Obesity In Asians Research Articles

A5280 - Early weight loss after laparoscopic sleeve gastrectomy predicts mid-term weight loss in morbidly obese Asians

To investigate the effect of initial weight loss on mid-term weight maintenance and the remission of co-morbidities after laparoscopic sleeve gastrectomy in morbidly obese Asians.

Interactions with the MC4R rs17782313 variant, mental stress and energy intake and the risk of obesity in Genome Epidemiology Study.

BackgroundThe melanocortin-4 receptor (MC4R) regulates metabolism by modulating eating behavior and MC4R variants (rs17782313 and rs571312) are associated with obesity in Asians and Caucasians. However, the impact of their interactions with nutritional and lifestyle factors on obesity are poorly described. Therefore, we investigated the interaction of MC4R variants and dietary patterns on the risk of obesity in Korean middle-aged adults.MethodsData collected included, genetic variations, anthropometric and biochemical measurements, dietary and lifestyle habits, and food intake. Data were obtained from the 8830 adults aged 40–69 years in the Ansung and Ansan cohort of the Korean Genome Epidemiology Study.ResultsThe MC4R rs18882313 minor allele had a higher frequency in the obese group (P < 0.01). MC4R genotypes were not associated with differences in daily energy and macronutrient intakes. However, the intakes of processed foods and fat (as percentages of energy) were significantly higher and intake of fruits were significantly lower in subjects with MC4R minor alleles (P < 0.05). Interestingly, there was a positive interaction between MC4R variants and mental stress levels that were associated with the risk of obesity after adjusting for age, gender, residence area, daily energy intake, smoking status and physical activity (interaction P = 0.0384). Only in subjects with high stress were MC4R minor alleles associated with higher BMIs after adjusting for confounders. The association was present without modulating energy and nutrient intake. In the group with energy intakes higher than estimated energy requirement (EER), subjects with MC4R minor alleles had higher BMIs than those with the major alleles (P < 0.001).ConclusionsThe interactions of mental stress and energy intakes with the MC4R minor allele genotype might be associated with increased risk of obesity in Korean adults. This research might identify subjects with a specific MC4R minor alleles as a human subset of people with a low metabolic tolerance for excessive energy intake, especially when under stress.

Impact of Physician Training on Diagnosis and Counseling of Overweight and Obese Asian Patients.

Obesity is widely underdiagnosed among Asians, due in part to a lack of physician awareness of the modified diagnostic criteria for Asians. This study investigated the effect of a physician training on accurately diagnosing obesity among and providing weight counseling to overweight and obese Asian patients. Physicians (N=16) from five primary care practices received 1h of face-to-face training and other reminder resources (e.g., wallet card) describing the guidelines for the diagnosis of overweight/obesity among Asians, as well as weight counseling instruction. Chart reviews of overweight/obese Asian patients were conducted for the 12months before the training (n=198) and 3months following the training (n=163). Physician race (Asian/non-Asian) and clinic setting (private/academic) were included as outcome moderators. Patients were predominantly male (63.1%), with a mean age of 46.0years (SD=14.9) and an average BMI of 28.2 (SD=3.8). Across all physicians, 26.8 and 45.1% of patients were accurately diagnosed as overweight or obese before and after the training, respectively (p<0.05). The odds of a physician correctly diagnosing Asian patients as overweight or obese were 102% higher at post-training after accounting for nesting of patients within physicians. Similarly, weight counseling was higher (65.0%) following training compared to pre-training levels (43.9%) but failed to reach significance (p=0.06). Accurate identification and counseling of overweight/obese Asian patients can be improved by education and training. Universal adoption of race-specific guidelines will ensure more successful weight management and reduced morbidity in a rapidly growing Asian population.

Food cravings, food addiction, and a dopamine-resistant (DRD2 A1) receptor polymorphism in Asian American college students.

In an era where obesity remains an important public health concern, food addiction has emerged as a possible contributor to obesity. The DRD2 gene is the most studied polymorphism. The aim of this study was to investigate a relationship between food addiction questionnaires, body composition measurements, and a dopamine- resistant receptor polymorphism (DRD2 A1) among Asian Americans. A total of 84 Asian American college students were recruited. Participants underwent body composition measurement via bioelectrical impedance, answered questionnaires (Food Craving Inventory and Power of Food Scale), and had blood drawn for genotyping (PCR). There was no difference in body composition (BMI, percent body fat) between the A1 (A1A1 or A1A2) and A2 (A2A2) groups. There were statistically significant differences in food cravings of carbohydrates and fast food on the Food Craving Inventory between the A1 and A2 groups (p=0.03), but not for sugar or fat. Among Asian college females, there was also a difference on the Power of Food questionnaire (p=0.04), which was not seen among men. 13 out of 55 women also had >30% body fat at a BMI of 21.4 to 28.5 kg/m2. Greater carbohydrate and fast food craving was associated with the DRD2 A1 versus A2 allele among Asian Americans. Further studies examining the ability of dopamine agonists to affect food craving and to reduce body fat in Asian American are warranted. More studies in food addiction among obese Asian Americans are needed with careful definition of obesity, specifically for Asian women.

Effect of weight loss after bariatric surgery on kidney function in a multiethnic Asian population.

Current literature reports improvement in kidney function in obese patients after bariatric surgery in non-Asian centers. It is unclear how kidney function is affected by postoperative body composition changes in obese Asian patients. To evaluate kidney function and its relationship to body composition in a multiethnic Asian population after bariatric surgery. This study was performed in a university hospital. Data of 68 obese patients who were followed for 1 year after surgery were retrieved from our university hospital clinical care database. Body composition was obtained by bioimpedance analysis. Kidney function was calculated as glomerular filtration rate (GFR) using the following formulas: (1) Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) (estimated GFR [eGFR], mL/min/1.73 m(2)); (2) absolute GFR (aGFR, mL/min); and (3) lean weight-adjusted Cockcroft-Gault creatinine clearance (CG-LBW, mL/min). Patients were further examined by 2 subgroups: eGFR<90 and>90 mL/min/1.73 m(2). One year after surgery, body mass index (BMI) declined from 41.9±5.7 to 29.6±4.2 kg/m(2) (P<.001), body surface area (BSA) decreased from 2.15±0.23 to 1.86±0.18 m(2) (P<.001), and fat mass (FM) reduced from 45.8±9.4 to 25.6±10.5 kg (P<.001). There were significant differences in percentage excess weight loss (%EWL) among Chinese, Malays, Indians, and other ethnicities. Similar results were found with percentage fat mass loss (%FML). Changes in aGFR were associated with reductions in FM (P = .010), BSA (P = .049), and %EWL (P<.001). In the eGFR>90 subgroup, eGFR decreased from 143±22 to 122±19 mL/min/1.73 m(2). Conversely, in the eGFR<90 subgroup, eGFR had a trend of improvement from 69 to 79 mL/min/1.73 m(2). Changes in eGFR after bariatric surgery in the obese Asian patient are strongly associated with reduction in FM, BSA, and %EWL. More work is required to investigate if certain ethnicities have better postoperative renal profiles.

Exercise-Induced Weight Loss is More Effective than Dieting for Improving Adipokine Profile, Insulin Resistance, and Inflammation in Obese Men.

The adipokines chemerin and adiponectin are reciprocally related in the pathogenesis of insulin resistance and inflammation in obesity. Weight loss increases adiponectin and reduces chemerin, insulin resistance, and inflammation, but the effects of caloric restriction and physical activity are difficult to separate in combined lifestyle modification. We compared effects of diet- or exercise-induced weight loss on chemerin, adiponectin, insulin resistance, and inflammation in obese men. Eighty abdominally obese Asian men (body mass index [BMI] ≥ 30 kg/m(2), waist circumference [WC] ≥ 90 cm, mean age 42.6 years) were randomized to reduce daily intake by ~500 kilocalories (n = 40) or perform moderate-intensity aerobic and resistance exercise (200-300 min/week) (n = 40) to increase energy expenditure by a similar amount for 24 weeks. The diet and exercise groups had similar decreases in energy deficit (-456 ± 338 vs. -455 ± 315 kcal/day), weight (-3.6 ± 3.4 vs. -3.3 ± 4.6 kg), and WC (-3.4 ± 4.4 vs. -3.6 ± 3.2 cm). The exercise group demonstrated greater reductions in fat mass (-3.9 ± 3.5 vs. -2.7 ± 5.3 kg), serum chemerin (-9.7 ± 11.1 vs. -4.3 ± 12.4 ng/ml), the inflammatory marker high-sensitivity C-reactive protein (-2.11 ± 3.13 vs. -1.49 ± 3.08 mg/L), and insulin resistance as measured by homeostatic model assessment (-2.45 ± 1.88 vs. -1.38 ± 3.77). Serum adiponectin increased only in the exercise group. Exercise-induced fat mass loss was more effective than dieting for improving adipokine profile, insulin resistance, and systemic inflammation in obese men, underscoring metabolic benefits of increased physical activity.

PNPLA3 genotype increases susceptibility of nonalcoholic steatohepatitis among obese patients with nonalcoholic fatty liver disease

BackgroundThe patatin-like phospholipase domain-containing protein 3 (PNPLA3) rs738409 variant is associated with histologic disease severity in patients with nonalcoholic fatty liver disease (NAFLD); however, whether the PNPLA3 genotype has an effect on susceptibility of nonalcoholic steatohepatitis (NASH) from NAFLD among severely obese patients remains unclear. The objective of this study was to investigate the role of the PNPLA3 genotype on NASH in severely obese Asian patients with NAFLD. MethodsThe PNPLA3 rs738409 genotype was determined in 181 severely obese patients who underwent bariatric surgery. The diagnosis of NASH and the NAFLD activity score (NAS) were determined by liver histopathology. ResultsOf the 181 patients, 29 (16.0%), 60 (33.2%), and 92 (50.8%) were in the non-NAFLD, steatosis, and NASH groups, respectively. The PNPLA3 rs738409 GG genotype was associated with higher liver enzymes and a higher risk for NASH (odds ratio [OR], 3.72; 95% CI, 1.25–11.05). The GG genotype was also associated with histologic severity of NAFLD, including higher steatosis grade (OR, 9.94; 95% CI, 2.20–44.83 for patients with grade 3 steatosis) and NAS (OR, 11.49; 95% CI, 2.50–52.83 for patients with a NAS ≥5). Finally, multiple logistic regression also showed that the GG genotype was an independent risk factor for NASH (OR, 3.58; 95% CI, 1.15–11.12) in NAFLD patients. ConclusionThe PNPLA3 rs738409 GG genotype increases susceptibility of NASH in severely obese Asians with NAFLD and correlates to histologic severity of NAFLD.

Pancreas Volume With Obesity in Asians

Department of Internal Medicine Keio University School of Medicine Tokyo, Japan Larry Hillblom Islet Research Center UCLA David Geffen School of Medicine Los Angeles, CA [email protected] The author declares no conflict of interest.

Association of the UCP polymorphisms with susceptibility to obesity: case-control study and meta-analysis.

This paper describes a case-control study and a meta-analysis performed to evaluate if the following polymorphisms are associated with presence of obesity: -3826A/G (UCP1); -866G/A, Ala55Val and Ins/Del (UCP2) and -55C/T (UCP3). The case-control study enrolled 282 obese and 483 non-obese patients with type 2 diabetes. A literature search was made to identify all studies that evaluated associations between UCP1-3 polymorphisms and obesity. In the case-control study the distributions of the UCP variants did not differ between obese and non-obese groups (P > 0.05). Forty-seven studies were eligible for the meta-analysis and the results showed that the UCP2 -866G/A and UCP3 -55C/T polymorphisms were associated with protection to obesity in Europeans (OR = 0.89, 95% CI 0.82-0.97 and OR = 0.88, 95% CI 0.80-0.97, respectively). The UCP2 Ala55 val polymorphism was associated with obesity in Asians (OR = 1.61, 95% CI 1.13-2.30). The UCP2 Ins/Del polymorphism was associated with obesity mainly in Europeans (OR = 1.19, 95% CI 1.00-1.42). There was no significant association of the UCP1 -3826A/G polymorphism with obesity. In our case-control study we were not able to demonstrate any association between UCP polymorphisms and obesity in T2DM patients; however, in the meta-analysis we detected a significant association of UCP2 -866G/A, Ins/Del, Ala55Val and UCP3 -55C/T polymorphisms with obesity.

Prevalence, clinical significance, and predictors for sleep-related hypoventilation among obese Asians with obstructive sleep apnea syndrome

Introduction Sleep-related hypoventilation may be important in the development of hypercapnic respiratory failure in obstructive sleep apnea syndrome (OSAS) particularly in obese group. Current available data on clinical significance of sleep-related hypoventilation is still lacking. Objective: To study the prevalence, clinical significance, and predictors of sleep-related hypoventilation among obese OSAS patients. Materials and methods Retrospective analysis of 221 patients diagnosed with OSAS. Sleep-related hypoventilation was defined as definite or possible using criteria as follows; an increase of >10 mmHg of end tidal CO2 during sleep in comparison to an awake supine value or low baseline asleep oxygen saturation ⩽85% not explained by apnea or hypopnea; respectively. No hypoventilation was defined if the patients did not meet above two criteria. We conducted two arms of analysis; study arm I compared the group with definite and possible hypoventilation against no hypoventilation group and study arm II compared the group with definite hypoventilation against possible hypoventilation and no hypoventilation groups. Results 35.75% and 31.22% exhibited sleep-related hypoventilation in study arm I and II, respectively. Sleep-related hypoventilation group in both study arms had more cardiovascular comorbidities and more severe sleep disordered breathing. Logistic regression analysis showed that BMI, total AHI, ESS, and morning headache (at least 3–4 times a week) were independent predictors of sleep-related hypoventilation in both study arms. Using regression co-efficient analysis, prediction scores using the above variables were derived to predict the likelihood of sleep-related hypoventilation at different sensitivity and specificity rates. Conclusion We established important clinical significance and predictors of sleep-related hypoventilation which can be utilized to predict the probability of having sleep-related hypoventilation with reasonable sensitivity and specificity. Acknowledgements We would like to thank Mr. Dittapol Muntham, a statistician. at the Section of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital for additional statistical review.

Comparing the effects of meal replacements with reduced-fat diet on weight, sexual and endothelial function, testosterone and quality of life in obese Asian men

Sexual dysfunction is more prevalent in obese than in normal-weight men. Meal replacements (MRs) are useful weight-loss strategies. We randomized obese (body mass index 27.5 kg m(-2), waist circumference (WC) 90 cm) Asian men (mean age 40.5 years, range 30-61) to a conventional reduced-fat diet (CD) (n=24) or MR-based plan (n=24) to reduce daily intake by 400 kcal for 12 weeks. There were significantly greater reductions in weight (4.2 ± 0.8 kg), WC (4.6 ± 0.7 cm), calorie and fat intake in the MR group, compared with the CD group (2.5 ± 0.4 kg, 2.6 ± 0.5 cm). Erectile function (International Index of Erectile Function 5-item score) improved comparably in the MR (3.4 ± 0.7 points) and CD (2.5 ± 0.5 points) groups, as did the Sexual Desire Inventory score (5.5 ± 2.3 vs 7.7 ± 2.1 points), quality of life (36-item Short Form survey score), plasma testosterone and endothelial function (Reactive Hyperemia Index). Subjects were switched to or continued CD for another 28 weeks. Weight, WC and erectile function were maintained at 40 weeks. MR induces greater reductions in weight and abdominal obesity than conventional diet, and comparable improvements in sexual and endothelial function, testosterone and quality of life.

Severity of Obstructive Sleep Apnea Correlates With 25-Hydroxyvitamin-D Levels in Obese Asian Indian

Severity of Obstructive Sleep Apnea Correlates With 25-Hydroxyvitamin-D Levels in Obese Asian Indian

Comparing the effects of meal replacements with an isocaloric reduced‐fat diet on nutrient intake and lower urinary tract symptoms in obese men

Lower urinary tract symptoms (LUTS) in men are associated with obesity, particularly central obesity as measured by waist circumference (WC), and may improve with weight loss. We aimed to compare effects of a meal-replacement based diet with isocaloric reduced-fat plan on LUTS and nutrient intake in obese Asian men. Obese Asian [mean (range) body mass index of 32.9 (30.5-42.3) kg m(-2) ] men [mean (range) age 40.2 (30-61) years] were randomised to a reduced-fat (< 30% of energy) diet [conventional reduced-fat diet (CD) group; n = 23] or meal-replacement-based plan [meal replacement (MR) group; n = 23], to reduce daily intake by 2000 kJ for 12 weeks. CD and MR groups had statistically significant and similar reductions in weight (-2.6 ± 1.9 kg versus -4.2 ± 3.8 kg), overall LUTS severity measured with International Prostate Symptom Scale (IPSS) scores (-1.71 ± 1.93 points versus -2.42 ± 2.12 points) and insulin resistance [homeostasis model assessment (HOMA) calculated from plasma glucose and insulin]. The MR group had significantly greater decreases in WC (-4.8 ± 3.3 cm versus -2.5 ± 2.3 cm), fat mass (-2.47 ± 3.63 kg versus -1.59 ± 2.32 kg), fat intake, plasma C-reactive protein, and in storage LUTS score (-1.59 ± 1.33 points versus -1.00 ± 0.87 points), which was associated with a decreased fat intake (r = 0.48, P = 0.03). A decrease in overall IPSS score was associated with reductions in weight, WC and HOMA. Weight loss as a result of CD or MR had similar efficacy in relieving LUTS. MR produced greater reductions in fat intake, adiposity and storage LUTS.

Relationship between diabetes, race, obesity and outcomes in patients with acute coronary syndrome: a pool analysis from randomized trials

Background: Asian patients with diabetes (DM), who have more disturbance of insulin secretion, tend to be less obese than Caucasian patients with DM, who have more insulin resistance. There is little information about the relationship between DM, race, obesity and ischemic outcomes in patients with acute coronary syndrome (ACS). Methods: Using data from 32,804 patients with ACS, we identified 3,258 East Asians (Chinese, Filipino, Indonesian, Japanese, Korean, and Malaysian) and 29,546 Caucasians enrolled in the PARAGON B, EARLY ACS, APPRAISE-2, and TRACER trials. We evaluated the relationship between DM, Asian vs. Caucasian race and body mass index (BMI) and ischemic outcomes. Interaction between DM, race and outcome was assessed using a Cox model containing covariates, including BMI and trial. Results: Caucasian patients with DM had higher BMI than those without DM (median 29.3 vs. 27.1) while Asian patients with and without DM had similar BMI (median 24.8 vs. 24.0). Both Caucasian and Asian patients with DM had higher rates of ischemic outcomes including death (Table). There was no significant interaction between race and DM for clinical outcomes (Table). View this table: BMI and Outcomes by Race and DM status Conclusions: In patients with ACS, DM is associated with adverse outcomes irrespective of the differential relationship between DM and obesity in Asians and Caucasians. Further studies to better investigate the mechanisms behind our findings are warranted.

Serum Prostate-Specific Antigen Concentration and Hemodilution among Chinese Middle-Aged Obese Men: A Hematocrit-Based Equation for Plasma Volume Estimation Is Induced

A hematocrit (HCT)-based and a body surface area (BSA)-based equations were applied for plasma volume (PV) estimation, respectively, to confirm and quantify the hemodilution effect in prostate-specific antigen (PSA) screening among obese men. The agreement between the equations was additionally investigated. A total of 1,444 men were retrospectively collected, with ages 40 to 65 years, PSA 0 to 4 ng/mL, and no prostate cancer. PSA mass was calculated as PSA concentration multiplied by PV. Multivariable linear regression models, theoretical models, and the Bland-Altman method were used. PSA concentration significantly decreased with increasing body mass index (BMI; β = -0.011, P < 0.001); however, PSA mass estimated by HCT- (β = 0.004, P = 0.132) and BSA (β = -0.003, P = 0.094)-based equations remained consistent. A screening PSA of 4.0 ng/mL in nonobese men was found to be corresponding to 3.32 and 3.68 ng/mL in obese men extrapolated by PV on the basis of HCT and BSA, respectively. Moreover, the mean (95% confidence interval) difference of PV between the two equations was 0.33 (-0.06 to 0.73) L. The inverse relationship between PSA concentration and BMI might be explained by a hemodilution effect among obese men. There is significant variation in PV calculated by the two equations. A value between 3.32 and 3.68 ng/mL might be recommended for PSA screening in middle-aged obese Asian men.

Abstract 129: Effect of Immigration to the US on Prevalence of Hypertension and Obesity in Asians

Introduction: In the United States, three fourths of the Asian population growth has been due to immigration. However, the effect of immigration on health of Asian immigrants has not been studied systematically. The goal of this project was to evaluate the effect of immigration on hypertension and obesity prevalence in Far East Asians. Hypothesis : The prevalence of hypertension and obesity is higher in Asians who immigrated to US as compared to Asians residing in the country of birth. Methods: We used the Korean National Health and Nutrition Examination Survey (KNHANES) and the US National Health Interview Survey (NHIS) to compare prevalence of hypertension and obesity in each population. The KNHANES is a national survey conducted by the Korea Institute of Health and Social Affairs with a multistage probability sampling design. The NHIS is an annual public health survey collected in US to monitor the overall health of US population. From NHIS, a subgroup of adults born in Korea and neighboring Far East countries who immigrated to US were compared to adults residing in Korea. In order to conduct a case-control study, Korean immigrants from NHIS were matched with Koreans from KNHANES by age, sex and income level in 1:1 ratio. The prevalence of hypertension and obesity (BMI≥25 kg/m 2 ) was evaluated then in both cohorts. The case-control study was limited to the subjects of 40 years and older. Results: Overall, in the KNHANES adult population 27% reported to have high blood pressure and 34% had BMI≥25 whereas in the NHIS Korean population 30% had hypertension and 37% had obesity. The case-control study based on matching Korean adults from KNHANES and NHIS included 236 adults from each survey who were 40 years and older, 55% were females, 67% belonged to the high income group, and the mean age was 54.4±11.7. In the controls from Korean NHANES, 26% (N=60) reported to have hypertension and 32% (N=76) had a BMI&gt;25 whereas in the matched cases from US NHIS 31% (N=73) had hypertension and 36% (N=86) had BMI&gt;26. The differences in hypertension and obesity prevalence between two groups were statistically significant (P&lt;0.05). Conclusions: The overall prevalence of hypertension and obesity was lower in Koreans residing in the country of birth than in Koreans who immigrated to the United States.

Clinical Importance of Assessment of Type 2 Diabetes Mellitus with Visceral Obesity. A Japanese Perspective

Type 2 diabetes mellitus (T2DM) is a complex heterogeneous group of metabolic disorders including hyperglycemia and impaired insulin action and/or insulin secretion. Obesity T2DM has become a serious problem in Japan as in Western countries, with over-eating and physical inactivity. Obese Asians have mild degree of adiposity, compared with Western subjects. Unlike total body fat, body fat distribution, especially excess accumulation of visceral fat, correlates with various diabetogenic, atherogenic, prothrombotic and proinflammatory metabolic abnormalities, which increase the risk of atherosclerotic cardiovascular disease (ACVD). Obese patients with T2DM have poor glycemic control with disordered eating behaviors, and complications of hypertension and dyslipidemia, leading to ACVD. The major therapies in obese T2DM, hyperinsulinemia and low insulin sensitivity, available for weight loss, especially visceral fat reduction, include caloric restriction, physical activity and behavior modification. On the other hand, the major therapies in non-obese T2DM with insufficient insulin secretion, are insulin-secretory agents and injectable insulin. For clinically meaningful prevention/reduction in the rate of future ACVD in T2DM, it may be important to stratify T2DM subjects into those with and without visceral obesity and design specific management protocols for each group.

Role of Retinol-Binding Protein 4 in Obese Asian Indians with Metabolic Syndrome

Role of Retinol-Binding Protein 4 in Obese Asian Indians with Metabolic SyndromeRetinol-binding protein 4 is an adipocytokine separately implicated in the development of obesity-related insulin resistance and proatherogenic lipid profile, however, its role in humans is unclear. This study was carried out to assess the role of retinol-binding protein 4 as a potential marker of metabolic syndrome in obese Asian Indians (a high-risk population for diabetes). 52 obese (BMI &gt;23 kg/m2) Asian Indians were grouped into those with and without metabolic syndrome based on IDF criteria and compared with healthy controls. The anthropometric and biochemical parameters (fasting blood sugar, lipid profile, serum insulin, high-sensitivity C-reactive protein, and retinol-binding protein 4) were estimated. The obese groups had significantly altered adiposity indices, insulin resistance parameters (fasting blood sugar (only in the metabolic syndrome group), serum insulin, HOMA-IR and QUICKI), index of inflammation (C-reactive protein) and proatherogenic dyslipidemic profile (serum triglycerides, VLDL-cholesterol, and triglyceride/HDL-cholesterol ratio). Retinol-binding protein 4 levels were elevated in the obese groups, but were not significant. Retinol-binding protein 4 levels were correlated with anthro-pometric parameters and atherogenic lipids, while C-reactive protein was correlated with anthropometric and insulin resistance parameters in the entire group of subjects. Although these correlations were not observed in the obese groups, in the control group, retinol-binding protein 4 was correlated to the lipid parameters and C-reactive protein to adiposity indices. Thus, the role of retinol-binding protein 4 as a potential marker of metabolic syndrome is limited to the prediction of proatherogenic risk among Asian Indians.

Is Head Rotation Preferred During Right Internal Jugular Vein Cannulation in Obese Asians?

Background: Obese subjects are considered to be a difficult group for central vein cannulation. We investigated the optimal position for right internal jugular vein (IJV) cannulation in relation to BMI in Asians. Methods: 102 subjects were divided into three groups; 34 with a BMI of less than 25 kg/aŽi (Group â ), 34 with a BMI from 25 to 30 kg/aŽi (Group II), and 34 with a BMI of 30 kg/aŽi or above (Group III). Using a 5-12 MHz linear probe of an ultrasound system, the IJV depth, the diameter of the IJV and common carotid artery (CCA) and overlap length between them were measured at six positions: 0°, 30°, and 60° of head rotation to the contralateral side combined with 0° and 10° of Trendelenburg tilt. Results: The IJV depth was deepest in Group III and significantly shorter at 10° Trendelenburg tilt compared to 0° Trendelenburg tilt. The IJV diameter increased by 10 to 20% with 10° Trendelenburg tilt and there were not significant change by head rotation or BMI. The overlap of the IJV and CCA was significantly increased in Group III compared to Group I and in Group III, there were significant increases of the overlap according to the degree of head rotation, regardless of Trendelenburg tilt.

Weight loss, health-risk and co-morbidity improvements achieved in 12 weeks by 103 obese Asian vs 103 Caucasian patients on the LighterLife VLCD

Weight loss, health-risk and co-morbidity improvements achieved in 12 weeks by 103 obese Asian vs 103 Caucasian patients on the LighterLife VLCD