Magnitude Of Obesity Research Articles

Magnitude of Obesity Alone does not Alter the Alveolar Lipidome.

Obesity may lead to pulmonary dysfunction through complex and incompletely understood cellular and biochemical effects. Altered lung lipid metabolism has been identified as a potential mechanism of lung dysfunction in obesity. While murine models of obesity demonstrate changes in pulmonary surfactant phospholipid composition and function, data in humans are lacking. We measured untargeted shotgun lipidomes in two bronchoalveolar lavages (BAL) from apical and anteromedial pulmonary subsegments of 14 adult subjects (7 males and 7 females) with body mass indexes ranging from 24.3 to 50.9 kg/m2. The lipidome composition was characterized at the class, species, and fatty acyl / alkyl level using total lipid molecular ion signal intensities normalized to BAL protein concentration and epithelial lining fluid volumes. Multivariate analyses were conducted to identify potential changes with increasing BMI. The alveolar lipidomes contained the expected composition of surfactant associated phospholipids, sphingolipids, and sterols in addition to cardiolipin and intracellular signaling lipid species. No significant differences in lipidomes were detected between the two BAL regions. Though a small number of lipid species were associated with BMI in multivariate analyses, no robust differences in lipidome composition or specific lipid species were identified over the range of body habitus. The magnitude of obesity alone does not substantially alter the alveolar lipidome in patients without lung disease. Differences in lung function in patients with obesity and no lung disease are unlikely related to changes in alveolar lipid composition.

Prevalence of obesity using new adiposity indices among the Barwar community: A Denotified Tribe of Gonda district, Uttar Pradesh, India

IntroductionThe present study assesses the prevalence of obesity using new adiposity indices and evaluatesthe association between socio-demographic factors and combined obesity among the denotified tribe of Gonda district, Uttar Pradesh, India. Materials and methodsThe present study was undertaken among 315 rural adults (141 males; 174 females) aged 20–59 years. Sex wise mean differences were observed by the t-test. The Chi-square tests were used for any significant relationships between categoricalvariables. Binary logistic regression was used to identify the risk factors for combined obesity. ROC curve was used for predicting the combined obesity. ResultsThe prevalence's of combined general obesity, combined central obesity, and overall combined obesity are 34.9%, 69.8%, and 75.6% respectively. Combined obesity always shows higher prevalence of obesity than any obesity-related single parameter. The prevalence of single obesity, dual obesity, and no obesity is 46.3%, 29.3% and 24.4% respectively. In the case of all socio demographic parameters, widow shows the high risk of CGO (OR = 8.83, CI: 1.97–39.58, p= <0.01) and the higher age groups (50–59 years) show the higher risk of CCO (OR = 4.95, CI: 2.47–9.90, p= <0.001) and OCO (OR = 6.51, CI: 2.68–15.84, p= <0.001). ConclusionThe current study concludes that any single parameter or index is not enough to measure the actual prevalence of obesity. The present study shows females have a higher prevalence of all three types of combined obesity than males. Combined obesity assesses the overall magnitude of obesity and identifies communities with multiple obesity parameters.

Orthopaedic Diagnoses in the Black Pediatric Population.

The Black pediatric population is one that has been historically underserved and continues to have unmet needs. Factors including lack of diversity in orthopaedic studies and in historical standards, such as bone age, may inadvertently lead to inferior care. There are certain conditions in this population for which the practicing orthopaedic surgeon should have a higher degree of suspicion, including slipped capital femoral epiphysis, Blount disease, and postaxial polydactyly. Systemic diseases with higher rates in this population have orthopaedic manifestations, including sickle cell disease, vitamin D deficiency, and obesity. Racial discrepancies in access to prenatal care can have orthopaedic consequences for babies, especially cerebral palsy and myelodysplasia. Racial discrepancy exists in evaluation for nonaccidental trauma. Increased awareness of these issues better prepares practitioners to provide equitable care.

Magnitude and Determinants of Under-Nutrition Among Late Adolescent Girls in East Africa: Evidence From Demographic and Health Surveys (2010-2016).

BackgroundAdolescent girls are vulnerable to undernutrition owing to their increased nutrition demand for growth and development, including sexual development and maturation. Despite its public health importance, undernutrition among late adolescent girls has received little attention in health and nutrition policies. Although undernutrition in adolescent girls has been investigated, most of the previous study reports were based on small sample sizes and limited geographic settings. Therefore, we aimed to estimate the prevalence and determinants of undernutrition among late adolescent girls in East Africa.MethodsSecondary data analysis was conducted among 10 East African countries using the most recent Demographic and Health Survey (DHS) reports. A total of 21,779 adolescent girls aged 15–19 years were included in this study. Descriptive statistics were conducted to describe the study population. The binary logistic regression model was fitted to identify the determinants of undernutrition among late adolescent girls. Variables with a p-value of <0.05 in the multivariate analysis were identified as statistically significant determinants of undernutrition.ResultsThe overall magnitude of undernutrition among late adolescent girls in East Africa was 16.50% (95% CI: 16.00–17.00), whereas the overall magnitude of obesity among late adolescent girls in East Africa was 2.41% (95% CI: 2.21–2.62). In the final model of the multivariate analysis, adolescent girls aged 18–19 years [adjusted odds ratio (AOR) = 0.55; 95% CI: 0.51–0.60], having secondary education (AOR = 0.79; 95% CI: 0.68–0.93), being from a rich wealth index family (AOR = 0.63; 95% CI: 0.56–0.69), and being from a medium wealth index family (AOR = 0.80; 95% CI: 0.72–0.89) were negatively and statistically associated with undernutrition. Likewise, having more than seven household members (AOR = 1.36; 95% CI: 1.10–1.67), walking more than 30 min to a water source (AOR = 1.10; 95% CI: 1.01–1.20), and living in Ethiopia (AOR = 1.75; 95% CI: 1.51–2.03) were positive determinants of undernutrition among late adolescent girls.ConclusionIn this study, undernutrition in late adolescent girls remains a considerable public health problem in East Africa. Age group, educational status, marital status, family wealth index, family size, time taken to reach a water source, media exposure, and country of resident were significant determinants of undernutrition. Therefore, devising strategies that improve the socioeconomic status of households and/or adolescents would help to reduce the risks of undernutrition in late adolescents.

Obesity and associated factors among high school adolescent students in Bahir Dar town, North West Ethiopia: A cross-sectional study.

The aim of this study was to assess the magnitude and associated factors of obesity among high school adolescent students in Bahir Dar, Ethiopia. An institution-based cross-sectional study was conducted from 10 September 2019 to 10 October 2019 in Bahir Dar town. A total of 1018 students were enrolled using a multistage sampling procedure. Epidata version 3.1 was used for data entry, and SPSS version 24 was used for data analysis. A bivariable and multivariable logistic regression analysis was performed. The magnitude of obesity among high school adolescents was 8.3%. Attending a private school (adjusted odds ratio = 6.52; 95% confidence interval: 3.13, 13.59), not participating in moderate- to vigorous-intensity activities (AOR = 3.08; 95% confidence interval: 1.44, 6.64), coming from a wealthy family (adjusted odds ratio = 7.03; 95% CI: 2.16, 22.89), and snacking frequency (adjusted odds ratio = 9.64; 95% confidence Interval: 4.79, 19.39) were all associated with obesity. Obesity was prevalent among students in private schools and wealthy families in the research area. Family size, household wealth, participation in moderate-to-striving activities, and snacking frequency were all found to be significant factors of obesity.

Obesity Blunts the Ventilatory Response to Exercise in Men and Women.

Rationale: Obesity presents a mechanical load to the thorax, which could perturb the generation of minute ventilation (V̇e) during exercise. Because the respiratory effects of obesity are not homogenous among all individuals with obesity and obesity-related effects could vary depending on the magnitude of obesity, we hypothesized that the exercise ventilatory response (slope of the V̇e and carbon dioxide elimination [V̇co2] relationship) would manifest itself differently as the magnitude of obesity increases.Objectives: To investigate the V̇e/V̇co2 slope in an obese population that spanned across a wide body mass index (BMI) range.Methods: A total of 533 patients who presented to a surgical weight loss center for pre-bariatric surgery testing performed an incremental maximal cycling test and were studied retrospectively. The V̇e/V̇co2 slope was calculated up to the ventilatory threshold. Patients were examined in groups based on BMI (category 1: 30-39.9 kg/m2, category 2: 40-49.9 kg/m2, and category 3: ≥50 kg/m2). Because the respiratory effects of obesity could be sex and/or age specific, we further examined patients in groups by sex and age (younger: <50 yr and older: ≥50 yr). Differences in the V̇e/V̇co2 slope were then compared between BMI category, age, and sex using a three-way ANOVA.Results: No significant BMI category by sex by age interactions was detected (P = 0.75). The V̇e/V̇co2 slope decreased with increases in BMI (category 1, 29.1 ± 4.0; category 2, 28.4 ± 4.1; and category 3, 27.1 ± 3.3) and was elevated in women (28.9 ± 4.1) compared with men (26.7 ± 3.2) (BMI category by sex interaction, P < 0.05). No age-related differences were observed (BMI category by age interaction, P = 0.55). The partial pressure for end-tidal CO2 was elevated at the ventilatory threshold in BMI category 3 compared with BMI categories 1 and 2 (both P < 0.01).Conclusions: These findings suggest that obesity presents a unique challenge to augmenting ventilatory output relative to CO2 elimination, such that the increase in the exercise ventilatory response becomes blunted as the magnitude of obesity increases. Further studies are required to investigate the clinical consequences and the mechanisms that may explain the attenuation of exercise ventilatory response with increasing BMI in men and women with obesity.

Postoperative Complication in Overweight Patients Undergoing Coronary Artery Bypass Graft Surgery

Background: Obesity has a great impact on overall mortality and morbidity in cardiac surgery. The magnitude of obesity is defined by means of body mass index (BMI). At this study we aim to correlate between grade of BMI and postoperative complications in patients undergoing coronary revascularization. Methods: A prospective observational study was conducted in Ain Shams University hospitals and the National Heart Institute of Egypt. 98 patients with multi-vessel CAD and candidate for CABG were included in the study and divided into two groups Group I: 53 patients with BMI over 30. Group II: 45 patients with a BMI under 30. The primary endpoint was wound infection and mediastinitis. Secondary endpoints included mortality, prolonged ICU and hospital stay, stroke, renal and hepatic impairment. Results: As regard primary ending point, eight patients of Group I had their wounds infected which is significantly higher than the other group (p-value 0.034). The total ward stay in days was significantly higher in Group I (p-value 0.027). Conclusion: BMI more than 30 is associated with increased rates of wound complications either superficial or deep wound infections. Robust measures should be taken to prevent such grave complications.

Is abnormal glucose tolerance or diabetes a risk factor for knee, hip, or hand osteoarthritis? A systematic review

Diabetes (DM) and osteoarthritis (OA) are two common co-existing chronic conditions. However, whether this is due to shared risk factors or may differ between joints is unclear. We performed a systematic review to determine whether abnormal glucose metabolism is a risk factor for knee, hip and hand OA, separately, independent of age and obesity. A systematic search of Ovid Medline and EMBASE was performed from inception until October 2016 to identify studies relating glucose metabolism to osteoarthritis-related outcomes. Studies were included if they related DM and OA and the knee, hip, or hand were examined separately. In the structured synthesis, objective measures of DM and adjustment for age and obesity were also required. Of the 40 included studies, 28 examined the knee, nine the hip and 14 the hand. Five studies with a longitudinal component used objective measures of DM (blood glucose) and knee OA (radiography or joint replacement) and adjusted for age and obesity (21,299 participants). Of these, three found no association, one found a reduction in risk and one, which adjusted for the presence but not magnitude of obesity, found an increase in risk. Of the longitudinal studies examining the relationship between DM and OA that accounted for obesity, none provided evidence of an independent relationship between DM and hip (2 studies) or hand OA (1 study). There is little evidence to suggest that impaired glucose metabolism is a risk factor, independent of obesity, for knee OA and no evidence that impaired glucose metabolism is an independent risk factor for hip or hand OA.

Age of onset of obesity and risk of type 2 diabetes

ObjectiveTo compare a simple measure ‐ age of onset of obesity ‐ to an obese‐years construct (a product of duration and magnitude of obesity) as risk factors for type 2 diabetes. MethodParticipants from the Framingham Heart Study who were not obese and did not have diabetes at baseline were included (n=4,320). The Akaike Information Criterion (AIC) was computed to compare four Cox proportional hazards models with incident diabetes as the outcome and: (i) obese‐years; (ii) age of onset of obesity; (iii) body mass index (BMI); and (iv) age of onset of obesity plus magnitude of BMI combined, as exposures. ResultsAIC indicated that the model with obese‐years provided a more effective explanation of incidence of type 2 diabetes compared to the remaining three models. Models including age of onset of obesity plus BMI were not appreciably different from the model with BMI alone, except in those aged ≥60. ConclusionsWhile obese‐years was the optimal obesity construct to explain risk of type 2 diabetes, age of onset may be a useful, practical addition to current BMI in the elderly. ImplicationsWhere computation of obese‐years is not possible or impractical, age of onset of obesity combined with BMI may provide a useful alternative.

Hypothalamic Pomc‐deficiency Impairs the Function of Leptin to Decrease Food Intake and Bodyweight

Proopiomelanocortin (Pomc) in the arcuate nucleus (Arc) of the hypothalamus is necessary for normal energy homeostasis; therefore, its deficiency leads to obesity. We recently reported that ArcPomc‐rescue by genetic intervention prevents obesity in otherwise obesity‐destined ArcPomc‐knockout (KO) mice. However, the efficiency of ArcPomc‐rescue to normalize body weight (BW) was contingent on the magnitude of obesity at the time of genetic intervention. To dissect the molecular mechanism(s) responsible for that observation, we hypothesized that ArcPomc‐rescue mediated reversal of obesity is linked to the function of leptin to reduce BW and food intake (FI). To test our hypothesis, we performed a longitudinal study during which we assessed BW, FI, plasma leptin levels and leptin sensitivity in the same set of ArcPomc‐KO mice when they were obese, weight‐matched to WT mice by calorie restriction, and after ArcPomc rescue. ArcPomc was rescued in the weight‐matched mice by tamoxifen‐inducible Cre recombinase technology. We found that obese KO mice exhibited significantly higher plasma leptin levels (68 ±4.1 vs. 5.6 ±0.4 ng/ml), which were reduced by 78% in the weight‐matched group (14.5 ±1.2 ng/ml) but still remained higher, relative to WT group (P&lt;0.01). Moreover, leptin treatment did not reduce BW relative to saline‐group (Δ BW, 0.52 ±0.06 vs. 0.56 ±0.07 g/24 h when mice were obese; 0.8 ± 0.08 vs 0.6 ±0.07 g/24 h when mice were weight‐matched) and FI (Δ FI, 5.8 ±0.2 vs. 6.1 ±0.1 g/24 h when mice were obese; 6.0 ±0.1 vs. 6.2 ±0.1 g/24 h when mice were weight‐matched) in the KO mice at different stages of the longitudinal study. Remarkably, we found that ArcPomc‐rescue in the weight‐matched KO mice restored normal BW (32.6 ±1.0 g), FI (4.4 ±0.6 g), leptin levels (4.6 ±1.3 ng/ml) and sensitivity [Δ BW, −1.6 ±0.1 (leptin) vs. 0.01 ±0.06 (saline) g/24 h] in the mice that had a history of obesity. In contrast, mice that remained ArcPomc deficient regained massive obesity (BW: 68.4 ±1.5 g, P&lt;0.001) and hyperleptinemia (70.2 ±5.4 ng/ml, P&lt;0.001). To further confirm the association of hypothalamic Pomc with leptin action, we treated weight‐matched ArcPomc KO mice without a history of obesity with leptin. Intraperitoneal and intracerebroventricular leptin administration failed to reduce BW and FI in the KO mice. Interestingly, there was no change in hypothalamic leptin receptor gene expression; however, relative hypothalamic pSTAT3 levels after leptin administration were 20% lower in the KO mice compared to wildtype mice. Altogether, our study suggests that restoration of normal body weight and food intake in ArcPomc KO mice after ArcPomc‐rescue is linked with leptin sensitivity. Moreover, hypothalamic Pomc appears to mediate the function of leptin to control BW and FI. Therefore, stimulating hypothalamic Pomc signaling provides an alternative approach to treat obesity in face of leptin resistance.Support or Funding InformationNIH grants R01 DK066604 (to M.J.L.), R01 DK068400 (to M.J.L. and M.R.). NIH grants P30 DK020572 and P30 DK089503 to University of Michigan Animal Phenotyping and Chemistry Cores supported by the Michigan Diabetes Research Center and the Michigan Nutrition and Obesity Research Center

Abstract P2-08-30: The role of skeletal muscle volume on prognosis of breast cancer survivors using with cross-sectional image

Abstract Background: Obesity is one of the well-known cause and prognostic factor of breast cancer. Body mass index (BMI) is often used to estimate the magnitude of obesity. Currently, muscle weight itself, instead of higher BMI, is more closely related to poor outcomes in chronic metabolic disease. However, this question was not thoroughly questioned in breast cancer survivors. We aim to find out whether the prognosis of breast cancer survivors is affected by muscle mass and fat volume. We also present that the higher muscle mass and muscle fat ratio do have a good influence on the prognosis. Methods and Materials: Between January, 2001, and December, 2009, all consecutive patients diagnosed the breast cancer in National cancer center, Republic of Korea were 3909. Of all populations, the patients who had available chest Computed Tomography (CT) images within two years after the time of diagnosis were extracted. CT images were analyzed for total skeletal muscle and adipose tissue in cross-sectional area of 10mm thickness at level 3 of the lumbar vertebrae. Results: Of all consecutive 3909 patients, final eligible cases were 1493. The median age was 46.0 (range 25∼77). Median follow up period was 96.8 months and the 5 year survival rate was 96.5%. Recurrence free survival rate was 92.1%, and local recurrence free survival was 98.6% in 5 years. Median skeletal muscle volume of all patients was 93.3cc (range 39.6∼236.9). Median fat volume of the same sections was 419.7cc (range 19.5∼1392.3) and the median muscle-fat ratio was 0.22 (0.08∼3.18). There is no known standard value of muscle mass in Korean women, the median volume was used as an indicator for comparison of two groups in terms of overall survival and recurrence free survival. The group with muscle volume greater than median value appeared better outcomes in overall survival and recurrence free survival than those of the other group (p=0.007, p=0.019). There were several factors related to overall survival and recurrence free survival such as age, operation types, clinical stage, pathologic stage, and tumor size in univariate cox regression analysis. In multivariate analysis by adjusting those factors, the muscle volume showed a remarkable correlation with survival, especially in recurrence free survival (Hazard ratio 0.61, p=0.029). As the indicator using with median muscle-fat ratio, the analysis revealed that overall survival had no significant difference (p=0.177) between two groups. However, the group with higher muscle-fat ratio showed better recurrence free survival and local recurrence free survival (p-value &amp;lt;0.0001, 0.038 respectively). Conclusions: Our study showed that the actual amount of skeletal muscle rather than fat volume has higher effect on the prognosis of breast cancer survivors. In our knowledge, this is the largest study to analyze the prognosis of breast cancer with skeletal muscle volume. In view of the different magnitude of obesity among multiple ethnics, the actual muscle mass could be the most important parameter to assess the amount of exercise and patient's health status. Citation Format: Song EJ, Park SJ, Lee MH, Kwon Y, Ko KL, Lee KS, Ro J, Jung SY, Lee SY, Kang HS, Lee ES. The role of skeletal muscle volume on prognosis of breast cancer survivors using with cross-sectional image. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-08-30.

Relationship between dietary calcium intake and adiposity in female adolescents

Abstract Background and objective The prevalence and magnitude of obesity in children and adolescents increase rapidly. Besides genetic and environmental factors, calcium intake has recently been identified as a dietary factor that is inversely related with body mass index and development of overweight and obesity. The purpose of this study was to assess the correlation between dietary calcium intake and body mass index and fat distribution in female adolescents. Materials and methods This was a cross-sectional study where anthropometric variables (weight, height, body mass index, waist and hip circumference) were collected in 244 female adolescents to establish total body adiposity and fat distribution. A 24-h recall and a food frequency questionnaire were used to assess total calorie, calcium, and dairy products intake. Results Calcium intake was inversely related to body mass index ( p p p > .05), and waist to hip ratio ( p p = .06). Conclusions Dietary calcium intake and, to a lesser extent, consumption of dairy products are inversely related to total and abdominal adiposity, and also to the prevalence of overweight in this group of adolescents.

Relación entre ingesta dietética de calcio y adiposidad corporal en adolescentes mujeres

Background and objectiveThe prevalence and magnitude of obesity in children and adolescents increase rapidly. Besides genetic and environmental factors, calcium intake has recently been identified as a dietary factor that is inversely related with body mass index and development of overweight and obesity.The purpose of this study was to assess the correlation between dietary calcium intake and body mass index and fat distribution in female adolescents. Materials and methodsThis was a cross-sectional study where anthropometric variables (weight, height, body mass index, waist and hip circumference) were collected in 244 female adolescents to establish total body adiposity and fat distribution. A 24-hour recall and a food frequency questionnaire were used to assess total calorie, calcium, and dairy products intake. ResultsCalcium intake was inversely related to body mass index (P<.05), waist circumference(P<.05), hip circumference (P>.05), and waist to hip ratio (P<.05).Overweight (8.3%) and obese (0.7%) adolescents had a lower mean calcium intake than adolescents of normal weight (P=.06). ConclusionsDietary calcium intake and, to a lesser extent, consumption of dairy products are inversely related to total and abdominal adiposity, and also to the prevalence of overweight in this group of adolescents.

Diabetes and periodontal therapy

This issue of The Journal of the American Dental Association (JADA) contains a report1 of the periodontal treatment response among people who participated in the Diabetes and Periodontal Therapy Trial (DPTT).2 The DPTT is a large, multicenter randomized controlled clinical trial that was designed to study the effect of nonsurgical periodontal therapy among people who have type 2 diabetes mellitus and periodontitis. The periodontal treatment consisted of two or more sessions of scaling and root planing (totaling more than 2.5 hours and involving the use of local anesthetic) and follow-up supportive periodontal care. The main conclusion of this six-month trial was that nonsurgical periodontal therapy did not improve glycemic control in patients with type 2 diabetes who had periodontitis.2 This trial has received considerable attention because its findings are contrary to what many people anticipated—and because it did not support results of smaller clinical trials and meta-analyses that showed improvements in hemoglobin A1c (HbA1c) levels as a result of nonsurgical periodontal therapy.3 We wish to address the generalizability of the DPTT. As reported by the authors in this issue of JADA,1 the patient sample of the DPTT reflects the population of people with diabetes in the United States. The DPTT included participants who had type 2 diabetes with HbA1c levels between 7 percent and less than 9 percent; 72 percent of the participants were obese (body mass index [BMI] greater than 30 kilograms per square meter).1 The National Health and Nutrition Examination Survey is a population-based survey of people with diabetes in the United States; its results demonstrated that only 12.6 percent of people with diabetes in the United States are estimated to have HbA1c levels greater than 9 percent and 62.4 percent to have a BMI of 30 or greater.4,5 The DPTT does not address the possible effect of periodontal treatment in the 12 percent of the population with HbA1c levels greater than 9 percent or the 50 percent of the population with HbA1c levels less than 7 percent, because efforts were made to exclude these patients. However, the magnitude of obesity was not constrained by trial entry criteria. Patients with type 2 diabetes who have HbA1c levels higher than 9 percent and a BMI of less than 30 are rare. Because the participant sample was typical of patients with diabetes both in terms of HbA1c and obesity, the results of the DPTT should be viewed as fully generalizable to patients with diabetes in the United States.

Magnitude of Obesity, Abdominal Adiposity and their Association with Hypertension and Diabetes- A Cross Sectional Study

Background: The transition from customary African lifestyles to a “western” standard has resulted in the increase of obesity, abdominal adiposity and diabetes known to contribute significantly to morbidity and mortality rates around the world. We therefore aimed to identify the magnitude of overweight, obesity, abdominal adiposity and hypertension among a sample of patients with type 2 diabetes. Methods: A sample of convenience was utilized to recruit all Type 2 diabetes patients that attended the 2013 World Diabetes day celebration. Sociodemographic information along with anthropometric measurements was taken (BMI, WC, WHR). Furthermore, blood pressure and fasting blood sugar level was measured for each participant. Result: Out of the 468 diabetics that participated in this study, majority 248 (53.0%) were males and 220 (47.0%) females. The mean age and FBS was 42.6 ± 11.3 years and 6.9 ± 3.2mm/dl respectively. Hypertension was reported in 226 (48.3%) diabetics; while 182 (38.9%) were within the normal weight range, 41.0% (192) were overweight and 20.1% (94) were obese. A high WC was reported in 51.7% (n=242) and a high WHR in 52.6% (n=246). Obesity was significantly associated with middle-age (40-64 years) (p=0.001, F=15.4) and females (p=0.000, F=15.8). Those who were hypertensive had a significantly higher BMI (p=0.000, F=12.4), WHR (p=0.000, F=2.1) and WC (p=0.000, F=5.2). High WHR and WC was associated with higher FBS (p=0.000).There was a tenuous but significant difference in WHR by gender (p<0.05), with females having a higher WHR than males (0.88 ± 0.1 vs. 0.87 ± 0.1). There was a relationship between BMI, WC and WHR. Conclusion: The proportion of obesity, abdominal adiposity and hypertension among type 2 diabetics is worrisome. Early diagnosis of obesity and abdominal adiposity and advice on lifestyle modification is imperative. Furthermore, a coherent and multifaceted public health strategy aimed at systematically debunking unhealthy myths and encouraging adoption of healthy lifestyles is imperative.

Loss of tumor necrosis factor‐alpha diminishes indicators of colonic Wnt‐signaling activation induced by obesity

Epidemiological studies implicate obesity as an important risk factor for colorectal cancer (CRC). However, the mechanism(s) responsible for this effect remains unclear. Our prior study suggested that the molecular mechanism might consist of obesity‐induced upregulation of tumor necrosis factor alpha (TNF‐α) and thereby the Wnt‐signaling. In the present study, a TNF‐α knockout mouse was utilized to further establish the seminal role of TNF‐α in mediating this phenomenon. The results show that the TNF‐α−/− mouse is responsive to high‐fat diet‐induced obesity, as measured by body weight and magnetic resonance imaging of body fat (p&lt;0.05), although the magnitude of obesity was attenuated by TNF‐α deletion (p&lt;0.05). Colonic TNF‐α expression was abolished by the genetic deletion of TNF‐α in both lean and obese mice (p&lt;0.01). The increase of TNF‐α expression induced by obesity was significant in male mice (p&lt;0.05), but not significant in female mice. Obesity‐promoted over‐expression of Axin2, a readout of the Wnt pathway, was diminished by TNF‐α deletion (p&lt;0.05). Colonic epithelial proliferation (Ki‐67), which is partly under the control of Wnt signaling, was also decreased by the blockade of TNF‐α in obese mice. These results demonstrate that TNF‐α plays a substantial role in regulating Wnt‐signaling in the colonic epithelium due to obesity.

Atherogenic changes in low-density lipoprotein particle profiles were not observed in non-obese women with polycystic ovary syndrome

Is a preponderance of small dense low-density lipoprotein-cholesterol (LDL-C) observed in non-obese women with polycystic ovary syndrome (PCOS)? Non-obese Korean women with PCOS have no quantitative or qualitative changes in LDL-C profiles. Small dense LDL particles (sd-LDL) are more atherogenic than large buoyant ones and are strongly associated with coronary artery disease independent of other risk factors. Many investigators have found an increased proportion of atherogenic sd-LDL or a decreased mean LDL particle size in women with PCOS, but all of these studies have been based primarily on obese or overweight women with PCOS. This was a case-control study evaluating complete lipid and lipoprotein profiles in 64 PCOS patients and 64 age- and BMI-matched controls. All women with PCOS in our study population were not obese. To determine the differences in the LDL particle profiles between PCOS phenotypes, the patients with PCOS were divided into two subgroups according to the presence of clinical or biochemical hyperandrogenism. Using the Rotterdam criteria, we recruited 64 women (18-40 years) with PCOS who were attending a tertiary university hospital. A total of 64 premenopausal control women were matched with patients based on exact age and BMI (± 1.0 kg/m(2)). All the participants fell within the non-obese range of the BMI (<25 kg/m(2)) according to the definition of obesity for Asians. The LDL subfraction was analyzed by 3% polyacrylamide gel tube electrophoresis. Seven LDL subclasses were quantified and LDL subclasses 3-7 were small LDL subfractions. LDL subfraction scores were calculated based on the following weighted scoring system developed by the manufacturer: scores of <5.5 were categorized as phenotype A (large, buoyant LDLs), and those >5.5 were categorized as non-A phenotype (sd-LDLs). The system also determined the mean LDL particle size diameter. There were no differences in the absolute level of LDL-C, mean LDL diameter or percentage of atherogenic sd-LDLs between PCOS patients and controls or between hyperandrogenic and non-hyperandrogenic PCOS subgroups. Also, none of the subjects showed a non-A LDL phenotype. The most notable finding of our study was the difference in the lipoprotein (a) levels and prevalence of its elevation in PCOS patients versus controls (P = 0.002 and P = 0.004, respectively), and between PCOS subgroups (P = 0.030 and P = 0.047, respectively). Inclusion of only non-obese subjects, small sample size and lack of information on other potential confounding factors, such as differences in diet and/or exercise patterns. Although our findings suggest that non-obese women with PCOS have no significant quantitative or qualitative changes in LDL-C profile, data on obese Korean women with PCOS could offer complementary findings about the possible relationship between the magnitude of obesity and LDL phenotype. Further investigations are needed to determine whether a change in lipoprotein (a) in non-obese women with PCOS is also found in other ethnic groups. No conflict of interest exists. This study was supported by a grant of the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (A100624). N/A.

Birthweight and cytochrome P4503A4/5 activity in obese women

Large interindividual variability in drug pharmacokinetics is a challenge in the delivery of optimal pharmacotherapy. Obesity is a confirmed source of interindividual variability in the activity of cytochrome P4503A4/5 (CYP3A4/5) [1], an important determinant of drug pharmacokinetics. In a recently published study [2], we observed a large interindividual variability in CYP3A4/5 activity within obese women. However, the magnitude of change did not correlate linearly with the magnitude of obesity or the percentage of body fat, leading to speculation that sources other than sex and body mass index are at play. The need for understanding and predicting interindividual variability within these patients is critical given the current obesity epidemic. In utero growth restriction is strongly correlated to a higher incidence of obesity during adulthood [3]. In utero growth restriction is accompanied by morphological and physiological alterations in various organs [4]. These changes, especially to the liver, may affect drug metabolism during postnatal life, resulting in interindividual variability. We hypothesize that CYP3A4/5 is functionally altered by in utero growth restriction. The objective of this study is to determine whether birthweight, a surrogate marker of in utero growth restriction, is predictive of CYP3A4/5 enzyme activity in obese women. A randomized, prospective study was conducted at the Oregon Health & Science University. The Institutional Review Board approved the study protocol, and all subjects provided written informed consent. Thirty-two obese women (18–35 years old; body mass index ≥30 kg m−2) were divided into quartiles based on their self-reported birthweight (in kilograms): (1) 3.63. There were no statistical differences in age or body mass index in the four quartiles of women. Venous blood samples were collected via an indwelling catheter at 0 (baseline), 0.25, 0.5, 1, 2, 4, 5, 6, 12 and 24 h following a single 2 mg oral dose of midazolam. Plasma was separated, and aliquots were stored at −80°C prior to analysis. Both bioanalysis and pharmacokinetics analysis were described previously [2]. A one-way ANOVA was used to examine the effect of birthweight on midazolam oral clearance. The relationship between birthweight and oral clearance was also tested using regression analysis. The CYP3A4/5 activity, measured as midazolam oral clearance, was similar among the four quartiles of birthweight (Figure 1). However, an interesting, inverted U-shaped trend was observed; clearance trended to increase as quartiles of birthweight increased until quartile 3 (normal birthweight; 3.18–3.63 kilograms), then the trend reversed as birthweight continued to increase further. In order to confirm the U-shaped trend, clearance was fitted using polynomial regression, which demonstrated a statistically significant third-order polynomial fit to birthweight (P= 0.044). Figure 1 Effect of birthweight on midazolam clearance. Each box represents 25–75 percentile data, with a line representing the median and whiskers depicting 5–95 percentile data; n= 5–11. The 95% confidence intervals (whiskers) were not ... The change in clearance that is related to growth in the womb suggests that the complex determinants of drug disposition are permanently changed by the intrauterine environment. It is striking that the nature of this observed relationship between birthweight and clearance in the present study is similar to those linking birthweight to the incidence of diseases during adulthood [5, 6]. This similarity is suggestive of the critical role played by an adverse in utero environment in drug pharmacokinetics. Clearance is of critical importance in the therapeutic use of a drug, and our data suggest that part of the biological variation in the clearance is related to historical prenatal growth patterns. Birthweight is a relatively accessible, no-cost, patient-specific parameter that could be utilized in the optimization of pharmacotherapies. Along with other patient-specific parameters, such as body mass index, age, ethnicity, race, etc, birthweight could serve as useful information to personalize medicine. Although our observation was novel, the small sample size limits our ability to reach definitive conclusions. Further studies with a larger sample size, both sexes and a wider body mass index range are required, along with recorded birthweight, to establish conclusively the relevance of birthweight information in clinical practice.

The effects of exercise on C-reactive protein, insulin, leptin and some cardiometabolic risk factors in Egyptian children with or without metabolic syndrome

BackgroundThe prevalence and magnitude of obesity in the children and the adolescents have increased dramatically in the developing countries over the last 20–30 years. The prevalence of metabolic syndrome (MS) in children is increasing. Aim: This study aimed to investigate the changes of C-reactive protein (CRP), leptin, insulin, and blood lipids before and after the exercise therapy in normal and obese children (with or without metabolic syndrome).MethodsThe study covered 49 normal children (control), 32 obese children without metabolic syndrome and 12 obese children with metabolic syndrome. We examined the influence of exercise (3 times/week) for 12 weeks on the levels of serum CRP, leptin, insulin, homeostatic model assessment insulin resistance (HOMA-IR), triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) in all groups.ResultsThere were significant correlations between HOMA-IR and the individual components of the metabolic syndrome. After 12 weeks of exercise, both of the obese children groups, with and without metabolic syndrome, showed reduced body weight, body mass index (BMI), and CRP level, and increased HDL-C level. The percentage of metabolic syndrome decreased from 12.9% before the exercise training to 7.5% after training. Also, there was a significant reduction in BMI (from 47.3 to 32.6%), in systolic blood pressure (from 18.3 to 15.1%) and in HDL-C level (from 18.3 to 9.7%).ConclusionOverweight children have multiple risk factors associated with the metabolic syndrome. 12-week exercise may have a positive effect on reducing risk factors for the metabolic syndrome.

Analysis of anatomical and functional determinants of obstructive sleep apnea

Craniofacial abnormalities have an important role in the occurrence of obstructive sleep apnea (OSA) and may be particularly significant in Asian patients, although obesity and functional abnormalities such as reduced lung volume and increased airway resistance also may be important. We conducted simultaneous analyses of their interrelationships to evaluate the relative contributions of obesity, craniofacial structure, pulmonary function, and airway resistance to the severity of Japanese OSA because there are little data in this area. A cross-sectional observational study was performed on 134 consecutive Japanese male patients. A sleep study, lateral cephalometry, pulmonary function tests, and impulse oscillometry (IOS) were performed on all patients. Age, body mass index (BMI), position of the hyoid bone, and proximal airway resistance on IOS (R20) were significantly related to the apnea/hypopnea index (AHI) (p < 0.05) in multiple regression analysis. Subgroup analysis showed that, for moderate-to-severe OSA (AHI ≥ 15 events/h), neck circumference and R20 were predominantly related to AHI, whereas for non-to-mild OSA (AHI < 15 events/h), age and expiratory reserve volume were the predominant determinants. In obese subjects (BMI ≥ 25kg/m(2)), alveolar-arterial oxygen tension difference, position of the hyoid bone, and R20 were significantly associated with AHI, whereas age alone was a significant factor in nonobese subjects (BMI < 25kg/m(2)). Aside from age and obesity, anatomical and functional abnormalities are significantly related to the severity of Japanese OSA. Predominant determinants of AHI differed depending on the severity of OSA or the magnitude of obesity.