Obesity Research & Clinical Practice

Association between insulin resistance, cardiovascular risk factors and overweight in Japanese schoolchildren

Chie Fujii, Hisataka Sakakibara — 2011-05-19

Summary: Objective: The aim of this study was to examine the association between insulin resistance, cardiovascular risk factors and overweight in Japanese schoolchildren.Methods: A cross-sectional study was performed on 310 schoolchildren (155 boys and 155 girls) of the fifth grade and the eighth grade in a town in Nagano Prefecture, Japan. The survey was conducted on anthropometric, blood examinations, and by calculation of body mass index (BMI: body weight/body height2) and HOMA-IR (fasting insulin×fasting glucose/405).Results: Hemoglobin A1c and fasting glucose were not associated with BMI, whereas fasting insulin and HOMA-IR were significantly higher in overweight children in comparison with the lowest quartile BMI group. In the overweight, the mean and standard deviation of HOMA-IR were 2.51±1.01, and the prevalence of HOMA-IR≧2.5 was 46.8%. Schoolchildren with HOMA-IR≧2.5 had more several cardiovascular risk factors.Conclusions: Insulin resistance was observed in overweight Japanese children, though their hemoglobin A1c and fasting glucose were within the normal range. In addition, with higher BMI, the number of cardiovascular risk factors was increased. Weight management should be started in childhood.

Dysmetabolic signals in “metabolically healthy” obesity

2011-05-25

Summary: Background: Obesity is associated with decreased insulin sensitivity, atherogenic dyslipidemia and hypertension, but clinical studies have also identified a “metabolically healthy” obese phenotype.Objective: To compare the characteristics of so-called “metabolically healthy” obese (MHO), normal weight subjects (MHNW) and obese with insulin resistance in the United States National Health and Nutrition Examination Survey, 1999-2004 (NHANES).Design, setting and participants: Insulin resistance was defined by a homeostatic model assessment (HOMA) value in the upper tertile for the entire NHANES cohort. “Metabolic health” was defined as the absence of diabetes, insulin resistance, metabolic syndrome, and lipid-lowering therapy. The study evaluated the 314 MHO, 1173 MHNW and 843 insulin-resistant obese from among the 6485 non-diabetic, non-pregnant adults aged 20–79 years.Main outcome measures: Demographic, metabolic, nutrition and physical activity features.Results: MHO and MHNW groups were similar regarding age, and fasting glucose and triglyceride levels. MHO had higher insulin (P<0.0001), insulin resistance as measured with the homeostatic model (P<0.0001), non-HDL cholesterol (P=0.002 in females and P=0.049 in males) and C-reactive protein levels (P<0.0001 in females and P=0.038 in males), and lower high-density lipoprotein cholesterol (HDL) levels (P<0.002). In addition, MHO females had higher low-density lipoprotein (LDL) cholesterol levels (P=0.012) and systolic blood pressure (P=0.02), and lower intake of dietary fiber (P=0.0009) and levels of physical activity (P=0.002). Triglycerides levels were normal in the MHO group.Conclusions: “Metabolically healthy” obese people have multiple dysmetabolic changes that may signal increased risk for coronary artery disease.

Acceptance and commitment therapy for bariatric surgery patients, a pilot RCT

Sandra Weineland, Dag Arvidsson, Thanos P. Kakoulidis, Joanne Dahl — 2011-05-18

Summary: Bariatric surgery (BS) is rated as the best evidence based treatment for obesity with regard to weight loss and maintenance of weight loss evaluated to date. Although BS interventions are effective, 20–30% of BS patients start to regain weight within 24 months. Emotional eating is a behavior pattern which has been found to predict poor outcome. The aim of this study is to evaluate the effects of acceptance and commitment therapy (ACT) for patients who underwent BS, with regard to emotional eating, body dissatisfaction and quality of life. This study is a randomized controlled trial (n=39) with two conditions (1) ACT including two face-to-face sessions and support via an Internet application and (2) treatment as usual (TAU) comprising the standard follow-up used by the BS team. Results show that participants in the ACT condition significantly improve on eating disordered behaviors, body dissatisfaction, quality of life and acceptance for weight related thoughts and feelings, as compared to those in the TAU group. This study shows that it is possible to improve effects of BS by specifically targeting emotional eating behavior.

The risky body mass index ranges for significant hepatitis B viral load: A campus-based study

2011-05-18

Summary: Significant hepatitis B viral load (≥10,000 copies/mL) was established to increase risk of advanced liver diseases. The aim of this study was to explore the metabolic risk factors for significant hepatitis B viral load. A campus-based cohort consisting of 146 participants of chronic hepatitis B virus (HBV) infection in Northern Taiwan was investigated in 2009. Clinical profiles including serum levels of deoxyribonucleic acid of hepatitis B virus (HBV DNA) were collected. Hepatitis B e antigen (HBeAg) serostatus, high alanine aminotransferase level, body mass index (BMI) ranges, and insulin resistance were related to significant HBV DNA levels in univariate analysis. Compared to individuals with BMI 23–24.9kg/m2 in multivariate analysis, those with BMI ≥25kg/m2 (OR=3.86, 95% CI=1.38–10.8, P=0.010) and those with BMI <23kg/m2 (OR=4.47, 95% CI=1.32–15.2, P=0.016) were at higher risk for significant HBV DNA levels. This phenomenon was also manifest in HBeAg seronegatives, who contributed to a majority of significant viral load in our study. Furthermore, insulin resistance and BMI ≥25kg/m2 had positive additive effects on significant HBV DNA levels (adjusted OR=9.34, 95% CI=1.74–50.3, P=0.009). In conclusion, having certain BMI ranges (BMI ≥25kg/m2 or BMI <23kg/m2) could be a risk factor of significant HBV DNA levels.

Do cell phones, iPods/MP3 players, siblings and friends matter? Predictors of child body mass in a U.S. Southern Border City Middle School

2011-05-25

Summary: Objective: This study examines the association of children's (i) micro-social environment, specifically siblings [kin-friends] and friends from school and neighborhood [non-kin-friends], and (ii) ownership of information and communication technologies (ICT), specifically cell phones and iPod/MP3 players, with body mass index percentile (BMIp).Subjects: Fifty-five randomly selected 6th graders with a mean age of 12 years, stratified by gender (23 boys and 32 girls), from a Texas middle school located in a city along the U.S. southern border.Methods: The linear regression of BMIp on number of siblings and of non-kin-friends, and ownership of cell phone and of iPod/MP3 player was examined using two models: M1 was based on the manual selection of predictors from a pool of potential predictors. M2 was derived from the predictors specified in M1 using backward elimination technique. Because sample size was small, the significance of regression coefficients was evaluated using robust standard errors to calculate t-values. Data for predictors were obtained through a survey. Height and weight were obtained through actual anthropometric measurements. BMIp was calculated using the on-line BMI calculator of the Center for Disease Control and Prevention.Results: Findings reveal that children's social environment and ICT ownership predict BMIp; specifically, number of siblings (M2: β=−0.34, p-value<.001), and ownership of iPod/MP3 players (M2: β=0.33, p-value<.001). These results underscore the importance of family in configuring, and of new personal technical devices (that encourage solitary, and oftentimes sedentary, activities) in predicting child body mass.

Hepatic tumor necrosis factor-α, leptin and adiponectin expression in morbid obese patients: Clinicopathological correlations

Phui-Ly Liew, Chi-Long Chen, Yi-Chih Lee, Ming-Te Huang, Weu Wang, Wei-Jei Lee — 2011-05-30

Summary: Background: Nonalcoholic fatty liver disease (NAFLD) is associated with obesity. We retrospectively studied the clinicopathology and different hepatic adipocytokine expressions between nonalcoholic steatohepatitis (NASH) and non-NASH in morbid obesity.Methods: We enrolled 40 patients undergoing liver biopsy during bariatric surgery. We analyzed hepatic mRNA and immunohistochemistry of TNF-α, leptin, adiponectin and adiponectin receptor.Results: Thirty patients (75%) presented with NASH, including 11 with mild fibrosis and 19 with advanced fibrosis. The HbA1c (P=0.000), AST (P=0.000), ALT (P=0.000), GGT (P=0.016) and liver fibrosis (P=0.028) have statistically difference between NASH and non-NASH groups. Steatosis was the only significant factor (r=0.348, P<0.05) associated with TNF-α mRNA level. Adiponectin mRNA was inversely associated with C-peptide (r=−0.416, P<0.05) and uric acid level (r=−0.426, P<0.05). The best predictors for TNF-α immunostain were hemoglobin (r=0.432, P<0.01), AST (r=0.371, P<0.05), lobular inflammation (r=0.315, P<0.05), portal inflammation (r=0.331, P<0.05), and NAS (r=0.365, P<0.05). Leptin immunostain was correlated with C-peptide (r=0.356, P<0.05) and portal inflammation (r=0.334, P<0.05). The AdipoRII immunoexpression was negatively correlated with systolic blood pressure (r=−0.481, P<0.01). Multivariate linear regressions of adipocytokine profile related mostly to age, gender, systolic blood pressure, serum uric acid, steatosis, NAS and portal inflammation.Conclusion: Although different adipocytokines may be associated with NAFLD progression in morbid obesity, their major correlations in the pathogenesis of obesity-related NASH are not clear. Additional confirmatory studies are deserved.

Ageing, adiposity indexes and low muscle mass in a clinical sample of overweight and obese women

M. Siervo, B.C.M. Stephan, G. Nasti, A. Colantuoni — 2011-06-10

Summary: Objective: Ageing is associated with a progressive decline in the quantity (mass) and quality (function) of the muscular tissue. To assess the prevalence of low muscle mass (LMM) alone and in combination with high adiposity (LMM-HA) in a clinical representative sample of adult women and to determine how the prevalence of (LMM-HA) changes using different adiposity indexes.Methods: 763 overweight and obese women (age range: 18–87 years) attending a weight loss clinic. Weight, height, and waist circumference (WC) were measured and BMI calculated. Bioelectrical impedance (BIA) was used to measure fat mass (FM). Skeletal muscle index (SMI) was used for the diagnosis of LMM. Adiposity indexes (BMI, WC, FM%, FM index) were combined with SMI to assess the prevalence of LMM-HA.Results: The prevalence of LMM was 27.4% in women older than 60 years. Established cut-off scores for excess adiposity determined differences in the prevalence of LMM-HA. The lowest was observed using the BMI derived cut-off score (≥30kg/m2), with FM% (≥35%) the most inclusive, classifying more than 90% of sarcopenia cases as LMM-HA.Conclusions: The prevalence of LMM-HA is different between anthropometric (BMI, WC) and bioimpedance measures (FM% and FMI) of adiposity. The sensitivity of the adiposity indexes for the diagnosis of sarcopenic obesity and its impact on the prediction of cardio-metabolic diseases remain to be tested.

A 12-week, randomised, controlled trial to examine the acceptability of the Korean diet and its effectiveness on weight and metabolic parameters in an Australian overweight and obese population

2011-07-04

Summary: Background: South Korea has a significantly lower prevalence of overweight and obesity compared to Western countries. This may be due to differences between the traditional Korean diet (KD) and western diet (WD).Objective: Our study investigated whether a Western population would accept a KD, compared to a WD, in a weight loss oriented lifestyle program.Design: 70 overweight or obese participants were randomised to a 12-week weight loss program. All participants followed a standardised lifestyle intervention incorporating diet, exercise and behavioural modification techniques. KD participants were provided with a traditional Korean lunch and dinner (Monday to Saturday). WD participants were provided with a weekly grocery food voucher. Weight and metabolic parameters were measured.Results: 60 participants completed the study (KD=25; WD=35). No significant difference was found for percentage weight loss (KD: −5.8±4.7%; WD: −5.7±4.1%; p=0.93). On the 10-item Food Acceptability Questionnaire, there was a decline in acceptance for the KD group over the 12-week intervention.Conclusions: When incorporated into a lifestyle intervention a traditional KD resulted in similar weight loss to a WD, despite a significantly higher energy intake. Food acceptability scores significantly favoured the WD for some of the measures at week 12, and the most common staple Korean foods were reported highest amongst the food returns, suggesting that the KD was not as well accepted and less enjoyable on a range of measures. More variability in the menu and flexibility in portion sizes of the KD may improve its acceptance and could further optimise its weight loss potential for Westerners.

Quercetin/adenosine combination may induce insulin resistance in high fat diet-fed mice

Chooi Yeng Lee — 2011-06-20

Summary: Quercetin and adenosine are natural antioxidants separately claimed to improve metabolic syndrome parameters. The effect of this combination (QA) was examined in high fat diet-fed mice. Results showed that growth and blood parameters, as observed for quercetin-treated mice, were not significantly different from the control. Adenosine alone caused hyperglycemia and reduced plasma adiponectin. QA feeding led to increased adiposity and circulatory insulin, and concomitantly down-regulated liver eNOS and LFABP expressions. This showed that interaction occurred between quercetin and adenosine, and combined ingestion may lead to insulin resistance, while adenosine does not prevent the development of metabolic syndrome.