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Circulating leptin is associated with oxidized LDL in postmenopausal women.

Recently, leptin has been suggested as a possible cause of atherosclerotic disease. In the present study, we have investigated in postmenopausal women (n = 60; age: 52 +/- 13) the relationship between circulating levels of leptin, oxidized LDL (Ox-LDL) and other biochemical and anthropometric variables of atherosclerotic risk. In addition, we have evaluated soluble thrombomodulin (sTM) as a marker of endothelial damage. An additional study was conducted in a subgroup of obese subjects to determine the short-term effects of weight loss on selected variables. Ox-LDL showed a positive correlation with leptin circulating levels (r = 0.65, P < 0.0001). A significant association was also found between Ox-LDL and body mass index (r = 0.69, P < 0.0001), waist-to-hip ratio (r = 0.50, P < 0.0001), insulin levels (r = 0.65, P < 0.0001), HOMA index (r = 0.55, p < 0.0001) and sTM (r = 0.74, P < 0.0001) levels. After multivariate regression analysis leptin was still related to Ox-LDL levels (P = 0.007). In obese women who completed the program of weight reduction, leptin changes persisted as a significant predictor of plasma changes in Ox-LDL levels. These findings suggested a novel link between leptin and Ox-LDL, possibly involved in atherosclerotic disease.

Arteriosclerosis↗

The effect of random alcohol screening in reducing motor vehicle crash injuries.

OBJECTIVE: Programs that randomly stop drivers to detect alcohol use have been introduced as a deterrence measure for drinking and driving. The objective of this review is to determine if this random screening reduces fatalities and injuries. The two types of random screening programs included are Random Breath Testing and Sobriety Checkpoints. METHODS: Fourteen studies met inclusion criteria, which required an evaluation of a random screening program with a control population or baseline comparison. Proportional decreases in total or alcohol-related fatalities or injuries were the outcome of interest. MAIN RESULTS: All fourteen studies found that random screening was effective in reducing fatalities and injuries. The decreases found had wide variation, but did not depend on the size of the population. Alcohol-related fatalities generally showed the greatest decreases, ranging from 8% to 71%. The few multivariate analyses showed that random screening significantly reduced crashes and injuries. CONCLUSIONS: Random screening appears to be effective in a wide range of both United States and Australian populations. Although there are many limitations to the studies reviewed, such as the difficulty in determining alcohol involvement and the inability to control for the presence of other drunk driving reduction programs, the weight of the evidence indicates that random screening reduces fatalities and injuries. There was some disagreement among studies as to how long the effects of random alcohol screening can be sustained and the level of enforcement necessary, and these remain questions to be answered.

Accidents, Traffic↗

Sympathovagal balance, nighttime blood pressure, and QT intervals in normotensive obese women.

OBJECTIVE: We describe associations among the heart-rate-corrected QT (QTc) interval, QTc dispersion (QTc-d), circadian BP variation, and autonomic function in obese normotensive women and the effect of sustained weight loss. RESEARCH METHODS AND PROCEDURES: In 71 obese (BMI = 37.14 +/- 2.6 kg/m(2)) women, 25 to 44 years of age, circadian BP variations (24-hour ambulatory BP monitoring), autonomic function (power spectral analysis of RR interval oscillations), and cardiac repolarization times (QTc-d and QTc interval) were recorded at baseline and after 1 year of a multidisciplinary program of weight reduction. RESULTS: Compared with nonobese age-matched women (n = 28, BMI = 23 +/- 2.0 kg/m(2)), obese women had higher values of QTc-d (p < 0.05) and QTc (p < 0.05), an altered sympathovagal balance (ratio of low-frequency/high-frequency power, p < 0.01), and a blunted nocturnal drop in BP (p < 0.01). In obese women, QTc-d and the QTc interval correlated with diastolic nighttime BP (p < 0.01) and sympathovagal balance (p < 0.01). Waist-to-hip ratio, free fatty acids, and plasma insulin levels correlated with QT intervals and reduced nocturnal drops in both systolic and diastolic BP and sympathovagal balance (p < 0.01). After 1 year, obese women lost at least 10% of their original weight, which was associated with decrements of QTc-d (p < 0.02), the QTc interval (p < 0.05), nighttime BP (p < 0.01), and sympathovagal balance (p < 0.02). DISCUSSION: Sustained weight loss is a safe method to ameliorate diastolic nighttime BP drop and sympathetic overactivity, which may reduce the cardiovascular risk in obese women.

Adult↗

Relationship between dietary restraint, binge eating, and leptin in obese women.

OBJECTIVE: To describe some biological, behavioural and psychological correlates of the Three-Factor Eating Questionnaire, and to determine the relationship between dietary restraint, binge eating, and leptin among obese women seeking treatment. DESIGN: Consecutive series of obese women enrolled in a clinical program for weight reduction treatment. SUBJECTS: Forty-two obese women. Eight participants met the criteria for 'severe binge eating' as measured by the Binge Eating Scale. MEASUREMENTS: Energy intake, resting energy expenditure, body composition, leptin, restraint, disinhibition, hunger and binge eating were assessed before starting the treatment. RESULTS: In this sample both higher disinhibition and hunger scores were associated with greater binge eating severity. Obese women with severe binge eating had lower restraint, higher disinhibition and hunger scores, as well as higher daily fat intake, when compared with obese non-binge-eaters. Interestingly, restraint scores were negatively associated with leptin levels among subjects with severe binge eating. CONCLUSION: In obese women with severe binge eating, the negative relationship between dietary restraint and serum leptin concentrations seems mediated by a greater fat intake. These findings need to be verified in further human studies.

Bulimia↗

The effects of weight loss on the activity and expression of adipose-tissue lipoprotein lipase in very obese humans.

Lipoprotein lipase is an enzyme in adipose tissue that hydrolyzes circulating triglycerides and thereby generates the fatty acids used in the synthesis of triglyceride in fat cells. To determine whether the activity and expression of lipoprotein lipase are affected by weight loss, we studied lipoprotein lipase in the adipose tissue of nine very obese subjects before and after a program of weight reduction. The subjects' mean (+/- SEM) initial weight was 136 +/- 7.3 kg, and the body-mass index (weight in kilograms divided by the square of the height in meters) ranged from 33.3 to 52.8 (mean, 43.0 +/- 2.5). Biopsies of adipose tissue were performed before weight loss and after it, when weight had been stable for three months. The weight reduction was achieved by a very-low-calorie diet (mean weight loss, 42.5 +/- 6.8 kg). After weight loss, the level of heparin-releasable lipoprotein lipase activity increased in all patients, from 3.8 +/- 1.1 to 7.1 +/- 1.6 neq of free fatty acid released per minute per 10(6) cells (P less than 0.05). In addition, the amount of lipoprotein lipase immunoreactive protein increased from 6.3 +/- 1.7 to 24.4 +/- 6.9 ng per 10(6) cells (P less than 0.05), and there was also an increase in the level of lipoprotein lipase messenger RNA as measured by Northern blotting. There was a strongly positive correlation between the initial body-mass index and the magnitude of the increase in lipoprotein lipase activity (r = 0.80, P less than 0.01) and immunoreactive protein (r = 0.92, P less than 0.01). We conclude that weight loss in very obese subjects leads to the increased activity and expression of lipoprotein lipase, thereby potentially enhancing lipid storage and making further weight loss more difficult.

Adipose Tissue↗

The impact of body mass index on pulse pressure in obesity.

OBJECTIVE: Pulse pressure, a marker of arterial vascular properties, has been linked to cardiovascular diseases and complications. This study examined the impact of excess body mass and cardiovascular disease risk factors on pulse pressure (PP). DESIGN: Cross-sectional and prospective study. METHODS: Baseline data consist of 219 obese African Americans, with mean +/- SD age of 46.8 +/- 10.9 years enrolled in a diet and exercise program of weight reduction. A non-invasive monitoring device was used to acquire 24 hourly ambulatory blood pressures. Pulse pressure was calculated as the difference between the average 24-h systolic and diastolic blood pressure and studied as a continuous variable and according to quartiles. The cross-sectional association of pulse pressure with body mass index (BMI) was examined using multivariate linear regression and proportional odds models that controlled for cardiovascular disease risk factors. In addition, we examined prospectively, in 36 participants, the effect of weight loss on pulse pressure, using the Wilcoxon signed ranked test. RESULTS: At baseline, a 5 kg/m2 increase in BMI was independently associated with a 35% risk [relative risk (RR) = 1.35, confidence interval (CI) = 1.10-1.65, P < 0.01] in the general study population and 19% (RR = 1.19, CI = 1.07-1.56, P = 0.04) in obese normotensives for increasing PP by one quartile after adjustment for other significant variables. After 3 months of diet and exercise intervention, BMI decreased by an average of 10.6% (P < 0.01) and resulted in an 8.8% (P < 0.01) reduction in PP. CONCLUSIONS: In the context of obesity, increasing BMI is independently associated with decreasing arterial compliance, as reflected in PP. This association highlights the potential value to cardiovascular health of any reduction in body weight in obese individuals.

Adult↗

Obesity treatment: research and application.

This paper reviews the research that reports (a) some of the physical and social considerations in treating the obese, (b) characteristics that identify overeaters and some implications for treatment, and (c) treatment settings and personnel who treat the obese. It then examines three major treatment approaches utilized by social workers and other health care professionals and reports findings on the effectiveness of each. Finally, it describes one weight reduction treatment program in which social work intervention is viewed as a central and vital component. In conclusion, issues for the practitioner's further consideration regarding intervention with this population are presented.

Adolescent↗

Effect of weight loss on cardiac synchronization and proinflammatory cytokines in premenopausal obese women.

OBJECTIVE: Obesity is an important risk factor for heart failure in both women and men. Dyssynchrony between right and left ventricular contraction and relaxation has been identified as an independent predictor of heart failure. We examined the relationship of ventricular synchronization abnormalities with the concentration of proinflammatory cytokines in obese women at baseline and after sustained weight loss. RESEARCH DESIGN AND METHODS: Echocardiographic parameters of ventricular dyssynchrony, circulating levels of tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, IL-18, and C-reactive protein (CRP) were investigated in 67 healthy, premenopausal obese women and 40 age-matched normal-weight women. RESULTS: Compared with nonobese women, obese women had increased concentrations of CRP (P < 0.01), TNF-alpha (P < 0.01), IL-6 (P < 0.01), and IL-18 (P < 0.01). Moreover, obese women had a higher myocardial performance index (P < 0.02) and lower transmitral Doppler flow (P < 0.05), pulmonary venous flow analysis (P < 0.02), and ejection fraction (P < 0.05), indicating ventricular dyssynchrony. Concentrations of CRP, TNF-alpha, and IL-6 were related to anthropometric indexes of obesity and to echocardiographic parameters of ventricular dyssynchrony. After 1 year of a multidisciplinary program of weight reduction, obese women lost at least 10% of their original weight. This was associated with reduction of cytokine (P < 0.01) and CRP (P < 0.02) concentrations and with improvement of echocardiographic parameters of ventricular dyssynchrony, which correlated with changes in adiposity, particularly visceral adiposity. CONCLUSIONS: In obese women, ventricular dyssynchrony correlates with body fat, possibly through inappropriate secretion of cytokines. Weight loss represents a safe method for downregulating the inflammatory state and ameliorating cardiac function in obese women.

Adult↗

Coca leaf as a therapeutic agent.

South American Indians have used coca leaf as a remedy for thousands of years. Coca might be useful as a treatment for gastrointestinal ailments and motion sickness, as a fast-acting antidepressant medication, as a substitute stimulant for coffee in certain cases, and as an adjunct in programs of weight reduction and physical fitness. In leaf form, coca does not produce toxicity or dependence. Its effects are distinct from those of cocaine, which is but one of a number of active compounds in the leaf. Coca can be administered as a chewing gum containing a whole extract of the leaf, including alkaloids, natural flavors, and several nutrients. Legal mechanisms exist for importing, distributing, and dispensing coca, and experimentation with it by interested physicians would be valuable.

Chewing Gum↗

Medical management of osteoarthritis.

Osteoarthritis (OA) is the most common articular disease, and it continues to be a major public health problem related to pain, disability, loss of time from work, and economics. Most patients with OA seek medical attention because of pain. In the past few years, changes in the treatment of OA have been substantial. More effective nonnarcotic analgesics, cyclooxygenase-2-specific inhibitors, nutraceuticals, and intra-articular hyaluronates are some of the new medications and agents that are now available. The understanding and use of nonpharmacological interventions, including patient education, exercise programs, and weight reduction when appropriate, have also improved. Relief of pain and restoration of function can be accomplished in many patients, particularly with an integrated approach. This article focuses on medical treatment approaches for OA, both pharmacological and nonpharmacological.

Aged↗

Controlling the intake of calories with the intake of food.

The author presents a dietary program for weight reduction based not on the substitution of a low calorie meal for a high calorie meal, but on the pre-meal ingestion of low calorie bulk beverages that are pleasant to taste and space filling, thereby compromising the capacity of the stomach to accommodate much of the higher calorie foods of the regular meals. This method makes any form of fasting unnecessary, as the intake of calories is already limited. Because of this method, few changes need to be made in food selection for regular meals.

Beverages↗

Body image of obese adolescent girls in a high school and clinical setting.

There have been many investigations of body image in cases of anorexia nervosa in adolescent females. However, there has been limited research with normal adolescent girls who happen to be overweight. In this study, 27 girls found to be obese (at least 20 percent above average body weight for age, sex and height) among 203 girls in home economics classes of four suburban high schools were compared to 20 girls seeking help for their obesity on an outpatient basis in hospital-affiliated programs for weight reduction in a nearby city. The two groups were assessed and compared regarding body image factors. The clinical subjects showed a significantly greater difference in their selection of outline drawings of the female figure perceived to represent their actual as compared to ideal body sizes. No significant difference was found in articulation of body concept as revealed in human figure drawings judged according to Witkin's Articulation of Body Concept (ABC) Scale, and in the mean number of uncomplimentary adjectives used to describe present appearance. However, the difference between the mean scores of the two groups in the latter two variables, when submitted to t tests, were shown to approach significance (.017 less than p less than .05).

Adolescent↗

Truncal vagotomy in morbid obesity.

Vagotomy has been shown to reduce body weight in several species of experimental animals. Due to the relative safety and simplicity of the procedure and the long-clinical evaluation of vagotomy in ulcer disease, truncal vagotomy without drainage has been performed in a series of 21 morbidly obese patients. The mean maximum body weight was 12.8 +/- 3 kg (s.e.). In the 14 patients observed for 12-40 months, the mean weight decrease is 20 +/- 4 kg (range: 0-51). Apart from lesion of the oesophagus in one patient, there have been no operative complications. In one 45-year-old patient sudden death due to myocardial fibrosis occurred three years after the operation. Four patients have had short episodes of diarrhea, and vomiting has occurred in two patients who "tested the limits'. There is no evidence of gastric dilatation or ulcers, yet gastric stasis is prevalent. Three patients are failures, two not having reduced and the third regaining 28 of her initial 31 kg weight loss postoperatively. Five patients have participated in programs for weight reduction in which they claim greater ease in complying than before operation, due to the characteristic lack of hunger sensations in all of the successful patients. The mechanisms for weight reduction after vagotomy are not known, yet seem to involve other factors than delayed gastric emptying of solids. Longer follow-up is necessary for evaluation of this procedure in the treatment of morbid obesity.

Adolescent↗

Self-administered programs for health behavior change: smoking cessation and weight reduction by mail.

Forty smokers and 47 overweight individuals were recruited for a home correspondence program for either smoking cessation or weight loss. Participants were assigned to one of four programs for changing their respective health behaviors: (1) a home correspondence program conducted entirely by mail, (2) the mail program with supplemental financial contigency contracts tied to completion of written homework, (3) the correspondence programs supplemented both by homework contracts and by regular calls to a telephone answering system, and (4) a standard behavioral group program which acted as a comparison condition. Results showed that all three correspondence approaches produced significant changes in health behaviors equal to the changes experienced by participants in the standard group program. The implication of these findings for development of low cost programs for disease prevention are discussed.

Adult↗

High-risk individuals' willingness to pay for diabetes risk-reduction programs.

OBJECTIVE: The purpose of this study was to estimate how much at-risk individuals are willing to pay for type 2 diabetes primary prevention programs. RESEARCH DESIGN AND METHODS: An Internet-based, choice-format conjoint survey was presented to individuals at elevated risk for type 2 diabetes. Hypothetical diabetes risk-reduction programs included seven features: diet, exercise, counseling, medication, weight loss goal, risk reduction, and program costs. The sample included 582 individuals aged > or =45 years, two-thirds of whom were obese. Conditional logit models were used to calculate participants' willingness to pay for risk reduction programs. Each respondent's self-assessed risk of developing diabetes was compared with an objective measure based on a diabetes screening tool. RESULTS: Many respondents underestimated their personal risk of developing diabetes. Those with a low perceived risk were less likely to indicate that they would participate in a diabetes prevention program. Individuals had the strongest preference for programs with large weight loss goals, fewer restrictions on diet, and larger reductions in the risk of diabetes. Respondents were willing to pay approximately $1,500 over 3 years to participate in a lifestyle intervention program similar to the Diabetes Prevention Program. Individuals with a high perceived risk were willing to pay more than individuals with lower perceived risk. CONCLUSIONS: Many individuals will be willing to participate in interventions to delay or prevent diabetes if the interventions are subsidized, but most will be unwilling to pay the full program cost. Our results also offer insights for designing risk-reduction programs that appeal to potential participants.

Attitude to Health↗

Cuidando El Corazon--a weight-reduction intervention for Mexican Americans.

Cuidando El Corazon (CEC; Taking Care of Your Heart) was designed to assess the effectiveness of a culturally adapted weight-reduction and exercise program for achieving long-term weight loss in Mexican Americans. CEC used a family-oriented approach to achieve lifestyle change in behavior. Participants were assigned to 1) a booklet-only comparison group that received a manual including behavior change, nutrition, and exercise information and traditional recipes modified in fat content; 2) an individual group that received the same manual and attended year-long classes; or 3) a family group that received a manual and attended classes that emphasized techniques for making changes in the family's eating and exercising habits. The family and individual groups had significantly greater weight losses than the information-only group. Weight loss was greatest in the family-involvement group and least in the information-only comparison group.

Adolescent↗

Effect of weight reduction on metabolic syndrome in Korean obese patients.

The Third Report of the National Cholesterol Education Program Adult Treatment Panel III emphasized the importance of management of the metabolic syndrome. However, little information is available about the effect of weight reduction on the metabolic syndrome in obese patients among Koreans. A longitudinal clinical intervention study from the 12-week of weight reduction program, including life style modification and adjuvant appetite suppressants, in 78 obese persons was performed. Anthropometry and metabolic risk factors were measured before and after weight reduction. Visceral (VAT), subcutaneous (SAT), and total adipose tissue (TAT) on abdomen were determined by CT scan. Moderate decrease in weight (9.3%) induced significant reduction of waist circumference, systolic and diastolic blood pressure, and triglyceride. Weight reduction also resulted in significant decrease in total cholesterol, LDL-C, uric acid, fasting insulin, and HOMA score. The subjects with metabolic syndrome showed more improvements of metabolic components than those without metabolic syndrome through weight reduction. The reductions of visceral-subcutaneous fat ratio (VSR) and waist circumference were observed as for the predictable variables related to the improvement of metabolic component and insulin resistance in Korean obese patients.

Abdomen↗

Effects of aerobic exercise and obesity phenotype on abdominal fat reduction in response to weight loss.

OBJECTIVE: To test the effects on abdominal fat reduction of adding aerobic exercise training to a diet program and obesity phenotype in response to weight loss. DESIGN: A prospective clinical trial with a 14-week weight-loss intervention design. SETTING AND PARTICIPANTS: In total, 209 overweight and obese women were assigned to four subgroups depending on type of treatment and the subject's obesity phenotype: diet alone (DA) with intra-abdominal fat (IF) obesity (> or =mean IF area), diet plus exercise (DE) with IF obesity, DA with abdominal subcutaneous fat (ASF) obesity (<mean IF area) and DE with ASF obesity. Abdominal fat areas were evaluated by CT scans, with values adjusted for selected variables. RESULTS: Values were adjusted for age, menopausal status and change in body weight and total fat mass. The IF reductions were significantly (P<0.0001) greater in subjects with IF obesity phenotype (-45.1 cm2) compared to the ASF obesity phenotype (-22.2 cm2). The ASF reductions were significantly (P<0.001) greater for subjects with ASF obesity (-74.5 cm2) compared to IF obesity (-55.5 cm2). For IF obesity, the IF reduction was significantly (P<0.01) greater in the DE group (-49.3 cm2) than in the DA group (-37.8 cm2). CONCLUSION: These results suggest that for individuals with IF obesity, the efficacy on reducing IF of adding aerobic exercise training to a diet-alone weight-reduction program is more prominent (-49.3 cm2/-37.8 cm2=1.3 times) compared with DA. Moreover, abdominal fat reduction was found to be modified by obesity phenotype in response to weight loss.

Adult↗