Obese Control Women Research Articles

－75 G/A Polymorphism of Apolipoprotein A1 Gene Promoter Region in Normal Pregnant Women and Patients With Gestational Diabetes Mellitus

To investigate the －75 G/A single-nucleotide polymorphism in the promoter region of apolipoprotein A1 gene (apoA1) and its association with gestational diabetes mellitus (GDM) in pregnant women and to provide references for the exploration in the molecular genetic basis of GDM. A total of 626 GDM patients and 1022 normal pregnant women, ie, the controls, were included in the study. The genotyping of apoA1 －75 G/A polymorphism was performed by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) analysis. Total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and glucose (Glu) were measured by enzymatic methods. Plasma insulin (INS) was measured by chemiluminescence immunoassay. The protein levels of apoA1 and apoB were measured by the turbidimetric immunoassay. Allele frequencies of G and A were 0.718 and 0.282 in the GDM group and 0.713 and 0.287 in the control group, respectively. Distribution of the genotype frequencies was found to be in Hardy-Weinberg equilibrium in both the GDM and control groups. There was no significant difference in the frequencies of alleles G and A and the genotypes of apoA1 －75 G/A polymorphism between the GDM and the control group (P>0.05). In the GDM group, the carriers with the genotype AA were associated with significantly higher levels of TC, HDL-C, and apoA1 than those with genotypes GG and GA did (all P<0.05). After the GDM patients were divided into obese and non-obese subgroups, the genotype-related apoA1 variation was observed only in obese patients, while the genotype-related TC and HDL-C variations were evident in non-obese patients (P<0.05). In the control group, carriers of genotypes AA and GA had higher systolic blood pressure (SBP) and HDL-C than the carriers of genotype GG did (all P<0.05). Carriers of genotypes AA had significantly lower Glu levels than carriers of genotypes GG and GA did (P<0.05). The control subjects were further divided into subgroups according to their body mass index (BMI). Analysis of the subgroups showed that AA carriers were associated with higher SBP levels in the obese control women only, while lower Glu levels were evident in both obese and non-obese control women. These results suggest that －75 G/A polymorphism in the apoA1 gene is not associated with GDM. However, the genetic variation is closed associated with the plasma apoA1, HDL-C, and TC levels in GDM patients and plasma HDL-C, Glu, and SBP levels in the control subjects. The apoA1 variant-associated lipids and SBP variation is BMI dependent in both groups.

1679-P: L-arginine Ameliorates Polycystic Ovary Syndrome and Attenuates Intestinal Oxidative Stress by Regulating Gut Microbiota

More than half of Polycystic ovary syndrome (PCOS) women are overweight or obese, and weight gain amplifies and worsens the symptoms of PCOS. Hence, it is essential to further understand and treat PCOS women with obesity. Therefore, this study tried to use a multi-omics approach that integrates the gut microbiome, serum metabolomics, serum transcriptomics, and clinical indicators to distinguish obese PCOS from obese non-PCOS women. The stool and blood samples from 33 obese PCOS patients and 30 obese control women were collected. The sequencing results suggested there were significant differences in gut microbiome and metabolites between obese PCOS women and obese women. Of which, the level of L-arginine (Arg) in obese PCOS patients was significantly lower than that in the control group and associated with gut microbiota alterations. Further correlation analysis between metabolite and clinical phenotype showed that Arg was significantly correlated with the clinical phenotype of obese PCOS patients. In this study, C57BL/6 mice were treated with dehydroepiandrosterone (DHEA) with a high-fat diet (HFD) to induce obese PCOS mice models for 3 weeks. PCOS mice were randomly divided into four groups: Arg group, Arg + antibiotic cocktail (ABX) group, PCOS group, and PCOS + ABX group. After 3 weeks of Arg supplementation, the estrous cycle, ovarian morphology, intestinal oxidative stress and intestinal barrier integrity were improved in Arg group PCOS mice, while testosterone levels and insulin resistance levels were decreased. However, these improvements were not observed in the Arg plus ABX group, suggesting that ABX-mediated depletion of the gut microbiome would eliminate these improvements. Then the 16s rRNA sequencing was performed to determine the gut microbiota of the four groups. The results showed that Arg can ameliorate reproductive characteristics of PCOS and attenuate intestinal oxidative stress by regulating gut microbiota. Disclosure D.Dilimulati: None. M.Cai: None. Y.Zhang: None. S.Qu: None. M.Zhang: None.

Polycystic ovarian syndrome increases prevalence of concentric hypertrophy in normotensive obese women.

BackgroundIt remains unclear as to whether polycystic ovary syndrome (PCOS) is an additional risk factor in the development of left ventricular (LV) hypertrophy in obese women. In the current study, we provide clarity on this issue by rigorously analysing patient LV geometry beyond the basic clinical measures currently used. Importantly, the cohort contained only normotensive patients that would normally be deemed low risk with no further intervention required.MethodsThe study comprised 24 obese women with PCOS and 29 obese Control women. Transthoracic echocardiography was used to evaluate LV structure/function. Basic clinical and metabolic data were collected for each participant consisting of age, BMI, blood pressure, fasting glucose, LDL-C, HLD-C, cholesterol and triglyceride levels. Exclusion criteria; BMI < 30 g/m2, type 2 diabetes, hypertension.ResultsBoth groups exhibited concentric remodelling of the LV posterior wall at a prevalence of ~20%, this associated with grade 1 diastolic dysfunction. Estimated LV mass/height2.7 was increased patients with PCOS (45 ± 2.2 vs 37 ± 1.6) with 33% exhibiting LV mass/height2.7 above ASE guidelines, compared to 7% in Controls. Furthermore, 25% of patients with PCOS were characterised with concentric hypertrophy, an alteration in LV geometry that was not observed in the Control group.ConclusionsTo our knowledge, this is the first study to assess LV geometric patterns in obese women with PCOS. The results suggest that obese women with PCOS are at greater risk of concentric hypertrophy than obese only women and provide justification for additional cardiovascular risk assessment in normotensive obese/PCOS women.

Serum leptin level-insulin resistance-based correlation in polycystic ovary syndrome obese and non-obese sufferer female.

Polycystic ovary syndrome (PCOS) is a common heterogeneous endocrine disorder, affecting 5-10% of females with hyperandrogenism and prolonged anovulation. This study was done to understand the serum leptin role in women with PCOS and its link with the body mass index (BMI) and insulin resistance (IR). This 1-year study was conducted in the Departments of Obstetrics and Gynecology as well as Infertility Unite in AL-Diwaniyah Maternity and Pediatrics Teaching Hospital, Iraq, in which 40 patients with PCOS (study group) and 40 healthy (non-PCOS) patients (control group) participated. After BMI assessment, both the study and control groups were further stratified into subgroups as normal weight and overweight patients. Blood samples were obtained for all patients for the serum leptin level (SLL), fasting blood glucose (FBG), and serum insulin level. The HOMA-IR equation was used to estimate insulin resistance for all patients. SLL of the PCOS women (mean ± SD, 22.29 ± 10.96 ng/ml) was significantly (P < 0.05) higher (17.89 ± 8.29 ng/ml) when compared to that of the control group. Insulin level was significantly elevated in the obese control and PCOS women (16.87 ± 3.52) µ UI/L and (15.09 ± 5.27) µUI, respectively, compared to normal BMI control and PCOS patients (P ≤ 0.01). Insulin resistance was significantly higher in obese (control and PCOS) patients (2.47 ± 0.40 and 2.30 ± 0.43, respectively), compared to normal BMI (control and PCOS) patients (P ≤ 0.01). In obese patients, serum leptin significantly correlated with BMI in the presence of hyperinsulinemia and elevated insulin resistance.

OR33-1 Metabolic Inflexibility in Obese versus Lean Women with Polycystic Ovary Syndrome (PCOS): Is PCOS Status or Adiposity the Critical Factor?

Metabolic flexibility reflects the ability to switch from lipid to carbohydrate oxidation during insulin stimulation manifested in increased respiratory quotient (∆RQ). Obese adolescent girls with PCOS have metabolic inflexibility compared with their non-PCOS obese peers (JCEM 2018, PMID 29220530). To examine if metabolic inflexibility is also present in lean PCOS or is unique to obese PCOS, we investigated metabolic flexibility in lean and obese women (ages 18-42 yrs.) with PCOS. Data in 24 obese (body mass index, BMI 33.4 ± 4.7 [SD] kg/m2) and 15 lean (BMI 22.7 ± 2.0 kg/m2) PCOS women (diagnosed by the Rotterdam criteria), and 14 obese (BMI 32.5 ± 5.0 kg/m2) and 16 lean (22.9 ± 1.4 kg/m2) control women without PCOS were examined. RQ and lipid oxidation, by indirect calorimetry, were analyzed at fasting and during a hyperinsulinemic-euglycemic clamp. The relationship between metabolic flexibility (assessed as ∆RQ from fasting to hyperinsulinemia) and clamp insulin sensitivity (IS), sex hormones, C-reactive protein (CRP), BMI and leptin concentrations was evaluated. Despite similar BMI and leptin levels, obese PCOS women had lower ∆RQ compared with obese control women (0.07 ± 0.04 vs. 0.11 ± 0.04, p< 0.0001). However, ∆RQ was not different between obese and lean PCOS women, nor was fasting lipid oxidation and suppression in lipid oxidation during hyperinsulinemia. Insulin sensitivity was lower (3.9 ± 1.4 vs. 7.4 ± 2.6 mg/Kg/min per mU/L, p< 0.0001), and CRP and leptin concentrations were higher in obese PCOS vs. lean PCOS (3.34 ± 1.87 vs. 1.29 ± 1.18 mg/L; and 33.6 ± 11.0 vs. 12.4 ± 8.5 ng/L, respectively, all p< 0.05). In the total cohort, ∆RQ correlated with free androgen index (r = -0.359), androstenedione (r = -0.271), and IS (r = 0.452) (all p< 0.05). Multiple regression analysis in the total cohort revealed that the best predictor of metabolic flexibility was PCOS status (partial r = -0.243, p= 0.05) independent of BMI and age. In PCOS women, IS (partial r = 0.503, p= 0.002) and baseline RQ (partial r = -0.489, p= 0.003) explained 46% of the variance in metabolic flexibility with no significant effect of BMI and age. Findings were similar in non-PCOS women (model R2 = 0.750, p= 0.001). Replacing BMI with leptin in the models for PCOS or control women did not change the results. In conclusion, our data suggest that PCOS status, rather than adiposity plays a role in the metabolic inflexibility observed in women with PCOS. It remains to be determined if the lack of a difference in metabolic inflexibility between obese and lean PCOS women applies across the lifespan and holds true in adolescents too, or if metabolic flexibility differs early in the course of PCOS between obese and lean adolescents, but the difference fades as they get older and enter womanhood. Sources of Research Support: Juselius Foundation and Academy of Finland

Women with polycystic ovary syndrome demonstrate worsening markers of cardiovascular risk over the short-term despite declining hyperandrogenaemia: Results of a longitudinal study with community controls.

To compare age-associated changes in cardiovascular risk markers in lean and obese reproductive-aged women with polycystic ovary syndrome (PCOS) with community controls. Longitudinal study at an academic medical centre PATIENTS: Patients diagnosed with PCOS by 2004 Rotterdam criteria in a multidisciplinary clinic were systematically enrolled from 2006-2014 in a PCOS cohort study and subsequently agreed to participate in a longitudinal study. The comparison controls were from the prospective, longitudinal Ovarian Aging (OVA) study, which consists of healthy women with regular menstrual cycles recruited from 2006 to 2011. Cardiovascular risk markers and hormone parameters at baseline and follow-up. Obese and lean PCOS (n=38) and control women (n=296) completed two study visits. The follow-up time (3.5±1.5 vs 4.0±0.8years, P=.06) and magnitude of BMI gain (+0.1kg/m2 /y [-0.11, 0.36] vs +0.26 [-0.18, 0.87] P=.19) did not differ between obese and lean PCOS and controls. In PCOS subjects, total testosterone decreased in both obese and lean, but the decrease was greater in obese subjects (-0.09nmol/L per year; 95% CI: -0.16, -0.02 vs -0.04nmol/L per year; 95%CI: -0.11, 0.03). Compared to their respective controls, obese and lean PCOS saw worsening triglyceride (TG) levels (P<.05) and HOMA-IR (P<.05) over time, but there was no difference in change in LDL, HDL, fasting glucose, C-reactive protein or ALT. In a longitudinal study, reproductive-aged women with PCOS demonstrated declines in biochemical hyperandrogenaemia over time. Despite this, PCOS subjects experienced steeper increases in cardiovascular risk factors associated with insulin resistance, including triglycerides and HOMA-IR.

Serum Irisin levels as a marker in some phenotypes of PCOS

Abstract Study objectives The aim of the study was to assay the serum levels of Irisin in women with PCOS. Study design Serum Irisin levels were investigated in obese and normal weight cases with PCOS and in control cases. Study setting The study was done in the Obstetrics and Gynecology Department, Mansoura University, Egypt. Material and methods The study included 80 cases with PCOS and 80 control cases. The patients were stratified by BMI as obese and normal weight. Statistical analysis was performed by using Statistical Package for Social scientists (SPSS) for Windows 7 (SPSS Inc., Chicago, IL, USA). Main outcome measure was to measure the serum Irisin levels in obese and in normal weight cases. Also, some metabolic indices including lipid profile and HOMA-IR were measured in the cases of study. Results Fasting Irisin levels were significantly elevated in obese and in normal weight PCOS patients as compared to the levels in obese and normal weight control women (P = 0.000). The serum Irisin levels in obese and in normal weight PCOS cases were found to be significantly positively correlated with BMI, insulin levels, HOMA-IR, triglycerides levels, and triglycerides/HDL ratio (P Major conclusion Changes in Irisin levels may be considered as a biomarker for the detection polycystic ovarian syndrome. In the future, it may be used as a marker to follow the disease under various modalities of treatments.

Assessment of glucose regulation in pregnancy after gastric bypass surgery

Aims/hypothesisRoux-en-Y gastric bypass (RYGB) surgery is characterised by glycaemic variability. Prospective studies of glucose metabolism in pregnancy after RYGB are not available, therefore this study aimed to evaluate physiological alterations in glucose metabolism in pregnancy following RYGB.MethodsSixty-three pregnant women (25 who underwent RYGB, 19 non-operated obese control women and 19 normal weight control women) were included. Frequently sampled 3 h OGTTs and 1 h IVGTTs were performed between 24 and 28 weeks of gestation and, in a subgroup, were repeated at 3–6 months after delivery.ResultsWe observed major alterations in glucose kinetics during the OGTT, including an early increase in plasma glucose followed by hypoglycaemia in 90% of women who had previously undergone RYGB. The higher degree of glycaemic variability in this group was accompanied by increased insulin, C-peptide and glucagon concentrations after oral glucose load, whereas no differences in insulin response were observed after parenteral glucose administration (RYGB vs normal weight). IVGTT data suggested improved insulin sensitivity (mean difference 0.226 × 10−4 min−1 [pmol/l]−1 [95% CI 0.104, 0.348]; p < 0.001) and disposition index in pregnancies after RYGB when compared with obese control women. However, subtle alterations in insulin action and beta cell function were still observed when comparing women who had undergone RYGB with the normal-weight control group. Moreover, we observed that fetal growth was associated with maternal glucose nadir levels and insulin secretion in offspring of those who had previously undergone RYGB.Conclusions/interpretationPregnancies after RYGB are affected by altered postprandial glucose, insulin and C-peptide dynamics. Insulin sensitivity is improved by RYGB, although subtle alterations in beta cell function are observed. Longitudinal studies are needed to assess potential consequences for fetal development and pregnancy outcomes.

Understanding Neuronal Architecture in Obesity through Analysis of White Matter Connection Strength.

Despite the prevalence of obesity, our understanding of its neurobiological underpinnings is insufficient. Diffusion weighted imaging and calculation of white matter connection strength are methods to describe the architecture of anatomical white matter tracts. This study is aimed to characterize white matter architecture within taste-reward circuitry in a population of obese individuals. Obese (n = 18, age = 28.7 ± 8.3 years) and healthy control (n = 24, age = 27.4 ± 6.3 years) women underwent diffusion weighted imaging. Using probabilistic fiber tractography (FSL PROBTRACKX2 toolbox) we calculated connection strength within 138 anatomical white matter tracts. Obese women (OB) displayed lower and greater connectivity within taste-reward circuitry compared to controls (Wilks’ λ < 0.001; p < 0.001). Connectivity was lower in white matter tracts connecting insula, amygdala, prefrontal cortex (PFC), orbitofrontal cortex (OFC) and striatum. Connectivity was greater between the amygdala and anterior cingulate cortex (ACC). This study indicates that lower white matter connectivity within white matter tracts of insula-fronto-striatal taste-reward circuitry are associated with obesity as well as greater connectivity within white matter tracts connecting the amygdala and ACC. The specificity of regions suggests sensory integration and reward processing are key associations that are altered in and might contribute to obesity.

Anxiety, stress and depression: A comparison between anorexic, obese and healthy control women

IntroductionSeveral studies have proved that people who suffer from Anorexia Nervosa (AN) experience higher levels of anxiety, stress and depression than general population; while controversial results have been found among obese people (OB); the purpose of this study is to compare levels of anxiety, stress, and depression in AN sample, in OB sample and in Healthy Control Group (HC).MethodsAN sample: 27 anorexic inpatient women in an eating disorder unit. OB sample: 27 obese women evaluated for elegibility of bariatric surgery intervention. HC group: 27 women from different countries had been recruited. DASS 21 and STAI-Y questionnaires had been subministred to evaluate anxiety, stress and depression. The questionnaires had been scores and statistical analysis had been held to determine whether the differences founded in the 3 populations were significant or not (P-value &lt; 0.05).ResultsTable 1. The differences founded were significant.ConclusionAnxiety and stress (DASS21, STAI): AN have reported higher levels than OB and HC that present similar levels. Depression (DASS21): AN have reported higher levels than OB and HC; OB higher levels than HC.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Association of single-nucleotide polymorphisms rs2197076 and rs2241883 of FABP1 gene with polycystic ovary syndrome.

The objective of this study was to evaluate the association between single-nucleotide polymorphisms (SNPs) rs2197076 and rs2241883 in fatty acid-binding protein 1 (FABP1) gene and polycystic ovary syndrome (PCOS). The two alleles rs2197076 and rs2241883 in FABP1 gene in 221 PCOS women and 198 normal women were amplified and sequenced. Allele frequency comparison was performed between the PCOS and control groups, and genotype-phenotype correlation analysis was performed using dominant and recessive models to assess the association of FABP1 and the main features of PCOS. Allele frequency analyses showed a strong association of SNPs rs2197076 and rs2241883 of FABP1 gene with PCOS (P < 0.001). The additive, dominant, and recessive genotype model analyses further supported this association even after adjusting for age and body mass index (BMI). The minor allele frequency (MAF) of rs2241883 in obese PCOS women was less than that in obese control women. Further genotype-phenotype correlation analysis showed that SNP rs2197076 had a stronger association with the main features of PCOS than SNP rs2241883. In the association of SNPs in FABP1 gene with PCOS, rs2197076 was more closely associated with its main features than rs2241883 and seemed to play a more important role in the pathogenesis of PCOS.

Subjective and objective physical activity patterns after Roux-en Y gastric bypass surgery compared with non-operated obese and non-obese control women

Previous studies on physical activity after bariatric surgery provided inconsistent results. The aim of our study was to comprehensively assess physical activity by subjective (questionnaires) and objective (accelerometry) measures in women who had undergone Roux-en Y gastric bypass (RYGB) surgery and to compare results with those of women displaying grade II or higher obesity and of non-obese control women. Our cross-sectional case-control study included 12 women in each group (RYGB, obese, non-obese). Wrist accelerometry was performed over 5 days. Two questionnaires were used to assess women's self-reported leisure- and work-time and sport-related physical activity. Accelerometry indicated a lower physical activity in RYGB women than in non-obese women in particular during the weekend (p=0.010), while there was no difference between RYGB and obese women (p=0.57). Questionnaires revealed that RYGB women self-report a greater leisure- and work-time physical activity than obese women and also greater work-related physical activity than non-obese women (all p≤0.032). In contrast, sport-related activities were reduced in RYGB as compared with non-obese women (p=0.011), while there was no difference between RYGB and obese women (p=0.51). Comparison of the obese and non-obese group revealed less leisure-time and sport-related activities in the obese women (both p≤0.002). Despite the preliminary character of our rather small study, data suggest a differential physical activity pattern in women who have previously undergone RYGB surgery that is characterized by rare sport activities, an increased subjective work-related physical activity and objectively reduced physical activity during the weekend as compared with non-obese control women.

Orbitofrontal cortex volume and brain reward response in obesity.

Background/ObjectivesWhat drives overconsumption of food is poorly understood. Alterations in brain structure and function could contribute to increased food seeking. Recently brain orbitofrontal cortex volume has been implicated in dysregulated eating but little is know how brain structure relates to function.Subjects/MethodsWe examined obese (n=18, age=28.7.4±8.3 years) and healthy control women (n=24, age=27.4±6.3 years) using a multimodal brain imaging approach. We applied magnetic resonance and diffusion tensor imaging to study brain gray and white matter volume as well as white matter integrity, and tested whether orbitofrontal cortex volume predicts brain reward circuitry activation in a taste reinforcement-learning paradigm that has been associated with dopamine function.ResultsObese individuals displayed lower gray and associated white matter volumes (p<.05 family wise error (FWE)-small volume corrected) compared to controls in the orbitofrontal cortex, striatum, and insula. White matter integrity was reduced in obese individuals in fiber tracts including the external capsule, corona radiata, sagittal stratum, and the uncinate, inferior fronto-occipital, and inferior longitudinal fasciculi. Gray matter volume of the gyrus rectus at the medial edge of the orbitofrontal cortex predicted functional taste reward-learning response in frontal cortex, insula, basal ganglia, amygdala, hypothalamus and anterior cingulate cortex in control but not obese individuals.ConclusionsThis study indicates a strong association between medial orbitofrontal cortex volume and taste reinforcement-learning activation in the brain in control but not in obese women. Lower brain volumes in the orbitofrontal cortex and other brain regions associated with taste reward function as well as lower integrity of connecting pathways in obesity may support a more widespread disruption of reward pathways. The medial orbitofrontal cortex is an important structure in the termination of food intake and disturbances in this and related structures could contribute to overconsumption of food in obesity.

Are there differences in quality of life, symptomatology and functional capacity among different obesity classes in women with fibromyalgia? The al-Ándalus project

Obesity may influence fibromyalgia severity. The present study aimed to examine fibromyalgia (FM) symptomatology, quality of life (QoL), and functional capacity across obesity class categories. A total sample of 208 obese FM patients and 108 obese control women were included in the study. The sample was further categorized following the international criteria for obesity classes: obesity I (BMI 30.0-34.99 kg/m(2)), obesity II (BMI 35.0-39.99 kg/m(2)), and obesity III (BMI ≥40.0 kg/m(2)). QoL was assessed by means of the Short-Form-36 Health Survey (SF-36) and FM symptomatology with the Fibromyalgia Impact Questionnaire (FIQ). Standardized field-based fitness tests were used to assess cardiorespiratory fitness, muscular strength, flexibility, agility, and balance. All the dimensions of QoL, as measured by SF-36, were worse in obese FM patients compared to the obese control group (all p < 0.001). Obese FM patients also scored worse in the entire functional capacity tests studied (all p < 0.001). Except for the higher FIQ-depression across obesity status categories (p < 0.05), no differences between obesity status groups were found in QoL and FM impact. However, upper-body muscular strength and cardiorespiratory fitness were worse across obesity class categories and pairwise comparisons showed differences mainly between obesity I and II (p < 0.05, and p < 0.01, respectively). The absence of clear differences in QoL and FM symptomatology among obesity classes suggests that just avoiding any obese status may be a useful advice for a better management of the disease. Nevertheless, upper-body muscular strength and cardiorespiratory fitness, which are important health indicators highly related to the mortality risk, were worse across obesity categories.

High Aminopeptidase N/CD13 Levels Characterize Human Amniotic Mesenchymal Stem Cells and Drive Their Increased Adipogenic Potential in Obese Women

Maternal obesity is associated to increased fetal risk of obesity and other metabolic diseases. Human amniotic mesenchymal stem cells (hA-MSCs) have not been characterized in obese women. The aim of this study was to isolate and compare hA-MSC immunophenotypes from obese (Ob-) and normal weight control (Co-) women, to identify alterations possibly predisposing the fetus to obesity. We enrolled 16 Ob- and 7 Co-women at delivery (mean/SEM prepregnancy body mass index: 40.3/1.8 and 22.4/1.0 kg/m2, respectively), and 32 not pregnant women. hA-MSCs were phenotyped by flow cytometry; several maternal and newborn clinical and biochemical parameters were also measured. The expression of membrane antigen CD13 was higher on Ob-hA-MSCs than on Co-hA-MSCs (P = 0.005). Also, serum levels of CD13 at delivery were higher in Ob- versus Co-pregnant women and correlated with CD13 antigen expression on Ob-hA-MSCs (r2 = 0.84, P < 0.0001). Adipogenesis induction experiments revealed that Ob-hA-MSCs had a higher adipogenic potential than Co-hA-MSCs as witnessed by higher peroxisome proliferator-activated receptor gamma and aP2 mRNA levels (P = 0.05 and P = 0.05, respectively), at postinduction day 14 associated with increased CD13 mRNA levels from baseline to day 4 postinduction (P < 0.05). Adipogenesis was similar in the two sets of hA-MSCs after CD13 silencing, whereas it was increased in Co-hA-MSCs after CD13 overexpression. CD13 expression was high also in Ob-h-MSCs from umbilical cords or visceral adipose tissue of not pregnant women. In conclusion, antigen CD13, by influencing the adipogenic potential of hA-MSCs, could be an in utero risk factor for obesity. Our data strengthen the hypothesis that high levels of serum and MSC CD13 are obesity markers.

Nitric oxide‐mediated cutaneous microvascular function is impaired in polycystic ovary sydrome but can be improved by exercise training

Polycystic ovary syndrome (PCOS) is associated with cardiovascular disease. The contribution of the nitric oxide (NO) dilator system to cutaneous endothelial dysfunction is currently unknown in PCOS. Our aim was to examine whether women with PCOS demonstrate impaired cutaneous microvascular NO function and whether exercise training can ameliorate any impairment. Eleven women with PCOS (age, 29 ± 7 years; body mass index, 34 ± 6 kg m(-2)) were compared with six healthy obese control women (age, 29 ± 7 years; body mass index, 34 ± 5 kg m(-2)). Six women with PCOS (30 ± 7 years; 31 ± 6 kg m(-2)) then completed 16 weeks of exercise training. Laser Doppler flowmetry, combined with intradermal microdialysis of l-N(G)-monomethyl-l-arginine, a nitric oxide antagonist, in response to incremental local heating of the forearm was assessed in women with PCOS and control women, and again in women with PCOS following exercise training. Cardiorespiratory fitness, homeostasis model assessment for insulin resistance, hormone and lipid profiles were also assessed. Differences between women with PCOS and control women and changes with exercise were analysed using Student's unpaired t tests. Differences in the contribution of NO to cutaneous blood flow [expressed as a percentage of maximal cutaneous vasodilatation (CVCmax)] were analysed using general linear models. At 42°C heating, cutaneous NO-mediated vasodilatation was attenuated by 17.5%CVCmax (95% confidence interval, 33.3, 1.7; P = 0.03) in women with PCOS vs. control women. Exercise training improved cardiorespiratory fitness by 5.0 ml kg(-1) min(-1) (95% confidence interval, 0.9, 9.2; P = 0.03) and NO-mediated cutaneous vasodilatation at 42°C heating by 19.6% CVCmax (95% confidence interval, 4.3, 34.9; P = 0.02). Cutaneous microvascular NO function is impaired in women with PCOS compared with obese matched control women but can be improved with exercise training.

Evidence for Masculinization of Adipokine Gene Expression in Visceral and Subcutaneous Adipose Tissue of Obese Women With Polycystic Ovary Syndrome (PCOS)

Sex hormones, particularly androgens, may influence not only adipose tissue distribution but also its functions. We explored the possibility of sexual dimorphism in adipose tissue and skeletal muscle function. This was a case-control study. The setting was an academic hospital. Participants were severely obese men (n = 7), control women (n = 7), and hyperandrogenic women presenting with polycystic ovary syndrome (PCOS) (n = 7) submitting to bariatric surgery and an independent series of 40 patients with PCOS and 40 control women matched for age and body mass index. Samples of subcutaneous (SAT) and visceral adipose tissue (VAT) and skeletal muscle were obtained during bariatric surgery in severely obese subjects. Gene expression of chemerin, lipocalin-2, and omentin-1 in tissue samples was measured. We analyzed the effects of PCOS and obesity on serum concentrations of these adipokines in the larger series of women with PCOS and in control women. Expression of chemerin and lipocalin-2 was higher in VAT than in SAT in men and women with PCOS; the opposite was observed in control women. Omentin-1 expression was higher in VAT than in SAT in the three groups. No differences were observed in the skeletal muscle expression of these adipokines. Obesity increased serum chemerin and lipocalin-2 levels and tended to decrease omentin-1, irrespective of PCOS. The present results suggest that there is sexual dimorphism in some adipose tissue functions and that this dimorphism may be related to differences in androgen concentrations because women with PCOS show a masculinized pattern of expression of some adipokines.

Obesity is the predominant predictor of impaired glucose tolerance and metabolic disturbance in polycystic ovary syndrome

To evaluate the contribution to glucose intolerance and metabolic syndrome of obesity combined with the diagnostic criteria of polycystic ovary syndrome (PCOS). Prospective study. University teaching hospital from 31 August 2010 to 31 August 2011. Two hundred and twenty women with PCOS and seventy normal control women. The clinical and biochemical characteristics of women with PCOS and control women were evaluated. Main outcome measures. The impact of obesity, hyperandrogenism, oligo-anovulation and polycystic ovary morphology on impaired glucose tolerance and metabolic disturbances. Obese women with PCOS had significantly higher insulin resistance than obese normal control women. Logistic regression analysis showed that obesity was the only factor that predicted impaired glucose tolerance and metabolic syndrome. Use of the area under the receiver operating characteristic curve (AUROC) for the body mass index to predict impaired glucose tolerance and metabolic syndrome was more accurate than AUROCs for serum total testosterone level and the average menstrual interval. Body weight status was the major factor determining the risk of impaired glucose tolerance and metabolic syndrome in women with PCOS. Obesity should be treated as the major factor determining long-term health consequences associated with PCOS.

Obesity and Asthma

Obesity is a major risk factor for asthma; the reasons for this are poorly understood, although it is thought that inflammatory changes in adipose tissue in obesity could contribute to airway inflammation and airway reactivity in individuals who are obese. To determine if inflammation in adipose tissue in obesity is related to late-onset asthma, and associated with increased markers of airway inflammation and reactivity. We recruited a cohort of obese women with asthma and obese control women. We followed subjects with asthma for 12 months after bariatric surgery. We compared markers in adipose tissue and the airway from subjects with asthma and control subjects, and changes in subjects with asthma over time. Subjects with asthma had increased macrophage infiltration of visceral adipose tissue (P < 0.01), with increased expression of leptin (P < 0.01) and decreased adiponectin (p < 0.001) when controlled for body mass index. Similar trends were observed in subcutaneous adipose tissue. Airway epithelial cells expressed receptors for leptin and adiponectin, and airway reactivity was significantly related to visceral fat leptin expression (rho = -0.8; P < 0.01). Bronchoalveolar lavage cytokines and cytokine production from alveolar macrophages were similar in subjects with asthma and control subjects at baseline, and tended to increase 12 months after surgery. Obesity is associated with increased markers of inflammation in serum and adipose tissue, and yet decreased airway inflammation in obese people with asthma; these patterns reverse with bariatric surgery. Leptin and other adipokines may be important mediators of airway disease in obesity through direct effects on the airway rather than by enhancing airway inflammation.

Revisiting optimal hormonal contraception following bariatric surgery

Surgical weight loss alternatives most popularly gastric banding and gastric bypass are an increasingly common strategy for greater and more durable weight reduction among reproductive-aged women. As surgical weight loss becomes more commonly performed in women of reproductive age addressing the need for adequate contraception in post-bariatric-surgery patients is more frequently becoming an issue. There is limited an inconsistent evidence on the adverse effects of rapid weight loss on pregnancy and about the decreased effectiveness of hormonal contraceptive among obese women. A discussion and evaluation of the limited studies and evidence concerning OCP effectiveness after bariatric surgical procedures with malabsorption includes concerns about OCP and IUD use. In conclusion there is a critical need to establish a rational plan of action for women who undergo bariatric surgery and require contraception as the operation raises a number of concerns for women. To address these issues including reduced fertility future studies should compare the hormonal profiles of women who are taking OCPs following bariatric surgery to those of obese control women. Lastly there is a wide opportunity for clinicians to improve counseling and increase the use of an adequate contraception in this understudied population; health care coordination between gynecologists and bariatric surgeons is crucial. Copyright © 2013 Elsevier Inc. All rights reserved.