Improvements In Metabolic Risk Factors Research Articles

#2858 EXERCISE AND PREDIABETES AFTER RENAL TRANSPLANTATION: THE EXPRED I STUDY

Abstract Background and Aims Post-Transplant Diabetes Mellitus (PTDM) is a severe disease that may affect about 30% of renal transplant patients. PTDM beyond 12 months (late PTDM) mostly develops in subjects with prediabetes. Although exercise may have a potential role in preventing late PTDM, there is scarce evidence on the effect of exercise in renal transplantation. We designed a 12-month exploratory study to test the capacity of therapeutic exercise in reverting prediabetes to prevent the development of late-PTDM. Method This is a pilot study in which renal transplant patients with prediabetes were treated with exercise for 12 months. To detect prediabetes and to evaluate the reversibility, relapse, or persistence of prediabetes, the oral glucose tolerance test (OGTT) was performed at baseline and every 3 months to the end of the study. Prediabetes was defined by the presence of Impaired Fasting Glucose (IFG) in 100-125 mg/dl and/or Impaired Glucose Tolerance (IGT) between 140-199 mg/dL after the OGTT. The protocol included a stepped incremental plan of aerobic and/or strength training. The frequency, intensity, and duration of aerobic exercise, as well as the addition of strength training depended on the recovery, persistence, or recurrence of prediabetes. All patients started with moderate aerobic exercise (brisk walking), 30 min/day and 5 times per week and, based on that, changes in prescription were considered every 3 months. Additionally, we evaluated: (a) an active plan for promoting adherence to exercise (telephone calls, digital technology, and visits) and (b) improvements in metabolic risk factors: obesity, dyslipidaemia, and blood pressure. Since prediabetes may spontaneously revert to normal glucose metabolism in 25-30% [1], we assume that in 60 cases, the spontaneous reversibility could be of 30% (n = 18) and the reversibility induced by exercise may account for another 30% (n = 18), so the total reversibility will be 60%. Considering an expected drop out of 20%, the number of cases necessary to include was 72 patients. Results The study was early interrupted due to efficacy after the evaluation of 27 patients that reach 12 months of follow-up. Mean age was 54.2 ± 9.6 and 67% were men. Half of the patients were obese and most had overweight. At baseline IGT or IFG alone were found, respectively, in 13 (48%) and 5 (19%) patients, and the combination of both in 9 (33%). All patients were on prednisone and tacrolimus with the addition of mycophenolate on 20 subjects and 7 on everolimus. Of the group, 16 (60%) reverted to normal glucose levels (fasting and 120 min after an OGTT): this was two time higher than the 30% reversibility rate shown in a previous publication [1], p <0.05, assuming a potency of 85%. In parallel, 11 (40%) subjects had prediabetes (9) or developed PTDM (2). No significant changes were found in weight during follow-up in all groups whereas triglycerides diminished in patients on whom prediabetes reverted (154 mg/dL ± 61 to 96 ± 27; p = 0.016). At the end of follow up, adherence to exercise was good (≥70%) in 13 patients (∼50%), moderate (40-70%) in 9 (∼30%) and bad (≤40%) in 5 (∼20%). Finally, all patients with good adherence reverted to normoglycaemia, 3 out of 9 (33%) cases with moderate reverted to normal glucose metabolism and no cases with bad adherence improved on follow-up. No relevant injuries attributed to exercise were observed during the study. Conclusion Therapeutic exercise is safe and effective to improve glucose metabolism in renal transplant patients with prediabetes. Adherence is a crucial aspect to consider in the planification of exercise treatment.

Appointment Adherence to a City-Wide Cardiovascular Disease Prevention Program: Its Predictors and Outcomes.

This study identified predictors of appointment adherence and examined its impacts on improvements in metabolic risk factors in a free city-wide cardiovascular disease prevention program in Seoul, South Korea. Data of 8251 citizens with metabolic syndrome were used. Appointment adherers were defined as having 70% or higher adherence rates, that is, 3 or more visits. Of the 8251 citizens, 17.6% were appointment adherers. Appointment adherers were significantly more likely to be older, low-income earners, nonsmokers, and nonobese than appointment nonadherers. Moreover, appointment adherers, compared with nonadherers, showed significant improvements in waist circumference, systolic blood pressure, and high-density lipoprotein cholesterol, but not in fasting glucose and triglycerides. Designing strategies for increasing appointment adherence to a free city-wide cardiovascular disease prevention program is essential to improve health outcomes, especially targeting population groups with young age, high-income, current smoking, or obesity.

Long-term physical activity on prescription intervention for patients with insufficient physical activity level\u2014a randomized controlled trial

BackgroundPhysical activity (PA) can be used to prevent and treat diseases. In Sweden, licensed healthcare professionals use PA on prescription (PAP) to support patients to increase their PA level. The aim of this randomized controlled trial was to evaluate a 2-year intervention of two different strategies of PAP treatment for patients with insufficient PA level, after a previous 6-month period of ordinary PAP treatment in a primary health care setting.MethodsWe included 190 patients, 27–77 years, physically inactive with metabolic risk factors where the patients were not responding to a previous 6-month PAP treatment with increased PA. The patients were randomized to either enhanced support from a physiotherapist (PT group) or continued ordinary PAP treatment at the health care centre (HCC group). The PAP treatment included an individualized dialogue; an individually dosed PA recommendation, including a written prescription; and a structured follow-up. In addition to PAP, the PT group received aerobic fitness tests and more frequent scheduled follow-ups. The patient PA level, metabolic health, and health-related quality of life (HRQOL) were measured at baseline and at 1- and 2-year follow-ups.ResultsAt the 2-year follow-up, 62.9% of the PT group and 50.8% of the HCC group had increased their PA level and 31.4% vs. 38.5% achieved ≥ 150 min of moderate-intensity PA/week (difference between groups n.s.). Over 2 years, both groups displayed increased high-density lipoproteins (HDL) (p = 0.004 vs. baseline), increased mental health status (MCS) (p = 0.036), and reduced body mass index (BMI) (p = 0.001), with no difference between groups.ConclusionDuring long-term PAP interventions, the PA level, metabolic health, and HRQOL increased in patients at metabolic risk without significant differences between groups. The results indicate to be independent of any changes in pharmacological treatment. We demonstrated that the PAP treatment was feasible in ordinary primary care. Both the patients and the healthcare system benefitted from the improvement in metabolic risk factors. Future studies should elucidate effective long-term PAP-treatment strategies.Trial registrationClinicalTrials.gov NCT03012516. Registered on 30 December 2016—retrospectively registered.

Pioglitazone is equally effective for diabetes prevention in older versus younger adults with impaired glucose tolerance.

To determine the efficacy of pioglitazone to prevent type 2 diabetes in older compared to younger adults with pre-diabetes. Six hundred two participants with impaired glucose tolerance (IGT) were randomized in double blind fashion to placebo or pioglitazone for diabetes prevention in the ACT NOW study (NEJM 364:1104–1115, 2011). Cox proportional hazard regression was used to compare time to development of diabetes over a mean of 2 years between older (≥61 years) and younger participants. We compared effects of pioglitazone versus placebo on metabolic profiles, inflammatory markers, adipokines, β cell function (disposition index), insulin sensitivity (Matsuda index), and body composition by ANOVA. Diabetes incidence was reduced by 85 % in older and 69 % in younger subjects (p = 0.41). β cell function (disposition index) increased by 35.0 % in the older and 26.7 % in younger subjects (p = 0.83). Insulin sensitivity (Matsuda index) increased by 3.07 (5.2-fold) in older and by 2.54 (3.8-fold) in younger participants (p = 0.58). Pioglitazone more effectively increased adiponectin in older versus younger subjects (22.9 ± 3.2 μg/mL [2.7-fold] vs. 12.7 ± 1.4 μg/mL [2.2-fold], respectively; p = 0.04). Younger subjects tended to have a greater increase in whole body fat mass compared to older subjects (3.6 vs. 3.1 kg; p = 0.061). Younger and older subjects had similar decreases in bone mineral density (0.018 ± 0.0071 vs. 0.0138 ± 0.021 g/cm2). Younger and older pre-diabetic adults taking pioglitazone had similar reductions in conversion to diabetes and older adults had similar or greater improvements in metabolic risk factors, demonstrating that pioglitazone is useful in preventing diabetes in older adults.Electronic supplementary materialThe online version of this article (doi:10.1007/s11357-016-9946-6) contains supplementary material, which is available to authorized users.

An Intervention with Physical Activity and Lifestyle Counseling Improves Health-Related Quality of Life and Shows Small Improvements in Metabolic Risks in Persons with Psychosis

This research studied the effects of a lifestyle intervention on health-related quality of life (HRQoL) and metabolic risk factors in persons with psychosis, using a longitudinal intervention design with a matched reference sample. In participants in the intervention group, scores on the EQ-VAS, which measured HRQoL, improved from 57.6 to 63.3 (SD = 17.8) (p = 0.05), and HDL cholesterol concentration increased from 1.03 to 1.11 (0.19) mmol/l. (p = 0.02). There was no significant change in body weight among participants. The results of this study indicate that a lifestyle intervention based on group meetings improves HRQoL in patients with psychosis and provides small improvements in metabolic risk factors.

The effects of improved metabolic risk factors on bone turnover markers after 12 weeks of simvastatin treatment with or without exercise

ObjectiveEmerging evidence supports an association between metabolic risk factors and bone turnover. Statins and exercise independently improve metabolic risk factors; however whether improvements in metabolic risk factor affects bone turnover is unknown. The purpose of the present study was to: 1) evaluate the relationship between metabolic risk factors and bone turnover; and 2) determine if improvements in metabolic risk factors after 12weeks of statin treatment, exercise or the combination affect bone turnover. MethodsFifty participants with ≥2 metabolic syndrome defining characteristics were randomly assigned to one of three groups: statin (STAT: simvastatin, 40mg/day), exercise (EX: brisk walking and/or slow jogging, 45minutes/day, 5days/week), or the combination (STAT+EX). Body composition and whole body bone mineral density were measured with dual energy X-ray absorptiometry. Serum markers of bone formation (bone specific alkaline phosphatase, BAP; osteocalcin, OC), resorption (C-terminal peptide of type I collagen, CTX) and metabolic risk factors were determined. Two-factor (time, group) repeated-measures ANCOVA was used to examine changes of metabolic risk factors and bone turnover. General linear models were used to determine the effect of pre-treatment metabolic risk factors on post-treatment bone turnover marker outcomes. ResultsParticipants with ≥4 metabolic syndrome defining characteristics had lower pre-treatment OC than those with 3 or fewer. OC was negatively correlated with glucose, and CTX was positively correlated with cholesterol. STAT or STAT+EX lowered total and LDL cholesterol. The OC to CTX ratio decreased in all groups with no other significant changes in bone turnover. Higher pre-treatment insulin or body fat predicted a greater CTX reduction and a greater BAP/CTX increase. ConclusionMetabolic risk factors were negatively associated with bone turnover markers. Short-term statin treatment with or without exercise lowered cholesterol and all treatments had a small effect on bone turnover.

Effect of exercise intervention on changes in free Fatty Acid levels and metabolic risk factors in stroke patients.

[Purpose] The present study investigated the effects of regular exercise on the improvement of free fatty acid (FFA) levels and metabolic risk factors of stroke patients. [Methods] The subjects were 20 male patients aged 47−59 years who were diagnosed as having hemiplegia resulting from stroke. Exercise was conducted using a stationary bicycle, a rehabilitative exercise machine. The exercise program utilized the heart rate reserve (HRR) method to create an exercise intensity amounting to 50−70% of the target heart rate (THR). The program lasted for 30 minutes and was conducted 5 times per week for a total of 12 weeks. [Results] In stroke patients, 12 weeks of exercise training yielded a significant interaction effect with weight, body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR). There were also significant differences in triglycerides (TG) according to the time of measurement, and an interaction effect was observed for triglycerides (TC). High-density lipoprotein cholesterol (HDLC), an important marker of improvement in metabolic risk factors, showed a significant interaction effect with exercise training. In addition, free fatty acids (FFA) showed a significant difference based on the time of measurement and showed a significant negative correlation with HDLC (r = −0.77). [Conclusion] The results of the present study suggest that regular exercise by stroke patients reduces their risk of metabolic complications and stroke recurrence by reducing obesity indices, improving serum lipid and FFA levels, and increasing HDLC levels.

Benefits and risks of weight-loss treatment for older, obese women.

BackgroundA key issue in the treatment of obesity in older adults is whether the health benefits of weight loss outweigh the potential risks with respect to musculoskeletal injury.ObjectiveTo compare change in weight, improvements in metabolic risk factors, and reported musculoskeletal adverse events in middle-aged (50–59 years) and older (65–74 years), obese women.Materials and methodsParticipants completed an initial 6-month lifestyle intervention for weight loss, comprised of weekly group sessions, followed by 12 months of extended care with biweekly contacts. Weight and fasting blood samples were assessed at baseline, month 6, and month 18; data regarding adverse events were collected throughout the duration of the study.ResultsBoth middle-aged (n = 162) and older (n = 56) women achieved significant weight reductions from baseline to month 6 (10.1 ± 0.68 kg and 9.3 ± 0.76 kg, respectively) and maintained a large proportion of their losses at month 18 (7.6 ± 0.87 kg and 7.6 ± 1.3 kg, respectively); there were no significant differences between the two groups with respect to weight change. Older women further experienced significant reductions in systolic blood pressure, HbA1c, and C-reactive protein from baseline to month 6 and maintained these improvements at month 18. Despite potential safety concerns, we found that older women were no more likely to experience musculoskeletal adverse events during the intervention as compared with their middle-aged counterparts.ConclusionThese results suggest that older, obese women can experience significant health benefits from lifestyle treatment for obesity, including weight loss and improvements in disease risk factors. Further investigation of the impact of weight loss on additional health-related parameters and risks (eg, body composition, muscular strength, physical functioning, and injuries) in older adults is needed.

Management of diabesity in primary care: individualisation of care

Management of diabesity in primary care: individualisation of care

Postprandial substrate use in overweight subjects with the metabolic syndrome after isomaltulose (Palatinose™) ingestion

ObjectiveDietary interventions with a low glycemic index have shown to be successful for the prevention and therapy of the metabolic syndrome. In the present study, we investigated the postprandial metabolic response at rest and during physical activity the low glycemic carbohydrate isomaltulose (Palatinose™) intake compared with a conventional carbohydrate (glucose syrup/sucrose [glc/suc]) with a higher glycemic index. MethodsTwenty overweight or obese men (32–64 y old) with the metabolic syndrome and insulin resistance were enrolled in this double-blinded, randomized, cross-over study. In the morning, a breakfast consisting of a 250-mL drink and 140 g of cookies containing in a total of 50 g of Palatinose™ or glc/suc was consumed. Two hours after breakfast, subjects exercised at moderate intensity on a treadmill for 30 min. Thereafter, subjects ingested a standardized lunch consisting of a 250-mL drink with 10% Palatinose™ or glc/suc, mini pizzas, and an apple. ResultsBlood levels of glucose and insulin were measured and the postprandial substrate metabolism was determined. The glycemic and insulinemic responses were considerably lower after the ingestion of Palatinose™ (incremental area under the curve, P < 0.05). The total fat oxidation was significantly higher with Palatinose™ from breakfast to the beginning of lunch including the exercise and postexercise periods (P < 0.05). Fat oxidation with Palatinose™ was numerically higher throughout the entire examination period (P = 0.09). ConclusionIn obese subjects with insulin resistance and the metabolic syndrome, the partial substitution of carbohydrates with a higher glycemic index in foods and drinks by Palatinose™ resulted in greater postprandial fat oxidation at rest and during physical activity. It is hypothesized that this increased fat oxidation may confer further benefits for long-term weight management and for an improvement in metabolic risk factors.

Fuel selection and appetite-regulating hormones after intake of a soy protein-based meal replacement

Objective The present study investigated the postprandial glycemic and insulinemic responses, the levels of satiety-related proteins, and substrate use after a single dose of a meal replacement (MR) with a high soy protein content and a low glycemic index (GI). The results were compared with a standardized breakfast showing a high GI and a low protein content. Methods Eleven overweight or obese male subjects with the metabolic syndrome and insulin resistance were included in the study. In the morning, each subject consumed, in a randomized design, 65 g of a MR or an isocaloric standardized breakfast. Four hours after breakfast, all subjects consumed the same standardized lunch. Blood levels of glucose, insulin, ghrelin, protein YY(PYY), oxygen uptake, and carbon dioxide production were determined and the respiratory quotient and substrate use were calculated. Results The glycemic and insulinemic responses were considerably higher after the standardized breakfast. In addition, in these obese insulin-resistant subjects, the postprandial decease in fat oxidation was significantly less pronounced after intake of the MR. This effect was also detectable after lunch in terms of a second meal effect. Ghrelin levels were significantly lower 2 h after the intake of the MR and PYY levels tended higher. Conclusion Compared with the high GI/low-protein SB, a high soy protein MR with a low GI was associated with lower glycemia and insulinemia and relatively higher fat oxidation in the postprandial period. Together with a favorable course of appetite-regulating hormones, this could further help to explain the beneficial role of MR regimines high in soy protein for weight reduction and improvement of metabolic risk factors.

High-Milk Supplementation with Healthy Diet Counseling Does not Affect Weight Loss but Ameliorates Insulin Action Compared with Low-Milk Supplementation in Overweight Children1–3

Milk consumption has decreased in children over the past years. This may play a role in the prevalence of pediatric obesity, because clinical studies have found a beneficial effect of milk consumption for weight management. The objectives of this study were to test whether high-milk consumption leads to greater weight loss and improvements in metabolic risk factors than low milk consumption during a 16-wk healthy eating diet. Overweight children aged 8–10 y were randomized to either high (4 × 236 mL/d) or low (1 × 236 mL/d) milk consumption. Children were provided dietary counseling on healthy eating at baseline and at wk 1, 2, 4, 6, 8, and 12. Serum glucose, insulin, and lipids were measured in fasting children at baseline and wk 8 and 16. An oral glucose tolerance test and body composition assessment by magnetic resonance imaging were conducted at baseline and endpoint. Body weight changes during the16-wk study not differ between the high-milk (1.3 ± 0.3 kg) and low-milk (1.1 ± 0.3 kg) groups. There was no beverage × week interaction on any of the body composition and metabolic variables studied (blood pressure, serum lipids, glucose, and insulin). There was a beverage × week interaction (P = 0.044) on insulin area under the curve showing a trend toward reduced insulin output with a glucose challenge after high-milk consumption (P = 0.062). These data suggest that in overweight children, high-milk consumption in conjunction with a healthy diet does not lead to greater weight loss but may ameliorate insulin action compared with low-milk consumption.

Body composition, fitness, and metabolic health during strength and endurance training and their combination in middle-aged and older women

In this study adaptations in body composition, physical fitness and metabolic health were examined during 21 weeks of endurance and/or strength training in 39- to 64-year-old healthy women. Subjects (n = 62) were randomized into endurance training (E), strength training (S), combined strength and endurance training (SE), or control groups (C). S and E trained 2 and SE 2 + 2 times in a week. Muscle strength and maximal oxygen uptake (VO(2)max) were measured. Leg extension strength increased 9 +/- 8% in S (P < 0.001), 12 +/- 8% in SE (P < 0.001) and 3 +/- 4% in E (P = 0.036), and isometric bench press 20% only in both S and SE (P < 0.001). VO(2)max increased 23 +/- 18% in E and 16 +/- 12% in SE (both P < 0.001). The changes in the total body fat (dual X-ray absorptiometry) did not differ between groups, but significant decreases were observed in E (-5.9%, P = 0.022) and SE (-4.8%, P = 0.005). Lean mass of the legs increased 2.2-2.9% (P = 0.004-0.010) in S, SE and E. There were no differences between the groups in the changes in blood lipids, blood pressure or serum glucose and insulin. Total cholesterol and low-density lipoprotein cholesterol decreased and high-density lipoprotein cholesterol increased in E. Both S and SE showed small decreases in serum fasting insulin. Both endurance and strength training and their combination led to expected training-specific improvements in physical fitness, without interference in fitness or muscle mass development. All training methods led to increases in lean body mass, but decreases in body fat and modest improvements in metabolic risk factors were more evident with aerobic training than strength training.

Citraturic, alkalinizing and antioxidative effects of limeade-based regimen in nephrolithiasis patients

Potassium citrate has long been used as a prophylactic remedy for nephrolithiasis recurrence. Lemonade consumption is also suggested as an option. We compared the efficacy of consumption of solution containing manufactured lime powder with that of potassium citrate, on the improvement of metabolic risk factors, oxidative stress and renal tubular damage in nephrolithiasis patients. Patients with kidney stone were enrolled and randomly assigned to three treatment programs for 3 month period consisting of consumption of solution containing lime powder (Group 1, n=13), potassium citrate (Group 2, n=11) and lactose as placebo regimen (Group 3, n=7). Lime powder and potassium citrate contained equal amounts of potassium (21 mEq) and citrate (63 mEq). After treatment, there was an increase in urinary pH, potassium and citrate in Group 1 and 2. Increased plasma potassium and red blood cell glutathione (R-GSH) and decreased urinary malondialdehyde were found in Group 1, but not observed in Group 2. R-GSH was decreased in Group 2. Urinary N-acetyl-beta-glucosaminidase activity and fractional excretion of magnesium, as renal tubular damage indicators, were decreased only in Group 1. In Group 3, all measured parameters were unaltered except for an increased urinary chloride. In conclusion, consumption of our in-house lime powder exerted citraturic and alkalinizing actions as efficient as consumption of potassium citrate. In addition, it provided an antioxidative effect and was able to attenuate renal tubular damage. These pharmacological properties may be clinically useful to diminish the stone-forming potential in kidney stone patients and hence for preventing recurrent calculi.

Effect of a weight loss intervention on anthropometric measures and metabolic risk factors in pre- versus postmenopausal women

BackgroundThe present study examines changes in body weight, fat mass, metabolic and hormonal parameters in overweight and obese pre- and postmenopausal women who participated in a weight loss intervention.MethodsSeventy-two subjects were included in the analysis of this single arm study (premenopausal: 22 women, age 43.7 ± 6.4 years, BMI 31.0 ± 2.4 kg/m2; postmenopausal: 50 women, age 58.2 ± 5.1 years, BMI 32.9 ± 3.7 kg/m2). Weight reduction was achieved by the use of a meal replacement and fat-reduced diet. In addition, from week 6 to 24 participants attended a guided exercise program. Body composition was analyzed with the Bod Pod®. Blood pressures were taken at every visit and blood was collected at baseline and closeout of the study to evaluate lipids, insulin, cortisol and leptin levels.ResultsBMI, fat mass, waist circumference, systolic blood pressure, triglycerides, glucose, leptin and cortisol were higher in the postmenopausal women at baseline.Both groups achieved a substantial and comparable weight loss (pre- vs. postmenopausal: 6.7 ± 4.9 vs 6.7 ± 4.4 kg; n.s.). However, in contrast to premenopausal women, weight loss in postmenopausal women was exclusively due to a reduction of fat mass (-5.3 ± 5.1 vs -6.6 ± 4.1 kg; p < 0.01). In premenopausal women 21% of weight loss was attributed to a reduction in lean body mass.Blood pressure, triglycerides, HDL-cholesterol, and glucose improved significantly only in postmenopausal women whereas total cholesterol and LDL-cholesterol were lowered significantly in both groups.ConclusionBoth groups showed comparable weight loss and in postmenopausal women weight loss was associated with a pronounced improvement in metabolic risk factors thereby reducing the prevalence of metabolic syndrome.

Effect of a vegan based high protein, low carbohydrate diet on weight loss and serum lipids

Background High protein, low carbohydrate diets, such as the Atkins’ diet, have gained popularity in recent years as weight loss strategies. However, high amounts of animal protein and its associated saturated fat, in the absence of weight loss, may result in undesirable effects on the lipid profile and increase coronary heart disease risk. Objective To determine if exchange of saturated fat and animal protein for monounsaturated fat and vegetable protein, mainly from soy, will result in a significant effect on blood lipids while still encouraging weight loss. Method Thirty overweight hyperlipidemic subjects will each undergo 1 of 2 interventions for 1 month: a diet high in vegetable proteins and vegetable fats (26% carbohydrate, 30% protein, 44% fat) or a diet very low in saturated fat, based on milled whole-wheat cereals and low-fat dairy foods (58% carbohydrate, 16% protein, 26% fat). Subjects will consume 70% of their estimated energy requirements and all study foods will be provided. Fasting blood lipids and glucose, blood pressure and body weight will be measured at weeks 0, 2 and 4, with body composition (Bioelectrical Impedance Analysis) measured at baseline and at the end of the treatment. Results Twenty-five hyperlipidemic subjects have been recruited thus far. Preliminary data will be presented. Conclusion A diet where carbohydrates are exchanged for unsaturated fats, such as vegetable oils and nuts, and high animal protein for vegetable proteins, such as soy, may result in significant weight loss and significant improvements in metabolic risk factors for CHD. Research support: Solae Company

The metabolic challenge of obesity: impact of weight management on improvement of metabolic risk factors. April 13, 2002, Prague, Czech Republic. Symposium proceedings.

The metabolic challenge of obesity: impact of weight management on improvement of metabolic risk factors. A one-day symposium held in April 2002

Gender Differences in Changes in Subcutaneous and Intra‐abdominal Fat during Weight Reduction: An Ultrasound Study

In weight-reducing programs, men usually display greater improvement in metabolic risk factors than women. This gender difference may be related to enhanced weight and fat loss due to a greater energy deficit in men. To clarify the relationship between changes in metabolic profile, body fat composition, and weight loss, both sexes were studied under a regimen in which similar amounts of weight were lost. A cross-sectional study using anthropometric (body mass index and waist-to-hip ratio), impedance (bioelectrical impedance analysis) and ultrasound measurement methods (thickness of subcutaneous fat layers, intra-abdominal sagittal diameter) were conducted. The metabolic risk profile was determined by measuring lipids, lipoproteins, and blood pressure. The weight loss program lasted 15 weeks: 3 weeks under controlled conditions in the hospital and 12 weeks on an ambulatory basis. Patients were instructed to follow a mixed diet. Calorie intake was restricted to 1500 kcal/day for the men and 1200 kcal/day for the women. Thirty-two subjects with obesity (16 men and 16 women), with a mean body mass index of 35 kg/m2--matched with regard to age, height, and body weight--took part in the study. As expected, weight loss was similar for both sexes (-13.4 kg vs. -12.8 kg). Also, body fat mass changed to the same extent in absolute and relative terms. The waist-to-hip ratio was identical before and after treatment in both sexes. The men lost more visceral fat than the women. This result is based on changes in intra-abdominal diameter as well as abdominal subcutaneous fat in relation to waist circumference. Changes in abdominal diameter were paralleled by reductions in triglycerides and increases in high-density lipoprotein-cholesterol. Subcutaneous fat loss was more pronounced in women than in men. Where absolute and relative reductions in body weight and body fat are similar, men mobilize more intra-abdominal fat than women, whereas women lose more subcutaneous fat. The greater reduction in intra-abdominal fat seen in men is accompanied by a more pronounced improvement in the metabolic risk profile. Therefore, greater improvement of risk factors in men is not only related to a greater negative energy balance, as shown in most studies, but is also sex-specific.

Clinical studies with dexfenfluramine: from past to future.

d Fenfluramine (dF) (15 mg twice daily) has been studied in controlled trials in human obesity. It has been shown to increase adherence to weight lowering programs, to double the number of patients losing 10 kg or more when compared with a fairly efficient placebo plus dietary counselling, and to prevent weight regain when continued over a 1 year period. Weight loss after 1 month and 4 months is likely to predict subsequent outcome. Also, significant improvement in metabolic risk factors and blood pressure were clearly demonstrated, even more markedly in some obesity-associated diseases, when body weight is maintained at a lower level. Even moderate but sustained weight loss of some 10% of starting weight or less has been confirmed to be of medical value. Tolerance and safety of dF can be considered acceptable, even if longer term follow-up is clearly needed. These studies support the concept that long-term pharmacotherapy with this serotoninergic drug might help achieve better outcome in the management of many obese patients, particularly in preventing relapse. The long-term managerial strategies to be developed for each patient might thus include dF together with dietary advice, behavioral modification and physical exercise, either simultaneously or sequentially.

Improvement in Metabolic Risk Factors for Coronary Heart Disease Associated With Cilazapril Treatment

Patients with hypertension tend to be glucose intolerant, hyperinsulinemic, and dyslipedemic. Since all of these changes increase risk of coronary heart disease (CHD), it is important to know what effect antihypertensive treatment has on these variables. The current open-labelled, uncontrolled study was initiated in order to extend our understanding of these issues. This study was performed in 19 patients with hypertension who were started on an angiotensin converting enzyme (ACE)-inhibitor, cilazapril, with hydrochlorothiazide (HC) added if needed to control blood pressure. Plasma glucose and insulin responses to oral glucose and lipid concentrations were measured before, 26, and 52 weeks after starting treatment. Patients treated with either cilazapril (n = 9) or cilazapril+HC (n = 10) did not differ in terms of original (mean +/- SEM) blood pressure (159 +/- 5/101 +/- 1 v 156 +/- 4/103 +/- 2 mm Hg), age (53 +/- 2 v 54 +/- 2 years), sex distribution (5M:4F v 7M:3F), or body mass index (24.4 +/- 0.5 v 24.2 +/- 0.9 kg/m2). Blood pressure was also similar after 26 (137 +/- 4/88 +/- 1 v 133 +/- 3/90 +/- 1 mm Hg) and 52 (137 +/- 4/87 +/- 1 v 134 +/- 4/89 +/- 2 mm Hg) weeks of treatment. Plasma glucose and insulin responses decreased by 8 +/- 3% (P less than .05) and 25 +/- 9% (P less than .002), respectively, in cilazapril-treated patients, but did not change in those treated with cilazapril plus HC.(ABSTRACT TRUNCATED AT 250 WORDS)