bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of Weight History on Functional Limitations and Disability in Late Adulthood: The ARIC Study
Authors: Houston Denise K. , Stevens June , Cai Jianwen , Morey Miriam C.
Published: April 2008

Objective: To examine associations of weight history with functional limitations and disability in white and African‐American men and women.

Research Methods and Procedures: Data were from the Atherosclerosis Risk in Communities study (n = 11, 177). Associations of recalled weight status at age 25 and weight change from age 25 to ages 45 to 64 with functional limitations, activities of daily living (ADLs), and instrumental activities of daily living (IADLs) at follow‐up (ages 52 to 75) were examined using logistic regression.

Results: Obesity (BMI ≥ 30 kg/m2) at age 25 was associated with functional limitations and ADL and IADL impairment at follow‐up in white and African‐American men and women. For example, obese compared with normal weight (BMI, 18.5 to 24.9 kg/m2) white women had higher odds of mild [odds ratio (95% confidence interval), 1.97 (1.18 to 3.29)] and severe [9.81 (5.92 to 16.27)] functional limitations and ADL [3.48 (2.36 to 5.13)] and IADL [2.95 (2.00 to 4.33)] impairment. In African‐American women, obesity was associated with higher odds of mild [2.71 (1.14 to 6.41)] and severe [6.01 (2.53 to 14.26)] functional limitations and ADL [1.82 (1.10 to 3.00)] and IADL [2.39 (1.47 to 3.90)] impairment. Similar associations were found in men. Compared with weight maintenance (±10 lbs), large weight gain (>30 lbs) from age 25 to ages 45 to 64 was also associated with functional limitations and ADL and IADL impairment in white and African‐American men and women.

Discussion: Maintenance of a healthy body weight throughout adulthood may play a role in preventing or delaying the onset of functional limitations and disability, resulting in increased quality of life and decreased health care costs.
Eligibility for Obesity Treatment and Risk of Mortality in Men
Authors: Mason Caitlin , Katzmarzyk Peter T. , Blair Steven N.
Published: April 2008

Objective: To evaluate the risk of all‐cause and cardiovascular disease (CVD) mortality associated with each outcome of the NIH obesity treatment algorithm and to examine the effects of cardiorespiratory fitness on the risk of mortality associated with these outcomes.

Research Methods and Procedures: The NIH obesity treatment algorithm was applied to 18, 666 men (20 to 64 years of age) from the Aerobics Center Longitudinal Study in Dallas, TX, examined between 1979 and 1995. Risk of all‐cause and CVD mortality was assessed using Cox proportional hazards regression.

Results: A total of 7029 men (37.7%) met the criteria for needing weight loss treatment [overweight (BMI = 25 to 29.9 kg/m2 or WC > 102 cm) with ≥2 CVD risk factors or obese (BMI ≥ 30 kg/m2)]. Mortality surveillance through 1996 identified 435 deaths (151 from CVD) during 191, 364 man‐years of follow‐up. Compared with the normal weight reference group, the hazard ratios (95% confidence interval) for death from all causes were 0.63 (0.45 to 0.88), 1.23 (0.98 to 1.54), 1.05 (0.60 to 1.85), and 1.71 (1.64 to 2.31) for men who were overweight with <2 CVD risk factors, overweight with ≥2 CVD risk factors, obese with <2 CVD risk factors, and obese with ≥2 CVD risk factors, respectively. Corresponding hazard ratios for CVD mortality were 0.72 (0.38 to 1.37), 1.67 (1.12 to 2.50), 1.69 (0.67 to 4.30), and 3.31 (2.07 to 5.30). Including physical fitness as a covariate significantly attenuated all risk estimates.

Discussion: The NIH obesity treatment algorithm is useful in identifying men at increased risk of premature mortality; however, including an assessment of fitness would help improve risk stratification among all groups of patients.
Obesity in the Elderly and Its Relationship with Cardiovascular Risk Factors in Taiwan**
Authors: Huang Kuo‐Chin , Lee Meei‐Shyuan , Lee Shyh‐Dye , Chang Yung‐Han , Lin Yi‐Chin , Tu Su‐Hao , Pan Wen‐Harn
Published: April 2008

Objectives: The obese elderly are at increased risk of mortality, morbidity, and functional disability. In this study, we examined the prevalence of obesity and relationship between various anthropometric indices (AI) and cardiovascular disease (CVD) risk factors in the elderly.

Research Methods and Procedures: A stratified multistage clustered sampling scheme was used in the Elderly Nutrition and Health Survey in Taiwan during 1999 to 2000. 2432 non‐institutionalized subjects (age, 72.8 ± 9.4 years; BMI, 23.6 ± 6.4 kg/m2) were recruited. The receiver operating characteristic analysis was used to compare predictive validity of CVD risk factors among various AI, including BMI, waist circumference (WC), and waist‐to‐hip ratio (WHR).

Results: The prevalence of obesity was 29.0% in men and 36.8% in women by obesity criteria for Asians (BMI ≥ 25 kg/m2) and 13.3% in men and 21.0% in women by the Taiwanese definition (BMI ≥ 27 kg/m2). Odds ratios of acquiring various CVD risk factors increased significantly with increment of WC, WHR, and BMI. The areas under the curve predicting metabolic syndrome were all <0.8. The cut‐off values of WC corresponding to the highest sensitivity and the highest specificity in predicting various CVD risk factors were 86.2–88.0 cm in men and 82.0–84.0 cm in women, respectively.

Discussion: Obesity was prevalent in the Taiwanese elderly. WC was related to CVD risk factors to a greater extent than BMI and WHR. However, none of them alone was a good screening tool for CVD risk factors. Therefore, how to apply AI prudently to screen elderly for CVD risk factors needs further research.
High‐Sensitivity C‐Reactive Protein in Japanese Patients with Type 2 Diabetes
Authors: Tajiri Yuji , Mimura Kazuo , Umeda Fumio
Published: April 2008

Objective: To assess the relationship between high‐sensitivity (HS) C‐reactive protein (CRP) and metabolic syndrome (MetS) or atherosclerosis and to assess effects of strict metabolic control on the degree of inflammation and MetS in patients with type 2 diabetes.

Research Methods and Procedures: Four hundred thirteen patients with diabetes were enrolled in the cross‐sectional study. Of these 413 patients, 161 patients were further admitted for 2.4 ± 0.4 weeks (mean ± SD) to investigate the change in HS‐CRP or other parameters under strict metabolic control.

Results: Log‐transformed HS‐CRP value (log HS‐CRP) was strongly correlated with BMI (r = 0.448, p < 0.01). Log HS‐CRP was also correlated with the presence of MetS or each component of MetS. Furthermore, a positive significant trend in HS‐CRP levels was shown with an increasing number of MetS components (p < 0.05). Log HS‐CRP showed a significant positive correlation with carotid artery intima‐media thickness (IMT) (r = 0.152, p < 0.01). In multiple step‐wise regression analysis, BMI, hemoglobin A1c, right IMT, duration of diabetes, and triglyceride were selected as explanatory variables for log HS‐CRP (R2 = 0.412). Under strict metabolic control, HS‐CRP was significantly (p < 0.01) lower, together with lower levels of other markers for MetS. The change in HS‐CRP was significantly correlated with the change in BMI (r = 0.161, p = 0.04).

Discussion: In subjects with type 2 diabetes, HS‐CRP levels are related to MetS and subclinical atherosclerosis. Strict weight management and metabolic control were associated with a reduction in HS‐CRP levels, and changes in HS‐CRP were related to changes in weight, supporting the hypothesis that lifestyle modification reduces inflammation and the risk of CHD.
Cost‐Effectiveness of a Low‐Carbohydrate Diet and a Standard Diet in Severe Obesity
Authors: Tsai Adam Gilden , Glick Henry A. , Shera David , Stern Linda , Samaha Frederick F.
Published: April 2008

Objective: Low‐carbohydrate diets have become a popular alternative to standard diets for weight loss. Our aim was to compare the cost‐effectiveness of these two diets.

Research Methods and Procedures: The patient population included 129 severely obese subjects (BMI = 42.9) from a randomized trial; participants had a high prevalence of diabetes or metabolic syndrome. We compared within‐trial costs, quality‐adjusted life years (QALYs), and the incremental cost‐effectiveness ratio (CER) for the two study groups. We imputed missing values for QALYs. The CER was bootstrapped to derive 95% confidence intervals and to define acceptability cut‐offs. We took a societal perspective for our analysis.

Results: Total costs during the one year of the trial were $6742 ± 6675 and $6249 ± 5100 for the low‐carbohydrate and standard groups, respectively (p= 0.78). Participants experienced 0.64 ± 0.02 and 0.61 ± 0.02 QALYs during the one year of the study, respectively (p= 0.17 for difference). The point estimate of the incremental CER was $−1225/QALY (i.e., the low‐carbohydrate diet dominated the standard diet). However, in the bootstrap analysis, the wide spread of CERs caused the 95% confidence interval to be undefined. The probabilities that the low‐carbohydrate diet was acceptable, using cut‐offs of $50, 000/QALY, $100, 000/QALY, and $150, 000/QALY, were 72.4% 78.6%, and 79.8%, respectively.

Discussion: The low‐carbohydrate diet was not more cost‐effective for weight loss than the standard diet in the patient population studied. Larger studies are needed to better assess the cost‐effectiveness of dietary therapies for weight loss.
Meal Frequency and Childhood Obesity
Authors: Toschke André M. , Küchenhoff Helmut , Koletzko Berthold , Von Kries Rüdiger
Published: April 2008

Objective: Previous studies have demonstrated an inverse association between meal frequency and the prevalence of obesity in adulthood. The aim of this study was to assess the relationship between meal frequency and childhood obesity.

Research Methods and Procedures: Stature and weight of 4370 German children ages 5 to 6 years were determined in six Bavarian (Germany) public health offices during the obligatory school entry health examination in 2001/2002. An extensive questionnaire on risk factors for obesity was answered by their parents. Obesity was defined according to sex‐ and age‐specific BMI cut‐off points proposed by the International Obesity Task Force. The main exposure was daily meal frequency.

Results: The prevalence of obesity decreased by number of daily meals: three or fewer meals, 4.2% [95% confidence interval (CI), 2.8 to 6.1]; four meals, 2.8% (95% CI, 2.1 to 3.7); and 5 or more meals, 1.7% (95% CI, 1.2 to 2.4). These effects could not be explained by confounding due to a wide range of constitutional, sociodemographic, and lifestyle factors. The adjusted odds ratios for obesity were 0.73 (95% CI, 0.44 to 1.21) for four meals and 0.51 (95% CI, 0.29 to 0.89) for five or more meals. Additional analyses pointed to a higher energy intake in nibblers compared with gorgers.

Discussion: A protective effect of an increased daily meal frequency on obesity in children was observed and appeared to be independent of other risk factors for childhood obesity. A modulation of the response of hormones such as insulin might be instrumental.
Association of Family Environment with Children's Television Viewing and with Low Level of Physical Activity
Authors: Salmon Jo , Timperio Anna , Telford Amanda , Carver Alison , Crawford David
Published: April 2008

Objective: This study examined associations between the family environment and children's television (TV) viewing and likelihood of being low‐active.

Research Methods and Procedures: In 2001, children were recruited from 19 primary schools in Melbourne, Australia. Parents completed a questionnaire about their child's TV viewing and the family environment. Children also completed a questionnaire and wore an accelerometer for 8 days. Movement counts were used to identify low‐active children (lowest quartile). Data were analyzed in May 2004.

Results: The sample consisted of 878 children (mean age = 11.5 ± 0.6 yrs). Multiple logistic regression revealed that socioeconomic status [adjusted odds ratios (AOR) = 0.4 boys], frequency families watched TV together (AOR = 2.0 boys), mothers’ (AOR = 1.8 boys; AOR = 2.5 girls) and fathers’ (AOR = 2.6 boys; AOR = 2.8 girls) TV viewing, and rules prohibiting TV during mealtimes (AOR = 0.6 boys; AOR = 0.6 girls) related to children watching TV ≥2 h/d. Variables associated with low‐level physical activity included self‐reported enjoyment of Internet use (AOR = 1.7 boys) and preference for watching TV (AOR = 2.3 girls), perception that mother uses computer a lot (AOR = 1.9 boys) and likes using the computer (AOR = 0.6 girls), fathers’ reported computer/electronic games use (AOR = 1.7 girls), frequency families used computer together (AOR = 0.4 girls), rules that TV viewing must be supervised (AOR = 1.9 boys; AOR = 0.6 girls), and having pay TV (AOR = 0.6 boys) and electronic games at home (AOR = 2.6 boys).

Discussion: These findings suggest that the relationships between the family environment and TV viewing and low‐level activity are complex and that these behaviors are distinct.
Plasma Levels of Adiponectin, a Novel Adipocyte‐Derived Hormone, in Sleep Apnea**
Authors: Wolk Robert , Svatikova Anna , Nelson Christy A. , Gami Apoor S. , Govender Kogilan , Winnicki Mikolaj , Somers Virend K.
Published: April 2008

Objective: Obstructive sleep apnea (OSA) is associated with obesity, sympathetic activation, systemic inflammation, and cardiovascular morbidity. Obesity, β‐adrenergic agonists, and inflammation are linked to decreased expression and/or secretion of an adipose tissue‐derived antiatherogenic hormone, adiponectin. The purpose of the study was to investigate whether OSA affected plasma levels of adiponectin, which might help explain OSA‐associated cardiovascular morbidity.

Research Methods and Procedures: We randomly selected 68 otherwise healthy male subjects, either with moderate/severe OSA [apnea‐hypopnea index (AHI) ≥ 20; n = 35] or without OSA (AHI ≤ 5; n = 33). The diagnosis of OSA was made based on prospective full polysomnography. Adiponectin was measured before polysomnography between 8 and 10 PM.

Results: AHI was higher in the OSA group (49.5 ± 4.4 vs. 2.9 ± 0.4 events/h; p < 0.001). OSA subjects were also more obese, with greater BMI (33 ± 1 vs. 30 ± 1; p = 0.016) and percentage body fat (29 ± 1% vs. 26 ± 1%; p = 0.030). Adiponectin levels were 7.67 ± 0.73 and 6.33 ± 0.51 μg/mL in the OSA and non‐OSA groups, respectively, and this difference was significant in covariate analysis (taking into account age, hemodynamic characteristics, measures of body fat, and OSA severity) (p = 0.009). After excluding from both groups the subjects with extreme BMI, such that the OSA and non‐OSA study cohorts had similar BMI and percentage body fat, subjects with OSA had significantly higher plasma adiponectin (8.49 ± 0.92 vs. 6.32 ± 0.55 μg/mL; p = 0.042), differences also evident in covariate analysis (p = 0.017).

Discussion: Plasma adiponectin levels are elevated in otherwise healthy subjects with OSA. Therefore, low adiponectin is unlikely to explain the association between OSA and cardiovascular disease.
Is Maternal Psychopathology Related to Obesigenic Feeding Practices at 1 Year?
Authors: Farrow Claire V. , Blissett Jacqueline M.
Published: April 2008

Objective: To investigate the relationship between maternal psychopathological symptomatology during pregnancy and at 6 and 12 months postnatally and maternal use of controlling and restrictive feeding practices at 1 year.

Research Methods and Procedures: Eighty‐seven women completed a measure of psychological distress during pregnancy and at 6 and 12 months postpartum, and at 12 months postnatally these women reported their usage of controlling and restrictive feeding practices and were observed feeding their infants.

Results: General psychological distress, particularly anxious psychopathology, during pregnancy and at 6 and 12 months postnatally was significantly associated with maternal use of restrictive feeding practices at 1 year, even when controlling for length of breast‐feeding and the infants’ weights at 1 year. Contrary to expectations, depression and eating psychopathology as measured by the SCOFF eating disorder measure during pregnancy or at 6 or 12 months postnatally were not associated with the use of controlling or restrictive feeding practices at 1 year.

Discussion: These findings indicate that anxious maternal psychopathology may partially explain the development of maternal use of restriction when feeding.
Correlates of Persistent Thinness in Black and White Young Women
Authors: Franko Debra L. , Thompson Douglas , Russell Rachel , Schreiber George B. , Crawford Patricia B. , Daniels Stephen R. , Striegel‐Moore Ruth H.
Published: April 2008

Objective: To examine health and psychosocial correlates of persistent thinness in black and white young adult women.

Research Methods and Procedures: 1830 females (n = 988 black, n = 842 white) who participated in the National Heart, Lung, and Blood Institute Growth and Health Study were asked to indicate their current body size from a series of nine pictograms (1, emaciated to 9, obese). Persistent thinness was defined as having at least seven non‐missing measurement points between ages 9 to 18 with a body size rating of <4 at all points. Generalized linear models were used to examine whether persistently thin women differed from comparison women on cardiovascular disease risk factors measured at age 18.5 and psychosocial variables measured at age 21.5. Prospective associations between psychological measures in childhood and persistent thinness through the course of adolescence were also examined.

Results: In the sample, 145 women (7.9%) met criteria for persistent thinness and 1685 women (92.1%) were classified as not persistently thin. Persistently thin women had a later age of menarche, fewer weight concerns, and healthier eating attitudes, were less likely to have had a child, came from higher socioeconomic backgrounds, and had significantly lower blood pressure and higher high‐density lipoprotein‐cholesterol than comparison women. Differences were not found on measures of depression or health services use. Girls with higher self‐esteem in childhood were more likely to remain persistently thin throughout adolescence.

Discussion: Persistently thin women seem to be healthier on several indicators relative to comparison women, and race did not moderate these differences.
Achieving Healthy Weight in African‐American Communities: Research Perspectives and Priorities
Authors: Kumanyika Shiriki K. , Gary Tiffany L. , Lancaster Kristie J. , Samuel‐Hodge Carmen D. , Banks‐Wallace Joanne , Beech Bettina M. , Hughes‐Halbert Chanita , Karanja Njeri , Odoms‐Young Angela M. , Prewitt T. Elaine , Whitt‐Glover Melicia C.
Published: April 2008

The longstanding high burden of obesity in AfricanAmerican women and the more recent, steeper than average rise in obesity prevalence among African‐American children constitute a mandate for an increased focus on obesity prevention and treatment research in African‐American communities. The African‐American Collaborative Obesity Research Network (AACORN) was formed to stimulate and support greater participation in framing and implementing the obesity research agenda by investigators who have both social and cultural grounding in AfricanAmerican life experiences and obesity‐related scientific expertise. AACORN's examination of obesity research agenda issues began in 2003 in conjunction with the Think Tank on Enhancing Obesity Research at the National Heart, Lung, and Blood Institute (NHLBI). The assessment was subsequently expanded to take into account the overall NIH strategic plan for obesity research, literature reviews, and descriptions of ongoing studies. In identifying priorities, AACORN members considered the quality, quantity, focus, and contextual relevance of published research relevant to obesity prevention and treatment in African‐American adults or children. Fifteen recommended research priorities are presented in five categories adapted from the NHLBI Think Tank proceedings: health effects, social and environmental context, prevention and treatment, research methods, and research training and funding. These recommendations from an African‐American perspective build on and reinforce certain aspects of the NHLBI and overall NIH research agendas by providing more specific rationale and directions on areas for enhancement in the type of research being done or in the conceptualization and implementation of that research.
Glucose‐dependent Insulin Modulation of Oscillatory Lipolysis in Perifused Rat Adipocytes
Authors: Getty‐Kaushik Lisa , Richard Ann‐Marie T. , Corkey Barbara E.
Published: April 2008

Objective: We showed glucose‐dependent lipolytic oscillations in adipocytes that are modulated by free fatty acids (FFAs). We hypothesized that the oscillations are driven by oscillatory glucose metabolism that leads to oscillatory formation of α‐glycerophosphate (α‐GP), oscillatory removal of long‐chain coenzyme A (LC‐CoA) by α‐GP to form triglycerides, and oscillatory relief of LC‐CoA inhibition of triglyceride lipases. This study examined the effect of insulin on this hypothesis.

Research Methods and Procedures: Samples were collected every minute from perifused rat adipocytes during the basal state followed by insulin (±glucose) or isoproterenol (±insulin; n = 4 each).

Results: Insulin caused a significant increase in glycerol release (18%), with a concomitant significant decrease in FFA release (38%). Without glucose, insulin had no effect on glycerol release while still decreasing FFA release (35%). Insulin (5 μU/mL) attenuated the response of lipolysis to isoproterenol (∼3‐fold increase with isoproterenol vs. 2‐fold increase with insulin + isoproterenol). However, 1 mU/mL insulin amplified the lipolytic response (∼5‐fold increase in glycerol release with insulin + isoproterenol), with a concomitant increase in FFA reesterification (no increase in FFA release compared with isoproterenol alone).

Discussion: We interpret these results to be due to insulin's ability to increase glucose uptake and conversion to α‐GP, thus removing LC‐CoA inhibition of triglyceride lipases. While the physiological importance of lipolytic oscillations remains to be determined, we hypothesize that such an oscillation may play an important role in the delivery of FFAs to the liver, β cells, and other tissues.
Thyroid‐Stimulating Hormone Stimulates Interleukin‐6 Release from 3T3‐L1 Adipocytes through a cAMP‐Protein Kinase A Pathway
Authors: Antunes Tayze T. , Gagnon AnneMarie , Bell Andrea , Sorisky Alexander
Published: April 2008

Objective: Thyroid‐stimulating hormone (TSH) is a novel modulator of adipokine release from human and mouse adipocytes. The aim of our study was to identify the signal transduction pathways activated by TSH that stimulate interleukin (IL)‐6 production.

Research Methods and Procedures: Mouse 3T3‐L1 preadipocyte and differentiated adipocyte cell cultures were studied. The effect of 0 to 1 μM TSH on IL‐6 protein release into the medium over 0 to 24 hours was assessed. TSH signaling pathways responsible for regulating IL‐6 were studied through the use of 1 μM forskolin, 100 μM 8‐pCPT‐2′‐O‐Me‐cAMP, 10 μM H89, 50 μM PD98059, and 2 μg/mL actinomycin D.

Results: TSH stimulated IL‐6 release by 2.6‐fold from 3T3‐L1 adipocytes at concentrations as low as 0.01 μM but did not alter IL‐6 production of corresponding preadipocytes. Forskolin (elevates intracellular cAMP) stimulated IL‐6 release from 3T3‐L1 adipocytes (n = 3, p < 0.005), and H89, an inhibitor of cAMP‐dependent protein kinase A (PKA), reduced TSH‐stimulated IL‐6 release by 66% (n = 3, p < 0.01), indicating a requirement for cAMP‐dependent PKA. Inhibition of the mitogen‐activated protein kinase pathway with PD98059 did not affect TSH‐stimulated IL‐6 release. Activation of an alternate cAMP target, the exchange protein of cAMP, with 8‐pCPT‐2′‐O‐Me‐cAMP, had no effect on IL‐6 release. TSH raised the level of IL‐6 mRNA, and blockade of transcription with actinomycin D abrogated IL‐6 protein release by TSH (n = 3, p < 0.05).

Discussion: TSH stimulates IL‐6 release from differentiated 3T3‐L1 adipocytes, but not preadipocytes, by signaling through cAMP‐PKA to activate IL‐6 gene transcription.
Evidence in Female Rhesus Monkeys (Macaca mulatta) that Nighttime Caloric Intake is not Associated with Weight Gain
Authors: Sullivan Elinor L. , Daniels Alejandro J. , Koegler Frank H. , Cameron Judy L.
Published: April 2008

Objective: To evaluate the hypothesis that nighttime consumption of calories leads to an increased propensity to gain weight.

Research Methods and Procedures: Sixteen female rhesus monkeys (Macaca mulatta) were ovariectomized and placed on a high‐fat diet to promote weight gain, and we examined whether monkeys that ate a high percentage of calories at night were more likely to gain weight than monkeys that ate the majority of calories during the day.

Results: Within 6 weeks post‐ovariectomy, calorie intake and body weight increased significantly (129 ± 14%, p = 0.04; 103 ± 0.91%, p = 0.02, respectively). Subsequent placement on high‐fat diet led to further significant increases in calorie intake and body weight (368 ± 56%, p = 0.001; 113 ± 4.0%, p = 0.03, respectively). However, there was no correlation between the increase in calorie intake and weight gain (p = 0.34). Considerable individual variation existed in the percentage of calories consumed at night (6% to 64% total daily caloric intake). However, the percentage of calorie intake occurring at night was not correlated with body weight (r = 0.04; p = 0.87) or weight gain (r = 0.07; p = 0.79) over the course of the study. Additionally, monkeys that showed the greatest nighttime calorie intake did not gain more weight (p = 0.94) than monkeys that showed the least nighttime calorie intake.

Discussion: These results show that eating at night is not associated with an increased propensity to gain weight, suggesting that individuals trying to lose weight should not rely on decreasing evening calorie intake as a primary strategy for promoting weight loss.
Intramyocellular Lipid Content and Molecular Adaptations in Response to a 1‐Week High‐Fat Diet
Authors: Schrauwen‐Hinderling Vera B. , Kooi Marianne Eline , Hesselink Matthijs K.C. , Moonen‐Kornips Esther , Schaart Gert , Mustard Kirsty J. , Hardie D. Grahame , Saris Wim H.M. , Nicolay Klaas , Schrauwen Patrick
Published: April 2008

Objective: To investigate molecular adaptations that accompany the elevation of intramyocellular lipid (IMCL) content on a high‐fat (HF) diet for 1 week.

Research Methods and Procedures: Ten subjects consumed a normal‐fat (NF) diet for 1 week, followed by an HF diet for another week. After both dietary periods, we determined the IMCL content by proton magnetic resonance spectroscopy in the vastus lateralis muscle and quantified changes in gene expression, protein content, and activity in biopsy samples. We investigated genes involved in carbohydrate and fatty acid handling [lipoprotein lipase, acetyl‐coenzyme A carboxylase (ACC) 2, hormone‐sensitive lipase, hexokinase II, and glucose transporter 4] and measured protein levels of CD36 and phosphorylated and unphosphorylated ACC2 and the activity of adenosine monophosphate‐activated kinase.

Results: IMCL content was increased by 54% after the HF period. Lipoprotein lipase mRNA concentration was increased by 33%, whereas ACC2 mRNA concentration tended to be increased after the HF diet. Hexokinase II, glucose transporter 4, and hormone‐sensitive lipase mRNA were unchanged after the HF diet. ACC2 and CD36 protein levels, phosphorylation status of ACC2, and adenosine monophosphate‐activated kinase activity did not change in response to the HF diet.

Discussion: We found that IMCL content in skeletal muscle increased after 1 week of HF feeding, accompanied by molecular adaptations that favor fat storage in muscle rather than oxidation.
Effect of Low‐ and High‐Calcium Dairy‐Based Diets on Macronutrient Oxidation in Humans
Authors: Melanson Edward L. , Donahoo William T. , Dong Fran , Ida Therese , Zemel Michael B.
Published: April 2008

Objective: Higher calcium and dairy intakes may be associated with lower body weights, but a mechanism in humans has yet to be elucidated. We compared the effects of a dairy‐based high‐calcium diet and a low‐calcium diet on macronutrient oxidation.

Research Methods and Procedures: Subjects (10 men and nine women) consumed a low‐dairy (LD, ∼one serving per day, ∼500 mg Ca2+/d) or high‐dairy (HD, ∼three to four servings per day, ∼1400 mg Ca2+/d) energy balance diet for 1 week. Each diet condition was performed twice. On the 7th day, subjects were studied in a room calorimeter under one of four study conditions, applied in a randomized crossover design. Within each diet condition, subjects were studied under conditions of energy balance and acute energy deficit. The deficit (−600 kcal/d) was induced only for the 24 hours that subjects resided in the room and was achieved by a combination of caloric restriction and exercise.

Results: Under energy balance conditions, there was no effect of diet treatment on respiratory quotient or 24‐hour macronutrient oxidation. Under energy deficit conditions, 24‐hour fat oxidation was significantly increased on the HD diet (HD with deficit = 136 ± 13 g/d, LD with deficit = 106 ± 7 g/d, p = 0.02).

Discussion: Consumption of a dairy‐based high‐calcium diet increased 24‐hour fat oxidation under conditions of acute energy deficit. We hypothesize that these effects are due to an increased fat oxidation during exercise.
ACDC/Adiponectin and PPAR‐γ Gene Polymorphisms: Implications for Features of Obesity
Authors: Tankó László B. , Siddiq Afshan , Lecoeur Cécile , Larsen Philip J. , Christiansen Claus , Walley Andrew , Froguel Philippe
Published: April 2008

Objective: The main purpose of this study was to investigate associations of single‐nucleotide polymorphisms (SNPs) in the adipocyte C1q and collagen domain‐containing (ACDC) gene and its regulator, the nuclear peroxisome proliferator‐activated receptor (PPAR)‐γ gene, with body fat mass and its topographical distribution in postmenopausal women.

Research Methods and Procedures: Participants were 1501 healthy women, 60 to 85 years old, who were genotyped for four SNPs in the ACDC gene (−11391G/A, −11377C/G, +45T/G, +276G/T) and the Pro12Ala SNP in the PPAR‐γ gene. Total body fat mass and the central to peripheral fat mass ratio (CFM/PFM ratio) were measured using DXA. Adiponectin and homeostasis model assessment of insulin resistance were measured in 287 subjects.

Results: The −11377C/G SNP was associated with adiponectin (p < 0.001) and the CFM/PFM ratio (p = 0.005); the G allele being associated with low adiponectin and high CFM/PFM ratio. Similar associations of adiponectin (p = 0.0001) and the CFM/PFM ratio (p = 0.002) characterized the 1_2 (G_G) promoter haplotype (11391G/A_−11377C/G). Genotype variation of SNP Pro12Ala was associated with total body fat mass (p = 0.04); women with GG being the most obese (p = 0.01). The Ala/Ala (GG) genotype of Pro12Ala SNP interacted with the CC genotype of SNP‐11377C/G in the determination of BMI (p = 0.001), when analyzed using a codominant model.

Discussion: Polymorphisms in the ACDC gene are associated with body fat distribution, whereas the Pro12Ala polymorphism in PPAR‐γ is associated with overall adiposity, apparently in interaction with an ACDC promoter SNP.
Meta‐analysis on the G‐308A Tumor Necrosis Factor α Gene Variant and Phenotypes Associated with the Metabolic Syndrome
Authors: Sookoian Silvia C. , González Claudio , Pirola Carlos J.
Published: April 2008

Objective: The G‐308A tumor necrosis factor (TNF) α gene variant has been associated with obesity, insulin resistance, and hypertension. We performed a systematical review of the literature by means of a meta‐analysis to assess the association of the G‐308A TNFα polymorphism with the components of the metabolic syndrome.

Research Methods and Procedures: Studies were identified by searches of the literature for reports using the terms: diabetes, insulin resistance, hypertension, obesity or metabolic syndrome and TNF, variants or polymorphism or alleles, and Nco or −308. From 824 reports, we included 31 observational studies, case control and cohort at baseline, which analyzed the association between the TNFα polymorphism and one or more components of the metabolic syndrome. A fixed effect model was used to pool data from individual studies.

Results: Obesity [odds ratio, 1.23; 95% confidence interval (CI), 1.045 to 1.45; p = 0.013] in a total of 3562 individuals from eight homogeneous studies, systolic arterial blood pressure (standardized difference, 0.132; 95% CI, 0.016 to 0.25; p < 0.03) in a total of 1624 individuals from four homogeneous studies and plasma insulin levels (standardized difference, 0.095; 95% CI, 0.020 to 0.17; p = 0.013) in a total of 3720 subjects from 16 homogeneous studies were positively associated with the −308A variant.

Discussion: These results indicate that individuals who carried the −308A TNFα gene variant are at 23% risk of developing obesity compared with controls and showed significantly higher systolic arterial blood pressure and plasma insulin levels, supporting the hypothesis that the TNFα gene is involved in the pathogenesis of the metabolic syndrome.
Total and Regional Fat Distribution is Strongly Influenced by Genetic Factors in Young and Elderly Twins
Authors: Malis Charlotte , Rasmussen Eva L. , Poulsen Pernille , Petersen Inge , Christensen Kaare , Beck‐Nielsen Henning , Astrup Arne , Vaag Allan A.
Published: April 2008

Objective: Indirect estimates of obesity such as BMI seem to be strongly influenced by genetic factors in twins. Precise measurements of total and regional fat as determined by direct techniques such as DXA scan have only been applied in a few twin studies. The aim of the present study was to estimate the heritability (h2) of total and regional fat distribution in young and elderly Danish twins.

Research Methods and Procedures: Monozygotic (108) and dizygotic (88) twins in two age groups (25 to 32 and 58 to 66 years) underwent anthropometric measurements and DXA scans. Intraclass correlations and etiologic components of variance were estimated for total and regional fat percentages using biometric modeling.

Results: The intraclass correlations demonstrated higher correlations for all fat percentages among monozygotic twins as compared with dizygotic twins. The biometric modeling revealed a major genetic component (h2) of total (h2young = 0.83, h2elderly = 0.86) and regional fat percentages (trunk, h2young = 0.82, h2elderly = 0.85; lower body, h2young = 0.83, h2elderly = 0.81; and trunk/lower body, h2young = 0.83, h2elderly = 0.71) in both the young and elderly twins.

Discussion: The h2 estimates emphasize that body fat and distribution as determined by DXA scan are under extensive genetic control.
Stability of the Association between Birth Weight and Childhood Overweight during the Development of the Obesity Epidemic
Authors: Rugholm Susi , Baker Jennifer L. , Olsen Lina W. , Schack‐Nielsen Lene , Bua Jenny , Sørensen Thorkild I. A.
Published: April 2008

Objective: To assess whether changes in the birth weight distribution or changes in the association of birth weight with the later risk of childhood overweight have contributed to the development of the obesity epidemic.

Research Methods and Procedures: A Danish population‐based cohort study of 124,615 girls and 128,346 boys (ages 6 to 13 years), born between 1936 and 1983, were studied. Birth weight and annual measurements of height and weight were obtained from school health records. Overweight was defined by BMI in relation to internationally accepted criteria. The relative risk of being overweight by birth weight was calculated separately for each age, sex, and time period.

Results: The birth weight distribution remained relatively stable over time. Compared with children with a birth weight of 3.0 to 3.5 kg, the risk of overweight increased consistently with each increase in birth weight category among girls and boys and at all ages between 6 and 13 years. Furthermore, the association between birth weight and increased risk of overweight in childhood remained stable across a 48‐year period.

Discussion: The increase in the prevalence of overweight could not be explained by time trends in the distribution of birth weight or by changes in the association between birth weight and the later risk of overweight over time. This implies that, unless the prenatal environment influences the later risk of overweight without increasing birth weight, the environmental influences contributing to the obesity epidemic in children of school age operate in the early postnatal period.
Comparison of Fat Storage between Fischer 344 and Obesity‐Resistant Lou/C Rats Fed Different Diets**
Authors: Héliès Jean‐Marie , Diane Abdoulaye , Langlois Allan , Larue‐Achagiotis Christiane , Fromentin Gilles , Tomé Daniel , Mormède Pierre , Marissal‐Arvy Nathalie
Published: April 2008

Objective: We aimed to characterize further the Lou/C (LOU) and Fischer 344 (F344) rat strains for nutritional traits to validate their use as contrasting strains for molecular genetic studies.

Research Methods and Procedures: Five batches of LOU and F344 rats were used to measure caloric intake, weight gain, and body composition when fed a chow diet, a self‐selection diet (together with the study of preferences for macronutrients), hypercaloric diets, and a chow diet in a cold environment.

Results: Despite a higher caloric intake when fed a chow diet, LOU rats showed a lower weight gain, final body weight, and percentage of fat tissue, together with a higher percentage of carcass weight, than F344 rats. When fed a self‐selection diet, LOU males ingested less protein and more fat than F344 males, and the reverse was observed for females. In this condition, feed efficiency was reduced in LOU but increased in F344 rats compared with the chow diet. Diet‐induced obesity was observed in F344 rats but not in LOU rats fed hypercaloric diets. In a cold environment, both LOU and F344 rats displayed an increased percentage of brown adipose tissue compared with control groups, together with a higher caloric intake.

Discussion: The study shows robust nutritional differences between the LOU rat, a lean strain with a low feed efficiency and resistant to diet‐induced obesity, and the contrasting F344 rat strain. It also shows the interest in these strains for studying the genetic components of resistance to obesity.
Criteria for Patient Selection and Multidisciplinary Evaluation and Treatment of the Weight Loss Surgery Patient
Authors: Saltzman Edward , Anderson Wendy , Apovian Caroline M. , Boulton Hannah , Chamberlain Alison , Cullum‐Dugan Diana , Cummings Susan , Hatchigian Edward , Hodges Barbara , Keroack Christopher R. , Pettus Mark , Thomason Phyllis , Veglia Linda , Young Lorraine S.
Published: April 2008

Objective: To provide evidence‐based guidelines for patient selection and to recommend the medical and nutritional aspects of multidisciplinary care required to minimize perioperative and postoperative risks in patients with severe obesity who undergo weight loss surgery (WLS).

Research Methods and Procedures: Members of the Multidisciplinary Care Task Group conducted searches of MEDLINE and PubMed for articles related to WLS in general and medical and nutritional care in particular. Pertinent abstracts and literature were reviewed for references. Multiple searches were carried out for various aspects of multidisciplinary care published between 1980 and 2004. A total of 3000 abstracts were identified; 242 were reviewed in detail.

Results: We recommended multidisciplinary screening of WLS patients to ensure appropriate selection; preoperative assessment for cardiovascular, pulmonary, gastrointestinal, endocrine, and other obesity‐related diseases associated with increased risk for complications or mortality; preoperative weight loss and cessation of smoking; perioperative prophylaxis for deep vein thrombosis and pulmonary embolism (PE); preoperative and postoperative education and counseling by a registered dietitian; and a well‐defined postsurgical diet progression.

Discussion: Obesity‐related diseases are often undiagnosed before WLS, putting patients at increased risk for complications and/or early mortality. Multidisciplinary assessment and care to minimize short‐ and long‐term risks include: comprehensive medical screening; appropriate pre‐, peri‐, and postoperative preparation; collaboration with multiple patient care disciplines (e.g., anesthesiology, pulmonary medicine, cardiology, and psychology); and long‐term nutrition education/counseling.
Best Practice Guidelines on Informed Consent for Weight Loss Surgery Patients
Authors: Sabin James , Fanelli Robert , Flaherty Helen , Istfan Nawfal , Mariner Wendy , Barnes Janet Nally , Pratt Janey S.A. , Rossi Laura , Samour Patricia
Published: April 2008

Objective: To provide evidence‐based guidelines on informed consent and the education that underlies it for legally competent, severely obese weight loss surgery (WLS) patients.

Research Methods and Procedures: We conducted a systematic review of the scientific literature published on MEDLINE between 1984 and 2004. Three articles focused on informed consent for WLS; none was based on empirical studies. We summarized each paper and assigned evidence categories according to a grading system derived from established evidence‐based models. We also relied on informed consent and educational materials from six WLS programs in Massachusetts. All evidence is Category D. Recommendations were based on a review of the available literature, informed consent materials from WLS programs, and expert opinion.

Results: This Task Group found that the informed consent process contributes to long‐term outcome in multiple ways but is governed by limited legal requirements. We focused our report on the legal and ethical issues related to informed consent, i.e., disclosure vs. comprehension. Recommendations centered on the importance of assessing patient comprehension of informed consent materials, the content of those materials, and the use of active teaching/learning techniques to promote understanding.

Discussion: Although demonstrated comprehension is not a legal requirement for informed consent in Massachusetts or other states, the members of this Task Group found that the best interests of WLS patients, providers, and facilities are served when clinicians engage patients in active learning and collaborative decision making.
Best Practice Recommendations for Anesthetic Perioperative Care and Pain Management in Weight Loss Surgery
Authors: Schumann Roman , Jones Stephanie B. , Ortiz Vilma E. , Connor Kathleen , Pulai Istvan , Ozawa Edwin T. , Harvey Alan M. , Carr Daniel B.
Published: April 2008

Objective: To develop evidence‐based recommendations that optimize the safety and efficacy of perioperative anesthetic care and pain management in weight loss surgery (WLS) patients.

Research Methods and Procedures: This Task Group examined the scientific literature on anesthetic perioperative care and pain management published in MEDLINE from January 1994 to March 2004. We also reviewed additional data from other sources (e.g., book chapters). The search yielded 195 abstracts, of which 35 references were reviewed in detail. Task Group consensus was used to provide recommendations when evidence in the literature was insufficient.

Results: We developed anesthesia practice and patient safety advisory recommendations for preoperative evaluation, intraoperative management, and postoperative care and pain management of WLS patients. We also provided suggestions related to medical error reduction and systems improvements, credentialing, and future research.

Discussion: Obesity‐related comorbidities including obstructive sleep apnea place WLS patients at increased risk for complications perioperatively. Regarding perioperative safety and outcomes, conclusive evidence beyond the accepted standard of care in the reviewed literature is limited. Few reports specifically address the perioperative needs of severely obese patients. In this advisory, we synthesize current knowledge and make best practice recommendations for perioperative care and pain management in WLS patients. These recommendations require periodic review as further medical knowledge and evidence evolve.
Best Practices for Perioperative Nursing Care for Weight Loss Surgery Patients
Authors: Mulligan Ann , Young Lorraine S. , Randall Sheldon , Raiano Carol , Velardo Priscilla , Breen Catherine , Bushee Laura
Published: April 2008

Objective: To describe the unique nursing responsibilities involved in providing nursing care to severely obese weight loss surgery patients and to develop evidence‐based guidelines for safe patient care.

Research Methods and Procedures: We performed a systematic review of the scientific literature using MEDLINE and CINAHL. A specific search of nursing journals from 1985 to 2004 identified 134 articles; 16 were found to be pertinent. These were reviewed in detail and used in the context of this report. The quality of the evidence was graded according to a system derived from established evidence‐based models. Recommendations were developed from published evidence and expert opinion.

Results: This Task Group found that safe and competent nursing care requires assessment of, and provision for, the complex physical and psychological needs of weight loss surgery patients. We developed evidence‐based guidelines for preoperative, perioperative, and postoperative care that address risk factors unique to severely obese patients. We also addressed issues related to the use of proper body mechanics and positioning to avoid on‐the‐job injury to nursing staff.

Discussion: We found that patient safety is best served when nurses are specifically trained to deal with the physical, medical, and psychosocial needs of severely obese patients and when they play an integral role in the multidisciplinary healthcare team. This role should start with a patient's first contact with the system and continue through discharge and follow‐up. Special attention needs to be paid to the widespread bias and discrimination that severely obese individuals often experience.
Best Practice Guidelines in Pediatric/Adolescent Weight Loss Surgery
Authors: Apovian Caroline M. , Baker Christina , Ludwig David S. , Hoppin Alison G. , Hsu George , Lenders Carine , Pratt Janey S.A. , Forse R. Armour , O'Brien Adrienne , Tarnoff Michael
Published: April 2008

Objective: To establish evidence‐based guidelines for best practices in pediatric/adolescent weight loss surgery (WLS).

Research Methods and Procedures: We carried out a systematic search of English‐language literature in MEDLINE on WLS performed on children and adolescents. Key words were used to narrow the field for a selective review of abstracts. Data were extracted, and evidence categories were assigned according to a grading system based on established evidence‐based models. Eight pertinent case series, published between 1980 and 2004, were identified and reviewed. These data were supplemented with expert opinions and literature on WLS in adults.

Results: Recommendations focused on patient safety, reduction of medical errors, systems improvements, credentialing, and future research. We developed evidence‐based criteria for eligibility, assessment, treatment, and follow‐up; recommended surgical procedures based on the best available evidence; and established minimum guideline requirements for data collection.

Discussion: Lack of adequate data and gaps in knowledge were cited as important reasons for caution. Physiological status, comprehensive screening of patients and their families, and required education and counseling were identified as key factors in assessing eligibility for surgery. Data collection and peer review were also identified as important issues in the delivery of best practice care.