Modest weight loss and reduction in waist circumference after medical treatment are associated with favorable changes in serum adipocytokines.

Modest weight loss if maintained is associated with significant metabolic benefits and reduction in cardiovascular risk. Adipose tissue secretes cytokines believed to contribute to the pathogenesis of insulin resistance and cardiovascular risk. We therefore observed the effect of modest weight loss on serum adipocytokines and their relationship with changes in anthropometric and metabolic parameters within a period of 6 months in the setting of a routine obesity hospital clinic after various medical treatments. In this prospective, nonrandomized, nonblinded observational study, patients were first given treatment (Sibutramine ( Meridia ) or Orlistat ( Xenical )) as decided by the treating clinician and then allocated into 1 of 2 groups according to the treatment prescribed. The first group included 21 Caucasian nondiabetic female subjects, with a mean (+/-SD) age of 43 +/- 11 years and a mean body mass index (BMI) of 46 +/- 8.6 kg/m(2); subjects were treated with Sibutramine ( Meridia ) 10 or 15 mg/d for weight loss. The second group included 20 Caucasian nondiabetic female subjects, mean age 42 +/- 9 years and mean BMI 45.2 +/- 5.2 kg/m(2); Orlistat ( Xenical ) was introduced after 1 month on a low-fat (</=30%) diet in this group. Blood pressure and anthropometric measurements were performed before and after weight loss by a single observer. Serum glucose, insulin, lipid profile, C-reactive protein (CRP), resistin, leptin, and adiponectin were measured before and after weight loss on a fasting sample. After 6 months, the Sibutramine ( Meridia ) group had a modest mean weight loss of 5.4% (P =.0001), and waist circumference was reduced by 4.5 +/- 1.4 cm. There was a decrease in serum resistin, leptin, and CRP levels, and a rise in serum adiponectin (P <.05). Change (%) (Delta) in BMI (DeltaBMI%) was associated with Deltainsulin(%) (P =.02, r = 0.53) and Deltaleptin(%) (P =.01, r = 0.58). Change in waist was associated with Deltainsulin(%) (P =.005, r = 0.75) and Deltaresistin(%) (P =.03, r = -0.55). The Orlistat ( Xenical )-treated group had a mean weight loss of 2.5%. Although this group did not show significant change in metabolic parameters, surprisingly there was a greater decrease of resistin (P =.02) associated with comparable (%) increase in adiponectin and (%) reduction of waist circumference and CRP. We conclude that modest weight loss (>5%) after medical treatment in a routine obesity hospital clinic is associated with improvements in insulin sensitivity and lipid profile. Modest weight loss is also associated with potentially favourably changes in serum adipocytokines, particularly in a rise of serum adiponectin. Reduction of waist circumference is associated with a change in serum resistin.

Very low carbohydrate diets for weight loss and cardiovascular risk1.

Background - It is not clear to what extent high saturated fat very low carbohydrate (VLCARB) diets for weight loss affect cardiovascular (CVD) risk. Objective - To compare a VLCARB diet isicalorically to 2 conventional weight loss strategies on a spectrum of cardiovascular risk factors after energy balance was re-established. Design - Sixty seven subjects aged 48+/-8y, total cholesterol 5.9+/-1.0mmol/L, and BMI 33+/-3kg/m2 were randomly allocated to one of 3 isocaloric weight loss dietary interventions which were energy restricted for 8 weeks (6MJ) and in energy balance for 4. The diets were Very Low Fat (VLF) (10% fat, 3% saturated fat), High Unsaturated Fat (HUF) (30% fat, 6% saturated fat) and Very Low Carbohydrate (VLCARB) (61% fat, 20% saturated; 4% carbohydrate). Outcomes - VLCARB resulted in 9.2% weight loss compared to VLF (7.3%) and HUF (7.0%) (P=0.034). DEXA data revealed no difference in percent total fat loss between diets. Lean mass loss was higher on VLCARB and VLF (31-32% of weight loss) compared to HUF (21%) (P<0.05). LDL-C increased 0.18+/-0.18mmol/L on VLCARB but decreased 0.40+/-0.11mmol/L on VLF and 0.34+/-0.14mmol/L on HUF (P=0.009). VLCARB had the greatest triglyceride reduction (-0.73+/-0.12mmol/L) followed by HUF (-0.15+/-0.07mmol/L) and VLF (-0.06+/-0.13mmol/L) (P<0.001). HDL-C increased only on VLCARB (+0.06+/-0.03mmol/L). Plasma homocysteine increased 6.6% on VLCARB, decreased 6.8% on VLF and remained unchanged on HUF (P=0.026 for diet effect). VLCARB lowered fasting insulin by 33% compared to a 19% fall on HUF and no change on VLF (P<0.001). All diets resulted in significant decreases in fasting glucose, blood pressure and CRP with weight loss (P<0.05). Conclusion - Under isocaloric conditions VLCARB results in substantial improvements but also some deterioration in cardiovascular risk factors compared to conventional weight loss patterns. Sponsorship: National Heart Foundation of Australia

Bacterial degradation of natural and synthetic rubber.

The degradation of natural rubber (NR), synthetic poly(cis-1,4-isoprene) (SR), and cross-linked NR (latex gloves) by Gram-positive and Gram-negative bacteria was analyzed by weight loss, gel permeation chromatography, and determination of the protein content. weight losses of 11-18% and an increase in protein up to 850 microg/mL after incubation of Nocardia sp. DSMZ43191, Streptomyces coelicolor, Streptomyces griseus, bacterial isolate 18a, Acinetobacter calcoaceticus, and Xanthomonas sp. with latex gloves as a carbon source indicated degradation of the polymer. An increase of protein up to 1250 microg/mL was obtained upon incubation of the bacteria with SR. No or only little weight losses and no increase in the protein content were found for nondegrading control strains such as Streptomyces lividans and Streptomyces exfoliatus and for mutants of degrading strains of S. coelicolor and S. griseus, which have been identified by their inability to produce clearing zones on opaque latex agar. Measurement of the average molecular weight of synthetic rubber before and after degradation showed a time-dependent shift to lower values for the degrading strains. Diketone derivates of oligo(cis-1,4-isoprene) were identified as metabolites of rubber degradation. An oxidative degradation pathway of poly(cis-1,4-isoprene) to acetyl-coenzymeA and propionyl-coenzymeA by beta-oxidation is suggested for bacterial degradation of isoprene rubber.

Weight Loss from maximum body weight among middle-aged and older white women and the risk of hip fracture: the NHANES I epidemiologic follow-up study.

Although weight loss increases bone loss and hip fracture risk in older women, little is known about the relation between weight loss in middle-aged women and subsequent hip fracture risk. The objective of this study was to determine the association between weight loss from reported maximum body weight in middle-aged and older women and the risk of hip fracture. Data were from a nationally representative sample of 2180 community-dwelling white women aged 50-74 years from the Epidemiologic Follow-up Study of the first National Health and Nutrition Examination Survey (NHEFS). In this prospective cohort study, incident hip fracture was ascertained during 22 years of follow-up. The adjusted relative risks associated with weight loss of 10% or more from maximum body weight were elevated for both middle-aged (RR 2.54; 95% CI 1.10-5.86) and older women (RR 2.04; 95% CI 1.37-3.04). For both ages combined, women in the lowest tertile of body mass index at maximum who lost 10% or more of weight had the highest risk of hip fracture (RR 2.37; 95% CI 1.32-4.27). weight loss from maximum reported body weight in women aged 50-64 years and 65-74 years increased their risk of hip fracture, especially among those who were relatively thin. weight loss of 10% or more from maximum weight among both middle-aged and older women is an important indicator of hip fracture risk.

Effect of lifestyle modification on adipokine levels in obese subjects with insulin resistance.

OBJECTIVE: To study the effect of weight loss in response to a lifestyle modification program on the circulating levels of adipose tissue derived cytokines (adipokines) in obese individuals with insulin resistance. RESEARCH METHODS AND PROCEDURES: Twenty-four insulin-resistant obese subjects with varying degrees of glucose tolerance completed a 6-month program consisting of combined hypocaloric diet and moderate physical activity. Adipokines [leptin, adiponectin, resistin, tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6)] and highly sensitive C-reactive protein were measured before and after the intervention. Insulin sensitivity index was evaluated by the frequently sampled intravenous glucose tolerance test. RESULTS: Participants had a 6.9 +/- 0.1 kg average weight loss, with a significant improvement in sensitivity index and reduction in plasma leptin (27.8 +/- 3 vs. 23.6 +/- 3 ng/mL, p = 0.01) and IL-6 (2.75 +/- 1.51 vs. 2.3 +/- 0.91 pg/mL, p = 0.012). TNF-alpha levels tended to decrease (2.3 +/- 0.2 vs. 1.9 +/- 0.1 pg/mL, p = 0.059). Adiponectin increased significantly only among diabetic subjects. The reductions in leptin were correlated with the decreases in BMI (r = 0.464, p < 0.05) and with changes in highly sensitive C-reactive protein (r = 0.466, p < 0.05). DISCUSSION: Weight reduction in obese individuals with insulin resistance was associated with a significant decrease in leptin and IL-6 and a tendency toward a decrease in circulating TNF-alpha, whereas adiponectin was increased only in diabetic subjects. Further studies are needed to elucidate the relationship between changes of adipokines and the health benefits of weight loss.

Laparoscopic Roux-en-Y gastric bypass: minimally invasive bariatric surgery for the superobese in the community hospital setting.

Roux-en-Y gastric bypass (RYGB) operation has become a popular choice for weight-reduction surgery. We report an outcome analysis of our early results with laparoscopic Roux-en-Y gastric bypass for superobese (BMI >50) patients. Between January 2000 and October 2001, we operated on 71 superobese patients. The mean body mass index (BMI) of patients at time of surgery was 57 kg/m2. The prospectively collected data included patient demographics, comorbidities, operative times, postoperative weight loss, and complications. Conversion to open gastric bypass was required in one patient. The overall complication rate was 10 per cent. Preoperative comorbidities were resolved or improved in 93 per cent of patients at 1-year postoperative. Average operative time and length of hospital stay were 196 minutes and 2.3 days, respectively. Mean percentage excess weight loss at 3, 6, 9, and 12 months was 27 per cent, 39 per cent, 49 per cent, and 55 per cent, respectively. Mean BMI decreased to 36 kg/m2 over a 12-month period. Laparoscopic Roux-en-Y gastric bypass surgery for superobese patients as performed in the community hospital setting can be both safe and effective with respect to overall postoperative course, early weight loss, and reduction of comorbidity.

Effect of moderate weight loss on health-related quality of life: an analysis of combined data from 4 randomized trials of Sibutramine ( Meridia ) vs placebo.

OBJECTIVES: To determine whether (1) patients who experience greater weight loss also experience correspondingly greater improvements in health-related quality of life (HRQOL); (2) the improvement in HRQOL is noticeable for patients achieving moderate (5%-10%) weight reduction; and (3) the relationship between weight reduction and HRQOL is similar for patients receiving Sibutramine ( Meridia ) hydrochloride vs placebo. STUDY DESIGN: We combined data from 4 double-blind, randomized, controlled trials of administration of Sibutramine ( Meridia ) (20 mg/d) vs placebo. PATIENTS AND METHODS: Patients (n = 555) were mildly to moderately obese and had type 2 diabetes mellitus, dyslipidemia, or hypertension that was well controlled with an angiotensin-converting enzyme inhibitor or calcium channel blocker. The HRQOL was operationalized using the Impact of Weight on Quality of Life (IWQOL) and the Medical Outcomes Study 36-Question Short-Form (SF-36) instruments. The main statistical technique was a patient-level analysis of variance predicting change in HRQOL from study, treatment, and weight change. RESULTS: Moderate weight loss was associated with a statistically significant improvement in HRQOL for approximately half of the subscales evaluated (P < .05). The greatest sensitivity to change was shown by the SF-36 general health perception and change in health since last year subscales and the IWQOL overall health, mobility, and total subscales. Greater weight loss was associated with the most improvement in HRQOL. weight losses of 5.01% to 10.00% were associated with 2-unit changes in the SF-36 general health perception subscale and 10-unit changes in the IWQOL total subscale. Results were similar across study and treatment. CONCLUSIONS: Moderate weight loss is associated with noticeably improved HRQOL. Improvements in HRQOL are achievable by patients receiving Sibutramine ( Meridia ).

Relationship of a large weight loss to long-term weight change among young and middle-aged US women.

OBJECTIVE: To assess the prevalence of clinically significant weight loss among women and whether this is associated with smaller long-term weight gains. DESIGN: Six-year follow-up of young and middle-aged women in the Nurses' Health Study II. SUBJECTS: A total of 47,515 women who did not report a pregnancy, or a diagnosis of cancer or cardiovascular disease any time between 1989 and 1995. MEASUREMENTS: Self-reported weights in 1989, 1991, 1993 and 1995, dietary intake, physical activity, inactivity, history of weight cycling and smoking. RESULTS: Between 1989 and 1991, 9% of the women lost > or =5% of their 1989 weight (6% lost 5--9.9% and 3% lost > or =10%). The proportion who lost > or =10% of their weight increased with category of body mass index (BMI, kg/m(2)) from 0.4% among women with a BMI <22 to 9% among women with a BMI > or =30 in 1989. Women who lost > or =5% of their weight between 1989 and 1991 gained more weight between 1991 and 1995 than their peers and the difference increased across categories of BMI in 1989. However, due to their large weight losses, women who lost > or =5% of their weight between 1989 and 1991 overall gained less weight than their peers between 1989 and 1995 (P<0.001). Moreover, women who engaged in 5 or more hours per week of vigorous physical activity gained approximately 0.5 kg less than their inactive peers (P<0.001). CONCLUSION: Although most women who lost a clinically significant amount of weight regained most of it, they gained less weight over the entire 6 y period than their peers.