Weight cycling--a 'new' risk factor?
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Animals↗
Biomedical subjects
S Rössner
Publications and source records attributed to S Rössner.
Pituitary-testicular axis in obese men during short-term fasting.
To investigate whether short-term fasting affects the pituitary-testicular axis in obese subjects, 9 massively obese men (Body Mass Index 39.0 +/- 1.3, mean +/- SEM) were given two identical iv GnRH tests, the first (control) after an overnight fast, the second after 56 h of food deprivation. Short-term fasting augmented the GnRH-induced LH incremental area by 26% (1317 +/- 251 vs 1661 +/- 297 U.l-1.min-1, p less than 0.05), but failed to affect the corresponding testosterone incremental area. Eight non-obese normal men (Body Mass Index 22.2 +/- 0.5) were investigated for comparison. All of them were studied according to the same protocol as the obese group. Short-term fasting increased the GnRH-elicited LH response by 67% in the non-obese group (LH incremental areas 2147 +/- 304 vs 3581 +/- 256, p less than 0.01), and the corresponding testosterone response by 180% (testosterone incremental areas 111 +/- 61 vs 311 +/- 49 micrograms.l-1.min-1, p less than 0.01). These results imply that food deprivation affects the pituitary-testicular axis differently in obese and non-obese men.
Adult↗
The "true" prevalence of obesity. A comparison of objective weight and height measures versus self-reported and calibrated data.
A regression model that describes the relationship between body mass index (BMI, kg/m2) based on self-reported weight and height, and body mass index based on objective measurements, makes it possible to calibrate the BMI based on self-reports. Calibrated data on prevalence of obesity are much higher than those calculated from self-reports. The aim of the present study was to evaluate which estimates of prevalence of obesity agreed better with objective values, those based on self-reported data or those based on calibrated BMIs. Results from two different representative samples of the same Swedish rural county were compared. Objective values were based on measurements of 2190 men and 1511 women (25-65 years of age) in 1977. Self-reports from 148 men and 147 women (25-64 years of age) were derived from the ULF-study, 1980-81 (Survey on Living Conditions) and then calibrated. The comparison demonstrated that calibrated data, compared with self-reports, are much closer to objective values. There was a striking agreement between objective (14.0%) and calibrated (13.6%) estimates of prevalence of women with BMI greater than 30.0 kg/m2, in contrast to the under-estimation by self-reports (8.1%). The calibration method was reliable for the evaluation of the "true" prevalence of obesity in population studies.
Adult↗
Fatty acid composition in serum lipids and adipose tissue in severe obesity before and after six weeks of weight loss.
Fatty acid composition was studied in 25 grossly obese patients (mean weight 116 +/- 21 (s.d.) kg) before and after 6 weeks of treatment with a combined program consisting of diet, behavioral modification and light exercise. Data were compared with results from nonobese controls. In obese patients the most marked differences were reduced relative contents of linoleic acid in serum triglycerides (P less than 0.001), cholesterol esters (P less than 0.05) and phospholipids (P less than 0.001). Linolenic acid was reduced in serum triglycerides (P less than 0.001) and in cholesterol esters (P less than 0.01). There were reciprocal increases in palmitic and palmitoleic acid (P less than 0.05) in these two serum lipid fractions. In adipose tissue of obese patients only minor differences were found in palmitoleic acid, which was increased, and in the saturated fatty acids with 14, 16 and 18 carbon atoms which were decreased. Weight loss (600 kcal/day for 6 weeks, P/S ratio about 0.5) did not affect adipose tissue fatty acid composition, but resulted in reductions of linoleic acid content in cholesterol esters and phospholipids, with reciprocal increases of palmitic and arachidonic acid in these fractions. Our results suggest that obese patients have low essential fatty acids content in their circulating plasma lipids already in a weight stable phase. Therefore it may be argued that in the development of long-term dietary restriction programs attention should be paid to the quality of the dietary fat.
Adipose Tissue↗
Energy intake of obese women.
In connection with a weight reduction study over 12 weeks we included a dietary history of obese women before and during the study. The first interview was geared to find out their usual energy intake, the second to monitor compliance. All interviews were performed in the homes of the obese women by the same research dietitian. A pilot study was carried out in the spring with 19 women. The subsequent complete study was performed in the autumn when 33 women were interviewed. After the first interview, the women were taught to eat 1500 kcal/day. The anthropometric data of women in the spring and autumn group were similar. The mean energy intake calculated from the first spring interview was 2203 +/- 643 (s.d.) kcal/day, range 1053-3474 kcal, whereas the daily intake in the autumn group was 2805 +/- 803 kcal/day, range 1113-4042 kcal (P less than 0.01). Thus, after a pilot study a 27 per cent higher energy intake could be revealed in a group of obese women. The second dietary history showed a good compliance with the programme in both spring and autumn groups with a calculated daily intake of 1535 +/- 363 kcal, range 984-2612 kcal, and 1639 +/- 481 kcal, range 616-2995 kcal respectively and an accompanying weight loss of 5.7 +/- 4.1 kg and 4.9 +/- 3.0 kg. Our data indicate that after a dietitian run-in period a substantially higher energy intake can be detected in obese women than has generally been reported.
Energy Intake↗
The predictive validity of body mass index based on self-reported weight and height.
In the Western society where obesity is a less desired condition it is natural that individuals may tend to report values of weight and height that they believe conform with current norms. Although several previous studies have shown that for the individual the difference between reported and controlled data may be small, such differences may affect body mass index distributions in various populations. The predictive validity of self-reported weight and height and of body mass index (BMI) calculated from these measures was analysed by using data from a random sample including 182 women with a mean age of 62 years (20-84 years) and 119 men with a mean age of 56 years (16-84 years) from a health care centre. Multiple multivariate linear regression analysis was used to study the relationship between self-reported (subjective) and controlled (objective) values. The regression lines of subjective parameters on controlled ones were significantly different from the line of identity for both sexes for weight, height and BMI (P less than 0.001). These lines demonstrate a 'flat slope syndrome', i.e. there is a systematic tendency for high values to be underestimated and for low ones to be overestimated. There was one exception for height in women, which was always overestimated, even for tall subjects. A systematic tendency for overweight and obese subjects to underestimate their body size and conversely for underweight subjects to overestimate it resulted in an incorrect BMI category distribution of 30 per cent of these subjects. This fact may invalidate data and conclusions of population surveys based on self-reported measures.
Adolescent↗
[Art in hospitals: a renaissance of roof painting].
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Art↗
Relationship between serum lipoproteins and hemostatic parameters in men with prostatic cancer.
Serum lipoprotein concentrations were related to hemostatic parameters in a group of 31 men before and during three different hormone treatment regimens for prostate cancer in an attempt to analyse to what extent the changes in these two systems correlate. In a correlation matrix the number of significant relationships at the 5% and 1% level corresponded to what could be expected by chance. The study thus failed to demonstrate any consistent relationship between any lipoprotein lipid concentration and the hemostatic parameters in men treated for prostate cancer. Most significant relationships were found for HDL-TG versus plasminogen, but the clinical significance of this observation is not clear.
Estradiol Congeners↗
Impaired pancreatico-biliary response to vagal stimulation and to cholecystokinin in human obesity.
We previously found that massively obese patients respond with less gastric acid secretion in response to vagal stimulation. This is compatible with the described association between experimental obesity and altered vagal function in the rat. To confirm this observation, the pancreatic and biliary responses to vagal stimulation were examined in nine nondiabetic obese patients against a background secretin infusion of 15 CU x h-1, and monitored after a subsequent injection of 75 IDU of cholecystokinin. Two separate marker perfusion systems were used in the stomach and duodenum, respectively, and blood samples were drawn for hormone analyses. In contrast to controls having normal body weight, the obese patients failed to respond with increments of pancreatic enzyme secretion and duodenal bile acids after stimulation with modified sham feeding. Cholecystokinin stimulated the pancreatic secretion of trypsin, amylase, and lipase, the emptying of bile acids, and the release of gastrin, but the patients' responses were only half that of the controls. In the resting state the obese had higher outputs of bile and pancreatic enzymes and higher plasma levels of pancreatic polypeptide compared with controls, but the pancreatic bicarbonate secretion rate was not different. The almost complete suppression of the basal gastric acid secretion by a low dose of intravenous (IV) secretin in controls did not occur in the obese. We conclude that massive obesity is associated with a reduced pancreatic and biliary response to vagal stimulation. Compared with controls, the digestive functions of the obese patients seem to be less sensitive to stimulation by exogenous cholecystokinin.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Effects of a dietary fibre supplement to a weight reduction programme on blood pressure. A randomized, double-blind, placebo-controlled study.
Sixty-two moderately obese (body mass index = 34.8), but normotensive females were treated with a balanced hypocaloric diet providing 1,600 kcal/day and either a 6.5 g dietary fibre supplement or placebo in a randomized, double-blind, parallel group design. During a 12-week treatment programme, weight loss was similar in both groups (4.1 and 4.4 kg, respectively). Initially the blood pressure was 123/76 mmHg in the fibre group compared with 124/74 mmHg in the placebo group (p less than 0.05). In the fibre-treated group a significant fall in diastolic blood pressure by 4 mmHg was found (p less than 0.05). No significant change was seen in the placebo group. It is suggested that dietary fibre may affect blood pressure independently of weight change.
Adult↗
Melatonin secretion related to side-effects of beta-blockers from the central nervous system.
In two studies of hypertensive patients the relationship between beta-blocker-induced CNS side-effects and the nightly urinary secretion of melatonin was analysed. In one group (n = 10) placebo, atenolol (mean dose 86 mg/day) or propranolol (mean dose 305 mg/day) were given in a double-blind, randomised design. In the other (n = 13) 100-400 mg metoprolol was given daily (mean dose 197 mg). After 4 weeks of treatment all beta-blockers reduced melatonin excretion, but the effect was significant only for metoprolol. Sleep disturbance records revealed more disturbed nights in the metoprolol group compared with the propranolol and the atenolol groups, even when the difference in age between the groups was controlled for. In the metoprolol group a significant relationship (p less than 0.05) was found between the fall in melatonin and the percentage of disturbed nights. Severe CNS side-effects, such as nightmares, occurred only in patients treated with metoprolol (21%), which in all cases were accompanied by low levels of melatonin. Our data suggest that the CNS side-effects during beta-blockade are related to a reduction of melatonin levels.
Adult↗
French fries, fake food or fresh fruit?
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Diet↗
Long-term care of obese individuals in a community-based primary health care program.
A four-year treatment program for severe obesity containing behavioural modification, exercise and nutrition advice was developed at the obesity unit at the Karolinska Hospital. The program made it possible to achieve a sustained weight loss. As far as we know such long-term treatment result has not been reported for this group of patients before. As a consequence of the positive outcome the hospital treatment program was transformed to an out-patient program that could be used in a primary health care setting. The transformation process is emphasized in this presentation but also preliminary results of the weight reduction and the attrition rate in the primary health care setting of the weight reduction program are presented. The evaluation indicates that instructors and participants in the program overall have accepted the program. The mean weight reduction after ten weeks was 6.3 kg. The attrition rate during that time was 2%.
Adult↗
Intralipid disappearance from the circulation in critically ill patients.
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Chronic Disease↗
Serum lipids and lipoproteins in ischaemic heart disease following withdrawal of long-term metoprolol treatment.
In 39 patients who had been treated with metoprolol 100-200 mg daily or placebo for three years after acute myocardial infarction, serum lipids and lipoproteins were studied while the patients were on treatment as well as after its withdrawal. Withdrawal was performed over 1 week. Treatment had to be reinstituted in 6 patients (1 ex placebo and 5 ex metoprolol) because of aggravated symptoms. During the entire study period total cholesterol was significantly higher in the metoprolol withdrawal group and LDL cholesterol tended to be higher. HDL cholesterol in both groups increased significantly during the initial 28-day period following withdrawal of treatment. In both groups VLDL triglycerides tended to decrease during the first 28 days without treatment. Other lipoprotein fractions in both groups were unchanged. Overall, in patients who tolerated the ending of 3 years of treatment with metoprolol after myocardial infarction, there was no significant effect on lipoprotein fractions as compared to a placebo group.
Adult↗
Gastric secretion in massive obesity. Evidence for abnormal response to vagal stimulation.
Studies in animals and man suggest involvement of the vagal nerve in the pathophysiology of massive obesity. An abnormal vagal response pattern has been found in the obese rat, but corresponding functional studies in obese man are nonexistent. The gastric acid secretion was therefore examined in 13 nondiabetic grossly obese patients (average body weight 120 kg) and compared to 16 age-matched controls of normal body weight. The gastric acid response to modified sham feeding was significantly (P less than 0.05) reduced in obese patients, being on average 60% of the control output. The obese patients had a higher maximal gastric acid response to graded intravenous pentagastrin, 36.6 +/- 2.9 mmol/hr, compared to 27.1 +/- 2.4 mmol/hr in controls (P less than 0.05). In addition, the patients seemed to need less pentagastrin to reach a secretory plateau. Basal acid secretion rates were similar in obese and control groups. Plasma gastrin and blood glucose were not significantly different in obese patients and controls, but patients had significantly elevated plasma insulin levels. The change of plasma insulin during the sham-feeding procedure correlated with the magnitude of the secretory response in obese and control subjects. The reduced gastric acid response to vagal stimulation in the absence of impaired parietal cell function in obese patients is indicative of an association between massive obesity and altered vagal function in man.
Blood Glucose↗
Early and late effects of weight loss on lipoprotein metabolism in severe obesity.
In a group of grossly obese patients serum lipoproteins and the intravenous fat tolerance test were analysed before a weight reduction program (n = 98), after 6 weeks (n = 58) and 1 year (n = 15). At one year follow-up the mean weight had fallen from 120 to 105 to 100 kg, respectively. In spite of severe overweight, only a moderate hypertriglyceridaemia (males mean fasting concentration of plasma triglycerides (TG) 2.50 +/- 1.36, females 2.03 +/- 1.94 mmol/l) was found before treatment. After 6 weeks significant reductions were found in VLDL-TG, -cholesterol, LDL-cholesterol and HDL-cholesterol (P less than 0.05 at least). After one year VLDL-TG was still below pretreatment level, LDL-cholesterol had increased above pretreatment level, whereas HDL-cholesterol was significantly higher compared to pretreatment (P less than 0.05). Some previous studies suggest that weight loss may lead to HDL-cholesterol reductions, which would be undesirable. The present study indicates that after sustained weight loss and at a stable lower body weight, HDL-cholesterol levels may increase above pretreatment levels after an initial drop during the catabolic weight reduction phase.
Adult↗
Immediate intralipid clearance from plasma in critically ill patients after a single-dose injection.
Plasma fractional removal rates (k2) of Intralipid injected in parallel with 125I albumin were analyzed in five healthy males and nine critically ill patients. The k2 values of critically ill patients were similar to those of healthy subjects. However, the initial plasma concentrations of Intralipid calculated by extrapolation to zero-time (y0) were markedly different. The mean y0 value in the critically ill patients was 43% that of healthy subjects. No plasma loss of 125I albumin occurred throughout the test. Intralipid to 125I albumin plasma concentration ratios during the removal phase paralleled the curves obtained from the iv fat tolerance test. This suggests that these ratios depend on Intralipid clearance rather than leakage from the circulation. The immediate loss of Intralipid suggests that the pulmonary vasculature, the first capillary bed through which the emulsion passes, could be the site where a substantial uptake of the emulsion occurs in critically ill patients.
Adolescent↗