Leptin,adiponectin, and short-term and long-term weight loss after a lifestyle intervention in obese children

ObjectiveIn overweight children, high leptin levels are independently associated with higher risk for cardiovascular disease, whereas adiponectin seems to be protective against type 2 diabetes and atherosclerosis. The study examines the predictive value of leptin for weight loss after a 4- to 6-wk inpatient therapy and again after 1 y; as well as the association among weight loss, leptin, and adiponectin levels and changes in cardiometabolic risk factors after therapy.MethodsBody mass index (BMI), blood pressure, Tanner stage, and cardiometabolic risk factors were studied in 402 children (59.2% females, 13.9 ± 2.3 y, BMI 33.8 ± 5.7 kg/m²) before and after a 4-to 6-wk inpatient intervention (exercise, diet, and behavioral therapy) and BMI 1 y later (n = 206).ResultsBMI was reduced from 33.8 ± 5.7 to 30.5 ± 5.1 kg/m² (P < 0.001) during the lifestyle intervention and remained unchanged after 1 y. Baseline BMI was positively associated with leptin (r = 0.60; P < 0.001) and cardiometabolic risk factors (blood pressure, high-density lipoprotein [HDL] cholesterol, triglycerides). Baseline leptin was associated with BMI and triglycerides (r = 0.39; P < 0.001), baseline adiponectin with HDL-cholesterol (r = 0.40; P < 0.001). Baseline BMI explained 40.7% of the variance in weight loss during therapy. The combination of BMI, sex, and leptin explained 50.4% of the variance. Neither BMI nor leptin predicted weight changes over the long term.ConclusionsOverweight children maintained a substantial amount of weight loss after participation in a short-term inpatient lifestyle intervention. Baseline BMI was positively associated with weight reduction during the intervention, whereas baseline leptin had only a minor predictive value.     

Serum leptin level in obese women with polycystic ovary syndrome,and its relation to insulin resistance

ObjectiveTo compare serum leptin levels in obese women with polycystic ovary syndrome (PCOS) and normal ovulatory obese subjects in Saudi Arabia, and to evaluate the interrelationship between leptin concentration, sex hormones, and insulin resistance.MethodsThe present study was conducted on 40 women with PCOS (34.30 ± 2.08 years, body mass index (BMI) 34.84 ± 4.77 kg/m², mean ± SD) and 16 obese women as control group (28.10 ± 4.61 years, BMI 33.59 ± 1.23 kg/m²). Diagnostic criteria for PCOS based on the presence of two out of three traits including oligo –and/or anovulation, clinical and/or biochemical signs of hyperandrogenism and the presence of polycystic ovaries on ultrasound scan. Concentrations of testosterone, progesterone, prolactin, gonadotrophins, glucose, insulin, and leptin were measured in the baseline fasting blood sample. Serum leptin concentrations were measured by enzyme linked immunosorbant assay.ResultsSerum leptin levels in PCOS patients were significantly higher than that in the control group (P=0.005) independently of BMI, and were significantly different between insulin resistant and non-insulin resistant obese PCOS (P=0.044), In PCOS patients there was a positive correlation between leptin and BMI (P=0.049), and there was no correlation between leptin and other hormonal indices in PCOS patients.ConclusionsThe study revealed that the body mass index and insulin resistance are the two main factors governing serum leptin levels.     

Pre- and post- prandial appetite hormone levels in normal weight and severely obese women

Background

Appetite is affected by many factors including the hormones leptin, ghrelin and adiponectin. Ghrelin stimulates hunger, leptin promotes satiety, and adiponectin affects insulin response. This study was designed to test whether the pre- and postprandial response of key appetite hormones differs in normal weight (NW) and severely obese (SO) women.

Methods

Twenty three women ages 25–50 were recruited for this study including 10 NW (BMI = 23.1 ± 1.3 kg/m²) and 13 SO (BMI = 44.5 ± 7.1 kg/m²). The study was conducted in a hospital-based clinical research centre. Following a 12-hour fast, participants had a baseline blood draw, consumed a moderately high carbohydrate meal (60% carbohydrate, 20% protein, 20% fat) based on body weight. Postprandially, participants had six blood samples drawn at 0, 15, 30, 60, 90, and 120 minutes. Primary measures included pre- and post-prandial total ghrelin, leptin, adiponectin and insulin. A repeated measures general linear model was used to evaluate the hormone changes by group and time (significance p ≤ 0.05).

Results

There were significant differences between the NW and the SO for all hormones in the preprandial fasting state. The postprandial responses between the SO versus NW revealed: higher leptin (p < 0.0001), lower adiponectin (p = 0.04), trend for lower ghrelin (p = 0.06) and insulin was not different (p = 0.26). Postprandial responses over time between the SO versus NW: higher leptin (p < 0.001), lower ghrelin and adiponectin (p = 0.004, p = 0.015, respectively), and trend for higher insulin (p = 0.06).

Conclusion

This study indicates that significant differences in both pre- and selected post- prandial levels of leptin, ghrelin, adiponectin and insulin exist between NW and SO women. Improving our understanding of the biochemical mechanisms accounting for these differences in appetite hormones among individuals with varying body size and adiposity should aid in the development of future therapies to prevent and treat obesity.

     

A prospective study of maternal prenatal weight and offspring cardiometabolic health in midchildhood

PurposeTo examine the relations of maternal prepregnancy body mass index (ppBMI) and gestational weight gain (GWG) with offspring cardiometabolic health.DesignWe studied 1090 mother–child pairs in Project Viva, a Boston-area prebirth cohort. We measured overall (dual x-ray absorptiometry total fat; body mass index z-score) and central adiposity (dual x-ray absorptiometry trunk fat), and systolic blood pressure in offspring at 6 to 10 years. Fasting bloods (n = 687) were assayed for insulin and glucose (for calculation of homeostatic model assessment of insulin resistance), triglycerides, leptin, adiponectin, high sensitivity C-reactive protein, and interleukin 6. Using multivariable linear regression, we examined differences in offspring outcomes per 1 SD maternal ppBMI and GWG.ResultsAfter adjustment for confounders, each 5 kg/m² higher ppBMI corresponded with 0.92 kg (95% confidence interval, 0.70–1.14) higher total fat, 0.27 BMI z-score (0.21–0.32), and 0.39 kg (0.29–0.49) trunk fat. ppBMI was also positively associated with homeostatic model assessment of insulin resistance, leptin, high sensitivity C-reactive protein, interleukin 6, and systolic blood pressure; and lower adiponectin. Each 5 kg of GWG predicted greater adiposity (0.33 kg [0.11–0.54] total fat; 0.14 kg [0.04–0.23] trunk fat) and higher leptin (6% [0%–13%]) in offspring after accounting for confounders and ppBMI.ConclusionsChildren born to heavier mothers have more overall and central fat and greater cardiometabolic risk. Offspring of women with higher GWG had greater adiposity and higher leptin.     

Effects of a 12-Week Lifestyle Intervention on Health Outcome and Serum Adipokines in Middle-Aged Korean Men with Borderline High Blood Pressure

Background: High blood pressure, in relation to blood levels of adipokines such as adiponectin and leptin, is highly associated with an unhealthy lifestyle including sedentary behaviors, poor dietary habits such as excess sodium intake, and heavy drinking. Strategies to reduce blood pressure may benefit the levels of adipokines.

Objective: Thus, we aimed to investigate the effects of lifestyle intervention on blood pressure and serum adipokines in middle-aged Korean men with borderline high blood pressure (systolic blood pressure [SBP] ≥ 130 mm Hg or diastolic blood pressure [DBP] ≥ 85 mm Hg).

Methods: Fifty-two men (aged 42.5 ± 8.5 years) with normal weight (body mass index [BMI] < 25 kg/m²) and high BP (NH group) and 40 men (age 42.0 ± 8.4 years) who were obese (BMI ≥ 25 kg/m²) with high BP (OH group) underwent 5 sessions of one-on-one intensive counseling including instruction on a nutritionally balanced diet, a low-sodium diet, how to understand calorie requirements, and strategies to implement regular exercise for blood pressure regulation over 12 weeks. In order to increase the awareness of sodium education, a salt sensory test using an unseasoned soup was performed. Anthropometrics, blood pressure measurements, 24-hour recalls were performed, and blood levels of lipids, fasting plasma glucose, C-reactive protein (CRP), leptin, and adiponectin were analyzed at week 0 and at week 12. Sodium consumption was roughly estimated using the Dish-based Frequency Questionnaire–15.

Results: Weight, BMI, body fat (kg and %), waist circumference, hip circumference, and blood pressure were significantly decreased after 12 weeks (p < 0.05) in all subjects. Similarly, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and CRP were decreased (p < 0.05), but LDL-C/HDL-C was significantly decreased (p < 0.01) only in the obese subjects. At baseline, blood levels of leptin were significantly higher in the obese subjects than in the normal weight subjects. In the obese subjects, a significantly negative correlation was found between leptin levels at baseline and percentage change in DBP (r = –0.338, p < 0.05). After 12 weeks, blood levels of adipokines did not show significant changes.

Conclusions: These results suggest that a short-term (12 weeks) lifestyle intervention had positive effects on blood pressure control and weight reduction in the subjects, but not on their blood levels of adipokines. It is interesting that blood level of baseline leptin was negatively associated with the changes in blood pressure after this short-term intervention.     

Favorable Effect of Short-Term Lifestyle Intervention on Human Paraoxonase-1 Activity and Adipokine Levels in Childhood Obesity

Objective: The prevalence of obesity is increasing in adult and child populations throughout the world. Childhood obesity has a great impact on adult cardiovascular morbidity and mortality; treatment of this pathological state is important given the significant health consequences. We investigated the effect of short-term lifestyle changes on the alteration of human serum paraoxonase-1 (PON1) activities, leptin, adiponectin, E-selectin, and asymmetric dimethylarginine (ADMA) as atherogenic and antiatherogenic factors in obese children. PON1 protects lipoproteins against oxidation by hydrolyzing lipid peroxides in oxidized low density lipoprotein (LDL) and therefore may protect against atherosclerosis.

Methods: A total of 23 white obese and overweight children (age, 11.43 ± 1.78 years; 8 girls, 15 boys) participated in a 2-week-long lifestyle camp based on a diet and exercise program. Overweight and obesity were defined according to the national body mass index (BMI) reference tables for age and sex.

Results: After a 2-week-long supervised diet and aerobic exercise program, obese children had significantly lower leptin (55.02 ± 33.42 ng/ml vs 25.37 ± 19.07 ng/ml; p < 0.0001), ADMA (0.68 ± 0.15 μmol/l vs 0.55 ± 0.16 μmol/l; p < 0.01), and E-selectin levels (67.19 ± 30.35 ng/ml vs 46.51 ± 18.40 ng/ml; p < 0.0001), whereas they had significantly higher PON1 paraoxonase activity (110.48 ± 72.92 U/l vs 121.75 ± 93.48 U/l; p < 0.05) besides the antiatherogenic alteration of the lipid profile and significant weight change (70.32 ± 19.51 kg vs 67.01 ± 18.75 kg, p < 0.0001; BMI, 28.95 ± 5.05 kg/m² vs 27.43 ± 4.82 kg/m², p < 0.0001). Adiponectin and PON1 arylesterase activity did not change significantly.

Conclusions: Our investigation suggests that modifications in dietary habits and physical activity induce antiatherogenic changes in childhood obesity. These findings emphasize the major role of primary prevention and nonpharmaceutical treatment of childhood obesity through lifestyle changes based on diet and increased physical activity.     

Associations of body mass index and insulin resistance with leptin,adiponectin, and the leptin-to-adiponectin ratio across ethnic groups: the Multi-Ethnic Study of Atherosclerosis (MESA)

PurposeAssociations of adiponectin and leptin and their ratio with body mass index (BMI) and homeostasis model assessment of insulin resistance (HOMA-IR) have been investigated in different ethnic groups but variability in both assays and statistical methods have made cross-study comparisons difficult. We examined associations among these variables across four ethnic groups in a single study.MethodsAdiponectin and leptin were measured in a subset of participants from the Multi-Ethnic Study of Atherosclerosis study. We calculated associations (using both partial correlations and adjusted linear regression) in each ethnic group and then compared the magnitude of these associations across groups.ResultsAfter we excluded individuals with type 2 diabetes, there were 714 white, 219 Chinese, 332 African-American, and 405 Hispanic subjects in the study sample. Associations of BMI with adiponectin and leptin differed significantly (P < .05) across the ethnic groups in regression analyses, whereas associations of HOMA-IR with adiponectin and leptin did not differ across ethnic groups. The leptin-to-adiponectin ratio was not associated with a greater amount of adiposity or HOMA-IR variance than leptin or adiponectin in any ethnic group.ConclusionsGiven the consistency of HOMA-IR and adipokine associations, the differing means of adiponectin and leptin across ethnic groups may help to explain ethnic differences in mean insulin resistance.     

Prolonged fasting in patients with chronic pain syndromes leads to late mood-enhancement not related to weight loss and fasting-induced leptin depletion

Abstract

Periods of fasting are practiced worldwide on a cultural/religious background, and related mood-enhancing effects are postulated. We aimed to assess the effect of fasting on mood and to explore the interaction with neuroendocrine activation and leptin depletion in a controlled explorative study on consecutive inpatients (BMI < 35 kg/m²) of a nutritional ward. 36 subjects (38.9 ± 7.0 years; 29 female, BMI 26.7 ± 4.1 kg/m²) participated in an 8-day modified fast (300 kcal/day), 19 patients (38.1 ± 5.9 years; 18 female, 23.5 ± 4.1 kg/m²) received a mild low calorie diet. Measurements included daily ratings of mood (VAS), weight and levels of leptin and cortisol at four time-points of the 2-week study period. Weight loss was 4.8 ± 1.2 and 1.6 ± 0.9 kg in fasters and controls, respectively. Fasters showed a more pronounced decrease of leptin (58% vs. 20%; P < 0.001) and a 17% increase of cortisol levels (P < 0.001). Mood ratings increased significantly in the late phase of fasting (P < 0.01) but were not related to weight-loss, leptin-depletion or cortisol increase. Our findings suggest that fasting induces specific mood-enhancement. The physiological mediator appears to be neither leptin nor cortisol, the role of other mechanisms has to be further studied.     

Does there exist an obesity paradox in COVID-19? Insights of the international HOPE-COVID-19-registry

BackgroundObesity has been described as a protective factor in cardiovascular and other diseases being expressed as ‘obesity paradox’. However, the impact of obesity on clinical outcomes including mortality in COVID-19 has been poorly systematically investigated until now. We aimed to compare clinical outcomes among COVID-19 patients divided into three groups according to the body mass index (BMI).MethodsWe retrospectively collected data up to May 31^st, 2020. 3635 patients were divided into three groups of BMI (<25 kg/m²; n = 1110, 25?30 kg/m²; n = 1464, and >30 kg/m²; n = 1061). Demographic, in-hospital complications, and predictors for mortality, respiratory insufficiency, and sepsis were analyzed.ResultsThe rate of respiratory insufficiency was more recorded in BMI 25?30 kg/m² as compared to BMI < 25 kg/m² (22.8% vs. 41.8%; p < 0.001), and in BMI > 30 kg/m² than BMI < 25 kg/m², respectively (22.8% vs. 35.4%; p < 0.001). Sepsis was more observed in BMI 25?30 kg/m² and BMI > 30 kg/m² as compared to BMI < 25 kg/m², respectively (25.1% vs. 42.5%; p = 0.02) and (25.1% vs. 32.5%; p = 0.006). The mortality rate was higher in BMI 25?30 kg/m² and BMI > 30 kg/m² as compared to BMI < 25 kg/m², respectively (27.2% vs. 39.2%; p = 0.31) (27.2% vs. 33.5%; p = 0.004). In the Cox multivariate analysis for mortality, BMI < 25 kg/m² and BMI > 30 kg/m² did not impact the mortality rate (HR 1.15, 95% CI: 0.889?1.508; p = 0.27) (HR 1.15, 95% CI: 0.893?1.479; p = 0.27). In multivariate logistic regression analyses for respiratory insufficiency and sepsis, BMI < 25 kg/m² is determined as an independent predictor for reduction of respiratory insufficiency (OR 0.73, 95% CI: 0.538?1.004; p = 0.05).ConclusionsHOPE COVID-19-Registry revealed no evidence of obesity paradox in patients with COVID-19. However, Obesity was associated with a higher rate of respiratory insufficiency and sepsis but was not determined as an independent predictor for a high mortality.     

Is a body mass index of 23 kg/m2 a reliable marker of protein–energy wasting in hemodialysis patients?

ObjectiveTo evaluate the body composition and inflammatory status in patients on hemodialysis (HD) according to the cutoff of 23 kg/m² for the body mass index (BMI).MethodsForty-seven patients (30 men, 11 diabetics, 53.8 ± 12.2 y of age, 58.2 ± 50.9 mo on HD) were studied. Anthropometric data and handgrip strength were evaluated. C-reactive protein, tumor necrosis factor-α, leptin, and interleukin-6 were measured. Mortality was assessed after 24 mo of follow-up.ResultsNineteen patients (40.4%) presented BMI values lower than 23 kg/m² and leptin levels, midarm muscle area, and free-fat mass were significantly lower in these patients. The prevalence of functional muscle loss according to handgrip strength was not different between the BMI groups. The sum of skinfold thicknesses, the percentage of body fat, fat mass, the fat mass/free-fat mass ratio, and waist circumference were significantly lower in patients with a BMI lower than 23 kg/m², but the mean values did not indicate energy wasting. Patients with a BMI higher than 23 kg/m² presented a higher prevalence of inflammation and higher waist circumference and body fat values. The adiposity parameters were correlated with C-reactive protein and leptin. A Cox multivariate regression analysis demonstrated that C-reactive protein, tumor necrosis factor-α, and interleukin-6 predict cardiovascular mortality.ConclusionPatients on HD with a BMI lower than 23 kg/m² did not present signs of energy wasting, whereas those with a BMI higher than 23 kg/m² had more inflammation, probably because of a greater adiposity. Thus, the BMI value of 23 kg/m² does not seem to be a reliable marker of protein–energy wasting in patients on HD.     

Weight loss increased serum adiponectin but decreased lipid levels in obese subjects whose body mass index was lower than 30 kg/m

We hypothesized that weight loss in obese subjects may affect adipokine levels, such as adiponectin and tumor necrosis factor (TNF) α. This study investigated the effects of an 8-week weight-control program on serum adiponectin, TNF-α, and blood lipid level profiles in obese subjects. Twenty obese subjects with a body mass index (BMI) higher than 25 kg/m² were recruited for this weight loss program that used dietetic control and aerobic exercise training. A total of 3 obese men and 11 obese women (mean age, 40.3 ± 10.8 years; BMI, 30.0 ± 3.4 kg/m²) finished the program. Anthropometric and biochemical characteristics in subjects before and after the program were determined. The results showed that subjects' body weight, BMI, waist circumference, hip circumference, diastolic blood pressure, total cholesterol, and low-density lipoprotein cholesterol levels significantly (P < .05) decreased during the program. Further analysis showed a negative correlation between delta adiponectin and delta TNF-α, triacylglycerol, and systolic blood pressure in obese subjects. Subgroup analysis showed that obese subjects whose original BMI was less than 30 kg/m² had significantly increased serum adiponectin levels, and more than 3% weight reduction markedly improved blood lipids and body fat profiles during the program. Our findings suggest that weight reduction through an 8-week weight loss program may have anti-inflammatory and antiatherogenic effects via increased serum adiponectin levels and improvements in blood lipid profiles and systolic blood pressure.     

Circulating visfatin in obese non-diabetic patients in relation to cardiovascular risk factors,insulin resistance,and adipocytokines: A contradictory piece of the puzzle

ObjectiveObesity and insulin resistance are associated with cardiovascular risk factors. The aim of the present study was to explore the relation of circulating visfatin to insulin resistance, cardiovascular risk factors, anthropometry, and adipocytokines in obese patients without diabetes mellitus.MethodsA population of 228 obese non-diabetic outpatients was analyzed in a prospective way. All patients with a 2-wk weight-stabilization period before recruitment were enrolled. Biochemical analysis and nutritional evaluation were performed.ResultsSubjects were 62 men (27.2%) and 166 women (62.8%) with a mean age of 41.1 ± 16.4 y and a mean body mass index of 35.8 ± 3.6 kg/m². Patients were divided in two groups by median visfatin value (22.8 ng/mL), i.e., those with low values (group I) and those with high values (group II). Patients in group I had greater weight, body mass index, fat mass, fat-free mass, insulin, homeostasis model of assessment, triacylglycerol, leptin, and adiponectin than patients in group II. Patients in group II had higher total cholesterol, low-density lipoprotein cholesterol, resistin, and tumor necrosis factor-α levels than patients in group I. In a multivariate analysis with age- and sex-adjusted basal visfatin concentration as a dependent variable, only weight and leptin remained as an independent predictor in the model (F = 6.5, P < 0.05), with an inverse correlation.ConclusionTotal cholesterol, low-density lipoprotein cholesterol, tumor necrosis factor-α, and resistin levels are elevated in patients with visfatin levels above the median value. Homeostasis model of assessment, insulin, weight, fat mass, fat-free mass, triacylglycerols, leptin, and adiponectin are decreased in these patients.     

The association of circulating endocannabinoids with appetite regulatory substances in obese women

BackgroundsEndocannabinoids especially anadamide (AEA) and 2‑arachidonoylglycerol (2-AG) together with appetite modulators have recently been of great importance in body weight regulation and obesity incidence. The present study was carried out to investigate AEA and 2-AG levels and their association with leptin, insulin, orexin – A, and anthropometric indices in obese women.MethodsThe demographic and anthropometric data of 180 overweight/ obese women with mean age 34.2 ± 8.27 years old, and mean BMI 32.54 ± 3.73 kg/m² were evaluated. The plasma levels of anadamide and 2‑arachidonoylglycerol levels and also serum levels of leptin, insulin and orexin- A concentrations were measured. Pearson and spearmen correlation tests along with hieratical regression test were used to assess the association of endocannabinoids levels with anthropometric indices and appetite modulators.ResultsSignificant correlations were revealed between AEA and 2-AG with leptin, BMI, waist circumference (WC) and body fat percent (BF%) (P < 0.001). 2-AG levels correlated positively with mean insulin levels (P < 0.001). Neither AEA nor 2-AG correlated significantly with serum orexin - A levels. Leptin, insulin, BMI, WC, and BF% were significant independent predictors of AEA and 2-AG in the hierarchical regression model (P < .001) and explained 65% and 68% of variance in AEA and 2-AG respectively (P < 0.001).ConclusionThe findings showed that levels of AEA and 2-AG were associated with BMI, WC, BF%, and leptin and insulin levels. Also, BMI, WC, BF%, leptin and, insulin levels can have predictive value for determining AEA and 2-AG.     

Crosstalk Between Bone and Fat Tissue: Associations Between Vitamin D,Osteocalcin, Adipokines,and Markers of Glucose Metabolism Among Adolescents

Objectives: This study aimed to investigate the relationship between 25-hydroxyvitamin D (25(OH)D), osteocalcin, markers of glucose metabolism, and obesity-related parameters among adolescents.

Methods: This was a cross-sectional study with 198 adolescents age 14–18 years. Weight, height, and waist and hip circumferences were measured, as well as the following biochemical parameters: serum 25(OH)D, parathyroid hormone (PTH), total (tOC) and undercarboxylated (ucOC) osteocalcin, adiponectin, leptin, glucose, and insulin. The homeostasis model of assessment estimate of insulin resistance (HOMA-IR) and β-cell function (HOMA-β) and quantitative insulin sensitivity check index (QUICKI) were calculated. Student's t test, analysis of variance (ANOVA), Pearson's correlation, and linear regression models were performed.

Results: Overweight was observed in 42.6% of the sample. This group presented significantly higher PTH, leptin, insulin, HOMA-IR, and HOMA-β and lower 25(OH)D, adiponectin, tOC, ucOC, and QUICKI than normal-weight subjects. 25(OH)D was positively correlated with ucOC and adiponectin and negatively associated with body mass index (BMI), weight, and waist circumference (p < 0.05 for all). The association between 25(OH)D and ucOC was also observed in the multiple regression analysis, adjusted for age, BMI, and season of the year (partial r² = 0.071, p < 0.0001). 25(OH)D and ucOC were not associated with markers of glucose metabolism. However, leptin was strongly correlated with insulin, HOMA-IR, HOMA-β, and QUICKI (p < 0.0001 for all).

Conclusion: The present study demonstrated that undercarboxylated osteocalcin is related to 25(OH)D and adiponectin concentrations. Both ucOC and 25(OH)D were lower in overweight and obese adolescents, reinforcing the importance of fighting obesity. Although a relationship of ucOC and 25(OH)D with markers of glucose metabolism was not observed, leptin has shown to be the hormone most related to energy homeostasis.     

Efficacy,safety, and tolerability of a levonorgestrel/ethinyl estradiol transdermal delivery system: Phase 3 clinical trial results

ObjectiveTo assess the contraceptive efficacy, safety, and tolerability of a contraceptive transdermal delivery system, (TDS; TWIRLA^?) containing levonorgestrel (LNG) and ethinyl estradiol (EE).Study designThis single-arm, open-label, multicenter, 1-year (13 cycle), phase 3 study enrolled sexually active women ≥18 years old at risk for pregnancy irrespective of body mass index (BMI). Women used patches in 28-day cycles (3 consecutive administrations of 7-day patches followed by 7 days off-treatment/patch-free week). We assessed contraceptive efficacy by the Pearl Index (PI) in women 18 to 35 years, excluding cycles without intercourse or when other contraceptive methods were used.ResultsThe study enrolled 2032 demographically diverse women in the US, of which 35.3% had a BMI ≥30 kg/m². In the primary efficacy analysis, the PI (95% confidence interval) was 5.8 (4.5–7.2) pregnancies per 100 woman-years. PIs trended higher as BMI increased; the PI was 4.3 (2.9–5.8) in women with BMI <30 kg/m² and 8.6 (5.8–11.5) in women with BMI ≥30 kg/m². Hormone-related treatment-emergent adverse events included nausea (4.1%) and headache (3.6%); 11% of women discontinued due to adverse events. Four women (all with BMIs ≥30 kg/m²) reported thromboembolic events considered related to treatment.ConclusionsThe low-dose LNG/EE TDS was effective in preventing pregnancy in a population of women representative of US demographics. Efficacy was reduced in women with BMI ≥30 kg/m². The TDS safety and tolerability profile was consistent with other similar dose combined hormonal contraceptives. Results of this phase 3 study supported the US Food and Drug Administration approval of TWIRLA^? for prevention of pregnancy in women with BMI <30 kg/m².ImplicationsTDS (120 µg/day levonorgestrel and 30 µg/day ethinyl estradiol) is an effective, low-dose transdermal contraceptive patch with favorable tolerability profile approved for prevention of pregnancy in women with BMI <30 kg/m². TDS has reduced effectiveness in women with BMI ≥30 kg/m².     

Pre-pregnancy metabolic syndrome and insulin administration in gestational diabetes: A nationwide population-based cohort study

BackgroundThe present study aimed to evaluate whether mothers with obesity/central obesity and metabolic syndrome before gestation are at higher risk of insulin administration in gestational diabetes mellitus (GDM) to diminish the burden of insulin use during pregnancy.MethodsThis was a population-based retrospective cohort study conducted using data from the National Health Information Database of Korea. We identified all deliveries from January 1, 2011 to December 31, 2015 (N = 1,214,655). Among the deliveries, we identified mothers with pre-pregnancy health checkup records and without previous diabetes history (N = 325,208). Hazards of insulin use in GDM were calculated based on pre-pregnancy obesity/central obesity and metabolic syndrome.ResultsHazards of insulin use in GDM increased proportionately with an increase in the pre-pregnancy body mass index (BMI) and waist circumference (WC). After the adjustment for clinical factors, high BMI group (≥30 kg/m²) and high WC group (≥100 cm) were significantly associated with higher hazard ratios (HRs) (HR 4.161, 95% Confidence interval [CI] 3.381–5.121, P < 0.001 and HR 2.563, 95% CI 1.769–3.712, P < 0.001, respectively). The presence of pre-pregnancy metabolic syndrome significantly increased the hazard of insulin use in GDM (0.54% vs. 5.04%). In the presence of obesity (BMI ≥ 25 kg/m²) or central obesity (WC ≥ 85 cm), HRs of insulin use in GDM were 2.637 (95% CI 2.275–3.056) and 1.603 (95% CI 1.023–2.511), respectively, after adjustment for clinical factors.ConclusionsThe presence of pre-pregnancy obesity/central obesity and metabolic syndrome in Korean mothers is associated with increased risk of insulin use in GDM.     

Impact of Body Mass Index on the Incidence of Cardiometabolic Risk Factors in Ambulatory Care Settings over 5 Years or More

ObjectiveThis study was performed to evaluate the association of body mass index (BMI) with the incidence of cardiometabolic risk factors in ambulatory care electronic medical records (EMRs) over 5 years or more.DesignA retrospective cohort of normal versus obese patients.SubjectsSubjects ≥18 years were identified between 1996 and 2005.MeasurementsPatients were categorized as either normal weight (18 kg/m² < BMI ≤ 27 kg/m²) or obese (BMI > 27 kg/m²) based on baseline BMI (measured 395 days or more after first EMR activity). Outcomes included development, at least 180 days after the first BMI reading date, of four cardiometabolic risk factors (elevated triglycerides, low high-density lipoprotein cholesterol [HDL-C], hypertension, or type 2 diabetes) determined from ICD-9 code, prescribed drug, or biometric reading. Logistic regression estimated the odds of developing cardiometabolic risk factors, alone and combined for normal versus obese patients forward for at least 5 years.ResultsSeventy-one percent were female, mean age was 43.5 years, and 37.6% had a baseline BMI > 27 kg/m². Comparing obese versus normal weight patients, adjusted odds ratios for the incidence of elevated triglycerides, hypertension, diabetes, and low HDL-C were 2.1 (95% confidence interval [95% CI] 1.9–2.3), 2.2 (95% CI 2.1–2.4), 2.3 (95% CI 2.0–2.7), and 2.2 (95% CI 2.0–2.4), respectively. Adjusted odds ratios of developing one and all four new risk factors were 1.9 (95% CI 1.8–2.1) and 7.9 (95% CI 5.9–10.5), respectively.ConclusionObese patients are approximately twice as likely to develop cardiometabolic risk factors compared with those having normal weight over 5 or more years.     

Home-based exercise for middle-aged Chinese at diabetic risk: a randomized controlled trial

Objective

To evaluate short- (3 months) and long-term (9 months) effects of home-based exercise on adiponectin, exercise behavior and metabolic risk factors in middle-aged adults at diabetic risk.

Methods

One hundred and thirty-five middle-aged adults (38 men, 97 women) with at least one diabetic risk factor were randomly assigned to either a home-based exercise group (Ex-group) or a usual care group (C-group). Outcome measures included plasma adiponectin, exercise self-efficacy, physical activity, and metabolic risk factors, as follows: insulin levels, insulin resistance by homeostasis model assessment (HOMA-IR), physical fitness, and components of metabolic syndrome. This study was conducted in metropolitan Taipei from 2004 to 2005.

Results

The Ex-group had improvements in exercise self-efficacy (+ 2.5, p = 0.01), body mass index (BMI) (− 0.6 kg/m², p < 0.001) and flexibility (+ 2.4 cm, p < 0.001) at 3-month follow-up and maintained BMI and flexibility at 9-month follow-up. The Ex-group exhibited significantly increased physical activity while the C-group exhibited decreased physical activity at 9-month follow-up (p < 0.001). No intervention effect was found on adiponectin (p = 0.64) or other outcome measures over time.

Conclusions

Home-based exercise did not improve adiponectin levels, but significantly improved exercise behavior, and certain metabolic risk factors, with the effects maintained for 9-months in subjects with type 2 diabetic risk.     

中药正肝汤对乙型肝炎肝硬化患者血清瘦素、脂联素水平以及胰岛素抵抗影响的分析

目的 观察中药制剂正肝汤治疗乙型肝炎(乙肝)肝硬化患者对其血清瘦素(LEP)、脂联素(ADP)水平及胰岛素抵抗(IR)的影响。方法 将入选的66例乙肝肝硬化患者随机分为对照组(31例)和治疗组(35例), 其中对照组选用肌苷片和维生素C口服治疗, 治疗组在此基础上, 应用正肝汤治疗, 疗程为3个月, 测定治疗前后患者血清LEP、ADP水平及IR指数。结果 对照组血清LEP、ADP水平和IR指数与治疗前比较, 差异无统计学意义(P>0.05);治疗组血清LEP、ADP水平和IR指数较治疗前明显下降, 差异有统计学意义(P<0.05), 治疗组血清LEP和ADP水平与对照组比较, 差异有统计学意义(P<0.05)。结论 正肝汤治疗乙肝肝硬化患者具有降低血清LEP、ADP水平, 并有改善IR的作用。     

Body-Mass Index and Mortality in Incident Dementia: A Cohort Study on 11,398 Patients From SveDem,the Swedish Dementia Registry

BackgroundBody mass index (BMI) is used worldwide as an indirect measure of nutritional status and has been shown to be associated with mortality. Controversy exists over the cut points associated with lowest mortality, particularly in older populations. In patients suffering from dementia, information on BMI and mortality could improve decisions about patient care.ObjectivesThe objective was to explore the association between BMI and mortality risk in an incident dementia cohort.DesignCohort study based on SveDem, the Swedish Quality Dementia Registry; 2008–2011.SettingSpecialist memory clinics, Sweden.ParticipantsA total of 11,398 patients with incident dementia with data on BMI (28,190 person-years at risk for death).Main outcome measuresHazard ratios and 95% confidence intervals for mortality associated with BMI were calculated, controlling for age, sex, dementia type, results from Mini-Mental State Examination, and number of medications. BMI categories and linear splines were used.ResultsHigher BMI was associated with decreased mortality risk, with all higher BMI categories showing reduced risk relative to patients with BMI of 18.5 to 22.9 kg/m², whereas underweight patients (BMI <18.5 kg/m²) displayed excess risk. When explored as splines, increasing BMI was associated with decreased mortality risk up to BMI of 30.0 kg/m². Each point increase in BMI resulted in an 11% mortality risk reduction in patients with BMI less than 22.0 kg/m², 5% reduction when BMI was 22.0 to 24.9 kg/m², and 3% risk reduction among overweight patients. Results were not significant in the obese weight range. Separate examination by sex revealed a reduction in mortality with increased BMI up to BMI 29.9 kg/m² for men and 24.9 kg/m² for women.ConclusionHigher BMI at the time of dementia diagnosis was associated with a reduction in mortality risk up to and including the overweight category for the whole cohort and for men, and up to the normal weight category for women.