Low plasma leptin concentration and low rates of fat oxidation in weight-stable post-obese subjects

Trapped fat: Obesity pathogenesis as an intrinsic disorder in metabolic fuel partitioning

Our understanding of the pathophysiology of obesity remains at best incomplete despite a century of research. During this time, two alternative perspectives have helped shape thinking about the etiology of the disorder. The currently prevailing view holds that excessive fat accumulation results because energy intake exceeds energy expenditure, with excessive food consumption being the primary cause of the imbalance. The other perspective attributes the initiating cause of obesity to intrinsic metabolic defects that shift fuel partitioning from pathways for mobilization and oxidation to those for synthesis and storage. The resulting reduction in fuel oxidation and trapping of energy in adipose tissue drives a compensatory increase in energy intake and, under some conditions, a decrease in expenditure. This theory of obesity pathogenesis has historically garnered relatively less attention despite its pedigree. Here, we present an updated comprehensive formulation of the fuel partitioning theory, focused on evidence gathered over the last 80 years from major animal models of obesity showing a redirection of fuel fluxes from oxidation to storage and accumulation of excess body fat with energy intake equal to or even less than that of lean animals. The aim is to inform current discussions about the etiology of obesity and by so doing, help lay new foundations for the design of more efficacious approaches to obesity research, treatment and prevention.

The Physiological Regulation of Body Fat Mass

Disturbances inbody weight and adiposity in both humans and animals are met by compensatory adjustments in energy intake and energy expenditure, suggesting that body weight or fat is regulated. From a clinical viewpoint, this is likely to contribute to the difficulty that many people with obesity have in maintaining weight loss. Finding ways to modify these physiologic responses is likely to improve the long-term success of obesity treatments.

Impairment of adrenergically-regulated thermogenesis in brown fat of obesity-resistant mice is compensated by non-shivering thermogenesis in skeletal muscle

OBJECTIVE

Non-shivering thermogenesis (NST) mediated by uncoupling protein 1 (UCP1) in brown adipose tissue (BAT) can be activated via the adrenergic system in response to cold or diet, contributing to both thermal and energy homeostasis. Other mechanisms, including metabolism of skeletal muscle, may also be involved in NST. However, relative contribution of these energy dissipating pathways and their adaptability remain a matter of long-standing controversy.

METHODS

We used warm-acclimated (30 °C) mice to characterize the effect of an up to 7-day cold acclimation (6 °C; CA) on thermoregulatory thermogenesis, comparing inbred mice with a genetic background conferring resistance (A/J) or susceptibility (C57BL/6 J) to obesity.

RESULTS

Both warm-acclimated C57BL/6 J and A/J mice exhibited similar cold endurance, assessed as a capability to maintain core body temperature during acute exposure to cold, which improved in response to CA, resulting in comparable cold endurance and similar induction of UCP1 protein in BAT of mice of both genotypes. Despite this, adrenergic NST in BAT was induced only in C57BL/6 J, not in A/J mice subjected to CA. Cold tolerance phenotype of A/J mice subjected to CA was not based on increased shivering, improved insulation, or changes in physical activity. On the contrary, lipidomic, proteomic and gene expression analyses along with palmitoyl carnitine oxidation and cytochrome c oxidase activity revealed induction of lipid oxidation exclusively in skeletal muscle of A/J mice subjected to CA. These changes appear to be related to skeletal muscle NST, mediated by sarcolipin-induced uncoupling of sarco(endo)plasmic reticulum calcium ATPase pump activity and accentuated by changes in mitochondrial respiratory chain supercomplexes assembly.

CONCLUSIONS

Our results suggest that NST in skeletal muscle could be adaptively augmented in the face of insufficient adrenergic NST in BAT, depending on the genetic background of the mice. It may provide both protection from cold and resistance to obesity, more effectively than BAT.

Utility of 'substance use disorder' as a heuristic for understanding overeating and obesity

Rates of obesity and obesity-associated diseases have increased dramatically in countries with developed economies. Substance use disorders (SUDs) are characterized by the persistent use of the substance despite negative consequences. It has been hypothesized that overconsumption of palatable energy dense food can elicit SUD-like maladaptive behaviors that contribute to persistent caloric intake beyond homeostatic need even in the face of negative consequences. Palatable food and drugs of abuse act on many of the same motivation-related circuits in the brain, and can induce, at least superficially, similar molecular, cellular, and physiological adaptations on these circuits. As such, applying knowledge about the neurobiological mechanisms of SUDs may serve as useful heuristic to better understand the persistent overconsumption of palatable food that contributes to obesity. However, many important differences exist between the actions of drugs of abuse and palatable food in the brain. This warrants caution when attributing weight gain and obesity to the manifestation of a putative SUD-related behavioral disorder. Here, we describe similarities and differences between compulsive drug use in SUDs and overconsumption in obesity and consider the merit of the concept of "food addiction".

HOXC10 Suppresses Browning to Maintain White Adipocyte Identity

Promoting beige adipocyte development within white adipose tissue (WAT) is a potential therapeutic approach to staunch the current obesity epidemic. Previously, we identified homeobox-containing transcription factor HOXC10 as a suppressor of browning in subcutaneous WAT. Here, we provide evidence for the physiological role of HOXC10 in regulating WAT thermogenesis. Analysis of an adipose-specific HOXC10 knockout mouse line with no detectable HOXC10 in mature adipocytes revealed spontaneous subcutaneous WAT browning, increased expression of genes involved in browning, increased basal rectal temperature, enhanced cold tolerance, and improved glucose homeostasis. These phenotypes were further exacerbated by exposure to cold or a β-adrenergic stimulant. Mechanistically, cold and β-adrenergic exposure led to reduced HOXC10 protein level without affecting its mRNA level. Cold exposure induced cAMP-dependent protein kinase-dependent proteasome-mediated degradation of HOXC10 in cultured adipocytes, and shotgun proteomics approach identified KCTD2, 5, and 17 as potential E3 ligases regulating HOXC10 proteasomal degradation. Collectively, these data demonstrate that HOXC10 is a gatekeeper of WAT identity, and targeting HOXC10 could be a plausible therapeutic strategy to unlock WAT thermogenic potentials.

Human White Adipose Tissue Displays Selective Insulin Resistance in the Obese State

Selective hepatic insulin resistance is a feature of obesity and type 2 diabetes. Whether similar mechanisms operate in white adipose tissue (WAT) of those with obesity and to what extent these are normalized by weight loss are unknown. We determined insulin sensitivity by hyperinsulinemic euglycemic clamp and insulin response in subcutaneous WAT by RNA sequencing in 23 women with obesity before and 2 years after bariatric surgery. To control for effects of surgery, women postsurgery were matched to never-obese women. Multidimensional analyses of 138 samples allowed us to classify the effects of insulin into three distinct expression responses: a common set was present in all three groups and included genes encoding several lipid/cholesterol biosynthesis enzymes; a set of obesity-attenuated genes linked to tissue remodeling and protein translation was selectively regulated in the two nonobese states; and several postobesity-enriched genes encoding proteins involved in, for example, one-carbon metabolism were only responsive to insulin in the women who had lost weight. Altogether, human WAT displays a selective insulin response in the obese state, where most genes are normalized by weight loss. This comprehensive atlas provides insights into the transcriptional effects of insulin in WAT and may identify targets to improve insulin action.

Design of a randomised controlled trial: does indirect calorimetry energy information influence weight loss in obesity?

INTRODUCTION

Respiratory quotient (RQ) provides an indication of the relative balance of carbohydrate and fat oxidation. RQ could serve as an early biomarker of negative energy balance during weight loss. Restriction of energy intake relative to total daily energy requirements produces a negative energy balance which can lead to a fall in RQ, accompanied by a decrease in resting energy expenditure (REE). However, the net change in body weight does not usually match predicted weight change due to intraindividual metabolic adaptations. Our aim is to determine the effectiveness of utilising EE information from indirect calorimetry during weight loss intervention.

METHODS AND ANALYSIS

We will undertake an assessor-blinded, parallel-group randomised controlled trial of 105 adults with obesity randomised in 1:1 ratio to receive either standard weight management care (SC) or EE information plus SC (INT) during a 24-week multicomponent weight management programme. The primary outcome is difference in weight loss between INT and SC group at 24 weeks. Secondary outcomes include: change in RQ, REE, glycaemic variability, and appetite-relating gut hormones (glucagon-like peptide 1, gastric inhibitory polypeptide, peptide YY). Generalised linear mixed models (intention to treat) will assess outcomes for treatment (INT vs SC), time (baseline, 24 weeks) and the treatment-by-time interaction. This will be the first study to evaluate impact of utilising measured REE and RQ on the lifestyle-based intensive intervention programme.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the Health Research Authority and the North West Research Ethics Committee (18/NW/0645). Results from this trial will be disseminated through publication in peer-reviewed journals, national and international presentations.

TRIAL REGISTRATION NUMBERS

NCT03638895; UoL001379.

Toenail mercury levels positively correlate with obesity and abdominal obesity among Korean adults

BACKGROUND

Although previous studies have shown that short-term exposure to mercury is associated with obesity, it should be noted that mercury is not easily released and that it constantly accumulates in the body. However, few studies have explored the association between chronic mercury exposure and obesity. This study aimed to examine the association between chronic mercury exposure and obesity in Korean adults.

METHODS

The study used baseline data from the Trace Element Study of Korean Adults in Yeungnam area. A total of 495 participants aged 40-69 years who provided the required information (demographic, diet, lifestyle, toenail mercury levels, and health examination results) were included. Toenail mercury levels were measured using neutron-activation analysis. Body mass index and waist circumference were obtained from medical examination. Multivariable-adjusted logistic regression and restricted cubic spline regression were used in the analysis.

RESULTS

In the fully adjusted logistic regression models, participants with the highest toenail mercury levels had a higher prevalence of obesity (odds ratio [OR]: 3.26, 95 % confidence interval [CI]: 1.79-5.93) and abdominal obesity (OR: 2.30, 95 % CI: 1.15-4.59). In the cubic spline regression model, linear relationships were confirmed between increased toenail mercury levels and higher prevalence of obesity and abdominal obesity (all p > 0.05 for nonlinearity).

CONCLUSIONS

In summary, chronic mercury exposure was associated with higher prevalence of obesity and abdominal obesity in Korean adults. Therefore, the development of public health interventions against environmental exposure of foods is required to manage and prevent obesity.

Low capacity to oxidize fat and body weight

For a given positive energy balance, a low capacity to oxidize fat could contribute to weight gain (low fat oxidation hypothesis). This hypothesis is based on the arguments that for a given stable diet and food quotient (FQ), the respiratory quotient (RQ) is higher in obesity prone (OP) than in obesity resistant individuals (OR) and that a high RQ predicts higher future weight gain. A review of 42 studies shows that there is no convincing experimental support to these arguments and thus for the low fat oxidation hypothesis. A power analysis also shows that this hypothesis might be impossible to experimentally confirm because very large numbers of subjects would be needed to reject the null hypotheses that the 24-h RQ is not different in OP and OR or that future weight gain is not different in individuals with a low and high 24-h RQ at baseline. A re-examination of the significance of the 24-hour and fasting RQ also shows that the assumption underlying the low fat oxidation hypothesis that a high RQ reflects a low capacity to oxidize fat is not valid: For a stable diet, the 24-h RQ entirely depends on FQ and energy balance, and the fasting RQ mainly depends on the FQ and energy balance and on the size of glycogen stores.

Successful and unsuccessful weight-loss maintainers: strategies to counteract metabolic compensation following weight loss

Adaptive thermogenesis and reduced fat oxidative capacity may accompany weight loss, continuing in weight maintenance. The present study aimed (1) to determine whether weight-reduced and weight-loss relapsed women are at greater metabolic risk for weight gain compared with BMI-matched controls with no weight-loss history, and (2) to identify protective strategies that might attenuate weight loss-associated adaptive thermogenesis and support successful weight-loss maintenance. Four groups of women were recruited: reduced-overweight/obese (RED, n 15), controls (low-weight stable weight; LSW, n 19) BMI <27 kg/m²; relapsed-overweight/obese (REL, n 11), controls (overweight/obese stable weight; OSW, n 11) BMI >27 kg/m². Body composition (bioelectrical impedance), 75 g oral glucose tolerance test, fasting and postprandial metabolic rate (MR) and substrate utilisation (RER) and physical activity (accelerometer (7 d)) were measured. Sociobehavioural questionnaires and 3 × 24 h diet recalls were completed. Fasting and postprandial MR, RER and total daily energy intake (TDEI) were not different between RED and REL v. controls (P > 0·05). RED consumed less carbohydrate (44·8 (sd 10·3) v. 53·4 (sd 10·0) % TDEI, P = 0·020), more protein (19·2 (sd 6·0) v. 15·6 (sd 4·2) % TDEI, P = 0·049) and increased physical activity, but behaviourally reported greater dietary restraint (P = 0·002) compared with controls. TDEI, macronutrient intake and physical activity were similar between OSW and REL. REL reported higher subjective fasting and lower postprandial ratings of prospective food consumption compared with OSW. Weight-reduced women had similar RMR (adjusted for fat-free mass) compared with controls with no weight-loss history. Increased physical activity, higher protein intake and greater lean muscle mass may have counteracted weight loss-associated metabolic compensation and highlights their importance in weight-maintenance programmes.

Phytochemicals in regulating fatty acid β-oxidation: Potential underlying mechanisms and their involvement in obesity and weight loss

Excessive accumulation of fat as the result of more energy intake and less energy expenditure is known as obesity. Lipids are essential components in the human body and are vital for maintaining homeostasis and physiological as well as cellular metabolism. Fatty acid synthesis and catabolism (by fatty acid oxidation) are normal part of basic fuel metabolism in animals. Fatty acids are degraded in the mitochondria by a biochemical process called β-oxidation in which two-carbon fragments are produced in each cycle. The increase in fatty acid β-oxidation is negatively correlated with body mass index. Although healthy life style, avoiding Western diet, dieting and strenuous exercise are the commonly used methods to lose weight, they are not considered a permanent solution in addition to risk attenuation of basal metabolic rate (BMR). Pharmacotherapy offers benefits of weight loss by altering the satiety and lowering absorption of fat from the food; however, its side effects may outweigh the benefits of weight loss. Alternatively, dietary phytochemicals and natural health products offer great potential as an efficient weight loss strategy by modulating lipid metabolism and/or increasing BMR and thermogenesis. Specifically, polyphenols such as citrus flavonoids, green tea epigallocatechin gallate, resveratrol, capsaicin and curcumin, have been reported to increase lipolysis and induce fatty acid β-oxidation through modulation of hormone sensitive lipase, acetyl-coA carboxylase, carnitine acyl transferase and peroxisome proliferator-activated receptor gamma coactivator-1. In this review article, we discuss selected phytochemicals in relation to their integrated functionalities and specific mechanisms for weight loss.

Prospective association between body composition, physical activity and energy intake in young adults

BACKGROUND/OBJECTIVES

Despite considerable research on the association between physical activity (PA) and body composition, there remains limited information on the directionality of the relationship. The present study examined the prospective associations among objectively measured PA, energy intake (EI) and body composition.

SUBJECTS/METHODS

A convenience sample of 430 adults (49% male) between 21 and 35 years of age was followed over 1 year with repeated measurements taken every 3 months. BMI (kg/m(2)) and percent body fat (%BF) were calculated based on anthropometric measurements and dual energy X-ray absorptiometry. A multi-sensor device was worn over a period of 10 days to estimate total daily energy expenditure and time spent in different intensities. EI was calculated based on change in body composition and total daily energy expenditure.

RESULTS

A total of 379 participants provided valid data. On average, participants experienced a significant weight gain of 1.2±4.3 kg during the 12-month observation period, which was associated with an increase in %BF (0.8±3.2 %). Average time spent in moderate-to-vigorous PA (MVPA) decreased significantly, whereas EI remained constant. Optimal linear mixed models, adjusting for age and sex, showed an inverse effect of MVPA on BMI and %BF, whereas EI only directly affected BMI (P<0.001). There was also a significant inverse effect of BMI and %BF on MVPA (P<0.001).

CONCLUSIONS

Results of this study indicate an inverse reciprocal association between MVPA and measures of adiposity. Thus, primary preventive actions are warranted to avoid excess weight gain, which may result in a vicious cycle of weight gain and low PA.

Does the method of weight loss effect long-term changes in weight, body composition or chronic disease risk factors in overweight or obese adults? A systematic review

BACKGROUND

Differences in biological changes from weight loss by energy restriction and/or exercise may be associated with differences in long-term weight loss/regain.

OBJECTIVE

To assess the effect of weight loss method on long-term changes in weight, body composition and chronic disease risk factors.

DATA SOURCES

PubMed and Embase were searched (January 1990-October 2013) for studies with data on the effect of energy restriction, exercise (aerobic and resistance) on long-term weight loss. Twenty articles were included in this review.

STUDY ELIGIBILITY CRITERIA

Primary source, peer reviewed randomized trials published in English with an active weight loss period of >6 months, or active weight loss with a follow-up period of any duration, conducted in overweight or obese adults were included.

STUDY APPRAISAL AND SYNTHESIS METHODS

Considerable heterogeneity across trials existed for important study parameters, therefore a meta-analysis was considered inappropriate. Results were synthesized and grouped by comparisons (e.g. diet vs. aerobic exercise, diet vs. diet + aerobic exercise etc.) and study design (long-term or weight loss/follow-up).

RESULTS

Forty percent of trials reported significantly greater long-term weight loss with diet compared with aerobic exercise, while results for differences in weight regain were inconclusive. Diet+aerobic exercise resulted in significantly greater weight loss than diet alone in 50% of trials. However, weight regain (∼ 55% of loss) was similar in diet and diet+aerobic exercise groups. Fat-free mass tended to be preserved when interventions included exercise.

The defence of body weight: a physiological basis for weight regain after weight loss

Although weight loss can usually be achieved by restricting food intake, the majority of dieters regain weight over the long-term. In the hypothalamus, hormonal signals from the gastrointestinal tract, adipose tissue and other peripheral sites are integrated to influence appetite and energy expenditure. Diet-induced weight loss is accompanied by several physiological changes which encourage weight regain, including alterations in energy expenditure, substrate metabolism and hormone pathways involved in appetite regulation, many of which persist beyond the initial weight loss period. Safe effective long-term strategies to overcome these physiological changes are needed to help facilitate maintenance of weight loss. The present review, which focuses on data from human studies, begins with an outline of body weight regulation to provide the context for the subsequent discussion of short- and long-term physiological changes which accompany diet-induced weight loss.

Comparison of substrate oxidation during walking and running in normal-weight and overweight/obese men

OBJECTIVE

The aim of the present study is to examine the differences in fat and carbohydrate (CHO) oxidation during walking and running between normal-weight and overweight/obese young adult men.

METHODS

19 healthy, normal-weight (age = 21.9 ± 0.7 years, BMI = 22.6 ± 0.4 kg, n = 10) and overweight (age = 21.4 ± 0.6 years, BMI = 31.6 ± 1.1, n = 9) young men volunteered to participate in this study. Body composition was assessed by bioelectrical impedance. Maximal oxygen uptake and maximal fat oxidation rate were determined with indirect calorimetry by using an incremental exercise test on a motor-driven treadmill. The participants' individual preferred transition speeds between walking and running were determined. Indirect calorimetry was used to calculate fat and CHO oxidation during the resting, walking and running tests.

RESULTS

Maximal fat oxidation rates during the graded exercise test were not significantly different between the groups. Changes in CHO and fat oxidation in the resting, walking and running tests were similar in the normal-weight and overweight groups.

CONCLUSION

The study results suggest that with regard to changes in CHO and fat oxidation, normal-weight and overweight/obese individuals have similar responses to walking and running at preferred speeds, despite significant differences in oxygen uptake during activity and body composition.

Diet and physical activity in women recovered from anorexia nervosa: a pilot study

OBJECTIVE

After recovery, women with anorexia nervosa (AN) tend to maintain lower body mass indices (BMI) than women in the general population. Reasons for this are unknown as little is known about diet, food choices, physical activity levels (PAL), and reasons for exercise in women recovered from AN.

METHOD

Diet, reasons for food choice, PAL, and reasons for exercise were measured in an exploratory study of 15 women recovered from AN and 22 women with no eating disorder history.

RESULTS

In these hypotheses generating analyses, mean BMI in recovered women was numerically lower than control women [21.4 kg/m(2) (2.0) and 23.6 kg/m(2) (4.4); respectively (p < .06)]. Recovered women were more likely to base food choice on health benefits (p < .04) compared with control women.

DISCUSSION

Pathological behaviors that are pathognomonic of AN may resolve into healthy food and activity choices that help maintain BMIs lower in the healthy range in recovered individuals.

Phenotypic and genetic variation in leptin as determinants of weight regain

AIMS

Over 75% of obese subjects fail to maintain their weight following weight loss interventions. We aimed to identify phenotypic and genetic markers associated with weight maintenance/regain following a dietary intervention.

SUBJECTS AND METHODS

In the 2-year Dietary Intervention Randomized Controlled Trial, we assessed potential predictors for weight changes during the 'weight loss phase' (0-6 months) and the 'weight maintenance/regain phase' (7-24 months). Genetic variation between study participants was studied using single-nucleotide polymorphisms in the leptin gene (LEP).

RESULTS

Mean weight reduction was -5.5% after 6 months, with a mean weight regain of 1.2% of baseline weight during the subsequent 7-24 months. In a multivariate regression model, higher baseline high-molecular-weight adiponectin was the only biomarker predictor of greater success in 0- to 6-month weight loss (β = -0.222, P-value = 0.044). In a multivariate regression model adjusted for 6-month changes in weight and various biomarkers, 6-month plasma leptin reduction exhibited the strongest positive association with 6-month weight loss (β = 0.505, P-value < 0.001). Conversely, 6-month plasma leptin reduction independently predicted weight regain during the following 18 months (β = -0.131, P-value < 0.013). Weight regain was higher among participants who had a greater (top tertiles) 6-month decrease in both weight and leptin (+3.4% (95% confidence interval 2.1-4.8)) as compared with those in the lowest combined tertiles (+0.2% (95% confidence interval -1.1 to 1.4)); P-value < 0.001. Weight regain was further significantly and independently associated with genetic variations in LEP (P = 0.006 for both rs4731426 and rs2071045). Adding genetic data to the phenotypic multivariate model increased its predictive value for weight regain by 34%.

CONCLUSION

Although greater reduction in leptin concentrations during the initial phase of a dietary intervention is associated with greater weight loss in the short term, plasma leptin reduction, combined with the degree of initial weight loss and with genetic variations in the LEP gene, constitutes a significant predictor of subsequent long-term weight regain.

Effects of protein quality on appetite and energy metabolism in normal weight subjects

OBJECTIVE

The purpose of this study was to compare the effects of consumption of different protein sources on food intake and energy expenditure in normal weight subjects.

SUBJECTS AND METHODS

Breakfast preparations (casein, soy protein, whey protein or control) were ingested during seven consecutive days. Appetite, food intake, and energy expenditure were assessed.

RESULTS

Casein consumption led to a lower energy intake than whey protein. There was lower energy intake on day 7 than on day 1 of the casein session. Soy protein preparations resulted in higher diet induced thermogenesis (DIT) than in control preparations. The respiratory quotient (RQ) obtained in the whey protein session was lower than the control and soy protein sessions.

CONCLUSION

These results suggest that the consumption of different protein types leads to distinct effects on satiety (casein), DIT (soy protein), and/or RQ (whey protein).

Prospective association between fasting NEFA and type 2 diabetes: impact of post-load glucose

AIMS/HYPOTHESIS

Elevated fasting NEFAs are thought to promote type 2 diabetes. Three prospective studies support this concept, showing increased diabetes risk associated with fasting NEFA. However, these prospective associations may be confounded by strong cross-sectional correlations between fasting NEFA and metabolic predictors of diabetes. To examine this assumption, we used cohort data from the Insulin Resistance Atherosclerosis Study (IRAS).

METHODS

Within the IRAS cohort (n = 902, 145 incident cases), we examined nine metabolic variables for their confounding effect on the fasting NEFA-diabetes association: 2 h glucose; fasting plasma glucose; body mass index; waist circumference; waist-to-hip ratio; weight; insulin sensitivity (S (I)); fasting insulin; and acute insulin response. We compared odds ratios for fasting NEFA (log( e ) transformed and adjusted for age, sex, ethnicity and clinic) before and after inclusion of each metabolic variable into a logistic regression model.

RESULTS

Three variables (2 h glucose, BMI and S (I)) cross-sectionally correlated with fasting NEFA (r > or = 0.1, p < 0.05). Unadjusted for metabolic predictors, fasting NEFA levels were positively associated with diabetes risk: OR 1.37 (95% CI 0.87-2.15) per unit on a log scale. All metabolic variables except AIR showed confounding. Inclusion of 2 h glucose reversed the positive association (OR 0.50 [95% CI 0.30-0.82]), whereas other predictors reduced the association to the null. The final model included the variables correlated with baseline fasting NEFA (2 h glucose, BMI and S (I)) and the demographic variables resulting in OR 0.47 (95% CI 0.27-0.81).

CONCLUSIONS/INTERPRETATION

Our results indicate that 2 h glucose strongly confounds the prospective association between fasting NEFA and diabetes; carefully adjusted fasting NEFA levels are inversely associated with diabetes risk.

Relationship of leptin, resting metabolic rate, and body composition in premenopausal hispanic and non-Hispanic White women

OBJECTIVE

The purpose was to evaluate the relationships between fasting serum leptin, resting metabolic rate (RMR), and body composition in premenopausal Hispanic and non-Hispanic White (White) women.

METHODS

Participants were 67 Hispanic and 43 White women who arrived at the laboratory in a fasted state for measurement of RMR by indirect calorimetry, bone mineral content measured by dual-energy X-ray absorptiometry, and body density measured by hydrodensitometry. Serum leptin levels were determined by EIA.

RESULTS

Multiple regression analysis revealed that body mass and lean body mass were the best predictors of RMR. Leptin was not a significant predictor of RMR.

CONCLUSION

Further research needs to be done to examine the role of leptin on metabolism, especially in ethnic groups predisposed to development of obesity and related disorders.

The role of impaired mitochondrial lipid oxidation in obesity

Obesity represents a disruption in balancing fuel intake with energy expenditure in favor of energy conservation. Adiposity is known to be carefully regulated and, over time, highly resistant to major changes, raising questions about how energy homeostasis can become dysregulated in favor of fat accumulation. In obesity, the excess lipid accumulation represents a surfeit of energy, but those who are obese often experience rapid fatigue and decreased physical endurance, reflecting an energy deficiency. To develop an explanation for this apparent contradiction in energy homeostasis and the chronic overeating relative to energy used in obesity, a review of the literature was conducted. The resulting model of obesity is based on a growing body of research demonstrating that altered mitochondrial energy production, particularly in skeletal muscles, is a major anomaly capable of setting off a chain of metabolic events leading to obesity. Alterations in skeletal muscle mitochondria distribution and their oxidative and glycolytic energy capacities in obesity are described. The metabolic responses of obese and normal individuals to exercise are contrasted, and the effects of weight loss on energy production are presented. The effect of altered fat oxidation is considered in relation to energy regulation by the central nervous system and the development of major obesity comorbidities, including systemic inflammation, insulin resistance and diabetes, and cardiovascular disease. Recommendations for clinical intervention and additional research are proposed based on the model presented of impaired mitochondrial function in obesity.

Energy balance in obesity

The current epidemic of human obesity implies that whilst energy balance appears to be regulated, the extent of this regulatory process is being overwhelmed in large numbers of the population by environmental changes. Clearly, the shift towards positive energy balance reflects both alterations in energy intake and decreases in physical activity. Increased energy intake and, in particular, the rising proportion of energy from fat is linked with obesity. However, on a population level reduced levels of activity probably play the predominant role. It is apparent that individual susceptibility to weight gain varies enormously. The factors underlying this susceptibility are an area of intense research interest. Variations in BMR from that predicted appear to be linked to the propensity to gain weight. The genes responsible for this variation may include uncoupling proteins-2 and -3, with a number of studies showing a link with obesity. However,in vivostudies of these proteins have not yet demonstrated a physiological role for them that would explain the link with obesity. Non-exercise activity thermogenesis may also protect from weight gain, but the regulation of this type of thermogenesis is unclear, although the sympathetic nervous system may be important. A profusion of hormones, cytokines and neurotransmitters is involved in regulating energy intake, but whilst mutations in leptin and the melanocortin-3 receptor are responsible for rare monogenic forms of obesity, their wider role in common polygenic obesity is not known. Much current work is directed at examining the interplay between genetic background and environmental factors, in particular diet, that both lead to positive energy balance and seem to make it so hard for many obese subjects to lose weight.

Revisiting leptin's role in obesity and weight loss

Maintenance of weight loss is often unsuccessful because of metabolic adaptations that conserve energy. Studies in rodents suggest that a reduction in leptin level during weight loss signals to the brain to increase feeding and decrease energy expenditure. In this issue of the JCI, Rosenbaum et al. examined this concept in obese patients who lost weight and were maintained at 10% below their initial weight (see the related article beginning on page 2583). Brain activity responses to visual food stimuli were visualized using functional MRI. Leptin levels fell during weight loss and increased brain activity in areas involved in emotional, cognitive, and sensory control of food intake. Restoration of leptin levels maintained weight loss and reversed the changes in brain activity. Thus, leptin is a critical factor linking reduced energy stores to eating behavior. Potentially, leptin therapy could sustain weight loss by overriding the tendency toward energy conservation.

Treatment modalities of obesity: what fits whom?

The prevalence of obesity is increasing in both developed and developing countries, with rates reaching approximately 10-35% among adults in the Euro-American region. Obesity is associated with increased risks of cardiovascular diseases, type 2 diabetes, arthritis, and some type of cancers. Obesity significantly affects the quality of life and reduces the average life expectancy. The effective treatment of obesity should address both the medical and the social burden of this disease. Obesity needs to be treated within the health care system as any other complex disease, with empathy and without prejudice. Both health care providers and patients should know that the obesity treatment is a lifelong task. They should also set realistic goals before starting the treatment, whereas keeping in mind that even a modest weight loss of 5-15% significantly reduces obesity-related health risks. Essential treatment of obesity includes low-calorie low-fat diets, increased physical activity, and strategies contributing to the modification of lifestyle. Anti-obesity drugs facilitate weight loss and contribute to further amelioration of obesity-related health risks. A short-term weight loss, up to 6 months, is usually achieved easily. However, the long-term weight management is often associated with a lack of compliance, failures, and a high dropout rate. Regular physical activity, cognitive behavioral modification of lifestyle, and administration of anti-obesity drugs improve weight loss maintenance. Bariatric surgery is an effective strategy to treat severely obese patients. Bariatric surgery leads to a substantial improvement of comorbidities as well as to a reduction in overall mortality by 25-50% during the long-term follow-up. Obesity treatment should be individually tailored and the following factors should be taken into account: sex, the degree of obesity, individual health risks, psychobehavioral and metabolic characteristics, and the outcome of previous weight loss attempts. In the future, an evaluation of hormonal and genetic determinants of weight loss could also contribute to a better choice of individual therapy for a particular obese patient. A multilevel obesity management network of mutually collaborating facilities should be established to provide individually tailored treatment. Centers of excellence in obesity management represented by multidisciplinary teams should provide comprehensive programs for the treatment of obesity derived from evidence-based medicine.

Leptin-adiposity relationship changes, plus behavioral and parental factors, are involved in the development of body weight in a Dutch children cohort

BACKGROUND

The development of body weight is determined by different factors, namely genetic, behavioral, parental and physiological.

OBJECTIVE

To investigate whether genetic, behavioral, parental and physiological factors are involved and the extent of involvement in the development of body weight at ages 12 and 13 y in a Dutch children cohort.

METHODS

In a Dutch cohort of 94 children at ages 12 and 13 y, we determined anthropometric measurements, body composition, leptin concentrations, TFEQ scores, physical activity, as well as 3 polymorphisms, and in the parents we determined anthropometric measurements and TFEQ scores.

RESULTS

11% of the children in the cohort were classified as overweight. The genotype frequency distributions of the PPARy2, GRL and CNTF genes at ages 12 and 13 y were not significantly different for the overweight children compared to the lean children. Overweight children showed higher dietary restraint and disinhibition scores. Overweight children's parents had a higher BMI, dietary restraint and disinhibition scores, compared to lean children's parents. A peak in leptin concentrations between 7 and 13 y was shown at 12 y. In lean boys, the decrease in leptin concentrations between 12 and 13 y was related to an increase in fat free mass. At the age of 12 y predominantly the physiological factors were predictors for body weight, and at the age of 13 y both the physiological and behavioral factors were predictors for body weight.

CONCLUSION

We conclude from this longitudinal study, that leptin appeared to play an important role in the development of body weight during puberty, in addition to behavioral and parental factors.

Alterations in plasma and tissue lipids associated with obesity and metabolic syndrome

The MS (metabolic syndrome) is a cluster of clinical and biochemical abnormalities characterized by central obesity, dyslipidaemia [hypertriglyceridaemia and decreased HDL-C (high-density lipoprotein cholesterol)], glucose intolerance and hypertension. Insulin resistance, hyperleptinaemia and low plasma levels of adiponectin are also widely related to features of the MS. This review focuses on lipid metabolism alterations associated with the MS, paying special attention to changes in plasma lipids and cellular fatty acid oxidation. Lipid metabolism alterations in liver and peripheral tissues are addressed, with particular reference to adipose and muscle tissues, and the mechanisms by which some adipokines, namely leptin and adiponectin, mediate the regulation of fatty acid oxidation in those tissues. Activation of the AMPK (AMP-dependent kinase) pathway, together with a subsequent increase in fatty acid oxidation, appear to constitute the main mechanism of action of these hormones in the regulation of lipid metabolism. Decreased activation of AMPK appears to have a role in the development of features of the MS. In addition, alteration of AMPK signalling in the hypothalamus, which may function as a sensor of nutrient availability, integrating multiple nutritional and hormonal signals, may have a key role in the appearance of the MS.

Vasodilator effects of leptin on canine isolated mesenteric arteries and veins

1. Although leptin increases sympathetic nerve activity and blood pressure, its direct action on large arterial rings is to cause relaxation. However, it is the small resistance arteries and veins that are important in blood pressure control. The effects of leptin on these small vessels has not been reported previously in the canine and the effect of leptin on the capacitance vessels is not known. 2. In the present study, third- or fourth-order canine mesenteric arteries and veins were isolated and placed in a perfusion myograph and preconstricted with noradrenaline. The responses to graded concentrations of leptin were determined and the role of nitric oxide was assessed by administration of N(G)-nitro-l-arginine methyl ester (l-NAME), a blocker of nitric oxide synthase. 3. Leptin induced dose-related dilatations in both arterial and venous segments. The mean (+/-SEM) maximum increases in the diameter of the arteries and veins were 25.0 +/- 4.8 and 29.9 +/- 2.0% of the initial preconstriction, respectively. Relaxations of both arteries and veins were abolished by l-NAME or by endothelium denudation, although dilatations were still obtained to sodium nitroprusside, a nitric oxide donor. 4. These results indicate that leptin dilates canine small mesenteric arteries and veins by a mechanism involving endothelial release of nitric oxide. This observation may result in a decrease of peripheral resistance and venous return and, hence, counteract the leptin-induced neurally mediated vasoconstriction that has been reported previously.

Trafficking of dietary fat in obesity-prone and obesity-resistant rats

The trafficking of dietary fat was assessed in obesity-prone (OP) and obesity-resistant (OR) male and female rats. Test meals containing [1-(14)C]palmitate were delivered through gastric feeding tubes while rats consumed a high-carbohydrate diet (HCD) or after 5 days of a high-fat diet (HFD). Over the subsequent 24 h, the appearance of (14)C was followed in the GI tract, skeletal muscles (SM), liver, adipose tissues (AT), and expired CO(2). There was no difference in the production of (14)CO(2) between OP and OR rats consuming a HCD. However, after 5 days on HFD, OR rats produced significantly more (14)CO(2) after the test meal than OP rats (P < 0.001 females, P = 0.03 males). The differential oxidation of dietary fat between OP and OR rats on HFD was not due to differences in absorption but rather was associated with preferential disposition of tracer to AT in OP rats. Measurements of lipoprotein lipase in part explained increased tracer uptake by AT in OP rats but were not consistent with increased SM tracer uptake in OR rats. Surprisingly, female rats oxidized more tracer than male rats irrespective of phenotype or diet. These results are consistent with the notion that differences in the partitioning of dietary fat between storage in AT and oxidation in SM and liver that develop shortly after the introduction of a HFD may in part underlie the differential tendency for OR and OP rats to gain weight on this diet.

Determinants of overweight in a cohort of Dutch children

BACKGROUND

To improve the effective prevention and treatment of obesity, it is important to focus on body weight (BW) development and its determinants during childhood.

OBJECTIVE

The aim of the present study was to investigate the effects of early development, parental and genetic variables, and behavioral determinants on overweight at 12 y.

DESIGN

In a Dutch cohort of 105 children, anthropometric measurements were conducted from birth until age 7 y. At age 12 y, anthropometric measurements were obtained again, as were measurements of body composition, leptin concentration, 3 polymorphisms, and physical activity, and the Three-Factor Eating Questionnaire was conducted. In addition, parental body mass indexes (BMIs, in kg/m2) and Three-Factor Eating Questionnaire scores were determined.

RESULTS

The children's mean (+/-SD) BMI at 12 y was 19.0 +/- 2.6, and 15.2% were classified as overweight. From the first year of life, BMI tracked significantly with BMI at age 12 y (r = 0.24, P < 0.05). Linear regression analyses showed that a rapid increase in BW during the first year of life, a high BMI of the father, and a high dietary restraint score of the mother were significantly associated with overweight at age 12 y (P < 0.05). No significant genetic relation was observed. In addition, overweight was positively associated with dietary restraint of the child, and percentage body fat was negatively associated with the child's activity score (P < 0.05).

CONCLUSIONS

In this homogeneous cohort of normal-weight to moderately overweight children, tracking of BMI during childhood took place from the first year of life. Overweight at age 12 y was predicted by an early rapid increase in BW and parental influences. Overweight during childhood may be maintained or even promoted by a high dietary restraint score and low physical activity.

The role of diet and exercise for the maintenance of fat-free mass and resting metabolic rate during weight loss

The incidence of obesity is increasing rapidly. Research efforts for effective treatment strategies still focus on diet and exercise programmes, the individual components of which have been investigated in intervention trials in order to determine the most effective recommendations for sustained changes in bodyweight. The foremost objective of a weight-loss trial has to be the reduction in body fat leading to a decrease in risk factors for metabolic syndrome. However, a concomitant decline in lean tissue can frequently be observed. Given that fat-free mass (FFM) represents a key determinant of the magnitude of resting metabolic rate (RMR), it follows that a decrease in lean tissue could hinder the progress of weight loss. Therefore, with respect to long-term effectiveness of weight-loss programmes, the loss of fat mass while maintaining FFM and RMR seems desirable. Diet intervention studies suggest spontaneous losses in bodyweight following low-fat diets, and current data on a reduction of the carbohydrate-to-protein ratio of the diet show promising outcomes. Exercise training is associated with an increase in energy expenditure, thus promoting changes in body composition and bodyweight while keeping dietary intake constant. The advantages of strength training may have greater implications than initially proposed with respect to decreasing percentage body fat and sustaining FFM. Research to date suggests that the addition of exercise programmes to dietary restriction can promote more favourable changes in body composition than diet or physical activity on its own. Moreover, recent research indicates that the macronutrient content of the energy-restricted diet may influence body compositional alterations following exercise regimens. Protein emerges as an important factor for the maintenance of or increase in FFM induced by exercise training. Changes in RMR can only partly be accounted for by alterations in respiring tissues, and other yet-undefined mechanisms have to be explored. These outcomes provide the scientific rationale to justify further randomised intervention trials on the synergies between diet and exercise approaches to yield favourable modifications in body composition.

Carbohydrate balance predicts weight and fat gain in adults

BACKGROUND

The prevention and treatment of obesity is a public health challenge.

OBJECTIVE

We investigated the effects of dietary composition, insulin sensitivity (S(I)), and energy balance on predicted changes in body composition.

DESIGN

In a randomized crossover design study, 39 normal-weight (n = 23), overweight (n = 8), and obese (n = 8) men and women (aged 25-36 y) each followed a 15-d isocaloric high-fat (HF; 50% fat) and high-carbohydrate [HC; 55% carbohydrate (CHO)] diet with a 4-6-wk washout period during the first year. During each treatment, energy balance was measured while the subjects were inactive by using indirect calorimetry on day 15, and S(I) was measured by using a euglycemic clamp study (40 mU . m(-2) . min(-1)) on day 16. Weight and body composition were then measured annually for 4 y. The outcomes for fat mass, percentage body fat, and weight were measured by using a linear 2-stage mixed model.

RESULTS

CHO balance (day 15) and S(I) (day 16) on the HC diet were highly and significantly correlated (r = 0.55, P < 0.001). On the HC diet, the subjects who had a higher positive CHO balance (day 15) gained less fat mass (P < 0.001), percentage body fat (P = 0.006), and weight (P = 0.024) over time. When adjusted for S(I), CHO balance remained a significant predictor of changes in fat mass (P = 0.021) and percentage body fat (P = 0.025).

CONCLUSIONS

On a HC diet, the subjects who had a higher positive CHO balance on day 15 while they were inactive gained less fat mass during 4 y, a predictive effect independent of S(I). As suggested in rodents, the capacity to expand the glycogen pool might reduce energy intake and protect against fat and weight gain.

Resting energy expenditure and fuel metabolism following laparoscopic adjustable gastric banding in severely obese women: relationships with excess weight lost

BACKGROUND

Although adjustable gastric banding is increasingly proposed for massively obese patients, little is known about the modifications of resting metabolic rate and substrate oxidation or about metabolic determinants of weight loss following this type of bariatric surgery.

OBJECTIVES

To evaluate the relationships between excess weight loss, resting metabolic rate (RMR) and substrate oxidation, and to identify metabolic predictive factors of weight loss after adjustable gastric banding.

SUBJECTS

Seventy-three obese nondiabetic women aged 39.1+/-10.4 years (18.4-64.8).

DESIGN

Resting metabolic rate and substrate oxidation (indirect calorimetry), body composition (bio-impedance), lipid profile and insulin sensitivity indexes were assessed before and after (13.3+/-6.0 months, range 6.0-31.1) adjustable gastric banding. Patients were classified according to postsurgery time: group A (6-12 months, n=39); group B (12-18 months, n=21); group C (>18 months, n=13). Metabolic parameters associated with the percentage of excess weight lost (EWL) 1 year after surgery were analyzed in univariate and multivariate regressions.

RESULTS

Mean weight loss was 26.2+/-11.4 kg. Mean fat mass loss was 17.3+/-8.1 kg. All biological parameters associated with excess weight improved after surgery. Excess weight lost at 1 year was 45.9+/-17.1% in group A, 47.4+/-17.1% in group B and 51.4+/-18.5% in group C (P=NS). Resting metabolic rate/fat-free mass (FFM) slightly decreased (28.9+/-3.26 vs 30.3+/-2.8, P<0.00001) and RMR/body weight slightly increased (18.5+/-2.8 vs 17.3+/-1.9, P<0.00001) after surgery. Respiratory quotient (0.81+/-0.06 vs 0.82+/-0.05) and FFM-adjusted lipid oxidation (1.10+/-0.41 vs 1.05+/-0.33 mg/min/kg FFM) were not significantly modified after surgery. In multiple linear regression analysis, difference in RMR/body weight, difference in energy sparing, baseline BMI and postsurgery time, were significantly and independently correlated with EWL (total R2=72.5%).

CONCLUSIONS

Adjustable gastric banding promotes gradual but sustained weight loss and is associated with long-term conservation of lipid oxidation and energy expenditure. The individual variability in energy sparing mechanisms predicts weight loss during the first year after surgery.

Bioefficacy of a novel calcium-potassium salt of (-)-hydroxycitric acid

Obesity is associated with cardiovascular disease, diabetes and certain forms of cancer. Popular strategies on weight loss often fail to address many key factors such as fat mass, muscle density, bone density, water mass, their inter-relationships and impact on energy production, body composition, and overall health and well-being. (-)-Hydroxycitric acid (HCA), a natural plant extract from the dried fruit rind of Garcinia cambogia, has been reported to promote body fat loss in humans without stimulating the central nervous system. The level of effectiveness of G. cambogia extract is typically attributed solely to HCA. However, other components by their presence or absence may significantly contribute to its therapeutic effectiveness. Typically, HCA used in dietary weight loss supplement is bound to calcium, which results in a poorly soluble (<50%) and less bioavailable form. Conversely, the structural characteristics of a novel Ca2+/K+ bound (-)-HCA salt (HCA-SX or Super CitriMax) make it completely water soluble as well as bioavailable. An efficacious dosage of HCA-SX (4500 mg/day t.i.d.) provides a good source of Ca2+ (495 mg, 49.5% of RDI) and K+ (720 mg, 15% of RDI). Ca2+ ions are involved in weight management by increasing lipid metabolism, enhancing thermogenesis, and increasing bone density. K+, on the other hand, increases energy, reduces hypertension, increases muscle strength and regulates arrhythmias. Both Ca and K act as buffers in pH homeostasis. HCA-SX has been shown to increase serotonin availability, reduce appetite, increase fat oxidation, improve blood lipid levels, reduce body weight, and modulate a number of obesity regulatory genes without affecting the mitochondrial and nuclear proteins required for normal biochemical and physiological functions.

Polymorphisms in the leptin and leptin receptor genes in relation to resting metabolic rate and respiratory quotient in the Québec Family Study

BACKGROUND

Leptin (LEP) is an endocrine hormone that participates in many metabolic pathways, including those associated with the central regulation of energy homeostasis.

OBJECTIVE

We examined the associations between polymorphisms in the LEP and leptin receptor (LEPR) genes and resting metabolic rate (RMR) and respiratory quotient (RQ) in the Quebec Family Study.

METHODS AND SUBJECTS

Three polymorphisms in LEPR (K109R, Q223R and K656N) and one in LEP (19A > G) were genotyped in 678 subjects. RMR, RQ at rest and RQ while sitting, standing and walking at 4.5 km/h (RQ45) were adjusted for age, sex, fat mass and fat-free mass.

RESULTS

RQ45 was associated with the LEPR-K109R (P = 0.004) and Q223R (P = 0.03) polymorphisms, and RMR showed association with the LEPR-K656N polymorphism (P = 0.006). For the LEP-19A > G polymorphism, no significant associations were observed. However, LEP-A19A homozygotes who were carriers of the LEPR N656 allele had a significantly lower RQ45 compared to other genotype combinations (P for interaction=0.003).

CONCLUSION

These findings suggest that DNA sequence variation in the LEPR gene contributes to human variation in RMR and in the relative rates of substrate oxidation during low-intensity exercise in steady state but not in a resting state.

Sustained weight loss in obese subjects has benefits that are independent of attained weight

OBJECTIVE

To explore the hypothesis that sustained weight loss in severely obese patients may have benefits that are independent of their attained BMI.

RESEARCH METHODS AND PROCEDURES

We conducted a comparison of two weight-stable groups with BMI in the 30 to 35 kg/m(2) range. Subjects (n = 79) were selected obese patients 3 years after laparoscopic adjustable gastric band surgery, and controls (n = 79) were obese patients seeking weight loss therapy. Subjects were selected in a de-identified manner from our database to best match the control group. A range of clinical, biochemical, and questionnaire measures were obtained to assess obesity-related health status

RESULTS

Subjects maintained a mean weight loss of 32.8 +/- 18 kg after surgery. The weight loss subjects had significantly lower fasting plasma glucose, insulin, and triglyceride concentrations, along with higher high-density lipoprotein-cholesterol levels and better indirect measures of insulin sensitivity when compared with controls (p < 0.05 for all). In addition, aminotransferase levels, neutrophil counts, and globulin levels were also significantly lower in weight loss subjects. All differences in laboratory variables remained significant after controlling for BMI. The subjects also reported better health-related quality of life, fewer symptoms of depression, and greater satisfaction with their appearance than controls.

DISCUSSION

These findings suggest that the post-weight loss state conveys benefits that are greater than predicted by the attained BMI. These findings may have important implications regarding the expectations of weight loss therapy, and mechanisms for this effect should be carefully sought.

Fasting Respiratory Quotient as a Predictor of Long-Term Weight Changes in Non-Obese Women

BACKGROUND/AIMS

The identification of metabolic and environmental predictors of excess body fat is still far from being achieved. The aim of this study was to evaluate whether respiratory quotient in non-obese women is a predictor of body weight changes after a 6-year follow-up period.

METHODS

Forty-three non-obese healthy women participated in the study. Their baseline general characteristics were: age 40.5 +/- 12.8 years; height 159 +/- 7 cm; weight 61.8 +/- 10.1 kg, and body mass index (BMI) 24.4 +/- 3.8 kg/m2. At baseline basal metabolic rate and respiratory quotient were determined by indirect calorimetry, while weight and BMI were recorded at the first observation and after the 3- and 6-year follow-ups.

RESULTS

At the first observation basal metabolic rate was 5,360 +/- 713 kJ/day and respiratory quotient 0.850 +/- 0.052. After 6 years, with weight changes equal to 1.4 +/- 4.5 kg, baseline respiratory quotient was a significant predictor (p < 0.05) of changes in body weight or BMI together with baseline BMI.

CONCLUSIONS

This follow-up study confirms that a high respiratory quotient (measured on free diet) predisposes to weight gain, especially in women with the highest baseline respiratory quotient (above the 90th percentile of the distribution for this variable).

Low resting and sleeping energy expenditure and fat use do not contribute to obesity in women

OBJECTIVE

Determine whether sleeping and resting energy expenditure and sleeping, resting, and 24-hour fuel use distinguish obesity-prone from obesity-resistant women and whether these metabolic factors explain long-term weight gain.

RESEARCH METHODS AND PROCEDURES

Forty-nine previously overweight but currently normal-weight women were compared with 49 never-overweight controls. To date, 87% of the 98 women have been re-evaluated after 1 year of follow-up, without intervention, and 38% after 2 years. Subjects were studied at a General Clinical Research Center after 4 weeks of tightly controlled conditions of energy balance and macronutrient intake. Forty-nine obesity-prone weight-reduced women were group-matched with 49 never-overweight obesity-resistant controls. All were premenopausal, sedentary, and normoglycemic. Energy expenditure and fuel use were assessed using chamber calorimetry. Body composition was assessed using DXA.

RESULTS

At baseline, percent body fat was not different between the obesity-prone and control women (33 +/- 4% vs. 32 +/- 5%, respectively; p = 0.22). Analysis of covariance results show that after adjusting for lean and fat mass, sleeping and resting energy expenditure of obesity-prone women was within 2% of controls. Neither sleeping nor resting energy expenditure nor sleeping, resting, or 24-hour fuel use was significantly different between the groups (p > 0.25). None of the metabolic variables contributed significantly to patterns of weight gain at 1 or 2 years of follow-up.

DISCUSSION

The results suggest that when resting and sleeping energy expenditure and fuel use are assessed under tightly controlled conditions, these metabolic factors do not distinguish obesity-prone from obesity-resistant women or explain long-term weight changes.

Controle neuroendócrino do peso corporal: implicações na gênese da obesidade

O peso corporal é regulado por uma interação complexa entre hormônios e neuropeptídeos, sob o controle principal de núcleos hipotalâmicos. Mutações nos genes de hormônios e neuropeptídeos, de seus receptores ou de elementos regulatórios, têm sido descritas na espécie humana, mas são tidas como raras, não explicando as formas mais comuns de obesidade. No entanto, o estudo destas mutações tem propiciado um grande avanço nos conhecimentos sobre a base genética e a fisiopatologia da obesidade, possibilitando o estudo e abrindo perspectivas para o desenvolvimento de novas modalidades terapêuticas. Recentemente, demonstrou-se que mutações no receptor 4 da melanocortina podiam ser encontradas em até 5% dos casos de obesidade severa, representando até o presente momento a forma mais prevalente de obesidade monogênica na espécie humana. Nesta revisão, são discutidas as diversas mutações descritas nos seres humanos de elementos da rede neuroendócrina de controle do peso corporal, bem como as implicações dos mesmos na gênese da obesidade.

Effects of a longitudinal training program on responses to exercise in overweight men

OBJECTIVE

The aim of this study was to determine how training modifies metabolic responses and lipid oxidation in overweight young male subjects.

RESEARCH METHODS AND PROCEDURES

Eleven overweight subjects were selected for a 4-month endurance training program. Before and after the training period, they cycled for 60 minutes at 50% of their VO(2)max after an overnight fast or 3 hours after eating a standardized meal. Various metabolic and endocrine parameters, and respiratory exchange ratio values were evaluated.

RESULTS

Exercise-induced plasma norepinephrine concentration increases were similar before and after training in fasted or fed conditions. After food intake, exercise promoted a decrease in plasma glucose and a higher increase in epinephrine than in fasting conditions. The increase in epinephrine after the meal was more marked after training (264 +/- 32 vs. 195 +/- 35 pg/mL). Training lowered the resting plasma nonesterified fatty acids. During exercise, changes in glycerol were similar to those found before training. Lipid oxidation during exercise was higher in fasting than in fed conditions (15.5 +/- 1.4 vs. 22.3 +/- 1.7 g/h). Training did not significantly increase fat oxidation when exercise was performed in fed conditions, but it did in fasting conditions (18.6 +/- 1.4 vs. 27.2 +/- 1.8 g/h).

DISCUSSION

Endurance training decreased plasma nonesterified fatty acids, cholesterol, and insulin concentrations. Training increased lipid oxidation during exercise, in fasting conditions, and not when exercise was performed after the meal. During exercise in overweight subjects, the fasting condition seems more suited to oxidizing fat and maintaining glucose homeostasis than a 3-hour wait after a standard meal.

Paradoxical resistance to diet-induced obesity in UCP1-deficient mice

The availability of mice lacking the mitochondrial uncoupling protein UCP1, has provided an opportunity to analyze the relationship between the capacity for energy expenditure and the development of obesity in response to a high-fat, high-sucrose diet. Congenic UCP1-deficient mice on a C57BL/6J genetic background show a temperature-dependent resistance to diet-induced obesity when compared with wild-type mice. This resistance, which occurs at 20 degrees C, is quickly reversed when the ambient temperature is increased to 27 degrees C. At 20 degrees C, total oxygen consumption and physical activity of mutant and wild-type mice are indistinguishable; however, body temperature is higher in UCP1-deficient mice by 0.1-0.3 degrees C, and respiratory quotient is slightly reduced. A reduced respiratory quotient, together with elevated beta-hydroxybutyrate and reduced plasma fatty acid levels, suggests that the mutants oxidize a greater proportion of fat than wild-type mice, and that this possibly accounts for the resistance to diet-induced obesity. Although shivering is one alternative mechanism of thermogenesis that is probably used in UCP1-deficient mice, whether there are others remains to be determined. Nevertheless, our study underscores the paradox that elimination of the major thermogenic mechanism in the animal reduces rather than increases metabolic efficiency. We propose that in the absence of nonshivering thermogenesis, alternative, calorically more costly pathways of metabolism must be used to maintain body temperature.

Should obese patients be counselled to follow a low-glycaemic index diet? Yes

A reduction in dietary fat has been widely advocated for the prevention and treatment of obesity and related complications. However, the efficacy of low-fat diets has been questioned in recent years. One potential adverse effect of reduced dietary fat is a compensatory increase in the consumption of high glycaemic index (GI) carbohydrate, principally refined starchy foods and concentrated sugar. Such foods can be rapidly digested or transformed into glucose, causing a large increase in post-prandial blood glucose and insulin. Short-term feeding studies have generally found an inverse association between GI and satiety. Medium-term clinical trials have found less weight loss on high GI or high glycaemic load diets compared to low GI or low glycaemic load diets. Epidemiological analyses link GI to multiple cardiovascular disease risk factors and to the development of cardiovascular disease and type 2 diabetes. Physiologically orientated studies in humans and animal models provide support for a role of GI in disease prevention and treatment. This review examines the mechanisms underlying the potential benefits of a low GI diet, and whether such diets should be recommended in the clinical setting.

Successful weight loss maintenance

Obesity is now recognized as a serious chronic disease, but there is pessimism about how successful treatment can be. A general perception is that almost no one succeeds in long-term maintenance of weight loss. To define long-term weight loss success, we need an accepted definition. We propose defining successful long-term weight loss maintenance as intentionally losing at least 10% of initial body weight and keeping it off for at least 1 year. According to this definition, the picture is much more optimistic, with perhaps greater than 20% of overweight/obese persons able to achieve success. We found that in the National Weight Control Registry, successful long-term weight loss maintainers (average weight loss of 30 kg for an average of 5.5 years) share common behavioral strategies, including eating a diet low in fat, frequent self-monitoring of body weight and food intake, and high levels of regular physical activity. Weight loss maintenance may get easier over time. Once these successful maintainers have maintained a weight loss for 2-5 years, the chances of longer-term success greatly increase.

Long-term effects of exogenous leptin on body weight and fat in post-obese female rats

This study was designed to test the hypothesis that short-term leptin infusion during the post-obese refeeding phase of weight-reduced rats would reduce the rate of weight regain and, as a result, reduce the final body weight and fat content in weight-reduced rats. Ninety-six female Wistar rats were divided into four groups: (1) LFCON (low-fat control) group: Rats in this group were fed the control low-fat (LF) diet ad lib for the entire study period. (2) HFCON (high-fat control) group: Rats in this group were fed the high-fat (HF, 40% fat) diet ad lib for the study period. (3) HFRLP (high-fat fed, weight-reduced, leptin treatment) group: Obese rats in this group were weight-reduced and received leptin infusion for 2 weeks (miniosmotic pumps, 0.5 microg/kg/day) during the post-obese refeeding period. (4) HFRSM (high-fat fed, weight-reduced, sham control) group: Rats in this sham-control group were treated the same as the rats in the HFRLP group with the exception that no leptin was actually infused during the first 2 weeks of refeeding period. The results demonstrated that 2 weeks of leptin treatment during the early refeeding phase did not prevent weight regain in weight-reduced rats, but it significantly reduced body fat content in these rats as compared to ad lib fed obese control rats. One cycle of weight reduction and regain did not alter the body weight and body fat content in HFRSM rats when compared to obese control rats. Therefore, leptin treatment was effective in reducing body fat content in post-obese rats for up to 7 weeks, but the long-term effect of short-term leptin treatment needs to be further examined.

Leptin and its role in lipid metabolism

Since the discovery of leptin in 1994, a considerable amount of research has focused on leptin as a central regulator of body weight. In the animal model, research has demonstrated leptin action through hypothalamic centres altering both satiety and energy expenditure. In contrast to animal studies, it is unlikely that leptin functioning in the human system exerts such a profound role in body weight regulation. Human studies suggest that leptin levels are strongly correlated with both percentage fat mass and body mass index, in accordance with the proposed 'lipostatic theory'. Current research suggests the existence of a unique inter-relationship between dietary fat, leptin expression and leptin action within the peripheral system. More specifically, it has been demonstrated that polyunsaturated fatty acid (PUFA) intake influences adipose tissue expression of leptin, and of several lipogenic enzymes and transcription factors. In addition, leptin stimulates triglyceride depletion in white adipose tissue without increasing free fatty acid release, thus favouring fatty acids versus glucose as a fuel source. Recent studies suggest that the reduction in adipose hypertrophy observed with n-3 PUFA-containing fish oil feeding might involve a leptin-specific process. A large amount of evidence supports direct functioning of leptin in peripheral lipid metabolism in vivo and in vitro. It is possible that PUFAs will maintain an efficient level of circulating leptin, thus preventing leptin insensitivity and weight gain. There has been much recent progress in clinical leptin research, from energy expenditure to leptin analogue efficacy; the purpose of the present review is to summarize our current understanding of leptin functioning.

Substrate utilization during exercise in formerly morbidly obese women

The purpose of this study was to compare substrate utilization during fasting and submaximal exercise in morbidly obese women after weight loss (WL) with that in weight-matched controls (C). WL were studied in the weight-stable condition approximately 24 mo after gastric bypass surgery. Energy intake (self-reported) and expenditure ((2)H(2)(18)O) were also compared. The respiratory exchange ratio during exercise at the same absolute (15 W) workload was significantly (P < or = 0.05) elevated in WL vs. C (0.90 +/- 0.02 vs. 0.83 +/- 0.03); this was reflected as lower fat utilization in WL (29.7 +/- 4.8 vs. 53.2 +/- 9.7% of energy from fat). Respiratory exchange ratio during exercise at the same relative (65% of maximal O(2) uptake) intensity was also significantly (P < 0.05) elevated in WL (0.96 +/- 0.01 vs. 0.89 +/- 0.02), and fat use was concomitantly depressed (12.4 +/- 3.0 vs. 34.3 +/- 9.9% of energy from fat). Resting substrate utilization, daily energy expenditure, and self-reported relative macronutrient intake did not differ between groups. These data suggest that lipid oxidation is depressed during physical activity in WL. This defect may, at least in part, contribute to a propensity for the development of morbid obesity.