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Wendolyn S. Gozansky

Bio: Wendolyn S. Gozansky is an academic researcher from Kaiser Permanente. The author has contributed to research in topics: Palliative care & Insulin. The author has an hindex of 22, co-authored 50 publications receiving 2115 citations. Previous affiliations of Wendolyn S. Gozansky include Anschutz Medical Campus & University of Colorado Denver.

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TL;DR: Whether salivary cortisol measured by a simple enzyme immunoassay (EIA) could be used as a surrogate for serum total cortisol in response to rapid changes and across a wide range of concentrations is investigated.
Abstract: Summary Objective The aim of this study was to determine whether salivary cortisol measured by a simple enzyme immunoassay (EIA) could be used as a surrogate for serum total cortisol in response to rapid changes and across a wide range of concentrations. Design Comparisons of matched salivary and serum samples in response to dynamic hypothalamic‐pituitary‐adrenal (HPA) axis testing. Subjects Healthy women ( n = 10; three taking oral oestrogens) and men ( n = 2), aged 23‐ 65 years, were recruited from the community. Measurements Paired saliva and serum samples were obtained during three protocols: 10 min of exercise at 90% of maximal heart rate ( n = 8), intravenous administration of corticotrophin-releasing hormone (CRH; n = 4), and dexamethasone suppression ( n = 7). Cortisol was measured in saliva using a commercial high-sensitivity EIA and total cortisol was measured in serum with a commercial radioimmunoassay (RIA). Results The time course of the salivary cortisol response to both the exercise and CRH tests paralleled that of total serum cortisol. Salivary cortisol demonstrated a significantly greater relative increase in response to the exercise and CRH stimuli (697 ± 826% vs. 209 ± 150%, P = 0·04 saliva vs. serum). A disproportionately larger increase in free cortisol, compared with total, would be expected when the binding capacity of cortisol-binding globulin (CBG) is exceeded. In response to dexamethasone suppression, relative decreases in cortisol were not significantly different between the two media ( − 47 ± 56% vs. − 84 ± 8%, P = 0·13 saliva vs. serum). Although a significant linear correlation was found for all paired salivary and serum total cortisol samples ( n = 183 pairs, r = 0·60, P < 0·001), an exponential model provided a better fit ( r = 0·81, P < 0·001). The linear correlations were strengthened when data from subjects on oral oestrogens ( n = 52 pairs, r = 0·75, P < 0·001) were separated from those not taking oestrogens ( n = 131 pairs, r = 0·67, P < 0·001). Conclusions Salivary cortisol measured with a simple EIA can be used in place of serum total cortisol in physiological research protocols. Evidence that salivary measures represent the biologically active, free fraction of cortisol includes: (1) the greater relative increase in salivary cortisol in response to tests that raise the absolute cortisol concentration above the saturation point of CBG; (2) the strong exponential relationship between cortisol assessed in the two media; and (3) the improved linear correlations when subjects known to have increased CBG were analysed separately. Thus, an advantage of measuring salivary cortisol rather than total serum cortisol is that it eliminates the need to account for within-subject changes or between-subject differences in CBG.

339 citations

Journal ArticleDOI
01 Sep 2016-Obesity
TL;DR: To evaluate the safety and tolerability of alternate‐day fasting (ADF) and to compare changes in weight, body composition, lipids, and insulin sensitivity index with those produced by a standard weight loss diet, moderate daily caloric restriction (CR).
Abstract: Objective To evaluate the safety and tolerability of alternate-day fasting (ADF) and to compare changes in weight, body composition, lipids, and insulin sensitivity index (Si) with those produced by a standard weight loss diet, moderate daily caloric restriction (CR). Methods Adults with obesity (BMI ≥30 kg/m2, age 18-55) were randomized to either zero-calorie ADF (n = 14) or CR (−400 kcal/day, n = 12) for 8 weeks. Outcomes were measured at the end of the 8-week intervention and after 24 weeks of unsupervised follow-up. Results No adverse effects were attributed to ADF, and 93% completed the 8-week ADF protocol. At 8 weeks, ADF achieved a 376 kcal/day greater energy deficit; however, there were no significant between-group differences in change in weight (mean ± SE; ADF −8.2 ± 0.9 kg, CR −7.1 ± 1.0 kg), body composition, lipids, or Si. After 24 weeks of unsupervised follow-up, there were no significant differences in weight regain; however, changes from baseline in % fat mass and lean mass were more favorable in ADF. Conclusions ADF is a safe and tolerable approach to weight loss. ADF produced similar changes in weight, body composition, lipids, and Si at 8 weeks and did not appear to increase risk for weight regain 24 weeks after completing the intervention.

199 citations

Journal ArticleDOI
TL;DR: The finding that regional adipose tissue depots have apparent independent and opposing effects on serum TG supports the need for further research into the physiological mechanisms governing these effects.
Abstract: Context: It has been suggested that the propensity to store fat in the gluteal-femoral region may be cardioprotective. Objective: The primary aim of this study was to test whether the favorable associations of leg fat with risk factors for cardiovascular disease persist after controlling for the highly unfavorable effects of abdominal (visceral or sc) adiposity in postmenopausal women. Study Participants: The study included 95 postmenopausal women [age, 60 ± 8 yr (mean ± sd)]. Main Outcomes: Whole-body and regional fat distribution was measured using dual-energy x-ray absorptiometry and abdominal computed tomography. Markers of insulin resistance and dyslipidemia were determined from oral glucose tolerance tests and fasted lipid and lipoprotein measurements, respectively. Primary outcomes were: fasting insulin (INS0), area under the insulin curve (INSAUC), product of the oral glucose tolerance test insulin and glucose AUC (INSAUC — GLUAUC), serum triglycerides (TG), and high-density lipoprotein (HDL) chol...

132 citations

Journal ArticleDOI
TL;DR: DHEA replacement therapy for 1 yr improved hip BMD in older adults and spine B MD in older women and the need for further investigations of the benefits and risks of D HEA replacement and the mechanisms for its actions is supported.
Abstract: Context: Dehydroepiandrosterone (DHEA) and its sulfate (DHEAS) decrease with aging and are important androgen and estrogen precursors in older adults. Declines in DHEAS with aging may contribute to physiological changes that are sex hormone dependent. Objective: The aim was to determine whether DHEA replacement increases bone mineral density (BMD) and fat-free mass. Design, Setting, and Participants: A randomized, double-blinded, controlled trial was conducted at an academic research institution. Participants were 70 women and 70 men, aged 60–88 yr, with low serum DHEAS levels. Intervention: The intervention was oral DHEA 50 mg/d or placebo for 12 months. Measurements: BMD, fat mass, and fat-free mass were measured before and after intervention. Results: Intent-to-treat analyses revealed trends for DHEA to increase BMD more than placebo at the total hip (1.0%, P = 0.05), trochanter (1.2%, P = 0.06), and shaft (1.2%, P = 0.05). In women only, DHEA increased lumbar spine BMD (2.2%, P = 0.04; sex-by-treatmen...

109 citations


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TL;DR: This work proposes that journal editors adopt a consistent definition of the term sedentary and require that all manuscripts published within their journal adhere to this common terminology, and suggests that authors use the term “inactive” to describe those who are performing insufficient amounts of MVPA.
Abstract: There has recently been an increase in research related to the health impact of sedentary behaviour (e.g., sitting) (Tremblay et al. 2010). Numerous studies suggest that those who engage in high amounts of sedentary behaviour can be at increased risk of morbidity and mortality regardless of their level of moderateto vigorous-intensity physical activity (MVPA) (Dunstan et al. 2010; Grøntved and Hu 2011; Katzmarzyk et al. 2009; Thorp et al. 2011; Wijndaele et al. 2011). Further, it has been noted that there is often little association between sedentary behaviour and MVPA (Biddle et al. 2004; Ekelund et al. 2006) and that it is possible for an individual to accumulate large amounts of both MVPA and sedentary behaviour in the course of a day (Healy et al. 2008; Katzmarzyk et al. 2009; Owen et al. 2010; Tremblay et al. 2010; Wong and Leatherdale 2008). Taken together, these findings suggest that too much sitting and too little MVPA represent separate and distinct risk factors for chronic, noncommunicable diseases (e.g., cardiovascular disease, diabetes, cancer). While research into the biology and health impact of sedentary behaviour represents an exciting new field of study, current inconsistencies in terminology are confusing for students, researchers, policymakers, and the general public. In short, the term “sedentary” currently has two separate and contradictory operational definitions. In this emerging field of research, sedentary behaviours are typically defined by both low energy expenditure (e.g., resting metabolic rate, typically ≤1.5 metabolic equivalents (METs)) and a sitting or reclining posture (Owen et al. 2010; Pate et al. 2008; Tremblay et al. 2010). In this context, a person may be described as sedentary if they engage in a large amount of sedentary behaviour. In contrast, in the sport and exercise literature the term sedentary is frequently used to describe the absence of some threshold of MVPA (Church et al. 2009; Melanson et al. 2009; Mullen et al. 2011; Sims et al. 2012; Smith et al. 2010). Thus, it is common for researchers in this field to describe a participant as sedentary because they are not meeting physical activity guidelines. Hence, many exercise studies include a “sedentary control group” or refer to their participants as coming from a “sedentary population” because of their lack of physical activity without actually measuring or assessing their level of sedentary behaviour. It is not difficult to see how these conflicting definitions of the term sedentary can easily lead to confusion. When reading the title or abstract of an article, it is often difficult to ascertain which definition of sedentary the authors have employed. If an article focuses on the health impact of a “sedentary lifestyle”, are they concerned with excessive sitting–lying down, the lack of physical activity, or both? Further, it is surprisingly common for articles within a given academic journal to oscillate between one definition and the other. To prevent further confusion, we propose that journal editors adopt a consistent definition of the term sedentary and require that all manuscripts published within their journal adhere to this common terminology. We suggest that journals formally define sedentary behaviour as any waking behaviour characterized by an energy expenditure ≤1.5 METs while in a sitting or reclining posture. In contrast, we suggest that authors use the term “inactive” to describe those who are performing insufficient amounts of MVPA (i.e., not meeting specified physical activity guidelines). The formal adoption of the above definitions by journal editors and reviewers would greatly improve the clarity of research and discussion related to these important health behaviours and help researchers searching for studies specific to sedentary behaviour or physical inactivity. We hope the research community will support these definitions and we look forward to further improvements in our understanding of the health impacts of sedentary behaviour and physical activity.

1,653 citations

Journal ArticleDOI
TL;DR: The literature in both rodents and humans on the role of estrogens and their receptors in the control of energy homeostasis and glucose metabolism in health and metabolic diseases is reviewed.
Abstract: Estrogens play a fundamental role in the physiology of the reproductive, cardiovascular, skeletal, and central nervous systems. In this report, we review the literature in both rodents and humans on the role of estrogens and their receptors in the control of energy homeostasis and glucose metabolism in health and metabolic diseases. Estrogen actions in hypothalamic nuclei differentially control food intake, energy expenditure, and white adipose tissue distribution. Estrogen actions in skeletal muscle, liver, adipose tissue, and immune cells are involved in insulin sensitivity as well as prevention of lipid accumulation and inflammation. Estrogen actions in pancreatic islet β-cells also regulate insulin secretion, nutrient homeostasis, and survival. Estrogen deficiency promotes metabolic dysfunction predisposing to obesity, the metabolic syndrome, and type 2 diabetes. We also discuss the effect of selective estrogen receptor modulators on metabolic disorders.

873 citations

Journal ArticleDOI
TL;DR: It is demonstrated for the first time in humans that eTRF improves some aspects of cardiometabolic health and that IF's effects are not solely due to weight loss.

746 citations

Journal ArticleDOI
01 Jun 2007-Diabetes
TL;DR: Omentin 1 and omentin 2 gene expression were decreased with obesity and were highly correlated with each other in visceral adipose tissue as mentioned in this paper, indicating that decreased Omentin levels are associated with increasing obesity and insulin resistance.
Abstract: Central obesity and the accumulation of visceral fat are risk factors for the development of type 2 diabetes and cardiovascular disease. Omentin is a protein expressed and secreted from visceral but not subcutaneous adipose tissue that increases insulin sensitivity in human adipocytes. To determine the impact of obesity-dependent insulin resistance on the regulation of two omentin isoforms, gene expression and plasma levels were measured in lean, overweight, and obese subjects. Omentin 1 was shown to be the major circulating isoform in human plasma. Lean subjects had significantly higher plasma omentin 1 levels than obese and overweight subjects. In addition, higher plasma omentin 1 levels were detected in women compared with men. Plasma omentin 1 levels were inversely correlated with BMI, waist circumference, leptin levels, and insulin resistance as measured by homeostasis model assessment and positively correlated with adiponectin and HDL levels. Both omentin 1 and omentin 2 gene expression were decreased with obesity and were highly correlated with each other in visceral adipose tissue. In summary, decreased omentin levels are associated with increasing obesity and insulin resistance. Therefore, omentin levels may be predictive of the metabolic consequences or co-morbidities associated with obesity.

673 citations

Journal ArticleDOI
11 Jan 2012-JAMA
TL;DR: Several indices for predicting overall mortality in different patient groups are identified; future studies need to independently test their accuracy in heterogeneous populations and their ability to improve clinical outcomes before their widespread use can be recommended.
Abstract: Context To better target services to those who may benefit, many guidelines recommend incorporating life expectancy into clinical decisions. Objective To assess the quality and limitations of prognostic indices for mortality in older adults through systematic review. Data Sources We searched MEDLINE, EMBASE, Cochrane, and Google Scholar from their inception through November 2011. Study Selection We included indices if they were validated and predicted absolute risk of mortality in patients whose average age was 60 years or older. We excluded indices that estimated intensive care unit, disease-specific, or in-hospital mortality. Data Extraction For each prognostic index, we extracted data on clinical setting, potential for bias, generalizability, and accuracy. Results We reviewed 21 593 titles to identify 16 indices that predict risk of mortality from 6 months to 5 years for older adults in a variety of clinical settings: the community (6 indices), nursing home (2 indices), and hospital (8 indices). At least 1 measure of transportability (the index is accurate in more than 1 population) was tested for all but 3 indices. By our measures, no study was free from potential bias. Although 13 indices had C statistics of 0.70 or greater, none of the indices had C statistics of 0.90 or greater. Only 2 indices were independently validated by investigators who were not involved in the index's development. Conclusion We identified several indices for predicting overall mortality in different patient groups; future studies need to independently test their accuracy in heterogeneous populations and their ability to improve clinical outcomes before their widespread use can be recommended.

662 citations