G-protein beta3 subunit gene splice variant in obesity and overweight.

OBJECTIVE: To determine whether the C825T polymorphism of the G-protein beta3 subunit gene (GNB3) is associated with overweight and obesity. This polymorphism leads to a splice variant (Gbeta3-s) with higher activity and very strong association with essential hypertension. DESIGN: A cross-sectional case-control study. SUBJECTS: The sets of affected and control British/European Caucasian subjects used were: (i) an obesity clinic group most of whom had "morbid obesity" (mean body mass index (BMI) for group=43+/-8 kg/m(2)) and non-obese controls (BMI< or =30); (ii) a group of overweight/obese healthy normotensive community volunteers (BMI>25; mean 29+/-5) and controls (BMI< or =25; mean 23+/-1); (iii) a group of overweight/obese hypertensive patients (BMI>25; mean 30+/-4) and lean hypertensive controls (BMI< or =25; mean=23+/-2). MEASUREMENTS: BMI, blood pressure, serum lipids, alleles of GNB3 polymorphism. RESULTS: Compared with control, frequency of the T allele in obese subjects was higher by 12% in (i), 17% in (ii) and 28% in (iii), but the differences were not statistically significant. Slight tracking of the T allele with elevation in BMI was, however, observed, in the obesity clinic group (P=0.018). CONCLUSION: The C825T splice variant of GNB3 makes little if any contribution to obesity in the groups we tested.     

The effect of massive weight loss on pulmonary function of morbid obese patients

STUDY OBJECTIVES: To test if morbid obesity causes pulmonary function changes and if massive weight loss have effect on pulmonary function (especially in subjects with BMI>or=60 kg/m(2)). PARTICIPANTS: Thirty-nine morbid obese subjects before and after massive weight loss. MEASUREMENTS AND RESULTS: Patients had baseline BMI>or=40 kg/m(2), pulmonary function test (PFT) before and after surgery for gastric volume reduction and massive weight loss, and presented no complaints unrelated to obesity. Based on initial BMI, the patients were divided in groups A (BMI 40-59.9 kg/m(2)) and B (BMI>or=60 kg/m(2)). Initially, group A (n=28) had normal PFT, however group B (n=11) presented FVC and FEV(1) measurements in the lowest limit of normality (with normal FEV(1)/FVC), significantly different from group A. After massive weight loss, the group B compared to A had a significant improvement in FVC (23.7% vs. 9.7%, P=0.012) and FEV(1) (25.6% vs. 9.1%, P=0.006); thus the initial difference in FVC and FEV(1) between groups no longer existed after weight loss. CONCLUSIONS: These results point out that the severe morbid obesity (BMI>or=60 kg/m(2)) may lead to pulmonary function impairment and presents more prominent pulmonary function gain after massive weight reduction. The possible clinical implications of these results are that PFT abnormalities in subjects with BMI<60 kg/m(2) should probably be interpreted as consequence of intrinsic respiratory disease and that severe morbid obese patients may be encouraged to lose weight to improve their pulmonary function, especially those with concomitant pulmonary disorders.     

2型糖尿病发病的炎症机制

2型糖尿病（T2DM）胰岛素抵抗与胰岛B细胞功能异常的机制包括氧化应激、内质网应激、胰岛淀粉样变性、肌肉与肝脏及胰腺部位异位脂肪沉积、脂毒性以及糖毒性等。上述机制均可因营养过剩而激活,且均可视为某种炎症反应,或与炎症相关。本文就免疫系统参与T2DM致病的有关机制研究以及T2DM抗炎治疗的临床试验做一简要回顾。     

The effect of weight loss on the mean platelet volume in obese patients

Obesity is a chronic metabolic disorder associated with cardiovascular disease and atherosclerosis. Platelet activation and aggregation are central processes in the pathophysiology of cardiovascular disease. Mean platelet volume (MPV), a determinant of platelet activation, is a newly emerging risk marker for atherothrombosis. Our objective was to evaluate the effect of weight loss on the MPV in obese patients. We selected 30 obese women patients and 30 non-obese healthy women subjects. All obese patients took the same content and caloric diet treatment for 3 months. Body mass index (BMI), metabolic parameters and MPV were measured at baseline and after 3 months diet treatment. Before diet treatment, obese group had significantly higher MPV levels than in the non-obese control group (8.18 +/- 1.09 fl vs. 8.01 +/- 0.95 fl, p = 0.004). MPV showed positive correlations with BMI level in the obese group (r = 0.43, p = 0.017). BMI significantly decreased after diet treatment (36.2 +/- 3.2 kg/m(2) vs. 34.7 +/- 3.6 kg/m(2), p < 0.001), in the obese group. MPV significantly decreased after diet treatment in the obese group (8.18 +/- 1.09 fl vs. 8.08 +/- 1.02 fl, p = 0.013). There was a positive correlation between weight loss and reduction in MPV (r = 0.41, p = 0.024). In addition to its well-known positive effects on cardiovascular disease risk, weight loss may also possess significant anti-platelet activation properties that can contribute its antiatherogenic effects in obese patients.     

The effect of orlistat-induced weight loss on interleukin-6 and C-reactive protein levels in obese subjects

OBJECTIVE: Inflammation plays a major role in the pathogenesis of atherosclerosis. Obesity is an independent risk factor for cardiovascular disease, which may be mediated by increased secretion of proinflammatory cytokines by adipose tissue. The aim of this study is to investigate changes in the inflammatory markers interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP) during weight reduction with orlistat treatment in obese patients. METHODS AND RESULTS: Thirty-six obese (BMI: 36.1 +/- 3.4 kg/m2) and II non-obese (BMI: 22.9 +/- 1.7 kg/m2) subjects were studied. IL-6 and hs-CRP levels were evaluated at baseline. In obese subjects after treatment of orlistat 120 mg three times daily for 6 months, IL-6 and hs-CRP levels were repeated. Levels of circulating IL-6 (p < 0.05) and hs-CRP (p < 0.01) were significantly higher in the obese group than in the non-obese group. Plasma IL-6 (r = 0.29 and p < 0.05) and CRP (r = 0.35 and p < 0.05) concentrations correlated positively with the level of obesity assessed by BMI at baseline. After 6 months of orlistat treatment in obese subjects, the mean weight of the patients decreased by 6.8 kg, the BMI by 3.2 kg/m2. Compared with baseline, weight loss was associated with significant reductions of IL-6 (p < 0.001) and hs-CRP (p < 0.001) levels. CONCLUSION: In summary plasma IL-6 and hs-CRP levels were increased in obese patients. Orlistat-induced weight reduction was associated with decreasing levels of both IL-6 and hs-CRP in obese subjects. Because inflammatory mediators may be directly involved in atherogenesis, this would suggest that interventions to reduce IL-6 and CRP levels could be cardioprotective.     

不同肥胖标准PCOS患者血清sICAM-1水平对比观察及意义

目的比较不同肥胖标准的多囊卵巢综合征(PCOS)患者血清可溶性细胞间黏附分子-1(sICAM-1)水平,并探讨其意义。方法选取PCOS患者54例,将体质量指数(BMI)≥24 kg/m~218例归为肥胖A组,<24 kg/m~2者36例归为非肥胖A组;腰臀比(WHR)≥0.8者29例归为肥胖B组,<0.8者25例归为非肥胖B组;WHR≥0.8且BMI≥24 kg/m~2的患者14例归为肥胖C组,BMI<24 kg/m~2且WHR<0.8的患者15例归为非肥胖C组。采用ELISA方法检测各组患者血清sICAM-1水平。结果肥胖A、B、C组血清sICAM-1水平分别高于非肥胖A、B、C组(P均<0.05);肥胖A、B、C组血清sICAM-1水平比较P均>0.05;非肥胖A组血清sICAM-1水平高于非肥胖B、C组(P均<0.05),非肥胖B、C组血清sICAM-1水平相比,P>0.05。患者血清sICAM-1水平与BMI、WHR均呈正相关(r=0.204,0.360,P均<0.05),sICAM-1与WHR的相关性高于sICAM-1与BMI的相关性(P<0.05)。结论 PCOS患者血清sICAM-1水平与BMI...     

Effect of obesity and erect/supine posture on lateral cephalometry: relationship to sleep-disordered breathing.

Craniofacial and upper airway anatomy, obesity and posture may all play a role in compromising upper airway patency in patients with the sleep apnoea/hypopnoea syndrome. The aim of this study was to investigate the relationship between obesity, facial structure and severity of sleep-disordered breathing using lateral cephalometric measurements and to assess the effect of body posture on cephalometric measurements of upper airway calibre variables in obese and non-obese subjects. Lateral cephalometry was carried out in erect and supine postures in 73 awake male subjects randomly selected from patients referred for polysomnography who had a wide range of apnoea/hypopnoea frequencies (1-131 events x h sleep(-1)). Subjects were divided into non-obese (body mass index (BMI) < 30 kg x m(-2); n=42) and obese (BMI > or = 30 kg x m(-2); n=31) groups. Significant but weak correlations were found between apnoea/hypopnoea index (AHI) and measurements reflecting upper airway dimensions: uvular protrusion-posterior pharyngeal wall (r=-0.26, p<0.05) and hyoid-posterior pharyngeal wall (r=0.26, p<0.05). Multiple regression using both upper airway dimensions improved the correlation to AHI (r=0.34, p=0.01). Obese subjects had greater hyoid-posterior pharyngeal wall distances than non-obese subjects, both erect (42+/-5 versus 39+/-4 mm, respectively (mean+/-SD) p<0.01) and supine (43+/-5 versus 40+/-4 mm, p<0.05). Skeletal craniofacial structure was similar in obese and non-obese subjects. In conclusion, measurements reflecting upper airway size were correlated with the severity of sleep-disordered breathing. Differences in upper airway size measurements between obese and non-obese subjects were independent of bony craniofacial structure.     

Self-efficacy in relation to eating behaviour among obese and non-obese women.

OBJECTIVE: To assess the effect of a 3 month behaviour modification weight management programme on self-efficacy and anthropometric variables among obese women seeking treatment at an obesity management clinic and to compare self-efficacy among these obese women to non-obese women. DESIGN: Cross sectional. SUBJECTS: A total of 161 non-obese (BMI 22.6+/-2.9 kg/m(2)) and 138 obese (BMI 37.7+/-5.8 kg/m(2)) women of similar age. MEASUREMENTS: Self-efficacy in relation to eating was assessed by the Weight Efficacy Lifestyle (WEL) questionnaire. Demographic information was obtained by interview and questionnaire in the obese and by questionnaire in the non-obese. Anthropometric measurements were obtained by direct measure in the obese and BMI was calculated from self-reported weight and height in the non-obese. RESULTS: At entry to the programme obese women scored significantly less (P<0.0001) than non-obese women on the WEL (99.4+/-34.1 vs 139.0+/-24.9). Women who completed the programme (n=65) demonstrated a decrease in waist circumference of 3.9+/-5.3 cm, a 10.0+/-11.5% loss of excess weight and a significant improvement in total WEL score from 106.0+/-30.3 to 126.5+/-28.4. CONCLUSION: Improvements in some dimensions of self-efficacy among obese women were of sufficient magnitude to attain scores similar to women of a normal weight. The WEL questionnaire may provide an additional measure of success as well as provide positive feedback and encouragement to the client.     

High frequency of mutations in the HNF-1alpha gene in non-obese patients with diabetes of youth in Japanese and identification of a case of digenic inheritance

AIMS/HYPOTHESIS: There is an emerging epidemic of Type II (non-insulin-dependent) diabetes mellitus of youth in Japan and in many other developed countries. The aim of this study was to determine the prevalence of mutations in the hepatocyte nuclear factor (HNF)-1alpha gene (TCF1) in a large group of Japanese patients with early-onset non-Type I (insulin-dependent) diabetes mellitus. Since approximately 20% of Caucasian patients with HNF-1alpha mutations have been shown to be obese or overweight, we also examined the association of genetic variations in TCF1 with body weight in Japanese subjects. METHODS: We examined 203 patients with non-Type 1 diabetes who had been diagnosed before they reached 15 years of age. Ten exons and flanking introns of TCF1 of these patients were directly sequenced for mutations. RESULTS: We found 14 different mutations in 18 patients (8.9%), including one that was found to be de novo. The patients with the mutations had lower BMI (20.1+/-3.0 kg/m(2)) at diagnosis than the patients without them (24.5+/-6.0 kg/m(2)) (p=0.0024). All of the patients with the mutations, except for one, Y120, had normal body weight (BMI<25 kg/m(2)); the frequency of HNF-1alpha mutations in the non-obese patients of this study was 17% (17/101). Patient Y120, who had atypical symptoms of mild obesity and insulin resistance at diagnosis, was found to have inherited an additional mutation in an obesity-related gene. CONCLUSION/INTERPRETATION: A considerable number of non-obese Japanese patients with non-Type 1 diabetes of youth have HNF-1alpha-deficient diabetes. Lack of obesity could well be a characteristic feature of this form of diabetes.     

Risk factors of obesity in preschool children in China: a population-based case--control study

OBJECTIVE: To identify the risk factors of obesity in preschool children in China. DESIGN: A nationwide case-control study in eight cities in China. SUBJECTS: A total of 748 boys and 574 girls (age 0.1 - 6.9 y), including the obese and non-obese. One obese child was matched with one non-obese child by sex and age. MEASUREMENTS: Weight, height and other measurements were taken for all the subjects. The information on child activity, feeding pattern and family background was collected by our study team from the parents and the kindergarten teacher. RESULTS: Birth weight > or =4.0 kg, high eating speed, obesity among the child's relatives > or =25%, mother's body mass index (BMI) > 25 kg/m2 and father's BMI > 25 kg/m2 were identified as the major significant (P < 0.05) risk factors of obesity in preschool children in China. CONCLUSION: Family history of obesity, high birth weight and eating speed were identified as the risk factors of obesity in preschool children in China. Our results show the need for family therapy as part of an intervention program for childhood obesity, which includes behavior modification.     

Recognition, diagnosis and management of obesity after myocardial infarction

OBJECTIVE: We investigated the documentation of obesity as a medical problem, and subsequent management recommendations, in patients after myocardial infarction (MI). DESIGN: We performed a cross-sectional analysis of a randomly selected sample of 627 patients discharged after an MI, from five US teaching hospitals between 1/1/01 and 12/31/02. Information was extracted from clinical notes using standardized definitions. RESULTS: Mean body mass index (BMI) was 31+/-13 kg/m2, which was documented in only 14% of patients and had to be calculated post hoc in the rest. Waist circumference and waist/hip ratio were not documented at all; 83% of patients were overweight, 55% obese, and 8% morbidly obese. In only 20% of patients with BMI> or =30 kg/m2 was the diagnosis of obesity documented either as a current medical problem, as part of past medical history or as a final diagnosis. A dietary counseling was carried out in 61% of patients with BMI> or =25 kg/m2 and in 61% of patients with BMI<25 kg/m2, P=0.96. Weight loss was described as part of the goals/plan at discharge in 7% of overweight and 9% of obese patients. There was no change in either the level of recognition of obesity (22 vs 19%, P=0.3) or in the proportion of obese patients for whom weight loss was described as part of the goals/plan at discharge (8 vs 10%, P=0.7) before (n=301) compared to after (n=326) the Call to Action in Obesity by the Surgeon General in December 2001. CONCLUSION: Obesity is underecognized, underdiagnosed and undertreated in persons with acute MI.     

Size at birth, childhood growth and obesity in adult life

BACKGROUND: Several studies have shown tracking of obesity from childhood to adult life. People who develop obesity in adult life may therefore have had a particular path of growth from birth through childhood. OBJECTIVE: To examine the relationship of obesity to size at birth and childhood growth. DESIGN: Birth cohort study. PARTICIPANTS: A total of 5210 individuals alive and living in Finland in 1997, who were born at the Helsinki University Central Hospital between 1924 and 1933 and who went to school in Helsinki were sent a questionnaire in order to get information about adult weight and height. Detailed birth and school health records were available for all subjects. In all, 3847 responded and 3659 (1552 men and 2107 women) with adequate data are included in the present study. MEASUREMENTS: Incidence of obesity based upon lifetime maximum body mass index (BMI) ascertained from a postal questionnaire and defined as a BMI>30 kg/m(2). The main explanatory measurements were size at birth and childhood growth in height, weight and BMI. RESULTS: The cumulative incidence of obesity was 34.2% in men and 33.9% in women. The incidence rose with increasing birth weight and ponderal index (birthweight/length(3); P=0.01 and P=0.04, respectively). These associations were statistically significant only among males. By the age of 7 y the mean weights, heights and BMI of people who later became obese exceeded the average and remained above average at all ages from 7 to 15 y. In both men and women there was a 3-fold increase in obesity associated with a BMI>16 kg/m(2) at age 7 compared with a BMI<14.5 kg/m(2) (P<0.0001). Boys and girls whose mothers had a high BMI in pregnancy had more rapid childhood growth and an increased risk of becoming obese. This effect was stronger among boys (P=0.008). CONCLUSIONS: Obesity is initiated early in life. These results emphasise the importance of early preventive measures for its treatment.     

Mutations in the adiponectin gene in lean and obese subjects from the Swedish obese subjects cohort

Adiponectin (also called AdipoQ, gelatin-binding protein 28, Acrp30) DNA sequence variants were determined in 96 unrelated female subjects with severe obesity (mean body mass index [BMI], 42.3 kg/m2) and in 96 non-obese female controls (mean BMI, 23.0 kg/m2) from the Swedish Obese Subjects (SOS) cohort. A single base substitution (T45G) at codon 15 of exon 2 resulting in no change in amino acid (Gly15Gly) was found in equal frequencies among obese and control subjects. However, this polymorphism was associated with serum cholesterol and waist circumference (P=.023 and.043, respectively) in the obese group. A IVS2 + G62T sequence variation was also identified, but had similar prevalence rates in obese and control subjects. Blood glucose was highest in the obese female subjects who were homozygotes for the G allele (GG) of the IVS2 + G62T polymorphism (N=56; P=.033) and all the diabetics (n=6) in this sample were in this group. IVS2 + G62T polymorphism was also associated with BMI (P=.014), diastolic blood pressure (P=.009), and sagittal diameter (P=.032). A missense point mutation at codon 111 (Tyr111His) was not associated with any obesity-related phenotypes. In conclusion, adiponectin DNA sequence variations might play a role in the complications of morbid obesity and should be further investigated.     

Is obesity an aggravating factor in chronic venous disease? Results of a French epidemiological study in male patients.

AIM: In a recent epidemiological study on chronic venous disease (CVD) in French male patients, a correlation was found between obesity and disease severity. The objective of this study was to further analyze the relationship between age and/or obesity, and CVD severity as assessed by the CEAP C-class. METHODS: Each physician taking part in this cross-sectional study included the first 3 adult male patients consulting for the first time and presenting at least one sign and one symptom of CVD. Patients' socio-demographic and clinical data were collected, and findings for obese (body mass index BMI: >30 kg/m(2)), overweight (25 60 years experienced trophic disorders, i.e., CEAP classes C4, C5, and C6). CONCLUSIONS: This study does not show any relationship between the CEAP C-class and obesity in male patients. Obesity was thus probably not an aggravating factor in CVD but a simple reflection of ageing.     

The impact of maternal obesity on midtrimester sonographic visualization of fetal cardiac and craniospinal structures

OBJECTIVE: To examine the impact of maternal obesity on the rate of suboptimal ultrasound visualization (SUV) of fetal anatomy and determine the optimal timing of prenatal ultrasound examination for the obese gravida. METHODS: A computerized ultrasound database was used to identify ultrasound examinations for singleton gestations performed between 14(0/7) and 23(6/7) weeks at a tertiary care, university-based hospital. Patients were divided into four groups and categorized based on body mass index (BMI): nonobese (BMI <30 kg/m2), class I obesity (30< or =BMI<35 kg/m2), class II obesity (35< or =BMI<40 kg/m2), and extreme obesity (BMI > or =40 kg/m2). The rates of SUV for fetal cardiac and craniospinal structures were calculated for each group and compared. RESULTS: A total of 11,019 pregnancies were studied, of which 38.6% of the patients were obese. Overall, the rate of SUV of the fetal structures was higher for obese compared to nonobese women for both cardiac (37.3 [1723/4200] vs 18.7% [1275/6819]; P<0.0001) and craniospinal structures (42.8 [1798/4200] vs 29.5% [2012/6819]; P<0.0001). Increased severity of maternal obesity was associated with SUV rate for both the cardiac (nonobese 18.7% [1275/6819], class I 29.6% [599/2022], class II 39.0% [472/1123], and extreme obesity 49.3% [580/1055]; P<0.0001) and for the craniospinal structures: (nonobese 29.5% [2012/6819], class I 36.8% [744/2022], class II 43.3% [486/1123], and extreme obesity 53.4% [563/1055]; P<0.0001). With increasing gestational age at examination, the rate of SUV decreased for both obese and nonobese women. However, for obese women there was minimal improvement in visualization after 18-20 weeks. Even after adjustment for gestational age and the type of ultrasound machine, obese women (class I, class II, and extreme obesity) were still associated with increased odds for SUV of the fetal cardiac and craniospinal structures compared to nonobese women. CONCLUSION: Maternal obesity increases the rate of SUV for the fetal cardiac structures by 49.8% and for the craniospinal structures by 31%. The optimal gestational age for visualization of fetal cardiac and craniospinal anatomy in obese patients may be after 18-20 weeks.     

Association between indices of body mass and antibody titres to heat-shock protein-60, -65 and -70 in healthy Caucasians

We have previously shown that antibody titres to several heat-shock proteins (Hsps) are elevated in dyslipidaemic patients and subjects with established vascular disease. Obesity is known to be associated with raised serum inflammatory markers suggesting a state of heightened immune activation. Hence, we have investigated the association between indices of obesity and several Hsp antibody titres in healthy subjects. Subjects (n=170) were recruited from among employees at the University of Surrey and the Royal Surrey County Hospital, Guildford, UK. Of these subjects, 35 were obese with a body mass index (BMI)>/=30 kg/m(2) (19 male and 16 female subjects), 58 were overweight with 30>BMI>/=25 kg/m(2) (36 male and 22 female subjects) and 77 were of a normal weight with BMI<25 kg/m(2) (31 male and 46 female subjects). Overall, obese subjects had significantly higher plasma anti-Hsp-60 (P<0.001), anti-Hsp-65 (P<0.05) and anti-Hsp-70 (P<0.05) compared with overweight and normal weight subjects.     

Changes in obesity status and lung function decline in a general population sample

Aim of this paper was to evaluate the effects of changes in obesity status on lung function decline over an 8-year follow-up. Adults over 24 years (n=1212) from the general population, who participated in both Po River Delta first (PD1, 1980-1982) and second (PD2, 1988-1991) epidemiological surveys, were stratified as "never obese" (BMI < 30 Kg/m(2) at both PD1 and PD2), "becoming obese" (BMI < 30 Kg/m(2) at PD1 and > or = 30 Kg/m(2) at PD2), "always obese" (BMI > or = 30 Kg/m(2) at both PD1 and PD2), and "becoming non-obese" (BMI > or = 30 Kg/m(2) at PD1 and < 30Kg/m(2) at PD2). Linear regression models for changes in FEV(1), FVC, and VC (computed as absolute differences between the values at PD2 and those at PD1) with longitudinal categories of obesity, gender, age, and baseline smoking habits as covariates were applied. The "becoming obese" and "always obese" categories had a significantly greater decline of lung function than "never obese" group; in the "always obese" group, this was true for vital capacities but not FEV(1). Conversely, in the "becoming non-obese" group lung function was at PD2 improved with respect to PD1. Compared with "Never obese" the mean increase in lung function was of 93, 180, and 48 mL for FEV(1), FVC, and VC, respectively. In this general population sample, remaining or becoming obese increases the decline in lung function over 8 years, while becoming non-obese decreases it.     

The effects of physical activity and body mass index on cardiovascular, cancer and all-cause mortality among 47 212 middle-aged Finnish men and women

OBJECTIVE: To examine the association of physical activity and body mass index (BMI), and their combined effect, with the risk of total, cardiovascular disease (CVD) and cancer mortality. DESIGN: Prospective follow-up study. SUBJECTS: In all, 22 528 men and 24 684 women aged 25-64 y at baseline having 7394 deaths during a mean follow-up of 17.7 y. MEASUREMENT: A self-administered questionnaire data on smoking, socioeconomic factors, physical activity and medical history, together with measured height, weight, blood pressure and serum cholesterol using standardized protocol. RESULT: Physically active subjects had significantly lower age-adjusted mortality from cardiovascular, cancer and all causes compared with sedentary ones. Further adjustment for smoking, systolic blood pressure, cholesterol, BMI, diabetes and education affected the results only slightly. Obese subjects (BMI> or =30 kg/m(2)) had significantly higher cardiovascular and total mortality than the normal weight (18.5< or =BMI<25 kg/m(2)) subjects. Part of increased mortality among obese subjects was mediated through obesity-related cardiovascular risk factors. BMI had an inverse association with cancer mortality among men and almost significant direct association among women. Total mortality was also increased among the lean (BMI<18.5 kg/m(2)) subjects. However, less than 0.3% of deaths were attributed to low body weight, whereas in men 5.5% and in women 17.7% of deaths were attributed to obesity. CONCLUSION: Regular physical activity and normal weight are both important indicators for a decreased risk of mortality from all causes, CVD and cancer. Physical activity had a strong independent effect on mortality, whereas the effect of BMI was partly mediated through other obesity-related risk factors.     

Gender differences in ambulatory blood pressure monitoring profile in obese, overweight and normal subjects

The incidence of obesity has increased enormously in the past several decades, and has been described as a modern epidemic. Obesity is a major factor contributing to hypertension. To the best of our knowledge, no study of ambulatory blood pressure monitoring (ABPM) comparing men with women in relation to body mass indexes (BMI) has been performed. From December 2002 to May 2006, we performed 24-h ABPM in 5950 subjects (3102 men and 2848 women), with a wide range of BMI (range 15.9-53.2 kg/m(2)). We defined obese subjects as those with BMI> or =30.0 kg/m(2), overweight subjects as those with BMI>25.0 and <30.0 kg/m(2), and normal subjects as those with BMI< or =25.0 kg/m(2). Data on 989 subjects (501 men and 488 women) aged from > or =18 to < or =69 years without antihypertensive treatment, atrial fibrillation or diabetes were included for analysis. We consistently found that obese men had the expected increased heart rate compared to normal and overweight men, whereas women (normal, overweight and obese) had similar HRs. In addition, normal and obese women had similar diastolic blood pressures (BP), as opposed to obese men, who had raised diastolic BP. These results may indicate that different pathogenetic mechanisms may be involved in the relationship between obesity and hypertension in men and women.     

Alterations in left ventricular structure and function in young healthy obese women: assessment by echocardiography and tissue Doppler imaging

OBJECTIVES: This study was designed to determine the effects of obesity on left ventricular (LV) structure and function in young obese women. BACKGROUND: Severe prolonged obesity in older adults results in increased plasma volume, eccentric LV hypertrophy, and systolic and diastolic dysfunction. Obese women are at increased risk for the development of heart failure. However, the effects of the obesity on cardiac structure and function in young, otherwise-healthy women are controversial. METHODS: Fifty-one women were evaluated: 20 were obese (body mass index [BMI] > or =30 kg/m(2)) and 31 were non-obese (BMI <30 kg/m(2)). Left ventricular structure and systolic and diastolic function were assessed by two-dimensional echocardiography and tissue Doppler imaging, including the load-independent systolic myocardial velocity (Sm global) and early diastolic myocardial velocity (Em global), respectively. The effects of BMI on LV structure and function were assessed using multivariate regression analyses. RESULTS: Obese women had higher end-diastolic septal and posterior wall thickness, LV mass, and relative wall thickness than non-obese women; BMI values showed significant correlations with these variables (r = 0.58, p < 0.0001; r = 0.50, p < 0.0002; r = 0.52, p < 0.0001, and r = 0.40, p < 0.005, respectively). The Sm global and Em global were lower in obese women, suggesting systolic and diastolic function are decreased; both were negatively correlated with BMI (r = -0.43, p <. 002 and r = -0.61, p < 0.0001, respectively). Multivariate analysis showed BMI was the only independent predictor of relative wall thickness, Sm global, and Em global. CONCLUSIONS: Obesity in young otherwise-healthy women is associated with concentric LV remodeling and decreased systolic and diastolic function. These early abnormalities in LV structure and function may have important implications for explaining the myocardial dysfunction that is associated with increased cardiovascular morbidity and mortality caused by obesity.