bluuebunny/crossref_metadata_2025 huggingface dataset:
Visceral Adipose Tissue and Markers of the Insulin Resistance Syndrome in Obese Black and White Teenagers
Authors: Owens Scott , Gutin Bernard , Barbeau Paule , Litaker Mark , Allison Jerry , Humphries Matthew , Okuyama Tomoki , Le Ngoc‐Anh
Published: April 2008

Objective: To determine the relationships between visceral and general adiposity, cardiovascular fitness, and markers of the insulin resistance syndrome in obese black and white teenagers.

Research Methods and Procedures: Cross‐sectional survey of 81 obese 13‐ to 16‐year‐old youths. Visceral adipose tissue was measured with magnetic resonance imaging, and percentage body fat was measured with dual‐energy X‐ray absorptiometry. Cardiovascular fitness was assessed with a submaximal treadmill test. Fasting blood samples were analyzed for lipids/lipoproteins and insulin. Resting blood pressure was obtained using an automated cuff.

Results: Visceral adipose tissue was significantly correlated with unfavorable levels of: triacylglycerol (r = 0.27, p < 0.05), total cholesterol (r = 0.27, p < 0.05), high‐density lipoprotein cholesterol (r = −0.26, p < 0.05), the ratio of total cholesterol/high‐density lipoprotein cholesterol (r = 0.42, p < 0.01), low‐density lipoprotein cholesterol (r = 0.27, p < 0.05), apolipoprotein B (r = 0.38, p < 0.01), and systolic blood pressure (r = 0.30, p < 0.01). Multiple regression analyses revealed that visceral adipose tissue was more powerful than percentage body fat for explaining variance in lipoproteins (e.g., for the ratio of total cholesterol/high‐density lipoprotein cholesterol, r2 = 0.13, p < 0.01, and for systolic blood pressure, r2 = 0.07, p < 0.05). Ethnicity was the most powerful of the demographic predictors for blood lipids (r2 = 0.15 for triacylglycerol with lower levels in blacks; r2 = 0.10 for high‐density lipoprotein cholesterol with higher levels in blacks; r2 = 0.06 for the ratio of total cholesterol/high‐density lipoprotein cholesterol with lower levels in blacks). Cardiovascular fitness was not retained as a significant predictor of markers of the insulin resistance syndrome.

Discussion: Some of the deleterious relationships between visceral adiposity and markers for the insulin resistance syndrome seen in adults were already present in these obese young people.
Effects of Sibutramine Plus Orlistat in Obese Women Following 1 Year of Treatment by Sibutramine Alone: A Placebo‐Controlled Trial
Authors: Wadden Thomas A. , Berkowitz Robert I. , Womble Leslie G. , Sarwer David B. , Arnold Marjorie E. , Steinberg Carrie M.
Published: April 2008

Objective: This study assessed whether adding orlistat to sibutramine would induce further weight loss in patients who previously had lost weight while taking sibutramine alone.

Research Methods and Procedures: Patients were 34 women with a mean age of 44.1 ± 10.4 years, weight of 89.4 ± 13.8 kg, and body mass index (BMI) of 33.9 ± 4.9 kg/m2 who had lost an average of 11.6 ± 9.2% of initial weight during the prior 1 year of treatment by sibutramine combined with lifestyle modification. Patients were randomly assigned, in double‐blind fashion, to sibutramine plus orlistat or sibutramine plus placebo. In addition to medication, participants were provided five brief lifestyle modification visits during the 16‐week continuation trial.

Results: Mean body weight did not change significantly in either treatment condition during the 16 weeks. The addition of orlistat to sibutramine did not induce further weight loss as compared with treatment by sibutramine alone (mean changes = +0.1 ± 4.1 kg vs. +0.5 ± 2.1 kg, respectively).

Discussion: These results must be interpreted with caution because of the study's small sample size. The findings, however, suggest that the combination of sibutramine and orlistat is unlikely to have additive effects that will yield mean losses ≥15% of initial weight, as desired by many obese individuals.
Differential Expression of Leptin Receptor in High‐ and Low‐Fat‐Fed Osborne‐Mendel and S5B/Pl Rats
Authors: Madiehe Abram M. , Schaffhauser Andrea O. , Braymer Douglas H. , Bray George A. , York David A.
Published: April 2008

Objective: The regulation of body weight and body composition involves input from genes and the environment. This interaction is demonstrated by the different susceptibility of Osborne‐Mendel (OM) and S5B/P1 rat strains to obesity when offered a high‐fat diet. In animals and humans, diet‐induced obesity has been characterized by hyperleptinemia, which has been interpreted as evidence for leptin resistance. This investigation determined if altered expression of leptin receptors (ObR) in the hypothalamus could potentially contribute to altered sensitivity to diet‐induced obesity between OM and S5B/Pl rats.

Research Methods and Procedures: OM and S5B/Pl rats were fed high‐fat (HF) or low‐fat (LF) diets for 14 days. Ribonuclease protection assays and Western blotting were used to assay the levels of mRNA and protein, respectively, for short (ObR‐S) and long (ObR‐L) forms of the leptin receptor in the hypothalamus.

Results: The mRNA encoding ObR‐L, the predominant signaling form of the receptor, was higher in OM rats than in S5B/P1 rats (p < 0.01) both on HF and LF diets. No changes in ObR‐L mRNA expression were observed in OM rats with diet, but, S5B/P1 rats showed a slight increase in the ObR‐L on the LF diet. On the contrary, there were no changes in ObR‐S mRNA expression due to diet or strain. Western blots showed that both the short and long forms of the receptor were increased on the LF diet, but there were no strain differences. OM and S5B/Pl rats had comparable leptin levels after maintenance on a LF diet (6.20 ± 0.63 and 4.81 ± 0.82 ng/mL, respectively). Serum leptin levels in OM rats were increased by the HF diet and were elevated 2‐fold over those of their S5B/Pl counterparts.

Discussion: These results suggest that a decrease in the levels of both the long form and short form of the receptor may contribute to the leptin resistance seen in HF‐fed rats. These effects appear to be post‐transcriptional, because equivalent changes were not observed in the expression of ObR‐L and ObR‐S mRNAs. They may be related to the increase in circulating leptin levels, suggesting that high serum leptin levels contribute to increased leptin resistance and subsequently lead to obesity. We conclude that down‐regulation of receptor protein levels is associated with hypothalamic leptin resistance of HF‐fed rats.
Associations of Fat Distribution and Obesity with Hypertension in a Bi‐ethnic Population: The ARIC Study
Authors: Harris Margaret M. , Stevens June , Thomas Neal , Schreiner Pam , Folsom Aaron R.
Published: April 2008

Objective: To examine associations of hypertension with obesity and fat distribution among African American and white men and women.

Research Methods and Procedures: The analysis sample included 15,063 African American and white men and women between the ages of 45 and 64 years who were participants in the 1987 through 1989 examination of the Atherosclerosis Risk in Communities Study (ARIC). Odds ratios and adjusted prevalences of hypertension were calculated across sexspecific quintiles of body mass index (BMI), waist‐to‐hip ratio (WHR), waist circumference, and waist‐to‐height ratio (waist/height) and adjusted for age, research center, smoking, education, physical activity, alcohol consumption, hormone replacement therapy, and menopausal status.

Results: The prevalence of hypertension was higher among African Americans than whites. In the lowest quintile of BMI, 41% of African American women and 43% of African American men had hypertension compared with 14% of white women and 19% of white men. Elevated BMI, WHR, waist circumference, and waist/height were associated with increased odds of hypertension in African American and white men and women. In women, but not in men, there were significant interactions between ethnicity and the anthropometric variables studied here. The direction of the interaction indicated larger odds ratios for hypertension with increasing levels of anthropometric indices in white compared with African American women.

Discussion: Obesity and abdominal fat preponderance were associated with increased prevalence of hypertension in African American and white men and women. Associations were similar among African American and white men, but obesity and fat patterning were less strongly associated with hypertension in African American than in white women.
Relationship Between Birth Weight and Body Composition, Energy Metabolism, and Sympathetic Nervous System Activity Later in Life
Authors: Weyer Christian , Pratley Richard E. , Lindsay Robert S. , Tataranni P. Antonio
Published: April 2008

Objective: Epidemiological studies suggest that high birth weight might be associated with an increased risk of obesity later in life. Programming of metabolic, endocrine, and/or autonomic pathways during intrauterine development has been proposed to explain this association.

Research Methods and Procedures: To determine the relationship between birth weight and body composition and energy metabolism later in life, we measured fat mass and fat‐free mass (hydrodensitometry or double‐energy X‐ray absorptiometry), 24‐hour energy expenditure, sleeping metabolic rate, and 24‐hour respiratory quotient (respiratory chamber) in 272 adult nondiabetic Pima Indians (161 males/111 females, age 25 ± 5 years, mean ± SD). In these subjects, birth weight varied over a wide range (2000 to 5000 g). Individuals known to be offspring of diabetic pregnancies were excluded. In 44 of the 272 subjects, muscle sympathetic nerve activity was assessed by microneurography.

Results: Birth weight was positively correlated with adult height (r = 0.20, p < 0.001) and fat‐free mass (r = 0.21, p < 0.001), but not with fat mass (r = 0.01, not significant). Sleeping metabolic rate, adjusted for age, sex, fat‐free mass, and fat mass, was negatively related to birth weight (r = −0.13, p < 0.05), whereas adjusted 24‐hour energy expenditure (r = 0.07, not significant) and 24‐hour respiratory quotient (r = −0.09, not significant) were not. There was no relationship between birth weight and muscle sympathetic nerve activity (r = 0.12, not significant, n = 44).

Discussion: In Pima Indians who are not offspring of diabetic pregnancies, high birth weight is associated with increased height and lean body mass, but not with increased adiposity later in life. Although high birth weight may be associated with relatively low resting energy expenditure, it is not associated with major abnormalities in 24‐hour energy metabolism or with low muscle sympathetic nerve activity later in life.
Comparison of Verbal and Pictorial Measures of Hunger During Fasting in Normal Weight and Obese Subjects
Authors: Lowe Michael R. , Friedman Mark I. , Mattes Rick , Kopyt Diana , Gayda Christine
Published: April 2008

Objective: Friedman, Ulrich, and Mattes described a new pictorial instrument for assessing hunger wherein respondents outline areas on a drawing of a human figure to depict the location of their hunger sensations. The present study compared normal weight and obese individuals on the pictorial measure and on more traditional verbal hunger measures during a 22‐hour fast.

Research Methods and Procedures: The pictorial measure, along with 13 verbal items assessing hunger and hunger‐related symptoms, was administered to 29 normal weight college students and 46 overweight clinic patients four times during a 22‐hour fast. Factor analyses of verbal hunger items produced Hunger, Somatic Symptoms, and Stomach Symptoms factors. The pictorial measure was divided into peripheral (arms, legs, head) and central (trunk) body areas.

Results: The increases in hunger during the fast were greater when measured using the pictorial as opposed to the verbal instrument. Correlations between and within the three verbal hunger measures and two pictorial measures were generally few in number and modest in size. The overall pattern of correlations suggested that the verbally based hunger measures more adequately reflected the experience of hunger in normal weight than in obese individuals. A significant interaction between weight status and assessment period was found for the pictorial measure, indicating that normal weight subjects experienced more bodily hunger than overweight subjects initially but experienced less hunger than obese subjects after a prolonged period of food deprivation.

Discussion: Although more testing is needed, these results suggest that the pictorial hunger assessment provides information about the experience of hunger that could complement information provided by traditional verbally based hunger measures.
Body Mass Index and the Prevalence of Hypertension and Dyslipidemia
Authors: Brown Clarice D. , Higgins Millicent , Donato Karen A. , Rohde Frederick C. , Garrison Robert , Obarzanek Eva , Ernst Nancy D. , Horan Michael
Published: April 2008

Objective: To describe and evaluate relationships between body mass index (BMI) and blood pressure, cholesterol, high‐density lipoprotein‐cholesterol (HDL‐C), and hypertension and dyslipidemia.

Research Methods and Procedures: A national survey of adults in the United States that included measurement of height, weight, blood pressure, and lipids (National Health and Nutrition Examination Survey III 1988–1994). Crude age‐adjusted, age‐specific means and proportions, and multivariate odds ratios that quantify the association between hypertension or dyslipidemia and BMI, controlling for race/ethnicity, education, and smoking habits are presented.

Results: More than one‐half of the adult population is overweight (BMI of 25 to 29.9) or obese (BMI of ≥30). The prevalence of high blood pressure and mean levels of systolic and diastolic blood pressure increased as BMI increased at ages younger than 60 years. The prevalence of high blood cholesterol and mean levels of cholesterol were higher at BMI levels over 25 rather than below 25 but did not increase consistently with increasing BMI above 25. Rates of low HDL‐C increased and mean levels of HDL‐C decreased as levels of BMI increased. The associations of BMI with high blood pressure and abnormal lipids were statistically significant after controlling for age, race or ethnicity, education, and smoking; odds ratios were highest at ages 20 to 39 but most trends were apparent at older ages. Within BMI categories, hypertension was more prevalent and HDL‐C levels were higher in black than white or Mexican American men and women.

Discussion: These data quantify the strong associations of BMI with hypertension and abnormal lipids. They are consistent with the national emphasis on prevention and control of overweight and obesity and indicate that blood pressure and cholesterol measurement and control are especially important for overweight and obese people.
Differences in Body Fat and Central Adiposity between Swedes and European Immigrants: The Malmö Diet and Cancer Study
Authors: Lahmann Petra H. , Lissner Lauren , Gullberg Bo , Berglund Göran
Published: April 2008

Objective: Comparative data on ecological differences in body fatness and fat distribution within Europe are sparse. Migration studies may provide information on the impact of environmental factors on body size in different populations. The objective was to investigate differences in adiposity between European immigrants and native Swedes, specifically to examine gender differences and the effect of time since immigration, and to compare two selected immigrant groups with their native countrymen.

Research Methods and Procedures: A cross‐sectional analysis of 27,808 adults aged 45 to 73 years participating in the Malmö Diet and Cancer prospective cohort study in Sweden was performed. Percentage body fat (impedance analysis) and waist‐hip ratio (WHR) were compared between Swedish‐born and foreign‐born participants.

Results: Obesity was 40% more prevalent in non‐Swedish Europeans compared with Swedes. Controlling for age, height, smoking, physical activity, and occupation, it was found that women born in the former Yugoslavia, southern Europe, Hungary, and Finland had a significantly higher percentage of body fat, and those from Hungary, Poland, and Germany had more centralized adiposity compared with Swedish women. Men born in the former Yugoslavia, Hungary, and Denmark had a significantly higher mean percentage of body fat compared with Swedish‐born men, whereas Yugoslavian, Finnish, and German men differed significantly in mean WHR. Length of residence in Sweden was inversely associated with central adiposity in immigrants. A comparison between German and Danish immigrants, their respective native populations, and Swedes indicated an intermediate positioning of German immigrants with regard to body mass index and WHR.

Discussion: Differences in general and central adiposity by country of origin appear to remain after migration. Central adiposity seems to be more influenced than fatness per se by time of residency in Sweden.
Topiramate Reduces Energy and Fat Gains in Lean (Fa/?) and Obese (fa/fa) Zucker Rats
Authors: Picard Frédéric , Deshaies Yves , Lalonde Josée , Samson Pierre , Richard Denis
Published: April 2008

Objective:This study examined the effects of topiramate (TPM), a novel neurotherapeutic agent reported to reduce body weight in humans, on the components of energy balance in female Zucker rats.

Research Methods and Procedures:A 2 × 3 factorial experiment was performed in which two cohorts of Zucker rats differing in their phenotype (phenotype: lean,Fa/?; obese,fa/fa) were each divided into three groups defined by the dose of TPM administered (dose: TPM 0, vehicle; TPM 15, 15 mg/kg; TPM 60, 60 mg/kg).

Results:The reduction in body weight gain induced by TPM in both lean and obese rats reflected a decrease in total body energy gain, which was more evident in obese than in lean rats. Whereas TPM administration did not influence the intake of digestible energy in lean rats, it induced a reduction in food intake in obese animals. In lean, but not in obese rats, apparent energy expenditure (as calculated by the difference between energy intake and energy gain) was higher in rats treated with TPM than in animals administered the vehicle. The low dose of TPM decreased fat gain (with emphasis on subcutaneous fat) without affecting protein gain, whereas the high dose of the drug induced a reduction in both fat and protein gains. The effects of TPM on muscle and fat depot weights were representative of the global effects of TPM on whole body fat and protein gains. The calculated energetic efficiency (energy gain/energy intake) was decreased in both lean and obese rats after TPM treatment. TPM dose independently reduced hyperinsulinemia of obese rats, but it did not alter insulinemia of lean animals.

Discussion:The present results provide sound evidence for the ability of TPM to reduce fat and energy gains through reducing energetic efficiency in both lean and obese Zucker rats.
Comparison of Thermogenic Sympathetic Response to Food Intake between Obese and Non‐obese Young Women
Authors: Matsumoto Tamaki , Miyawaki Chiemi , Ue Hidetoshi , Kanda Tomo , Yoshitake Yasuhide , Moritani Toshio
Published: April 2008

Objective: Sympathetic nervous system abnormality in humans is still a matter of debate. The present study was designed to examine diet‐induced autonomic nervous system activity and metabolic change in obese and non‐obese young women.

Research Methods and Procedures: Sixteen age‐ and height‐matched obese and non‐obese young women participated in this study. Sympathovagal activities were assessed by means of our newly developed spectral analysis procedure of heart‐rate variability during the resting condition and after mixed‐food ingestion (480 kcal). Energy expenditure was also measured under these two conditions.

Results: There was no significant difference in any of the parameters of the heart‐rate variability between the obese group and control group during the resting condition. In the control group, both absolute values (221.5 ± 54.5 vs. 363.8 ± 43.7 ms2, p < 0.05) and relative values (0.23 ± 0.03 to 0.36 ± 0.02, p < 0.05) of a very‐low‐frequency component and global sympathetic nervous system index (1.46 ± 0.19 vs. 3.26 ± 0.61, p < 0.05) were significantly increased after mixed‐food ingestion compared with the values obtained after resting condition. However, no such sympathetic response was found in the obese group. Energy expenditure increased in the two groups after the meal, but the magnitude of the increase above the preprandial resting condition was significantly greater in the control group than in the obese group (11.2 ± 2.3 vs. 6.7 ± 0.8%, p < 0.05).

Discussion: Our data suggest that despite identical sympathovagal activities at the resting condition, obese young women may possess a reduced sympathetic response to physiological perturbation such as mixed food intake, which might be related to lowered capacity of thermogenesis and the state of obesity.
Association of BMI with the β3‐Adrenergic Receptor Gene Polymorphism in Japanese: Meta‐Analysis
Authors: Kurokawa Naoyuki , Nakai Kunihiko , Kameo Satomi , Liu Zhong‐Min , Satoh Hiroshi
Published: April 2008

Objective: To assess the effect of the Trp64Arg polymorphism in the β3‐adrenergic receptor gene (ADRB3) on body mass index (BMI) in the Japanese population.

Research Methods and Procedures: We selected studies that evaluated the association between BMI and ADRB3 polymorphism among Japanese, using MEDLINE and PubMed. After data collection, an extension of ANOVA was performed to assess the differences according to the genotype.

Results: In a total of 35 subgroups including 2316 subjects with the Trp64Arg variant and 4266 subjects without this variant, the weighted mean difference in BMI was 0.26 kg/m2 (95% confidence interval: 0.18 to 0.42; p < 0.01), indicating that variant carriers exhibited higher BMI than did normal homozygous subjects.

Discussion: Although it is known that the allele frequency of the ADRB3 polymorphism differs among races, this study focuses on the Japanese population, which has a high allele frequency of ADRB3 polymorphism. We assumed that statistical errors would be prevented due to the sufficient number of subjects. In conclusion, the results support the hypothesis that ADRB3 gene polymorphism is associated with BMI.
Men Gain Additional Psychological Benefits by Adding Exercise to a Weight‐Loss Program
Authors: Kiernan Michaela , King Abby C. , Stefanick Marcia L. , Killen Joel D.
Published: April 2008

Objective: Adding exercise to a comprehensive weight‐loss program might not only attenuate any psychological distress associated with weight‐loss attempts but also may provide psychological benefits. This study examined whether a diet‐plus‐exercise weight‐loss program improved psychological outcomes more than a diet‐only weight‐loss program or an assessment‐only control group.

Research Methods and Procedures: This study was part of a larger 1‐year randomized weight‐loss trial examining the effects of diet and exercise on cardiovascular disease risk factors in 264 overweight adults. Psychological measures specific to weight control (e.g., cognitive restraint, disinhibition, hunger, and body dissatisfaction) as well as traditional measures of psychological distress (e.g., symptoms of depression, anxiety, and stress) were obtained at baseline and 1 year.

Results: Men and women in either weight‐loss program reported greater restraint, less disinhibition, and less hunger at 1 year than those in no program. Men in the diet‐plus‐exercise program experienced additional increases in restraint and decreases in hunger than did men in the diet‐only program. Women in the diet‐plus‐exercise program did not experience additional psychological benefits specific to weight control than those in the diet‐only program, despite increases in aerobic capacity.

Discussion: The pattern seen for overweight men in the diet‐plus‐exercise program at 1 year—greater restraint, less disinhibition, and less hunger—is similar to the pattern seen in successful weight maintainers. These results underscore the need for innovative strategies that will enhance and sustain the pattern of psychological benefits specific to weight control associated with successful weight loss, especially for overweight women.
Prediction of Body Fat by Anthropometry in Older Chinese People
Authors: Kwok Timothy , Woo Jean , Lau Edith
Published: April 2008

Objective: To derive regression equations for fat percentage by using simple anthropometric measurements applicable in normal and immobile (cannot stand or walk) older people.

Research Methods and Procedures: The study population comprised 352 females and 261 males, apparently well and community‐dwelling, aged 69 to 82 years. Fifty‐one females and 27 males were recruited for external validation. Body weight, standing height, arm span, triceps and biceps skinfold thicknesses (SFTs), and midarm circumference were measured. The reference method of total body fat percentage was dual‐energy X‐ray densitometry. Predictive equations for fat percentages were derived by stepwise multiple linear regression on anthropometric indices and gender.

Results: Upper‐limb SFTs, body mass index, and gender yielded the more predictive equation. The SEE was 4.1% weight. There was a significant trend of underestimation in overweight subjects, especially in females. The equation using SFTs and midarm circumference was less reliable but more applicable to older immobile people and those with significant kyphoscoliosis.

Conclusions: The combination of body mass index and upper‐limb SFTs gives reliable prediction of fat percentages in older Chinese people, except in the obese.
Treatment Approaches: Food First for Weight Management and Health
Authors: Blackburn George L.
Published: April 2008

Many genetic, environmental, behavioral, and cultural factors affect health. Diet is as vital as any of them for preventing disease and promoting well‐being. We know that what we eat can lead to premature disability and mortality: to obesity, coronary heart disease, type 2 diabetes, degenerative arthritis, sleep apnea, and other illnesses. Now scientific evidence points to links between dietary patterns and illness. The study of these links is a new approach to understanding the role that diet plays in chronic disease. Initial studies include those on eating patterns and risk of colon cancer. More recently, researchers have investigated all‐cause mortality and leading causes of chronic disease. Novel epidemiological approaches include factorial analysis to evaluate dietary patterns and cluster analysis to examine nutrient intake, gender, and weight status across food‐pattern clusters. These methods work best within groups to identify major dietary patterns, but not necessarily ideal diets. They may also differ across population groups. The success of the Dietary Approaches to Stop Hypertension and Lyon Diet Heart studies supports the value of dietary pattern analysis. At the same time, the relative failure of single‐nutrient studies underscores the need for new methodologies and directions in research.
Food Provision as a Strategy to Promote Weight Loss
Authors: Wing Rena R. , Jeffery Robert W.
Published: April 2008

Intervention strategies used in weight‐control programs typically rely on participants to make behavior changes on their own. Better results might be achieved if more direct approaches were taken to make environmental changes by providing food to participants and paying them for weight loss. Two studies on food provision for improving weight loss were conducted. The first study used a five‐group design contrasting no treatment, standard behavior therapy (SBT), SBT plus food provision, SBT plus financial incentives, and SBT plus food provision and incentives. At 6, 12, and 18 months, weight losses in the two groups receiving food provision were significantly greater than in the two groups without food provision. The incentives did not affect weight loss. To better understand the reasons for the success of food provision a second study was conducted comparing SBT, SBT plus menus, SBT plus food provision with a copay, and SBT plus free food. Groups 2, 3, and 4 all had better weight losses than SBT and did not differ from each other at the end of the 6‐month treatment and at the 18‐month follow‐up. Food provision and menus were associated with increased behavior compliance, increased nutrition knowledge, more regular meals and fewer snacks, reduced barriers to weight loss, and improved quality of foods in participants’ homes. Food provision seems to be a useful strategy for promoting weight loss.
Foods, Health Claims, and the Law: Comparisons of the United States and Europe
Authors: Greene Harry L. , Prior Tessa , Frier Hank I.
Published: April 2008

Government, academia, and the food industry can play a significant role in the identification of healthy foods and ingredients important for weight management and health. The U.S. Food and Drug Administration developed regulations that define specific food categories for weight management and health. These categories include foods for special dietary uses and medical foods. Medical foods are classified for use in specific disease states and require a physician's recommendation and continuous monitoring. The European regulations specify energy‐restricted foods as a subcategory of food for particular nutritional uses, which includes infant formula, medical foods, and foods for sports. European standards for energy‐restricted diets have been established, leaving little flexibility for change. Three categories exist (i.e., very‐low‐calorie diets [450 to 800 kcal], low‐calorie diets [800 to 1200 kcal], and meal replacements [200 to 400 kcal]). No claims on anticipated weight loss can be made even where significant clinical research has demonstrated long‐term efficacy, thereby preventing informed choice management. Dramatic changes in lifestyle (e.g., disruption of the family unit, altered eating occasions, fast foods, and food grazing) have resulted in an epidemic of obesity and chronic disease. Regulating food selection or dietary patterns to limit the epidemic is not realistic. However, stimulating government health agencies and the food industry to increase public awareness through educational programs and regulating the definition of acceptable methods and products can provide an environment for change. A consensus is needed among academia, government, and industry for appropriate food labeling and claims. These actions are needed to help individuals make healthy food selections and maintain a healthy weight. Public health initiatives should change consumer attitudes with programs that are simple, affordable, effective, and accessible.
Very‐Low‐Calorie Diets and Sustained Weight Loss
Authors: Saris Wim H.M.
Published: April 2008

Objective: To review of the literature on the topic of very‐low‐calorie diets (VLCDs) and the long‐term weight‐maintenance success in the treatment of obesity.

Research Methods and Procedures: A literature search of the following keywords: VLCD, long‐term weight maintenance, and dietary treatment of obesity.

Results: VLCDs and low‐calorie diets with an average intake between 400 and 800 kcal do not differ in body weight loss. Nine randomized control trials, including VLCD treatment with long‐term weight maintenance, show a large variation in the initial weight loss regain percentage, which ranged from −7% to 122% at the 1‐year follow‐up to 26% to 121% at the 5‐year follow‐up. There is evidence that a greater initial weight loss using VLCDs with an active follow‐up weight‐maintenance program, including behavior therapy, nutritional education and exercise, improves weight maintenance.

Conclusions: VLCD with active follow‐up treatment seems to be one of the better treatment modalities related to long‐term weight‐maintenance success.
Meal Replacements in Weight Intervention
Authors: Ashley Judith M. , St. Jeor Sachiko T. , Perumean‐Chaney Suzanne , Schrage Jon , Bovee Vicki
Published: April 2008

Objective: To evaluate the effectiveness of meal replacements (MRs) in weight loss interventions in premenopausal women.

Research Methods and Procedures: Overweight premenopausal women (n = 113; body mass index: 25 to 35 kg/m2; 30 to 50 years old) were randomized into three interventions: group A, a dietitian‐led intervention; group B, a dietitian‐led intervention incorporating MRs; and group C, a clinical office‐based intervention incorporating MRs. In year 1, groups A and B attended 26 group sessions, whereas group C received the same educational materials during 26 10‐minute office visits with a physician–nurse team. In year 2, participants attended monthly group seminars and drop‐in visits with a dietitian.

Results: For the 74 subjects completing year 1, weight loss in the office‐based group C was as effective as the traditional dietitian‐led group A (4.3 ± 6.5% vs. 4.1 ± 6.4%), while group B maintained a significantly greater weight loss (9.1 ± 8.9%; p < 0.02; mean ± SD). For the 43 subjects completing year 2, group B showed significant differences in the percentage of weight loss (−8.5 ± 7.0%) compared with group A (−1.5 ± 5.0%) and group C (−3.0 ± 7.0%; p < 0.001).

Discussion: Study results showed that a traditional weight loss intervention incorporating MRs was effective as a weight loss tool in the medical office practice and in the dietitian‐led group setting.
Reducing Cardiovascular Disease Risk with Diet
Authors: McCarron David A. , Reusser Molly E.
Published: April 2008

Objective: Past research efforts to determine the influence of the diet on cardiovascular (CV) health have focused on the individual roles of specific dietary components with debatable success. Awareness of the impact and complexity of nutrient interactions has expanded in recent years to include assessment of dietary patterns as they contribute to lower CV disease risk.

Research Methods and Procedures: In a series of multicenter studies, we compared a comprehensive, prepared meal plan, formulated to meet recommended intake levels of macro‐ and micronutrients, with a self‐selected diet based on the exchange system. The three studies comprised adult participants with hypertension, hyperlipidemia, and type 2 diabetes (n = 560, 251, and 330, respectively). The first two studies (10 weeks) varied by the amount of contact with study personnel, and the third study assessed long‐term effects over 52 weeks. Outcome measures included: blood pressure, lipid and lipoprotein levels, glycemic control, homocysteine, compliance, quality of life, and weight.

Results: The first study demonstrated significant improvements in all measures, with greater improvements with the prepared meal plan compared with the self‐selected diet. The second study, designed to parallel the contact frequency that would occur in a real world clinical setting, also produced significant improvements in multiple CV risk factors. In the long‐term study, in addition to sustained improvements in risk factors, significant weight loss was achieved and maintained over the 52 weeks.

Discussion: These trials demonstrate that regular consumption of a nutritionally complete diet offers multiple, concurrent clinical benefits for reducing CV disease risk and body weight.
Waist Circumference and Cardiovascular Risk Factors in Prepubertal Children
Authors: Maffeis Claudio , Pietrobelli Angelo , Grezzani Alessandra , Provera Silvia , Tatò Luciano
Published: April 2008

Objective: Intra‐abdominal fat has been identified as being the most clinically relevant type of fat in humans. Therefore, an assessment of body‐fat distribution could possibly identify subjects with the highest risk of adverse lipid profile and hypertension. Few data on the relationship between body‐fat distribution and cardiovascular risk factors are available in children, especially before puberty.

Research Methods and Procedures: This cross‐sectional study was undertaken to explore the relationship between anthropometric variables, lipid concentrations, and blood pressure (BP) in a sample of 818 prepubertal children (ages 3 to 11 years) and to assess the clinical relevance of waist circumference in identifying prepubertal children with higher cardiovascular risk. Height, weight, triceps and subscapular skinfolds, waist circumference, and BP were measured. Plasma levels for triacylglycerol, total cholesterol, high‐density lipoprotein (HDL) cholesterol, low‐density lipoprotein cholesterol, apolipoprotein A1 (ApoA1), and apolipoprotein B (ApoB) were determined.

Results: Females were fatter than males (5.8 [3.5] vs. 4.8 [3.3] kg of fat mass; p < 0.01). Males had higher HDL cholesterol and ApoA1/ApoB plasma concentrations than females (p < 0.001 and p < 0.01, respectively). Waist circumference had a higher correlation with systolic and diastolic BP (r = 0.40 and 0.29, respectively; p < 0.001) than triceps (r = 0.35 and 0.21, respectively; p < 0.001) and subscapular (r = 0.28 and 0.16, respectively; p < 0.001) skinfolds and relative body weight (0.33 and 0.23, respectively; p < 0.001). Multivariate linear model analysis showed that ApoA1/ApoB, HDL cholesterol, total cholesterol/HDL cholesterol, and systolic as well as diastolic BP were significantly associated with waist circumference and triceps and subscapular skinfolds, independently of age, gender, and body mass index.

Discussion: Waist circumference as well as subscapular and triceps skinfolds may be helpful parameters in identifying prepubertal children with an adverse blood‐lipids profile and hypertension. However, waist circumference, which is easy to measure and more easily reproducible than skinfolds, may be considered in clinical practice. Children with a waist circumference greater than the 90th percentile are more likely to have multiple risk factors than children with a waist circumference that is less than or equal to the 90th percentile.
Subclinical Hypothyroidism in Obese Patients: Relation to Resting Energy Expenditure, Serum Leptin, Body Composition, and Lipid Profile
Authors: Tagliaferri Mariantonella , Berselli Maria Elisa , Calò Giovanna , Minocci Alessandro , Savia Giulio , Petroni Maria Letizia , Viberti Gian Carlo , Liuzzi Antonio
Published: April 2008

Objective: To evaluate whether subclinical hypothyroidism (SH) affects resting energy expenditure (REE) as well as body composition, lipid profile, and serum leptin in obese patients.

Research Methods and Procedures: A total of 108 obese patients with SH defined as normal free thyroxine levels and thyroid‐stimulating hormone (TSH) values of >4.38 μU/ml (mean ± 2 SD of the values of our reference group of obese patients with normal thyroid function) were compared with a group of 131 obese patients matched for age, sex, and body mass index (BMI) but with normal TSH levels. We assessed estimated daily caloric intake by 7‐day recall, REE by indirect calorimetry, body composition by bioelectrical impedance analysis, serum leptin by radioimmunoassay, and lipid profile (i.e., total cholesterol, high‐density lipoprotein cholesterol, low‐density lipoprotein cholesterol, and triglycerides).

Results: All of the variables measured were not different between the euthyroid obese patients and those with SH. In a multiple regression model with REE expressed for kilograms of fat free mass (REE/kgFFM) as a dependent variable and percentage of fat mass, BMI, waist‐to‐hip ratio, age, TSH, free thyroxine, serum leptin, and caloric intake as independent variables, only percentage of fat mass was significantly correlated with REE/kgFFM in both groups. In the SH group only, BMI, waist‐to‐hip ratio, age, and TSH were related to REE/kgFFM and explained 69.5% of its variability. After dividing the patients with SH using a cutoff TSH value of 5.7 μU/ml, which represents 3 SD above the mean of TSH levels of the group of obese patients with normal thyroid function, only REE/kgFFM was significantly different and lower in the group of more severely hypothyroid patients.

Discussion: In patients with obesity, SH affects energy expenditure only when TSH is clearly above the normal range; it does not change body composition and lipid profile. We suggest that, at least in obese patients, evaluation of TSH levels may be useful to rule out a possible impairment of resting energy expenditure due to a reduced peripheral effect of thyroid hormones.
Central but Not Peripheral Glucocorticoid Infusion in Adrenalectomized Male Rats Increases Basal and Substrate‐Induced Insulinemia through a Parasympathetic Pathway
Authors: Sainsbury Amanda , Wilks Donna , Cooney Gregory J.
Published: April 2008

Objective: Glucocorticoids acting through the central nervous system are postulated to play a role in the hyperinsulinemia and increased adiposity of obesity. We investigated the role of parasympathetic activation in glucocorticoid‐induced hyperinsulinemia.

Research Methods and Procedures: Plasma pancreatic polypeptide (PP) levels were used as an index of parasympathetic output. Insulinemia and plasma PP levels were measured basally and after intravenous glucose injection (300 mg/kg) in adrenalectomized male rats infused with dexamethasone (7.5 μg/kg per day) intracerebroventricularly (ICV) or subcutaneously (SC) for 3 to 6 days in the presence or absence of acute atropine blockade (1.0 mg/kg). Food intake was controlled between groups.

Results: Compared with normal rats, adrenalectomy decreased white adipose tissue depot weights and leptinemia, and these were restored to normal values by ICV but not SC dexamethasone infusion. Adrenalectomy significantly reduced insulinemia below normal levels, which was restored by SC dexamethasone replacement. However, ICV dexamethasone replacement increased insulinemia of adrenalectomized rats to levels higher than normal control values (basal, 500 ± 40 pM vs. 280 ± 40 pM; 1‐minute postglucose, 2500 ± 180 pM vs. 1240 ± 260 pM; p < 0.0001) and increased plasma PP levels, which were correlated with insulinemia. Atropine significantly reduced plasma insulin and PP to levels similar to normal controls but had no effect in any other group.

Discussion: These data show that glucocorticoids act within the brain to increase insulinemia, most likely through activation of parasympathetic efferent fibers. Such an affect would contribute to the adipogenic effects of central glucocorticoids.
Scaling Vo2 Peak in Obese and Non‐obese Girls
Authors: Loftin Mark , Sothern Melinda , Trosclair Laura , O'Hanlon Ann , Miller James , Udall John
Published: April 2008

Objective: The conventional ratio method (milliliters O2 per mass) typically is used to express Vo2 peak. The goal of the current study was to compare Vo2 peak of obese girls with normal‐weight girls by ratio and allometric scaling methods.

Research Methods and Procedures: We compared Vo2 peak by ratio and allometric methods in 46 obese and 47 normal‐weight girls. Indirect calorimetry was used to measure Vo2 peak during either treadmill running or walking. Regression analysis was used to determine coefficients for mass and stature for each group with ANOVA used to compare data between groups.

Results: The obese girls were taller and had higher values of body fatness (p ≤ 0.05). Absolute Vo2 peak (liters per minute) was similar between groups; however Vo2 peak relative to mass was 50% lower (p ≤ 0.05) in the obese girls. When Vo2 peak (milliliters per minute per kilogram) and mass were correlated, r = −0.48 was found in the obese group. Allometric scaling of logarithmic transformed stature and mass reduced this to r = −0.002, thus eliminating the bias associated with the ratio method. Adjusting Vo2 peak allometrically scaled for mass, stature, and the combination of mass and stature reduced the difference between groups from 50% (ratio method) to 10% to 11% (p ≤ 0.05) with higher values found in the normal‐weight girls.

Discussion: These results demonstrate the bias associated with the ratio method when comparing Vo2 peak in obese girls with Vo2 peak in normal‐weight girls. Allometric scaling eliminated the bias and thus may reflect a truer comparative response.
Comparative Evaluation of Fecal Fat Excretion Induced by Orlistat and Chitosan
Authors: Guerciolini Roberto , Radu‐Radulescu Lucian , Boldrin Mark , Dallas Jayson , Moore Rema
Published: April 2008

Objective: To compare the effects of chitosan and orlistat on fecal fat excretion.

Research Methods and Procedure: A randomized, open‐label, two‐period sequential design study was used. A total of 12 healthy adult volunteers within 20% of their ideal body weight entered a 7‐day run‐in diet period before being randomized to orlistat (120 mg) or chitosan (890 mg) three times daily for 7 days. Subjects then crossed over treatment regimens for an additional 7‐day period. Subjects followed a standardized diet (2500 kcal/d, 30% as fat) for the entire 21‐day study. Feces were collected on days 4 to 7 of the run‐in period (baseline) and during the two treatment periods. Mean daily fecal fat excretion was measured at baseline and during each treatment regimen.

Results: Mean baseline fecal fat excretion for all subjects was 1.36 ± 0.45 g/d. During orlistat treatment, mean fecal fat excretion significantly increased from baseline (+16.13 ± 7.27 g/d; p < 0.001). No significant effect was observed with chitosan (+0.27 ± 1.02 g/d; p = 0.379). Fecal fat excretion was significantly greater with orlistat than with chitosan (p < 0.001; 95% confidence intervals: 11.73; 20.00 g/d).

Discussion: This study provides additional evidence of the inhibitory effect of orlistat on dietary fat absorption. Chitosan, however, has no effect on fecal fat excretion.
Different Methods for Assessing the Features of Eating Disorders in Patients with Binge Eating Disorder: A Replication
Authors: Grilo Carlos M. , Masheb Robin M. , Wilson G. Terence
Published: April 2008

Objective: To compare different methods for assessing the features of eating disorders in patients with binge eating disorder (BED).

Research Methods and Procedures: A total of 47 participants with BED were administered the Eating Disorder Examination (EDE) Interview and completed the EDE‐Questionnaire (EDE‐Q) at baseline. A total of 37 participants prospectively self‐monitored their eating behaviors daily for 4 weeks and then completed another EDE‐Q.

Results: At baseline, the EDE and the EDE‐Q were significantly correlated on frequencies of objective bulimic episodes (binge eating), overeating episodes, and on the dietary restraint, eating concern, weight concern, and shape concern subscales. Mean differences in the EDE and EDE‐Q frequencies of objective bulimic episodes and overeating were not significant but scores on the four subscales differed significantly, with the EDE‐Q yielding higher scores. At the 4‐week point, the EDE‐Q retrospective 28‐day assessment was significantly correlated with the prospective daily self‐monitoring records for frequency of objective bulimic episodes and the mean difference between the methods was not significant. The EDE‐Q and self‐monitoring findings for subjective bulimic episodes and objective overeating differed significantly.

Discussion: In patients with BED, the three assessment methods showed some areas of acceptable convergence.