Diabetes mellitus is commonly associated with systolic/diastolic hypertension, and a wealth of epidemiological data suggest that this association is independent of age and obesity. Much evidence indicates that the link between diabetes and essential hypertension is hyperinsulinemia. Thus, when hypertensive patients, whether obese or of normal body weight, are compared with age- and weight-matched normotensive control subjects, a heightened plasma insulin response to a glucose challenge is consistently found. A state of cellular resistance to insulin action subtends the observed hyperinsulinism. With the insulin/glucose-clamp technique, in combination with tracer glucose infusion and indirect calorimetry, it has been demonstrated that the insulin resistance of essential hypertension is located in peripheral tissues (muscle), is limited to nonoxidative pathways of glucose disposal (glycogen synthesis), and correlates directly with the severity of hypertension. The reasons for the association of insulin resistance and essential hypertension can be sought in at least four general types of mechanisms: Na+ retention, sympathetic nervous system overactivity, disturbed membrane ion transport, and proliferation of vascular smooth muscle cells. Physiological maneuvers, such as calorie restriction (in the overweight patient) and regular physical exercise, can improve tissue sensitivity to insulin; evidence indicates that these maneuvers can also lower blood pressure in both normotensive and hypertensive individuals. Insulin resistance and hyperinsulinemia are also associated with an atherogenic plasma lipid profile. Elevated plasma insulin concentrations enhance very-low-density lipoprotein (VLDL) synthesis, leading to hypertriglyceridemia. Progressive elimination of lipid and apolipoproteins from the VLDL particle leads to an increased formation of intermediate-density and low-density lipoproteins, both of which are atherogenic. Last, insulin, independent of its effects on blood pressure and plasma lipids, is known to be atherogenic. The hormone enhances cholesterol transport into arteriolar smooth muscle cells and increases endogenous lipid synthesis by these cells. Insulin also stimulates the proliferation of arteriolar smooth muscle cells, augments collagen synthesis in the vascular wall, increases the formation of and decreases the regression of lipid plaques, and stimulates the production of various growth factors. In summary, insulin resistance appears to be a syndrome that is associated with a clustering of metabolic disorders, including non-insulin-dependent diabetes mellitus, obesity, hypertension, lipid abnormalities, and atherosclerotic cardiovascular disease.

Insulin Resistance: A Multifaceted Syndrome Responsible for NIDDM, Obesity, Hypertension, Dyslipidemia, and Atherosclerotic Cardiovascular Disease

A review of 144 published studies of the relationship between socioeconomic status (SES) and obesity reveals a strong inverse relationship among women in developed societies. The relationship is inconsistent for men and children in developed societies. In developing societies, however, a strong direct relationship exists between SES and obesity among men, women, and children. A review of social attitudes toward obesity and thinness reveals values congruent with the distribution of obesity by SES in different societies. Several variables may mediate the influence of attitudes toward obesity and thinness among women in developed societies that result in the inverse relationship between SES and obesity. They include dietary restraint, physical activity, social mobility, and inheritance.

Socioeconomic Status and Obesity: A Review of the Literature

Background. Overweight in adults is associated with increased morbidity and mortality. In contrast, the long-term effect of overweight in adolescence on morbidity and mortality is not known. Methods. We studied the relation between overweight and morbidity and mortality in 508 lean or overweight adolescents 13 to 18 years old who participated in the Harvard Growth Study of 1922 to 1935. Overweight adolescents were defined as those with a body-mass index that on two occasions was greater than the 75th percentile in subjects of the same age and sex in a large national survey. Lean adolescents were defined as those with a body-mass index between the 25th and 50th percentiles. Subjects who were still alive were interviewed in 1988 to obtain information about their medical history, weight, functional capacity, and other risk factors. For those who had died, information on the cause of death was obtained from death certificates. Results. Overweight in adolescent subjects was associated with an increase...

https://www.nejm.org/doi/pdf/10.1056/NEJM199211053271904

Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard Growth Study of 1922 to 1935.

Higher BMI during childhood is associated with an increased risk of CHD in adulthood. The associations are stronger in boys than in girls and increase with the age of the child in both sexes. Our findings suggest that as children are becoming heavier worldwide, greater numbers of them are at risk of having CHD in adulthood.

/pdf/childhood-body-mass-index-and-the-risk-of-coronary-heart-1b62ll4umc.pdf

Childhood body-mass index and the risk of coronary heart disease in adulthood

Objective: To examine prevalence of overweight and trends in overweight for children and adolescents in the US population. Design: Nationally representative cross-sectional surveys with an in-person interview and a medical examination, including measurement of height and weight. Participants: Between 3000 and 14000 youths aged 6 through 17 years examined in each of five separate national surveys during 1963 to 1965, 1966 to 1970, 1971 to 1974, 1976 to 1980, and 1988 to 1991 (Cycles II and III of the National Health Examination Survey, and the first, second, and third National Health and Nutrition Examination Surveys, respectively). Main Outcome Measures: Prevalence of overweight based on body mass index and 85th or 95th percentile cutoff points from Cycles II and III of the National Health Examination Survey. Results: From 1988 to 1991, the prevalence of over-weight was 10.9% based on the 95th percentile and 22% based on the 85th percentile. Overweight prevalence increased during the period examined among all sex and age groups. The increase was greatest since 1976 to 1980, similar to findings previously reported for adults in the United States. Conclusions: Increasing overweight among youths implies a need to focus on primary prevention. Attempts to increase physical activity may provide a means to address this important public health problem. (Arch Pediatr Adolesc Med. 1995;149:1085-1091)

Overweight Prevalence and Trends for Children and Adolescents: The National Health and Nutrition Examination Surveys, 1963 to 1991

Quantification of synovistis by MRI: correlation between dynamic and static gadolinium-enhanced magnetic resonance imaging and microscopic and macroscopic signs of synovial inflammation.

http://labs.biology.ucsd.edu/pprice/YKL-40%20papers/Volck%202001.pdf

Studies on YKL-40 in knee joints of patients with rheumatoid arthritis and osteoarthritis. Involvement of YKL-40 in the joint pathology

In a suburban area of Copenhagen with approximately 620,000 inhabitants, all the openly operated on meniscal lesions of the knee joint between 1982 and 1984 inclusive were reviewed. The mean annual incidence of meniscal lesions per 10,000 inhabitants was 9.0 in males and 4.2 in females. The highest incidences were seen in the 3rd, 4th, and 5th decades of life. A higher frequency of trauma related to onset of symptoms was found among males (77 percent) than among females (64 percent). The bucket-handle lesion was the most frequent type of meniscal lesion in males (35 percent), whereas peripheral detachment was the most frequent in females (41 percent). A variable frequency of trauma inducing the lesions in males and females did not explain differences in type of meniscal lesion. Nineteen percent of our 1,215 patients had a partial meniscectomy, whereas 0.7 percent had meniscal repair.

https://www.tandfonline.com/doi/pdf/10.3109/17453679008993557

Epidemiology of meniscal lesions in the knee: 1,215 open operations in copenhagen 1982-84

STUDY OBJECTIVE: The aim was to investigate the characteristics of non-responders to an invitation to attend a health examination. DESIGN: Taking advantage of an ongoing study of obesity, this was a survey of a cohort of severely obese men, with a randomly selected control group. PARTICIPANTS: The participants were draftees to the compulsory Danish military draft board examination between 1943 and 1977. Among 362,200 draftees, 1940 were identified as severely obese (body mass index greater than or equal to 31 kg/m2). A comparison group of 1801 subjects was randomly drawn from the remaining population. During the period 1981-3 those still alive and living in the same region (1651 obese, 1504 control) were invited to a health examination. MEASUREMENTS AND MAIN RESULTS: The examination was attended by 964 obese (58%) and 1134 controls (75%). In both groups an increasing response rate was associated with decreasing body mass index, and increasing intelligence test score, educational level, current social class, age (up to 50 years) and proximity of residence. Logistic regression analysis showed that all these variables had independent effects on response rate. Frequency and duration of hospital admissions during the period 1977-82 did not differ among responders and non-responders in either group. CONCLUSION: Response rates in health surveys are strongly influenced by degree of fatness, intelligence, educational level, social class, age, and proximity of residence.

https://jech.bmj.com/content/jech/43/4/369.full.pdf

Influence of fatness, intelligence, education and sociodemographic factors on response rate in a health survey.

OBJECTIVE--To assess the relations among prevalence of arterial hypertension, history of weight change, and current body weight in the range from normal weight to severe obesity. DESIGN--Retrospective analysis of medical records of men registered with Danish military authorities from 1943 to 1977 and followed up four to 40 years later. SETTING--Draft board of Copenhagen and surrounding counties and the rest of Sjaelland and surrounding islands. SUBJECTS--964 Men who were severely obese (body mass index greater than or equal to kg/m2 at the first examination) and 1134 random controls. MAIN OUTCOME MEASURES--Blood pressure and weight. RESULTS--Hypertension was more prevalent in subjects with an unchanged body mass index as that index increased over the range studied. At any body mass index hypertension was more prevalent in subjects who had increased to this index and less common in those who had decreased to it than in those who had stayed the same weight since the first examination. Hypertension among controls was most common in those subjects who had become obese during adulthood. CONCLUSIONS--Changes in body weight have a great influence on arterial hypertension independent of the effect of attained weight, particularly in obese subjects.

https://www.bmj.com/content/bmj/299/6702/767.full.pdf

Stig Sonne-Holm

Papers

Quantification of synovistis by MRI: correlation between dynamic and static gadolinium-enhanced magnetic resonance imaging and microscopic and macroscopic signs of synovial inflammation.

Studies on YKL-40 in knee joints of patients with rheumatoid arthritis and osteoarthritis. Involvement of YKL-40 in the joint pathology

Epidemiology of meniscal lesions in the knee: 1,215 open operations in copenhagen 1982-84

Influence of fatness, intelligence, education and sociodemographic factors on response rate in a health survey.

Independent effects of weight change and attained body weight on prevalence of arterial hypertension in obese and non-obese men.