Cerebrospinal fluid and plasma concentrations of leptin, NPY, and alpha-MSH in obese women and their relationship to negative energy balance.

Leptin and its principal mediators, NPY and alpha-MSH are postulated to play a pivotal role in energy balance. To determine the possibility of the disturbance in neuropeptides in human obesity and their consequent changes in response to negative energy balance, we evaluated plasma and cerebrospinal fluid (CSF) leptin, NPY, and alpha-MSH levels in obese women before and after weight loss in comparison with normal control women. Subjects included 16 obese women [mean body mass index (BMI), 35.6 kg/m(2)] before and after weight loss induced by a 2-wk very low caloric diet (800 kcal/d) and 14 normal weight women (mean BMI, 20.4 kg/m(2)). The CSF to plasma leptin ratio in normal weight subjects was 2.3-fold higher than that in obese subjects. After weight loss in obese subjects, plasma leptin levels decreased by 40% and CSF levels decreased by 51%. There was a positive linear correlation between CSF and plasma leptin levels at baseline in obese subjects (r = 0.74, P < 0.05) and a positive logarithmic correlation in normal weight subjects (r = 0.89, P < 0.05) and in obese subjects after weight loss (r = 0.64, P < 0.05). The BMI was negatively correlated with the CSF to plasma leptin ratio (r = -0.86, P < 0.05) in all subjects. Neither the baseline plasma levels nor the baseline CSF levels of NPY were different between normal weight subjects and obese subjects. After weight loss, the CSF NPY level decreased significantly compared with baseline values in obese subjects. The alpha-MSH levels in plasma and CSF did not differ significantly from controls in obese subjects at baseline or after weight loss. Baseline CSF leptin level correlated with neither the baseline CSF NPY level nor the baseline CSF alpha-MSH level. In conclusion, this study demonstrated that the efficiency of brain leptin delivery is reduced in human obesity and central nervous system leptin uptake involves a combination of a saturable and an unsaturable mechanism. CSF NPY and alpha-MSH did not differ from controls in human obesity, and the CSF NPY level decreased significantly whereas alpha-MSH did not differ after weight loss in obese subjects compared with baseline. There was no significant correlation between CSF leptin and CSF NPY or alpha-MSH. This could be the result of leptin resistance present in human obesity and/or the more complex mechanisms involved in modulating appetite and regulating energy balance in human obesity.

Body mass index, weight loss and energy intake of old Danish nursing home residents and home-care clients.

Low body mass index (BMI) and weight loss is common among old home-care clients and nursing home residents in many countries - often in spite of an apparent sufficient intake of energy. The aim of this study was to assess whether a similar problem exists in Denmark. Information regarding height, body weight, BMI, and energy intake was collected. Besides this, 24 residents were weighed regularly during 1 year. The study was carried out in five nursing homes and two home-care districts situated in the area of Copenhagen. A total of 180 residents and 200 clients 65+ years of age participated. Main outcome measures were prevalence of BMI < 20 kg/m2, BMI < 18.5 kg/m2, acute weight loss and median energy intake. Thirty-three and thirty per cent of the residents and clients had a BMI < 20 kg/m2 and, 22 and 12% had a BMI < 18.5 kg/m2. Of the residents, who were weighed regularly, 38% had a weight loss above 5%. The median intake of energy was equal to or above the estimated median energy requirement. Hence, the prevalence of low BMI and weight loss among old Danish nursing home residents and home-care clients is high and similar to that found in other countries. There is a need for increased focus on nutritional state and risk factors in these settings.

Are meal replacements an effective strategy for treating obesity in adults with features of metabolic syndrome?

Background - Meal replacements as a weight loss strategy are widely used, however their effectiveness outside controlled clinical trial environments is unknown. Objective - To compare meal replacements with a structured weight reduction diet in overweight/obese Australians with raised triglycerides. Design - In a randomised parallel design, 2 groups [Meal Replacement (MR) and Control (C)] of 66 matched subjects underwent a 6000kj intervention for 3 months (stage 1) and a further 3 months (stage 2). Groups were provided oral and written information. C was supplied shopping vouchers and followed a low fat/energy diet. MR was supplied Slimfast(tm) product for two meals (1800kj) and consumed a low fat evening meal. Clients were weighed every 2-wk, received structured supervision without professional dietary input, with compliance assessed by 3d-weighed food records. Blood biomarkers assessed fruit/vegetable intake and questionnaire assessed attitudes to treatment. Outcomes - Fifty-five subjects completed stage 1 and 42 stage 2. Mean weight loss was comparable in both groups at 3 months (6.0+/-4.2 kg +/- sem MR, 6.6+/-3.4 kg C) and at 6 months (9.0+/-6.9 kg MR, 9.2+/-5.1 kg C). Serum folate and plasma beta-carotene were higher in MR, and plasma homocysteine fell in both groups. Diets were nutritionally adequate in both groups, but some nutrient intakes were higher in MR than C. The MR program was viewed by subjects remaining in the study as acceptable and convenient, thereby aiding compliance. Conclusions - A meal replacement program is equally effective for losing weight compared to a conventional but structured weight loss diet. Meal replacements offer a convenient and potentially nutritionally beneficial weight loss alternative than conventionally structured weight loss diets.

Comparison of self-reported with objectively assessed energy expenditure in black and white women before and after weight loss.

BACKGROUND: Weight maintenance is less successful in black women than in white women after weight loss. OBJECTIVE: We compared objectively assessed total energy expenditure (TEE) with estimates of energy expenditure (EE) from self-reported physical activity (PA) in overweight black and white women before and after weight loss. We also compared those values with values in never-overweight control subjects. DESIGN: A total of 20 white and 21 black premenopausal women were evaluated while overweight and weight reduced; 20 white and 14 black control subjects (matched with women in the weight-reduced state) were evaluated once. weight loss of >/=10 kg was achieved by energy restriction in the overweight subjects. The evaluations were as follows: body composition (dual-energy X-ray absorptiometry), free-living TEE (doubly labeled water), Tecumseh Occupational Activity Questionnaire, Minnesota Leisure Time PA Questionnaire, and Baecke Activity Questionnaire. RESULTS: Questionnaire estimates of TEE were overestimated when compared with TEE (P < 0.001). Overweight women overestimated TEE 49% more than did never-overweight control subjects. After weight loss, white women reduced overestimation of EE 48% (P < 0.05), so that their overestimation of EE was not different from that of black and white control subjects. Black women overestimated to the same extent both before and after weight loss. CONCLUSIONS: Premenopausal women overestimate PA estimates on questionnaires. Overestimation of PA in weight-reduced black women is greater than in weight-reduced white women and never-overweight black and white women.

Exercise-induced weight loss preferentially reduces abdominal fat.

PURPOSE: To investigate whether abdominal fat is reduced in response to substantial weight loss induced by exercise in young obese men. METHODS: Thirty obese men (mean age 19.8 +/- 0.6 yr) were evaluated before (pretraining) and after (posttraining) 4 months of regimented training in the Singapore Armed Forces. There were 30 obese male subjects (mean age 19.2 +/- 1.3 yr) without training who were monitored as control subjects. Fat free mass (FFM), fat mass, and percent body fat were determined from skinfold measurements. Differences between pre- and posttraining responses were analyzed with a paired -test. RESULTS: Subjects lost 12.0 +/- 3.6 kg (P < 0.001) from pre- to posttraining, which was attributable to a reduction in fat mass (P < 0.001), as FFM was unchanged. Both waist circumference (WC) and hip circumference (HC) decreased (P < 0.01), the reduction in WC (13.7%) being greater than the reduction in HC (7.7%) as reflected by the decrease in waist-to-hip ratio (WHR; P < 0.001). These data reveal that large exercise-induced weight losses are associated with maintenance of FFM. The significant reduction in WHR indicates a greater mobilization of abdominal fat and a preferential loss of fat from this region. CONCLUSIONS: Large exercise-induced weight loss is associated with a preferential reduction in abdominal fat and a corresponding maintenance of FFM. Such an effect on body composition should reduce disease risk and the eventual weight regain that typically follows diet-induced weight losses with obese subjects.

Weight Loss reduces circulating asymmetrical dimethylarginine concentrations in morbidly obese women.

The endogenous nitric oxide-synthase inhibitor asymmetrical dimethyl-L-arginine (ADMA) is elevated in patients with increased risk for arteriosclerosis. obesity is a risk factor for cardiovascular disease. We measured plasma ADMA concentrations in morbidly obese women before and after weight loss following gastroplastic surgery. ADMA and symmetrical dimethyl-L-arginine concentrations were analyzed by HPLC from 34 female patients (age 41 +/- 7 yr) with a body mass index (BMI) of 49 +/- 1 kg/m2 before and 14 months after vertical ring gastroplasty. Age-matched healthy women (BMI < 25 kg/m2; n = 24) were studied as controls. After gastroplastic surgery, BMI decreased to 34 +/- 1 kg/m2 in obese women (P < 0.00001), and ADMA concentrations were reduced from 1.06 +/- 0.06 micromol/liter at baseline to 0.81 +/- 0.04 micromol/liter after weight loss (P < 0.00001). Symmetrical dimethyl-L-arginine plasma levels were not affected. ADMA correlated with high-sensitivity C-reactive protein at baseline (r = 0.42; P < 0.05) and after weight loss (r = 0.56; P < 0.005). No association with blood pressure or plasma lipids could be observed. ADMA concentrations were lower in controls (0.68 +/- 0.04 micromol/liter; P < 0.05) compared with obese patients before or after weight reduction. The decrease of highly elevated ADMA concentrations in morbidly obese patients is paralleled by improvement of parameters associated with the metabolic syndrome after weight loss.

Analysis of puberal development and influence of weight loss in obese adolescent girlsTo study several aspects of puberal development in obese adolescent girls, and the influence of weight loss on these aspects. METHODS: A longitudinal retrospective study was performed of a sample of 26 adolescent girls with normal weight and 46 obese adolescent girls at the onset of puberty. The obese teenagers were further divided into two groups (normal and obese) according to their body mass index (BMI) at the end of puberty. Height, chronological and bone age, and growth velocity were evaluated in both groups. RESULTS: Of the teenagers who were obese at the onset of puberty, 63 % remained obese at the end of puberty.The obese teenagers were significantly taller than non-obese teenagers at the onset of puberty (143.2 +/- 6.96 vs 138.9 +/- 5.95 cm, respectively; p < 0.01). However, there were no differences between the two groups in final height. No differences were found between obese teenagers who lost weight and those who did not.There were no differences in chronological or bone age throughout puberal development in any of the groups.The mean growth velocity during puberty was significantly lower in obese teenagers than in non-obese teenagers (6.18 +/- 1.94 and 6.90 +/- 127 cm/year, respectively; p < 0.02). However, there were no differences between obese teenagers who lost weight and those who did not. CONCLUSIONS: Height gain in obese girls is greater in childhood but lower in adolescence. Final height is similar in both groups. Chronological age at the onset and end of puberty and bone maturation are similar in both groups. weight loss during puberty does not modify growth pattern during this period of development.

An integrated method to determine meaningful changes in health-related quality of life.

OBJECTIVE: We describe an integrated method for determining meaningful change in health-related quality of life (HRQOL) that combines information from anchor-based and distribution-based methods and illustrate this method using data aggregated from weight loss studies. STUDY DESIGN AND SETTING: A total of 1476 participants in weight loss studies were evaluated at baseline and at 6 months using the Impact of Weight on Quality of Life-Lite (IWQOL-Lite). Severity of baseline impairment was determined by comparing scores with those obtained from a normative sample of 534 normal/overweight individuals. The precision of the IWQOL-Lite was evaluated using standard error of measurement corrected for regression to the mean. weight loss was used as an anchor for evaluating changes in IWQOL-Lite scores. RESULTS: Change in HRQOL varied as a function of weight loss and baseline severity of HRQOL. Using this integrated method, an improvement of 7.7 to 12 points (depending on baseline severity) on IWQOL-Lite total score is considered meaningful. CONCLUSION: Meaningful change in HRQOL can be determined using an integrated method that (1) combines information from anchor-based and distribution-based methods, (2) reconciles discrepancies between these two methods, and (3) adjusts for baseline severity and regression to the mean. This method may be applied to other types of HRQOL measures and conditions.