[Association between CD40-CD40L system and obesity in children]

OBJECTIVE

To study the association between CD40-CD40L system and obesity in children.

METHODS

A total of 76 obese children were enrolled as the obese group, and 74 healthy children with normal body mass index (BMI) were enrolled as the control group. The two groups were compared in terms of morphological indices, biochemical parameters, and serum levels of CD40 and CD40L. Partial correlation analysis and multivariate linear regression analysis were performed to investigate the correlation of CD40 and CD40L with other clinical indices.

RESULTS

Compared with the control group, the obese group had significantly higher BMI, waist circumference/height ratio, systolic pressure, diastolic pressure, alanine aminotransferase (ALT), aspartate aminotransferase (AST), uric acid, triglyceride, apolipoprotein B, fasting blood glucose, fasting insulin, glycosylated hemoglobin, platelet count, CD40L, and mean carotid intima-media thickness (P<0.05), but significantly lower high-density lipoprotein cholesterol and apolipoprotein A1 (P<0.05). With age and sex as the control factors, the partial correlation analysis showed that CD40L was positively correlated with height, weight, BMI, diastolic pressure, bile acid, triglyceride, total cholesterol, low-density lipoprotein cholesterol, apolipoprotein B, and platelet count (P<0.05). CD40 was positively correlated with waist circumference/height ratio and platelet count (P<0.05). The multivariate linear regression analysis showed that ALT, AST, total cholesterol, and platelet count were the dependent factors influencing the level of CD40L (R²=0.266, P<0.05).

CONCLUSIONS

CD40-CD40L system is closely associated with obesity and related hyperlipidemia and hypertension. CD40 and CD40L may be used as new indicators for early warning of metabolic syndrome and provide new ideas for the prevention and treatment of related chronic diseases.

Synergistic effects of depression and obesity on type 2 diabetes incidence in Chinese adults

BACKGROUND

Cross-sectional studies have supported the association among depression, obesity, and type 2 diabetes, but the causality remains controversial in Chinese adults. In this longitudinal study, we evaluated the synergistic effect of depression and obesity on the risk of type 2 diabetes.

METHODS

This study included 2809 participants randomly selected from the Qingdao Diabetes Prevention Program, and their type 2 diabetes incidence was determined over a follow-up period of 3 years. The WHO 2006 criteria and the Zung Self-Rating Depression Scale score were employed to identify type 2 diabetes and depression at baseline, respectively. Multivariable-adjusted logistic regression was used to evaluate the synergistic effects of depression and obesity indicators on type 2 diabetes, with adjustment for age, sex, family history of diabetes, and other potential risk factors.

RESULTS

During 3-year follow-up, 316 new incident cases were identified. The relative risk and 95% confidence interval of depression for diabetes incidence was 1.52 (1.05-2.21), after controlling for potential confounders. Sensitivity analysis showed that depression was significantly associated with diabetes incidence in women, younger people, and obese people (1.82 [1.14-2.92], 1.94 [1.25-3.02], and 4.29 [1.44-12.78], respectively]. The synergistic effects of positive depression and body mass index ≥30 kg/m² on type 2 diabetes incidence were observed, with a synergy index of 5.49 (1.75-17.19).

CONCLUSIONS

Depression was associated with a 52% increased risk of type 2 diabetes incidence and exerts synergistic effects with obesity on diabetes incidence in Chinese adults. Early identification and intervention for depression and obesity can reduce the risk of diabetes.

Saxagliptin alters bile acid profiles and yields metabolic benefits in drug-naïve overweight or obese type 2 diabetes patient

BACKGROUND

The aim of the present study was to investigate the metabolic benefits of saxagliptin and its effects on serum bile acids (BAs) in normal weight and overweight/obese drug-naïve type 2 diabetes (T2D) patients.

METHODS

In all, 282 drug-naïve T2D patients (123 normal weight [NW], with body mass index [BMI] between 19.0 and <25.0 kg/m² ; 159 overweight/obese [OW/OB], with BMI ≥25.0 kg/m² ) were enrolled in the study and treated with saxagliptin 5 mg daily for 24 weeks. Serum BAs were assayed by liquid chromatography with tandem mass spectrometry.

RESULTS

At 24 weeks, HbA1c was significantly reduced in both groups, but the HbA1c levels were lower in the OW/OB than NW group. Moreover, significant decreases were seen at 24 weeks in C-reactive protein (CRP), aspartate aminotransferase, alanine aminotransferase, waist circumference, and systolic blood pressure in the OW/OB group. Interestingly, cholic acid, glycocholic acid, glycochenodeoxycholic acid, glycodeoxycholic acid (GDCA), and glycoursodeoxycholic acid (GUDCA) were increased in both groups after treatment, whereas chenodeoxycholic acid and deoxycholic acid (DCA) were specifically increased in the OW/OB group. Increased DCA and GDCA concentrations were significantly associated with decreased HbA1c or fasting blood glucose and CRP levels, whereas increased GDCA and GUDCA concentrations were associated with decreased waist circumference in the OW/OB group during treatment. In the NW group, increased GUDCA concentrations were significantly associated with a decrease in HbA1c.

CONCLUSIONS

Type 2 diabetes patients with OW/OB exhibited greater improvement in glycemic control and additional metabolic benefits after saxagliptin treatment. Saxagliptin significantly increased the BA pool, and DCA and GDCA were associated with metabolic improvements in OW/OB T2D patients.

Dose-response relationships between dairy intake and chronic metabolic diseases in a Chinese population

BACKGROUND

This study investigated associations between dairy intake and chronic metabolic diseases (CMDs), and evaluated possible dose-response relationships in Chinese.

METHODS

This cross-sectional study included 6073 adults aged ≥18 years from China. General characteristics were gathered using a validated dietary questionnaire. Multivariable logistic regression analyses investigated associations between dairy intake and chronic metabolic diseases (CMDs) (overweight/obesity, obesity, central obesity, and hyperlipidemia). Restricted cubic spline models explored dose-response relationships between dairy intake and CMDs, and possible dairy intake in the prevention of CMDs. Structural equation modeling explored the potential mechanisms of the effects of dairy intake on CMDs.

RESULTS

Significant inverse associations were found between dairy intake and overweight/obesity, obesity, central obesity, and hyperlipidemia, with odds ratios (ORs) of 0.66 (95% confidence interval [CI] 0.56-0.79), 0.63 (95% CI 0.47-0.85), 0.71 (95% CI 0.60-0.85), and 0.81 (95% CI 0.56-1.17), respectively (P < 0.05 for all). The intake of yogurt, milk, and total dairy to prevent CMDs differed according to age group (16-74, 29-187, and 159-269 mL/d, respectively, in the entire group; 69-110, 59-152, and 138-167 mL/d, respectively, in the young group, ≤ 44 years; 9-58, 57-149, and 117-145 mL/d, respectively, in the middle-aged group, 45-59 years; and 23-59 mL/d yogurt only in the old group, ≥ 60 years). Structural equation modeling showed that dairy intake could reduce body mass index and waist circumference by regulating carbohydrate, fat, protein, and total energy.

CONCLUSIONS

Dairy intake was inversely associated with the prevalence of overweight, obesity, central obesity, and hyperlipidemia, and the optimal range of dairy intake differed with age. The beneficial effects of dairy intake in preventing CMDs could involve regulation of carbohydrate, fat, protein, and total energy.

[Association between obesity and sleep disorders among children in Lanzhou, China]

OBJECTIVE

To investigate the prevalence of obesity and sleep disorders and the association between them among children in Lanzhou, China.

METHODS

The stratified cluster random sampling method was used to select 3 283 primary school students in four districts of Lanzhou of Gansu province. Physical examination and sleep questionnaire were conducted to screen out the children who met the criteria for sleep disorders or obesity as subjects. Among the 3 283 children, 200 healthy children without sleep disorders or obesity were enrolled as the control group.

RESULTS

The prevalence rate of obesity among the 3 283 children was 5.76% (189/3 283). Among these 189 obese children, 80 (42.3%) had sleep disorders. The prevalence rate of sleep disorders was 16.24% (533/3 283), and the prevalence rate of obesity among the children with sleep disorders was 24.6% (131/533). Snoring was the most common sleep disorder in obese children. The prevalence rate of obstructive sleep apnea hypopnea syndrome was 45% (36/80) among obese children with sleep disorders. The obese children had a significantly higher prevalence rate of sleep disorders than the children with normal body weight [42.3% (80/189) vs 20% (40/200), P<0.01].

CONCLUSIONS

There is a close relationship between obesity and sleep disorders in children in Lanzhou, China.

[Association between obesity and sleep disorders among children in Lanzhou, China]

OBJECTIVE

To investigate the prevalence of obesity and sleep disorders and the association between them among children in Lanzhou, China.

METHODS

The stratified cluster random sampling method was used to select 3 283 primary school students in four districts of Lanzhou of Gansu province. Physical examination and sleep questionnaire were conducted to screen out the children who met the criteria for sleep disorders or obesity as subjects. Among the 3 283 children, 200 healthy children without sleep disorders or obesity were enrolled as the control group.

RESULTS

The prevalence rate of obesity among the 3 283 children was 5.76% (189/3 283). Among these 189 obese children, 80 (42.3%) had sleep disorders. The prevalence rate of sleep disorders was 16.24% (533/3 283), and the prevalence rate of obesity among the children with sleep disorders was 24.6% (131/533). Snoring was the most common sleep disorder in obese children. The prevalence rate of obstructive sleep apnea hypopnea syndrome was 45% (36/80) among obese children with sleep disorders. The obese children had a significantly higher prevalence rate of sleep disorders than the children with normal body weight [42.3% (80/189) vs 20% (40/200), P<0.01].

CONCLUSIONS

There is a close relationship between obesity and sleep disorders in children in Lanzhou, China.

[Level of circulating Alarin in obese children and its association with insulin resistance]

OBJECTIVE

To study the level of circulating Alarin in obese children and its association with various metabolic parameters.

METHODS

A total of 86 obese children with a body mass index (BMI) above the 95th percentile were enrolled as the obesity group, and 82 healthy children, matched for age and sex, with a BMI below the 85th percentile were enrolled as the healthy control group. According to the presence or absence of insulin resistance (IR), the obesity group was further divided into an IR group with 27 children and a non-IR group with 59 children. Related anthropometric parameters, including body height, body weight, systolic blood pressure (SBP), and diastolic blood pressure (DBP), were measured, and BMI was calculated. Total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), uric acid (UA), fasting insulin (FINS), and fasting blood glucose (FBG) were measured. The area under the receiver operating characteristic curve (AUC) for glucose and insulin, Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), and whole-body insulin sensitivity index (WBISI) were calculated. ELISA was used to measure the level of circulating Alarin.

RESULTS

The obesity group had a significantly higher level of circulating Alarin than the healthy control group (P<0.01). The IR group had a significantly higher level of circulating Alarin than the non-IR group (P<0.01). Circulating Alarin was positively correlated with BMI, TG, FBG, AUC-glucose, AUC-FINS, and HOMA-IR (P<0.05) and was negatively correlated with WBISI (P<0.05). The circulating Alarin level had a linear regression relationship with BMI, FBG, and HOMA-IR, among which HOMA-IR had the greatest influence on the circulating Alarin level (P<0.05).

CONCLUSIONS

There is a significant increase in the circulating Alarin level in obese children, which may be associated with the development of obesity and IR.

[Correlation between serum microRNA-122 and insulin resistance in obese children]

OBJECTIVE

To study the relationship between serum microRNA-122 (miR-122) and insulin resistance in obese children.

METHODS

Forty-seven children with severely obesity aged 7-14 years and 45 age- and gender matched healthy children with normal weight (control group) were enrolled. The levels of height, weight, waistline, hip circumference, fasting blood glucose (FBG), fasting insulin (FINS), triglyceride (TG), total cholesterol (TC), free fatty acid (FFA), interleukin-6 (IL-6) and miR-122 in the two groups were measured. Body mass index (BMI), waist-hip ratio (WHR) and insulin resistance index (HOMA-IR) were calculated.

RESULTS

Compared with the control group, the height, weight, BMI, WHR, FINS, HOMA-IR, TG, FFA, IL-6, and miR-122 levels in the obese group were significantly increased (P<0.05). MiR-122 levels in the obese group were positively correlated with FINS, HOMA-IR and IL-6 levels (r=0.408, 0.442, and 0.464 respectively, P<0.05). The changes of miR-122 have a linear regression relationship with IL-6 (b'=0.318, P<0.05).

CONCLUSIONS

The elevated serum miR-122 levels may be correlated with insulin resistance in obese children. The mechanism needs to be further studied.

Treating Multidimensional Presenting Problems with a Mutually Integrative Approach Using the Genogram

The present article introduces a case study and describes a mutually integrative approach to treating a complex presenting problem. This article examines the specific issues surrounding integration when a supervisor and supervisee hold different theoretical perspectives. On occasion, such a relationship demands that the supervisee adhere to the model being taught by the supervisor. Examining integration in this format presents many advantages for both treatment and training. The key to the mutual integration is that two schools of psychotherapy can be combined in a way that creates a synergy; in that, together they are more powerful than either may be in isolation. A genogram with symbols from each model is incorporated to focus the treatment and create a format for the mutual integration.

Influence of maternal reflective functioning on mothers' and children's weight: A follow-up study

Based on cross-sectional research linking poor reflective functionining (RF) to eating disorders, the current follow-up study tested whether maternal RF would explain the variance of mothers' and children's weight beyond the effects of maternal emotional dysregulation. During pregnancy (Time 1 [T1]), 51 women were administered the Difficulties in Emotion Regulation Scale (DERS) and interviewed using the Adult Attachment Interview (AAI). Seven months after delivery (Time 2 [T2]), mother-baby dyads who remained in the study (n = 44) were videotaped (Feeding Scale) during their feeding interaction. Last (Time 3 [T3]), the weight of the 34 children who were still in the study was collected at 3 years of age. Maternal AAI-RF at T1 did not correlate with the DERS at T1 nor with the quality of the feeding interacions at T2. However, it correlated, significantly, with maternal body mass index (BMI) at T1, r = -.298, P = .034, and marginally significantly with baby's BMI at T3, r = -.296, P = .089. Moreover, multiple regression models showed a trend indicating that maternal AAI-RF might explain the variance of mothers' and children's weight beyond the effects of maternal emotional dysregulation. These findings suggest that working on maternal mentalization might contribute to helping prevent childhood obesity from pregnancy.

Ethnic disparities in relationships of obesity indices with telomere length in Asians with type 2 diabetes

BACKGROUND

Obesity and shorter telomeres increase the risk for diabetes complications and mortality. However, the relationship between obesity and telomere length in diverse Asian populations with type 2 diabetes (T2D) is not well understood. This study examined the association of baseline and changes in obesity indices with telomere length in multiethnic Asian populations with T2D.

METHODS

Leukocyte telomere length (LTL) was measured by quantitative polymerase chain reaction in the SMART2D cohort (n = 1431 at baseline, n = 1039 after 3.2 years median follow-up). Associations between obesity indices and LTL were assessed by linear regression.

RESULTS

Compared with Chinese, LTL was longer in Malays (P < 0.0001) and similar in Indians. Cross-sectionally, body mass index (BMI)-adjusted (residual) visceral fat area (VFA; β = -0.004, P = 0.006), and waist-to-hip ratio (β = -1.95, P = 0.030) were significantly associated with LTL in Chinese but not in Malays and Indians. Changes in BMI (r = -0.080; P = 0.053) and VFA (r = -0.126; P = 0.002) were inversely correlated with changes in LTL only in Chinese. Furthermore, in Chinese, 1-SD incremental changes in BMI (β = -0.070; P = 0.040) and VFA (β = -0.088, P = 0.028) were significantly associated with larger telomere attrition, independent of age, sex, diabetes condition, baseline LTL, obesity, and inflammation markers.

CONCLUSIONS

Three-year changes in BMI and VFA were associated with telomere dynamics in Chinese but not in Malays and Indians with T2D. Reducing obesity may reduce the risk of diabetes complications associated with shorter LTL in the Chinese population.

Endoscopic bariatric and metabolic therapies: Another tool for the management of diabetes and obesity

Endoscopic bariatric and metabolic therapies (EBMTs) have sparked significant interest as minimally invasive therapeutic options for weight loss. Although bariatric surgery remains an effective option for sustained weight loss and improvement in the metabolic syndrome, access and utilization are limited. Various EBMTs have been designed to emulate the physiologic effects of established surgical interventions, including space-occupying and non-space-occupying gastric therapies, gastric remodeling procedures, and small bowel therapies. This review discusses the safety and efficacy of available US Food and Drug Administration-approved minimally invasive endoscopic bariatric interventions, as well as those currently under investigation. In addition, the role of endoscopic revision after failed surgical intervention is discussed.

Short-term high-fat diet exacerbates insulin resistance and glycolipid metabolism disorders in young obese men with hyperlipidemia, as determined by metabolomics analysis using ultra-HPLC-quadrupole time-of-flight mass spectrometry

BACKGROUND

The prevalence of obesity is increasing rapidly worldwide, and dietary intake is strongly associated with obesity-related chronic diseases. However, key metabolic perturbations in obese young men with hyperlipidemia after high-fat diet (HFD) intervention are not yet clear, and remain to be determined. The aim of this study was to investigate the effects of a short-term HFD on glycolipid metabolism, insulin resistance (IR), and urinary metabolomic profiling in young obese men with hyperlipidemia.

METHODS

Sixty young men (19-25 years; 30 normal weight, 30 obese with hyperlipidemia) were enrolled in the study. Differences in metabolomic profiling of urine between normal-weight and obese young men before and after 3 days intake of the HFD were investigated using ultra-HPLC-quadrupole time-of-flight mass spectrometry.

RESULTS

After the HFD intervention, total cholesterol (TC), low-density lipoprotein cholesterol, fasting plasma glucose, insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) were significantly increased and high-density lipoprotein cholesterol was significantly decreased in obese men, but only TC was significantly increased in normal-weight subjects. Based on metabolic differences, normal-weight and obese men, and obese men before and after the HFD intervention could be separated into distinct clusters. Seventeen major metabolites were identified that were associated with type 2 diabetes mellitus, glycolipid metabolism and IR; the changes in these metabolites suggest metabolic changes in young obese males after short-term HFD intake.

CONCLUSIONS

The findings of this study may contribute to increased understanding of the early biological adaptations of obesity with hyperlipidemia to HFD for the early prevention and control of diabetes and IR.

Prospective cohort studies of birth weight and risk of obesity, diabetes, and hypertension in adulthood among the Chinese population

BACKGROUND

Low birth weight (LBW) has been associated with subsequent risks of obesity and certain chronic diseases, but evidence for the associations is limited for the Chinese population.

METHODS

In this study we analyzed data from two population-based prospective cohort studies, the Shanghai Women's Health Study and the Shanghai Men's Health Study, to examine the associations between LBW and the risk of obesity and chronic diseases. Birth weight was self-reported at baseline; anthropometric measurements were made at study enrollment. Type 2 diabetes mellitus (T2DM) diagnoses were self-reported, whereas hypertension diagnoses were based on self-report and blood pressure measurements at baseline and follow-up surveys.

RESULTS

Birth weight was available for 11 515 men and 13 569 women. Non-linear associations were observed for birth weight with baseline body mass index (BMI), waist circumference (WC), waist:  hip ratio (WHR), and waist:  height ratio (WHtR; P < 0.05 for non-linearity), and LBW was linked with lower BMI, smaller WC, and larger WHR and WHtR. An excess risk of T2DM was observed for LBW (<2500 g) versus birth weight 2500-3499 g since baseline (hazard ratio [HR] 1.17; 95% confidence interval [CI] 0.92-1.49) and since birth (HR 1.29; 95% CI 1.07-1.54), whereas the HRs for hypertension since baseline and birth were 1.13 (95% CI 1.01-1.27) and 1.20 (95% CI 1.11-1.30), respectively. The risk of the diseases decreased as birth weight increased up to ~4000 g; further increases in birth weight did not convey additional benefits.

CONCLUSION

The results suggest that LBW, an index of poor intrauterine nutrition, may affect health risks later in life in the Chinese population.

Association between type 2 diabetes mellitus and disability: What is the contribution of diabetes risk factors and diabetes complications?

BACKGROUND

The aim of this study was to evaluate the association between type 2 diabetes and disability in Mauritius and to assess the extent to which the effect of diabetes is explained by diabetes risk factors and concomitant complications.

METHODS

Data from a national survey in the multiethnic nation of Mauritius, which comprises South Asians and African Creoles, were analyzed. Disability was measured using the Katz activities of daily living questionnaire in participants aged >50 years.

RESULTS

Among 3692 participants, 487 (13.2%) had some level of disability. Diabetes was associated with significantly higher risk of disability (odds ratio [OR] 1.67; 95% confidence interval [CI] 1.34-2.08). After adjusting for demographic, behavioral, and metabolic factors, as well as comorbidities, disability was significantly associated with diabetes among African Creoles (OR 2.03; 95% CI 1.16-3.56), but not South Asians (OR 1.27; 95% CI 0.98-1.66). Obesity explained much of the association between diabetes and disability (excess percentage of risk: 26.3% in South Asians and 12.1% in African Creoles). Obesity, history of cardiovascular disease (CVD), asthma-like symptoms, and depression together explained 46.5% and 29.0% of the excess risk in South Asians and African Creoles, respectively.

CONCLUSIONS

Diabetes is associated with a 67% increased risk of disability. Diabetes risk factors and comorbidities explain more of the association between diabetes and disability among South Asians than Africans. Obesity and history of CVD explained the largest percentage of the relationship between diabetes and disability, indicating that weight and CVD management may be helpful in controlling disability related to diabetes.

[Effect of vitamin D deficiency on cardiac autonomic nerve function in obese pre-school children]

OBJECTIVE

To study the effect of vitamin D (VitD) deficiency on cardiac autonomic nerve function in obese pre-school children.

METHODS

A total of 242 pre-school children with simple obesity were enrolled, and according to the serum 25-(OH) VitD level, they were divided into VitD deficiency group (76 children), VitD insufficiency group (83 children), and VitD sufficiency group (83 children). The three groups were compared in terms of deceleration capacity (DC) of heart rate, acceleration capacity (AC) of heart rate, and heart rate variability (HRV). The correlations of VitD level with DC, AC, and HRV were analyzed for the VitD insufficiency and VitD deficiency groups.

RESULTS

The VitD deficiency group had the lowest DC, root mean square of successive differences between adjacent RR intervals (RMSSD), and low-frequency power (LF) and the highest AC (P<0.05). The VitD insufficiency group had significantly lower DC, RMSSD, and LF and significantly higher AC compared with the VitD sufficiency group (P<0.05). The VitD deficiency group had significantly lower standard deviation of normal-to-normal RR intervals (SDNN) and high-frequency power (HF) than the VitD sufficiency group (P<0.05). In the VitD deficiency group, VitD level was positively correlated with DC, SDNN, standard deviation of average normal-to-normal RR intervals, RMSSD , LF, and HF and was negatively correlated with AC (P<0.05). In the VitD insufficiency group, VitD level was negatively correlated with AC (P<0.05).

CONCLUSIONS

Obese pre-school children with VitD insufficiency or deficiency have cardiac autonomic dysfunction, and cardiac vagal tone decreases with the reduction in VitD level.

[Effect of vitamin D deficiency on cardiac autonomic nerve function in obese pre-school children]

OBJECTIVE

To study the effect of vitamin D (VitD) deficiency on cardiac autonomic nerve function in obese pre-school children.

METHODS

A total of 242 pre-school children with simple obesity were enrolled, and according to the serum 25-(OH) VitD level, they were divided into VitD deficiency group (76 children), VitD insufficiency group (83 children), and VitD sufficiency group (83 children). The three groups were compared in terms of deceleration capacity (DC) of heart rate, acceleration capacity (AC) of heart rate, and heart rate variability (HRV). The correlations of VitD level with DC, AC, and HRV were analyzed for the VitD insufficiency and VitD deficiency groups.

RESULTS

The VitD deficiency group had the lowest DC, root mean square of successive differences between adjacent RR intervals (RMSSD), and low-frequency power (LF) and the highest AC (P<0.05). The VitD insufficiency group had significantly lower DC, RMSSD, and LF and significantly higher AC compared with the VitD sufficiency group (P<0.05). The VitD deficiency group had significantly lower standard deviation of normal-to-normal RR intervals (SDNN) and high-frequency power (HF) than the VitD sufficiency group (P<0.05). In the VitD deficiency group, VitD level was positively correlated with DC, SDNN, standard deviation of average normal-to-normal RR intervals, RMSSD , LF, and HF and was negatively correlated with AC (P<0.05). In the VitD insufficiency group, VitD level was negatively correlated with AC (P<0.05).

CONCLUSIONS

Obese pre-school children with VitD insufficiency or deficiency have cardiac autonomic dysfunction, and cardiac vagal tone decreases with the reduction in VitD level.

[Effect of lipoxin A4 on the expression of Toll-like receptor 4 and TNF receptor-associated factor 6 in the liver of obese rats with sepsis]

OBJECTIVE

To study the protective effect of lipoxin A4 (LXA4) against sepsis induced by lipopolysaccharide (LPS) in rats with obesity and its effect on the expression of Toll-like receptor 4 (TLR4) and TNF receptor-associated factor 6 (TRAF6) in the liver.

METHODS

A total of 60 male Sprague-Dawley rats aged three weeks were randomly divided into a normal group and an obesity group, with 30 rats in each group. A rat model of obesity was established by high-fat diet. Each of the two groups was further randomly divided into control group, sepsis group, and LXA4 group, and 8 rats were selected from each group. The rats in the control, sepsis, and LXA4 groups were treated with intraperitoneal injection of normal saline, LPS, and LXA4+LPS respectively. Twelve hours later, blood samples were collected from the heart and liver tissue samples were also collected. ELISA was used to measure the serum levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α). Western blot was used to measure the protein expression of TLR4 and TRAF6 in liver tissue. Quantitative real-time PCR was used to measure the mRNA expression of TLR4 and TRAF6.

RESULTS

After being fed with high-fat diet for 6 weeks, the obesity group had significantly higher average weight and Lee's index than the normal group (P<0.05). Compared with the normal group, the obesity group had significant increases in the serum levels of IL-6 and TNF-α (P<0.05). In the normal group or the obesity group, the sepsis subgroup had significant increases in the serum levels of IL-6 and TNF-α compared with the control subgroup (P<0.05), while the LXA4 subgroup had significant reductions in the two indices compared with the sepsis subgroup (P<0.05). Compared with the normal group, the obesity group had significant increases in the protein and mRNA expression of TLR4 and TRAF6 (P<0.05). In the normal group or the obesity group, the sepsis subgroup had significant increases in the protein and mRNA expression of TLR4 and TRAF6 compared with the control subgroup (P<0.05). Compared with the sepsis subgroup, the LXA4 subgroup had significant reductions in the protein and mRNA expression of TLR4 and TRAF6 (P<0.05).

CONCLUSIONS

LXA4 can reduce the serum levels of IL-6 and TNF-α and alleviate inflammatory response. LXA4 can inhibit the expression of TLR4 and TRAF6 in the liver of septic rats, possibly by inhibiting the TLR4 signaling pathway.

Stage of obesity epidemic model: Learning from tobacco control and advocacy for a framework convention on obesity control

The 2011 United Nations political declaration against non-communicable diseases (NCDs) targeted four major risk factors: tobacco use, harmful use of alcohol, an unhealthy diet, and a lack of physical activity. The Framework Convention on Tobacco Control (FCTC), MPOWER strategies, and the four-stage model of the tobacco epidemic are useful references for the prevention and control of other risk factors and NCDs. Obesity control is a more complex challenge. Herein we propose a stage of obesity epidemic model (SOEM). Obesity is in the early stages in most countries with increasing prevalence, but its effects on mortality will increase rapidly, even if its prevalence may have reached a peak and be declining. Based on current relative risk, obesity kills one in three obese people. Like tobacco, epidemiological studies of obesity in the early stages would underestimate the risks and disease burden. Further research will reveal more harm, especially from long-term obesity since childhood. The prevalence of obesity will likely overtake smoking prevalence, but commitments to obesity control are too weak. The SOEM is needed and should be useful to forewarn against the expanding public health problems attributable to obesity, and challenges in epidemiology and interventions. Learning from tobacco control, we advocate for a framework convention on obesity control. Framing obesity control initiatives in the spirit of MPOWER strategies against tobacco should be considered to prevent and control obesity and obesity-induced diseases. Healthcare professionals should take leading roles in these initiatives and obese individuals should reduce their weight and "quit" obesity.

[Association between copy number variations and risk of overweight/obesity among Han, Uyghur, and Kazak children]

OBJECTIVE

To study the association between the prevalence of overweight/obesity and copy number variations (CNVs) among Han, Uyghur, and Kazak children in Xinjiang, China.

METHODS

The kindergartens in Ili, Altay, and Karamay in Xinjiang were selected as research sites, and stratified cluster sampling was used to select the children aged 3-7 years. Body height and body weight were measured, and exfoliated buccal mucosa cells were collected. CNVplex® was used to measure the CNVs of FTO_1, IRX3_1, IRX3_2, MC4R_1, and MC4R_2.

RESULTS

A total of 603 children were surveyed (307 boys and 296 girls). There were 261 Han children, 194 Uyghur children, and 148 Kazak children. The overweight/obesity rates in Han, Uyghur, and Kazak children were 28.3%, 10.3%, and 31.1%, respectively (P<0.001). In Kazak children, the CNVs of IRX3_1 and MC4R_2 were associated with overweight/obesity (P<0.05). The multivariate logistic regression analysis showed that the risk of overweight/obesity in Han and Kazak children was 3.443 times (95%CI: 2.016-5.880) and 3.924 times (95%CI: 2.199-7.001), respectively, that in Uyghur children. The CNV of IRX3_1 was a risk factor for overweight/obesity (P=0.028, OR=2.251, 95%CI: 1.418-5.651).

CONCLUSIONS

The CNV of IRX3_1 is associated with overweight/obesity in Han, Uyghur, and Kazak children, and the association between the CNV of IRX3_1 and overweight/obesity in Kazak children should be taken seriously.

[An analysis of cardiac autonomic nerve function in girls with idiopathic central precocious puberty]

OBJECTIVE

To investigate the cardiac autonomic nerve function in girls with idiopathic central precocious puberty (ICPP).

METHODS

A total of 66 girls with ICPP were enrolled, among whom 36 were obese and 30 were not obese. A total of 68 age-matched healthy girls (normal controls) and 51 girls with simple obesity were enrolled as controls. All the subjects underwent 24-hour ambulatory electrocardiography, and deceleration capacity of heart rate (DC), acceleration capacity of heart rate (AC), and heart rate variability (HRV), and body mass index (BMI) were compared between groups.

RESULTS

Compared with the normal control group, the ICPP group had significantly lower DC, standard deviation of normal-to-normal R-R intervals (SDNN), standard deviation of the average normal-to-normal intervals (SDANN), root mean square of successive differences (RMSSD), and high-frequency power (HF) and significantly higher AC and BMI. The ICPP group had significantly lower RMSSD and BMI than the simple obesity group (P<0.05). Compared with the ICPP girls without obesity, those with obesity had significantly lower DC, RMSSD, and HF and significantly higher AC and BMI (P<0.05).

CONCLUSIONS

Cardiac autonomic dysfunction is seen in girls with ICPP, especially those with obesity, mainly presenting with reduced vagal tone.

[An analysis of cardiac autonomic nerve function in girls with idiopathic central precocious puberty]

OBJECTIVE

To investigate the cardiac autonomic nerve function in girls with idiopathic central precocious puberty (ICPP).

METHODS

A total of 66 girls with ICPP were enrolled, among whom 36 were obese and 30 were not obese. A total of 68 age-matched healthy girls (normal controls) and 51 girls with simple obesity were enrolled as controls. All the subjects underwent 24-hour ambulatory electrocardiography, and deceleration capacity of heart rate (DC), acceleration capacity of heart rate (AC), and heart rate variability (HRV), and body mass index (BMI) were compared between groups.

RESULTS

Compared with the normal control group, the ICPP group had significantly lower DC, standard deviation of normal-to-normal R-R intervals (SDNN), standard deviation of the average normal-to-normal intervals (SDANN), root mean square of successive differences (RMSSD), and high-frequency power (HF) and significantly higher AC and BMI. The ICPP group had significantly lower RMSSD and BMI than the simple obesity group (P<0.05). Compared with the ICPP girls without obesity, those with obesity had significantly lower DC, RMSSD, and HF and significantly higher AC and BMI (P<0.05).

CONCLUSIONS

Cardiac autonomic dysfunction is seen in girls with ICPP, especially those with obesity, mainly presenting with reduced vagal tone.

[Protective effects of rutin against obesity-induced reproductive impairment in male mice]

OBJECTIVE

To study the effect of rutin on body weight and obesity-induced reproductive impairment in male mice.

METHODS

Twenty-four male mice were randomized equally into normal control group, high-fat diet group (HFD group), and HFD + rutin intervention group (HRU group). After 28 days of treatments, the testes and epididymis of the mice were collected for detection of total cholesterol (TC) and triglycerides (TG) levels and for pathological examinations with HE staining. The expressions of related genes was detected with real-time PCR, and Western blotting was used to detect the expression of Ucp1 protein in the samples.

RESULTS

After 28 days of treatments, the mean body weight was lower in mice with rutin intervention than in those in HFD group. The mice in HFD group showed significantly higher TG levels in the testis and epididymis and higher TC levels in the epididymis than those in the control and HRU groups. In HFD group, the testis and the epididymis displayed loosened structures with abnormalcell structure, and the number ofmature spermatozoa in the lumen was decreased and the mobility of the sperms was reduced; all these changes were significantly alleviated in HRU group. The expression levels of Ucp1 mRNA and protein increased (P<0.05) and the expressions of Mcp1 and TNF-α decreased significantly in the mice after rutin treatment (P<0.05).

CONCLUSION

Rutin can effectively inhibit rapid increase of body weight and protect against obesity-induced reproductive impairment in obese mice.

Obesity, weight change, and chronic kidney disease in patients with type 2 diabetes mellitus: A longitudinal study in Taiwan

BACKGROUND

The aim of the present study was to investigate relationships between the risk of chronic kidney disease (CKD) and obesity and weight changes in Asian patients with type 2 diabetes.

METHODS

At baseline (2003-05), 1187 diabetic patients aged 30-70 years were recruited to the study, with follow-up surveys completed in 2008, 2009, and 2010. Chronic kidney disease was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min per 1.73 m² ; body mass index (BMI) was categorised as normal (18.5-22.9 kg/m² ), overweight (23-27.4 kg/m² ), or obese (≥27.5 kg/m² ); waist circumference (WC) ≥80 cm for women and ≥90 cm for men was taken to indicate abdominal obesity. Changes in weight and WC were calculated from baseline to each follow-up survey. Relative risk (RR) and 95% confidence intervals (CIs) of CKD were estimated. To estimate the risk for incident CKD, associations were examined in patients without CKD at baseline (n = 881).

RESULTS

Over 7 years of follow-up, obesity (RR 1.48; 95% CI 1.08-2.04; P = 0.015) and high WC (RR 1.23; 95% CI 1.00-1.52; P = 0.049) were associated with CKD after adjusting for covariates. Among participants without CKD at baseline, those who gained >10% weight (RR 1.43; 95% CI 1.07-1.90; P = 0.015) and in whom WC increased >15% (RR 1.37; 95% CI 1.01-1.85; P = 0.045) had a higher risk of incident CKD than those who remained stable (±5% changes in weight or WC).

CONCLUSIONS

Diabetic patients who are obese and those with excessive central fat were more likely to have CKD. Large weight gain (>10%) and increases in WC (>15%) independently predicted incident CKD.

[One-hour post-load plasma glucose: a better indicator of glucose metabolism for obstructive sleep apnea?]

OBJECTIVE

To assess the value of blood glucose at different time points in oral glucose tolerance test (OGTT), particularly one?hour post load plasma glucose (1 hPG), in evaluating glucose metabolism in adult patients with obstructive sleep apnea (OSA).

METHODS

Eighty nine adultswith newly diagnosed OSA were analyzed retrospectively for sleep architecture assessed using polysomnography and glucose metabolism assessed by OGTT at different time points (0, 30, 60, 120, and 180 min). Pearson's correlatives and multiple linear regression models were established to investigate the correlations between glucose metabolism and other indices including sleep architecture, apnea hypopnea index (AHI), mean and lowest oxygen saturation (MSO₂ and LSO₂) and obesity measurements.

RESULTS

The majority (67.4%) of the patients had abnormal 1 hPG, and 41.6% had abnormal 2 hPG. 1 hPG was positively correlated with neck circumference (r=0.245), abdomen circumference (r=0.231), systolic blood pressure (r=0.213), diastolic blood pressure (r=0.276) and AHI (r=0.324), and was negatively associated with MSO₂ (r=-0.341) and LSO₂ (r=-0.387) (all P<0.05). After controlling for age, BMI, neck and abdomen circumferences, 1 hPG was found to inversely correlated with MSO₂ (r=-0.253, P=0.032) and LSO₂ (r=-0.311, P=0.008). In non-obese OSA subgroup, 1 hPG was significantly associated with OSA-related indices, and regression models showed that LSO₂ and N2 were the two most important contributors to 1 hPG (adjusted R²=0.349, P<0.001); plasma glucose at other time points did not show such correlations.

CONCLUSIONS

1 hPG abnormality occurs earlier than 2 hPG in OSA patients. 1 hPG is significantly associated with OSA independent of obesity and may serve as a better index for measuring OSA-related glucose disorder.