSTI arm increased significantly as compared to baseline (p=0.00001). Subgroup analyses demonstrated significant increases in weight gain and clinically significant weight gain with tenofovir-based (tenofovir alafenamide and TDF) regimens compared to those with abacavir/lamivudine (p< 0.05).Primary Objective BMI Category Changes by INSTI or PI Agent NRTI Subgroup Analyses ConclusionLack of power makes meaningful interpretation of the results for the primary objective difficult. However, several of the prespecified secondary objectives and subgroup analyses demonstrated clinically significant results related to increased weight gain or BMI category changes with INSTI-, PI-, and tenofovir-based regimens. Checking the patient’s weight at every appointment is considered standard practice at IU Health clinics, but missing values despite qualifying encounters were observed. Further commitment to standardized weighing practices should be a priority at clinics caring for patients living with HIV.Disclosures All Authors: No reported disclosures

SAT-436 Long-Term Analysis of Weight Change Following Thyroidectomy

Introduction: Weight gain is a common source of apprehension for patients undergoing thyroidectomy. However, contradictory reports exist regarding the presence and degree of weight gain following thyroid surgery and all known studies have short term follow-up This study evaluated weight changes following total thyroidectomy (TT) and lobectomy (L) over an extended time period. Methods: Retrospective analysis was performed of weight changes following surgery for patients who underwent TT or L (n=387) as compared with those undergoing parathyroidectomy for primary hyperparathyroidism (n=201) in a tertiary referral hospital between 2007-2012. Clinical, demographic and pre- and postoperative weight data was collected with a median follow-up of 55.6 months. Results: Postoperative weight change was observed at 1, 6, 12, and 36-months in patients who underwent TT (μ=+0.21kg, μ=+1.33kg, μ=+0.59kg, μ=+0.60kg; p<0.05) and at 6-months for patients who underwent L (μ=+0.93kg, p<0.05) compared with those who underwent parathyroidectomy. Patients having TT and L showed a general trend of weight gain compared to the control group up to 108-months post-operation; however, this weight gain was non-significant (p<0.05). Significant postoperative weight gain was observed in patients who had TT (1-month μ=+0.40kg, 6-months μ=+2.14kg, and 12-months μ=+1.40kg) and L (6-months μ=+1.04kg) for benign conditions compared with the parathyroidectomy group. Patients who had TT gained 0.40kg more than L patients at 12-months post-op (p<0.05), but no significant difference existed at other time points up to 108-months. Tukey HSD post-hoc analysis showed weight gain in benign, thyroiditis, and thyroid cancer patient groups was not significantly different from 6-months to 108-months post-operation. Furthermore, neither race nor sex was correlated with weight gain. Relative risks with 95% CI for weight gain following TT and L compared to control are: 1-month TT=1.74, 0.96-3.14, L=1.59, 0.58-2.58; 6-month TT=1.27, 0.85-1.89, L=1.42, 0.85-2.11; 12-month TT=1.44, 0.92-2.28, L=1.34, 0.86-2.36; 24-month TT=1.17, 0.82-1.67, L=1.22, 0.69-1.60. In the group of patients who gained greater than 2kg, those who underwent TT had significant weight increase compared to the parathyroidectomy group at 6-months postoperatively (Mann-Whitney U, p=0.011). In the subgroup of patients with weight gain greater than 2kg, those who had L did not have significant weight increase at any time point. Conclusion: Weight change following TT when compared with parathyroidectomy is significant shortly after surgery. However, these changes are not significant at long-term follow-up.

Getting to precision psychopharmacology: Combining clinical and genetic information to predict fat gain from aripiprazole

IntroductionAll atypical antipsychotics are associated with some degree of weight gain. We applied a novel statistical approach to identify moderators of aripiprazole-induced fat gain using clinical and genetic data from a randomized clinical trial (RCT) of treatment resistant depression in older adults. Materials and methodsAdults aged ≥60 years with non-response to a prospective trial of venlafaxine were randomized to 12 weeks of aripiprazole augmentation (n = 91) or placebo (n = 90). Dual energy x-ray absorptiometry (DEXA) measured adiposity at baseline and 12 weeks. Independent moderators of total body fat gain were used to generate two combined multiple moderators, one including clinical data alone and one including both clinical and genetic data to characterize individuals who gained fat during aripiprazole augmentation. ResultsThe value of the combined genetic + clinical multiple moderator (Mcg) was 0.57 [95% CI 0.46, 0.68] (effect size: 0.57), compared to the combined clinical moderator (Mc) value of 0.49 [0.34, 0.63] (effect size: 0.49). Individuals who gained adiposity in this study were more likely to be female and younger in age, have lower weight, fasting glucose and lipids at baseline and positive for the HTR2C polymorphism. DiscussionThese results demonstrate a combined multiple moderator approach, including both clinical and genetic moderators, can be applied to existing clinical trial data to understand adverse treatment effects. This method allowed for more specific characterization of individuals at risk for the outcome of interest. Further work is needed to identify additional genetic moderators and to validate the approach.

Brexpiprazole for the maintenance treatment of adults with schizophrenia: an evidence-based review and place in therapy.

The purpose of this review is to describe the available data for brexpiprazole in the maintenance treatment of schizophrenia. This objective was completed by searching the databases PubMed, Embase, and ClinicalTrials.gov to identify relevant study results presented as papers or abstracts. In summary, brexpiprazole is a new agent in the D2 partial agonist class that has a unique receptor-binding profile, based in part on high affinity for serotonin 5HT1A and 5HT2A receptors, paired with lower intrinsic activity at dopamine D2 receptors. The average dose used in efficacy and safety studies for the maintenance treatment of schizophrenia ranged from 3.0 and 3.1 mg in the open-label safety studies to 3.6 mg in the double-blind randomized relapse-prevention study. Highlights from the 52-week double-blind placebo-controlled relapse-prevention trial evidenced rates of relapse in the brexpiprazole group of 13.5% vs 38.5% in the placebo group (number needed to treat 4, 95% CI 3–8; P<0.0001). Safety data indicate that brexpiprazole is tolerated well, with rates of discontinuation due to treatment-emergent adverse events that ranged from 5.2% of those taking brexpiprazole in the double-blind maintenance phase of the relapse-prevention trial to 15.3% in a 52-week open-label safety study. In the available trials, there were relatively low rates of akathisia, and the degree of weight gain was similar to that seen in studies with aripiprazole for the treatment of schizophrenia. Positive and Negative Syndrome Scale scores also remained relatively stable in the open-label safety studies. Available data indicate that brexpiprazole is an effective agent for the maintenance treatment of schizophrenia that is overall well tolerated.

Environmental Forces that Shape Early Development: What We Know and Still Need to Know

Understanding health requires more than knowledge of the genome. Environmental factors regulate gene function through epigenetics. Collectively, environmental exposures have been called the “exposome.” Caregivers are instrumental in shaping exposures in a child’s initial years. Maternal dietary patterns, physical activity, degree of weight gain, and body composition while pregnant will influence not only fetal growth, but also the infant’s metabolic response to nutrients and energy. Maternal over- or underweight, excess caloric intake, nutrient imbalances, glucose dysregulation, and presence of chronic inflammatory states have been shown to establish risk for many later chronic diseases. During the period from birth to age 3 y, when the infant’s metabolic rate is high and synaptogenesis and myelination of the brain are occurring extremely rapidly, the infant is especially prone to damaging effects from nutrient imbalances. During this period, the infant changes from a purely milk-based diet to one including a wide variety of foods. The process, timing, quality, and ultimate dietary pattern acquired are a direct outcome of the caregiver-infant feeding relationship, with potentially lifelong consequences. More research on how meal time interactions shape food acceptance is needed to avoid eating patterns that augment existing disease risk. Traditional clinical trials in nutrition, meant to isolate single factors for study, are inadequate to study the highly interconnected realm of environment-gene interactions in early life. Novel technologies are being used to gather broad exposure data on disparate populations, employing pioneering statistical approaches and correlations applied specifically to the individual, based on their genetic make-up and unique environmental experiences.

Su1139 PRIMARY STUDY ON SUBMUCOSAL TUNNELING ENDOSCOPIC SEPTUM DIVISION FOR ESOPHAGEAL DIVERTICULUM

Submucosal tunneling endoscopic septum division (STESD) is a minimal invasive surgical therapy for esophageal diverticulum. This study is to evaluate the efficacy and safety of this operation. Patients with typical symptoms (dysphagia, regurgitation, foreign body sensation, etc.) who received STESD during April 2016 to June 2017 were included in this study. Patients with atypical symptoms or those with other esophageal motility disorders were excluded. STESD was performed by 4 steps: 1) mucosal incision; 2) submucosal tunneling; 3) septum division; and 4) mucosal closure. SF-36 health survey was used for the assessment of quality of life. A total of 8 patients were included in this study, the mean age was 59.9 years old (range, 39-80). There were 3 male patients and 5 females. Among them, 3 (3/8, 37.5%) were diagnosed with Zenker’s diverticulum, 4 (4/8, 50.0%) were diagnosed with epiphrenic diverticulum, 1 (1/8, 12.5%) was diagnosed with mid-esophageal diverticulum. The mean procedure time was 47.0 mins (range, 22-106mins, SD, 27.6mins). The mean of hospital stay after surgery was 4.3 days (range, 3-9days, SD, 2.0days). Mucosal injury was found in 2 patients during the procedure, and was closed by hemostatic clips, no major adverse event was found during hospital stay or after discharge. The depth of diverticulum (vertical distance from the septum to the bottom) was 23.13±8.43mm before and 19.25±8.88mm after STESD (mean±SD, p=0.281, two-tail-t-test). 2 patients (2/8, 25.0%) were completely symptom-free, 5 (5/8, 62.5%) reported relieved symptoms after the procedure, and only one (1/8, 12.5%) complained no significant change after the surgery (Table 1). One patient was lost to follow up the SF-36 scale. In patients who accomplished the follow-up, the total score of SF-36 was 112.1±27.1 before and 134.9±10.0 after the procedure (mean±SD, p=0.034, t-test). Among 8 sub-scales analysis of SF-36, GH (general health) and VT (vitality) analysis after surgery showed significant improvement with those before surgery (p=0.018 in GH, p=0.013 in VT, t-test). Various degrees of weight gain after STESD were observed, except one patient who lost weight through exercising. Submucosal tunneling endoscopic septum division can efficiently improve patients’ quality of life, especially in general health and vitality. Furthermore, based on our pilot study to date, this procedure is safe, although prospective studies in large scales are still needed.Tabled 1Table 1. Main symptoms before and after STESDCaseSiteBeforeAfterMain SymptomSeverityFrequencyMain SymptomSeverityFrequency1Zenker’sChest tightnessModerateEverydayChest tightnessMildEverydayForeign body sensationModerateEveryday---2EpiphrenicRegurgitation of foodSevere1∼2/monthAcid refluxModerate3∼4/half a year3EpiphrenicDysphagiaSevereEverydayDysphagiaModerateEverydayRegugitation of foodMild1∼2/weekAcid refluxModerate1∼2/week4EpiphrenicDysphagiaSevereEveryday---5Zenker’sDysphagiaSevereEveryday------Foreign body sensation*Mild2∼3/week6EpiphrenicDysphagiaModerateEveryday------Gurgling after meal*Mild3∼4/week7Zenker’sDysphagiaSevereEveryday---8**Mid-esophagealDysphagiaSevereEverydayDysphagiaMild3∼4/weekAcid refluxModerateEveryday---*Emerging symptoms **Lost to follow-up at 4-month after STESD Open table in a new tab

Temporal changes in filtering-facepiece respirator fit

ABSTRACTA three-year study examined changes in N95 filtering-facepiece respirator (FFR) fit at six-month intervals and the relationship between fit and changes in weight for 229 subjects. During each visit, subjects performed a total of nine fit tests using three samples of the same FFR model. Inward leakage and filter penetration were measured for each donned respirator to determine face seal leakage (FSL). A total of 195 subjects completed the second visit and 134 subjects completed all seven visits. Acceptable fit was defined as 90th percentile FSL ≤ 5% and at least one fit factor ≥ 100. An unacceptable fit was observed for 14, 10, 7, 12, 15, and 16% of subjects on Visits 2–7, respectively. The predicted risk of an unacceptable fit increased with increasing length of time between fit tests, from 10% at Year 1 to 20% at Year 2 and to 25% at Year 3. Twenty-four percent of subjects who lost ≥ 20 lb had an unacceptable fit; these percentages ranged from 7–17% for subjects with lower weight losses or any degree of weight gain. Results support the current OSHA requirement for annual fit testing and suggest that respirator users who lose more than 20 lb should be re-tested for respirator fit.

Duration and Degree of Weight Gain and Incident Diabetes in Younger Versus Middle-Aged Black and White Adults: ARIC, CARDIA, and the Framingham Heart Study.

OBJECTIVETo determine whether duration and degree of weight gain are differentially associated with diabetes risk in younger versus middle-aged black and white adults.RESEARCH DESIGN AND METHODSWe combined data from three cohort studies: Atherosclerosis Risk in Communities (ARIC), Coronary Artery Risk Development in Young Adults (CARDIA), and the Framingham Heart Study. A total of 17,404 participants (56% women; 21% black) were stratified by baseline age (younger: ≥30 and <45 years; middle-aged: ≥45 and <60 years) and examined for incident diabetes (median follow-up 9 years). Duration and degree of gain in BMI were calculated as “BMI-years” above one’s baseline BMI.RESULTSDiabetes incidence per 1,000 person-years in the younger and middle-aged groups was 7.2 (95% CI 5.7, 8.7) and 24.4 (22.0, 26.8) in blacks, respectively, and 3.4 (2.8, 4.0) and 10.5 (9.9, 11.2) in whites, respectively. After adjusting for sex, baseline BMI and other cardiometabolic factors, and age and race interaction terms, gains in BMI-years were associated with higher risk of diabetes in the younger compared with middle-aged groups: hazard ratios for 1-unit increase in log BMI-years in younger versus middle-aged blacks were 1.18 (P = 0.02) and 1.02 (P = 0.39), respectively (P for interaction by age-group = 0.047), and in whites were 1.35 (P < 0.001) and 1.11 (P < 0.001), respectively (P for interaction by age-group = 0.008).CONCLUSIONSAlthough middle-aged adults have higher rates of diabetes, younger adults are at greater relative risk of developing diabetes for a given level of duration and degree of weight gain.

Changes in objectively measured BMI in children aged 4-11 years: data from the National Child Measurement Programme.

This study looked at the degree of weight gain between the first (Reception) and last year (Year 6) of primary school and how weight status in Reception predicts becoming overweight/obese by Year 6. A longitudinal sample of 1863 children was created using two time points (2006/7, 2012/13) from the National Child Measurement Programme (NCMP) in South Gloucestershire. T-test and logistic regression were used to test the difference between the BMI z-scores and BMI percentiles, and predict the probability of being overweight (BMI ≥ 85th) or obese (≥95th) at Year 6 based on BMI percentile in Reception. Of those children who were obese at Reception age, 68% were obese at Year 6. Compared with children with a BMI in the 2nd to 49th percentile range, children between the 75th and 84th percentiles of BMI at Reception age were 10 times more likely (odds ratio (OR) = 10.18, P < 0.01), and those with a BMI between the 85th and 94th percentiles were 13 times more likely (OR = 13.38, P < 0.01), to become obese by Year 6. Boys were more likely than girls to revert to a healthy weight. This is the first study to link data from the NCMP. It provides estimates of prevalence and offers new evidence on obesity emergence and gender differences.

Beyond Pharmacotherapy: Understanding the Links between Obesity and Chronic Mental Illness

While differences in weight-gain potential exist, both between and within classes of psychiatry medications, most commonly used atypical antipsychotics, mood stabilizers, and antidepressants result in some degree of weight gain. This is not new information and it requires an understanding of the tolerability profiles of different treatments and their goodness of fit with specific patient phenotypes. However, this iatrogenic association represents only a piece of this obesity-mental illness dyad. The complex interplay between psychiatric illness and weight involves neurobiology, psychology, and sociological factors. Parsing the salient variables in people with mental illness is an urgent need insofar as mortality from physical health causes is the most common cause of premature mortality in people with chronic mental illness. Our review examines issues associated with common chronic mental illnesses that may underlie this association and warrant further study if we hope to clinically intervene to control this life-threatening comorbidity.

Weight Gain, Obesity, and Psychotropic Prescribing

A majority of psychiatric medications are known to generate weight gain and ultimately obesity in some patients. There is much speculation about the prevalence of weight gain and the degree of weight gain during acute and longitudinal treatment with these agents. There is newer literature looking at the etiology of this weight gain and the potential treatments being used to alleviate this side effect. The authors undertook a comprehensive literature review in order to present epidemiology, etiology, and treatment options of weight gain associated with antipsychotics, mood stabilizers, and antidepressants.

Serum adipokine profile in Indian men with nonalcoholic steatohepatitis: Serum adiponectin is paradoxically decreased in lean vs. obese patients

Background Asian Indians are known to be more insulin resistant for the same degree of weight gain. It is therefore likely that the adipokine profile in nonalcoholic fatty liver disease (NAFLD) in Asian Indian population could be different from the Western subjects. Aims To study the serum adiponectin, resistin, leptin and TNF-α profile in NAFLD and cryptogenic cirrhosis patients. Subjects and methods Body mass indices, insulin resistance and serum adipokine levels were studied in 56 patients; 10 with fatty liver, 30 with nonalcoholic steatohepatitis (NASH) and 16 with cryptogenic cirrhosis. Eighteen healthy controls were also included. Results Patients in general were obese compared to controls (mean BMI 26.9 ± 4.5 vs. 22.6 ± 2.5, respectively, p < 0.0001). In patients with NASH, adiponectin levels were lower than controls (5.4 ± 3 μg/ml vs.7.2 ± 2.9 μg/ml, p = 0.037). Insulin Resistance as assessed by homeostasis model assessment (HOMA) was higher in obese than lean, NAFLD patients (HOMA IR obese, median = 2.8, range = 0.8–16.3 and lean: median = 1.05, range = 0.51–2.75, p = 0.003). Lean NAFLD patients had adiponectin levels lower than obese patients (3 ± 1 μg/ml vs.6.7 ± 3.8 μg/ml respectively, p = 0.003). Serum resistin levels were higher in NAFLD patients (3.7 ± 3 ng/ml) than controls (2.1 ± 1.7 ng/ml, p = 0.007). This difference was significant even when cirrhotic patients were excluded (3.4 ± 2.7 ng/ml, p = 0.036). Serum leptin levels were raised in cryptogentic cirrhosis compared to NASH ( p = 0.03). All adipokines tested were raised in cirrhotic patients compared to NAFLD and controls. Conclusions A significant reduction in serum adiponectin and increase in serum resistin levels were observed in NAFLD patients, more so in lean than obese NAFLD. This paradoxical decrease of serum adiponectin as well as low frequency of insulin resistance in lean NAFLD suggests a possible different etiology for this subset of patients.

1H-nuclear magnetic resonance spectroscopy-based metabolic assessment in a rat model of obesity induced by a high-fat diet

Obesity, whose prevalence is increasing rapidly worldwide, is recognized as a risk factor for diabetes, cardiovascular disease, liver disease, and renal disease. To investigate metabolic changes in the urine of a rat model of obesity induced by a high-fat diet (HFD), rats were divided into the following four groups based on the diet type and degree of weight gain: normal-diet (ND) low gainers, ND high gainers, HFD low gainers, and HFD high gainers. Biochemical analyses of visceral fat-pad weight, plasma, and liver tissues were performed. The (1)H-nuclear magnetic resonance ((1)H-NMR) spectra of urine were analyzed using multivariate statistical analysis to identify the separation of the groups. It was observed that the metabolic profile of urine obtained by (1)H-NMR-spectroscopy-based metabolomic analysis differed between ND low gainers and ND high gainers even though these animals consumed the same normal diet. Several key metabolites in urine, such as betaine, taurine, acetone/acetoacetate, phenylacetylglycine, pyruvate, lactate, and citrate contributed to the classification of these two groups. The metabolic profile of urine also differed between ND low gainers and HFD high gainers, which consumed the different diet and showed a different weight gain. This study has identified features of urine metabolites in various groups and demonstrated the reliability of an NMR-based metabolomics approach to investigate the effects of the diet and the physical constitution on obesity.

Maintenance treatment in bipolar disorder: a reassessment of lithium as the first choice

In consideration of the declining use of lithium over the past several decades, this review focuses on three topics to argue for lithium's status as first choice as the maintenance treatment of bipolar disorder. This review (i) describes success rates for patients assigned to lithium and those assigned to placebo in early (1973-1976) and recent (2000-2003) trials, as well as those assigned to alternative mood stabilizers versus placebo; (ii) summarizes the results of studies that compared lithium to alternative mood stabilizers by the degree of weight gain during maintenance therapy; and (iii) reviews evidence that lithium exhibits unique antisuicidal properties. Differing success rates in early and more recent maintenance trials strongly suggest a cohort effect in which the lithium responders are relatively unavailable for recent maintenance trials. Moreover, among mood stabilizers studied in randomized trials, lithium appears least likely to cause substantial weight gain, and a considerable literature has developed to suggest that lithium has antisuicidal effects that extend beyond its benefits in relapse prevention. The evidence reviewed here strongly supports the consideration of lithium when prophylactic treatment is first begun for a bipolar patient.

Drug‐Induced Hyperphagia: What Can We Learn From Psychiatric Medications?

This brief review examines hyperphagia and associated weight gain as undesirable side effects of psychiatric medications; exploring the scope of the problem, proposed mechanisms, and potential interventions. Mechanisms of action appear to include drug-mediated effects on hypothalamic appetite pathways that have been implicated in other etiologies of obesity. There is great individual variation in response to these medications as well as variation in the degree of weight gain within drug classes. Gene polymorphisms may be a key factor in determining individual variations in response. Better understanding of the underlying mechanisms can guide useful interventions. Medication selection and dosing appear to be important strategies to minimize adverse weight gain.

Excessive Gestational Weight Gain in Chronic Liver Disease Is Associated with Advanced Fibrosis

Purpose: Background: Chronic liver disease is an increasing problem as non-alcoholic fatty liver disease (NAFLD) has a prevalence of 3%- 24% in the general population. NAFLD is strongly associated with obesity. No published studies have investigated the association of NAFLD, other chronic liver diseases and gestational weight gain. Excessive weight gain during pregnancy from the literature is 25 pounds or greater. Aim: To examine: 1) the gestational weight gain in NAFLD subjects compared to other liver disease controls; 2) relationship between the severity of fibrosis and degree of weight gain during pregnancy. Methods: Using Weight and lifestyle inventory (WALI) gestational weight gain was divided into 2 groups: NAFLD and other liver diseases with diagnosis and stage liver biopsy proven. Net gestational weight gain (NGWG) was calculated in each patient by adding the weight gain minus loss for each pregnancy together. The average gestational weight gain (AGWG) for each patient was calculated by the mean of the weight gained of each pregnancy. Comparisons of NGWG between groups were made by the student t-test. AGWG (≥24 pounds and <24 pounds) were compared with stage of fibrosis of liver (I/II and III/IV) and analyzed by two-by-two table (Fisher Exact). Results: There were 16 NAFLD patients and 12 other liver disease patients with a history of pregnancy. The mean NGWG was 23.56 ± 24.53 pounds in the NAFLD group and 9.25 ± 10.89 pounds in the other liver disease group (P= 0.049). NAFLD patients did not have a higher AGWG then the other liver disease patients. Of total 26 pregnant patients (NAFLD + others), 15 patients had AGWG ≥ 24 pounds with 7 (47%) at fibrosis stage III or IV, whereas 11 patients with AGWG < 24 pounds had only 1 (9%) at stage III or IV fibrosis (P= 0.045). Conclusion: Discussion: NAFLD is associated with increased gestational weight gain as defined by the accumulated NGWG through all pregnancies. In all forms of liver disease, more advanced stages of fibrosis are associated with high AGWG but not with NGWG. These findings suggest that excessive gestational weight gain in the setting of chronic liver disease is a serious concern, because it may predispose these patients to an increased risk of progression of fibrosis. Recommendations of gestational weight gain control in patients with NAFLD and other liver diseases are of vital importance and need to be a part of prenatal counseling.