bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Psychosocial Status in Treatment‐Seeking Women with Class III vs. Class I–II Obesity
Authors: Wadden Thomas A. , Butryn Meghan L. , Sarwer David B. , Fabricatore Anthony N. , Crerand Canice E. , Lipschutz Patti E. , Faulconbridge Lucy , Raper Steven E. , Williams Noel N.
Published: April 2008

Objective: This study compared the psychosocial status and weight loss expectations of women with extreme (class III) obesity who sought bariatric surgery with those of women with class I–II obesity who enrolled in a research study on behavioral weight control.

Research Methods and Procedures: Before treatment, all participants completed the Beck Depression Inventory‐II and the Weight and Lifestyle Inventory. This latter questionnaire assesses several domains including symptoms of depression and low self‐esteem, history of psychiatric complications, current stressors, and weight loss expectations.

Results: Women with class III obesity, as compared with class I–II, reported significantly more symptoms of depression. Fully 25% of women in the former group appeared to have a significant mood disorder that would benefit from treatment. As compared with women with class I–II obesity, significantly more women with class III obesity also reported a history of psychiatric complications, which included physical and sexual abuse and greater stress related to their physical health and financial/legal matters. Both groups of women had unrealistic weight loss expectations. Those who sought surgery expected to lose 47.6 ± 9.3% of initial weight, compared with 24.8 ± 8.7% for those who enrolled in behavioral weight control.

Discussion: These findings suggest that women with extreme obesity who seek bariatric surgery should be screened for psychosocial complications. Those determined to have significant psychiatric distress should be referred for behavioral or pharmacological treatment to alleviate their suffering. Long‐term studies are needed to provide definitive guidance concerning the relationship between preoperative psychopathology and the outcome of bariatric surgery.
Relationship of Adiponectin with Insulin Sensitivity in Humans, Independent of Lipid Availability
Authors: Furler Stuart M. , Gan Seng Khee , Poynten Ann M. , Chisholm Donald J. , Campbell Lesley V. , Kriketos Adamandia D.
Published: April 2008

Objective: To test in humans the hypothesis that part of the association of adiponectin with insulin sensitivity is independent of lipid availability.

Research Methods and Procedures: We studied relationships among plasma adiponectin, insulin sensitivity (by hyperinsulinemic‐euglycemic clamp), total adiposity (by DXA), visceral adiposity (VAT; by magnetic resonance imaging), and indices of lipid available to muscle, including circulating and intramyocellular lipid (IMCL; by 1H‐magnetic resonance spectroscopy). Our cohort included normal weight to obese men (n = 36).

Results: Plasma adiponectin was directly associated with insulin sensitivity and high‐density lipoprotein‐cholesterol and inversely with plasma triglycerides but not IMCL. These findings are consistent with adiponectin promoting lipid uptake and subsequent oxidation in muscle and inhibiting TG synthesis in the liver. In multiple regression models that also included visceral and total fat, free fatty acids, TGs, and IMCL, either alone or in combination, adiponectin independently predicted insulin sensitivity, consistent with some of its insulin‐sensitizing effects being mediated through mechanisms other than modulation of lipid metabolism. Because VAT directly correlated with total fat and all three indices of local lipid availability, free fatty acids, and IMCL, an efficient regression model of insulin sensitivity (R2 = 0.69, p < 0.0001) contained only VAT (part R2 = 0.12, p < 0.002) and adiponectin (part R2 = 0.41, p < 0.0001) as independent variables.

Discussion: Given the broad range of total adiposity and body fat distribution in our cohort, we suggest that insulin sensitivity is robustly associated with adiponectin and VAT.
Use of Lifestyle Changes Treatment Plans and Drug Therapy in Controlling Cardiovascular and Metabolic Risk Factors
Authors: Pi‐Sunyer F. Xavier
Published: April 2008

Intervention in weight management should begin before the onset of the metabolic syndrome. Therapeutic lifestyle changes (e.g., diet and physical activity) comprise the cornerstone of care for overweight and obese patients. Behavior modification approaches are useful in facilitating adherence to specific dietary regimens. Pharmacotherapy is an option for patients with a BMI >30 kg/m2 or for those with a BMI of 27 to 30 kg/m2 and two or more risk factors, who have failed on diet and exercise alone. To date, the U.S. Food and Drug Administration has approved three weight loss agents: sibutramine, orlistat, and phentermine.
Potential Role of New Therapies in Modifying Cardiovascular Risk in Overweight Patients with Metabolic Risk Factors
Authors: Jensen Michael D.
Published: April 2008

The serotonin, norepinephrine, dopamine, and endocannabinoid systems, as well as a host of other systems, mediate hunger and satiety signals. Weight loss agents that modulate appetite through pure central nervous system pathways (e.g., APD356, a selective serotonin receptor agonist) and peripheral signals to central nervous system pathways (e.g., cholecystokinin receptor agonists and ghrelin receptor antagonists) are in preclinical or early phase studies. Both devices and pharmacological compounds that facilitate weight loss and/or target multiple components of metabolic risk also are in development. One of the medications that has completed extensive phase III clinical trials and may become available in the foreseeable future is rimonabant, a selective cannabinoid 1‐receptor antagonist. Drugs that improve adipose tissue function or fatty acid metabolism (e.g., AOD9604) also are in clinical trials. Some currently available medications may reduce metabolic complications without treating obesity per se (e.g., acipimox, pioglitazone). Surgically implanted gastric pacemaker systems that modulate vagus nerve activity and delay gastric emptying are under study.
Obesity: Person and Population
Authors: Cope Mark B. , Allison David B.
Published: April 2008

COPE, MARK B. AND DAVID B. ALLISON. Obesity: person and population.
Dietary Synergies in Appetite Control: Distal Gastrointestinal Tract
Authors: Woods Stephen C.
Published: April 2008

WOODS, STEPHEN C. Dietary synergies in appetite control: distal gastrointestinal tract.
Novel Food Technologies: Enhancing Appetite Control in Liquid Meal Replacers
Authors: Mela David J.
Published: April 2008

MELA, DAVID J. Novel food technologies: enhancing appetite control in liquid meal replacers.
Blood–Brain Barrier and Energy Balance
Authors: Banks William A.
Published: April 2008

The blood–brain barrier (BBB) plays a critical role in the transduction of signals between the central nervous system and peripheral tissues. It does so through several mechanisms, including the direct transport of peptides and regulatory proteins such as insulin and leptin. Another mechanism that may be important is the secretion by brain endothelial cells of substances that affect feeding, such as proinflammatory cytokines and NO. We have recently shown that the BBB is capable of receiving an input from one side and secreting a substance into the other. Additionally, BBB secretions can be modulated by substances that affect feeding, such as adiponectin and lipopolysaccharide.
Adipose Tissue as an Endocrine Organ
Authors: Ahima Rexford S.
Published: April 2008

Adipose tissue plays a critical role in energy homeostasis, not only in storing triglycerides, but also responding to nutrient, neural, and hormonal signals and secreting adipokines that control feeding, thermogenesis, immunity, and neuroendocrine function. A rise in leptin signals satiety to the brain through receptors in hypothalamic and brainstem neurons. Leptin activates tyrosine kinase, Janus kinase 2, and signal transducer and activator of transcription 3, leading to increased levels of anorexigenic peptides, e.g., α‐melanocyte stimulating hormone and cocaine‐ and amphetamine‐regulated transcript, and inhibition of orexigenic peptides, e.g., neuropeptide Y and agouti‐related peptide. Obesity is characterized by hyperleptinemia and hypothalamic leptin resistance, partly caused by induction of suppressor of cytokine signaling‐3. Leptin falls rapidly during fasting and potently stimulates appetite, reduces thermogenesis, and mediates the inhibition of thyroid and reproductive hormones and activation of the hypothalamic–pituitary–adrenal axis. These actions are integrated by the paraventicular hypothalamic nucleus. Leptin also decreases glucose and stimulates lipolysis through central and peripheral pathways involving AMP‐activated protein kinase (AMPK). Adiponectin is secreted exclusively by adipocytes and has been linked to glucose, lipid, and cardiovascular regulation. Obesity, diabetes, and atherosclerosis have been associated with reduced adiponectin levels, whereas adiponectin treatment reverses these abnormalities partly through activation of AMPK in liver and muscle. Administration of adiponectin in the brain recapitulates the peripheral actions to increase fatty acid oxidation and insulin sensitivity and reduce glucose. Although putative adiponectin receptors are widespread in peripheral organs and brain, it is uncertain whether adiponectin acts exclusively through these targets. As with leptin, adiponectin requires the central melanocortin pathway. Furthermore, adiponectin stimulates fatty acid oxidation and reduces glucose and lipids, at least in part, by activating AMPK in muscle and liver.
Effect of a Community‐Based Weight Management Program on Weight Loss and Cardiovascular Disease Risk Factors
Authors: Graffagnino Cheryl L. , Falko James M. , La Londe Michelle , Schaumburg Joann , Hyek Michael F. , Shaffer Lynn E.T. , Snow Richard , Caulin‐Glaser Teresa
Published: April 2008

Objective: The purpose of our retrospective database analysis was to describe and evaluate the outcomes of a weight loss intervention in a community medical wellness center.

Research Methods and Procedures: Four hundred eighteen overweight and obese adults entered the program between 2001 and 2004. Forty‐seven percent completed the 6‐month program designed using standards and recommendations established by the NIH, the American Dietetic Association, and the American Academy of Sports Medicine. Data analysis was limited to 198 participants (142 women, 56 men) completing the program.

Results: Individuals completing the 6‐month program averaged a weight loss of 7.3% in men and 4.7% in women. Fasting lipids and blood glucose improved in both genders regardless of age. Outcomes including BMI and lipids improved in women regardless of menopausal status or hormone replacement therapy. There was a significant correlation between percentage weight loss and number of weekly counseling sessions attended and number of visits to the wellness center for exercise.

Discussion: Participants who complete a structured community‐based weight management program can achieve significant weight loss and improvement in cardiovascular risk factors regardless of age, gender, or menopausal status. Our analysis suggests that national treatment guidelines/recommendations for weight management can be effectively implemented in a community medical wellness center. The relatively high drop‐out rate associated with this program suggests the need to identify strategies and techniques to enhance adherence and completion of programs.
Age‐dependent Changes in Body Size of Greek Boys From 1982 to 2002
Authors: Magkos Faidon , Manios Yannis , Christakis George , Kafatos Anthony G.
Published: April 2008

Objective: The prevalence of childhood obesity has been rising during the past decades in many parts of the world, including Greece. The dispersion of these trends across age, however, is less clear. The aim of this study was to examine the relationship between age and 20‐year changes in anthropometric characteristics of Greek boys.

Research Methods and Procedures: A total of 204 and 106 boys 9 years old, 163 and 274 boys 12 years old, and 161 and 240 boys 15 years old were randomly recruited in 1982 and 2002, respectively, throughout the county of Iraklio, Crete, Greece. Height, weight, and BMI were measured.

Results: Contemporary 9 and 12 year olds were taller than their peers in 1982 (+2.9% and +1.2%, respectively; p < 0.005), but this was not the case for 15 year olds (−0.8%; p = 0.083). Body weight and BMI were higher now than in the 1980s, and this held true for all age groups (p < 0.001). Increases in weight also showed a decline with advancing age (+17.4%, +13.9%, and +4.0% for 9, 12, and 15 year olds, respectively), whereas BMI changes were similar for those 9 and 12 years of age (∼10.5%), but were almost 2‐fold higher than in 15 year olds (+5.5%).

Discussion: Contemporary boys are taller, heavier, and have higher BMI values than their peers in 1982, but the magnitude of these increases gradually declines with advancing age. Rates of increase in BMI, however, seem to have greatly accelerated compared with previous decades.
Racial and Ethnic Differences in Secular Trends for Childhood BMI, Weight, and Height
Authors: Freedman David S. , Khan Laura Kettel , Serdula Mary K. , Ogden Cynthia L. , Dietz William H.
Published: April 2008

Objectives: The prevalence of childhood overweight in the United States has markedly increased over the last 30 years. We examined differences in the secular trends for BMI, weight, and height among white, black, and Mexican‐American children.

Research Methods and Procedures: Analyses were based on nationally representative data collected from 2 to 17 year olds in four examinations (1971–1974 through 1999–2002).

Results: Overall, black children experienced much larger secular increases in BMI, weight, and height than did white children. For example, over the 30‐year period, the prevalence of overweight increased ∼3‐fold (4% to 13%) among 6‐ to 11‐year‐old white children but 5‐fold (4% to 20%) among black children. In most sex‐age groups, Mexican‐American children experienced increases in BMI and overweight that were between those experienced by blacks and whites. Race/ethnicity differences were less marked among 2 to 5 year olds, and in this age group, white children experienced the largest increase in overweight (from 4% to 9%). In 1999–2002, the prevalence of extreme BMI levels (≥99th percentile) reached 6% to 7% among black girls and Mexican‐American boys.

Discussion: Because of the strong tracking of childhood BMI levels into adulthood, it is likely that the secular increases in childhood overweight will greatly increase the burden of adult disease. The further development of obesity interventions in different racial/ethnic groups should be emphasized.
Serum Amyloid A: A Marker of Adiposity‐induced Low‐grade Inflammation but Not of Metabolic Status
Authors: Poitou Christine , Coussieu Christiane , Rouault Christine , Coupaye Muriel , Cancello Raffaella , Bedel Jean‐François , Gouillon Madeleine , Bouillot Jean‐Luc , Oppert Jean‐Michel , Basdevant Arnaud , Clément Karine
Published: April 2008

Objective: Adipocytes secrete a series of acute phase proteins including serum amyloid A (SAA); the link with metabolic status is unknown. We studied the variations of expression of the SAA gene in adipose and liver tissues and of SAA serum levels, as well as their relationships with metabolic features during weight loss.

Research Methods and Procedures: Plasmatic variations of SAA, inflammatory markers (high sensitivity C‐reactive protein, interleukin‐6, fibrinogen, and orosomucoid), and adipokines (adiponectin, leptin) were studied in 60 morbidly obese patients before and after gastric surgery. For 10 subjects, SAA mRNA expression was measured at baseline in subcutaneous white adipose tissue (scWAT) and visceral white adipose tissue (vWAT) and in the liver. The evolution of SAA mRNA expression was also studied after surgery in scWAT.

Results: SAA serum concentration displayed a significant reduction 3 months after surgery and remained stable beyond 6 months. mRNA expression of inducible SAA isoforms (SAA 1 and 2) in scWAT was higher than in vWAT (p = 0.01) and the liver (p < 0.01) and correlated significantly with BMI, SAA, and high sensitivity C‐reactive protein serum concentrations but not with metabolic markers (glucose, insulin, lipid parameters, adiponectin). SAA serum level and its variation during weight loss significantly correlated with adiposity markers (BMI and adipocyte volume, p < 0.01) and inflammatory markers but not with variations of metabolic parameters. The variations of SAA expression in scWAT after surgery correlated with changes in BMI and SAA protein serum levels (p < 0.05).

Discussion: SAA can be considered as a marker of adiposity‐induced low‐grade inflammation but not of the metabolic status of obese subjects.
Adiponectin, Visceral Fat, Oxidative Stress, and Early Macrovascular Disease: The Coronary Artery Risk Development in Young Adults Study
Authors: Steffes Michael W. , Gross Myron D. , Lee Duk‐Hee , Schreiner Pamela J. , Jacobs David R.
Published: April 2008

Objective: Adiponectin is a collagen‐like product of visceral fat that offers apparent protection against macrovascular disease. We evaluated the relationships of concentrations of adiponectin with oxidative stress and the major risk factors for and/or the presence of macrovascular disease.

Research Methods and Procedures: Adiponectin was measured by radioimmunoassay in serum from 3045 fasting participants (ages 33 to 45) of the Coronary Artery Risk Development in Young Adults Study. Cross‐sectional correlation of the concentrations of adiponectin with F2‐isoprostane concentrations (a marker of systemic oxidative damage), coronary artery calcification (CAC; an estimate of early macrovascular disease), and several macrovascular risk factors was analyzed.

Results: F2‐isoprostanes and CAC were unrelated to adiponectin after minimal adjustment for gender, race, and center. After additional adjustment for insulin resistance and waist circumference and other macrovascular risk factors, adiponectin correlated positively with high‐density lipoprotein‐cholesterol (p < 0.0001), F2‐isoprostanes (p < 0.0001), and CAC (less strongly, p < 0.01) and negatively with triglycerides (p < 0.0001) and C‐reactive protein (marking inflammation, p = 0.01).

Discussion: Although these data are consistent with reduced cardiovascular disease risk imparted by adiponectin, the higher circulating levels of adiponectin present with oxidative stress and CAC (adjusting for waist and insulin resistance) may indicate an enhanced adiponectin secretory response of adipose tissue to the metabolic environment present in the early development of macrovascular disease. Thus, the elevated levels of adiponectin may comprise an attempt to alleviate risk for additional development and progression of macrovascular disease in an at‐risk environment.
Visceral Fat Is an Independent Predictor of All‐cause Mortality in Men
Authors: Kuk Jennifer L. , Katzmarzyk Peter T. , Nichaman Milton Z. , Church Timothy S. , Blair Steven N. , Ross Robert
Published: April 2008

Objective: To examine the independent associations of abdominal fat (visceral and subcutaneous) and liver fat with all‐cause mortality.

Research Methods and Procedures: Participants included 291 men [97 decedents and 194 controls; mean age, 56.4 ± 12.0 (SD) years] who received a computed tomography (CT) examination at the preventive medicine clinic in Dallas, TX, between 1995 and 1999, with a mean mortality follow‐up of 2.2 ± 1.3 years. Abdominal fat was determined using contiguous CT images from the L3‐L4 to L4‐L5 intervertebral space. Liver fat was assessed using the CT‐determined liver attenuation value, which is inversely related to liver fat. Logistic regression was used to determine the independent association between the fat depots and all‐cause mortality.

Results: During the study, there were 97 deaths. Visceral fat [odds ratio (OR) per SD: 1.83; 95% CI: 1.23 to 2.73], abdominal subcutaneous fat (1.44; 1.02 to 2.03), liver fat (0.64; 0.46 to 0.87), and waist circumference (1.41; 1.01 to 1.98) were significant individual predictors of mortality after controlling for age and length of follow‐up. In a model including all three fat measures (subcutaneous, visceral, and liver fat), age, and length of follow‐up, only visceral fat (1.93; 1.15 to 3.23) was a significant predictor of mortality.

Discussion: Visceral fat is a strong, independent predictor of all‐cause mortality in men.
Prevalence of Obese Patients in a Primary Care Setting
Authors: Stecker Tracy , Sparks Shane
Published: April 2008

Objective: Previous research has addressed the relationship between BMI and chronic disease in primary care; however, little has been done with regard to the association between obesity and depression in primary care. The purpose of this paper is to assess the relationship between obesity and chronic conditions including depression.

Research Methods and Procedures: Data from primary care patients seen at a university‐based family medicine clinic in the southeastern United States were extracted for the time between January 1, 1999 and January 1, 2002. Data extracted included most recent height and weight, age, ethnicity, pregnancy status, number of office visits, blood pressure, cholesterol, hemoglobin A1C, current diagnoses, and medications.

Results: A total of 8197 patients were included in the analysis. Sixty‐nine percent of patients seen in a 3‐year period were either overweight or obese. Comparing blood pressure, cholesterol, diagnoses, and medications between BMI groups found differences in virtually all categories. Diagnoses of high cholesterol, hypertension, diabetes, and depression significantly increased for obese patients.

Discussion: Obese patients are over‐represented in primary care, and this over‐representation of obesity correlates with several diagnoses, including depression. Depression is a chronic disease that may interfere with health‐related behaviors and must be addressed within the health care system.
Effect of Gastric Bypass on Spontaneous Growth Hormone and Ghrelin Release Profiles
Authors: Mancini Marcio C. , Costa Ana P.A.C. , de Melo Maria Edna , Cercato Cintia , Giannella‐Neto Daniel , Garrido Arthur B. , Rosberg Sten , Albertsson‐Wikland Kerstin , Villares Sandra M.F. , Halpern Alfredo
Published: April 2008

Objective: The purpose of this study was to analyze growth hormone (GH) concentrations in obese women before and after Roux‐en‐Y gastric bypass (RYGBP) and how resulting changes in weight, fat mass, ghrelin levels, and insulin sensitivity affect GH secretion.

Research Methods and Procedures: Blood was sampled at 20‐minute intervals for 24 hours in 10 non‐diabetic premenopausal severely obese women before and 6 months after RYGBP. GH concentrations were measured in all samples, and serum ghrelin was collected at five time‐points.

Results: After a 27% BMI drop (55.9 ± 6.2 to 40.7 ± 5.8 kg/m2), blunted GH profiles underwent partial recovery. Basal, postprandial, and mean ghrelin concentrations were not changed. A negative correlation was found between mean GH levels and insulin and homeostasis model assessment (p < 0.01). BMI accounted for 54% of GH variation.

Discussion: Partial recovery of GH secretion after RYGBP‐induced weight loss suggests that a blunted secretion is not a causal factor of obesity but a consequence of the obese state and does not seem to be ghrelin‐level dependent.
Effect of Endothelin‐1 on Lipolysis in Rat Adipocytes
Authors: Juan Chi‐Chang , Chang Li‐Wei , Huang Seng‐Wong , Chang Chih‐Ling , Lee Ching‐Yin , Chien Yueh , Hsu Yung‐Pei , Ho Pei‐Hsuan , Chen Yu‐Ching , Ho Low‐Tone
Published: April 2008

Objective: To explore the role of endothelin‐1 (ET‐1) on lipid metabolism, we examined the effect of ET‐1 on lipolysis in rat adipocytes.

Research Methods and Procedure: Adipocytes isolated from male Sprague‐Dawley rats, weighing 400 to 450 grams, were incubated in Krebs‐Ringer buffer with or without 10−7 M ET‐1 for various times or with various concentrations of ET‐1 for 4 hours; then glycerol release into the incubation medium was measured. In addition, selective ETAR and ETBR blockers were used to identify the ET receptor subtype involved. We also explored the involvement of cyclic adenosine monophosphate (cAMP) in ET‐1‐stimulated lipolysis using an adenylyl cyclase inhibitor and by measuring changes in intracellular cAMP levels in response to ET‐1 treatment. To further explore the underlying mechanism of ET‐1 action, we examined the involvement of the extracellular signal‐regulated kinase (ERK)‐mediated pathways.

Results: Our results showed that ET‐1 caused lipolysis in rat adipocytes in a time‐ and dose‐dependent manner. BQ610, a selective ETAR blocker, blocked this effect. The adenylyl cyclase inhibitor, 2′, 5′‐dideoxyadenosine, had no effect on ET‐1‐stimulated lipolysis. ET‐1 did not induce an increase in intracellular cAMP levels. In addition, ET‐1‐induced lipolysis was blocked by inhibition of ERK activation using PD98059. Coincubation of cells with ET‐1 and insulin suppressed ET‐1‐stimulated lipolysis.

Discussion: These findings show that ET‐1 stimulates lipolysis in rat adipocytes through the ETAR and activation of the ERK pathway. The underlying mechanism is cAMP‐independent. However, this non‐conventional lipolytic effect of ET‐1 is inhibited by the anti‐lipolytic effect of insulin.
Hormonal and Metabolic Effects of Olanzapine and Clozapine Related to Body Weight in Rodents
Authors: Albaugh Vance L. , Henry Cathy R. , Bello Nicholas T. , Hajnal Andras , Lynch Susan L. , Halle Beth , Lynch Christopher J.
Published: April 2008

Objective: To characterize a model of atypical antipsychotic drug‐induced obesity and evaluate its mechanism.

Research Methods and Procedures: Chronically, olanzapine or clozapine was self‐administered via cookie dough to rodents (Sprague‐Dawley or Wistar rats; C57Bl/6J or A/J mice). Chronic studies measured food intake, body weight, adiponectin, active ghrelin, leptin, insulin, tissue wet weights, glucose, clinical chemistry endpoints, and brain dopaminergic D2 receptor density. Acute studies examined food intake, ghrelin, leptin, and glucose tolerance.

Results: Olanzapine (1 to 8 mg/kg), but not clozapine, increased body weight in female rats only. Weight changes were detectable within 2 to 3 days and were associated with hyperphagia starting ∼24 hours after the first dose. Chronic administration (12 to 29 days) led to adiposity, hyperleptinemia, and mild insulin resistance; no lipid abnormalities or changes in D2 receptor density were observed. Topiramate, which has reversed weight gain from atypical antipsychotics in humans, attenuated weight gain in rats. Acutely, olanzapine, but not clozapine, lowered plasma glucose and leptin. Increases in glucose, insulin, and leptin following a glucose challenge were also blunted.

Discussion: A model of olanzapine‐induced obesity was characterized which shares characteristics of patients with atypical antipsychotic drug‐induced obesity; these characteristics include hyperphagia, hyperleptinemia, insulin resistance, and weight gain attenuation by topiramate. This model may be a useful and inexpensive model of uncomplicated obesity amenable to rapid screening of weight loss drugs. Olanzapine‐induced weight gain may be secondary to hyperphagia associated with acute lowering of plasma glucose and leptin, as well as the inability to increase plasma glucose and leptin following a glucose challenge.
Comparison of Bioelectrical Impedance and BMI in Predicting Obesity‐Related Medical Conditions
Authors: Willett Kamali , Jiang Rui , Lenart Elizabeth , Spiegelman Donna , Willett Walter
Published: April 2008

Objective: To determine the relative validity of specific bioelectrical impedance analysis (BIA) prediction equations and BMI as predictors of physiologically relevant general adiposity.

Research Methods and Procedures: Subjects were >12, 000 men and women from the Third National Health and Nutrition Examination Survey population. We examined the correlations between BMI and percentage body fat based on 51 different predictive equations, blood pressure, and blood levels of glucose, high‐density lipoprotein cholesterol, and triglycerides, which are known to reflect adiposity, while controlling for other determinants of these physiological measures.

Results: BMI consistently had one of the highest correlations across biological markers, and no BIA‐based measure was superior. Percent body fat estimated from BIA was minimally predictive of the physiological markers independent of BMI.

Discussion: These results suggest that BIA is not superior to BMI as a predictor of overall adiposity in a general population.
Rapid Infant Weight Gain Predicts Childhood Overweight
Authors: Dennison Barbara A. , Edmunds Lynn S. , Stratton Howard H. , Pruzek Robert M.
Published: April 2008

Objective: To determine among a contemporary cohort whether rapid weight gain between birth and 6 months is associated with risk of childhood overweight and if this risk differs by ethnicity and/or breast‐feeding history.

Research Methods and Procedures: This was a cross‐sectional survey in 1999 to 2000 of parents/guardians of children participating in the Special Supplemental Nutrition Program for Women, Infants, and Children in New York State. Measurements were abstracted by chart review, including weight at birth and 6 months, and height and weight at time of survey and every 6 months subsequently. Overweight at 4 years of age was defined as a BMI ≥ 95th age‐ and sex‐specific percentiles.

Results: The study sample was 32% Hispanic, 19% black, and 49% white; 17% of children were overweight. Rate of infant weight gain (expressed in terms of 100 g/mo) was significantly associated with being overweight at 4 years (odds ratio, 1.4; 95% confidence interval, 1.3 to 1.6 after adjusting for history of breast‐feeding, birth weight, and ethnicity). The odds of being overweight at 4 years of age for Hispanic children were twice those of non‐Hispanic children (odds ratio, 2.2; 95% confidence interval, 1.5 to 3.3). The population‐attributable risk of overweight at 4 years of age was 19% for children in the highest quintile of infant weight gain.

Discussion: Among this contemporary, multi‐ethnic cohort, rapid infant weight gain was associated with increased risk of being overweight at 4 years of age, independently of potential confounders. Identification of the risk factors contributing to rapid weight gain during infancy might improve early recognition and guide strategies for optimal nutrition to prevent the development of childhood overweight.
The Human Obesity Gene Map: The 2005 Update
Authors: Rankinen Tuomo , Zuberi Aamir , Chagnon Yvon C. , Weisnagel S. John , Argyropoulos George , Walts Brandon , Pérusse Louis , Bouchard Claude
Published: April 2008

This paper presents the 12th update of the human obesity gene map, which incorporates published results up to the end of October 2005. Evidence from single‐gene mutation obesity cases, Mendelian disorders exhibiting obesity as a clinical feature, transgenic and knockout murine models relevant to obesity, quantitative trait loci (QTL) from animal cross‐breeding experiments, association studies with candidate genes, and linkages from genome scans is reviewed. As of October 2005, 176 human obesity cases due to single‐gene mutations in 11 different genes have been reported, 50 loci related to Mendelian syndromes relevant to human obesity have been mapped to a genomic region, and causal genes or strong candidates have been identified for most of these syndromes. There are 244 genes that, when mutated or expressed as transgenes in the mouse, result in phenotypes that affect body weight and adiposity. The number of QTLs reported from animal models currently reaches 408. The number of human obesity QTLs derived from genome scans continues to grow, and we now have 253 QTLs for obesity‐related phenotypes from 61 genome‐wide scans. A total of 52 genomic regions harbor QTLs supported by two or more studies. The number of studies reporting associations between DNA sequence variation in specific genes and obesity phenotypes has also increased considerably, with 426 findings of positive associations with 127 candidate genes. A promising observation is that 22 genes are each supported by at least five positive studies. The obesity gene map shows putative loci on all chromosomes except Y. The electronic version of the map with links to useful publications and relevant sites can be found athttp:obesitygene.pbrc.edu
Temperature Dependence of O2 Consumption; Opposite Effects of Leptin and Etomoxir on Respiratory Quotient in Mice
Authors: Högberg Helena , Engblom Lars , Ekdahl Åsa , Lidell Veronica , Walum Erik , Alberts Pēteris
Published: April 2008

Objectives: The aims were to compare the temperature dependence of the metabolic rate in young ob/ob mice with that in mature ob/ob and db/db mice and to examine the effect on the metabolic substrate preference of leptin and etomoxir in ob/ob, C57BL/6J (wild‐type), and db/db mice.

Research Methods and Procedures: In vivo oxygen consumption and carbon dioxide production were continuously measured by indirect calorimetry, and body temperature and total locomotor activity were measured by an implanted transponder. Leptin, etomoxir, or vehicle was administered intraperitoneally.

Results: The temperature dependence of the metabolic rate of mature ob/ob and db/db mice were similar to that in wild‐type mice. In young 6‐week‐old ob/ob mice, the metabolic rate was almost doubled at 15 °C. Leptin (2 × 3 mg/kg) decreased the respiratory quotient (RQ) and carbon dioxide production but did not alter oxygen consumption, body temperature, or locomotor activity in ob/ob and C57BL/6J mice and had no effect in the db/db mice. Etomoxir (2 × 30 mg/kg) enhanced RQ and decreased oxygen consumption, carbon dioxide production, and body temperature in ob/ob, C57BL/6J, and db/db mice. Total locomotor activity was reduced in ob/ob and C57BL/6J mice.

Discussion: In young ob/ob mice, the temperature sensitivity was enhanced compared with mature mice. Leptin and etomoxir had opposite effects on metabolic substrate preference. Leptin and lowered environmental temperature increased the relative fat oxidation as indicated by decreased RQ, possibly through activation of the sympathetic nervous system.
Weekly Changes in Basal Metabolic Rate with Eight Weeks of Overfeeding
Authors: Harris Ann M. , Jensen Michael D. , Levine James A.
Published: April 2008

Objective: The contribution of basal metabolic rate (BMR) to weight gain susceptibility has long been debated. We wanted to examine whether BMR changes in a linear fashion with overfeeding. Our hypothesis was that BMR does not increase linearly with 1000‐kcal/d overfeeding in lean healthy subjects over 8 weeks. The null hypothesis states that BMR increases linearly with 1000‐kcal/d overfeeding in lean healthy subjects.

Research Methods and Procedures: Initially, 16 lean healthy sedentary subjects completed 2 weeks of weight maintenance feeding at the General Clinical Research Center. The subjects were then overfed by 1000 kcal/d over 8 weeks. BMR was measured under standard conditions each week using indirect calorimetry.

Results: Baseline BMR was 1693 ± 154.5 kcal/d. BMR increased from 1711 ± 201.3 kcal/d at week 1 of overfeeding to 1781 ± 171.65 kcal/d at the second week of overfeeding (p = 0.05). BMR fell during the third week of overfeeding to 1729 ± 179.5 kcal/d (p = 0.05). After 5 weeks of overfeeding, BMR reached a plateau. Thereafter, there was no further change. Comparison of BMR with weeks of overfeeding was significantly different compared with the linear model (p < 0.05).

Discussion: Increases in BMR in lean sedentary healthy subjects with 1000‐kcal/d overfeeding are not linear over 8 weeks. There seems to be a short‐term increase in BMR in the first 2 weeks of overfeeding that is not representative of longer‐term changes.
Value of Heartburn for Diagnosing Gastroesophageal Reflux Disease in Severely Obese Patients
Authors: Ortiz Vicente , Ponce Marta , Fernández Alberto , Martínez Beatriz , Ponce Jose Luis , Garrigues Vicente , Ponce Julio
Published: April 2008

Objective: To evaluate the prevalence of gastroesophageal reflux disease (GERD) in severely obese patients and the association between symptoms and objective data of GERD in this population.

Research Methods and Procedures: A total of 158 consecutive severely obese patients (BMI ≥ 40 kg/m2) were prospectively evaluated. Symptoms were evaluated by a structured clinical questionnaire. Objective assessment was made by ambulatory 24‐hour esophageal pH monitoring and endoscopy. GERD was defined by the presence of symptoms or complications (esophagitis). The clinical criterion defining GERD was the presence of at least two episodes of heartburn per week.

Results: The mean age of the 138 patients subjected to complete study was 42.6 ± 10.2 years, with a BMI of 50.1 ± 6.9 kg/m2 (range, 40.6 to 69.4 kg/m2); 78% were women. The prevalence of GERD evaluated by symptoms and/or esophagitis was 33.3% (46/138). Clinical criteria of GERD were present in 31/138 cases (22.5%), and 26 (18.8%) had esophagitis. In 69/138 patients (50%), pHmetry was abnormal. Fifty‐three patients with esophagitis and/or abnormal pHmetry were asymptomatic. The sensitivity of heartburn as a diagnostic criterion of GERD in patients with severe obesity was 29.3%, with a specificity of 85.7%. No significant association was observed between severe obesity grade and the prevalence of symptoms and/or objective data.

Discussion: Asymptomatic gastroesophageal reflux (abnormal esophageal acid exposure and/or reflux esophagitis) is more common than symptomatic gastroesophageal reflux in severely obese patients. Increased BMI is not associated with a greater prevalence of GERD in these patients.
Are the Eating and Exercise Habits of Successful Weight Losers Changing?
Authors: Phelan Suzanne , Wyatt Holly R. , Hill James O. , Wing Rena R.
Published: April 2008

Objective: The purpose of this study was to examine whether the diet and exercise behaviors of successful weight losers entering the National Weight Control Registry (NWCR) have changed between 1995 and 2003.

Research Method and Procedures: Participants (N = 2708) were members of the NWCR who enrolled in intermittent years since 1995. Participants had lost an average of 33.1 kg and maintained a 13.6‐kg loss for 5.8 years before enrollment. Evaluations of diet and physical activity were conducted at entry into the NWCR and prospectively over 1 year.

Results: From 1995 to 2003, the daily percentage of calories from fat increased from 23.8% to 29.4%, saturated fat intake increased from 12.3 to 154.0 g/d, and calories from carbohydrate decreased from 56.0% to 49.3% (p < 0.0001). The proportion consuming <90 grams of carbohydrate (considered a low‐carbohydrate diet) increased from 5.9% to 17.1% (p = 0.0001). Physical activity was elevated in 1995 (mean = 3316 kcal/wk) but comparable in all other years (mean = 2620 kcal/wk). Stepwise regression collapsing across cohorts indicated that weight regain over 1 year was related to higher levels of caloric intake, fast food consumption, and fat intake and lower levels of physical activity (p < 0.03).

Discussion: The macronutrient composition of the diet of NWCR members has shifted over the past decade. Still, only a minority consumes a low‐carbohydrate diet. Despite changes in the diet over time, the variables associated with long‐term maintenance of weight loss were the same: continued consumption of a low‐calorie diet with moderate fat intake, limited fast food, and high levels of physical activity.
Waist Circumference Correlates with Metabolic Syndrome Indicators Better Than Percentage Fat
Authors: Shen Wei , Punyanitya Mark , Chen Jun , Gallagher Dympna , Albu Jeanine , Pi‐Sunyer Xavier , Lewis Cora E. , Grunfeld Carl , Heshka Stanley , Heymsfield Steven B.
Published: April 2008

Objective: Percent fat is often considered the reference for establishing the magnitude of adipose tissue accumulation and the risk of excess adiposity. However, the increasing recognition of a strong link between central adiposity and metabolic disturbances led us to test whether waist circumference (WC) is more highly correlated with metabolic syndrome components than percent fat and other related anthropometric measures such as BMI.

Research Methods and Procedures: BMI, WC, and percent fat, measured by DXA, were evaluated in 1010 healthy white and African‐American men and women [age, 48.3 ± 17.2 (standard deviation) years; BMI, 27.0 ± 5.3 kg/m2]. The associations of BMI, WC, and percent fat with age and laboratory‐adjusted health risk indicators (i.e., serum glucose, insulin, triglycerides, high‐density lipoprotein cholesterol, blood pressure) in each sex and ethnicity group were examined.

Results: For 18 of 24 comparisons, the age‐ and laboratory‐adjusted correlations were lowest for percent fat and in 16 of 24 comparisons were highest for WC. Fifteen of the between‐method differences reached statistical significance. With health risk indicator as the dependent variable and anthropometric measures as the independent variable, the contribution of percent fat to the WC regression model was not statistically significant; in contrast, adding WC to the percent fat regression model did make a significant independent contribution for most health risk indicators.

Discussion: WC had the strongest associations with health risk indicators, followed by BMI. Although percent fat is a useful measure of overall adiposity, health risks are best represented by the simply measured WC.
Association of Glucocorticoid Receptor Polymorphism A3669G in Exon 9β with Reduced Central Adiposity in Women
Authors: Syed Akheel A. , Irving Julie A. E. , Redfern Christopher P. F. , Hall Andrew G. , Unwin Nigel C. , White Martin , Bhopal Raj S. , Weaver Jolanta U.
Published: April 2008

The glucocorticoid receptor (GR) may be a common link between human obesity/metabolic syndrome and Cushing's syndrome. The effects of glucocorticoids are mediated through the functional isoform, GRα. An alternative isoform, GRβ, behaves as a dominant negative inhibitor of GRα and has been implicated as a contributing factor to glucocorticoid resistance. A naturally occurring ATTTA to GTTTA single nucleotide polymorphism (A3669G) located in the 3′ end of exon 9β results in increased stability of GRβ mRNA and increased GRβ protein expression. Enhanced GRβ expression may result in greater inhibition of GRα transcriptional activity, resulting in glucocorticoid insensitivity. To test the hypothesis that the 3669G allele would result in a phenotype less likely to express features of glucocorticoid excess, we studied the prevalence of this polymorphism and its relationship with obesity and features of the metabolic syndrome in 322 Europid and 262 South‐Asian subjects in northeast England. We report evidence that 3669G allele is associated with reduced central obesity in Europid women and a more favorable lipid profile in Europid men. These data suggest that the 3669G allele may attenuate the undesirable effects of glucocorticoids on fat distribution and lipid metabolism, although its penetrance may vary in different ethnic groups.
Prevalence of Overweight and Obesity in 2‐ to 6‐year‐old Italian Children
Authors: Maffeis Claudio , Consolaro Alessandro , Cavarzere Paolo , Chini Lorenza , Banzato Claudia , Grezzani Alessandra , Silvagni Davide , Salzano Giuseppina , De Luca Filippo , Tatò Luciano
Published: April 2008

Objective: To assess the prevalence of overweight and obesity in 2‐ to 6‐year‐old Italian children and to compare the prevalence between the north and the south of the country.

Research Methods and Procedures: This was a cross‐sectional study of 2150 subjects (M/F: 1137/1013), 5.36 ± 0.83 years of age. The sampling areas were Verona (north Italy) and Messina (south Italy). We used definitions of overweight and obesity using BMI values, with cut‐off values proposed by the International Obesity Task Force.

Results: The prevalence of overweight was 16.6% (males: 13.9%, females: 19.6%), and it was higher in the south (males: 17.8%, females: 22.4%) than in the north (males: 11.3%, females: 17.9%). The prevalence of obesity was 8.0% (males: 8.3%, females: 7.7%), and it was higher in the south (males: 12.3%, females: 10.7%) than in the north (males: 5.7%, females: 5.8%). Using the Centers for Disease Control reference charts, the prevalence of overweight and obesity of Italian children was close to that reported in children living in the United States (32% vs. 32.7%, respectively).

Discussion: The prevalence of overweight and obesity in young Italian children is very high, and it is rapidly growing. In the south of the country, the prevalence is higher than in the north.
Obesity as an Obstetric Risk Factor: Does It Matter in a Perinatal Center?
Authors: Stepan Holger , Scheithauer Susann , Dornhöfer Nadja , Krämer Thomas , Faber Renaldo
Published: April 2008

Objectives: Obesity before and during pregnancy is associated with several obstetrics risk factors for both mother and fetus. The aim of this retrospective study was to analyze the influence of BMI before pregnancy on distinct perinatal parameters.

Research Methods and Procedures: The study includes 5067 singleton pregnancies from 2001 to 2004 at the Department of Obstetrics and Gynecology, University of Leipzig. The study group was divided into BMI groups: <18.5, ≥18.5 to <25, ≥25 to <30, ≥30 to <35, ≥35 to <40, and ≥40 kg/m2. Analysis of perinatal data included rate of intrauterine death, rate of cesarean section and shoulder dystocia, time of hospital stay for mother and newborn, and gestational age of delivery. Neonatal outcome variables included percentage of newborns weighing >4000 grams, rate of umbilical cord pH <7.10, and rate of 1‐, 5‐, and 10‐minute Apgar scores of <8.

Results: There was no difference in the gestational age at delivery among the groups. In the group with BMI ≥30 kg/m2, the cesarean section rate was significantly elevated to 25.1%, with a more dramatic increase up to 30.2% in the group with BMI ≥35 kg/m2 and 43.1% in the group with BMI ≥40 kg/m2, mainly because of a higher number of secondary cesarean sections. Although newborns of obese women showed worse initial neonatal adaptation, the 10‐minute Apgar values did not differ among the groups. The higher rate of operative deliveries and the trend to an increased rate of shoulder dystocia did not influence duration of the hospital stay for mothers and newborns or morbidity of both.

Discussion: A high pre‐pregnancy BMI is clearly associated with a higher rate of cesarean section deliveries. However, under the compensating conditions of a tertiary perinatal center, overall morbidity of mothers and newborns seems not to be increased.
Moderate‐to‐Vigorous Physical Activity among Children: Discrepancies in Accelerometry‐Based Cut‐off Points
Authors: Guinhouya Comlavi B. , Hubert Hervé , Soubrier Stéphane , Vilhelm Christian , Lemdani Mohamed , Durocher Alain
Published: April 2008

Objective: To highlight the discrepancies in accelerometry cut‐off points of moderate‐to‐vigorous physical activity (MVPA) according to the definitions of Puyau et al. (MVPAP) and Trost et al. (MVPAT).

Research Methods and Procedures: Forty‐five children from 8 to 11 years old were monitored with the ActiGraph (ActiGraph, LLC, Fort Walton Beach, FL) for 3 consecutive days. Daily time spent at MVPA obtained with MVPAP was compared with that obtained with MVPAT using variability, regression, and agreement statistics. Data were then discussed with regard to physical activity recommendations.

Results: The mean daily time spent at MVPAP (28 ± 18 minutes) was significantly lower (p < 10−4) than that spent at MVPAT (141 ± 39 minutes). The coefficient of determination between the two definitions was low (R2 = 0.49 ± 0.71). There was a lack of agreement between the two definitions, with a mean error or bias of 113 min/d. Thirty‐four point eight percent and 100% of children underwent 30‐minute MVPA/d with MVPAP and MVPAT definitions, respectively.

Discussion: Comparability between studies devoted to describing children's physical activity or to assessing interventions may lack consistency according to the definition, with a real risk of misclassification.