Biomedical subjects
G Enzi
Publications and source records attributed to G Enzi.
Lipoprotein sub-fraction levels and composition in obese subjects before and after gastroplasty.
Obesity is frequently associated with several alterations of plasma lipid levels and lipoprotein metabolism. To evaluate the effects of severe obesity and weight loss on plasma lipoprotein sub-class levels and composition 11 grossly obese patients were examined before and six and 12 months after gastroplasty. Plasma lipoproteins were isolated by ultracentrifugation in a zonal rotor under rate flotation conditions. Mean body weight was 121.9 kg before gastroplasty, 97.6 kg after six months, and 90.7 kg after 12 months. Total plasma cholesterol was not affected by the weight reduction. Obese patients were characterized by increased levels of IDL and small dense LDL (LDL3). LDL levels, but not LDL3, were reduced following weight reduction. Plasma apo B levels of obese patients were always higher than in controls and were not affected by the weight reduction. After 12 month's weight loss total HDL cholesterol increased without modification of HDL sub-class cholesterol distribution, which was similar to that of normal controls. Plasma apo AI in obese patients was not affected by changes in body weight, and remained below normal. The percentage protein-lipid composition of LDL2 and HDL3 in obese patients was characterized by a decreased cholesterol ester content before gastroplasty which was normalized 12 months after gastroplasty. The presence of IDL and LDL3 in increased concentrations in severely obese patients may represent a vascular risk factor since similar abnormalities were recently observed in non-obese patients affected with vascular diseases.
Assessment of abdominal fat distribution in obese patients: anthropometry versus computerized tomography.
The accuracy of waist to hip girth ratio (WHR) in assessing visceral/subcutaneous abdominal fat distribution has not yet been clearly established in the obese population. The purpose of the present study was to evaluate the relationship between WHR and visceral/subcutaneous fat distribution, both assessed by computerized tomography (CT), in a group of 28 obese patients (15 male, 13 female). Furthermore, 33 normal weight or slightly overweight subjects (23 male, 10 female) were studied as a control group. Obese subjects of both sexes were found to have higher values of WHR than non-obese; conversely visceral:subcutaneous fat area ratio (VSR) values did not differ significantly. Significant correlation between WHR and BMI was present both in males (r = 0.41, P < 0.01) and in females (r = 0.54, P < 0.01). In normal weight males significant correlations between WHR and visceral fat area or VSR were found. In obese males these correlations were much weaker. In normal weight females a significant correlation was found between waist circumference and visceral fat area, whereas in obese females no positive correlations were found between anthropometric measurements and CT indices of visceral fat distribution. In conclusion, WHR cannot be considered as a reliable index of visceral/subcutaneous fat distribution in obese patients, particularly if they are females.
Italian Consensus Conference--overweight, obesity and health.
On 5 and 6 April 1991, at the National Research Council (CNR) in Rome, a Consensus Conference on the relationship between overweight, obesity and health was held. The conference was sponsored by FATMA (Applied Project on Disease Factors of the CNR) and UICO (Italian Society for the Study of Obesity) with the purpose of establishing guidelines for health employees. The development of the conference followed the methodology set down by OMAR to obtain a rational and significant consensus on the answers to six basic questions prepared by the planning committee. The questions were the pivotal point of the conference and were brought to the attention of all the attendees and widely diffused among the medical community; they were proposed with the aim of giving an exhaustive definition of obesity, to investigate its relationship with mortality and morbidity, to highlight its social characterization, to indicate methods of evaluation and recommendations for weight loss, to select groups at risk, and to focus general guidelines for research. After the presentation of the state of the art on 18 topics by experts in the field, the 22 members of the consensus panel, impartial experts from a vast area of the scientific community, discussed a draft document representing the answers to the questions, which was subsequently submitted to the 307 attendees, discussed and then approved. This paper is the definitive document of the Consensus Conference. The introduction explains the reasons which led to the decision to promote the conference six years after the one held in the United States. The methodology is then set out. The questions are answered in the form of recommendations and backed up by data and scientific evidence from the literature.
Life-style: physical activities and activities of daily living. Euronut SENECA investigators.
In 19 towns and cities across Europe, physical activity and activities of daily living were studied in 2586 elderly people born between 1913 and 1918. Data were obtained as part of a standardized questionnaire. Large variations in both levels of physical activity and activities of daily living existed among research towns and cities. Altogether, women spent more hours per day on physically active tasks than men, including more time on housework (2.6-3.9 h/day versus 0.7-2.3 h/day for men) and on leisuretime activities (2.0-4.2 h/day versus 0.9-2.3 h/day for men). According to 16 items of functioning, including both items of personal functioning and more complex tasks, functioning was rated as good in most of the elderly. In all centres good functioning was most prevalent in men, and in the younger elderly born in 1917 or 1918. In further cross-sectional analyses the relationship between physical activity, nutrition and other life-style factors, on the one hand, and anthropometry, health and performance, on the other hand, will be examined.
Assessment of health: self-perceived health, chronic diseases, use of medicine. Euronut SENECA investigators.
In 17 towns in 11 countries across Europe, 10 questions on health were asked as part of a general standardized interview regarding self-perceived global and relative health, quality of life, chronic diseases, use of medicine and specific ailments. 2544 men and women born between 1913 and 1918 participated in the survey. No age-related health differences were found within this 5-year age group. Self-perceived global health was better in men than in women, and more men than women judged their health to be better than that of other persons of their age. The gender difference in prevalence of chronic diseases and use of medicine was less pronounced. Most people judged their health to be good (20-82%) despite a high prevalence of chronic disease (59-92%) and symptoms from different organ systems (leg problems: 16-60%). There were large variations in all measures of health between towns, even between towns within the same country. The trend was in the direction of better health in northern industrial towns than in southern rural towns. The differences were still significant after correction for differences in non-participation rate. The findings are consistent with findings in other health surveys. The findings about self-rated health, chronic diseases and specific ailments will be used in further cross-sectional analyses of the role of differences in diet habits and nutrition for health in Europeans, controlled for living conditions and life-style.
Quality of life among the elderly in Veneto, Italy: a cross-sectional study.
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Insulin regulation of glucose and lipid metabolism in massive obesity.
Eight obese patients and 12 normal individuals underwent a euglycaemic insulin clamp (20 and 40 mU m2-1.min-1) along with continuous infusion of 3-3H-glucose and 1-14C-palmitate and indirect calorimetry. Basal plasma glucose concentration (4.7 +/- 0.3 vs 4.4 +/- 0.2 mmol/l) was similar in the two groups, whereas hepatic glucose production was slightly higher in obese individuals (1.11 +/- 0.06 vs 0.84 +/- 0.05 mmol/min) in spite of higher plasma insulin levels (17 +/- 2 vs 6 +/- 1 mU/l; p less than 0.01). Insulin inhibition of hepatic glucose production was impaired in obese subjects. Glucose disposal by lean body mass was markedly reduced both at baseline (11.7 +/- 1.1 vs 15.6 +/- 0.6 mumol.kg-1.min-1; p less than 0.05) and during clamp (15.0 +/- 1.1 vs 34.4 +/- 2.8 and 26.7 +/- 3.9 vs 62.2 +/- 2.8 mumol.kg-1.min-1; p less than 0.01) Oxidative (12.2 +/- 1.1 vs 17.8 +/- 1 and 16.1 +/- 1.1 vs 51.1 +/- 1.7 mumol.kg-1.min-1; p less than 0.05-0.002) and non-oxidative glucose metabolism (3.9 +/- 1.1 vs 15.0 +/- 2.8 and 12.8 +/- 3.3 vs 38.2 +/- 2.2 mumol.kg-1.min-1; p less than 0.01-0.001) were impaired. Basal plasma concentrations of non-esterified fatty acids (635 +/- 75 vs 510 +/- 71 mumol/l) and blood glycerol (129 +/- 17 vs 56 +/- 5 mumol/l; p less than 0.01) were increased in obese patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Lipid and apoprotein modifications in body builders during and after self-administration of anabolic steroids.
To determine the effects of anabolic steroids on serum lipid and apoprotein levels, 14 white male body builders who self-administered steroids for 2 to 3 months (steroid users) were studied; 10 agreed to screening while they were taking the drugs (ON treatment) and also at about 3 months following their suspension (OFF treatment). Controls consisted of 17 body builders who had never taken steroids (nonusers), and a group of 18 healthy sedentary subjects (controls). During the period of steroid administration, there was a slight reduction in total serum cholesterol, with a marked cholesterol decrease in the high-density lipoprotein (HDL) subfractions HDL2 and HDL3, and a significant reduction in the HDL2 cholesterol/HDL3 cholesterol ratio; the percentage of serum cholesterol transported by low-density lipoproteins (LDL) increased significantly. In addition, a marked apoprotein (apo) A-I reduction in the HDL2 and HDL3 subfractions was observed, as well as an apo A-II decrease that was significant only in the HDL3 subfraction, with an A-I/A-II ratio significantly reduced in both subfractions. Serum apo B was only slightly increased, with a very high B/A-I ratio. Apolipoprotein C-II and E levels showed no modifications, while apo C-III reduced significantly. Lipid and apoprotein values returned to almost normal levels in the OFF treatment period. Findings in the group of nonusers were similar to those in sedentary subjects. These results indicate that anabolic steroids profoundly alter the serum lipid-protein profile, and the changes may be caused in part by the significant differences observed in apoprotein levels.
Epidemiology of obesity in the elderly: CNR multicentric study in Italy.
This study includes anthropometric measurements (Body Mass Index, triceps and subscapular skinfolds, % Body Fat and Mid Arm Muscle circumference) of a cross-sectional sample of 1247 elderly representative of the Italian population between 65-95 yr (522 males and 725 females). BMI at the 50th percentile is 26 for males and 27.7 for females, at the 90th it is 31.1 and 34.7 for males and females, respectively. Compared with the data of Master et al. (1960), 13% (males) and 28% (females) of the elderly Italian subjects were overweight in 1985.
Very early nutrition supplementation in burned patients.
We studied some metabolic and hormonal effects of a very early nutrition supplementation in burned patients. The patients were divided into two groups of 10 patients each. Supplementation in the first group, the very early nutritionally supplemented (VENS) group, was started immediately after admission, ie, after 4.4 +/- 0.5 h (mean +/- SEM) from the injury; it was started after 57.7 +/- 2.6 h from the injury in the second group (control group). Hormonal and metabolic indices were recorded every 4 d up to 28 d. In the VENS group, the nitrogen balance became positive in 8.8 +/- 4.1 d whereas it took 24.1 +/- 6.9 d in the control group (p less than 0.05). Urinary catecholamine excretion and plasma glucagon concentrations were lower during the first 2 wk of observation in the VENS group compared with the control group. Insulin concentrations were significantly higher on the fourth and eighth days in VENS patients and plasma cortisol concentrations were similar in both groups.
Metabolic and hormonal effects of early nutritional supplementation after surgery in burn patients.
We evaluated, in burn patients, the metabolic and hormonal effects of early nutritional supplementation after a severe stress event represented by the deep surgical excision of the burn wounds and autograft coverage. The surgical procedure induced a 50% increase from baseline value of the resting metabolic rate. Immediate nutritional supplementation avoids the adaptive stress-related increments of urinary catecholamine excretion and glucagon secretion while insulin secretion is maintained. The urinary cortisol excretion, significantly increased after surgery in study and control groups, was unaffected by the nutritional intervention. The favorable insulin/glucagon ratio and the control of catecholamine response in early nutritionally supplemented patients are associated with the maintenance of a positive N balance in the days after surgery.
Multiple symmetric lipomatosis. Ultrastructural investigation of the tissue and preadipocytes in primary culture.
Multiple symmetric lipomatosis (MSL) is characterized by enlarging, painless fat deposits in the neck and upper trunk. The pathogenesis of MSL is unknown. Owing to localization of MSL fat deposits in the neck and interscapular region, it has been suggested that they could originate from brown fat. However, the histological appearance of MSL adipose tissue is that of white fat, with prevailing monovacuolar adipocytes. Nevertheless, MSL adipocytes are smaller than adipocytes of the common white adipose tissue and show peculiar metabolic features. The ultrastructure of MSL lesions has been not described. The present work investigated the ultrastructural morphology of MSL adipose tissue and lipomatous adipocyte precursors maintained in long-term culture. Samples of lipomatous tissue were obtained from patients affected with MSL undergoing surgical lipectomy. Portion of the tissue was processed for electron microscopy; the rest was digested with collagenase, and isolated preadipocytes from the stromal-vascular fraction were cultured up to 15 days. Cultured cells were prepared for electron microscopy in situ and their morphology compared with human white adipose tissue preadipocytes and rat brown preadipocytes cultured in parallel. Results show the following. 1) Adipocytes of MSL are not monovacuolar and resemble the largest adipocytes that can be found in rat and human brown fat. 2) Some morphological features of MSL adipocyte precursors resemble brown adipocyte more than white: cultured MSL preadipocytes transiently develop large mitochondria with parallel cristae resembling those of the brown fat cell and maintain a multivacuolar lipid deposit in culture, i.e. a typical feature of brown preadipocytes. 3) Some morphological features suggest a neoplastic nature of MSL adipocytes. Taken together, these findings suggest that MSL is a neoplastic disease which could originate in brown fat.
[Socioeconomic status and chronic diseases of the aged. A multicenter study].
The above study was carried out in a population sample of 1250 elderly subjects living at home, from five Italian regions (Budrio in Emilia-Romagna, Ponte S. Nicolò in Veneto, Bernareggio in Lombardy, Sezze in Latiumm, Melito in Campania). The results obtained lead to the following conclusions: 1. The condition of loneliness appears to have a detrimental influence on health in both sexes. Among other consequences, loneliness leads to progressive spontaneous reduction of daily milieu and social requirements, as well as to an impression of dependence that cannot be easily overcome. 2. The study of the relationship between the presence or absence of chronic pathologies and legal title of domicile has shown that if the home is their own by legal property or usufruct this has a favorable influence, especially in males. Property also satisfies emotional needs, through the profound ties between personal history and certain places. 3. Positive changes in life style may have beneficial effects on the interaction between socio-economic variables and the onset of chronic pathologies, especially in old age.
Specific features of left ventricular hypertrophy in hypertensive obese women. An echocardiographic study.
The echocardiographic features of the left ventricle of 37 obese women (body mass index above 30) and 37 lean controls, matched for sex, age, height and blood pressure levels, were studied. Twenty-six patients in each group were hypertensive. The normotensive obese patients did not show any differences, comparing to the normotensive controls; on the contrary, the hypertensive obese patients had higher left ventricular mass (LVM), stroke volume and cardiac output (CO), and lower total peripheral resistance (TPR) than the hypertensive controls. A positive correlation was found between the LVM and the CO (r = 0.57, P less than 0.01) in hypertensive obese patients, and between the relative wall thickenss (h/r, that is the ratio between the left ventricular wall thickness and the left ventricular radius) and TPR (r = 0.64, P less than 0.01) in the hypertensive controls. It is concluded that obesity per se does not determine left ventricular hypertrophy in women; however, when obesity is associated with arterial hypertension, a distinct pattern of hypertrophy, characterized by high CO and low TPR, develops.
Lipid metabolism in lipoatrophic diabetes.
Some aspects of lipid metabolism were studied in 4 patients with a congenital lipoatrophic diabetes (LAD) associated to a type IV hyperlipoproteinemia. The analysis of lipoprotein composition, expressed as mg/dl, demonstrates a significant increase of VLDL mass and a significant reduction of HDL mass. The analysis of lipoprotein composition, expressed as per cent of total mass demonstrates an increase of the triglyceride content in all fractions and a significant reduction of the cholesterol and phospholipid content in HDL2 particles. Apo C-II, C-III0, C-III1 and C-III2 levels in lipoprotein fractions were normal in LAD patients. Lipoprotein lipase activity in omental adipose tissue, collected during laparoscopy in one patient was undetectable. The serum of this patient did not fully activate the lipoprotein lipase eluted from normal adipose tissue. In all patients the adipose tissue lipoprotein lipase activity in post-heparin plasma was blunted or near absent. Thus a reduced peripheral clearance of triglyceride-rich lipoprotein could be an important determinant of lipoprotein abnormalities in lipoatrophic diabetes.
Efficacy and safety of dexfenfluramine in obese patients: a multicenter study.
We have evaluated the effects of dextrofenfluramine treatment on body weight control during a 90 day period, in obese patients on a calorie-restricted diet. The weight loss in dextrofenfluramine-treated patients was significantly higher than in placebo group. The rate of weight loss was linear up to the end of the trial in d-fenfluramine patients. Neural disturbances (vertigo, headache, depression) were the most frequent side effects observed in both the d-fenfluramine and in the placebo-treated groups, without significant differences between the groups. A total number of 23 patients in the dextrofenfluramine group and 20 patients in the placebo group complained side effects. Six patients (five in the d-fenfluramine group and one in the placebo group) discontinued the treatment, due to the side effects. No modifications of the biochemical parameters considered (fasting blood glucose, bilirubin, alkaline phosphatase, creatinine, blood cell counts, asparate-amino transferase (AST), alanine-amino transferase (ALT), total plasma and HDL cholesterol, and triglycerides) were observed at the end of the trial. A significant reduction of total serum cholesterol was observed in both groups at the end of the period of treatment. In conclusion, dextrafenfluramine was proved to be in short term trials an effective and safe tool in overweight control in obese patients.
Visceral obesity and diabetes.
The cross-sectional subcutaneous and visceral areas of adipose tissue, measured on computed tomographic scans at abdominal level and the subcutaneous/visceral fat area ratio (S/V ratio) distribution have been calculated in 155 subjects. Using the S/V ratio as discriminator, two groups of patients of both sexes, with subcutaneous or visceral type of obesity have been selected. Metabolic studies demonstrate a significant reduction of glucose tolerance at the oral glucose load and a significant increase of the insulin response in patients with visceral obesity. The size of the omental fat cells was larger in visceral obesity, while the size of subcutaneous fat cells was larger in subcutaneous obesity. A significant correlation was found between the S/V area ratios and the subcutaneous/visceral fat cell weight ratios. In vitro studies on subcutaneous and omental fat obtained during surgery from 9 patients with subcutaneous obesity and 7 patients with visceral obesity demonstrate a significantly higher isoprenaline-stimulated lipolytic response in omental fat of patients with visceral obesity. The lipoprotein lipase activity in subcutaneous fat was higher than in omental fat in both types of obesity.