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PubMed2006

Regional fat localizations and racial/ethnic variations in odds of hypertension in at-risk American adults.

The objective of this study was to determine the contribution of regional fat localizations defined as abdominal (AO) or truncal (TO) obesity in racial/ethnic differences to the prevalence odds of hypertension in overweight American adults. Data (n=5,694) from the 1999-2002 US National Health and Nutrition Examination Survey were utilized for this analysis. Abdominal obesity was defined as waist circumference >or=102 and >or=88 cm for men and women, respectively. Truncal obesity was defined using ratio of subscapular to triceps skinfold thickness and were >or=2.24 and >or=1.32, for men and women, respectively. Prevalence odds ratios from gender-specific logistic regression models were used to evaluate the contribution of regional fat localizations to racial/ethnic variation in hypertension. Statistical adjustment was made for age, education, alcohol intake and body mass index. In both men and women, coexistence of AO and TO was associated with much higher prevalence odds of hypertension than association due to each of the regional fat localizations. In men, coexistence of AO and TO was associated with 1.99, 2.47 and 2.10 increased prevalence odds of hypertension in Whites, Blacks and Mexican Americans, respectively. The corresponding values in women were 2.83, 4.07 and 3.61 in Whites, Blacks and Mexican Americans, respectively. The coexistence of AO and TO appears to be the culprit that contributes to high blood pressure on top of body mass index. Weight reduction programs that are targeted toward abdominal and truncal regions in at-risk populations and along racial/ethnic lines may help to alleviate racial/ethnic disparity in risk of hypertension.

Abdomen↗

PubMed1997

Morbid obesity, absorption, neuroticism, and the high risk model of threat perception.

We studied 70 morbidly obese patients, candidates for gastric exclusion surgery. We found that their mean absorption score was significantly lower and that their mean neuroticism score significantly higher than a matched control group. These results are consistent with predictions from the High Risk Model of Threat Perception (Wickramasekera, 1979, 1986, 1988, 1993a). People high in neuroticism are hypothesized to be hypersensitive to threat and, therefore, at greater risk for stress related psychobiological disorders. But if they are also low in absorption, they are hypothesized to have poor conscious perception of psychosocial threats and, therefore, they develop a very restricted range of psychosocial methods of coping with such threats. Consequently, lows may be mainly restricted to behavioral methods of coping like feeding and drinking to self-soothe unconscious aversive emotions associated with autonomic dysregulation and elevated parasympathetic tone. Their skeptical, rational, pragmatic cognitive style drives them to perceive medical surgical solutions to weight gain as more credible than psychosocial weight reduction programs.

Adult↗

PubMed1998

Cardiovascular risk factors among Arabic-speaking patients attending Arabic-speaking general practitioners in Sydney, Australia: opportunities for intervention.

BACKGROUND: Australia has a high rate of cardiovascular disease mortality and also a significant proportion of migrants. Little is known about the morbidity experience or cardiovascular risk factors among the larger migrant groups, and this is especially true of the Arabic-speaking population. OBJECTIVES: The objectives of the study were to identify the health profile of Arabic-speaking people in Sydney, Australia, to explore the relationship between level of acculturation and health indicators and to identify the morbidity profile of patients presenting to Arabic-speaking general practitioners (GPs). DESIGN: Adult Arabic-speaking patients aged 18-70 years attending 20 Arabic-speaking GPs in Canterbury, Sydney, during the 2-week study period were asked to complete a self-administered questionnaire in Arabic or English while waiting to see the GP. Data on cardiovascular risk factors, level of acculturation and reasons for seeing the GP were collected. RESULTS: Data were collected from 851 patients (62% response rate). Almost three-quarters (73%) of males and 36% of females were considered overweight or obese (body mass index > 25). Of concern, 37% of males and 28% of females were smokers. Females were significantly less likely to have been tested for diabetes (p < .05) or raised blood pressure (p < 0.05) compared with females in NSW. Respondents consumed less bread per day and more fruits than in NSW overall. Respiratory complaints (flu and colds) were the most frequently reported reasons for patient encounters. Except for the youngest age group, males gave more reasons for encounters than females. CONCLUSIONS: Consecutive sampling of ethnic patients attending a GP who speaks their language holds promise as a method of needs assessment with migrant populations. Further, our results suggest that smoking and weight reduction programs are priorities in the Arabic-speaking community. These risk factors are ideal for intervention by GPs speaking the same language.

Acculturation↗

PubMed2001

Virtual reality-based multidimensional therapy for the treatment of body image disturbances in obesity: a controlled study.

The main goal of this paper is a preliminary evaluation of the efficacy of a virtual reality VR-based multidimensional approach to the treatment of body image attitudes and related constructs. The female obese patients (n = 28) involved in a residential weight control treatment, including low-calorie diet (1,200 kcal/day) and physical training, were randomly assigned either to the VR treatment or to psychonutritional groups based on the cognitive-behavior approach. Patients were administered a battery of outcome measures assessing eating disorders symptomatology, attitudes toward food, body dissatisfaction, level of anxiety, motivation for change, level of assertiveness, and general psychiatric symptoms. In the short-term, the VR treatment was more effective than the traditional cognitive-behavioral psychonutritional groups in improving the overall psychological state of the patients. In particular, it was more effective in improving body satisfaction, self-efficacy, and motivation for change. The improvement was associated with a reduction in problematic eating and social behaviors. The possibility of inducing a significant change in body image and its associated behaviors using a VR-based short-term therapy can improve body satisfaction in traditional weight reduction programs. However, given that this research that does not include a follow-up study, the obtained results are preliminary.

Adolescent↗

PubMed1985

Assessment in humans of hypolipidemia induced by orotic acid.

The hypolipidemia induced by oral orotic acid in rats but not in other experimental species was investigated in human adults. Twelve outpatients in a medically-supervised weight reduction program participated in the study. After adaptation to their restricted dietary regime for at least 8 weeks, all subjects were given placebos (1 g lactose/day) for 2 weeks, then orotic acid (1 g/day) for 4 weeks, followed by placebos for 2 more weeks. Pertinent dietary, urinary, and serum parameters were monitored biweekly and intake of calories, carbohydrate, protein and fat was similar throughout. The ingestion of orotic acid did not lower serum triglycerides or cholesterol in these subjects. Since the daily dose tested corresponds to the orotic acid in 12 liters of cow's milk, milk orotic acid at levels normally consumed should not be considered a hypolipidemic or hypocholesteremic agent for humans.

Adult↗

PubMed2003

Maternal body mass index and the risk of preeclampsia: a systematic overview.

BACKGROUND: Maternal obesity, both in itself and as part of the insulin resistance syndrome, is an important risk factor for the development of preeclampsia. Accurately quantifying the relation between prepregnancy maternal body mass index and the risk of preeclampsia may better identify those at highest risk. We performed a systematic overview of the literature to determine the association between prepregnancy body mass index and the risk of preeclampsia. METHODS: Two reviewers independently retrieved all relevant English language cohort studies through a systematic search of Medline and Embase between 1980 and June 2002. Study data were abstracted in a similar fashion. For each study, the risk ratio of preeclampsia was calculated by comparing the risk of preeclampsia among women with the highest body mass index with those with the lowest. RESULTS: We identified thirteen cohort studies, comprising nearly 1.4 million women. The risk of preeclampsia typically doubled with each 5-7 kg/m2 increase in prepregnancy body mass index. This relation persisted in studies that excluded women with chronic hypertension, diabetes mellitus or multiple gestations, or after adjustment for other confounders. CONCLUSIONS: Most observational studies demonstrate a consistently strong positive association between maternal prepregnancy body mass index and the risk of preeclampsia. Increasing obesity in developed countries is likely to increase the occurrence of preeclampsia. Consideration should be given to the potential benefits of prepregnancy weight reduction programs.

Body Mass Index↗

PubMed2005

ACOG Committee Opinion number 315, September 2005. Obesity in pregnancy.

One third of adult women in the United States are obese. During pregnancy, obese women are at increased risk for several adverse perinatal outcomes, including anesthetic, perioperative, and other maternal and fetal complications. Obstetricians should provide preconception counselling and education about the possible complications and should encourage obese patients to undertake a weight reduction program before attempting pregnancy. Obstetricians also should address prenatal and peripartum care considerations that may be especially relevant for obese patients, including those who have undergone bariatric surgery.

Cesarean Section↗

PubMed2006

Alanine amino transferase concentrations are linked to folate intakes and methylenetetrahydrofolate reductase polymorphism in obese adolescent girls.

OBJECTIVE: The objective of this study was to investigate the consequences of low dietary folate intake and the impact of the 677 C-->T methylenetetrahydrofolate reductase (MTHFR) common mutation on liver function in obese adolescents. METHODS: Fifty-seven obese girls (BMI = 36.1 +/- 6.0 kg/m) aged 14.1 +/- 1.5 years were included before starting a weight reduction program. Dietary intakes for folate were assessed by means of an adapted food frequency questionnaire (n = 50). Liver enzymes, plasma lipids, glucose metabolism parameters, ferritin, homocysteine and erythrocyte folate content were measured in plasma or blood obtained under fasting conditions. The MTHFR 677 C-->T polymorphism, which is associated with decreased enzyme activity, was determined using PCR. Body composition was assessed using dual x-ray absorptiometry. RESULTS: Twenty-three subjects were heterozygote (CT) for the mutation and 5 were homozygote (TT). An increase in alanine amino transferase (ALT) and ALT/aspartate aminotransferase ratio was associated with the mutation (F = 4.46, P = 0.016 and F = 5.92, P = 0.0049, respectively). Alanine amino transferase was correlated negatively to folate intake (r = -0.32, P = 0.024) (n = 50) and positively to homocysteine concentrations (r = 0.30, P = 0.025). Body composition was similar among the 3 genotypic groups. Ferritin was also correlated to ALT concentrations of the entire group (P = 0.009). CONCLUSION: Our data suggest that folate intake and the MTHFR polymorphism represent a part of the link between antioxidant status and liver disease in obese adolescent girls.

Adolescent↗

PubMed2002

Virtual-reality-based multidimensional therapy for the treatment of body image disturbances in binge eating disorders: a preliminary controlled study.

The main goal of this paper is to preliminarily evaluate the efficacy of a virtual-reality (VR)-based multidimensional approach in the treatment of body image attitudes and related constructs. The female binge eating disorder (BED) patients (n = 20), involved in a residential weight control treatment including low-calorie diet (1200 cal/day) and physical training, were randomly assigned either to the multidimensional VR treatment or to psychonutritional groups based on the cognitive-behavior approach. Patients were administered a battery of outcome measures assessing eating disorders symptomathology, attitudes toward food, body dissatisfaction, level of anxiety, motivation for change, level of assertiveness, and general psychiatric symptoms. In the short term, the VR treatment was more effective than the traditional cognitive-behavioral psychonutritional groups in improving the overall psychological state of the patients. In particular, the therapy was more effective in improving body satisfaction, self-efficacy, and motivation for change. No significant differences were found in the reduction of the binge eating behavior. The possibility of inducing a significant change in body image and its associated behaviors using a VR-based short-term therapy can be useful to improve the body satisfaction in traditional weight reduction programs. However, given the nature of this research that does not include a followup study, the obtained results are preliminary only.

Adolescent↗

PubMed2006

[Dietary salt in the era of antihypertensive drugs].

Hypertension has a high prevalence and worldwide distribution, secondary to economics, social, cultural and ethnics factors. The prevalence increases with the age, over 50 year a 50% of the population has hypertension. No pharmacological approach is an important device in the treatment of these patients, salt restriction is one of the main dietary treatment. A lot of studies and designs have been realized in this topic area with controversial results. In summary, restriction in salt intake improves blood pressure (BP). However, other nutritional interventions such as DASH diet (Dietary Approaches to Stop Hypertension) have been usefull. This diet is low in saturated fat, total fat and cholesterol, and it has high levels of fruit, vegetable, pulses and semiskimmed dairy products. In a recent metaanalysis, it has been demonstrated the improvement in BP with different interventions: aerobic exercise, 4.6 mmHg, reducing alcohol intake, 3.8 mmHg, decreasing salt intake, 3.6 mmHg and using supplements of fish oil, 2.3 mmHg. In conclusion, restriction in salt intake is important in the prevention and treatment of hypertension. However this treatment has another piece in the integral approach of this entity with weight reduction programs, suppression of coffe, alcohol and smoking habit, and a right source and type of fats.

Blood Pressure↗

PubMed2006

Inflammation in metabolic syndrome and type 2 diabetes: Impact of dietary glucose.

Chronic overnutrition combined with a lack of exercise is the main cause for the rapidly increasing prevalence of overweight and obesity. It seems accepted that adipositis (macrophage infiltration and inflammation of adipose tissue in obesity) and systemic low grade inflammation affect the pathogenesis of the metabolic syndrome or type 2 diabetes mellitus (T2DM). Therefore, modern weight reduction programs additionally focus on strategies to attenuate the inflammation state. Exercise is one major factor, which contributes to the reduction of both the incidence of T2DM and inflammation, and the immunomodulatory effects of exercise are supported by similarly beneficial effects of dietary changes. In this context, glucose is the most extensively studied nutrient and current investigations focus on postprandial glucose-induced inflammation, one possible reason why hyperglycemia is detrimental. Indeed, glucose may modulate the mRNA expression and serum concentrations of immune parameters but these alterations rapidly normalize in normoglycemic subjects. In case of an impaired metabolic state, however, postprandial hyperglycemia increases magnitude and duration of systemic inflammatory responses, which probably promotes the development of T2DM and of cardiovascular disease.

Cytokines↗

PubMed2005

Efficacy of the SF-36 questionnaire in identifying obese patients with psychological discomfort.

BACKGROUND: The primary endpoint of this study was to assess the association of health-related quality of life (QoL) and the presence of psychopathology. The association of other patients' characteristics and of Cognitive Behavioral Assessment (CBA) scales with quality of life (QoL) was also evaluated. METHODS: 100 consecutive obese patients (WHO grade 2 and 3 obesity), addressed for psychological advice before either invasive or non-invasive treatment of obesity, were investigated. The instruments used were the SF-36 questionnaire (physical and mental component summaries, PCS and MCS), the CBA scales and psychological counselling. The association of PCS and MCS with the presence of psychopathology (Marked or DSM IV discomfort) was assessed by means of logistic regression. RESULTS: SF-36 PCS was 39.5 (95% CI 37.7-41.3) and MCS 49.8 (95% CI 47.7-51.9). PCS only was significantly lower than the average for the reference normal population. The mean PCS score was similar in the No-Moderate (39.6 (SD 7.6)) and Marked-DSM IV (39.1 (SD 7.6)) groups, with an adjusted odds ratios (OR) of 1.07 (95% CI 0.74-1.55), P=0.706, for 5 points increase in PCS. The mean MCS score was 51.7 (SD 10.3) in the No-Moderate group and 42 (SD 8.1) in the Marked-DSM IV group, with an adjusted OR for 5 points increase in score of 0.63 (95% CI 0.43-0.95), P=0.003. CONCLUSIONS: SF-36, and particularly the MCS component, is a simple tool of easy use that could be utilized for identifying patients needing a specific psychological intervention in severely obese subjects applying for a weight reduction program.

Adult↗

PubMed2000

Who's overweight? Comparison of the medical definition and community views.

OBJECTIVE: To investigate the extent to which people who are medically defined as overweight perceive themselves to be overweight. DESIGN: Secondary data analysis of the National Health Survey and the National Nutrition Survey conducted by the Australian Bureau of Statistics in 1995. PARTICIPANTS: 10,652 people aged 18 years and over (5076 men, 5576 women) in a multistage cluster sample of households throughout Australia. MAIN OUTCOME MEASURES: Body mass index (BMI) based on measured height and weight; self-reported perception of body weight (underweight, acceptable weight, or overweight). RESULTS: Among people with a measured BMI > or = 25, 49.3% of men (95% CI, 48.1%-50.5%) and 72.0% of women (95% CI, 70.8%-73.1%) considered themselves overweight. Among those with a measured BMI < 25, 3.4% of men (95% CI, 2.8%-4.1%) and 12.4% of women (95% CI, 11.4%-13.3%) considered themselves overweight. Older women were less likely to perceive themselves as overweight than younger women. The lowest BMI at which at least half the respondents considered themselves overweight was 26 to < 27 for women aged 18-59 years, and 28 to < 29 for older women and men. CONCLUSION: For many people, particularly men and older women, the meaning of "overweight" differs from the medical definition. Clinical and public health weight reduction programs which do not take this into account are unlikely to be successful.

Adolescent↗

PubMed2000

Vitamin E treatment of nonalcoholic steatohepatitis in children: a pilot study.

AIM: To determine whether supplemental oral vitamin E is effective in lowering serum aminotransferase and alkaline phosphatase levels in children with nonalcoholic steatohepatitis (NASH) associated with obesity. STUDY DESIGN: Open-label pilot study enrolling all children <16 years old with chronically elevated serum aminotransferase (alanine aminotransferase and aspartate aminotransferase) levels for greater than 3 months, who demonstrated a diffusely echogenic liver on ultrasonography, had no demonstrable reason for abnormal serum chemistry values other than obesity, and therefore were diagnosed to have NASH. Patients were prescribed oral vitamin E between 400 and 1200 IU per day. Serum chemistry values were monitored monthly during treatment. RESULTS: Eleven subjects with a mean age of 12.4 years were enrolled; treated patients were followed up for 4 to 10 months. The body mass index did not change significantly before and after treatment (32.8 +/- 3.8 kg/m(2) vs 32.5 +/- 4.4 kg/m(2), respectively). Serum alanine aminotransferase decreased from 175 +/- 106 IU/L to 40 +/- 26 IU/L (P <.001, paired Student t test), serum aspartate aminotransferase decreased from 104 +/- 61 IU/L to 33 +/- 11 IU/L (P <.002), and alkaline phosphatase decreased from 279 +/- 42 IU/L to 202 +/- 66 IU/L (P <.003) during treatment. Serum aminotransferase levels remained normal during treatment but returned to abnormal in those electing to stop treatment. Serum alpha-tocopherol levels were within the normal range before the commencement of therapy and increased significantly with supplementation. The liver remained diffusely echogenic during therapy, at the time serum aminotransferase levels were reduced. CONCLUSIONS: Daily oral vitamin E administration normalized serum aminotransferase and alkaline phosphatase levels in children with NASH. Obese children with NASH should be encouraged to lose weight as part of a comprehensive weight reduction program and to consider taking supplemental alpha-tocopherol.

Adolescent↗

PubMed2004

Obese African Americans: the prevalence of dyslipidemia, hypertension, and diabetes mellitus.

CONTEXT: The prevalence of the cardiovascular disease risk factors, dyslipidemia, hypertension, and diabetes mellitus, is increased in the setting of obesity. OBJECTIVE: To determine whether the prevalence of these risk factors increases with increasing body mass index in an obese cohort, or whether there is a threshold for their appearance. DESIGN AND SETTING: Individuals with body mass index > or = 30 kg/m2 joined a weight reduction program in the Howard University General Clinical Research Center. PARTICIPANTS: Five hundred fifteen African Americans (aged 12-74 years, mean body mass index of 42.8 +/- 8.5 kg/m2). OUTCOME MEASURES: The cohort was divided by incremental increases in body mass index of 4.99 kg/m2, and the prevalence rates of hypertension (blood pressure > or = 140/90 mm Hg), dyslipidemia (total cholesterol > 200 mg/dL, or low-density lipoprotein > 130 mg/dL, or elevated ratio of total or low-density to high-density lipoprotein cholesterol) and diabetes mellitus (fasting blood glucose > or = 126 mg/dL or random blood glucose > 200 mg/dL) were determined for each group. RESULTS: The cohort prevalence rates were: dyslipidemia, 27.0%; hypertension, 56.9%; and diabetes mellitus, 24.1%. These rates are higher than those found in the African-American population by the third National Health and Nutrition Examination Survey. After adjusting for age and sex, there were no significant differences in the prevalence rates of these risk factors according to increasing body mass index, suggesting a threshold of between 30 kg/m2-34.99 kg/m2 for maximal appearance of these risk factors. CONCLUSION: The incidence rates of dyslipidemia, hypertension, and diabetes mellitus do not increase with a greater degree of obesity above a body mass index of 34.99 kg/m2.

Adolescent↗

PubMed1990

Phenylpropanolamine hydrochloride.

Phenylpropanolamine has been classified by the FDA advisory review panel as generally safe and effective for short-term weight control. The maximum daily dose for this indication is 75 mg. When used in recommended doses by patients without significant risk factors, serious side effects appear to occur infrequently. The pharmacist has an important role in preventing misuse and abuse of phenylpropanolamine through counseling the patient about its appropriate, short-term (not exceeding 12 weeks) use in a comprehensive weight-reduction program. Patients should be alerted to signs and symptoms of serious adverse reactions and advised to discontinue use if any reactions appear.

Appetite Depressants↗

PubMed1990

Predicting attrition and adherence to a very low calorie diet: a prospective investigation of the eating inventory.

This prospective study examined the use of the eating inventory and its association with adherence, attrition, and dysphoric emotional states on patients treated with a very low calorie diet (VLCD). Subjects were 81 severely (medically significant) obese patients (mean BMI (weight in kilograms/height in meters squared) for women 36.25; men 39.16) enrolled in a university-based weight reduction program employing a liquid protein supplement VLCD with behavior modification. The eating inventory's factors hunger and restraint successfully discriminated attrition/adherence groups while disinhibition did not. Subjects with scores above the mean on disinhibition and hunger and below the mean on restraint had consistently poorer outcomes. The hunger factor was significantly related to dietary nonadherence, with those scoring in the highest quartile on this dimension eating three times the number of calories of those scoring in the lowest quartile. Disinhibition and hunger were significantly related to anxiety and depression while restraint was not. These findings provide support for the use of the eating inventory in screening and treatment of severely obese patients receiving very low calorie diets.

Adult↗

PubMed1988

Menopause.

The body of evidence now swings the scale toward the benefit of HRT for women beginning at the menopause. Based on newer studies, the risks for osteoporosis, cardiovascular morbidity, breast carcinoma, symptomatic vasomotor and anatomic changes occurring postmenopausally outweigh the risks of hormone replacement therapy in the end of the 20th century. Women should be instructed in adequate calcium intake, 1000 mg per day premenopausally and 1500 mg per day postmenopausally. Osteoporotic, breast carcinoma, and cardiovascular risks should be investigated at age 35 with appropriate lab screening, including lipoprotein analysis. Screening mammography should begin at age 40, continuing every 5 years until age 50, and yearly between ages 50 and 65. A diet high in calcium, low in cholesterol and fat, and a weight reduction program should be made available as early as possible and continued indefinitely. HRT should be made available beginning at menopause and continued to age 70. Moderate exercise should be encouraged at all ages. The next 5 to 10 years will answer some of the questions about the benefits of long-term HRT postmenopausally, especially with respect to its influence on cardiovascular risk. New progestational agents will probably be developed that will have fewer adverse effects on lipid profiles, while maintaining the protective effect on the endometrium and breast and further influencing the benefits of HRT postmenopausally. Modern medicine certainly cannot ensure living forever. The body of knowledge now available can modify the major causes for morbidity and mortality as the baby boom population reaches their middle age and golden years.

Estrogens↗