Sleep and body weight in diabetes mellitus: a large retrospective analysis from South India

AIM: To analyze the pattern of sleep disorders among 4624 individuals with type 2 diabetes mellitus who complained of disturbed sleep at our centre in South India. METHODS: Retrospective analysis of data from electronic medical records. RESULTS: Body mass index or body weight was not related to the prevalence of sleep disturbances. They were more in sedentary individuals, who consumed alcoholic beverages, and those with known hypertension or with a family history of diabetes. Body mass index was not a risk factor even after excluding known factors disturbing sleep (viz. nocturia, body pains, burning soles). CONCLUSION: Body weight in type 2 diabetes mellitus was not related to the prevalence of sleep disorders in our sample.     

Composition of insulin-induced body weight gain in diabetic patients: a bio-impedance study

Although insulin is a well-known cause of body weight gain, it is not clear whether it is due to the accumulation of fat or lean mass. We performed a 3 months Body-Impedance Analysis follow-up in 72 diabetic patients in a wide range of insulin indications: insulin introduction in young inaugural type 1 diabetics (n = 12), late-onset type 1 (n = 12), type 2 affected by intercurrent diseases (n = 12) or microangiopathic complications (n = 12), type 2 with failure of oral antidiabetic agents (n = 12), and insulin withdrawal in type 2 (n = 12). In type 1 patients, insulin led to the most important weight gain, but it was fat-free, with a major benefit on HbA1C. Type 2 patients affected by intercurrent diseases or microangiopathic complications had a mild, also fat-free weight gain, with a clear benefit on HbA1C. In type 2 patients with failure of oral agents, HbA1C declined less, weight gain was intermedia, but predominantly fat, mirrored by a predominant fat loss in type 2 patients whose insulin was stopped (without significant change in HbA1C). Both fat and lean mass contributed to insulin-induced body weight gain, but a significant negative relationship existed between their respective evolution in our patients (r = -0.23, p < 0.05 by linear regression analysis between delta fat mass and delta lean mass). Insulin-induced body weight gain is not univocal: insulin restaures or protects lean mass in its less controversial indications, whereas it leads to fat accumulation in type 2 patients with isolated failure of oral agents.     

Asthma and body weight change: a 20-year prospective community study of young adults

OBJECTIVE: There is increasing evidence for an association between asthma and body weight change. The objectives of these analyses were to examine the temporal relationships of this association and to explore the role of childhood depression as an explanatory factor. METHODS: Data were derived from six subsequent semistructured interviews on health habits and health conditions from a single-age community study of 591 young adults followed up between ages 20 and 40 years. RESULTS: Cross-sectionally (over the whole study period), asthma was significantly associated with obesity (odds ratio=3.9 [95% confidence interval 1.2, 12.2]). Multivariate longitudinal analyses revealed that asthma was associated with increased later weight gain and later obesity among women after controlling for potentially confounding variables, whereas weight gain and obesity were not associated with later asthma. A secondary analysis showed that depressive symptoms during childhood were associated with adult obesity and asthma, partially explaining the asthma-obesity comorbidity. CONCLUSION: This study encourages further research on mechanisms underlying the asthma-obesity comorbidity, particularly on shared psychosocial factors operating during critical periods in childhood and adolescence that may influence the development and persistence of both obesity and asthma during adulthood.     

Energy expenditure, fat oxidation, and body weight regulation: a study of metabolic adaptation to long-term weight change

Relatively low rates of energy expenditure and fat oxidation predict body weight gain. Weight gain, in turn, is associated with increases in energy expenditure and fat oxidation that may oppose further weight change. In response to experimental weight gain induced by overfeeding, increases in energy expenditure and fat oxidation are overcompensatory, i.e. greater than predicted for the change in body composition. To determine whether such metabolic adaptation occurs in response to spontaneous long term weight change, we conducted a longitudinal study in which 24-h energy expenditure (24-EE) and 24-h respiratory quotient (24-RQ; i.e. fat to carbohydrate oxidation) were repeatedly measured in 102 Pima Indians at baseline and after a mean follow-up of 3.6 +/- 2.7 yr, during which changes in body weight varied widely (-21 to +28 kg). We found that changes in 24-EE and 24-RQ in response to weight change were related to the amount of weight change, even after adjustment for body composition (partial r = 0.23 and -0.30, respectively; both P < 0.05). For a 15-kg weight gain, the increases in 24-EE (+244 Cal/day) and 24-h fat oxidation (+152 Cal/day) were 33 and 53 Cal/day greater than predicted from the cross-sectional relationship between both measures and body weight. Changes in 24-EE and 24-RQ varied substantially among individuals. Thus, on the average, spontaneous long term weight changes are accompanied by small metabolic adaptations in both energy expenditure and fat oxidation. The metabolic responses to weight changes are highly variable among individuals, however.     

Association between primary hyperparathyroidism and increased body weight: a meta-analysis

Although primary hyperparathyroidism is frequently asymptomatic, it has been associated with an increased prevalence of hypertension, insulin resistance, dyslipidemia, cardiovascular mortality, and cancer. Previously we reported that patients with primary hyperparathyroidism are heavier than age-matched controls. Increased body weight could contribute to the association between primary hyperparathyroidism and these extraskeletal complications. We searched MEDLINE for English language studies published between 1975 and 2003 that reported body weight or body mass index in subjects with primary hyperparathyroidism and a healthy age- and sex-comparable eucalcemic control group. Seventeen eligible studies were identified. Subjects with primary hyperparathyroidism were 3.34 kg (95% confidence interval, 1.97-4.71; P < 0.00001) heavier than controls in 13 studies reporting body weight. In four studies reporting body mass index, subjects with primary hyperparathyroidism had an increased body mass index of 1.13 kg/m(2) (-0.29 to 2.55; P = 0.12) compared with controls. Standard mean difference analysis showed that subjects with primary hyperparathyroidism had an increased weight or body mass index of 0.3 sd (0.19-0.40; P < 0.00001) compared with controls. We conclude that patients with primary hyperparathyroidism are heavier than their eucalcemic peers, and that increased body weight may contribute to the reported associations between primary hyperparathyroidism and some extraskeletal complications.     

Non-gonococcal infectious arthritis: a retrospective study

In a retrospective study the outcome of non-gonococcal infectious arthritis was evaluated in 76 adult patients admitted to the Leiden University Hospital between 1970 and 1984. The mortality rate was 12%, and complete recovery was achieved in only 19 of the 76 patients (25%). Each of the following had a significantly unfavourable influence on the residual joint function: duration of infection more than 14 days, female sex, presence of rheumatoid arthritis, and presence of a joint prosthesis.     

Selected eating behaviours and excess body weight: a systematic review

The relationship between obesity and the intake of macronutrients and specific foods is uncertain. Thus, there is growing interest in some eating behaviours because they may reflect the joint effect of several foods and nutrients and, thus, increase the likelihood of finding a link to obesity. This study examined the association between selected eating behaviours and excess weight in the general population throughout a systematic review of publications written in English, Spanish or Portuguese identified in a PubMed search up to 31 December 2010. We included 153 articles, 73 of which have been published since 2008. Only 30 studies had a prospective design; of these, 15 adjusted for sociodemographic variables, physical activity and energy or food intake. Moreover, definitions of eating behaviours varied substantially across studies. We found only small or inconsistent evidence of a relationship between excess weight and skipping breakfast, daily eating frequency, snacking, irregular meals, eating away from home, consumption of fast food, takeaway food intake, consumption of large food portions, eating until full and eating quickly. In conclusion, this review highlights the difficulty in measuring human behaviour, and suggests that a more systematic approach is needed for capturing the effects of eating behaviours on body weight.     

Infections after craniotomy: a retrospective study

A retrospective study was performed to evaluate the rate of infection directly related to craniotomy. Of 246 craniotomies performed in 1981, 234 could be evaluated. The overall incidence of infection was 8.1% (19 infections in 18 patients). The infection rate was 15.2% after insertion of a ventricular shunt (seven infections after 45 ventriculostomies). Staphylococcus aureus, Staphylococcus epidermidis and Propionibacterium acnes were the most frequent isolated micro-organisms. We recommended a double-blind prospective study to evaluate the possible benefit of antibiotic prophylaxis in craniotomies.     

A prospective study of body fat distribution and weight loss

Previous studies have suggested an association between adipose tissue cellularity and body fat distribution, and between adipose tissue cellularity and ability to lose weight. To determine whether there was an association between body fat distribution and ability to lose weight, we prospectively studied 187 severely obese women. The women were all 50 percent or more above ideal body weight, with personal physician documentation of no known major illnesses. Weights were recorded at the beginning and end of a 3-week hospitalization and every 3 months following hospitalization, for up to 2 years. The ratio of waist girth to hip girth (WHR) was used as an index of body fat distribution. A statistical analysis which adjusted for age and weight on admission did not find any association between WHR and weight loss during hospitalization, or at any time up to 2 years after hospital discharge. We conclude that the WHR index of body fat distribution is not a useful prognostic indicator of weight change for severely obese women with refractory obesity.     

Alcohol and body weight

Alcohol intake contributes to energy balance. Chronic and moderate alcohol consumption (i.e. 20-40 g/day) plus a high fat intake (i.e. > 40% of energy intake) favor a positive energy balance and thus weight gain. By contrast a high alcohol intake (i.e. > 20% of energy intake) may lead to malnutrition depending on the concomitant nutrient intake. It is evident that alcohol cannot be considered as an "empty" calorie. Energy wasting mechanisms, which have been proposed by some authors, are unlikely to contribute to energy balance in healthy subjects. Our present knowledge on the energetic value of alcohol mainly depend on physiologic data based on the measurements of energy and substrate balances. By contrast epidemiologic data on the effect of alcohol intake on body weight are contradictory. This is explained by the limitations of epidemiological studies as well as by the possible contributions of other life style-related factors. It is evident that many studies on the effect of alcohol on body weight are uncontrolled studies. It is surprising that although 100 years of research have gone in this area we still have no definite answer to the question.     

Metformin and body weight

Most patients with type 2 diabetes are overweight or obese, overweight or obesity increases the risk of developing type 2 diabetes and obesity per se is strongly associated with multiple cardiometabolic risk factors. However, many antidiabetic treatments increase body weight. The oral antidiabetic agent, metformin, has been evaluated in hundreds of clinical studies in diverse patient populations during approximately five decades of clinical use. This review summarizes the effects of metformin on body weight, with special reference to studies of longer duration (>/=6 months) as both diabetes and obesity are long-term conditions. Approximately half of studies in drug-naive type 2 diabetic patients demonstrated significant weight loss with metformin compared with baseline or comparator drugs, although pooled analyses have suggested no significant effect versus placebo. Similarly, metformin has been shown to induce weight loss in obese nondiabetic populations, although studies of long duration in this population are scarce. Metformin does appear to mitigate the adverse effects of insulin on body weight. The weight-neutral or weight-sparing effects of metformin constitute a therapeutic advantage in diabetes management where other first-line oral antidiabetic treatments often promote clinically significant weight gain.     

The effect of anti‐inflammatory (aspirin and/or statin) therapy on body weight in Type 2 diabetic individuals: EAT,a retrospective study

Aims Obesity is associated with inflammation. Anti‐inflammatory interventions such as aspirin and statins (anti‐IFRx) might be a novel approach to the treatment of obesity and Type 2 diabetes mellitus (T2DM). The present study was designed to determine whether exposure to anti‐IFRx is associated with weight loss in T2DM patients. Methods Exposure to anti‐IFRx was compared between T2DM patients with a history of weight loss (n = 100) and those with no weight loss or with weight gain (n = 102) during a 1‐year follow‐up period. Logistic regression was used to develop odds ratios for weight loss status. Results Subjects who lost weight were more frequently exposed to anti‐IFRx (85.0 vs. 71.5%, P = 0.018) than subjects who maintained or gained weight during follow‐up. The 158 subjects exposed to anti‐IFRx were older (64.2 ± 9.4 vs. 60.6 ± 11.2 years, P = 0.04), had longer duration T2DM (14.5 ± 9.5 vs. 9.0 ± 9.4 years, P = 0.001), had greater prevalence of dyslipidaemia (72 vs. 19%, P < 0.0001) hypertension (57.3 vs. 38.1%, P = 0.03) and cardiovascular disease (37.7 vs. 9.5%, P < 0.0001) than subjects not exposed to anti‐IFRx. In a logistic regression model for weight change status, anti‐IFRx exposure was significantly associated with weight status (odds ratio = 2.3, 95% confidence interval 1.1–4.8, P = 0.02, an association that persisted), even after controlling for age, sex, baseline body mass index, years since diagnosis, OHA therapy and co‐morbidities. Conclusions Exposure to anti‐IFRx more than doubled the odds of weight loss in T2DM patients. Results of this study justify a randomized clinical trial to determine definitively the role of anti‐IFRx in weight loss in subjects with T2DM.     

Religion and body weight

OBJECTIVES: Relationships between religion and body weight were examined in a US national sample. METHODS: Data from the National Survey of Midlife Development in the United States (MIDUS), collected through telephone and postal questionnaires, were analyzed for 3032 adults aged 25-74. RESULTS: Religious denomination was significantly related to higher body weight in men after accounting for sociodemographic controls. Conservative Protestant men had a 1.1 +/- 0.45 higher body mass index (BMI) than those reporting no religious affiliation. Other religion variables that initially had significant relationships with greater body weight before adjusting for control variables became nonsignificant after smoking was controlled. No significant relationships between religion and body weight were present in women. CONCLUSIONS: Religious denomination was related to body weight in men. Other dimensions of religiosity showing a relationship with higher BMI appeared to be because of the lower rates of smoking among more religious individuals.     

Nutrition and body weight

Certain dietary components play a key role for the development of coronary artery disease (CAD). Complex carbohydrates lower the prevalence of CAD. Protein should provide 15% of daily calories. Populations with a high consumption of soy protein have a low coronary event rate and a high life expectancy. Soy protein has a favorable effect on LDL cholesterol, triglycerides and HDL cholesterol. Dietary cholesterol correlates with an increased incidence of CAD. Saturated fats increase cholesterol levels as well as the activity of clotting factor VII and promote progression of CAD. Mono-(MUFA) and poly-unsaturated fatty acids lower LDL-cholesterol to a similar extent. MUFA are contained in rape seed oil, olive oil and pea nut oil, but also in avocados and almonds. Omega-3-fatty acids are in fatty fish like salmon, tuna and herring and improve survival after myocardial infarction. They improve among others endothelial function (adhesion molecules). Eating 1-2 fish meals per week has a preventive effect on CAD and stroke. Dietary fiber decreases the risk for CAD up to 30% and favorably influences carbohydrate metabolism. Antioxidants have a favorable effect in their natural form (fruits and fresh vegetables). The secondary preventive effect of a mediterranean diet after myocardial infarction (probably by a combination of the above effects) has been validated. Body weight correlates with coronary risk, diabetes and use of health care resources. A reduction of body weight is best achieved by calory reduction plus an increase of physical activity. A calory-adjusted diet, low in total fat with a significant proportion of unsaturated fats and omega-3-fatty acids and rich in fiber is of great importance for primary and secondary prevention of cardiovascular diseases. Fruits, vegetables and whole grain products are important components of this diet, which lowers the coronary event rate, increases longevity and is associated with a low rate of malignancies and osteoporosis.     

Evaluating diagnostic strategy of older patients with unexplained unintentional body weight loss: a hospital-based study

Unexplained unintentional weight loss (UUWL) is a common health problem in older adults, and raises significant diagnostic challenges. Currently, there is no consensus or guideline to help physicians approach these patients. The main purpose of this study is to evaluate physicians’ behaviors in evaluating elderly patients with UUWL and to compare the diagnostic strategy of internists and geriatricians. From January of 2008 to December of 2009, medical records of all elderly patients admitted to Taipei Veterans General Hospital with UUWL were obtained for study. All diagnostic procedures used during admissions were evaluated and the final diagnosis for each patient was obtained. Overall, data of 136 patients (mean age: 79.8 ± 6.3 years, 80.9% males) were obtained for study with their mean weight loss of 8.6 ± 6.4 kg. Among them, 79 (58.1%) patients were admitted to the geriatric evaluation and management unit (GEMU) and 57 (41.9%) patients were admitted to the general medical wards. There were no statistically significant differences in terms of age, sex, mean age and average weight loss between these two groups. After extensive diagnostic effort, the most common diagnostic entity was benign organic disease (33.8%), followed by unknown (25.7%), neuropsychiatric disorder (23.5%), and malignancy (16.9%). Tumor markers are commonly used, including carcinoembryonic antigen (CEA) (80.9%), prostate specific antigen (PSA) (81.8%), and carbohydrate 19-9 (CA 19-9) (65.4%). Imaging studies were also commonly used diagnostic tools, including gastrointestinal endoscopy (70.6%), colonoscopy (42.6%) and computerized tomography (44.1%). Compared with internists, geriatricians were more likely to order PSA testing (70.5% vs. 89.4%, p = 0.021). In contrast, internists were more likely to order CA-199 (75.4%% vs. 58.2%, p = 0.045), and to arrange gastrointestinal endoscopy than geriatricians (82.4% vs. 62.0%%, p = 0.013). In conclusion, cancer accounts for only 16.9% of all elderly patients with UUWL in this study, tumor markers are very commonly used for screening of occult cancer. Compared with internists, geriatricians are more likely to order PSA and to establish neuropsychiatric diagnosis, and internists are more prone to order carbohydrate (CA 19-9) and gastrointestinal endoscopy.     

Correlation between change in body weight rather than current body weight and change in serum adiponectin levels in a Japanese population -- the Funagata study

Serum adiponectin levels are decreased in obese subjects. We examined the association of current body weight (BW) and its change with a change in serum adiponectin levels. Serum adiponectin levels at the baseline (from 1995 to 1997) and the 5-year follow-up (from 2000 to 2002) examinations were evaluated in 1003 (M/F, 425/578; age at the baseline examinations, 58.3 +/- 11.7/57.5 +/- 11.0 years) Japanese subjects from a cohort population (N = 2013) of the Funagata study. Correlations and associations of BW at the baseline examinations and changes in BW between the baseline and the follow-up examinations (deltaBW) with changes in the serum adiponectin levels in the study period (deltaAdiponectin) were examined. Stepwise regression analyses revealed a significant correlation of the deltaBW (r = -0.233 and -0.204 for men and women, respectively; r = -0.324 for the upper tertile group divided based on their body mass index in women) with the deltaAdiponectin. However, the BW at the baseline examinations was not significantly correlated in both sexes. Multiple logistic regression analyses revealed that subjects who reduced their BW by 2 kg or more were 2.56 (95% confidence interval, 1.21-5.42; P = .014) and 8.24 times (95% confidence interval, 3.59-18.9; P < .001) more likely to be in the upper tertile of the deltaAdiponectin than those who increased their BW by 2 kg or more in men and women, respectively, independent of their BW at the baseline examinations. In conclusion, we showed here that the deltaBW was strongly associated with the deltaAdiponectin in both sexes, whereas the BW at the baseline examinations was not associated with the deltaAdiponectin, at least in women.