1
|
Rasouli N, Younes N, Ghosh A, Albu J, Cohen RM, DeFronzo RA, Diaz E, Sayyed Kassem L, Luchsinger JA, McGill JB, Sivitz WI, Tamborlane WV, Utzschneider KM, Kahn SE. Longitudinal Effects of Glucose-Lowering Medications on β-Cell Responses and Insulin Sensitivity in Type 2 Diabetes: The GRADE Randomized Clinical Trial. Diabetes Care 2024; 47:580-588. [PMID: 38211595 PMCID: PMC10973918 DOI: 10.2337/dc23-1070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/28/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE To compare the long-term effects of glucose-lowering medications (insulin glargine U-100, glimepiride, liraglutide, and sitagliptin) when added to metformin on insulin sensitivity and β-cell function. RESEARCH DESIGN AND METHODS In the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE) cohort with type 2 diabetes (n = 4,801), HOMA2 was used to estimate insulin sensitivity (HOMA2-%S) and fasting β-cell function (HOMA2-%B) at baseline and 1, 3, and 5 years on treatment. Oral glucose tolerance test β-cell responses (C-peptide index [CPI] and total C-peptide response [incremental C-peptide/incremental glucose over 120 min]) were evaluated at the same time points. These responses adjusted for HOMA2-%S in regression analysis provided estimates of β-cell function. RESULTS HOMA2-%S increased from baseline to year 1 with glargine and remained stable thereafter, while it did not change from baseline in the other treatment groups. HOMA2-%B and C-peptide responses were increased to variable degrees at year 1 in all groups but then declined progressively over time. At year 5, CPI was similar between liraglutide and sitagliptin, and higher for both than for glargine and glimepiride [0.80, 0.87, 0.74, and 0.64 (nmol/L)/(mg/dL) * 100, respectively; P < 0.001], while the total C-peptide response was greatest with liraglutide, followed in descending order by sitagliptin, glargine, and glimepiride [1.54, 1.25, 1.02, and 0.87 (nmol/L)/(mg/dL) * 100, respectively, P < 0.001]. After adjustment for HOMA2-%S to obtain an estimate of β-cell function, the nature of the change in β-cell responses reflected those in β-cell function. CONCLUSIONS The differential long-term effects on insulin sensitivity and β-cell function of four different glucose-lowering medications when added to metformin highlight the importance of the loss of β-cell function in the progression of type 2 diabetes.
Collapse
Affiliation(s)
- Neda Rasouli
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, and VA Eastern Colorado Health Care System, Aurora, CO
| | - Naji Younes
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - Alokananda Ghosh
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - Jeanine Albu
- Icahn School of Medicine, Mount Sinai Morningside, New York, NY
| | - Robert M. Cohen
- Division of Endocrinology, Diabetes and Metabolism, University of Cincinnati College of Medicine and Cincinnati VA Medical Center, Cincinnati, OH
| | | | - Elsa Diaz
- VA San Diego Healthcare System, San Diego, CA
| | - Laure Sayyed Kassem
- Department of Endocrinology, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH
| | - José A. Luchsinger
- Departments of Medicine and Epidemiology, Columbia University Irving Medical Center, New York, NY
| | - Janet B. McGill
- Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine, St. Louis, MO
| | | | | | - Kristina M. Utzschneider
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, VA Puget Sound Health Care System and University of Washington, Seattle
| | - Steven E. Kahn
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, VA Puget Sound Health Care System and University of Washington, Seattle
| |
Collapse
|
2
|
Hamm JD, Dotel J, Tamura S, Shechter A, Herzog M, Brunstrom JM, Albu J, Pi-Sunyer FX, Laferrère B, Kissileff HR. Reliability and responsiveness of virtual portion size creation tasks: Influences of context, foods, and a bariatric surgical procedure. Physiol Behav 2020; 223:113001. [PMID: 32522683 PMCID: PMC7370306 DOI: 10.1016/j.physbeh.2020.113001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/22/2020] [Accepted: 06/02/2020] [Indexed: 12/01/2022]
Abstract
Food portion size influences energy intake and sustained high-energy intake often leads to obesity. Virtual portion creation tasks (VPCTs), in which a participant creates portions of food on a computer screen, predict intake in healthy individuals. The objective of this study was to determine whether portions created in VPCTs are stable over time (test-retest reliability) and responsive to factors known to influence food intake, such as eating contexts and food types, and to determine if virtual portions can predict weight loss. Patients with obesity scheduled for bariatric surgery (n = 29), and individuals with a normal BMI (18.5-24.9 kg/m2, controls, n = 29), were instructed to create virtual portions of eight snack foods, which varied in energy density (low and high) and taste (sweet and salty). Portions were created in response to the following eating situations, or "contexts": What they would a) eat to stay healthy (healthy), b) typically eat (typical), c) eat to feel comfortably satisfied (satisfied), d) consider the most that they could tolerate eating (maximum), and e) eat if nothing was limiting them (desired). Tasks were completed before, and 3 months after, surgery in patients, and at two visits, 3 months apart, in controls. Body weight (kg) was recorded at both visits. Virtual portions differed significantly across groups, visits, eating contexts, energy densities (low vs. high), and tastes (sweet vs. salty). Portions created by controls did not change over time, while portions created by patients decreased significantly after surgery, for all contexts except healthy. For patients, desired and healthy portions predicted 3-month weight loss. VPCTs are replicable, responsive to foods and eating contexts, and predict surgical weight loss. These tasks could be useful for individual assessment of expectations of amounts that are eaten in health and disease and for prediction of weight loss.
Collapse
Affiliation(s)
- Jeon D Hamm
- Institute of Human Nutrition, Vagelos College of Physicians & Surgeons, Columbia University, 630 W 168th Street #1512, New York 10032, NY, United States; Diabetes, Obesity, and Metabolism Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York 10029, NY, United States; Division of Endocrinology, Department of Medicine, Mount Sinai - Morningside Hospital, 1111 Amsterdam Avenue, New York 10025, NY, United States.
| | - Jany Dotel
- Diabetes, Obesity, and Metabolism Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York 10029, NY, United States; Division of Endocrinology, Department of Medicine, Mount Sinai - Morningside Hospital, 1111 Amsterdam Avenue, New York 10025, NY, United States
| | - Shoran Tamura
- New York Obesity Nutrition Research Center, Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, 1150 St. Nicholas Avenue #121, New York 10032, NY, United States
| | - Ari Shechter
- Institute of Human Nutrition, Vagelos College of Physicians & Surgeons, Columbia University, 630 W 168th Street #1512, New York 10032, NY, United States; Center for Behavioral Cardiovascular Health, Columbia University, 622 W 168th Street, New York, 10032, NY, United States
| | - Musya Herzog
- Teachers College, Columbia University, 525 W 120th Street, New York 10027, NY, United States
| | - Jeffrey M Brunstrom
- Nutrition and Behaviour Unit, School of Psychological Science, University of Bristol, 12a Priory Road, Bristol BS8 1TU, UK
| | - Jeanine Albu
- Diabetes, Obesity, and Metabolism Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York 10029, NY, United States; Division of Endocrinology, Department of Medicine, Mount Sinai - Morningside Hospital, 1111 Amsterdam Avenue, New York 10025, NY, United States
| | - F Xavier Pi-Sunyer
- New York Obesity Nutrition Research Center, Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, 1150 St. Nicholas Avenue #121, New York 10032, NY, United States
| | - Blandine Laferrère
- New York Obesity Nutrition Research Center, Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, 1150 St. Nicholas Avenue #121, New York 10032, NY, United States
| | - Harry R Kissileff
- Diabetes, Obesity, and Metabolism Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York 10029, NY, United States; Division of Endocrinology, Department of Medicine, Mount Sinai - Morningside Hospital, 1111 Amsterdam Avenue, New York 10025, NY, United States.
| |
Collapse
|
3
|
Arad AD, Basile AJ, Albu J, DiMenna FJ. No Influence of Overweight/Obesity on Exercise Lipid Oxidation: A Systematic Review. Int J Mol Sci 2020; 21:ijms21051614. [PMID: 32120832 PMCID: PMC7084725 DOI: 10.3390/ijms21051614] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/21/2020] [Accepted: 02/24/2020] [Indexed: 12/16/2022] Open
Abstract
Compared to lean counterparts, overweight/obese individuals rely less on lipid during fasting. This deficiency has been implicated in the association between overweight/obesity and blunted insulin signaling via elevated intramuscular triglycerides. However, the capacity for overweight/obese individuals to use lipid during exercise is unclear. This review was conducted to formulate a consensus regarding the influence of overweight/obesity on exercise lipid use. PubMed, ProQuest, ISI Web of Science, and Cochrane Library databases were searched. Articles were included if they presented original research on the influence of overweight/obesity on exercise fuel use in generally healthy sedentary adults. Articles were excluded if they assessed older adults, individuals with chronic disease, and/or exercise limitations or physically-active individuals. The search identified 1205 articles with 729 considered for inclusion after duplicate removal. Once titles, abstracts, and/or manuscripts were assessed, 24 articles were included. The preponderance of evidence from these articles indicates that overweight/obese individuals rely on lipid to a similar extent during exercise. However, conflicting findings were found in eight articles due to the outcome measure cited, participant characteristics other than overweight/obesity and characteristics of the exercise bout(s). We also identified factors other than body fatness which can influence exercise lipid oxidation that should be controlled in future research.
Collapse
Affiliation(s)
- Avigdor D. Arad
- Division of Endocrinology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (A.D.A.); (A.J.B.); (J.A.)
| | - Anthony J. Basile
- Division of Endocrinology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (A.D.A.); (A.J.B.); (J.A.)
| | - Jeanine Albu
- Division of Endocrinology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (A.D.A.); (A.J.B.); (J.A.)
| | - Fred J. DiMenna
- Division of Endocrinology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (A.D.A.); (A.J.B.); (J.A.)
- Department of Biobehavioral Sciences, Columbia University Teachers College, New York, NY 10027, USA
- Correspondence:
| |
Collapse
|
4
|
Blase B, Albu J, Lopez Gordillo K, Weininger Cohen D, Moctezuma S. SUN-394 A Curious Case of Cushing's. J Endocr Soc 2019. [PMCID: PMC6552918 DOI: 10.1210/js.2019-sun-394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Cushing’s Disease and Syndrome is a rare condition that can greatly impact a person’s health. Usually, it is easy to determine the cause of cortisol excess. However, when adrenal and pituitary examination fail to reveal a source, devising a management strategy can prove difficult. Clinical Case: A 27-year-old male with no significant PMH presented originally to an urgent care clinic with non-specific complaints, gaining weight, back spasms weakness, and chest pain. He was hypertensive and had significant abdominal stria. He was referred to endocrinology and found to be very cushingoid. Initial laboratory testing found a random cortisol 29.3 mcg/dl and ACTH was 227.4 pg/ml. Salivary cortisol was elevated at 0.526 ug/dl. A 24 hour urinary cortisol was 800 ug/24 hours. An 8mg dexamethasone suppression test was performed which did not suppress cortisol (22.2 mcg/dl). An MRI of his pituitary was read as normal. A chest CT showed a healed 2nd rib fracture but otherwise unremarkable. CT of abdomen and pelvis showed no adrenal mass and demineralization of the bone especially at the spine. The patient then underwent inferior petrosal sinus sampling which showed no step up from peripheral to central. At this point the he was started on Ketoconazole which was titrated up to 800mg mg/day. The patient was subsequently admitted multiple times to the hospital for cellulitis of his lower left extremity. A skin biopsy of his lower extremity revealed erythema nodosum. During one of these admissions he developed adrenal insufficiency which was treated with hydrocortisone replacement. Gallium-68 somatostatin receptor positron emission tomography was performed to determine the source of ACTH. It revealed a nonspecific subcentimeter nodular focus of tracer uptake just lateral to the right atrial appendage. Since being on the ketoconazole the patient has experienced significant improvement in his blood pressure, strength and abdominal striae. Conclusion: This unusual case provides valuable insight into the process of diagnosing Cushing’s Disease and Syndrome. While this process is usually straight forward, if an ectopic source of elevated ACTH remains unknown, the case can require a very substantial investigation. Because of the unique complexity of this case, it allows for a useful review of the physiology and pathophysiology of the pituitary adrenal axis.
Collapse
Affiliation(s)
- Bryan Blase
- Icahn School of Medicine at Mount Sinai (Beth Israel), New York, NY, United States
| | - Jeanine Albu
- Obesity Research Center, Icahn School of Medicine at Mt Sinai, New York, NY, United States
| | | | - David Weininger Cohen
- Icahn School of Medicine at Mount Sinai (St. Luke's/West), New York, NY, United States
| | - Sananda Moctezuma
- Icahn School of Medicine at Mount Sinai (St. Luke's/West), New York, NY, United States
| |
Collapse
|
5
|
Kissileff HR, Gordon RJ, Thornton JC, Laferrère B, Albu J, Pi-Sunyer X, Geliebter A. Combined effects of cholecystokinin-8 and gastric distension on food intake in humans. Am J Physiol Regul Integr Comp Physiol 2019; 317:R39-R48. [PMID: 30916576 DOI: 10.1152/ajpregu.00339.2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In a previous study (Kissileff HR, Carretta JC, Geliebter A, Pi-Sunyer FX. Am J Physiol Regul Integr Comp Physiol 285: R992-R998, 2003), when subthreshold gastric distension (300 ml) and a low dose of cholecystokinin octapeptide (CCK-8) (112 ng/min for 21 min) were concurrently administered to human participants, intake of a test meal was significantly reduced. However, the supra-additive interaction of CCK-8 and gastric distension was not significant. The purpose of the present study was to determine whether a significant interaction would be obtained when CCK-8 and gastric distension were each increased by 50% above levels used in the previous study. Twelve normal-weight, healthy participants were tested four times each with either CCK-8 (168 ng/min for 30 min) or saline infusion crossed with gastric distension (450 ml) or no distension. The combination of CCK-8 and gastric distension reduced food intake by a mean of 405 ± 86 g (SE) in comparison with the saline nondistension condition (P < 0.001), which is a 51% reduction. Although there were some differences in the protocols, the combined effect was double that seen in the previous study. Although the interactive effect was larger [118 ± 109 g (SE)] than it was previously [73 ± 86 (SE)], it was not significant (P = 0.29). There were also reports of a short-lived sick feeling after CCK-8, with and without distension, that was not observed in the previous study. Thus the combination of CCK-8 at 1.5 times threshold and gastric distension at 450 ml (increased from 300 ml) resulted in a combined effect to reduce food intake, which was also 1.5 times its previous value, and thus appears linear.
Collapse
Affiliation(s)
- Harry R Kissileff
- New York Obesity Nutrition Research Center, Columbia University, Mount Sinai St. Luke's Hospital , New York, New York
| | - Rebecca J Gordon
- New York Obesity Nutrition Research Center, Columbia University, Mount Sinai St. Luke's Hospital , New York, New York
| | - John C Thornton
- New York Obesity Nutrition Research Center, Columbia University, Mount Sinai St. Luke's Hospital , New York, New York
| | - Blandine Laferrère
- New York Obesity Nutrition Research Center, Columbia University, Mount Sinai St. Luke's Hospital , New York, New York
| | - Jeanine Albu
- New York Obesity Nutrition Research Center, Columbia University, Mount Sinai St. Luke's Hospital , New York, New York
| | - X Pi-Sunyer
- New York Obesity Nutrition Research Center, Columbia University, Mount Sinai St. Luke's Hospital , New York, New York
| | - Allan Geliebter
- New York Obesity Nutrition Research Center, Columbia University, Mount Sinai St. Luke's Hospital , New York, New York
| |
Collapse
|
6
|
Ali MK, Wharam F, Kenrik Duru O, Schmittdiel J, Ackermann RT, Albu J, Ross-Degnan D, Hunter CM, Mangione C, Gregg EW. Advancing Health Policy and Program Research in Diabetes: Findings from the Natural Experiments for Translation in Diabetes (NEXT-D) Network. Curr Diab Rep 2018; 18:146. [PMID: 30456479 PMCID: PMC6640642 DOI: 10.1007/s11892-018-1112-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW To advance our understanding of the impacts of policies and programs aimed at improving detection, engagement, prevention, and clinical diabetes management in the USA, we synthesized findings from a network of studies that used natural experiments to evaluate diabetes health policies and programs. FINDINGS Studies from the Natural EXperiments for Translation in Diabetes (NEXT-D) network used rigorous longitudinal quasi-experimental study designs (e.g., interrupted time series) and analytical methods (e.g., difference-in-differences) to augment causal inference. Investigators partnered with health system stakeholders to evaluate whether glucose testing rates changed from before-to-after clinic interventions (e.g., integrating electronic screening decision prompts in New York City) or employer programs (e.g., targeted messaging and waiving copayments for at-risk employees). Other studies examined participation and behavior change in low- (e.g., wellness coaching) or high-intensity lifestyle modification programs (e.g., diabetes prevention program-like interventions) offered by payers or employers. Lastly, studies assessed how employer health insurance benefits impacted healthcare utilization, adherence, and outcomes among people with diabetes. NEXT-D demonstrated that low-intensity interventions to facilitate glucose testing and enhance engagement in lifestyle modification were associated with small improvements in weight but large improvements in screening and testing when supported by electronic health record-based decision-support. Regarding high-intensity diabetes prevention program-like lifestyle programs offered by payers or employers, enrollment was modest and led to weight loss and marginally lower short-term health expenditures. Health plans that incentivize patient behaviors were associated with increases in medication adherence. Meanwhile, shifting patients to high-deductible health plans was associated with no change in medication use and preventive screenings, but patients with diabetes delayed accessing healthcare for acute complications (e.g., cellulitis). Findings were more pronounced among lower-income patients, who experienced increased rates and acuity of emergency department visits for diabetes complications and other high-severity conditions. Findings from NEXT-D studies provide informative data that can guide programs and policies to facilitate detection, prevention, and treatment of diabetes in practice.
Collapse
Affiliation(s)
- Mohammed K Ali
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Mailstop K10, 4770 Buford Highway, Atlanta, GA, 30341, USA.
- Hubert Department of Global Health, Emory University, 1518 Clifton Road NE, Ste 7041 CNR Building, Atlanta, GA, 30322, USA.
| | - Frank Wharam
- Harvard Pilgrim Health Care Institute, Department of Population Medicine, Harvard Medical School, 401 Park Drive, Suite 401 East, Boston, MA, 02215, USA
| | - O Kenrik Duru
- Division of General Internal Medicine, University of California Los Angeles, 911 Broxton Ave., Los Angeles, CA, 90024, USA
| | - Julie Schmittdiel
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Ronald T Ackermann
- Department of Medicine, General Medicine Division, Northwestern University, Rubloff Building 10th Floor 750 N Lake Shore, Chicago, IL, 60611, USA
| | - Jeanine Albu
- Division of Endocrinology, Diabetes and Bone Diseases, Icahn School of Medicine at Mount Sinai, 1111 Amsterdam Avenue Babcock Building - 10th Floor, New York, NY, 10025, USA
| | - Dennis Ross-Degnan
- Harvard Pilgrim Health Care Institute, Department of Population Medicine, Harvard Medical School, 401 Park Drive, Suite 401 East, Boston, MA, 02215, USA
| | - Christine M Hunter
- Office of Behavioral and Social Sciences Research, National Institutes of Health, 31 Center Drive, Bethesda, MD, 20892, USA
| | - Carol Mangione
- Division of General Internal Medicine, University of California Los Angeles, UCLA Med-GIM & HSR BOX 957394, 10940 Wilshire Blvd, Los Angeles, CA, 90095, USA
| | - Edward W Gregg
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Mailstop K10, 4770 Buford Highway, Atlanta, GA, 30341, USA
| |
Collapse
|
7
|
Hamm JD, Herzog M, Shechter A, Albu J, Laferrère B, Brunstrom J, Pi-Sunyer FX, Kissileff HR. Use of a virtual portion selection instrument in persons undergoing bariatric surgery. Appetite 2018. [DOI: 10.1016/j.appet.2018.05.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
8
|
Hosseini Dehkordi SH, Albu J, Aziz EF, Herzog E. Pathway for the Management of Hyperglycemia in the Cardiac Care Unit. Crit Pathw Cardiol 2018; 16:119-125. [PMID: 29135618 DOI: 10.1097/hpc.0000000000000112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Inpatient hyperglycemia has been associated with increased morbidity and mortality in critically ill patients. Optimal control of blood glucose (BG) levels using insulin infusion protocols has been shown to improve clinical outcomes. Protocols have been developed to prescribe a safe and effective rate of insulin infusion for optimal control of BG levels; however, a major obstacle in their implementation is their complexity. We have revised and updated our previously published pathway for the management of hyperglycemia, which introduces the "wheel" concept for insulin dosing. The "wheel" serves as a treatment guide. It is made up of 6 concentric circles. The core circle represents the goal of BG in critically ill patients, with inner circle showing the actual BG range of the patient. The 4 outer circles correspond to increasing rates of insulin infusion from tier 1 to tier 4. Simple guidelines are provided to facilitate conversion from insulin infusion to a subcutaneous insulin-delivery regimen in preparation for transfer from the cardiac care unit (CCU) setting. Our protocols also provide guidelines for management of diabetic ketoacidosis and hyperosmolar hyperglycemic states while at the same time creates a flowchart for activation of diabetes care team and their involvement in the multidisciplinary care of a patient in CCU with hyperglycemia and/or diabetes mellitus. This pathway provides a comprehensive and detailed, yet simple and practical algorithm for management of hyperglycemia in the CCU.
Collapse
Affiliation(s)
- Seyed Hamed Hosseini Dehkordi
- From the *Division of Internal Medicine, Icahn School of Medicine at Mount Sinai St. Luke's-West Hospital Center, New York, NY; †Division of Endocrinology, Icahn School of Medicine at Mount Sinai St. Luke's-West Hospital Center, New York, NY; ‡Division of Electrophysiology, Icahn School of Medicine at Mount Sinai St. Luke's-West Hospital Center, New York, NY; and §Cardiac Care Unit, Icahn School of Medicine at Mount Sinai St. Luke's Hospital. New York, NY
| | | | | | | |
Collapse
|
9
|
Rising R, Foerster T, Arad AD, Albu J, Pi-Sunyer X. Validation of whole room indirect calorimeters: refinement of current methodologies. Physiol Rep 2017; 5:5/22/e13521. [PMID: 29180485 PMCID: PMC5704087 DOI: 10.14814/phy2.13521] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 10/15/2017] [Accepted: 10/29/2017] [Indexed: 11/24/2022] Open
Abstract
Whole room indirect calorimeter (WRIC) validation techniques consist of propane combustion (PC) or infusion of mixed carbon dioxide (CO2) and nitrogen (N2) by a precision blender (PB). To determine the best method, PC of 6, 10, 22‐h and PB infusions of 6, 10, and 14‐h, were conducted. The 14‐h infusion consisted of two metabolic settings. Energy expenditure (EE; kJ), ventilation (V; liters/min) of oxygen (VO2), VCO2, and respiratory quotient (VCO2/VO2) obtained from the WRIC were extrapolated to the respective test durations and compared to similarly calculated values. Moreover, accurate equations (AE) were derived to correct infusions for additional N2. As a final evaluation of a PC validated WRIC, weight maintenance (WM), energy balance (EB), respiratory quotient (RQ), and food quotients (FQ) were determined in 22 subjects who had repeat 24‐h EE measurements. Statistical analyses (P < 0.05) were conducted (SPSS, version 23). Significant differences in RQ existed between PC and stoichiometry after 6‐h. Errors for the rest of the PC tests ranged from −1.5 ± 2.4 (VCO2) to 2.8 ± 4.6% (EE). When compared with the WRIC, all uncorrected metabolic parameters for six and 10‐h PB infusions were significantly different with errors from −12.8 ± 1.6 (VO2) to 6.0 ± 2.8% (RQ). The AE reduced the magnitude of errors to −12.4 ± 1.5 (RQ) to 2.2 ± 3.0% (RQ). The PB infusion with two settings showed similar performance. No differences in WM, EB, RQ, or FQ existed in the subjects. In conclusion, 10‐h PC tests are sufficient for validating WRICs.
Collapse
Affiliation(s)
- Russell Rising
- New York Obesity/Nutrition Research Center, Department of Medicine, Columbia University, New York, New York
| | | | - Avigdor D Arad
- Department of Endocrinology, Diabetes, and Metabolism, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jeanine Albu
- Department of Endocrinology, Diabetes, and Metabolism, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Xavier Pi-Sunyer
- New York Obesity/Nutrition Research Center, Department of Medicine, Columbia University, New York, New York
| |
Collapse
|
10
|
Rising R, Whyte K, Albu J, Pi-Sunyer X. A New Whole Room Indirect Calorimeter for Measurement of the Energetics of Exercise. J Exerc Physiol Online 2016; 19:156-169. [PMID: 28179805 PMCID: PMC5292921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The purpose of this study was to compare the accuracy of exercise energy expenditure (EXEE) measurements from a metabolic cart (HG_MC) to that obtained with a new exercise whole room indirect calorimeter (EX_WRIC). First, the HG_MC and the EX_WRIC were subjected to 10, 30-min ethanol (99.8% purity) and propane (99.5% purity) combustion validations, respectively, for EE, ventilation rates (liters) of oxygen (VO2), carbon dioxide (VCO2), and the respiratory quotient (RQ; VCO2/VO2). Then, 15 healthy adults (13 men and 2 women) cycled at 65% age predicted heart rate max for random determination of their EXEE, VO2, VCO2 and RQ after a 12-hr fast with both the HG-MC and EX_WRIC. Comparing stoichiometry to combustion, the HG_MC underestimated EE (P<0.05), VO2 (P<0.05), VCO2 (P<0.05), and RQ (P<0.05) while no differences were found for the EX_WRIC. The EXEE and VO2 were lower (P<0.05) while RQ was greater (P<0.05) when measured with the HG_MC versus the EX_WRIC. The EX_WRIC was more accurate than the HG_MC without the related tethered connections.
Collapse
Affiliation(s)
- Russell Rising
- Columbia University Medical Center, Department of Medicine, Columbia University, New York, NY
| | | | - Jeanine Albu
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Xavier Pi-Sunyer
- Columbia University Medical Center, Department of Medicine, Columbia University, New York, NY
| |
Collapse
|
11
|
Albu J. Nutritional Management Following Massive Upper Gastrointestinal Resection. Nutr Clin Pract 2016. [DOI: 10.1177/088453368700200505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
12
|
Leung V, Chiu YL, Kotler DP, Albu J, Zhu YS, Ham K, Engelson ES, Hammad H, Christos P, Donovan DS, Ginsberg HN, Glesby MJ. Effect of Recombinant Human Growth Hormone and Rosiglitazone for HIV-Associated Abdominal Fat Accumulation on Adiponectin and other Markers of Inflammation. HIV Clin Trials 2016; 17:55-62. [PMID: 27077672 DOI: 10.1080/15284336.2015.1126424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND/OBJECTIVE In a previous report of HIV-infected patients with fat redistribution, we found that recombinant human growth hormone (rhGH) therapy reduced visceral adipose tissue (VAT) but increased insulin resistance, and that the addition of rosiglitazone reversed the negative effects of rhGH on insulin sensitivity. In this study, we sought to determine the effects of rhGH and rosiglitazone therapy on an array of inflammatory and fibrinolytic markers. METHODS 72 patients with HIV-associated abdominal obesity and insulin resistance were randomized to treatment with rhGH, rosiglitazone, the combination of rhGH and rosiglitazone, or placebo for 12 weeks. Subjects with plasma and serum samples available at weeks 0 (n=63) and 12 (n=46-48) were assessed for adiponectin, C-reactive protein, homocysteine, interleukin-1, interleukin-6, tumor necrosis factor alpha, interferon gamma, fibrinogen, plasminogen activator inhibitor-1 antigen, and tissue plasminogen activator antigen. RESULTS Treatment with both rosiglitazone alone and the combination of rosiglitazone and rhGH for 12 weeks resulted in significant increases in adiponectin levels from baseline. Adiponectin levels did not change significantly in the rhGH arm alone . There were no significant changes in the other biomarkers among the different treatment groups. DISCUSSION In this study of HIV-infected patients with altered fat distribution, treatment with rosiglitazone had beneficial effects on adiponectin concentrations, an effect that was also seen with a combination of rosiglitazone and rhGH. RhGH administration alone, however, did not demonstrate any significant impact on adiponectin levels despite reductions in VAT.
Collapse
Affiliation(s)
- Vivien Leung
- a Department of Medicine , Weill Cornell Medical College , New York , NY , USA.,e Department of Medicine , Bronx-Lebanon Hospital Center , Bronx , NY , USA
| | - Ya-Lin Chiu
- b Department of Healthcare Policy and Research , Weill Cornell Medical College , New York , NY , USA
| | - Donald P Kotler
- c Department of Medicine , Mount Sinai St. Luke's-Roosevelt Hospital Center , New York , NY , USA
| | - Jeanine Albu
- c Department of Medicine , Mount Sinai St. Luke's-Roosevelt Hospital Center , New York , NY , USA
| | - Yuan-Shan Zhu
- a Department of Medicine , Weill Cornell Medical College , New York , NY , USA
| | - Kirsis Ham
- a Department of Medicine , Weill Cornell Medical College , New York , NY , USA
| | - Ellen S Engelson
- c Department of Medicine , Mount Sinai St. Luke's-Roosevelt Hospital Center , New York , NY , USA
| | - Hoda Hammad
- b Department of Healthcare Policy and Research , Weill Cornell Medical College , New York , NY , USA
| | - Paul Christos
- b Department of Healthcare Policy and Research , Weill Cornell Medical College , New York , NY , USA
| | - Daniel S Donovan
- d Department of Medicine , Columbia University College of Physicians and Surgeons , New York , NY , USA
| | - Henry N Ginsberg
- d Department of Medicine , Columbia University College of Physicians and Surgeons , New York , NY , USA
| | - Marshall J Glesby
- a Department of Medicine , Weill Cornell Medical College , New York , NY , USA.,b Department of Healthcare Policy and Research , Weill Cornell Medical College , New York , NY , USA
| |
Collapse
|
13
|
Rising R, Whyte K, Albu J, Pi-Sunyer X. Evaluation of a new whole room indirect calorimeter specific for measurement of resting metabolic rate. Nutr Metab (Lond) 2015; 12:46. [PMID: 26594229 PMCID: PMC4653920 DOI: 10.1186/s12986-015-0043-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 11/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The most common methods for obtaining human resting metabolic rate (RMR) use either a ventilated hood connected to a metabolic cart (VH_MC) or calculation by many prediction equations utilizing the person's height and weight. These methods may be inherently inaccurate. The objective of this study is to compare the accuracy for the measurement of RMR by three methods: a new whole room indirect calorimeter specific for this purpose (RMR_WRIC), VH_MC and calculation by the Mifflin equation (ME). First, the VH_MC (Vmax Encore 2900, Carefusion Inc, San Diego, CA) and RMR_WRIC (Promethion GA-6/FG-1, Sable Systems Intl, Las Vegas, NV) were subjected to 10, one-hour ethanol (99.8 % purity) and propane (99.5 % purity) combustion tests, respectively, for simulated metabolic measurements. Thereafter, 40 healthy adults (22 M/18 F, 78.0 ± 24.5 kg, BMI = 25.6 ± 4.8, age 36.6 ± 13.4 years) had one-hour RMR (kcal), ventilation (liters) rates of oxygen (VO2), carbon dioxide (VCO2) and RQ (VCO2/VO2) measured after a 12-h fast with both the VH_ MC and the RMR_WRIC in a randomized fashion. The resting state was documented by heart rate. The RMR was also calculated using the ME, which was compared to both the RMR_WRIC and the VH_MC. All simulated and human metabolic data were extrapolated to 24-h and analyzed (SPSS, Ver. 22). RESULTS Comparing stoichiometry to actual combustion, the VH_MC underestimated simulated RMR (p < 0.05), VO2 (p < 0.05), VCO2 (p < 0.05) and the RQ. Similarly the RMR_WRIC underestimated simulated RMR (p < 0.05) and VO2 while overestimating VCO2 and the RQ. There was much greater variability in the simulated metabolic data between combustion and the VH_MC as compared to that of the RMR_WRIC. With regards to the volunteers, the RMR, RQ, VO2 and VCO2 determined by the VH_MC tended to be lower in comparison to these measurements determined by the RMR_WRIC. Finally, RMR calculated utilizing the ME was significantly (p < 0.05) less than the RMR_WRIC but similar to that obtained by the VH_MC. CONCLUSION The RMR_WRIC was more accurate and precise than either the VH_MC or ME, which has implications for determining energy requirements for individuals participating in weight loss or nutrition rehabilitation programs.
Collapse
Affiliation(s)
- Russell Rising
- />New York Obesity Research Center, Department of Medicine, Columbia University, 1150 St. Nicholas Ave, 1st Floor, Suite 121, New York, NY 10032 USA
| | - Kathryn Whyte
- />46 Meadowbrook Drive, Apt 121, Slingerlands, NY 12159 USA
| | - Jeanine Albu
- />Icahn School of Medicine at Mount Sinai, 1111 Amsterdam Avenue, New York, NY 10025 USA
| | - Xavier Pi-Sunyer
- />New York Obesity Research Center, Department of Medicine, Columbia University, 1150 St. Nicholas Ave, 1st Floor, Suite 121, New York, NY 10032 USA
| |
Collapse
|
14
|
Freudenberg N, Franzosa E, Sohler N, Li R, Devlin H, Albu J. The State of Evaluation Research on Food Policies to Reduce Obesity and Diabetes Among Adults in the United States, 2000-2011. Prev Chronic Dis 2015; 12:E182. [PMID: 26513438 PMCID: PMC4651114 DOI: 10.5888/pcd12.150237] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Improvements in diet can prevent obesity and type 2 diabetes. Although policy changes provide a foundation for improvement at the population level, evidence for the effectiveness of such changes is slim. This study summarizes the literature on recent efforts in the United States to change food-related policies to prevent obesity and diabetes among adults. METHODS We conducted a systematic review of evidence of the impact of food policies. Websites of government, academic, and nonprofit organizations were scanned to generate a typology of food-related policies, which we classified into 18 categories. A key-word search and a search of policy reports identified empirical evaluation studies of these categories. Analyses were limited to strategies with 10 or more reports. Of 422 articles identified, 94 met these criteria. Using publication date, study design, study quality, and dietary outcomes assessed, we evaluated the strength of evidence for each strategy in 3 assessment categories: time period, quality, and study design. RESULTS Five strategies yielded 10 or more reports. Only 2 of the 5 strategies, menu labeling and taxes on unhealthy foods, had 50% or more studies with positive findings in at least 2 of 3 assessment categories. Most studies used methods that were rated medium quality. Although the number of published studies increased over 11 years, study quality did not show any clear trend nor did it vary by strategy. CONCLUSION Researchers and policy makers can improve the quality and rigor of policy evaluations to synthesize existing evidence and develop better methods for gleaning policy guidance from the ample but imperfect data available.
Collapse
Affiliation(s)
- Nicholas Freudenberg
- City University of New York School of Public Health, Silberman Bldg, 2180 Third Ave, New York, NY 10035.
| | - Emily Franzosa
- City University of New York School of Public Health, New York, New York
| | - Nancy Sohler
- City University of New York School of Public Health, New York, New York
| | - Rui Li
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Heather Devlin
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeanine Albu
- St Luke's Roosevelt Hospital Center, Obesity Research Center, New York, New York
| |
Collapse
|
15
|
Albu J, Sohler N, Matti-Orozco B, Sill J, Baxter D, Burke G, Young E. Expansion of electronic health record-based screening, prevention, and management of diabetes in New York City. Prev Chronic Dis 2013; 10:E13. [PMID: 23369766 PMCID: PMC3562173 DOI: 10.5888/pcd10.120148] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
To address the increasing burden of diabetes in New York City, we designed 2 electronic health records (EHRs)-facilitated diabetes management systems to be implemented in 6 primary care practices on the West Side of Manhattan, a standard system and an enhanced system. The standard system includes screening for diabetes. The enhanced system includes screening and ensures close patient follow-up; it applies principles of the chronic care model, including community–clinic linkages, to the management of patients newly diagnosed with diabetes and prediabetes through screening. We will stagger implementation of the enhanced system across the 6 clinics allowing comparison, through a quasi-experimental design (pre–post difference with a control group), of patients treated in the enhanced system with similar patients treated in the standard system. The findings could inform health system practices at multiple levels and influence the integration of community resources into routine diabetes care.
Collapse
Affiliation(s)
- Jeanine Albu
- St. Luke's and Roosevelt Hospital Center, Obesity Research Center, 1111 Amsterdam Ave, New York, NY 10025, USA.
| | | | | | | | | | | | | |
Collapse
|
16
|
Ettinger SE, Nasser J, Engelson E, Albu J, Hashim S, Pi‐Sunyer FX. Innovative Postdoctoral Fellowship in Medical Nutrition. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.47.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | - Jeanine Albu
- New York Obesity Nutrition Research CenterNew YorkNY
| | - Sami Hashim
- New York Obesity Nutrition Research CenterNew YorkNY
| | | |
Collapse
|
17
|
Shen W, Chen J, Gantz M, Punyanitya M, Heymsfield SB, Gallagher D, Albu J, Engelson E, Kotler D, Pi-Sunyer X, Gilsanz V. MRI-measured pelvic bone marrow adipose tissue is inversely related to DXA-measured bone mineral in younger and older adults. Eur J Clin Nutr 2012; 66:983-8. [PMID: 22491495 PMCID: PMC3396793 DOI: 10.1038/ejcn.2012.35] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 03/09/2012] [Accepted: 03/09/2012] [Indexed: 12/30/2022]
Abstract
BACKGROUND/OBJECTIVES Recent research has shown an inverse relationship between bone marrow adipose tissue (BMAT) and bone mineral density (BMD). There is a lack of evidence at the macro-imaging level to establish whether increased BMAT is a cause or effect of bone loss. This cross-sectional study compared the BMAT and BMD relationship between a younger adult group at or approaching peak bone mass (PBM; age 18.0-39.9 years) and an older group with potential bone loss (PoBL; age 40.0-88.0 years). SUBJECTS/METHODS Pelvic BMAT was evaluated in 560 healthy men and women with T1-weighted whole-body magnetic resonance imaging. BMD was measured using whole-body dual-energy X-ray absorptiometry. RESULTS An inverse correlation was observed between pelvic BMAT and pelvic, total and spine BMD in the younger PBM group (r=-0.419 to -0.461, P<0.001) and in the older PoBL group (r=-0.405 to -0.500, P<0.001). After adjusting for age, sex, ethnicity, menopausal status, total body fat, skeletal muscle, subcutaneous and visceral adipose tissue, neither subject group (younger PBM vs older PoBL) nor its interaction with pelvic BMAT significantly contributed to the regression models with BMD as dependent variable and pelvic BMAT as independent variable (P=0.434-0.928). CONCLUSIONS Our findings indicate that an inverse relationship between pelvic BMAT and BMD is present both in younger subjects who have not yet experienced bone loss and also in older subjects. These results provide support at the macro-imaging level for the hypothesis that low BMD may be a result of preferential differentiation of mesenchymal stem cells from osteoblasts to adipocytes.
Collapse
Affiliation(s)
- W Shen
- New York Obesity Nutrition Research Center, St Luke's-Roosevelt Hospital and Institute of Human Nutrition, Columbia University, New York, NY 10025, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Shen W, Chen J, Gantz M, Punyanitya M, Heymsfield SB, Gallagher D, Albu J, Engelson E, Kotler D, Pi-Sunyer X, Shapses S. Ethnic and sex differences in bone marrow adipose tissue and bone mineral density relationship. Osteoporos Int 2012; 23:2293-301. [PMID: 22173789 PMCID: PMC3378820 DOI: 10.1007/s00198-011-1873-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 09/26/2011] [Indexed: 12/16/2022]
Abstract
UNLABELLED The relationship between bone marrow adipose tissue and bone mineral density is different between African Americans and Caucasians as well as between men and women. This suggests that the mechanisms that regulate the differentiation and proliferation of bone marrow stromal cells may differ in these populations. INTRODUCTION It has long been established that there are ethnic and sex differences in bone mineral density (BMD) and fracture risk. Recent studies suggest that bone marrow adipose tissue (BMAT) may play a role in the pathogenesis of osteoporosis. It is unknown whether ethnic and sex differences exist in the relationship between BMAT and BMD. METHODS Pelvic BMAT was evaluated in 455 healthy African American and Caucasian men and women (age 18-88 years) using whole-body T1-weighted magnetic resonance imaging. BMD was measured using whole-body dual-energy X-ray absorptiometry. RESULTS A negative correlation was observed between pelvic BMAT and total body BMD or pelvic BMD (r = -0.533, -0.576, respectively; P < 0.001). In multiple regression analyses with BMD as the dependent variable, ethnicity significantly entered the regression models as either an individual term or an interaction with BMAT. Menopausal status significantly entered the regression model with total body BMD as the dependent variable. African Americans had higher total body BMD than Caucasians for the same amount of BMAT, and the ethnic difference for pelvic BMD was greater in those participants with a higher BMAT. Men and premenopausal women had higher total body BMD levels than postmenopausal women for the same amount of BMAT. CONCLUSIONS An inverse relationship exists between BMAT and BMD in African American and Caucasian men and women. The observed ethnic and sex differences between BMAT and BMD in the present study suggest the possibility that the mechanisms regulating the differentiation and proliferation of bone marrow stromal cells may differ in these populations.
Collapse
Affiliation(s)
- W Shen
- New York Obesity Nutrition Research Center, St. Luke's-Roosevelt Hospital, New York, NY, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Lin WY, Albu J, Liu CS, Huang HY, Pi-Sunyer FX, Li CI, Li TC, Lin CC, Huang KC. Larger body mass index and waist circumference are associated with lower mortality in Chinese long-term care facility residents. J Am Geriatr Soc 2010; 58:2092-8. [PMID: 21054289 DOI: 10.1111/j.1532-5415.2010.03148.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the association between body mass index (BMI) and waist circumference (WC) and all-cause mortality of Chinese residents in long-term care facilities in Taiwan. DESIGN Prospective cohort study. SETTING Eight long-term care facilities in Taiwan. PARTICIPANTS Three hundred fifty-four residents aged 60 and older (median 78.4, range 60-101; 156 men, 198 women) were recruited during the study period. MEASUREMENTS Anthropometrics and metabolic parameters were measured at baseline. Mean BMI was 21.7 ± 4.2 kg/m(2) (range 11.6-35.3 kg/m(2) , and mean WC was 82.4 ± 10.9 cm (range 55.0-124.0 cm). Mortality data were from the Department of Health in Taiwan. RESULTS There were 219 deaths during the 5 years of follow-up. After adjusting for age, sex, albumin, Karnofsky performance status scale, hypertension, and diabetes mellitus, subjects in the highest quartile of BMI (27.3 ± 2.8 kg/m(2) ) and WC (96.7 ± 7.4 cm) had a significantly lower mortality rate than did subjects in the lowest quartile (BMI, 16.7 ± 1.7 kg/m(2) ; WC, 69.6 ± 4.2 cm). After further stratification according to central obesity status, the subjects in the two highest BMI quartiles had a lower mortality rate than those in the lowest BMI quartile but only in the central obesity group (≥ 90 cm in men or ≥ 80 cm in women). The adjusted relative risk for all-cause mortality in the highest versus lowest BMI quartile was 0.17 (95% confidence interval = 0.05-0.57). CONCLUSION BMI and WC were negative predictors for all-cause mortality in older Chinese adults living in long-term care facilities. Participants with higher WC and BMI had lower all-cause mortality.
Collapse
Affiliation(s)
- Wen-Yuan Lin
- Department of Family Medicine, China Medical University Hospital, [corrected] Taichung, Taiwan
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Hull HR, Thornton J, Wang J, Pierson RN, Kaleem Z, Pi-Sunyer X, Heymsfield S, Albu J, Fernandez JR, Vanitallie TB, Gallagher D. Fat-free mass index: changes and race/ethnic differences in adulthood. Int J Obes (Lond) 2010; 35:121-7. [PMID: 20531353 DOI: 10.1038/ijo.2010.111] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Nutritional status is assessed by measuring BMI or percent body fat (%fat). BMI can misclassify persons who carry more weight as fat-free mass and %fat can be misleading in cases of malnutrition or in disease states characterized by wasting of lean tissue. The fat-free mass index (FFMI) is proposed to assess body composition in individuals who have a similar body composition but differ in height allowing identification of those suffering from malnutrition, wasting or those that possess a relatively high muscle mass. The purpose was to determine whether the FFMI differs in a group of racially/ethnically diverse adults. DESIGN Cross-sectional. SUBJECTS Subjects were a multi-ethnic sample (Caucasian, CA; African American, AA; Hispanic, HIS and Asian, AS) of 1339 healthy males (n = 480) and females (n = 859) ranging in age from 18-110 years. Total body fat, total fat-free mass and bone mineral density were estimated using dual energy X-ray absorptiometry. RESULTS FFMI differed among the four ethnic groups (P ≤ 0.05) for both genders. A curvilinear relationship was found between age and FFMI for both genders although the coefficients in the quadratic model differed between genders (P ≤ 0.001) indicating the rate of change in FFMI differed between genders. The estimated turning point where FFMI started to decline was in the mid 20s for male and mid 40s for female participants. An age × gender interaction was found such that the rate of decline was greater in male than female participants (P ≤ 0.001). For both genders, FFMI was greatest in AA and the least in AS (P ≤ 0.001). There was no significant interaction between race and age or age(2) (P = 0.06). However, male participants consistently had a greater FFMI than female participants (P ≤ 0.001). CONCLUSIONS These findings have clinical implications for identifying individuals who may not be recognized as being malnourished based on their BMI or %fat but whose fat-free mass corrected for height is relatively low.
Collapse
Affiliation(s)
- H R Hull
- Department of Medicine, New York Obesity Nutrition Research Center, St Luke's-Roosevelt Hospital, New York, NY, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Javed F, He Q, Davidson LE, Thornton JC, Albu J, Boxt L, Krasnow N, Elia M, Kang P, Heshka S, Gallagher D. Brain and high metabolic rate organ mass: contributions to resting energy expenditure beyond fat-free mass. Am J Clin Nutr 2010; 91:907-12. [PMID: 20164308 PMCID: PMC2844678 DOI: 10.3945/ajcn.2009.28512] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The degree to which interindividual variation in the mass of select high metabolic rate organs (HMROs) mediates variability in resting energy expenditure (REE) is unknown. OBJECTIVE The objective was to investigate how much REE variability is explained by differences in HMRO mass in adults and whether age, sex, and race independently predict REE after adjustment for HMRO. DESIGN A cross-sectional evaluation of 55 women [30 African Americans aged 48.7 +/- 22.2 y (mean +/- SD) and 25 whites aged 46.4 +/- 17.7 y] and 32 men (8 African Americans aged 34.3 +/- 18.2 y and 24 whites aged 51.3 +/- 20.6 y) was conducted. Liver, kidney, spleen, heart, and brain masses were measured by magnetic resonance imaging, and fat and fat-free mass (FFM) were measured by dual-energy X-ray absorptiometry. REE was measured by indirect calorimetry. RESULTS REE estimated from age (P = 0.001), race (P = 0.006), sex (P = 0.31), fat (P = 0.001), and FFM (P < 0.001) accounted for 70% (adjusted (2)) of the variability in REE. The addition of trunk HMRO (P = 0.001) and brain (P = 0.006) to the model increased the explained variance to 75% and rendered the contributions of age, sex, and race statistically nonsignificant, whereas fat and FFM continued to make significant contributions (both P < 0.05). The addition of brain to the model rendered the intercept (69 kcal . kg(-1) . d(-1)) consistent with zero, which indicated zero REE for zero body mass. CONCLUSIONS Relatively small interindividual variation in HMRO mass significantly affects REE and reduces the role of age, race, and sex in explaining REE. Decreases in REE with increasing age may be partly related to age-associated changes in the relative size of FFM components.
Collapse
Affiliation(s)
- Fahad Javed
- New York Obesity Nutrition Research Center, St Luke's-Roosevelt Hospital, New York, NY, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Lu G, Thomas-Geevarghese A, Anuurad E, Raghavan S, Minolfo R, Ormsby B, Karmally W, El-Sadr WM, Albu J, Berglund L. Relationship of postprandial nonesterified fatty acids, adipokines, and insulin across gender in human immunodeficiency virus-positive patients undergoing highly active antiretroviral therapy. Metab Syndr Relat Disord 2009; 7:199-204. [PMID: 19320559 DOI: 10.1089/met.2008.0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Metabolic derangements are common in human immunodeficiency virus (HIV)-positive subjects undergoing antiretroviral therapy, but little is known about postprandial conditions. METHODS We investigated the relationship between leptin, adiponectin, nonesterified fatty acids (NEFA), and insulin in response to a day-long meal pattern and evaluated gender differences in HIV-positive men (n = 12) and women (n = 13) undergoing highly active antiretroviral therapy (HAART). RESULTS For both men and women, a significant decrease in postprandial NEFA levels was observed following breakfast (0.53 vs. 0.22 mmol/L, P < 0.001, baseline and at 3 hours, respectively), whereas day-long postprandial leptin and adiponectin levels showed small nonsignificant oscillations. In contrast to NEFA and adiponectin, postprandial leptin levels were significantly higher among women compared to men (P < 0.05). Postprandial NEFA levels correlated positively with fasting insulin levels (r(2) = 0.25, P = 0.016), and the postbreakfast decrease in NEFA levels correlated significantly with the postbreakfast increase in insulin levels (r(2) = 0.17, P = 0.038). No significant association between postprandial adipokines and insulin was observed. CONCLUSIONS In HAART-treated, HIV-infected men and women, levels of NEFA, but not adipokines, showed significant postprandial variation. Furthermore, food intake resulted in significant NEFA suppression in proportion to the food-stimulated insulin increase.
Collapse
Affiliation(s)
- Guijing Lu
- Department of Medicine, University of California Davis, Sacramento, California 95817, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Abstract
Autopsy/cadaver data indicate that many organs and tissues are smaller in the elderly compared with young adults; however, in vivo data are lacking. The aim of this study was to determine whether the mass of specific high-metabolic-rate organs is different with increasing age, using MRI. Seventy-five healthy women (41 African-Americans and 34 Caucasians, age range 19-88 yr) and 36 men (8 African-Americans and 28 Caucasians, age range 19-84 yr) were studied. MRI-derived in vivo measures of brain, heart, kidneys, liver, and spleen were acquired. Left ventricular mass (LVM) was measured by either echocardiography or cardiac gated MRI. Total body fat mass and fat-free mass (FFM) were measured with a whole body dual-energy X-ray absorptiometry (DXA) scanner. Multiple regression analysis was used to investigate the association between the organ mass and age after adjustment for weight and height (or DXA measures of FFM), race, sex, and interactions among these variable. No statistically significant interaction was found among age, sex, and race in any regression model. Significant negative relationships between organ mass and age were found for brain (P < 0.0001), kidneys (P = 0.01), liver (P = 0.001), and spleen (P < 0.0001). A positive relationship between LVM and age was found after adjustment for FFM (P = 0.037). These findings demonstrate that age has a significant effect on brain, kidneys, liver, spleen, and heart mass. The age effect was independent of race and sex.
Collapse
Affiliation(s)
- Qing He
- New York Obesity Research Center, New York, NY 10025, USA
| | | | | | | | | | | | | |
Collapse
|
24
|
Gallagher D, Kelley DE, Yim JE, Spence N, Albu J, Boxt L, Pi-Sunyer FX, Heshka S. Adipose tissue distribution is different in type 2 diabetes. Am J Clin Nutr 2009; 89:807-14. [PMID: 19158213 PMCID: PMC2714397 DOI: 10.3945/ajcn.2008.26955] [Citation(s) in RCA: 145] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The extent to which adipose tissue (AT) distribution is different between persons with type 2 diabetes (T2DM) and nondiabetic control subjects remains unclear. OBJECTIVE The aim of this study was to establish whether total body adiposity and its distribution, quantified by using state-of-the-art whole-body magnetic resonance imaging, differs between these 2 groups. DESIGN This cross-sectional evaluation included 93 participants (n = 56 women and 37 men) in the Look AHEAD (Action for HEAlth in Diabetes) Trial with T2DM who had a mean (+/-SD) age of 58.3 +/- 6.6 y and body mass index (in kg/m(2)) of 31.6 +/- 3.1 and 93 healthy non-T2DM control subjects (n = 64 women and 29 men) who had a mean (+/-SD) age of 60.6 +/- 17.1 y and body mass index of 29.6 +/- 3.0. All participants self-reported being of African American or white ancestry. Magnetic resonance imaging-derived in vivo measures of total-body AT (TAT) and its distribution, subcutaneous AT (SAT), visceral AT (VAT), and intermuscular AT (IMAT) were acquired. Linear regression models were developed for each AT compartment to adjust for important covariates of race, sex, age, height, and weight and to examine potential interactions of covariates. RESULTS These models showed significantly less SAT (African American: -1.2 kg; white: -2.4 kg; both P = 0.001), including less femoral-gluteal SAT, more VAT (African American: 0.7 kg, P < 0.001; white: 1.8 kg, P = 0.007), and more IMAT (0.5 kg, P = 0.001) in the T2DM group. CONCLUSION We concluded that AT distribution is significantly altered in T2DM, ie, more VAT and IMAT--2 depots known to exacerbate insulin resistance--and less SAT in persons with T2DM than in healthy control subjects, a novel finding that we posit may compound the risk of insulin resistance.
Collapse
Affiliation(s)
- Dympna Gallagher
- Body Composition Unit-New York Obesity Research Center, St Luke's-Roosevelt Hospital, 1111 Amsterdam Avenue, Scrymser Basement, New York, NY 10025, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Silva AM, Heymsfield SB, Gallagher D, Albu J, Pi-Sunyer XF, Pierson RN, Wang J, Heshka S, Sardinha LB, Wang Z. Evaluation of between-methods agreement of extracellular water measurements in adults and children. Am J Clin Nutr 2008; 88:315-23. [PMID: 18689366 PMCID: PMC2752354 DOI: 10.1093/ajcn/88.2.315] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Extracellular water (ECW), a relevant molecular level component for clinical assessment, is commonly obtained by 2 methods that rely on assumptions that may not be possible to test at the time the measurements are made. OBJECTIVE The aim of the current study was to evaluate the degree of agreement between ECW assessment by the sodium bromide dilution (ECW(NaBr)) and total body potassium (TBK; whole-body (40)K counting) to total body water (TBW; isotope dilution) methods (ECW(TBK-TBW)) in an ethnically mixed group of children and adults. DESIGN ECW was measured with the ECW(NaBr) and ECW(TBK-TBW) methods in 526 white and African American males and females (86 nonobese children, 193 nonobese adults, and 247 obese adults). Fat mass was assessed with dual-energy X-ray absorptiometry. Multiple regression analysis was used to examine the variables related to between-ECW method differences. RESULTS Significant but generally small group mean (+/-SD) differences in ECW were found in the obese adults (1.28 +/- 2.54 kg) and children (-0.71 +/- 1.78 kg). The magnitude of the differences was related to mean ECW in obese adults, children, and nonobese adults, and the relations between these variables were modified by sex for nonobese adults. ECW differences were also dependent on age, weight, sex, and race or on interactions between these variables. CONCLUSIONS Overall, although good between-method agreement was found across the 3 groups, the degree of agreement varied according to subject characteristics, particularly at the extremes of ECW and body weight. We advance a possible mechanism that may link subject characteristics with the degree of agreement between ECW measurement methods and their underlying assumptions.
Collapse
Affiliation(s)
- Analiza M Silva
- New York Obesity Research Center, St Luke's-Roosevelt Hospital, Columbia University Institute of Human Nutrition, College of Physicians and Surgeons, New York, NY, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Anuurad E, Thomas-Geevarghese A, Devaraj S, Albu J, Minolfo R, El-Sadr WM, Lu G, Karmally W, Berglund L. Increased lipoprotein remnant cholesterol levels in HIV-positive patients during antiretroviral therapy. Atherosclerosis 2007; 198:192-7. [PMID: 17996872 DOI: 10.1016/j.atherosclerosis.2007.09.042] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2007] [Revised: 09/10/2007] [Accepted: 09/21/2007] [Indexed: 10/22/2022]
Abstract
Increased levels of postprandial triglycerides (TG) and remnant like particles (RLP) are associated with cardiovascular disease. We evaluated whether postprandial lipemia differed in HIV-positive patients with or without different antiretroviral regimens. A standardized high fat load was administered to 28 subjects: 11 HIV-positive subjects receiving protease inhibitors (PI), 10 HIV-positive subjects receiving non-nucleoside reverse transcriptase inhibitors (NNRTI) and 7 HIV-positive subjects not receiving highly active antiretroviral therapy, HAART (Naïve). Baseline TG levels and TG area under the curve (AUC) did not differ among the three groups. The postprandial TG concentration curves were similar in the NNRTI and Naïve groups, peaking at 3-5-h. Baseline RLP cholesterol was higher in the NNRTI group compared to other two groups (P=0.035). Both HAART groups (NNRTI and PI) had higher postprandial RLP cholesterol AUC than the Naïve group (P=0.024, ANOVA). In conclusion, during HIV conditions, HAART resulted in a pro-atherogenic pattern with accumulation of remnant lipoproteins.
Collapse
|
27
|
Yim JE, Heshka S, Albu J, Heymsfield S, Kuznia P, Harris T, Gallagher D. Intermuscular adipose tissue rivals visceral adipose tissue in independent associations with cardiovascular risk. Int J Obes (Lond) 2007; 31:1400-5. [PMID: 17452994 PMCID: PMC2752367 DOI: 10.1038/sj.ijo.0803621] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The metabolic implications of intermuscular adipose tissue (IMAT) are poorly understood compared to those of visceral adipose tissue (VAT) even though the absolute quantities of both depots are similar in many individuals. OBJECTIVE The aim was to determine the independent relationship between whole-body IMAT and cardiovascular risk factor parameters. DESIGN Whole body magnetic resonance imaging (MRI) was used to quantify total skeletal muscle (SM), total adipose tissue (TAT) of which IMAT, defined as the AT visible by MRI within the boundary of the muscle fascia, is a sub-component. Fasting serum measures (n=262) of glucose, total cholesterol (T-Chol), high-density lipoprotein cholesterol (HDL-Chol), triglycerides (TG), protein bound glucose (PBG, n=206) and insulin (n=119) were acquired in healthy African-American (AA, n=78) and Caucasian (Ca, n=109) women (body mass index (BMI) 26.5+/-5.7 kg/m(2); 44.4+/-16.4 years) and men (39 AA, 62 Ca; BMI 25.6+/-3.5 kg/m(2); 45.6+/-17.4 years). General linear models identified the independent effects of IMAT after covarying for SM, VAT, TAT, race, sex and two-way interactions. RESULTS Significant independent associations were observed for IMAT with glucose (P<0.001), PBG (P<0.001) and T-Chol (P<0.05). The association of IMAT with cholesterol differed by race in such a manner that for a unit increase in IMAT, T-Chol increased more rapidly in Ca compared to AA (P<0.05). TG, HDL-Chol and insulin had no independent association with IMAT. CONCLUSION The strong independent associations of IMAT with fasting glucose and PBG suggest that IMAT may be related to glucose metabolism; however, IMAT is also associated with T-Chol in Ca.
Collapse
Affiliation(s)
- J-E Yim
- Department of Medicine, Obesity Research Center, St Luke’s-Roosevelt Hospital, Columbia University, New York, NY, USA
| | - S Heshka
- Department of Medicine, Obesity Research Center, St Luke’s-Roosevelt Hospital, Columbia University, New York, NY, USA
| | - J Albu
- Department of Medicine, Obesity Research Center, St Luke’s-Roosevelt Hospital, Columbia University, New York, NY, USA
| | - S Heymsfield
- Department of Medicine, Obesity Research Center, St Luke’s-Roosevelt Hospital, Columbia University, New York, NY, USA
| | - P Kuznia
- Laboratory of Epidemiology, Demography and Biometry, Geriatric Epidemiology Section, NIA, Bethesda, MD, USA
| | - T Harris
- Laboratory of Epidemiology, Demography and Biometry, Geriatric Epidemiology Section, NIA, Bethesda, MD, USA
| | - D Gallagher
- Department of Medicine, Obesity Research Center, St Luke’s-Roosevelt Hospital, Columbia University, New York, NY, USA
- Institute of Human Nutrition, Columbia University, New York, NY, USA
| |
Collapse
|
28
|
Shen W, Punyanitya M, Chen J, Gallagher D, Albu J, Pi-Sunyer X, Lewis CE, Grunfeld C, Heymsfield SB, Heshka S. Visceral adipose tissue: relationships between single slice areas at different locations and obesity-related health risks. Int J Obes (Lond) 2006; 31:763-9. [PMID: 17060927 PMCID: PMC3166348 DOI: 10.1038/sj.ijo.0803474] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Visceral adipose tissue (VAT) is widely recognized as conveying the highest health risk in humans among the currently measurable adipose tissue compartments. A recent study indicated that the traditionally measured VAT area at L(4)-L(5) is not the VAT area with the highest correlation with total VAT volume. At present, it is unknown whether the area with the highest correlation is also the most strongly associated with obesity-related health risk. OBJECTIVE The study aim was to establish which VAT slice area(s) are most strongly associated with obesity-related health risk indicators. DESIGN The subjects were a convenience sample of healthy adults who completed whole-body magnetic resonance imaging (MRI) scans. The correlations, with appropriate adjustments, were examined between individual MRI slice VAT areas and fasting serum/plasma triglycerides (TG), high-density lipoprotein cholesterol (HDL), glucose, insulin and blood pressure. RESULTS The sample consisted of 283 healthy men (age (mean+/-s.d.) 41.9+/-15.8 years; BMI, 26.0+/-3.2 kg/m(2); VAT, 2.7+/-1.8 L) and 411 women (age, 48.1+/-18.7 years; BMI 27.0+/-5.4 kg/m(2); VAT, 1.7+/-1.2 L). After adjusting for age, race, menopause status, scan position and specific blood analysis laboratory, VAT area at L(4)-L(5) had lower correlations with most metabolic risk factors including serum/plasma TG, HDL, glucose, insulin and blood pressure than VAT volume in both men and women. The VAT areas 10 and 15 cm above L(4)-L(5) in men had higher or equal correlations with health risk measures than VAT volume. In women, the VAT area 5 cm above or below L(4)-L(5) and total VAT volume had similar correlations with health risk measures. CONCLUSIONS An appropriately selected single slice VAT area is an equally reliable phenotypic marker of obesity-related health risk as total VAT volume. However, in both men and women the VAT slice area at the traditional L(4)-L(5) level is not the best marker of obesity-related health risk.
Collapse
Affiliation(s)
- W Shen
- Obesity Research Center, St Luke's-Roosevelt Hospital and Institute of Human Nutrition, Columbia University College of Physicians and Surgeons, New York, NY 10025, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Ruan XY, Gallagher D, Harris T, Albu J, Heymsfield S, Kuznia P, Heshka S. Estimating whole body intermuscular adipose tissue from single cross-sectional magnetic resonance images. J Appl Physiol (1985) 2006; 102:748-54. [PMID: 17053107 PMCID: PMC2758818 DOI: 10.1152/japplphysiol.00304.2006] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Intermuscular adipose tissue (IMAT), a novel fat depot linked with metabolic abnormalities, has been measured by whole body MRI. The cross-sectional slice location with the strongest relation to total body IMAT volume has not been established. The aim was to determine the predictive value of each slice location and which slice locations provide the best estimates of whole body IMAT. MRI quantified total adipose tissue of which IMAT, defined as adipose tissue visible within the boundary of the muscle fascia, is a subcomponent. Single-slice IMAT areas were calculated for the calf, thigh, buttock, waist, shoulders, upper arm, and forearm locations in a sample of healthy adult women, African-American [n = 39; body mass index (BMI) 28.5 +/- 5.4 kg/m2; 41.8 +/- 14.8 yr], Asian (n = 21; BMI 21.6 +/- 3.2 kg/m2; 40.9 +/- 16.3 yr), and Caucasian (n = 43; BMI 25.6 +/- 5.3 kg/m2; 43.2 +/- 15.3 yr), and Caucasian men (n = 39; BMI 27.1 +/- 3.8 kg/m2; 45.2 +/- 14.6 yr) and used to estimate total IMAT groups using multiple-regression equations. Midthigh was the best, or near best, single predictor in all groups with adjusted R2 ranging from 0.49 to 0.84. Adding a second and third slice further increased R2 and reduced the error of the estimate. Menopausal status and degree of obesity did not affect the location of the best single slice. The contributions of other slice locations varied by sex and race, but additional slices improved predictions. For group studies, it may be more cost-effective to estimate IMAT based on one or more slices than to acquire and segment for each subject the numerous images necessary to quantify whole body IMAT.
Collapse
Affiliation(s)
- Xiang Yan Ruan
- Department of Medicine, Obesity Research Center, St. Luke's-Roosevelt Hospital, New York, New York 10025, USA
| | | | | | | | | | | | | |
Collapse
|
30
|
Abstract
In addition to the revascularization and glycemic management interventions assigned at random, the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) design includes the uniform control of major coronary artery disease risk factors, including dyslipidemia, hypertension, smoking, central obesity, and sedentary lifestyle. Target levels for risk factors were adjusted throughout the trial to comply with changes in recommended clinical practice guidelines. At present, the goals are low-density lipoprotein cholesterol <2.59 mmol/L (<100 mg/dL) with an optional goal of <1.81 mmol/L (<70 mg/dL); plasma triglyceride level <1.70 mmol/L (<150 mg/dL); blood pressure level <130 mm Hg systolic and <80 mm Hg diastolic; and smoking cessation treatment for all active smokers. Algorithms were developed for the pharmacologic management of dyslipidemia and hypertension. Dietary prescriptions for the management of glycemia, plasma lipid profiles, and blood pressure levels were adapted from existing clinical practice guidelines. Patients with a body mass index >25 were prescribed moderate caloric restriction; after the trial was under way, a lifestyle weight-management program was instituted. All patients were formally prescribed both endurance and resistance/flexibility exercises, individually adapted to their level of disability and fitness. Pedometers were distributed as a biofeedback strategy. Strategies to achieve the goals for risk factors were designed by BARI 2D working groups (lipid, cardiovascular and hypertension, and nonpharmacologic intervention) and the ongoing implementation of the strategies is monitored by lipid, hypertension, and lifestyle intervention management centers.
Collapse
Affiliation(s)
- Jeanine Albu
- The New York Obesity Research Center, St. Luke's-Roosevelt Hospital Center, University Hospital of Columbia University, College of Physicians and Surgeons, Columbia University, New York, New York 10025, USA.
| | | | | | | | | |
Collapse
|
31
|
Gallagher D, Albu J, He Q, Heshka S, Boxt L, Krasnow N, Elia M. Small organs with a high metabolic rate explain lower resting energy expenditure in African American than in white adults. Am J Clin Nutr 2006; 83:1062-7. [PMID: 16685047 PMCID: PMC1847651 DOI: 10.1093/ajcn/83.5.1062] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND African Americans have a lower resting energy expenditure (REE) relative to fat-free mass (FFM) than do whites. Whether the composition of FFM at the organ-tissue level differs between African Americans and whites and, if so, whether that difference could account for differences by race in REE are unknown. OBJECTIVE The objectives were to quantify FFM in vivo in women and men at the organ-tissue level and to ascertain whether the mass of specific high-metabolic-rate organs and tissues differs between African Americans and whites and, if so, whether that difference can account for differences in REE. DESIGN The study was a cross-sectional evaluation of 64 women (n = 34 African Americans, 30 whites) and 35 men (n = 8 African Americans, 27 whites). Magnetic resonance imaging measures of liver, kidney, heart, spleen, brain, skeletal muscle, and adipose tissue and dual-energy X-ray absorptiometry measures of fat and FFM were acquired. REE was measured by using indirect calorimetry. RESULTS The mass of selected high-metabolic-rate organs (sum of liver, heart, spleen, kidneys, and brain) after adjustment for fat, FFM, sex, and age was significantly (P < 0.001) smaller in African Americans than in whites (3.1 and 3.4 kg, respectively; x +/- SEE difference: 0.30 +/- 0.06 kg). In a multiple regression analysis with fat, FFM, sex, age, and race as predictors of REE, the addition of the total mass rendered race nonsignificant. CONCLUSIONS Racial differences in REE were reduced by >50% and were no longer significant when the mass of specific high-metabolic-rate organs was considered. Differences in FFM composition may be responsible for the reported REE differences.
Collapse
Affiliation(s)
- Dympna Gallagher
- Obesity Research Center, St Luke's-Roosevelt Hospital, New York, NY 10025, USA.
| | | | | | | | | | | | | |
Collapse
|
32
|
Shen W, Punyanitya M, Chen J, Gallagher D, Albu J, Pi-Sunyer X, Lewis CE, Grunfeld C, Heshka S, Heymsfield SB. Waist circumference correlates with metabolic syndrome indicators better than percentage fat. Obesity (Silver Spring) 2006; 14:727-36. [PMID: 16741276 PMCID: PMC1894647 DOI: 10.1038/oby.2006.83] [Citation(s) in RCA: 160] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Percent fat is often considered the reference for establishing the magnitude of adipose tissue accumulation and the risk of excess adiposity. However, the increasing recognition of a strong link between central adiposity and metabolic disturbances led us to test whether waist circumference (WC) is more highly correlated with metabolic syndrome components than percent fat and other related anthropometric measures such as BMI. RESEARCH METHODS AND PROCEDURES BMI, WC, and percent fat, measured by DXA, were evaluated in 1010 healthy white and African-American men and women [age, 48.3 +/- 17.2 (standard deviation) years; BMI, 27.0 +/- 5.3 kg/m(2)]. The associations of BMI, WC, and percent fat with age and laboratory-adjusted health risk indicators (i.e., serum glucose, insulin, triglycerides, high-density lipoprotein cholesterol, blood pressure) in each sex and ethnicity group were examined. RESULTS For 18 of 24 comparisons, the age- and laboratory-adjusted correlations were lowest for percent fat and in 16 of 24 comparisons were highest for WC. Fifteen of the between-method differences reached statistical significance. With health risk indicator as the dependent variable and anthropometric measures as the independent variable, the contribution of percent fat to the WC regression model was not statistically significant; in contrast, adding WC to the percent fat regression model did make a significant independent contribution for most health risk indicators. DISCUSSION WC had the strongest associations with health risk indicators, followed by BMI. Although percent fat is a useful measure of overall adiposity, health risks are best represented by the simply measured WC.
Collapse
Affiliation(s)
- Wei Shen
- Obesity Research Center, St. Luke's-Roosevelt Hospital, New York, NY 10025, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Yim J, Heshka S, Albu J, Heymsfield S, Kuznia P, Harris T, Gallagher D. Independent association of intermuscular adipose tissue with CVD risk factors. FASEB J 2006. [DOI: 10.1096/fasebj.20.5.a1036-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jung‐Eun Yim
- Obesity Research CenterInstitute of Human NutritionSt. Luke's‐Roosevelt HospitalColumbia University1090 Amsterdam Ave, 14th FloorNew YorkNY10025
| | - Stanley Heshka
- Obesity Research CenterInstitute of Human NutritionSt. Luke's‐Roosevelt HospitalColumbia University1090 Amsterdam Ave, 14th FloorNew YorkNY10025
| | - Jeanine Albu
- Obesity Research CenterInstitute of Human NutritionSt. Luke's‐Roosevelt HospitalColumbia University1090 Amsterdam Ave, 14th FloorNew YorkNY10025
| | - Steven Heymsfield
- Obesity Research CenterInstitute of Human NutritionSt. Luke's‐Roosevelt HospitalColumbia University1090 Amsterdam Ave, 14th FloorNew YorkNY10025
| | - Patrick Kuznia
- Geriatric Epidemiology Section, NIA31 Center Drive, MSC 2292BethesdaMD20892
| | - Tamara Harris
- Geriatric Epidemiology Section, NIA31 Center Drive, MSC 2292BethesdaMD20892
| | - Dympna Gallagher
- Obesity Research CenterInstitute of Human NutritionSt. Luke's‐Roosevelt HospitalColumbia University1090 Amsterdam Ave, 14th FloorNew YorkNY10025
| |
Collapse
|
34
|
Ruan X, Gallagher D, Harris T, Albu J, Heymsfield S, Kuznia P, Heshka S. Estimating whole‐body intermuscular adipose tissue from single cross‐sectional magnetic resonance images. FASEB J 2006. [DOI: 10.1096/fasebj.20.4.a165-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Xiangyan Ruan
- Obesity Research CenterInstitute of Human NutritionSt. Luke’s‐Roosevent Hospital1090 Amsterdam Ave, 14th Floor, New York, New York, 10025New YorkNY10025
| | - Dympna Gallagher
- Obesity Research CenterInstitute of Human NutritionSt. Luke’s‐Roosevent Hospital1090 Amsterdam Ave, 14th Floor, New York, New York, 10025New YorkNY10025
| | - Tamara Harris
- Geriatric Epidemiology SectionNIA31 center Drive, MSC 2292BethesdaMD20892
| | - Jeanine Albu
- Obesity Research CenterInstitute of Human NutritionSt. Luke’s‐Roosevent Hospital1090 Amsterdam Ave, 14th Floor, New York, New York, 10025New YorkNY10025
| | - Steven Heymsfield
- Obesity Research CenterInstitute of Human NutritionSt. Luke’s‐Roosevent Hospital1090 Amsterdam Ave, 14th Floor, New York, New York, 10025New YorkNY10025
| | - Patrick Kuznia
- Geriatric Epidemiology SectionNIA31 center Drive, MSC 2292BethesdaMD20892
| | - Stanley Heshka
- Obesity Research CenterInstitute of Human NutritionSt. Luke’s‐Roosevent Hospital1090 Amsterdam Ave, 14th Floor, New York, New York, 10025New YorkNY10025
| |
Collapse
|
35
|
Falutz J, Allas S, Kotler D, Thompson M, Koutkia P, Albu J, Trottier B, Routy JP, Cote P, Abribat T, Grinspoon S. A placebo-controlled, dose-ranging study of a growth hormone releasing factor in HIV-infected patients with abdominal fat accumulation. AIDS 2005; 19:1279-87. [PMID: 16052083 DOI: 10.1097/01.aids.0000180099.35146.30] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the effects of TH9507, a novel growth hormone releasing factor, on abdominal fat accumulation, metabolic and safety parameters in HIV-infected patients with central fat accumulation. DESIGN AND METHODS Randomized, double-blind, placebo-controlled trial enrolling 61 HIV-infected patients with increased waist circumference and waist-to-hip ratio. Participants were randomized to placebo or 1 or 2 mg TH9507 subcutaneously, once daily for 12 weeks. The primary outcome was change in abdominal fat, assessed by dual energy X-ray absorptiometry and cross-sectional computerized tomography scan. Secondary endpoints included change in insulin-like growth factor-I (IGF-I), metabolic, quality of life, and safety parameters. RESULTS TH9507 resulted in dose-related physiological increases in IGF-I (P < 0.01 for 1 mg (+48%) and 2 mg (+65%) versus placebo). Trunk fat decreased in the 2 mg group versus placebo (0.8, -4.6 and -9.2%; placebo, 1 and 2 mg, respectively, P = 0.014 for 2 mg versus placebo), without significant change in limb fat. Visceral fat (VAT) decreased most in the 2 mg group (-5.4, -3.6 and -15.7%; placebo, 1 and 2 mg, respectively) but this change was not significant versus placebo. Subcutaneous fat (SAT) was preserved and did not change between or within groups. Lean body mass and the ratio of VAT to SAT improved significantly in both treatment groups versus placebo. Triglyceride and the cholesterol to high-density lipoprotein ratio decreased significantly in the 2 mg group versus placebo. Treatment was generally well tolerated without changes in glucose. CONCLUSIONS TH9507 reduced truncal fat, improved the lipid profile and did not increase glucose levels in HIV-infected patients with central fat accumulation. TH9507 may be a beneficial treatment strategy in this population, but longer-term studies with more patients are needed to determine effects on VAT, treatment durability, and safety.
Collapse
Affiliation(s)
- Julian Falutz
- Montreal General Hospital Immuno-Deficiency Treatment Centre, McGill University Health Center, Montréal, Quebec, Canada
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Thomas-Geevarghese A, Raghavan S, Minolfo R, Holleran S, Ramakrishnan R, Ormsby B, Karmally W, Ginsberg HN, El-Sadr WM, Albu J, Berglund L. Postprandial response to a physiologic caloric load in HIV-positive patients receiving protease inhibitor-based or nonnucleoside reverse transcriptase inhibitor-based antiretroviral therapy. Am J Clin Nutr 2005; 82:146-54. [PMID: 16002813 DOI: 10.1093/ajcn.82.1.146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Features of the dyslipidemic pattern reported with the use of antiretroviral therapy predict enhanced postprandial lipemia, which is an emerging cardiovascular disease risk factor. OBJECTIVE We evaluated the postprandial response to a physiologic, meal-based challenge in HIV-positive subjects without hyperlipidemia. DESIGN We measured hourly lipid, lipoprotein, glucose, and insulin concentrations during a 13-h period in 25 nonwhite patients (13 women, 12 men): 13 receiving a protease inhibitor (PI)-based regimen (6 nelfinavir and 7 indinavir) and 12 receiving a nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimen (6 efavirenz and 6 nevirapine). RESULTS Mean fasting HDL-cholesterol concentrations were lower in HIV patients than in healthy subjects without HIV infection matched for age, sex, and ethnicity (z score: -0.81 +/- 0.9; P = 0.0001). Fasting triacylglycerol concentrations were not significantly different between HIV-infected patients and healthy subjects but were higher in PI-treated than in NNRTI-treated patients [median (interquartile range): 144 (110-191) and 89 (62-135) mg/dL; P = 0.007]. Average daylong triacylglycerol concentrations, but not incremental concentrations, were higher in the PI group than in the NNRTI group [205% (185-248%) and 125% (78-191%); P < 0.05]. For all HIV-positive patients, the fractional triacylglycerol increase was lower after breakfast than after lunch (20 +/- 18% and 42 +/- 40%, respectively; P < 0.04). Insulin concentrations were higher in PI-treated than in NNRTI-treated patients [22.6 (13.1-29.8) and 11.8 (7.1-19.1) microU/mL; P = 0.01] and increased in both groups in response to each meal, whereas glucose concentrations increased only after breakfast. CONCLUSIONS Despite baseline differences, incremental triacylglycerol and insulin responses to a physiologic caloric load among HIV-positive patients were not significantly affected by differences in the type of antiretroviral therapy.
Collapse
Affiliation(s)
- Asha Thomas-Geevarghese
- Department of Medicine and the General Clinical Research Center, Harlem Hospital Center and Columbia University, New York, NY, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Thomas-Geevarghese A, Raghavan S, Minolfo R, Holleran S, Ramakrishnan R, Ormsby B, Karmally W, Ginsberg HN, El-Sadr WM, Albu J, Berglund L. Postprandial response to a physiologic caloric load in HIV-positive patients receiving protease inhibitor–based or nonnucleoside reverse transcriptase inhibitor–based antiretroviral therapy. Am J Clin Nutr 2005. [DOI: 10.1093/ajcn/82.1.146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Asha Thomas-Geevarghese
- From the Departments of Medicine (AT-G, HNG, and LB) and Pediatrics (SH and RR) and the General Clinical Research Center (WK), Columbia University, New York, NY; the Department of Medicine (JA), St Luke’s-Roosevelt Medical Center, Division of Infectious Disease (SR, RM, and WME-S), Harlem Hospital Center and Columbia University, New York, NY; the Department of Medicine, University of California D
| | - Subhashree Raghavan
- From the Departments of Medicine (AT-G, HNG, and LB) and Pediatrics (SH and RR) and the General Clinical Research Center (WK), Columbia University, New York, NY; the Department of Medicine (JA), St Luke’s-Roosevelt Medical Center, Division of Infectious Disease (SR, RM, and WME-S), Harlem Hospital Center and Columbia University, New York, NY; the Department of Medicine, University of California D
| | - Robert Minolfo
- From the Departments of Medicine (AT-G, HNG, and LB) and Pediatrics (SH and RR) and the General Clinical Research Center (WK), Columbia University, New York, NY; the Department of Medicine (JA), St Luke’s-Roosevelt Medical Center, Division of Infectious Disease (SR, RM, and WME-S), Harlem Hospital Center and Columbia University, New York, NY; the Department of Medicine, University of California D
| | - Steve Holleran
- From the Departments of Medicine (AT-G, HNG, and LB) and Pediatrics (SH and RR) and the General Clinical Research Center (WK), Columbia University, New York, NY; the Department of Medicine (JA), St Luke’s-Roosevelt Medical Center, Division of Infectious Disease (SR, RM, and WME-S), Harlem Hospital Center and Columbia University, New York, NY; the Department of Medicine, University of California D
| | - Rajasekhar Ramakrishnan
- From the Departments of Medicine (AT-G, HNG, and LB) and Pediatrics (SH and RR) and the General Clinical Research Center (WK), Columbia University, New York, NY; the Department of Medicine (JA), St Luke’s-Roosevelt Medical Center, Division of Infectious Disease (SR, RM, and WME-S), Harlem Hospital Center and Columbia University, New York, NY; the Department of Medicine, University of California D
| | - Bernard Ormsby
- From the Departments of Medicine (AT-G, HNG, and LB) and Pediatrics (SH and RR) and the General Clinical Research Center (WK), Columbia University, New York, NY; the Department of Medicine (JA), St Luke’s-Roosevelt Medical Center, Division of Infectious Disease (SR, RM, and WME-S), Harlem Hospital Center and Columbia University, New York, NY; the Department of Medicine, University of California D
| | - Wahida Karmally
- From the Departments of Medicine (AT-G, HNG, and LB) and Pediatrics (SH and RR) and the General Clinical Research Center (WK), Columbia University, New York, NY; the Department of Medicine (JA), St Luke’s-Roosevelt Medical Center, Division of Infectious Disease (SR, RM, and WME-S), Harlem Hospital Center and Columbia University, New York, NY; the Department of Medicine, University of California D
| | - Henry N Ginsberg
- From the Departments of Medicine (AT-G, HNG, and LB) and Pediatrics (SH and RR) and the General Clinical Research Center (WK), Columbia University, New York, NY; the Department of Medicine (JA), St Luke’s-Roosevelt Medical Center, Division of Infectious Disease (SR, RM, and WME-S), Harlem Hospital Center and Columbia University, New York, NY; the Department of Medicine, University of California D
| | - Wafaa M El-Sadr
- From the Departments of Medicine (AT-G, HNG, and LB) and Pediatrics (SH and RR) and the General Clinical Research Center (WK), Columbia University, New York, NY; the Department of Medicine (JA), St Luke’s-Roosevelt Medical Center, Division of Infectious Disease (SR, RM, and WME-S), Harlem Hospital Center and Columbia University, New York, NY; the Department of Medicine, University of California D
| | - Jeanine Albu
- From the Departments of Medicine (AT-G, HNG, and LB) and Pediatrics (SH and RR) and the General Clinical Research Center (WK), Columbia University, New York, NY; the Department of Medicine (JA), St Luke’s-Roosevelt Medical Center, Division of Infectious Disease (SR, RM, and WME-S), Harlem Hospital Center and Columbia University, New York, NY; the Department of Medicine, University of California D
| | - Lars Berglund
- From the Departments of Medicine (AT-G, HNG, and LB) and Pediatrics (SH and RR) and the General Clinical Research Center (WK), Columbia University, New York, NY; the Department of Medicine (JA), St Luke’s-Roosevelt Medical Center, Division of Infectious Disease (SR, RM, and WME-S), Harlem Hospital Center and Columbia University, New York, NY; the Department of Medicine, University of California D
| |
Collapse
|
38
|
Gallagher D, Kuznia P, Heshka S, Albu J, Heymsfield SB, Goodpaster B, Visser M, Harris TB. Adipose tissue in muscle: a novel depot similar in size to visceral adipose tissue. Am J Clin Nutr 2005; 81:903-10. [PMID: 15817870 PMCID: PMC1482784 DOI: 10.1093/ajcn/81.4.903] [Citation(s) in RCA: 255] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The manner in which fat depot volumes and distributions, particularly the adipose tissue (AT) between the muscles, vary by race is unknown. OBJECTIVE The objective was to quantify a previously unstudied and novel intermuscular AT (IMAT) depot and subcutaneous AT, visceral AT (VAT), and total-body skeletal muscle mass in healthy sedentary African American (AA), Asian, and white adults by whole-body magnetic resonance imaging. IMAT is the AT between muscles and within the boundary of the muscle fascia. DESIGN Analyses were conducted on 227 women [AA (n = 79): body mass index (BMI; in kg/m(2)), 29.0 +/- 5.5; age, 45.7 +/- 16.9 y; Asian (n = 38): BMI, 21.7 +/- 2.9; age, 47.2 +/- 19.9 y; whites (n = 110): BMI, 24.9 +/- 5.4; age, 43.7 +/- 16.2 y]) and 111 men [AA (n = 39): BMI, 25.6 +/- 3.2; age, 45.5 +/- 18.8 y; Asian (n = 13): BMI, 24.9 +/- 2.5; age, 45.6 +/- 25.0 y; white (n = 59): BMI, 25.8 +/- 3.8; age 44.5 +/- 16.3 y]. RESULTS IMAT depots were not significantly different in size between race groups at low levels of adiposity; however, with increasing adiposity, AAs had a significantly greater increment in the proportion of total AT (TAT) than did the whites and Asians (58, 46, and 44 g IMAT/kg TAT, respectively; P = 0.001). VAT depots were not significantly different in size at low levels of adiposity but, with increasing adiposity, VAT accumulation was greater than IMAT accumulation in the Asians and whites; no significant differences were observed in AAs. CONCLUSION Race differences in AT distribution extend to IMAT, a depot that may influence race-ethnicity differences in dysglycemia.
Collapse
Affiliation(s)
- Dympna Gallagher
- Department of Medicine, Obesity Research Center, St Luke's-Roosevelt Hospital, New York, NY, USA
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Shen W, Punyanitya M, Wang Z, Gallagher D, St-Onge MP, Albu J, Heymsfield SB, Heshka S. Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image. J Appl Physiol (1985) 2004; 97:2333-8. [PMID: 15310748 DOI: 10.1152/japplphysiol.00744.2004] [Citation(s) in RCA: 1118] [Impact Index Per Article: 55.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
A single abdominal cross-sectional computerized axial tomography and magnetic resonance image is often obtained in studies examining adipose tissue (AT) distribution. An abdominal image might also provide additional useful information on total body skeletal muscle (SM) and AT volumes with related physiological insights. We therefore investigated the relationships between abdominal SM and AT areas from single images and total body component volumes in a large and diverse sample of healthy adult subjects. Total body SM and AT volumes were derived by whole body multislice magnetic resonance imaging in 123 men [age (mean +/- SD) of 41.6 +/- 15.8 yr; body mass index of 25.9 +/- 3.4 kg/m(2)] and 205 women (age of 47.8 +/- 18.7 yr; body mass index of 26.7 +/- 5.6 kg/m(2)). Single abdominal SM and AT slice areas were highly correlated with total body SM (r = 0.71-0.92; r = 0.90 at L(4)-L(5) intervertebral space) and AT (r = 0.84-0.96; r = 0.94 at L(4)-L(5) intervertebral space) volumes, respectively. R(2) increased by only 5.7-6.1% for SM and 2.7-4.4% for AT with the inclusion of subject sex, age, ethnicity, scanning position, body mass index, and waist circumference in the model. The developed SM and AT models were validated in an additional 49 subjects. To achieve equivalent power to a study measuring total body SM or AT volumes, a study using a single abdominal image would require 17-24% more subjects for SM and 6-12% more subjects for AT. Measurement of a single abdominal image can thus provide estimates of total body SM and AT for group studies of healthy adults.
Collapse
Affiliation(s)
- Wei Shen
- Obesity Research Center, St. Luke's-Roosevelt Hospital, Columbia University, New York, NY, USA.
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Kim J, Heshka S, Gallagher D, Kotler DP, Mayer L, Albu J, Shen W, Freda PU, Heymsfield SB. Intermuscular adipose tissue-free skeletal muscle mass: estimation by dual-energy X-ray absorptiometry in adults. J Appl Physiol (1985) 2004; 97:655-60. [PMID: 15090482 DOI: 10.1152/japplphysiol.00260.2004] [Citation(s) in RCA: 136] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Skeletal muscle (SM) is a large and physiologically important compartment. Adipose tissue is found interspersed between and within SM groups and is referred to as intermuscular adipose tissue (IMAT). The study objective was to develop prediction models linking appendicular lean soft tissue (ALST) estimates by dual-energy X-ray absorptiometry (DXA) with whole body IMAT-free SM quantified by magnetic resonance imaging. ALST and total-body IMAT-free SM were evaluated in 270 healthy adults [body mass index (BMI) of <35 kg/m2]. The SM prediction models were then validated by the leave-one-out method and by application in a new group of subjects who varied in SM mass [anorexia nervosa (AN), n = 23; recreational athletes, n = 16; patients with acromegaly, n = 7]. ALST alone was highly correlated with whole body IMAT-free SM [ model 1: R2 = 0.96, standard error (SE) = 1.46 kg, P < 0.001]; age ( model 2: R2 = 0.97, SE = 1.38 kg, P < 0.001) and sex and race ( model 3: R2 = 0.97, SE = 1.06 kg, both P < 0.001) added significantly to the prediction models. All three models validated in the athletes and patients with acromegaly but significantly ( P < 0.01–0.001) over-predicted SM in the AN group as a whole. However, model 1 was validated in AN patients with BMIs in the model-development group range ( n = 11; BMI of >16 kg/m2) but not in those with a BMI of <16 kg/m2 ( n = 12). The DXA-based models are accurate for predicting IMAT-free SM in selected populations and thus provide a new opportunity for quantifying SM in physiological and epidemiological investigations.
Collapse
Affiliation(s)
- Jaehee Kim
- Obesity Research Center, College of Physicians and Surgeons, Columbia University, New York, NY 10025, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Shen W, Punyanitya M, Wang Z, Gallagher D, St-Onge MP, Albu J, Heymsfield SB, Heshka S. Visceral adipose tissue: relations between single-slice areas and total volume. Am J Clin Nutr 2004; 80:271-8. [PMID: 15277145 PMCID: PMC2040041 DOI: 10.1093/ajcn/80.2.271] [Citation(s) in RCA: 253] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Visceral adipose tissue (VAT), which is linked with the metabolic consequences of obesity, is usually characterized by measuring VAT area at the L4-L5 vertebral interspace. However, the location of the slice with the strongest relation to VAT volume is not established. OBJECTIVE We sought to investigate the relations between cross-sectional VAT areas at different anatomic locations and VAT volume in a large, diverse sample of healthy subjects. DESIGN VAT volume was derived from slice areas taken at 5-cm intervals from magnetic resonance images in 121 healthy men [x +/- SD age: 41.9 +/- 15.8 y; body mass index (BMI; in kg/m(2)): 26.0 +/- 3.2; VAT: 2.7 +/- 1.8 L] and 198 healthy women (age: 48.1 +/- 18.7 y; BMI: 27.0 +/- 5.4; VAT: 1.7 +/- 1.2 L). Regression models were developed to identify the best single slice for estimating VAT volume. RESULTS The VAT area 10 cm above L4-L5 (A(+10)) in men (R(2) = 0.932, P < 0.001) and 5 cm above L4-L5 (A(+5)) in women (R(2) = 0.945, P < 0.001) had the highest correlation with abdominal VAT. R(2) increased by only 3.8% in men and 0.5% in women with adjustment for age, race, scanning position, BMI, and waist circumference. Studies using A(+10) in men and A(+5) in women will require 14% and 9% fewer subjects, respectively, than those using slices at L4-L5 and will have equivalent power. CONCLUSION Measurement of slice areas at A(+10) in men and A(+5) in women provides greater power for the detection of VAT volume differences than does measurement at L4-L5.
Collapse
Affiliation(s)
- Wei Shen
- Obesity Research Center, St Luke's-Roosevelt Hospital, and the Institute of Human Nutrition, Columbia University, College of Physicians and Surgeons, 1090 Amsterdam Avenue, New York, NY 10025, USA.
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Abstract
The prevalence of obesity and diabetes is increasing in the United States and worldwide. These diseases are predicted to explode to epidemic proportions, unless appropriate counteractive measures are taken. Several large studies (DCCT, UKPDS, Kumamoto) clearly showed that intensive glycemic control in the diabetic patient reduced microvascular complications and improved mortality. Despite this, the NHANES III showed that only 50% of diabetics have been able to achieve a HgbAic level that is less than 7%; this suggests the need for a re-evaluation of our approach to these patients. The management of the obese diabetic patient involves glycemic control and weight reduction. These goals are particularly difficult to achieve in the obese diabetic patient because progressive beta-cell dysfunction and increasing insulin resistance necessitates the administration of increasingly higher dosages of insulin, which, in turn, promotes weight gain. A vicious cycle may ensue. Lifestyle modifications with diet and exercise are an essential part of the management of the obese diabetic patient. These measures alone are often insufficient and concomitant pharmacologic therapy is usually required to achieve glycemic and weight control. Oral agents that improve glycemia, decrease insulin resistance, and limit weight gain are desirable. Because of the progressive nature of diabetes, glycemic control with monotherapy often deteriorates over time, which necessitates the addition of other pharmacologic agents, including insulin. When insulin therapy is required in the treatment of the obese diabetic patient, combinations with oral agents that have been shown to minimize the amount of exogenous insulin that is required, may minimize weight gain. In addition, the obese diabetic patient who is poorly controlled with maximum oral hypoglycemic therapy may benefit from weight-reducing agents, such as sibutramine or orlistat. The introduction of these agents at other points in the management of the obese diabetic patients have been successful. Finally, for the severely obese diabetic patient, bariatric surgery may be the only effective treatment. Gastric bypass has been unequivocally shown to produce significant weight loss and improve glycemic control on a long-term basis in the obese diabetic patient. It is recommended that physicians avail themselves of all of these strategies in the management of the obese patient who has type 2 diabetes.
Collapse
Affiliation(s)
- Jeanine Albu
- Division of Endocrinology, St. Luke's Roosevelt Hospital, 1111 Amsterdam Avenue, College of Physicians and Surgeons, Columbia University, New York, NY 10025, USA.
| | | |
Collapse
|
43
|
He Q, Heo M, Heshka S, Wang J, Pierson RN, Albu J, Wang Z, Heymsfield SB, Gallagher D. Total body potassium differs by sex and race across the adult age span. Am J Clin Nutr 2003; 78:72-7. [PMID: 12816773 DOI: 10.1093/ajcn/78.1.72] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Total body potassium (TBK) is an index of fat-free mass. Data describing changes in TBK in African American, Asian, or Hispanic populations have not been reported. OBJECTIVE The aim was to investigate possible sex and racial differences in TBK in adults over an age range of 70 y. DESIGN The study used longitudinal and cross-sectional data collected in a body-composition unit from 973 men and 1368 women of African American, Asian, white, and Hispanic race-ethnicity. Random coefficient models in which baseline weight and height were taken into account were applied to estimate sex-specific changes in TBK among the 4 racial-ethnic groups. RESULTS The ages of 30 and 31 y were identified for women and men, respectively, as the cutoffs after which TBK began to decline. Both sexes had similar racial-ethnic patterns for expected mean TBK at the age cutoffs: African Americans had the highest value, followed by whites, Hispanics, and Asians. After the age cutoffs, the decline in TBK differed by race and sex. In women, African Americans showed the most rapid decline, whereas Asians had the lowest. In men, Hispanics had the most rapid decline in TBK, followed by African Americans, whites, and Asians. CONCLUSION Significant sex and racial differences exist in the rate of change in TBK with age. Further studies are needed to explore the associations of declining TBK with health risks.
Collapse
Affiliation(s)
- Qing He
- Obesity Research Center, St Luke's-Roosevelt Hospital, and Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University, New York, NY 1025, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Fernández JR, Shriver MD, Beasley TM, Rafla-Demetrious N, Parra E, Albu J, Nicklas B, Ryan AS, McKeigue PM, Hoggart CL, Weinsier RL, Allison DB. Association of African genetic admixture with resting metabolic rate and obesity among women. Obes Res 2003; 11:904-11. [PMID: 12855761 DOI: 10.1038/oby.2003.124] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate the role of genetic admixture in explaining phenotypic variation in obesity-related traits in a sample of African-American women (n = 145) and to determine significant associations between obesity traits and admixture genetic markers. RESEARCH METHODS AND PROCEDURES Associations between genetic admixture and BMI, resting metabolic rate, fat mass, fat-free mass, and bone mineral density were tested using linear regression considering the estimation of admixture by 1) a maximum-likelihood approach (MLA) and 2) a Bayesian analysis. RESULTS Both the conservative MLA and the Bayesian approach support an association between African genetic admixture and BMI. Evidence for the associations of African genetic admixture with fat mass and fat-free mass was supported by the Bayesian analysis; the MLA supported an association with bone mineral density. When the individual ancestry informative markers that were used to estimate admixture were tested for associations with BMI, significant associations were identified in chromosomes 1, 11, and 12. DISCUSSION These results provide evidence supporting the application of admixture mapping methods to the identification of genes that result in higher levels of obesity among African-American women. Further research is needed to replicate and further explore these findings.
Collapse
Affiliation(s)
- José R Fernández
- Department of Nutrition Sciences and the Clinical Nutrition Research Center, The University of Alabama at Birmingham, Birmingham, Alabama 35294, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Zhang K, Sun M, Werner P, Kovera AJ, Albu J, Pi-Sunyer FX, Boozer CN. Sleeping metabolic rate in relation to body mass index and body composition. Int J Obes (Lond) 2002; 26:376-83. [PMID: 11896493 DOI: 10.1038/sj.ijo.0801922] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2001] [Revised: 08/21/2001] [Accepted: 10/16/2001] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To determine whether patterns of sleeping metabolic rate (SMR) are altered in obesity. Specifically to determine the relationship between changes in SMR and body weight, body mass index (BMI, kg/m(2)), and fat-free mass (FFM); and to compare resting metabolic rate (RMR) with SMR during different periods of sleep. SUBJECTS Eighteen healthy, pre-menopausal, obese (BMI >30, n=9) and non-obese (BMI <30, n=9), female subjects (six Caucasians and 12 African-Americans), with an average age of 36 y (range 22-45). MEASUREMENTS Total energy expenditure (TEE or 24 h EE), metabolic rate (MR), SMR (minimum, average and maximum) and resting metabolic rate (RMR) or resting energy expenditure (REE) measured by human respiratory chamber, and external mechanical work measured by a force platform within the respiratory chamber. Physical activity index (PAL) was derived as TEE/REE. Body composition was determined by dual-energy X-ray absorptiometry (DXA). RESULTS SMR decreased continuously during sleep and reached its lowest point just before the subject was awakened in the morning by the research staff. Although averages for RMR and SMR were similar, RMR was lower than SMR at the beginning of the sleeping period and higher than SMR in the morning hours. The rate of decrease in SMR was faster with increasing body weight (-0.829, P<0.0001), BMI (correlation factor -0.896, P<0.0001) and FFM (-0.798, P=0.001). The relationship between the slope of SMR decrease and BMI (y=-5 x 10(-6)x(2)+0.0002x-0.0028) is highly significant, with a P-value of <0.0001 and r(2) value of 0.9622. CONCLUSIONS The rate of decline in metabolic rate during sleep is directly related to body weight, BMI and FFM. Average SMR tends to be lower than RMR in obese subjects and higher than RMR in non-obese subjects.
Collapse
Affiliation(s)
- K Zhang
- Institute of Human Nutrition, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, USA.
| | | | | | | | | | | | | |
Collapse
|
46
|
Gallagher D, Kovera AJ, Clay-Williams G, Agin D, Leone P, Albu J, Matthews DE, Heymsfield SB. Weight loss in postmenopausal obesity: no adverse alterations in body composition and protein metabolism. Am J Physiol Endocrinol Metab 2000; 279:E124-31. [PMID: 10893331 DOI: 10.1152/ajpendo.2000.279.1.e124] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We sought to determine if decrements in the mass of fat-free body mass (FFM) and other lean tissue compartments, and related changes in protein metabolism, are appropriate for weight loss in obese older women. Subjects were 14 healthy weight-stable obese (BMI > or =30 kg/m(2)) postmenopausal women >55 yr who participated in a 16-wk, 1, 200 kcal/day nutritionally complete diet. Measures at baseline and 16 wk included FFM and appendicular lean soft tissue (LST) by dual-energy X-ray absorptiometry; body cell mass (BCM) by (40)K whole body counting; total body water (TBW) by tritium dilution; skeletal muscle (SM) by whole body MRI; and fasting whole body protein metabolism through L-[1-(13)C]leucine kinetics. Mean weight loss (+/-SD) was 9.6+/-3.0 kg (P<0.0001) or 10.7% of initial body weight. FFM decreased by 2.1+/-2.6 kg (P = 0.006), or 19.5% of weight loss, and did not differ from that reported (2.3+/-0.7 kg). Relative losses of SM, LST, TBW, and BCM were consistent with reductions in body weight and FFM. Changes in [(13)C]leucine flux, oxidation, and synthesis rates were not significant. Follow-up of 11 subjects at 23.7 +/-5.7 mo showed body weight and fat mass to be below baseline values; FFM was nonsignificantly reduced. Weight loss was accompanied by body composition and protein kinetic changes that appear appropriate for the magnitude of body mass change, thus failing to support the concern that diet-induced weight loss in obese postmenopausal women produces disproportionate LST losses.
Collapse
Affiliation(s)
- D Gallagher
- Department of Medicine, Obesity Research Center, St. Luke's-Roosevelt Hospital, Columbia University, New York, New York 10025, USA.
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Gu W, Tu Z, Kleyn PW, Kissebah A, Duprat L, Lee J, Chin W, Maruti S, Deng N, Fisher SL, Franco LS, Burn P, Yagaloff KA, Nathan J, Heymsfield S, Albu J, Pi-Sunyer FX, Allison DB. Identification and functional analysis of novel human melanocortin-4 receptor variants. Diabetes 1999; 48:635-9. [PMID: 10078568 DOI: 10.2337/diabetes.48.3.635] [Citation(s) in RCA: 141] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Inactivation of the melanocortin-4 receptor (MC4-R) by gene-targeting results in mice that develop maturity-onset obesity, hyperinsulinemia, and hyperglycemia. These phenotypes resemble common forms of human obesity, which are late-onset and frequently accompanied by NIDDM. It is not clear whether sequence variation of the MC4-R gene contributes to obesity in humans. Therefore, we examined the human MC4-R gene polymorphism in 190 individuals ascertained on obesity status. Three allelic variants were identified, including two novel ones, Thr112Met and Ile137Thr. To analyze possible functional alterations, the variants were cloned and expressed in vitro and compared with the wild-type receptor. One of the novel variants, Ile137Thr, identified in an extremely obese proband (BMI 57), was found to be severely impaired in ligand binding and signaling, raising the possibility that it may contribute to development of obesity. Furthermore, our results also suggest that sequence polymorphism in the MC4-R coding region is unlikely to be a common cause of obesity in the population studied, given the low frequency of functionally significant mutations.
Collapse
Affiliation(s)
- W Gu
- Millennium Pharmaceuticals, Cambridge, Massachusetts 02139, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Albu J. Reply to HH Sandstead. Am J Clin Nutr 1998. [DOI: 10.1093/ajcn/67.4.741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
49
|
Abstract
In the United States, obesity is more prevalent in black than in non-Hispanic white women. Because low resting metabolic rate (RMR) has been suggested as a risk factor for weight gain, we compared RMR in 22 black and 20 white obese [body mass index (BMI; in kg/m2) range: 28.9-48.6 and 26.9-44.1, respectively], weight-stable, premenopausal, nondiabetic women. RMR was measured on two or three different occasions within a 1-wk period. The black and white groups did not differ significantly in age, degree of fitness, BMI, fat mass, or fat-free mass (FFM). In each group, RMR was predicted independently by FFM but not by age, degree of fitness, body fat mass, or body fat distribution. The slopes of the equations predicting RMR from FFM in black and white groups were not significantly different. However, the black women had significantly lower RMRs than the white women after adjustment for FFM measured by five body-composition models: dual-photon X-ray absorptiometry (DXA), hydrodensitometry, total body water, a three-compartment model, a four-compartment model, as well as for the absolute total-body potassium content as a measure of metabolically active FFM. By each analysis, the black women had significantly lower (P < 0.01) FFM-adjusted RMR than the white women; this difference ranged from 671 to 889 kJ/d depending on the body-composition method used to estimate FFM. This could contribute to the difference in the prevalence of obesity in the populations represented by these groups.
Collapse
Affiliation(s)
- J Albu
- Department of Medicine, Obesity Research Center, St Luke's-Roosevelt Hospital Center and Columbia University College of Physicians and Surgeons, New York, NY 10025, USA.
| | | | | | | | | | | |
Collapse
|
50
|
Albu J, Allison D, Boozer CN, Heymsfield S, Kissileff H, Kretser A, Krumhar K, Leibel R, Nonas C, Pi-Sunyer X, VanItallie T, Wedral E. Obesity solutions: report of a meeting. Nutr Rev 1997; 55:150-6. [PMID: 9212691 DOI: 10.1111/j.1753-4887.1997.tb06469.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
A workshop entitled "Obesity Solutions" was held on January 11, 1996, at St. Luke's-Roosevelt Hospital in New York City and was jointly sponsored by the St. Luke's-Roosevelt Obesity Research Center and the Nestlé R&D Center, Inc., of New Milford, Connecticut. The purpose of the workshop was to bring together experts from the research community and the pharmaceutical and food industries to address the epidemic of obesity in the United States and offer potential solutions. The following is a report of that meeting.
Collapse
Affiliation(s)
- J Albu
- Columbia University College of Physicians and Surgeons, St. Luke's-Roosevelt Hospital, New York City, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|