Increase of Intra-Abdominal Fat in Patients Treated with Continuous Ambulatory Peritoneal Dialysis

Objective

To evaluate changes in amount and distribution of body fat in patients treated with continuous ambulatory peritoneal dialysis (CAPD).

Design

Prospective study. Computed tomography (CT) and dual energy x-ray absorptiometry (DEXA) were used for determination of body composition at commencement of CAPD, and after a mean of 7.2 months of dialysis treatment.

Setting

CAPD unit at an academic teaching hospital.

Patients

The study included 19 consecutive patients who started CAPD during a 15-month time frame. Of these 19 patients, 12 (8 males) with a mean initial age of 60 years completed the study.

Main Outcome Measures

Siemens Somatom HiQ (Erlangen, Germany) was used for CT of the abdomen and of the right thigh. Fat and muscle areas were expressed as square centimeters. The proportion of total fat mass was determined by body composition analysis using DEXA (DPX-L densitometer) (Lunar, Madison, WI, U.S.A.) and expressed as percentage of total body weight (FAT%).

Results

Body weight changed from 67.1 to 68.4 kg (p = 0.20), and the intra-abdominal fat area increased 22.8% (p = 0.02). This increase was predominantly seen in male patients (p = 0.007). The FAT% changed from 27.8% to 30.9% (p = 0.25), without difference between sexes.

Conclusion

The increase of intra-abdominal fat found in this study may suggest a mechanism by which the established risk for CAPD patients to develop cardiovascular morbidity and mortality may be at least partially explained.

Atkins – the superior slimming diet?

Four diets of varying composition, from the high-protein Atkins diet to the balanced educational tool LEARN, showed modest one-year weight-loss results but had no adverse effects. None of the four diets reaches the standard figure of at least 5–10% used to evaluate the success of weight loss treatments. It seems reasonable to state that a well-conducted study has shown us that modest weight loss can be achieved in various ways. However, this is no breakthrough demonstrating that one method is superior to any other, and no reason to argue that those in favour of high-protein diets were the first to discover the truth of weight loss programs.

The significance of overweight and obesity for individual health behaviour: An economic analysis based on the Swedish surveys of living conditions 1980—81, 1988—89, and 1996—97

Aims: The aim of the study was to examine whether being overweight (25≤BMI<30) or obese (BMI≥30) affect subsequent individual health behaviour, applying the framework of the individual-as-producer-of-health model. Methods: A set of panel data for 3,693 individuals interviewed repeatedly in 1980—81, 1988—89, and 1996—97 was created from the Swedish population-based biannual survey of living conditions. Self-assessed health was chosen as indicator of individual health capital and physical exercise as indicator of individual health investment. Results: (a) Men and women who suffered from obesity invested significantly less in their health in terms of physical exercise and reported significantly lower self-assessed health than the general male and female population, respectively. (b) Men who suffered from overweight invested less in their health and reported significantly lower self-assessed health than the general population, whereas women who were overweight — but not obese — did not differ from the general population. (c) Men and women who went from being obese to being overweight reported self-assessed health levels that did not differ from the general male and female population, respectively, but exercised less than men and women in general. Conclusions: The results imply (a) that the individual weight history must be taken into account in studies of the effect of obesity and overweight on health and health-related behaviour and (b) that men and women differ concerning the impact of obesity and overweight on health and health investments.

Influence of rimonabant treatment on peripheral blood mononuclear cells; flow cytometry analysis and gene expression profiling

The cannabinoid receptor type 1 (CB1) antagonist rimonabant has been used as treatment for obesity. In addition, anti-proliferative effects on mitogen-activated leukocytes have been demonstrated in vitro. We have previously shown that rimonabant (SR141716A) induces cell death in ex vivo isolated malignant lymphomas with high expression of CB1 receptors. Since CB1 targeting may be part of a future lymphoma therapy, it was of interest to investigate possible effects on peripheral blood mononuclear cells (PBMC) in patients treated with rimonabant. We therefore evaluated leukocyte subsets by 6 color flow cytometry in eight patients before and at treatment with rimonabant for 4 weeks. Whole-transcript gene expression profiling in PBMC before and at 4 weeks of rimonabant treatment was done using Affymetrix Human Gene 1.0 ST Arrays. Our data show no significant changes of monocytes, B cells, total T cells or T cell subsets in PBMC during treatment with rimonabant. There was a small but significant increase in CD3-, CD16+ and/or CD56+ cells after rimonabant therapy. Gene expression analysis detected significant changes in expression of genes associated with innate immunity, cell death and metabolism. The present study shows that normal monocytes and leukocyte subsets in blood remain rather constant during rimonabant treatment. This is in contrast to the induction of cell death previously observed in CB1 expressing lymphoma cells in response to treatment with rimonabant in vitro. These differential effects observed on normal and malignant lymphoid cells warrant investigation of CB1 targeting as a potential lymphoma treatment.

Adipose tissue morphology predicts improved insulin sensitivity following moderate or pronounced weight loss

BACKGROUND

Cross-sectional studies show that white adipose tissue hypertrophy (few, large adipocytes), in contrast to hyperplasia (many, small adipocytes), associates with insulin resistance and increased risk of developing type 2 diabetes. We investigated if baseline adipose cellularity could predict improvements in insulin sensitivity following weight loss.

METHODS

Plasma samples and subcutaneous abdominal adipose biopsies were examined in 100 overweight or obese individuals before and 10 weeks after a hypocaloric diet (7±3% weight loss) and in 61 obese subjects before and 2 years after gastric by-pass surgery (33±9% weight loss). The degree of adipose tissue hypertrophy or hyperplasia (termed the morphology value) in each individual was calculated on the basis of the relationship between fat cell volume and total fat mass. Insulin sensitivity was determined by homeostasis model assessment-estimated insulin resistance (HOMAIR).

RESULTS

In both cohorts at baseline, subjects with hypertrophy displayed significantly higher fasting plasma insulin and HOMAIR values than subjects with hyperplasia (P<0.0001), despite similar total fat mass. Plasma insulin and HOMAIR were normalized in both cohorts following weight loss. The improvement (delta insulin or delta HOMAIR) was more pronounced in individuals with hypertrophy, irrespective of whether adipose morphology was used as a continuous (P=0.0002-0.027) or nominal variable (P=0.002-0.047). Absolute adipocyte size associated (although weaker than morphology) with HOMAIR improvement only in the surgery cohort. Anthropometric measures at baseline (fat mass, body mass index, waist-to-hip ratio or waist circumference) showed no significant association with delta insulin or delta HOMAIR.

CONCLUSIONS

In contrast to anthropometric variables or fat cell size, subcutaneous adipose morphology predicts improvement in insulin sensitivity following both moderate and pronounced weight loss in overweight/obese subjects.

The change in eating behaviors in a Web-based weight loss program: a longitudinal analysis of study completers

Background

Eating behaviors are essential components in weight loss programs, but limited research has explored eating behaviors in Web-based weight loss programs.

Objectives

The aim was to evaluate an interactive Web-based weight loss program on eating behaviors using the 18-item Three-Factor Eating Questionnaire Revised (TFEQ-R18) which measures uncontrolled eating, emotional eating, and cognitive restrained eating. Our Web-based weight loss program is comprised of information about healthy lifestyle choices, weekly chats with experts, social networking features, databases for recipe searches, and features allowing members to self-report and track their weight, physical activity, and dietary intake on the website.

Methods

On registering for the weight loss program, 23,333 members agreed to take part in the research study. The participants were then asked to complete the TFEQ-R18 questionnaire at baseline and after 3 and 6 months of participation. All data collection was conducted online, with no face-to-face contact. To study changes in TFEQ-R18 eating behaviors we restricted our study to those members who completed all 3 TFEQ-R18 questionnaires. These participants were defined as “completers” and the remaining as “noncompleters.” The relationships between sex, change in eating behaviors, and total weight loss were studied using repeated measures ANOVA and Pearson correlation coefficient.

Results

In total, 22,800 individuals participated (females: 19,065/22,800, 83.62%; mean age 39.6, SD 11.4 years; BMI 29.0 kg/m²; males: 3735/22,800, 16.38%; mean age 43.2, SD 11.7 years; BMI 30.8 kg/m²). Noncompleters (n=22,180) were younger and reported a lower score of uncontrolled eating and a higher score of cognitive restrained eating. Over time, completers (n=620) decreased their uncontrolled eating score (from 56.3 to 32.0; P<.001) and increased their cognitive restrained eating (from 50.6 to 62.9; P<.001). Males decreased their emotional eating (from 57.2 to 35.9; P<.001), but no significant change was found among females. The baseline cognitive restrained eating score was significantly and positively associated with weight loss for completers in both men (P=.02) and women (P=.002).

Conclusions

To our knowledge, this is the largest TFEQ sample that has been documented. This Web-based weight loss intervention suggests that eating behaviors (cognitive restrained eating, uncontrolled eating, and emotional eating) measured by TFEQ-R18 were significantly changed during 6 months of participation. Our findings indicate differences in eating behaviors with respect to sex, but should be interpreted with caution because attrition was high.

Weight reduction improves nocturnal respiration in obese sleep apnoea patients-A randomized controlled pilot study

SUMMARY

OBJECTIVES

Randomized controlled pilot study of the effect of weight reduction on nocturnal respiratory parameters in obese patients with obstructive sleep apnoea syndrome (OSAS).

METHODS

Twenty consecutive obese male patients fulfilling OSAS criteria at Karolinska University Hospital were randomized into two groups. Intervention with an 8-week weight reduction programme consisting of a low-calorie diet, together with group meetings, was evaluated compared to expectancy alone for the control group, followed by a crossover. Follow-up at 3 months included anthropometrics and ambulant sleep apnoea recordings.

RESULTS

Eleven of twenty men completed the protocol. There were significant differences between the intervention group (n = 6) and the control group (n = 5) in changes of weight (p < 0.01) and oxygen desaturation index (ODI4) (p < 0.05). We also found a significant positive correlation in these 11 males after the crossover between their reduction in weight and their reduction in ODI4 (p < 0.05).

CONCLUSIONS

This pilot study indicates that weight reduction improves nocturnal respiration in obese OSAS patients after 3 months' dietary treatment compared to expectancy.

Tolerability of nausea and vomiting and associations with weight loss in a randomized trial of liraglutide in obese, non-diabetic adults

BACKGROUND

Liraglutide 3.0 mg, with diet and exercise, produced substantial weight loss over 1 year that was sustained over 2 years in obese non-diabetic adults. Nausea was the most frequent side effect.

OBJECTIVE

To evaluate routinely collected data on nausea and vomiting among individuals on liraglutide and their influence on tolerability and body weight.

DESIGN

A randomized, placebo-controlled, double-blind 20-week study with an 84-week extension (sponsor unblinded at 20 weeks, open-label after 1 year) in eight European countries (Clinicaltrials.gov: NCT00422058).

SUBJECTS

After commencing a 500-kcal/day deficit diet plus exercise, 564 participants (18-65 years, body mass index (BMI) 30-40 kg m(-2)) were randomly assigned (after a 2-week run-in period) to once-daily subcutaneous liraglutide (1.2, 1.8, 2.4 or 3.0 mg), placebo or open-label orlistat (120 mg × 3 per day). After 1 year, participants on liraglutide/placebo switched to liraglutide 2.4 mg, and subsequently, to liraglutide 3.0 mg (based on 20-week and 1-year results, respectively).

RESULTS

The intention-to-treat population comprised 561 participants (n=90-98 per arm, age 45.9±10.3 years, BMI 34.8±2.7 kg m(-2) (mean±s.d.)). In year 1, more participants reported ⩾1 episode of nausea/vomiting on treatment with liraglutide 1.2-3.0 mg (17-38%) than with placebo or orlistat (both 4%, P⩽0.001). Most episodes occurred during dose escalation (weeks 1-6), with 'mild' or 'moderate' symptoms. Among participants on liraglutide 3.0 mg, 48% reported some nausea and 13% some vomiting, with considerable variation between countries, but only 4 out of 93 (4%) reported withdrawals. The mean 1-year weight loss on treatment with liraglutide 3.0 mg from randomization was 9.2 kg for participants reporting nausea/vomiting episodes, versus 6.3 kg for those with none (a treatment difference of 2.9 kg (95% confidence interval 0.5-5.3); P=0.02). Both weight losses were significantly greater than the respective weight losses for participants on placebo (P<0.001) or orlistat (P<0.05). Quality-of-life scores at 20 weeks improved similarly with or without nausea/vomiting on treatment with liraglutide 3.0 mg.

CONCLUSION

Transient nausea and vomiting on treatment with liraglutide 3.0 mg was associated with greater weight loss, although symptoms appeared tolerable and did not attenuate quality-of-life improvements. Improved data collection methods on nausea are warranted.

Obesity management: what brings success?

The upward trend in obesity prevalence across regions and continents is a worldwide concern. Today a majority of the world's population live in a country where being overweight or obese causes more deaths than being underweight. Only a portion of those qualifying for treatment will get the health care they need. Still, a minor weight loss of 5-10% seems to be sufficient to provide a clinically significant health benefit in terms of risk factors for cardiovascular disease and diabetes. Diet, exercise and behavior modifications remain the current cornerstones of obesity treatment. Weight-loss drugs play a minor role. Drugs which were available and reasonably effective have been withdrawn because of side effects. The fact that the 'old' well known, but pretty unexciting tools remain the basic armamentarium causes understandable concern and disappointment among both patients and therapists. Hence, bariatric surgery has increasingly been recognized and developed, as it offers substantial weight loss and prolonged weight control. The present review highlights the conventional tools to counter obesity, lifestyle modification, pharmacotherapy and bariatric surgery, including some of the barriers to successful weight loss: (1) unrealistic expectations of success; (2) high attrition rates; (3) cultural norms of self-acceptance in terms of weight and beliefs of fat being healthy; (4) neighborhood attributes such as a lack of well-stocked supermarkets and rather the presence of convenience stores with low-quality foods; and (5) the perception of the neighborhood as less safe and with low walkability. Prevention is the obvious key. Cost-effective societal interventions such as a tax on unhealthy food and beverages, front-of-pack traffic light nutrition labeling and prohibition of advertising of junk food and beverages to children are also discussed.

Change in proportional protein intake in a 10-week energy-restricted low- or high-fat diet, in relation to changes in body size and metabolic factors

OBJECTIVE

To investigate in a secondary analysis of a randomised trial the effects of a low-/high-fat diet and reported change from baseline in energy% from protein (prot%), in relation to changes in body size and metabolic factors.

METHODS

Obese adults (n = 771) were randomised to a 600 kcal energy-deficient low-fat (20-25 fat%) or high-fat (40-45 fat%) diet over 10 weeks. Dietary intake data at baseline and during the intervention were available in 585 completers. We used linear regression to calculate the combined effects of randomised group and groups of prot% change (<-2 /-2 to 2/>2) on outcomes.

RESULTS

The low-fat group with >2 prot% increase lost 1.1 kg more weight (p = 0.03) and reduced cholesterol by 0.25 mmol/l more (p = 0.003) than the high-fat group with >2 prot% decrease. These differences were 2.5-fold and 1.8-fold greater than the differences between the low-fat and high-fat groups while not considering prot% change. The high-fat group reduced plasma triglycerides more than the low-fat group, but not compared to those in the low-fat group with >2 units prot% increase (p fat-protein interaction = 0.01).

CONCLUSIONS

Under energy restriction, participants on a low-fat diet who had increased the percentage energy intake from protein showed the greatest reduction in weight and cholesterol, and a triglyceride reduction equally large to that of participants on a high-fat diet.