bluuebunny/crossref_metadata_2025 huggingface dataset:
Health‐Related Quality of Life Varies among Obese Subgroups
Authors: Kolotkin Ronette L. , Crosby Ross D. , Williams G. Rhys
Published: April 2008

Objective: To compare the health‐related quality of life (HRQOL) of overweight/obese individuals from different subgroups that vary in treatment‐seeking status and treatment intensity.

Research Methods and Procedures: Participants were from five distinct groups, representing a continuum of treatment intensity: overweight/obese community volunteers who were not enrolled in weight‐loss treatment, clinical trial participants, outpatient weight‐loss program/studies participants, participants in a day treatment program for obesity, and gastric bypass patients. The sample was large (n = 3353), geographically diverse (subjects were from 13 different states in the U.S.), and demographically diverse (age range, 18 to 90 years; at least 14% African Americans; 32.6% men). An obesity‐specific instrument, the Impact of Weight on Quality of Life‐Lite questionnaire, was used to assess health‐related quality of life (HRQOL).

Results: Results indicated that obesity‐specific HRQOL was significantly more impaired in the treatment‐seeking groups than in the nontreatment‐seeking group across comparable gender and body mass index (BMI) categories. Within the treatment groups, HRQOL varied by treatment intensity. Gastric bypass patients had the most impairment, followed by day treatment patients, followed by participants in outpatient weight‐loss programs/studies, followed by participants in clinical trials. Obesity‐specific HRQOL was more impaired for those with higher BMIs, whites, and women in certain treatment groups.

Discussion: There are differences in HRQOL across subgroups of overweight/obese individuals that vary by treatment‐seeking status, treatment modality, gender, race, and BMI.
Influence of Excess Fat on Cardiac Morphology and Function: Study in Uncomplicated Obesity
Authors: Iacobellis Gianluca , Ribaudo Maria Cristina , Leto Gaetano , Zappaterreno Alessandra , Vecci Elio , Di Mario Umberto , Leonetti Frida
Published: April 2008

Objective: To evaluate whether or not “uncomplicated” obesity (without associated comorbidities) is really associated with cardiac abnormalities.

Research Methods and Procedures: We evaluated cardiac parameters in obese subjects with long‐term obesity, normal glucose tolerance, normal blood pressure, and regular plasma lipids. We selected 75 obese patients [body mass index (BMI) >30 kg/m2], who included 58 women and 17 men (mean age, 33.7 ± 11.9 years; BMI, 37.8 ± 5.5 kg/m2) with a ≥10‐year history of excess fat, and 60 age‐matched normal‐weight controls, who included 47 women and 13 men (mean age, 32.7 ± 10.4 years; BMI, 23.1 ± 1.4 kg/m2). Each subject underwent an oral glucose tolerance test to exclude impaired glucose tolerance or diabetes mellitus, bioelectrical impedance analysis to calculate fat mass and fat‐free mass, and echocardiography.

Results: Obese patients presented diastolic function impairment, hyperkinetic systole, and greater aortic root and left atrium compared with normal subjects. No statistically significant differences between obese subjects and normal subjects were found in indexed left ventricular mass (LVM/body surface area, LVM/height2.7, and LVM/fat‐free masskg), and no changes in left ventricular geometry were observed. No statistically significant differences in cardiac parameters between extreme (BMI > 40 kg/m2) and mild obesity (BMI < 35 kg/m2) were observed.

Discussion: In conclusion, our data showed that obesity, in the absence of glucose intolerance, hypertension, and dyslipidemia, seems to be associated only with an impairment of diastolic function and hyperkinetic systole, and not with left ventricular hypertrophy.
Role of Ghrelin Polymorphisms in Obesity Based on Three Different Studies
Authors: Ukkola Olavi , Ravussin Eric , Jacobson Peter , Pérusse Louis , Rankinen Tuomo , Tschöp Matthias , Heiman Mark L. , Leon Arthur S. , Rao D.C. , Skinner James S. , Wilmore Jack H. , Sjöström Lars , Bouchard Claude
Published: April 2008

Objective: Associations between preproghrelin DNA variants and obesity‐related phenotypes were studied in 3004 subjects from the Québec Family Study (QFS), the HERITAGE Family Study (HERITAGE), and the Swedish Obese Subjects (SOS) Study.

Research Methods and Procedures: Body mass index (BMI), fat mass (FM) from underwater weighing, and abdominal fat from computerized tomography were measured. The ghrelin polymorphisms were identified by polymerase chain reaction.

Results: Arg51Gln QFS subjects (n = 6) had lower ghrelin concentrations (p = 0.007) than Arg51Arg subjects (n = 14). White preproghrelin Met72Met subjects in HERITAGE had the lowest BMI (p = 0.020), and those in the QFS cohort had the lowest FM (p < 0.001). Met72 carrier status (Met72+) was associated with lower FM (p = 0.026) and higher insulin‐like growth factor‐1 levels (p = 0.019) among blacks. Met72Met QFS subjects had less visceral fat (p = 0.002) and a lower fasting respiratory quotient (p = 0.037). HERITAGE Met72+ white subjects also showed lower exercise respiratory quotient (p = 0.030) and higher maximal oxygen uptake (p = 0.023). Furthermore, the prevalence of Met72+ was higher (19.2%; p < 0.05) in SOS subjects whose BMI was ≤25 kg/m2 than in those with BMI >25 kg/m2 (14.8%). SOS Met72+ obese women had a lower (11.4%; p = 0.032) prevalence of hypertension than noncarriers (23.9%).

Discussion: Arg51Gln mutation was associated with lower plasma ghrelin levels but not with obesity. The preproghrelin Met72 carrier status seems to be protective against fat accumulation and associated metabolic comorbidities.
Assessing the Validity of Body Mass Index Standards in Early Postmenopausal Women
Authors: Blew Robert M. , Sardinha Luis B. , Milliken Laura A. , Teixeira Pedro J. , Going Scott B. , Ferreira Dawna L. , Harris Margaret M. , Houtkooper Linda B. , Lohman Timothy G.
Published: April 2008

Objective: To examine the relationship between percentage of total body fat (%Fat) and body mass index (BMI) in early postmenopausal women and to evaluate the validity of the BMI standards for obesity established by the NIH.

Research Methods and Procedures: Three hundred seventeen healthy, sedentary, postmenopausal women (ages, 40 to 66 years; BMI, 18 to 35 kg/m2; 3 to 10 years postmenopausal) participated in the study. Height, weight, BMI, and %Fat, as assessed by DXA, were measured. Receiver operating characteristic analysis was performed to evaluate the ability of BMI to discriminate obesity from non‐obesity using 38%Fat as the criterion value.

Results: A moderately high relationship was observed between BMI and %Fat (r = 0.81; y = 1.41x + 2.65) with a SE of estimate of 3.9%. Eighty‐one percent of other studies examined fell within 1 SE of estimate as derived from our study. Receiver operating characteristic analysis showed that BMI is a good diagnostic test for obesity. The cutoff for BMI corresponding to the criterion value of 38%Fat that maximized the sum of the sensitivity and specificity was 24.9 kg/m2. The true‐positive (sensitivity) and false‐positive (1 − specificity) rates were 84.4% and 14.6%, respectively. The area under the curve estimate for BMI was 0.914.

Discussion: There is a strong association between %Fat and BMI in postmenopausal women. Current NIH BMI‐based classifications for obesity may be misleading based on currently proposed %Fat standards. BMI >25 kg/m2 rather than BMI >30 kg/m2 may be superior for diagnosing obesity in postmenopausal women.
Cross‐Sectional and Longitudinal Associations between Body Mass Index and Marriage‐Related Factors
Authors: Jeffery Robert W. , Rick Allison M.
Published: April 2008

Objective: To assess the relationship between marriage and obesity.

Research Methods and Procedures: Cross‐sectional and longitudinal associations were examined between participant body mass index (BMI), spouse BMI, and participant diet and exercise habits.

Results: Spouse and participant BMI and BMI changes over 2 years were significantly associated. Participant BMI was associated with higher consumption of calorie‐dense foods and lower frequency of physical activity. Participants’ eating and exercise habits were only weakly related to spouse BMI. BMI did not predict the likelihood of marriage or divorce. However, marriage was associated with a significant 2‐year weight gain and divorce with a significant 2‐year weight loss.

Discussion: The results suggest that spouse similarity in BMI is at least partly due to shared environment. The observed effects of marriage and divorce on weight may be due to the influence of marriage on inducements to eat (e.g., shared meals) or on motivation for weight control.
Use of the Health and Activities Limitation Index as a Measure of Quality of Life in Obesity
Authors: Livingston Edward H. , Ko Clifford Y.
Published: April 2008

Objective:Obesity reduces the quality of life (QOL); however, quantification of obesity's impact on QOL is cumbersome. Utility indices reduce QOL measurements to a single numerical value that can be used in the calculation of Quality‐Adjusted Life‐Years and the cost effectiveness for obesity treatment. The purpose of this investigation is to assess the sensitivity of the Health and Activities Limitation Index (HALex) utility index to obesity.

Research Methods and Procedures:The answers to five questions regarding an individual's self‐perception of his or her health status and information about limitation in daily and work activities were collected from 32,440 adults in the 1998 National Health Information Survey. Answers to the questions were scored and converted to a utility index score ranging from 0 (near‐death state) to 1 (perfect health) with no limitations. Average values for indices corresponding to differing body mass indices were obtained and significance determined by ANOVA.

Results:The utility index for normal weight males and females was 0.86 ± 0.19 and fell to 0.68 ± 0.27 for superobese males and 0.60 ± 0.28 in superobese females. Utility indices fell linearly with increasing body mass index and were lower for respondents having obesity‐related comorbid conditions known to reduce the quality of life.

Discussion:There is a statistically significant decrease in the QOL with increasing obesity, slightly worse for women compared with men. The Health and Activities Limitation Index can quantitate the effect obesity and its complications have on quality of life.
Assessment of Childhood Obesity: National Reference Data or International Approach?
Authors: Reilly John J.
Published: April 2008

Assessing body mass index in children requires cutoffs that are different from those for adults. The aim of this review is to summarize the evidence base, rationale, and practical issues that should inform decisions about the use of national and international reference data for assessing obesity in children. In many countries, decisions are being made without consideration of the existing evidence, and with limited understanding of the practical problems or potential harm that may arise.
Visceral Adipose Tissue in Women: Longitudinal Study of the Effects of Fat Gain, Time, and Race
Authors: Lara‐Castro Cristina , Weinsier Roland L. , Hunter Gary R. , Desmond Renée
Published: April 2008

Objective: To determine the effects of fat gain, time, and race on the accumulation of visceral adipose tissue (VAT) in a group of normal‐weight premenopausal women.

Research Methods and Procedures: Sixty‐five women participated in the study (32 African American and 33 white). The mean age of subjects was 34 ± 6 years (range, 22 to 47 years). Eligible subjects were women who had body mass indices <25 kg/m2 at baseline and who had completed evaluations at baseline and at follow‐up year 1, without intervention. A subset of subjects was reevaluated annually for up to 4 years. Body composition was assessed by DXA, and VAT was determined from a single computed tomography scan. A linear mixed model was used to examine changes in VAT over time, with total body fat as a covariate

Results: Total fat mass was not significantly different between races at baseline and increased significantly in both groups over time (p < 0.001). Time‐related increases in total body fat were greater in African‐American women (p < 0.01). VAT was significantly higher in white women at baseline (p < 0.01) and increased significantly over time in both races (p < 0.01), but remained higher in white women (p < 0.001). Increases in VAT, relative to total body fat, were greater than the increases in total body fat over time, independent of age and race (p < 0.001).

Discussion: Gaining total body‐fat mass results in a higher increase in VAT, relative to total body fat, regardless of race and age, although African‐American women maintain a lower VAT levels across time.
Regional Subcutaneous‐Fat Loss Induced by Caloric Restriction in Obese Women
Authors: Wang Jack , Laferrère Blandine , Thornton John C. , Pierson Richard N. , Pi‐Sunyer F. Xavier
Published: April 2008

Objective: With anthropometric models using skinfolds and circumferences, we studied changes in the percentage of subcutaneous fat in the total cross‐sectional area (SF%) at four body sites in obese women, before and after weight loss induced by 6 months of caloric restriction.

Research Methods and Procedures: In 61 obese women [31 African Americans and 30 whites; ages, 24 to 68 years; body mass index (BMI), ≥28kg/m2], we measured SF% at the midpoint of the upper arm and thigh and the waistline and hipline, and we measured the percentage of total body fat by DXA before (Obs#1) and after (Obs#2) a 6‐month nonintervention control period and then after 6 months on a 1200 kcal/d diet (Obs#3).

Results: The mean body weight and BMI increased (1.8 kg and 0.61 kg/m2; p = 0.0001), but there were no significant changes in any other body composition measurements from Obs#1 to Obs#2. The means of Obs#3 for weight and BMI decreased by 11%, and the percentage of total body fat decreased by 13% of Obs#2 mean values (p = 0.0001). The mean SF% at each site decreased 7.6% to 18.0% of the Obs#2 mean values (p < 0.001). The SF% decreases were greater at mid‐arm and mid‐thigh than in the cross‐sectional regions at the waistline and hipline (p = 0.05). There was no interaction between age or ethnicity (p > 0.2).

Conclusions: In obese women, caloric restriction alone reduces anthropometrically measured subcutaneous fat proportionally more in peripheral than in central regions.
Impact of Weight‐Cycling History on Bone Density in Obese Women
Authors: Gallagher Kara I. , Jakicic John M. , Kiel Douglas P. , Page Marie L. , Ferguson Erica S. , Marcus Bess H.
Published: April 2008

Objective: The purpose of this study was to examine the effect of weight cycling (as defined by the frequency and magnitude of intentional weight loss) on bone mineral density and bone mineral content in obese sedentary women.

Research Methods and Procedures: Bone mineral content and density measured by DXA, submaximal physical fitness assessment, nutrient intake, oral contraceptive use, and weight‐cycling history were assessed in 195 healthy, overweight sedentary women (age, 21 to 45 years; body mass index, 27 to 40 kg/m2) before beginning a behavioral weight‐loss intervention.

Results: After controlling for body weight, multivitamin use, oral contraceptive/estrogen use, and calcium and magnesium intake, women who had a history of weight cycling did not have significantly lower total‐body bone mineral content or density or total femur bone mineral density. In addition, 99% of subjects were above or within one SD of age and gender normative data for total femur bone mineral density.

Discussion: It does not seem that a history of weight cycling has an adverse affect on total femur and total‐body bone mineral density in overweight sedentary premenopausal women.
An Observational Study of Slimming Behavior in Denmark in 1992 and 1998
Authors: Bendixen Hanne , Madsen Jesper , Bay‐Hansen Dorthe , Boesen Ulrik , Ovesen Lars F. , Bartels Else Marie , Astrup Arne
Published: April 2008

Objective: To elucidate how frequent weight‐loss attempts are made, the methods used to achieve weight loss, and the extent to which the outcome is positive.

Research Methods and Procedures: Two independent interviews were conducted in 1992 and in 1998, each with 1200 randomly selected adult subjects. Each survey was designed to ensure an equal distribution of age, gender, and geographical regions in Denmark.

Results: The proportion of subjects having attempted weight loss did not change from 1992 to 1998, although the prevalence of overweight and obesity increased from 1992 (overweight, 30%; obesity, 6%) to 1998 (overweight, 35%; obesity, 8%). Almost twice as many women (61%) than men (32%) had attempted weight loss (p < 0.0001). Slimming occurred more often in subjects <50 years (51%) than >50 years (39%) (p < 0.0001), although overweight and obesity were more frequent in the elderly. Over‐the‐counter diet pills or meal replacements were associated with a negative outcome of slimming treatment (p < 0.0001).

Discussion: Approximately half of all adult Danes have attempted weight loss, particularly women and individuals <50 years. This finding is inconsistent with the fact that overweight and obesity are more prevalent in men and in individuals >50 years. Changes in habitual diet and increased physical activity are the most prevalent modes of slimming, whereas the use of over‐the‐counter diet pills or meal replacements has decreased from 1992 to 1998. This development may have a positive impact on future body‐ weight‐management strategies.
Leptin Production by the Stomach Is Up‐Regulated in Obese (fa/fa) Zucker Rats
Authors: Picó Catalina , Sánchez Juana , Oliver Paula , Palou Andreu
Published: April 2008

Objective: Genetically obese (fa/fa) Zucker rats display markedly elevated circulating leptin levels compared with their lean counterparts; this is expected because of the lack of a LepR‐mediated feedback inhibition. The aim of this study was to determine the effect of the leptin receptor mutation in the Zucker rat on gastric leptin production and on the response to 14 hours of starvation. The response to a short‐term period of food intake (20 minutes) on gastric leptin release was also analyzed.

Research Methods and Procedures: Leptin mRNA expression in the gastric mucosa and in adipose tissue depots (epididymal, retroperitoneal, mesenteric, and inguinal) was assessed by reverse transcriptase‐polymerase chain reaction and serum and stomach leptin content by enzyme‐linked immunosorbent assay.

Results: Obese Zucker rats overexpressed leptin in the stomach. They overexpress leptin in the inguinal adipose tissue but not in visceral adipose tissue depots, indicating tissue‐specific obesity‐dependent differences. Gastric leptin expression is regulated by feeding conditions in lean but not in obese (fa/fa) rats. In lean animals, leptin mRNA levels decrease in fasting conditions and increase rapidly with a short period of food intake. Obese Zucker rats also overdisplay stomach leptin levels. Feeding acutely stimulates leptin secretion by the stomach in lean, and to a lesser extent, in obese rats.

Discussion: These results indicate impaired regulation of leptin expression in the stomach of obese (fa/fa) Zucker rats. However, there is still an effect of the nutritional status on gastric leptin levels despite the lack of a functional leptin receptor.
Effects of Dietary Fatty Acids and Exercise on Body‐Weight Regulation and Metabolism in Rats
Authors: Pellizzon Michael , Buison Anne , Ordiz Frank , Ana Lardo Santa , Jen K.‐L. Catherine
Published: April 2008

Objective: To assess the interaction of high‐fat diets (HF) made with different dietary fatty acids and exercise on body‐weight regulation, adiposity, and metabolism.

Research Methods and Procedures: Male Wistar rats born to dams fed HF diets (40% w/w) made with either fish oil (FO), soybean oil (SO), or palm oil (PO) were fed diets similar to their dams and divided randomly into exercise (EX, swimming) or sedentary control (SD) groups when they were 9 weeks old. EX lasted for 6 weeks. Twenty‐four hours after the last EX bout, fasted rats were killed by decapitation. Chemical analyses and body composition analysis were conducted.

Results: The results demonstrated that different fatty acids had different effects on body weight, composition, and metabolism. SO‐fed rats gained the most weight and fat. EX reduced body weight of FO‐ and PO‐fed rats, but SO‐fed rats were still heavier and fatter than other rats. Data from SO‐ and PO‐fed rats suggested that they are insulin resistant and that EX normalized this abnormality. Of the three HF diets used, FO produced the least adverse effects compared with PO and SO.

Discussion: Not only the quantity of dietary fat, but also the type of fat used, will produce different effects on body weight and metabolism. EX ameliorates the suggested insulin resistance induced in rats fed either highly saturated or n‐6 polyunsaturated fatty acids. Long‐chain n‐3 polyunsaturated fatty acids, as found in fish oil, are more beneficial than n‐6 polyunsaturated fatty acids when fed in high amounts to rats.
Long‐Term Weight Loss and Breakfast in Subjects in the National Weight Control Registry
Authors: Wyatt Holly R. , Grunwald Gary K. , Mosca Cecilia L. , Klem Mary L. , Wing Rena R. , Hill James O.
Published: April 2008

Objective: To examine breakfast consumption in subjects maintaining a weight loss in the National Weight Control Registry (NWCR).

Research Methods and Procedures: A cross‐sectional study in which 2959 subjects in the NWCR completed demographic and weight history questionnaires as well as questions about their current breakfast consumption. All subjects had maintained a weight loss of at least 13.6 kg (30 lb) for at least 1 year; on average these subjects had lost 32 kg and kept it off for 6 years.

Results: A large proportion of NWCR subjects (2313 or 78%) reported regularly eating breakfast every day of the week. Only 114 subjects (4%) reported never eating breakfast. There was no difference in reported energy intake between breakfast eaters and non‐eaters, but breakfast eaters reported slightly more physical activity than non‐breakfast eaters (p = 0.05).

Discussion: Eating breakfast is a characteristic common to successful weight loss maintainers and may be a factor in their success.
Obesity, Aerobic Exercise, and Vascular Disease: The Role of Oxidant Stress
Authors: Fenster Catherine P. , Weinsier Roland L. , Darley‐Usmar Victor M. , Patel Rakesh P.
Published: April 2008

Oxidant formation in the vasculature contributes to vascular disease and dysfunction associated with obesity. In contrast, exercise‐dependent production of oxidants may stimulate adaptive responses that protect against the development of such diseases. In this review, we discuss current concepts in the biology of reactive oxygen and nitrogen species and how their function is modulated in the context of vascular disease, obesity, and aerobic exercise.
DXA: Potential for Creating a Metabolic Map of Organ‐Tissue Resting Energy Expenditure Components
Authors: Hayes Matthew , Chustek Michael , Wang ZiMian , Gallagher Dympna , Heshka Stanley , Spungen Ann , Bauman William , Heymsfield Steven B.
Published: April 2008

Objective: This study tested the hypothesis that tissue‐organ components can be derived from DXA measurements, and in turn, resting energy expenditure (REE) can be calculated from the summed heat productions of DXA‐estimated brain, skeletal muscle mass (SM), adipose tissue, bone, and residual mass (RM).

Research Methods and Procedures: Subjects were divided into five groups of adults <50 years of age. The specific metabolic rate of RM was developed in 13 Group I healthy subjects and a DXA‐brain mass prediction formula in 52 Group II subjects. SM, adipose tissue, and bone models were developed based on earlier reports. The composite REE prediction model (REEp) was tested in 154 Group III subjects in whom REEp was compared with measured REE (REEm). Features of the developed model were determined in 94 normal‐weight men and women (Group IV) and seven spinal cord injury patients and healthy matched controls (Group V).

Results: REEp and REEm in Group III were highly correlated (y = 0.85x + 233; r = 0.82, p < 0.001), and no bias was detected. Both REEm (mean ± SD, 1579 ± 324 kcal/d) and REEp (1585 ± 316 kcal/d) were also highly correlated (r values = 0.85 to 0.98; p values < 0.001) and provided similar group values to REE estimated by the Harris‐Benedict equations (1597 ± 279 kcal/d) and Wang's composite fat‐free mass–based REE equation (1547 ± 248 kcal/d). New insights into the sources and distribution of REE were provided by analysis of the demonstration groups.

Discussion: This approach offers a new practical and educational opportunity to examine REE in subject groups using modeling strategies that reveal the magnitude and distribution of fundamental somatic heat‐producing units.
Effect of Changes in Fat Distribution on the Rates of Change of Insulin Response in Children
Authors: Huang Terry T.‐K. , Johnson Maria S. , Gower Barbara A. , Goran Michael I.
Published: April 2008

Objective: To develop mixed models for examining longitudinal associations between rates of change in visceral, subcutaneous abdominal, and total body fat with rates of change in fasting insulin (FI) and insulin sensitivity (SI) over 3 years in children.

Research Methods and Procedures: Seventy‐seven children (mean age, 8.3 years at baseline) from Birmingham, Alabama, with three or more annual measures of FI and SI were included. Abdominal fat was measured by computed tomography, and total body fat and lean tissue mass were measured by DXA. Mixed models examined the longitudinal associations between the baseline level/rate of change of different fat compartments and the rate of change in FI or SI.

Results: An annual increase of ∼5% in FI was associated with 1 cm2/yr of visceral fat gain per year (p < 0.05), independent of subcutaneous abdominal fat. A 1‐cm2 difference in initial subcutaneous abdominal fat was associated with an ∼0.2% increase per year in FI (p < 0.02), independent of visceral fat. None of the rates of change in any of the fat measures was associated with the rate of change of SI.

Discussion: The rate of change in visceral fat was positively associated with the rate of change in FI, independent of increasing subcutaneous abdominal fat; however, subcutaneous abdominal fat may be more predictive of the rate of change of FI than visceral or total fat. Therefore, growth‐related increases in abdominal fat, particularly subcutaneous abdominal fat, may contribute to accelerating increases in FI, but have no effect on SI.
Plasma Adiponectin Levels Are Not Associated with Fat Oxidation in Humans
Authors: Stefan Norbert , Vozarova Barbora , Funahashi Tohru , Matsuzawa Yuji , Ravussin Eric , Weyer Christian , Tataranni P. Antonio
Published: April 2008

Objective: To test the hypothesis that low adiponectin is associated with low fat oxidation in humans.

Research Methods and Procedures: We measured plasma adiponectin concentrations in 75 healthy, nondiabetic Pima Indians (age, 28 ± 7 years; 55 men and 20 women; body fat, 29.7 ± 7.5%) and 18 whites [(age, 33 ± 8 years; 14 men and 4 women; body fat, 28.2 ± 10.8% (means ± SD)] whose body composition was measured by DXA and 24‐hour energy expenditure (24‐hour EE) by a respiratory chamber. Respiratory quotient (an estimate of whole‐body carbohydrate/lipid oxidation rate) was calculated over 24 hours (24‐hour RQ).

Results: Before correlational analyses, waist‐to‐thigh ratio (WTR) and percentage of body fat (PFAT) were adjusted for age, sex, and race; 24‐hour EE was adjusted for fat mass and fat‐free mass, and 24‐hour RQ were adjusted for energy balance. Plasma adiponectin concentrations were negatively correlated with WTR (r = −0.42, p < 0.0001) and PFAT (r = −0.46, p < 0.0001). There was no correlation between plasma adiponectin concentrations and 24‐hour RQ, (r = 0.09, p = 0.36) before or after adjustment for PFAT (r = 0.001, p = 0.99, respectively, partial correlation), and no correlation was found between plasma adiponectin concentrations and 24‐hour EE (r = −0.12, p = 0.27).

Discussion: Our cross‐sectional data do not suggest physiological concentrations of fasting plasma adiponectin play a role in the regulation of whole‐body fat oxidation or energy expenditure in resting conditions. Whether administration of adiponectin to individuals with low levels of this hormone will increase their fat oxidation rates/energy expenditure remains to be established.
Obesity and Long‐Term Clinical and Economic Outcomes in Coronary Artery Disease Patients
Authors: Eisenstein Eric L. , Shaw Linda K. , Nelson Charlotte L. , Anstrom Kevin J. , Hakim Zafar , Mark Daniel B.
Published: April 2008

Objective:Obesity is an important risk factor for coronary artery disease (CAD); however, its effect on acute coronary syndrome (ACS) patients’ long‐term clinical and economic outcomes has not been quantified. We assessed the impact of increasing body mass index (BMI) on 10‐year outcomes for ACS patients.

Research Methods and Procedures:ACS patients with significant CAD receiving an initial cardiac catheterization at Duke University Medical Center between 1986 and 1997 were included. Patients with a BMI < 18.5 kg/m2were excluded; the remaining patients were classified by BMI as normal, overweight, obese, or very obese. Medical costs were estimated from a prior ACS clinical trial with costs adjusted to 1997 dollars and discounted at 3% per annum.

Results:There were 9405 patients with data available for analysis. Follow‐up was complete on >95% of patients. Patients who were obese at baseline increased from 20% to 33% between 1986 and 1997. Increased BMI was associated with younger age, multi‐morbidity, and less severe CAD at baseline. It was also associated with more clinical events, higher cumulative inpatient medical costs, and significant differences in unadjusted survival at 10 years. However, it was not associated with differences in 10‐year survival after adjusting for baseline characteristic differences.

Discussion:Obese ACS pateints are younger and are hospitalized more frequently during the first 10 years of their illness than are non‐obese patients. They also incur higher cumulative inpatient medical costs, especially the very obese. These findings highlight the opportunities for therapeutic benefit that aggressive weight management and secondary prevention may provide this population.
Bupropion SR vs. Placebo for Weight Loss in Obese Patients with Depressive Symptoms
Authors: Jain Adesh K. , Kaplan Roy A. , Gadde Kishore M. , Wadden Thomas A. , Allison David B. , Brewer Edwin R. , Leadbetter Robert A. , Richard Nathalie , Haight Barbara , Jamerson Brenda D. , Buaron Kathleen S. , Metz Alan
Published: April 2008

Objective: This randomized, double‐blind, placebocontrolled study evaluated the efficacy and tolerability of bupropion sustained‐release (bupropion SR) in reducing weight and depressive symptoms in obese adults.

Research Methods and Procedures: Obese adults (body mass index, 30 to 44 kg/m2) not currently meeting criteria for major depression but with depressive symptoms (Beck Depression Inventory score 10–30) received bupropion SR 300 mg/d or placebo for 26 weeks with a 500 kcal/d‐deficit diet. Patients who lost <5% of baseline weight at week 12 had bupropion SR dosage or placebo increased to 400 mg/d in a blinded fashion.

Results: The bupropion SR group (n = 193) lost an average of 4.4 kg (4.6% of baseline weight) vs. 1.7 kg (1.8% of baseline weight) on placebo (n = 191, p < 0.001, last‐observation‐carried‐forward analysis). More patients in the bupropion SR group than in the placebo group (40% vs. 16% of intent‐to‐treat sample, 50% vs. 28% of completers, respectively) lost at least 5% of baseline weight (p < 0.05 at week 4, p < 0.001 at weeks 6 to 26). The percentage of patients reporting ≥50% decrease in depressive symptoms did not differ between groups, but depressive symptoms improved more with bupropion SR than with placebo among patients with a history of major depression (p < 0.05, weeks 4 to 26). In the sample as a whole, improvement in depressive symptoms was related to weight loss of ≥5% regardless of treatment (p < 0.0001). Bupropion SR was well‐tolerated.

Discussion: Bupropion SR in combination with a 500 kcal/d‐deficit diet facilitated weight loss. Weight loss of ≥5% may improve mood in obese patients with depressive symptoms.
Relationship between Obesity and Health‐Related Quality of Life in Men
Authors: Yancy William S. , Olsen Maren K. , Westman Eric C. , Bosworth Hayden B. , Edelman David
Published: April 2008

Objective:Few studies examining the relationship between obesity and health‐related quality of life (HRQOL) have used a medical outpatient population or demonstrated a relationship in men. Furthermore, most studies have not adequately considered comorbid illness. The goal of this study was to examine the relationship between body mass index (BMI) and HRQOL in male outpatients while considering comorbid illness.

Research Methods and Procedures:This cross‐sectional study examined 1168 male outpatients from Durham Veterans’ Affairs Medical Center. Multiple linear regression was used to examine the relationship of BMI with each subscale from the Medical Outcomes Study Short Form 36 while adjusting for age, race, comorbid illness, depression, and physical activity.

Results:Participants had a mean age of 54.7 ± 5.6 years; 69% were white and 29% were African American. The distribution for BMI was as follows: 18.5 to <25 kg/m2(21%), 25 to <30 kg/m2(43%), 30 to <35 kg/m2(25%), 35 to <40 kg/m2(8%), and ≥40 kg/m2(3%). Mean Short Form 36 subscale scores were lower than U.S. norms by an average of 27%. Individuals with BMI ≥40 kg/m2had significantly lower scores compared with normal weight individuals on the Role‐Physical and Vitality subscales. On the Physical Functioning and Physical Component subscales, lower scores were observed at BMI ≥35 kg/m2. On the Bodily Pain subscale, lower scores were observed at BMI ≥25 kg/m2.

Discussion:An inverse relationship between BMI and physical aspects of HRQOL exists in a population of male outpatients. Increased BMI was most prominently associated with bodily pain; this relationship should receive more attention in clinical care and research.
The Glucocorticoid Receptor Gene and Its Association to Metabolic Syndrome
Authors: Rosmond Roland
Published: April 2008

In recent decades, there has been an increasing interest in the role of endogenous glucocorticoids such as cortisol in the pathogenesis of metabolic syndrome. Studies in humans have suggested a positive association between obesity, hypertension, and insulin resistance, with alleles at the glucocorticoid receptor (GR) gene. For instance, the BclI polymorphism within the intron upstream of GR exon 2 has been associated with cardiovascular risk factors such as visceral obesity, hypertension, insulin resistance, and elevated cortisol concentrations. However, the location of the BclI polymorphism is not known, and the variant has so far not been compared with the wild‐type receptor for its ability to be activated by glucocorticoids. Although several other mutations in the GR gene have been postulated as being relevant to the progression to type 2 diabetes and cardiovascular diseases, conflicting results makes it difficult to determine exactly what effect these GR variations have on metabolic syndrome incidence and progression. Further studies focusing on the most compelling GR mutations might offer a better understanding of metabolic syndrome pathogenesis and progression, aiding in the development of more effective treatments for this condition.
Resistin and Adiponectin Expression in Visceral Fat of Obese Rats: Effect of Weight Loss
Authors: Milan Gabriella , Granzotto Marnie , Scarda Alessandro , Calcagno Alessandra , Pagano Claudio , Federspil Giovanni , Vettor Roberto
Published: April 2008

Objective: Obesity‐related insulin resistance is closely associated with visceral fat accumulation. Several adipocyte‐secreted molecules have been implicated in the development of type 2 diabetes, among them, the recently discovered adiponectin and resistin proteins. Some of these adipocytokines are also present in the immune system, thus suggesting an intriguing functional connection.

Research Methods and Procedures: We determined adiponectin and resistin expressions in visceral (VAT) and subcutaneous adipose tissue of lean and obese Zucker (fa/fa) rats using reverse‐transcription polymerase chain reaction. Moreover, we analyzed the variations after body‐weight reduction in food‐restricted obese rats.

Results: Resistin and adiponectin expression was significantly lower in VAT of genetically obese in comparison with lean rats; no differences were observed when subcutaneous adipose tissues of the same animals were compared. Weight loss resulted in an increase of adiponectin expression in VAT, whereas a further significant decrease in resistin mRNA level was observed. Resistin is also present and equally expressed in splenocytes of lean and obese rats.

Discussion: Adiponectin and resistin are down‐regulated in VAT of obese rats. Adiponectin expression is restored to normal levels after body‐weight reduction, supporting its link with obesity‐related insulin resistance. On the contrary, the further decrease of resistin mRNA after weight loss does not support the hypothesis that resistin may play a causative role in insulin resistance in obese rats. Moreover, we demonstrated the presence of resistin in immunocompetent cells in both humans and rats, thus adding another factor to the list of molecules that adipose tissue shares with the immune system.
Reduction of Plasma Leptin Concentrations by Arginine but Not Lipid Infusion in Humans
Authors: Stingl Harald , Raffesberg Wolfgang , Nowotny Peter , Waldhäusl Werner , Roden Michael
Published: April 2008

Objective: We examined short‐term effects of arginine infusion on plasma leptin in diabetic and healthy subjects.

Research Methods and Procedures: Arginine stimulation tests were performed in C‐peptide negative type 1 [DM1; hemoglobin A1c; 7.3 ± 0.3%], hyperinsulinemic type 2 diabetic (DM2; 7.6 ± 0.7%), and nondiabetic subjects (CON; 5.4 ± 0.1%).

Results: Fasting plasma leptin correlated linearly with body mass index among all groups (r = 0.61, p = 0.001). During arginine infusion, peak plasma insulin was lower in DM1 than in DM2 (p < 0.05) and CON (p < 0.01). Plasma leptin decreased within 30 minutes by ∼11% in DM1 (p < 0.001), DM2 (p < 0.01), and CON (p < 0.005), slowly returning to baseline thereafter. Plasma free fatty acids (FFAs) were higher in DM1 (0.6 ± 0.1 mM) and DM2 (0.6 ± 0.1 mM) than in CON (0.4 ± 0.1 mM, p < 0.05) and transiently declined by ∼50% (p < 0.05) at 45 minutes in all groups before rebounding toward baseline. To examine the direct effects of FFAs on plasma leptin, we infused healthy subjects with lipid/heparin and glycerol during fasting, and somatostatin‐insulin (∼35 pM) ‐glucagon (∼90 ng/mL) clamps were performed. In both protocols, plasma leptin continuously declined by ∼25% (p < 0.05) during 540 minutes without any difference between the high and low FFA conditions.

Discussion: Arginine infusion transiently decreased plasma leptin concentrations both in insulin‐deficient and hyperinsulinemic diabetic patients, indicating a direct inhibitory effect of the amino acid but not of insulin or FFAs.
Dietary Restraint and Stress‐Induced Snacking in Youth
Authors: Roemmich James N. , Wright Suzanne M. , Epstein Leonard H.
Published: April 2008

Objective: To determine whether dietary restraint modifies stress‐induced eating in youth.

Research Methods and Procedures: Snacking was measured in boys (9.5 ± 0.3 years) and girls (9.0 ± 0.3 years), with and without dietary restraint, across a control day after reading children's magazines and/or coloring, and on a stress day after giving a videotaped speech, with order of conditions counterbalanced. Children were divided into four groups based on dietary restraint and changes in perceived stress: low‐restraint/low‐reactive (n = 9), low‐restraint/high‐reactive (n = 13), high‐restraint/low‐reactive (n = 10), and high‐restraint/high‐reactive (n = 8). Body composition was estimated by skinfolds.

Results: Energy intake of snack foods was influenced differently by dietary restraint and stress reactivity in the stress and control conditions (p < 0.01). After being stressed, low‐restraint/low‐reactive children ate fewer snacks and high‐restraint/high‐reactive children ate more snacks compared with the control condition. After covarying for percentage of body fat, the interactions remained (p < 0.01). Girls ate less than boys (p < 0.001), but sex did not influence eating in control and stress conditions.

Discussion: Dietary restraint occurs in children and may influence the effect of stress on eating. Interpersonal stress decreases snacking in low dietary restrained youth but increases snacking in high dietary restrained children, perhaps because of stress‐induced disinhibition.
Are Obese Adolescents and Young Adults at Higher Risk for Mental Disorders? A Community Survey
Authors: Lamertz Christina M. , Jacobi Corinna , Yassouridis Alexander , Arnold Klaus , Henkel Andreas W.
Published: April 2008

Objective: Associations between body mass index (BMI) and mental disorders meeting Axis‐I diagnoses according to the Diagnostic and Statistical Manual for Mental Disorders IV (DSM‐IV) were investigated in The Early Developmental Stages of Psychopathology Study in a large population‐based sample, which included adolescents and young adults of both genders for the first time.

Research Methods and Procedures: A total of 3021 German subjects ranging from 14 to 24 years of age were assessed for specific DSM‐IV diagnoses derived from a modified version of the standardized Composite International Diagnostic Interview, and general psychological disturbances, using the Symptom Checklist‐90‐Revised. BMI percentiles for age and gender were calculated to avoid systematic bias in the BMI distribution resulting from the young age range represented in the sample. Additionally, subjects with a lifetime diagnosis of any eating disorder were excluded from statistical analysis to control the confounding effect of body weight‐related eating disorders on associations between BMI and psychopathology.

Results: The results based on logistic regression analyses and MANOVAs demonstrate that the BMI is not associated with mental disorders or general psychopathologies. There were no significant associations between BMI and mood, anxiety, substance, and somatoform disorders, a result that contrasts with almost all previous clinical studies. Additionally, in contrast to clinical investigations and most epidemiological studies, neither obesity nor underweight was significantly associated with any kind of general psychopathology.

Discussion: The overall finding that obesity is not significantly related to marked psychopathology in the general German population of adolescents and young adults has important clinical implications.
Relationship between Waist Circumference, Body Mass Index, and Medical Care Costs
Authors: Cornier Marc‐Andre , Tate Charles W. , Grunwald Gary K. , Bessesen Daniel H.
Published: April 2008

Objective: Excessive visceral adiposity as measured by anthropomorphic measures may be more closely associated with adverse health consequences than body weight or body mass index (BMI), the more commonly obtained clinical measures. Waist circumference (WC) provides information about regional adiposity and may correlate with health care costs better than body weight or BMI.

Research Methods and Procedures: A total of 424 men (37%) and women (63%) were identified as they were seen in outpatient medical clinics at Denver Health, an integrated health care system serving a largely indigent population. Height, weight, and WC were measured by one examiner. Information on outpatient, laboratory, pharmacy, inpatient, and total charges attributable to each subject for the preceding year were obtained from computerized databases. Data on health care charges were divided into quartiles based on WC and BMI.

Results: Total annual health care charges were significantly greater in the highest WC quartile (WC < 83.3 cm: $6062 ± $784; 83.3 to 93.5 cm: $5968 ± $812; 93.7 to 103.5 cm: $6369 ± $1015; >103.5 cm: $8699 ± $1092; p = 0.047). Those with a WC >103.5 cm generated 85% more inpatient charges than the group with a WC <83.3 cm. Although there was a positive trend, BMI was not found to significantly correlate with total health care charges in this population sample.

Discussion: These results suggest that abdominal adiposity as assessed by WC is associated with increased total health care charges and may be a better predictor of health care charges than the more widely used BMI.
The Food Amount Rating Scale: Development, Reliability, and Validity
Authors: Dohm Faith‐Anne , Striegel‐Moore Ruth H.
Published: April 2008

Objective: Implied in measures of binge eating is the assumption that individuals agree on what comprises a large amount of food. However, whether individuals estimate food amounts similarly or whether estimation of food amounts varies as a function of personal characteristics is unknown. The Food Amount Rating Scale (FARS) is a standardized set of stimuli for assessing individuals’ judgment of food amounts.

Research Methods and Procedures: Two versions of the FARS were developed, and their psychometric properties were assessed. These versions are the same in all respects except that the rater is instructed to rate various food amounts for the average woman on Form W and for the average man on Form M.

Results: Content validity was confirmed by 14 researchers and research assistants in the field of eating disorders. The FARS is a 24‐item inventory with adequate test–retest reliability (Form W = 0.85; Form M = 0.87) and split–half reliability (Form W = 0.90; Form M = 0.89). Convergent validity is suggested by the finding that ratings for the average woman (Form W) were significantly higher than ratings for the average man (Form M).

Discussion: The FARS is a psychometrically sound tool for use in basic research focused on identifying whether the subjective judgment of food amounts varies as a function of personal characteristics and in clinical research where it may be important to know how individuals judge food amounts.
Effects of a High‐Fat Diet and Strain on Hypothalamic Gene Expression in Rats
Authors: Schaffhauser Andrea O. , Madiehe Abram M. , Braymer Hugh D. , Bray George A. , York David A.
Published: April 2008

Objective: This study was designed to investigate whether dietary fat and genetic background might differentially alter the expression of hypothalamic genes involved in food intake.

Research Methods and Procedures: Three‐month‐old Osborne‐Mendel (OM) and S5B/Pl rats were fed either a high‐fat or a low‐fat diet for 14 days. mRNA for neuropeptide Y (NPY), corticotrophin‐releasing hormone, NPY Y‐1 receptor and Y‐5 receptor, and serotonin 2c (5‐HT2c) receptors were measured using Northern blotting or ribonuclease protection assays.

Results: OM rats showed an increased expression of NPY and corticotrophin‐releasing hormone compared with S5B/Pl rats. The expression of NPY‐Y1 and ‐Y5 receptor mRNA was significantly higher in the hypothalamus of OM rats compared with S5B/Pl rats. The expression of 5HT‐2c receptor mRNA was significantly reduced in both strains of rats eating a high‐fat diet when compared with the animals eating the low‐fat diet.

Discussion: These data suggest that over activity of the NPY system may contribute to the development of obesity in OM rats and that expression of the 5HT‐2c receptor gene may be modulated by dietary fat.