Showing papers in "International Journal of Obesity in 1982"

Female fat distribution-a simple classification based on two circumference measurements.

Abstract: An alternative to the fat distribution (FD) score based on photographic measurements is constructed by discriminant analysis based on waist and thigh circumferences: Fat distribution (circumference) score (CFD score) = 29 log10 (waist circumference-36 log10 (thigh circumference)+10.5. The CFD score shows a correlation of 0.88 with the FD score over 54 female subjects, and can be used instead of, but not interchangeably with, the FD score to classify female fat distribution.

Influence of genetic background and age on the expression of the obese hyperglycaemic syndrome in Aston ob/ob mice.

Abstract: Expression of the obese hyperglycaemic (bo/ob) syndrome in mice is modified by the background genome. The Aston colony carries the ob gene on a mixed background which produces a unique combination of different features shown by ob/ob mice on other backgrounds. The maximum body weight of Aston ob/ob mice exceeded that of other colonies, possibly reflecting a trait for higher growth rate in the background genome. The hyperphagia, marked hyperinsulinaemia and moderate hyperglycaemia observed during the development of the syndrome receded in old mice. Plasma glucagon concentrations in the fed state were similar to +/+ mice and did nor Vary throughout life. Hyperplasia of the B-cells increased inordinately during the development of the syndrome, but declined in older mice coincident with progressive intercellular vacuolation and the appearance of acinar-like cells within the islets. A-cell hyperplasia was greater in young mice, and A-cells became relocated throughout the islets of older mice. The distinct pattern of age-related changes in ob/ob mice indicates that experiments using this gene type should define clearly their age as well as genetic background.

Vitamin D deficiency in obese patients and changes in circulating vitamin D metabolites following jejunoileal bypass.

Abstract: The serum levels of the three major vitamin D metabolites [25-hydroxyvitamin D (25-OHD), 1,25-dihydroxyitamin D (1,25-(OH)2D), 24,25-dihydroxyvitamin D (24,25-(OH)2 D)] and immunoreactive parathyroid hormone (iPTH) were measured in 14 morbid obese patients, who later on were subjected to jejunoileal bypass surgery. The preoperative median values of 25-OHD and 24,25-(OH)2D were reduced compared with controls (P less than 0.001), whereas elevated concentrations were found of 1,25-(OH)2D (P less than 0.005). Median levels of iPTH in the obese group were significantly higher than those found in normal subjects (P less than 0.001). A decrease was observed in serum concentrations of all three vitamin D metabolites following jejunoileal bypass (P less than 0.005). An increase in the serum levels of iPTH and alkaline phosphatase was seen postoperatively (P less than 0.002), probably indicating a secondary hyperparathyroidism. The results show that the vitamin D metabolism is slightly abnormal in severely obese patients. Jejunoileal bypass is followed by severe disturbances of vitamin D metabolism.

Hyperinsulinemia and hypertriglyceridemia, a vicious cycle with atherogenic potential.

Abstract: This paper reviews and integrates a number of experiments which suggest the existence of a vicious cycle. In this cycle hypertriglyceridemia can lead to insulin resistance even without concomitant obesity or non-insulin dependent diabetes. This insulin resistance may be the basis for the hyperinsulinemia response to a glucose challenge. The hyperinsulinemia can stimulate VLDL-triglyceride production. This increase in production, if it is not accompanied by an equivalent increase in removal, will result in hypertriglyceridemia. The whole cycle would accelerate VLDL-triglyceride turnover and may increase the supply of potentially atherogenic VLDL-remnants.

Obesity-associated disorders in normal-weight individuals: some speculations.

Abstract: A number of disorders including maturity-onset (Type II) diabetes, hypertension and hypertriglyceridemia are frequently associated with adult-onset obesity and improve with energy restriction. It is the premise of this brief review that there are patients with these disorders who are not obese according to standard criteria; but who would also respond favorably to energy restriction. It is proposed that these 'metabolically-obese, normal weight' individuals might be characterized by hyperinsulinism and possibly an increase in fat cell size, compared to patients of similar age, height and weight and/or to themselves at an earlier time. It is also proposed that in some of these individuals inactivity and diet composition might be important contributing factors, and that for them, the appropriate therapy would include exercise and altered diet composition.

Adipose tissue cellularity in man: the relationship between fat cell size and number, the mass and distribution of body fat and the history of weight gain and loss.

Abstract: The aims of this work were to establish whether, in an obese population, a group characterized by a distinctly high fact cell number could be observed and whether the number of body fact cells was affected by slimming. In the obese group there were 75 obese females (kg/m2 greater than 27.0) and 19 obese males (kg/m2 greater than 27.5); the lean group contained 37 females and 11 males. Body fat was estimated either from skinfold thickness or from body potassium measurements. Fat cell size was measured by a well-established microscopic method. No clear distinction could be made between types of obese patients on the basis of their estimated total number of measurable body fact cells. This number was weakly related to the degree of obesity (r = 0.342; P less than 0.001). Weight reduction caused no appreciable change in fat cell number. We conclude that the whole concept of adipocyte hypercellularity as a causal factor in obesity has been overemphasized.

Intravenous lidocaine for the treatment of intractable pain of adiposis dolorosa.

Abstract: Adiposis dolorosa (Dercum's disease) is a syndrome of painful adipose tissue which occurs most often in post-menopausal women and is associated with obesity, asthenia, and emotional disturbances. The etiology is uncertain, but is probably multifactorial. Numerous treatments to relieve the pain have generally been unsuccessful. A patient with adiposis dolorosa was treated with intravenous infusions of lidocaine over a two-year period. Relief from pain lasted from two to 12 months after each infusion. A single-blind placebo infusion did not relieve the pain. Lidocaine infusions did not relieve the pain of diabetic neuropathy or of angina in this patient. The mechanism of relief of pain of adiposis dolorosa by lidocaine is uncertain, but previously reported central effects of lidocaine suggest that alterations in the central nervous system may be responsible.

Ephedrine, a potential slimming drug, directly stimulates thermogenesis in brown adipocytes via beta-adrenoreceptors.

Abstract: Ephedrine is a potential slimming drug that stimulates thermogenesis in man and laboratory animals. Considering that brown adipose tissue is an important site of catecholamine-induced thermogenesis in homeotherms, we tested the thermogenic efficiency of several ephedrine stereoisomers on adipocytes isolated from rat interscapular brown adipose tissue. Addition of (-)-ephedrine (0.1 mM) to brown adipocyte suspensions rapidly stimulated cellular respiration eight times above basal values. A stable Vmax of 335 nmol O2/min/10(6) cells was reached less than 5 min after the onset of respiratory stimulation. This value represents 85 percent of the maximal respiration observed with norepinephrine, the physiological effector of thermogenesis. The (-)isomer of ephedrine (1/2 Vmax = 20 microM) was more potent that other stereoisomers (+)-psi-ephedrine, (-)-psi-ephedrine (racephedrine) in enhancing brown adipocyte respiration. Beta-Adrenergic antagonists (alprenolol and propranolol) were much more effective than alpha-adrenergic antagonists (phentolamine and phenoxybenzamine) in inhibiting the respiratory effects of ephedrine. It is concluded that (-)-ephedrine mimics the calorigenic action of norepinephrine by directly stimulating brown adipocyte respiration via beta-adrenoreceptors.

Hypothalamic and pituitary dysfunction in obese males.

Abstract: Previous studies have indicated dysfunction of the hypothalamic-hypophyseal axis in obesity. We have studied 12 obese males to further characterize the extent of this dysfunction. The hypothalamic-hypophyseal-gonadal axis is normal as determined by the testicular response to human chorionic gonadotropin (hCG), the pituitary response to 200 micrograms gonadotropin-releasing hormone (GnRH), and the hypothalamic-pituitary-testicular response to clomiphene. Although L-dopa suppresses prolactin normally, the ability of thyrotropin releasing hormone (TRH) to stimulate the release of prolactin and thyroid stimulating hormone (TSH) is blunted. These latter responses are inversely related to the degree of obesity. The response to chlorpromazine, a hypothalamic stimulus for prolactin secretion, is also blunted, and to a greater extent than the prolactin response to TRH. These data indicate that exogenous obesity in males is associated with more extensive hypothalamic and pituitary dysfunction than previously realized. The abnormalities with regard to prolactin and TSH release become progressively worse when body weight exceeds 200 percent of ideal. In addition, when evaluating pituitary function with regard to gonadotropin release, obese males may have an abnormal response to 100 micrograms GnRH but respond normally to 200 micrograms.

Factors influencing the acute effect of food on oxygen consumption in the rat.

Abstract: The rise in resting oxygen consumption (VO2) during the 2-3 h following intragastric feeding (50 kJ [12 kcal]) was significantly greater in hyperphagic cafeteria-fed rats and hyperthyroid rats, but was markedly reduced in 3-day fasted and genetically-obese Zucker rats, compared to their respective stock-fed controls. In control and hyperthyroid animals this response was almost completely abolished by administration of propranolol. In another group of rats, resting VO/ was elevated by 8 per cent after 12 h of cafeteria feeding and was maximally increased by 20 per cent after 2.5 days on the diet. In rats previously cold-adapted (15 days at 5 degrees C) the maximal response (20 per cent) to cafeteria feeding was seen after only 12 h on the diet. These results suggest that the acute thermic response to food involves a sympathetic activation of thermogenesis, similar to that induced by chromic hyperphagia and cold-exposure, and can be influenced by genetic background plane of nutrition and thyroidal status.

Psychosocial effects of gastric reduction surgery for obesity.

Abstract: A sample of 44 patients who had undergone gastric reduction surgery for severe obesity responded to a questionnaire asking about psychosocial changes after the surgery and about their reactions to the weight loss and to previous weight reduction methods. Subjects reported substantial weight losses accompanied by reduced food intake and normalization of eating patterns; increases in physical and social activities; more positive relationships with others, including sexual functioning; and more positive self-perceptions in a number of areas. All were glad that they had had the operation and saw it as more successful than other methods of weight control. In light of the social pressures encouraging people to lose weight and the general lack of success of nonsurgical weight reduction methods, it is likely that this procedure will be increasingly widely used, although its long-term effects have not been studied.

Three controlled trials of weight loss with phenylpropanolamine.

Abstract: A multisite double-blind study was designed to determine the effectiveness of a phenylpropanolamine-caffeine combination in achieving weight loss. Two-hundred and one obese adult patients were divided into three separate groups in which phenylpropanolamine/caffeine was compared with either placebo (6 weeks), mazindol (6 weeks), or diethylpropion (8 weeks). In these clinical trials, phenylpropanolamine/caffeine proved to be as effective as mazindol and diethylpropion and significantly more effective than placebo in achieving weight loss. Overall, phenylpropanolamine/caffeine had fewer side effects than mazindol and diethylpropion. Its use as an effective anorectic agent in the treatment of obesity is reviewed.

Obesity among schoolchildren of different socioeconomic levels in a developing country.

Abstract: Obesity, as malnutrition, is associated with an increased tendency to morbidity and mortality. Its prevalence has been reported to be increasing. Studies carried out in developed countries have shown obesity to be directly correlated with low socioeconomic level. The objective of the present study was to determine the prevalence of obesity among 300 children aged 84 to 143 months who were attending three schools of different socioeconomic levels in the town of Ribeirao Preto, State of Sao Paulo, Brazil. Weight, height, arm circumference and tricepital skinfold were measured. The prevalence of obesity in the sample was 16.7 per cent, distributed as follows: 38 per cent for high socioeconomic level, 12 per cent for middle socioeconomic level, and 4 per cent for low socioeconomic level. The prevalence of malnutrition was 8.3 per cent. The overall frequency of obesity reported here is as high as that found in developed countries, but, in contrast, obesity was directly correlated with socioeconomic level.

Plasma catecholamines and autonomic responsiveness in obesity.

Abstract: The autonomic responsiveness of lean women to standing, passsive vertical tilting, noradrenaline infusion and the valsalva manoeuvre has been compared with that of obese women and a group of formerly obese women (post-obese). Upon standing, the lean and obese groups had comparable cardiovascular responses with similar rises in plasma noradrenaline. With passive 85 degrees head-up tilting at an ambient temperature of 26 degrees C the obese and post-obese subjects had a greater rise in plasma noradrenaline than the lean group who were less able to withstand the test. Noradrenaline infusions (at 26 degrees C) in the lean and post-obese subjects led to similar increases in plasma noradrenaline, systolic and diastolic pressures and plasma free fatty acids but the post-obese showed a greater bradycardia. The response to the valsalva manoeuvre was normal in lean and obese patients and was unaltered after a reduced energy intake in the obese. On energy restriction for two weeks 10 obese subjects showed a fall in pulse rate, in systolic and diastolic pressures and in plasma noradrenaline while the subjects remained supine. On standing there was less of a rise in plasma noradrenaline than when energy intake was high. The response in noradrenaline was restored to that seen on high energy intakes by giving L-dopa. Seasonal changes in venous noradrenaline concentrations were apparent in obese and post-obese patients but not in lean subjects. These differences may relate to altered responses to environmental temperature or to an altered food intake in the two obese groups. There appears to be no generalised in the autonomic system in obese women either before or after weight loss but the process of slimming does lead to a reduction in plasma noradrenaline levels.

Sex hormone levels and intestinal absorption of estradiol and D-norgestrel in women following bypass surgery for morbid obesity.

Abstract: A report of reduced serum levels of progestins, following oral administration after jejunoileal bypass, promoted the present investigation of the absorption of D-norgestrel and estradiol following different types of intestinal bypass surgery for morbid obesity. A group of non-operated obese patients served as control. Apart from significantly higher gonadotrophin levels, which could be attributed to periovulatory sampling in the non-operated group, there was no significant differences in basal levels of estradiol, estrone, conjugated estrone, androstendione, testosterone, and progesterone. The operation did not influence the pattern of the menstrual cycle. Following a single oral dose of 4 mg micronized estradiol and 125 microgram D-norgestrel, serum levels of estradiol and estrone were equal in the three groups. serum D-norgestrel was equal in the two operated groups, but was significantly higher in the bypass group with 1:3 jejunoileal ratio, compared with the non-operated group. Further, a significant negative correlation between peak levels and weight was found. It is suggested that one year following bypass surgery, obesity - but not intestinal bypass - might be associated with reduced serum levels of exogenous sex steroids following oral administration.

Zucker fafa rats maintain their obese body composition ten months after jejunoileal bypass surgery.

Abstract: In order to evaluate the long-term effects of intestinal bypass surgery in an animal model of early onset hypercellular-hypertrophic obesity, adult female obese and lean Zucker rats were given jejunoileal bypass surgery or sham operations. At sacrifice ten months post-surgery, body weights of obese bypass rats were nearly reduced to lean bypass levels. This reduction in body weight was not accompanied by normalization of body composition or of the hyperinsulinemia and hypertriglyceridemia characteristic of this obese syndrome. Obese bypass rats maintained 44 percent of their weight as lipid compared to 12 percent in lean bypass rats and 15 percent in sham-operated lean rats. In addition, obese bypass rats maintained elevated adipose tissue lipoprotein lipase activity and increased fat cell size and were hyperinsulinemic and hypertriglyceridemic. Furthermore, obese bypass rats had reduced carcass protein and reduced weight and DNA and/or protein contents in heart, liver, muscle and kidney. Therefore, although bypass surgery resulted in significant weight loss, it did not normalize the obese syndrome and may result in serious reductions in the weight and cellularity of vital organs.

Correlation between initial blood pressure and blood pressure decrease after weight loss: A study in patients with jejunoileal bypass versus medical treatment for morbid obesity.

Abstract: Blood pressure (BP) was followed simultaneously with body weight in 134 morbidly obese patients randomized to either jejunoileal bypass (101 patients) or dietary treatment (33 patients). After a median observation time of 24 months (range 12-48 months) body weight fell significantly from a median of 124.0 kg to 81.2 kg in the jejunoileal bypass patients whilst median BP decreased significantly from 140/85 mmHg to 120/80 mmHg. In the patients treated with diet, body weight decreased significantly from a median of 129.0 kg to 119.0 kg after a median observation time of 18 months (range 9-36 months) whereas the median BP of 140/90 mmHg was unaffected. The fall in BP after weight loss was significantly positively correlated with the height of BP before the weight loss. The correlation could not be explained by a greater weight loss in the patients with initially high BP. Furthermore, a significantly positive correlation between BP changes and body weight changes was demonstrated, but this correlation was lesser than the above-mentioned. The study shows that the beneficial effect of a weight loss upon BP in obese patients is greater the higher the initial BP is, but also that a normal BP is only little affected and explained mainly by cuff artifact.

Is obesity an advantageous adaptation

Abstract: It is undisputed that modern man is becoming fatter and the extreme expression of increased adiposity 'simple' obesity is becoming more common. Tanner & Whitehouse for example reported that average skinfold thickness in British school children increased by one standard deviation over a 25-year period. What are unclear are the main reasons for this change. In this 'Viewpoint' I will examine--I hope not too contentiously--evidence that this increased level of human adiposity associated with 'Westernisation' reflects an evolutionary adaptation to 'modern' food, particularly the refined carbohydrates, and is not simply a metabolic or behavioural ' disorder' as is commonly assumed. Some 'treatments', including some perhaps based on behavioural assumptions, have been described by Hirsch as equivalent to 'beating the insane to keep them quiet.

Congenital hypothyroidism in latent obese (ob/ob) mice.

Abstract: Activity of thyroid glands in latent-obese baby mice is below that of normal ones from birth on. Maturation of certain features, such as pinnae freeing, eye and ear opening, eruption of lower incisor teeth, is delayed in latent obese mice. After thyroxin injections maturation is normalized. Data support the hypothesis that the obese hyperglycemic syndrome in mice is characterized by congenital hypothyroidism.

Hyperinsulinemia in hepatic steatosis.

Abstract: Blood glucose, serum insulin, C-peptide, free fatty acids and growth hormone were evaluated in 45 patients with histologically established hepatic steatosis after an oral glucose load (100 g). Glucose tolerance was impaired in 59 per cent of the patients. Significantly increased levels were found for blood glucose (fasting and after 60 and 120 min), insulin (after 60, 120 and 180 min), C-peptide (fasting and after 60, 120 and 180 min), and free fatty acids (fasting and after 60 and 120 min). Human growth hormone levels were not altered. After glucose administration the C-peptide/insulin ratio was significantly reduced in hepatic steatosis compared to controls. In patients with hepatic steatosis there were no differences between subjects with normal body weight or overweight nor between stadium I and stadium II ('alcoholic hepatic steatosis') concerning glucose, insulin, C-peptide, HGH and FFA levels in blood. We conclude, that hepatic steatosis is associated with relative insulin resistance to which elevated FFA may contribute. In addition, the decreased C-peptide/insulin ratios suggest an impaired hepatic insulin degradation as it was already described for more serious liver diseases.

Effects of exercise in cool water on body weight loss.

Abstract: Seven obese women (greater than 30 per cent body fat, mean = 43 per cent) performed moderate exercise (30 to 40 per cent of maximal oxygen consumption) for 90 min during head-out immersion in cool water (17 to 22 degrees C) five times per week for eight weeks to determine if cold exposure and the attendant caloric deficit in body heat stores would lead to body weight loss. Exercise was on a cycle ergometer that was modified for underwater use. Body weight, body fat, fat-free body weight, and caloric intake did not change significantly as a result of the exercise program in cool water. The significant heat debts incurred were presumably repaid without an increase in energy expenditure. The caloric balance and the thermal data obtained suggest that body heat stores were slowly repaid during recovery by resting metabolic heat production associated with a reduced rate of body heat loss. Maximal oxygen uptake did not increase significantly. No metabolic or thermal evidence was found to support cold adaptation in the obese women. Ergometer exercise in water as well-tolerated, as evidenced by no exercise-related injuries and an adherence rate of 93 per cent. It was concluded that, while cold exposure does not increase caloric expenditure significantly in obese individuals, exercising regularly in cool water may be beneficial as it may motivate obese people to exercise at higher intensity for thermal comfort and the water environment may help prevent injuries.

Development of the hypothermia in obese mice (genotype ob/ob).

Abstract: Heavier-obese mice (genotype, ob/ob) displayed their characteristic hypothermia at ambient temperatures and obese mice at all body weights did so after 60 min in the cold (3.0 - 5.5 degrees C). The fall in core temperature was least in slightly obese (3.5 degrees C) and greatest in extremely-obese animals (12.5 degrees C). The fall could be prevented by previous pair feeding with wild-type animals, which limited the body weight by 52 per cent. Limiting the body weight of wild-type mice (23 per cent) was not followed by a change in core temperature. Neither grouping nor floor insulation altered the fall in core temperature of obese or wild-type mice. These results suggest the hypothermia of the mutant to be as much under a physical as a metabolic influence, such as the abnormal body form and consequent inactivity. Heat production in muscle would decrease with the inactivity, contributing to the hypothermia. The normothermia in obese mice of limited body weight could result from their increased (normal) activity, previously demonstrated.

Immunologic status in severe obesity.

Abstract: Aspects of humoral, secretory and cell-mediated immunologic status were studied in a group of 22 adults with severe, uncomplicated obesity. Normal concentrations of serum immunoglobulins (IgG, IgA, IgM, IgD) and complement components (C3, C4) were found. Levels of secretory IgA and lysozyme in the tears of obese patients did not differ from normal weight controls. The obese individuals had circulating sub-populations of T and B lymphocytes which were the same as controls. No effect of obesity was detected on the response of lymphocytes to stimulation in vitro with polyclonal T and B cell mitogens. All but two of the obese patients responded to one or more of the recall skin test antigens employed. We conclude that severe overweight alone, uncomplicated by diabetes or hyperlipidemia, is not associated with significant immunologic dysfunction.