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Biomedical subjects

F Quaade

Publications and source records attributed to F Quaade.

At least 19 recordsLinked to original sources

The effect of ephedrine/caffeine mixture on energy expenditure and body composition in obese women.

Treatment with beta 2-agonists promotes fat loss and muscle growth in numerous species, but human studies are lacking. We studied the effect of a compound with beta 2-agonistic properties (ephedrine 20 mg/caffeine 200 mg [E + C]). Fourteen obese women were treated with a 4.2-MJ/d diet and either E + C or placebo (P) three times per day for 8 weeks in a double-blind study. Weight-loss was not different in the groups, but the E + C group lost 4.5 kg more body fat and 2.8 kg less fat-free mass (FFM). The decrease in 24-hour energy expenditure (EE) seen in the P group was 10% at day 1 and 13% at day 56, but was only 7% and 8% in the treated group (P = .044). The higher EE in the E +C group was entirely covered by fat oxidation. These findings provide evidence that promotion of fat loss and preservation of FFM during weight reduction may also be achieved pharmacologically in humans.

Body Composition

Pharmacology of thermogenic drugs.

Thermogenic combinations of ephedrine with caffeine and newer selective beta 3-agonists are being assessed for the treatment of obesity. The actions of beta-agonists may be multifaceted, with acute stimulation of thermogenic mechanisms in various tissues. During chronic treatment recruitment of brown fat may occur and hypertrophy of skeletal muscle may occur and simultaneously increase lean body tissue and reduce fat mass by stimulation of lipolysis and energy expenditure. The weight-reducing effect of an ephedrine-caffeine combination was superior to placebo treatment during 24 wk of energy restriction in obese women, whereas caffeine and ephedrine separately had no effect. In a second study it was found that ephedrine-caffeine compared with placebo preserved fat-free mass and enhanced fat loss, which could be accounted for both by anorexia (75%) and by increased thermogenesis (25%). The ephedrine-caffeine compound seems useful for the treatment of obesity and may serve as reference in the clinical assessment of new beta-agonists.

Adrenergic beta-Agonists

Dexfenfluramine as adjuvant to a low-calorie formula diet in the treatment of obesity: a randomized clinical trial.

Dexfenfluramine (dF) was compared to placebo as adjuvant to a very energy-restricted diet (1.6-4.2 MJ/24 h). The diet was continued as long as possible or until a satisfactory weight loss had been achieved, and dietary efforts were continued throughout the study. Of the 37 females and five males included, 71 per cent could be followed up for 12 months. Initial BMI ranged from 28 to 54 kg/m2. The lowest body weight was reached 1 month earlier in the dF group (P = 0.037). Throughout the study, the reduction of excess weight (REW) was greater in dF patients (P less than 0.05 only at 4 and 6 months). At 6 months, excess weight had declined by 15 per cent more in the dF group than in the placebo group (95 per cent confidence limits of the median being 1-31 per cent). Between 6 and 12 months, both groups regained weight significantly, the rates of regain differing only insignificantly. At 12 months, excess weight showed a net decrease of only 8 per cent more in the dF group than in the placebo group (95 per cent confidence limits being -7 to +24 per cent). Therefore, REW showed no significant group difference after 12 months. Type of obesity (android or gynoid) as determined by waist to hip ratio had no significant impact on either weight loss, REW, reductions of waist and hip circumferences, or on waist to hip ratio changes. S-alkaline phosphatases and s-uric acid declined significantly in the dF group only. Side-effects were all mild and their prevalence showed no group difference.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult

The effect and safety of an ephedrine/caffeine compound compared to ephedrine, caffeine and placebo in obese subjects on an energy restricted diet. A double blind trial.

The sympathomimetic agent ephedrine has potent thermogenic and anti-obesity properties in rodents. The effect is markedly enhanced by caffeine, while caffeine given alone has no effect. This study was undertaken to find out if a similar weight reducing synergism between ephedrine and caffeine is present in obese patients. In a randomized, placebo-controlled, double blind study, 180 obese patients were treated by diet (4.2 MJ/day) and either an ephedrine/caffeine combination (20mg/200mg), ephedrine (20 mg), caffeine (200 mg) or placebo three times a day for 24 weeks. Withdrawals were distributed equally in the four groups, and 141 patients completed the trial. Mean weight losses was significantly greater with the combination than with placebo from week 8 to week 24 (ephedrine/caffeine, 16.6 +/- 6.8 kg vs. placebo, 13.2 +/- 6.6 kg (mean +/- s.d.), P = 0.0015). Weight loss in both the ephedrine and the caffeine groups was similar to that of the placebo group. Side effects (tremor, insomnia and dizziness) were transient and after eight weeks of treatment they had reached placebo levels. Systolic and diastolic blood pressure fell similarly in all four groups. We conclude, that in analogy with animal studies, the ephedrine/caffeine combination is effective, while caffeine and ephedrine separately are ineffective for the treatment of human obesity.

Administration, Oral

[Dietary fiber added to a very-low caloric diet reduces hunger and alleviates constipation].

To investigate whether supplement dietary fibre improves compliance to very low calorie diets (VLCD), a nutritional powder providing 388 kcal/day was compared with a similar preparation containing 30 plant fibre per day. Twenty-two obese patients participated in the study. After three days on their habitual diet they were allocated at random according to a single blind design to VLCD either with or without dietary fibre for two weeks. Thereafter, they were crossed over to the other form of diet for two further weeks. All of the patients completed the study. Both of the groups had considerable weight losses which were similar (about 10 kg/4 weeks) and dietary fibre did not improve the result further. During the period with VLCD with fibre, hunger ratings were significantly lower than on diets with VLCD without fibre (fibre effect p less than 0.01). Bowel movements decreased from 1.9 per day on the habitual diet to 0.7 per day on VLCD without fibre but increased to 1.0 per day with the fibre supplement (fibre effect p less than 0.01). No differences were found between the effects of the two types of diet on satiety, consistency of the faeces and flatulence. The supplement of dietary fibre did not influence plasma concentrations of divalent cations such as calcium, iron or magnesium nor did it contribute to the lowering effect of VLCD on plasma glucose, cholesterol or triglyceride. It is concluded that supplementation of VLCD with dietary fibre may improve compliance by normalising hunger and increasing the number of bowel movements without impairing the absorption of divalent cations.

Adolescent

Impaired glucose-induced thermogenesis and arterial norepinephrine response persist after weight reduction in obese humans.

A reduced thermic response and an impaired activation of the sympathetic nervous system (SNS) has been reported after oral glucose in human obesity. It is, however, not known whether the reduced SNS activity returns to normal along with weight reduction. The thermic effect of glucose was lower in eight obese patients than in matched control subjects (1.7% vs 9.2%, p less than 0.002). The increase in arterial norepinephrine after glucose was also blunted in the obese patients. After a 30-kg weight loss their glucose and lipid profiles were markedly improved but the thermic effect of glucose was still lower than that of the control subjects (4.2%, p less than 0.001). The glucose-induced arterial norepinephrine response remained diminished in the reduced obese patients whereas the changes in plasma epinephrine were similar in all three groups. The results suggest that a defective SNS may be a cause in the development of obesity.

Adult

Dietary fibre added to very low calorie diet reduces hunger and alleviates constipation.

To examine whether supplement of dietary fibre may improve compliance to a very low calorie diet (VLCD) a nutrition powder providing 388 kcal/day (men: 466 kcal/day) was compared with a similar version containing plant fibre 30 g/day. Twenty-two obese patients entered the study. After a baseline habitual diet, they were randomized to two weeks of treatment in a single blind design to either VLCD with or without dietary fibre. Subsequently, they were crossed over for further 2 weeks of treatment. All patients completed the study. The two groups had similar weight losses (about 10 kg/4 weeks), and dietary fibre did not improve this result. During VLCD with fibre hunger ratings were significantly lower than during VLCD without fibre (fibre effect, ANOVA; P less than 0.01). Bowel movements decreased from 1.9/day on habitual diet to 0.7/day on VLCD without fibre, but increased to 1.0/day by fibre supplement (fibre effect, P less than 0.01). No effect of fibre supplementation to VLCD was found on satiety, consistency of faeces and flatulence. The supplement of dietary fibre did not influence plasma concentrations of divalent cations as calcium, iron or magnesium, nor did it add any lowering effect on plasma glucose, cholesterol or triglyceride to that of VLCD. In conclusion, the supplement of dietary fibre to VLCD may improve compliance by reducing hunger and increasing the number of bowel movements, without impairment of absorption of divalent cations.

Adolescent

The effect of long-term dexfenfluramine treatment on 24-hour energy expenditure in man. A double-blind placebo controlled study.

In order to investigate the effect of long-term treatment with dexfenfluramine (dF) on 24-hour energy expenditure (EE), 10 obese females were studied in a double-blind design. Shortly before and 4 weeks after cessation of a 13 months treatment period with either dF (30 mg/day) or placebo (PL) the 24-hour EE was measured. The measurements were performed using a 24 m3 direct heat sink calorimeter with continuous real time measurements of evaporative and sensible heat losses. The patients performed a standardized program of exercise, rest and meals. The measurements were performed at 24 degrees C and at a humidity between 3 and 11 g/m3. Discontinuation of dF treatment did not change energy expenditure significantly from placebo, neither when expressed in kJ/kg lean body mass nor in kJ/kg body weight. After cessation of treatment total 24-hour EE decreased likewise nonsignificantly by 2.9 percent in the dF group and by 4.0 percent in the PL group. EE measured over 24 hours was subdivided into day and night periods and into resting energy expenditure as well as a measurement of the heat losses over a period of 3 hours after a meal. This subdivision of the EE showed similar nonsignificant differences. The conclusion is therefore that dF possesses no significant thermogenic effect during long-term administration in human obese subjects.

Adult

VLCD compliance and lean body mass.

Very low calorie diets (VLCD) have many advantages, as they are inexpensive, safe and easy to comply with, and give rapid and encouraging weight loss. On the other hand, many patients complain of hunger and constipation. We have shown that these drawbacks can be reduced by the supplementation of 30 g of dietary fibre to VLCD. By the use of a VLCD which provides approximately 60 g of protein for women and approximately 70 g for men, the dietary regimen is safe and no excessive loss of lean body mass seems to occur during VLCD in obese patients. However, the changes in body composition that may occur after cycles of weight loss and regain have not been clarified. After weight cycles with weight losses obtained by conventional diets, obese women have lower lean body mass than obese non-dieting controls. Hence, more information about the changes in body composition during dieting on conventional diets and VLCD are needed.

Body Composition

Initial very low calorie diet (VLCD) improves ultimate weight loss.

Thirty-eight consecutive obese persons were treated as outpatients. The treatment commenced with VLCD formula diet NUPO (females 388 kcal, 1600 kJ, 56 g protein; males 446 kcal, 1864 kJ, 69 g protein). VLCD had no untoward effects and was continued for as long as the patient would accept. After that the formula diet was supplemented with ordinary items of food and drink to the level of 1000 kcal (4200 kJ) for women and 1100 kcal (4600 kJ) for men. After 5 months the data were analyzed separately according to the duration of VLCD: group 1 (n = 20): VLCD for less than 2 months, and group 2 (n = 18): VLCD for 2 months or more. The two groups were comparable with regard to height, absolute weight and percentual overweight, but group 2 was somewhat older than group 1 (49.5 vs 38.3 years, P less than 0.01). Group 2 lost significantly more weight, both totally (17.1 kg (7.8-40.1] and on VLCD alone (12.3 kg (4.1-28.8], than group 1 (8.7 kg (-1.1 to 19.1), P = 0.008; and 7.3 kg (0.9-18.2 P = 0.01). Weight losses in both groups eliminated or strongly reduced the need for a wide variety of expensive drugs: antidiabetics, diuretics, antihypertensives, analgetics, etc. It is concluded that VLCD is an effective and encouraging way of starting a dieting program, and that it should be continued for at least two months, as the length of the initial VLCD period related significantly to the amount of weight eventually lost.

Adolescent

Long-term (5-year) results after either horizontal gastroplasty or very-low-calorie diet for morbid obesity.

Fifty-seven patients allocated at random to either diet supported by gastroplasty or very-low-calorie diet (VLCD) were followed for 5 years. One patient was lost to follow-up 1 year after surgery. Data were analyzed by survival statistics and success was liberally defined as a maintained weight loss of at least 10 kg. The cumulative success rate declined steadily in both groups, but it remained higher in the gastroplasty group (16 versus 3 percent, the 95 percent confidence limits being 11-21 percent and 1-5 percent, respectively; P less than 0.05). At 5 years, eight of 27 gastroplasty patients (30 percent, 95 percent confidence limits 14-50 percent) had not relapsed. Of 30 VLCD patients, relapse had not occurred in five (17 percent, 6-35 percent). The weight loss of patients without relapse did not differ significantly (medians of gastroplasty and VLCD patients 18 kg and 27 kg, respectively). Complications and side-effects were more numerous and serious among the gastroplasty patients. Although in this long-term study, the horizontal gastroplasty proved to be somewhat more effective than the diet alone, the surgical risks and the unsatisfactory maintenance of weight loss speak against the use of this operation.

Adult