Defining and Predicting Complete Remission of Type 2 Diabetes: A Short-Term Efficacy Study of Open Gastric Bypass

ObjectiveTo investigate the metabolic effects of open Roux-en Y gastric bypass (RYGB) on pancreatic endocrine reserve in overweight/obese Chinese patients with type 2 diabetes during postoperative year 1.MethodsRetrospective analysis comparing pre- and postoperative results of oral glucose tolerance tests (OGTT) with determinations of insulin and C-peptide, glycated hemoglobin (HbA1c), insulin resistance (HOMA-IR), and BMI at 1, 3, 6, and 12 months in 99 overweight patients (BMI 26.3 ± 4.0 kg/m²; 59 men) with type 2 diabetes at the General Hospital of Chengdu Military Region.Results79 patients (80%) achieved complete remission (maintaining random blood glucose levels < 11.1 mmol/l, fasting blood glucose levels < 7.0 mmol/l, 2-hour OGTT blood glucose levels < 11.1 mmol/l, and glycated hemoglobin < 6.5%). Nine cases (9%) were ‘improved’ (reduced medication or diet controlled blood sugar), and 11 cases did not meet either criterion (‘unchanged’). Patients in complete remission were younger and heavier, more often men, had significantly shorter history of diabetes (4.3 ± 3.8 years vs. 7.6 ± 3.8 years, p < 0.05), and exhibited significantly higher fasting and OGTT levels of C-peptide and insulin, and HOMA-IR than the other 2 groups (p < 0.05-0.01).ConclusionOpen gastric bypass achieved complete remission of type 2 diabetes in Chinese overweight/obese, heavier, younger, predominantly male patients with shorter duration of disease exhibiting greater pancreatic endocrine reserve.Key Words: Diabetes, Gastric bypass, Pancreatic function, Remission, Obesity     

Dietary Habits and Cardiometabolic Health in Obese Children

BackgroundPrevalence rates of cardiometabolic risk factors vary largely among overweight children. This study investigated the relationships between dietary habits and cardiometabolic health among obese children living in a city of Northern Italy.MethodsDietary habits were collected in 448 obese subjects aged 6-18 years, attending an obesity outpatient center in Milan. Anthropometry, blood pressure (BP), lipids, fasting and post-load glucose, and insulin were measured. Physical activity was assessed in adolescents using a questionnaire.ResultsFrequency of glucose intolerance, hypertension and dyslipidemia was 0.7%, 13% and 27.2%, respectively. Plausible reporters consumed more animal protein and sodium and less legumes than recommended in nutritional recommendations and adequate amounts of fiber mainly derived from whole grains. Subjects skipping breakfast had unhealthy diets and greater body fatness. After adjustment for confounders, waist/height and fasting glucose were associated with sodium intake (r =0.149 and r = 0.142, respectively; p < 0.05), 2-hour glucose with fiber (r = −0.172; p < 0.01), and BP with vegetable protein intake (systolic r = −0.120 (p < 0.05); diastolic r = −0.267 (p < 0.01)). Hypertensive children consumed less vegetable protein than normotensive children.ConclusionsThe cardiometabolic health of obese children improves with vegetable protein and whole grain intake, whereas dysglycemia and adiposity increase with sodium intake.Key Words: Dietary habits, Childhood obesity, Glucose metabolism, Hypertension, Cardiometabolic risk     

Increased ambulatory arterial stiffness index and blood pressure load in normotensive obese patients

ObjectivesIt has been shown that blood pressure (BP) values measured in obese subjects are higher than the individuals with normal weight, even in normotensive limits. However, data concerning the Ambulatory Arterial Stiffness Index (AASI) and blood pressure load in normotensive obese subjects is lacking. This study was aimed to compare the ambulatory arterial stiffness index and blood pressure load in normotensive obese and healthy controls.MethodsOne hundred normotensive obese and one hundred normal weight subjects were included in this study. All subjects underwent 24-hour ambulatory blood pressure monitoring. Ambulatory arterial stiffness index was calculated from 24-hour ambulatory blood pressure monitoring records. Ambulatory arterial stiffness index was defined as one minus the regression slope of unedited 24-h diastolic on systolic blood pressures. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) load values were calculated from 24-hour ambulatory blood pressure monitoring analysis.ResultsAmbulatory arterial stiffness index of the obese subjects was significantly higher than the healthy controls (0.48±0.2 vs. 0.33±0.11, p<0.001). 24-hours systolic blood pressure and diastolic blood pressure loads were significantly higher in obese subjects. Logistic regression analysis revealed that body mass index (BMI) was an independent predictor for an abnormal ambulatory arterial stiffness ındex (≥0.50) (OR: 1.137, 95% CI: 0.915-1.001, p=0.004).ConclusionBlood pressure load and ambulatory arterial stiffness index are increased in normotensive obese patients. Moreover, body mass index is an independent predictor for an abnormal ambulatory arterial stiffness index. Our results indicate that obese subjects are at higher risk for future cardiovascular events despite normal office BP levels.     

Hemodynamic mechanisms of the attenuated blood pressure response to mental stress after a single bout of maximal dynamic exercise in healthy subjects

To determine the hemodynamic mechanisms responsible for the attenuated blood pressure response to mental stress after exercise, 26 healthy sedentary individuals (age 29 ± 8 years) underwent the Stroop color-word test before and 60 min after a bout of maximal dynamic exercise on a treadmill. A subgroup (N = 11) underwent a time-control experiment without exercise. Blood pressure was continuously and noninvasively recorded by infrared finger photoplethysmography. Stroke volume was derived from pressure signals, and cardiac output and peripheral vascular resistance were calculated. Perceived mental stress scores were comparable between mental stress tests both in the exercise (P = 0.96) and control (P = 0.24) experiments. After exercise, the systolic blood pressure response to mental stress was attenuated (pre: 10 ± 13 vs post: 6 ± 7 mmHg; P < 0.01) along with lower values of systolic blood pressure (pre: 129 ± 3 vs post: 125 ± 3 mmHg; P < 0.05), stroke volume (pre: 89.4 ± 3.5 vs post: 76.8 ± 3.8 mL; P < 0.05), and cardiac output (pre: 7.00 ± 0.30 vs post: 6.51 ± 0.36 L/min; P < 0.05). Except for heart rate, the hemodynamic responses and the mean values during the two mental stress tests in the control experiment were similar (P > 0.05). In conclusion, a single bout of maximal dynamic exercise attenuates the blood pressure response to mental stress in healthy subjects, along with lower stroke volume and cardiac output, denoting an acute modulatory action of exercise on the central hemodynamic response to mental stress.     

Left Ventricular Hypertrophy and Asymptomatic Cardiac Function Impairment in Chinese Patients with Simple Obesity using Echocardiography

BackgroundSimple obesity in China is rising rapidly and causing increasing concern. The objectives of our study are to investigate cardiac structure and function in individuals with simple obesity and to analyze the effect of BMI on left ventricular structure and function.MethodsBetween January 2012 and July 2014, echocardiography was performed in 361 consecutive patients visiting the outpatient echocardiography center for a health examination or cardiac evaluation before a weight loss operation in our hospital. Echocardiographic indices, waist-to-hip ratios, BMI, and metabolic markers were evaluated. We analyzed these data using Student''s t test (normally distributed) or a nonparametric test (not normally distributed) for continuous variables and chi-square test for categorical variables. Multivariate correlation and regression analysis were conducted for comparisons.ResultsThe study sample was divided into three groups: a normal/overweight group (BMI < 28.0 kg/m²), a mildly/moderately obese group (BMI 28-39.9 kg/m²), and a severely obese group (BMI ≥ 40 kg/m²). There were no significant differences in clinical and laboratory characteristics among the groups, except for BMI and waist-to-hip ratio. The severely obese group had a higher left ventricular end diastolic diameter (LVEDD; p < 0.01) and lower left ventricular ejection fraction (LVEF; p < 0.01) than the mildly/moderately obese group, which had a higher LVEDD and LV mass index (LVMI) than the normal/overweight group. BMI correlated well with LVEDD, left ventricular posterior wall thickness at end-diastole (LVPW), LV mass, LVMI, and E/e’. In addition, age was significantly associated with some echocardiographic parameters, including left atrial dimension (r = 0.366, p < 0.01), LVPW (r = 0.347, p < 0.01), interventricular septal thickness at end- diastole (r = 0.351, p< 0.01), and E/A (r = −0.47, p < 0.01).ConclusionsSimple obesity caused cardiac structural changes, including LV hypertrophy and LV enlargement, and severe obesity resulted in asymptomatic LV systolic and diastolic function impairment.Key Words: Obesity, Body mass index, Echocardiography, Tissue Doppler imaging, Left ventricular function     

The association of anthropometric measurements and lipid profiles in Turkish hypertensive adults

Background

Few studies have associated anthropometric measurements and lipid profile with hypertension in adult populations and to the best of our knowledge none has been done in Turkey

Objectives

To relate anthropometric derivatives of overweight/obesity with hyperlipidemia status in a group of Turkish hypertensive adults.

Methods

Six hundred forty nine (307 male, 342 female) hypertensive adults aged between 20 and 64 yearswere included in the study.

Results

The mean systolic and diastolic blood pressure (BP) of participants were measured as 147.6±17.2 and 91.4±10.4 mmHg for males and 149.9±16.3 and 91.1±9.4 mmHg for females, respectively. With respect to BMI classification systolic BP was significantly higher in obese males and females, and diastolic BP was only higher in obese females (p<0.05). According to BMIs for lipid profile, high-density lipoprotein-cholesterol (HDL-C), total cholesterol (TC) levels were found to be lower in normal females than other BMI groups. Age and waist circumference (WC) in particular was the most related factor for systolic and diastolic BP in both genders (p<0.05).

Conclusions

This study indicates most hypertensive adults surveyed were overweight and obese. Furthermore, age and WC were the important factors that affects the systolic and diastolic BP in both genders.     

Correlation of Resistin with Inflammatory and Cardiometabolic Markers in Obese Adolescents with and without Metabolic Syndrome

ObjectiveThe link between plasma resistin and obesity-related cardiometabolic disorders in children remains debatable. This study assessed the relationships of plasma resistin with cardiovascular risk factors, pro-inflammatory markers and insulin resistance index (HOMA-IR) in obese (Ob) adolescents and obese adolescents with metabolic syndrome (Ob-MS) compared to healthy controls (CO).Methods114 obese adolescents (60 Ob, age 13.6 ± 0.9 years, BMI 28.0 ± 2.2 kg/m², and 54 Ob-MS, age 13.8 ± 1.0 years, BMI 32.5 ± 4.8 kg/m²) and 37 CO (age 13.7 ± 0.8 years, BMI 22.8 ± 0.8 kg/m²) were studied. Anthropometrics, cardiac variables as well as fasting plasma concentrations of lipids, glucose, insulin, and adipocytokines (resistin, tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP)) were measured. HOMA-IR was calculated, and the presence of MS was assessed.ResultsPlasma resistin was significantly higher in Ob-MS than in both Ob and CO and was correlated with anthropometric, cardiovascular, pro-inflammatory markers and several components of MS as was HOMA-IR in Ob and Ob-MS. With increasing the number of MS components, plasma resistin, pro-inflammatory markers, and HOMA-IR were also increased. Multiple regression models highlighted significant correlation between resistin and both HOMA-IR (r = 0.40, p < 0.05) and systolic blood pressure (r = 0.63, p < 0.01) in Ob-MS. Conclusion:These results support the hypothesis that there is an association between circulating resistin and childhood obesity-related inflammatory and cardiometabolic events.Key Words: Resistin, Metabolic syndrome, Insulin resistance, Childhood obesity, Inflammation     

A comparison of blood pressure control in hypertensive patients treated in hospital clinics and in general practice

Two thousand and twenty hypertensive patients of 45 years and over were treated and followed up for either 6 months, 12 months, 18 months or 2 years. Seventeen hundred and forty of these patients were seen in hospital outpatient clinics, 280 in general practice.

The patients followed in general practice had an average blood pressure of 182/111 mmHg prior to treatment. The blood pressure after follow-up for 18-24 months averaged 156/97 mmHg. The corresponding results for the patients followed in hospital clinics were 195/115 mmHg untreated and 150/92 mmHg after follow-up.

The untreated blood pressures were higher in the hospital patients (p < 0·001 for systolic, p < 0·05 for diastolic pressure) and the treated diastolic pressures at 18-24 months were lower in the hospital than the general practice group (p < 0·001). The hospital patients did not receive a greater variety of drugs but were prescribed them in higher doses. Blood pressure control was considered to be inadequate in many patients in both groups. At 18-24 months, 26 per cent of the general practice group had diastolic pressures of 105 mmHg or more, as had 13 per cent of the patients followed in the hospital clinics.

     

Bariatric Surgery Impact on Cardiovascular Risk Factors: Is Age a Factor to Consider?

IntroductionDespite the abundance of data addressing the influence of patient''s age on surgery-related complications, its impact on cardiometabolic outcomes following bariatric surgery has been overlooked.MethodsRetrospective unicentric study of 1,728 obese patients who underwent bariatric surgery between January 2010 and June 2015. Patients were divided in 3 age groups, according to their age at surgery: ˂40 (n = 751), 40–59 (n = 879), and ≥60 years (n = 98). Parameters with cardiometabolic impact, such as body anthropometric measures, lipid profile, and glycemic status, before and 24 months after surgery, were compared between these groups. A multiple linear regression was performed, adjusting differences between groups for sex, surgery type, and body mass index variation.ResultsThe group ˂40 years presented more weight loss (−35.4 ± 9.0 kg, p ˂ 0.001), greater BMI reduction (−15.8 ± 6.1 kg/m², p ˂ 0.001), and larger changes in waist (−34 ± 13.8 cm, p ˂ 0.001) and hip circumferences (−28.7 ± 11.9 cm, p ˂ 0.05). The group of ≥60 years presented the heaviest reduction in fasting glucose (−17.7 ± 32.8 mg/dL, p ˂ 0.001) and HbA1c (0.7 ± 1.0, p ˂ 0.001), and also had a tendency to have the biggest changes in systolic blood pressure (−14.7 ± 18.7 mm Hg, p = 0.071).ConclusionPatients with ≥60 years benefit the most from bariatric surgery regarding cardiometabolic parameters, presenting heavier reductions in fasting glucose, as well as HbA1c and a tendency towards a higher decrease in systolic blood pressure. No clinically significant differences in lipid profile were observed between groups.     

Relationship between plasma homocysteine and blood pressure in hypertensive Northern-Nigerians

AimThe study sought to determine whether there is any relationship between plasma homocysteine and blood pressure levels in Nigerians with essential hypertension.MethodIt was a cross-sectional analytical study done on 120 randomly selected hypertensive patients and 120 normal healthy controls seen at the large Conference hall of the Ahmadu Bello University (ABU) Medical Centre, Zaria as well as the ABU Teaching Hospital, Zaria, Northern-Nigeria. Pearson''s Correlation and Binary Logistic Regression analysis determined the relationship between homocysteine and hypertension.ResultsHyperhomocysteinaemia found in the hypertensive patients (22.8 ± 6.6 µmol/L) differed significantly (p<0.001) from controls (10.9 ± 2.8 µmol/L) with significant (p<0.001), blood pressure difference between both groups. Homocysteine significantly positively correlated with systolic (r = 0.51, p<0.001) and diastolic (r = 0.47, p<0.001) blood pressures in hypertensive subjects. The relation of plasma hcy to hypertension was statistically significant for SBP; OR: 1.08 (95% CI, 1.05–1.11) and DBP; OR: 1.08 (95% CI, 1.03–1.13) in the unadjusted model. When adjusted for confounding variables, hcy was significantly related to SBP; OR: 1.1 (95% CI, 1.04–1.18) but not DBP (p=0.25; OR: 1.06 (95 % CI, 0.96–1.18). The mean plasma folate level was high (115.2 ± 48.0 ng/mL) in the hypertensive subjects. The hyperhomocysteinaemic subjects showed a 2.8 times Odds of developing hypertension.ConclusionThis study showed higher mean plasma homocysteine levels in hypertensives than controls not accounted for by sub-optimal folate levels. Hyperhomocysteinaemia showed a positive relationship to systolic hypertension after adjusting for confounders.     

Social Supports, Perceived Stress, and Health: The Black Experience in Medical School��A Preliminary Study

Black medical students perceived significantly more stressors than white medical students in a predominantly white medical school environment (P=0.001). Black medical students perceived fewer social supports than white medical students, but not significantly fewer (P=0.224). There was no significant difference between mean systolic and diastolic blood pressure levels for the low and high stress groups (P=0.302 and 0.844, respectively). The total degree of perceived stressors did not predict systolic and diastolic blood pressure when controlling for potential confounders (0.05<P<0.1). The interaction of total degree stressors and total degree of social supports did not significantly predict systolic and diastolic blood pressures when controlling for potential confounding variables (P>0.25 and 0.1<P<0.25, respectively).     

A single resistance exercise session improves myocardial contractility in spontaneously hypertensive rats

Resistance training evokes myocardial adaptation; however, the effects of a single resistance exercise session on cardiac performance are poorly understood or investigated. This study aimed to investigate the effects of a single resistance exercise session on the myocardial contractility of spontaneously hypertensive rats (SHRs). Male 3-month-old SHRs were divided into two groups: control (Ct) and exercise (Ex). Control animals were submitted to sham exercise. Blood pressure was measured in conscious rats before the exercise session to confirm the presence of arterial hypertension. Ten minutes after the exercise session, the animals were anesthetized and killed, and the hearts were removed. Cardiac contractility was evaluated in the whole heart by the Langendorff technique and by isometric contractions of isolated left ventricular papillary muscles. SERCA2a, phospholamban (PLB), and phosphorylated PLB expression were investigated by Western blot. Exercise increased force development of isolated papillary muscles (Ex=1.0±0.1 g/mg vs Ct=0.63±0.2 g/mg, P<0.05). Post-rest contraction was greater in the exercised animals (Ex=4.1±0.4% vs Ct=1.7±0.2%, P<0.05). Papillary muscles of exercised animals developed greater force under increasing isoproterenol concentrations (P<0.05). In the isolated heart, exercise increased left ventricular isovolumetric systolic pressure (LVISP; Δ +39 mmHg; P<0.05) from baseline conditions. Hearts from the exercised rats presented a greater response to increasing diastolic pressure. Positive inotropic intervention to calcium and isoproterenol resulted in greater LVISP in exercised animals (P<0.05). The results demonstrated that a single resistance exercise session improved myocardial contractility in SHRs.     

Antioxidant-Rich Dietary Intervention Improves Cardiometabolic Profiles and Arterial Stiffness in Elderly Koreans with Metabolic Syndrome

PurposeOxidative stress plays an important role in the pathogenesis of chronic metabolic diseases. This study investigated the effect of the antioxidant-rich dietary intervention on oxidative stress, metabolic parameters, and arterial stiffness in elderly Koreans with metabolic syndrome (MetS).Materials and MethodsThirty-one subjects with MetS were enrolled and randomly divided into dietary intervention group and control group. Subjects in the intervention group received three meal boxes prepared with antioxidant-rich ingredients every day for 4 weeks, and subjects in the control group maintained their usual diets. Anthropometric and various biochemical parameters related to oxidative stress, inflammation, and MetS were assessed. Brachial-ankle pulse wave velocity (baPWV) and fat measurement using computed tomography were also conducted before and after 4 weeks.ResultsThere were significant differences in waist circumference, visceral to subcutaneous fat ratio, lipid peroxidation, oxidized low density lipoprotein (oxLDL), systolic and diastolic blood pressure, lipid parameters, advanced glycation end products, and baPWV between before and after the study in the experimental group (all p<0.05). Significant inter-group differences were observed between the experimental and control group in terms of the differences in body mass index, waist circumference, oxygen radical absorbance capacity, protein carboxylation, lipid peroxidation, oxLDL, blood pressure, lipid parameters, and baPWV between before and after the study (all p<0.05).ConclusionAntioxidant-rich dietary intervention for a 4-week period ameliorated the state of oxidative stress and improved the components of MetS including central obesity, dyslipidemia, hypertension, and arterial stiffness in elderly Koreans with MetS.     

Contrast in Cardiac Anatomy and Function Between Black and White Patients With Hypertension

To determine whether cardiac findings differ between blacks and whites with essential hypertension, members of a well-defined working population in New York City were examined. Hypertensives had diastolic blood pressure ≤95, or systolic blood pressure ≤160 mmHg, or both, sustained on three occasions over three weeks. Normotensives were selected to reflect the age, sex, and race distribution of the total working population. Of 207 employees, 75 hypertensives (40 percent blacks) and 132 normotensives (53 percent blacks) under-went M-mode echocardiography. Left ventricular (LV) measurements and simultaneous blood pressure by mercury manometer were used to calculate LV mass index (LVMI), relative wall thickness (RWTd), cardiac output (CO) and total peripheral resistance (TPR). There were no differences in any variable between black and white normotensives. Black and white hypertensives were similar in age (52 ± 10 and 54 ± 12 yr, respectively) and blood pressure (151/100 ± 15/11 and 153/99 ± 18/8 mmHg). Black hypertensives had significantly higher TPR (1.80 ± 0.74 vs 1.43 ± 0.46, P<.01), lower CO (6.0 ± 2.5 vs 7.2 ± 2.4 L/min, P<.01), and higher RWTd (0.43 ± 0.11 vs 0.37 ± 0.07, P<.05) than white hypertensives. Race, per se, cannot explain these differences since they did not occur among normotensives. Rather, these findings may reflect a differing patho-physiology of hypertension in blacks and whites with similar blood pressure elevation.     

Daily assessment of arterial distensibility in a pediatric population before and after smoking cessation

OBJECTIVES:

Cigarette smoking is an important modifiable cardiovascular risk factor associated with increased stiffness of the large arteries in adulthood. This study aimed to 1) evaluate arterial distensibility and echocardiographic measures in adolescent smokers before and after participation in a successful smoking cessation program and to 2) compare the findings obtained with data from a control population of healthy non-smokers.

METHODS:

A total of 31 young smoking subjects (58.1% male; range: 11-18 years old; mean: 16.5±1.4 years old; mean tobacco consumption: 2.6±0.6 years) were examined before commencing and after taking part for at least 1 year in a smoking cessation program (mean: 1.4±0.3 years). Arterial stiffness was measured using the previously validated QKd_100-60 method. Twenty-four-hour ambulatory blood pressure monitoring and transthoracic echocardiography were also performed.

RESULTS:

(Smokers before abuse cessation vs. smokers after abuse cessation) systolic blood pressure: p<0.004; diastolic blood pressure: p<0.02; mean blood pressure: p<0.01; QKd_100-60 value: 183±5 vs. 196±3 msec, p<0.009; p = ns for all echocardiographic parameters. (Smokers after abuse cessation vs. controls) systolic blood pressure: p<0.01; diastolic blood pressure: p<0.03; mean blood pressure: p<0.02; QKd_100-60 value: 196±3 vs. 203±2 msec, p<0.04; p<0.02, p<0.01, and p<0.05 for the interventricular septum, posterior wall, and left ventricular mass, respectively.

CONCLUSIONS:

Despite successful participation in a smoking cessation program, arterial distensibility improved but did not normalize. This finding underlines the presence of the harmful effect of arterial rigidity in these individuals, despite their having quit smoking and their young ages, thus resulting in the subsequent need for a lengthy follow-up period.     

Adipokine signatures of subcutaneous and visceral abdominal fat in normal-weight and obese women with different metabolic profiles

IntroductionMetabolic syndrome arises from abnormal adipose function accompanied by insulin resistance. As early factors reflecting/impacting lipid storage dysfunction of adipose tissues, we sought to determine adipokine levels in subcutaneous and visceral adipose tissues (SAT and VAT).Material and methodsGene and protein expression levels of leptin, adiponectin, and resistin were analysed in SAT and VAT of normal-weight and overweight/obese women, subclassified according to insulin resistance index, triglyceride, total, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol levels into metabolically healthy and “at risk” groups.ResultsCompared with normal-weight women, obese women had higher serum leptin levels (p < 0.05), as well as increased leptin gene and protein expression in VAT. Conversely, expression levels of leptin were lower in SAT of obese women, and minor in the SAT of “at risk” groups of women, compared with weight-matched healthy groups. In addition, lower adiponectin levels were detected in SAT of metabolically healthy obese women (p < 0.01), and lower in SAT and VAT (p < 0.05) of “at risk” obese women compared to healthy, obese women. Significant differences in resistin levels were only observed in obese women; resistin gene expression was higher in VAT and SAT of obese, compared to normal-weight women. However, higher gene expression was not consistent with protein expression of resistin.ConclusionsLow adiponectin in both examined adipose tissues and inappropriate leptin expression levels in SAT appear to be important characteristics of obesity-related metabolic syndrome. Intriguingly, this adipokine dysregulation is primary seen in SAT, suggesting that endocrine dysfunction in this abdominal depot may be an early risk sign of metabolic syndrome.     

Normobaric Intermittent Hypoxia over 8 Months Does Not Reduce Body Weight and Metabolic Risk Factors – a Randomized,Single Blind,Placebo-Controlled Study in Normobaric Hypoxia and Normobaric Sham Hypoxia

ObjectiveBoth a 1- to 4-week continuous or intermittent stay and moderate exercise in hypoxia versus normoxia can lead to weight loss. We examined the reproducibility and durability of added hypoxic exposure in a feasible health program of several months.Methods32 obese persons, randomly assigned to either a hypoxia (age 50.3 ± 10.3 years, BMI 37.9 ± 8.1 kg/m²) or a normoxia (age 52.4 ± 7.9 years, BMI 36.3 ± 4.0 kg/m²) group, completed 52 exercise sessions within 8 months. Participants exercised for 90 min (65-70% HR_peak) either at a simulated altitude of 3,500 m or in normoxia, and rested for further 90 min at 4,500 m or normoxia. Before, after 5 weeks, after 3 months, and after the intervention, body composition and exercise capacity were determined. Risk markers (e.g., blood pressure, cholesterol) were measured before, after 3 months, and after the intervention period.ResultsBody weight, BMI, waist and hip circumference, P_peak and BP_sys improved over time (p < 0.05) but without group difference. Fat mass reductions correlated with HDL changes (r = −0.427; p < 0.05) in the entire group.ConclusionLong-term, moderate intensity exercise and rest in hypoxia does not lead to higher reductions in body weight than normoxia alone. Therefore, for weight loss and metabolic markers hypoxic exposure does not add effects at least when stimuli (i.e., hypoxia dose, exercise intensity/duration) are unaltered throughout the intervention.Key Words: Hypoxia, Weight loss, Physical exercise, Obese, Overweight     

Association between Physical Activity,Sedentary Behaviors,Sleep, Diet,and Adiposity among Children and Adolescents in China

IntroductionPhysical activity (PA), sedentary behaviors (SB), sleep, and diet are related to adiposity among children and adolescents. However, there may be interactions between PA, SB, sleep, and diet, and these lifestyle behaviors may work together to affect body weight. The purpose of this study was to explore the impact of multiple lifestyle behaviors of PA, SB, sleep, and diet on childhood adiposity (body mass index z-score and overweight/obesity), and to investigate the effect of meeting multiple guidelines on adiposity among children and adolescents in China.MethodsCross-sectional results were based on 28,048 children aged 6–17 years from the China National Nutrition and Health Surveillance in 2010–2012. Information about PA, SB, and sleep was measured through interview-administered questionnaire. Dietary intake was assessed with food frequency questionnaire. The associations between multiple lifestyle behaviors and BMI z-score and overweight/obese were examined.ResultsThe prevalence of overweight/obesity in the participants was 19.2%. The average time of moderate-to-vigorous PA (MVPA), leisure SB, and sleep was 76.7 ± 45.5 min, 2.9 ± 1.4 h, and 8.5 ± 1.1 h per day, respectively. The China Dietary Guidelines Index for Youth (CDGI-Y) score was 62.6 ± 11.0. Sleep duration and diet score were negative associated with BMI z-score (both p < 0.001). MVPA and SB time were positive associated with BMI z-score (p = 0.041, 0.004). Meeting the SB, sleep, and diet guidelines had a lower BMI z-score (all p < 0.01) and lower odds of overweight/obesity (all p < 0.05). There were significant interactions between PA and diet. Compared with meeting no guidelines, those who met multiple guidelines had a lower risk of overweight/obesity (all p < 0.01). The more guidelines the participants met, the lower odds of overweight/obesity (p for trend <0.001).ConclusionsPA, SB, sleep, and diet are important behaviors associated with adiposity among children and adolescents. Attaining adequate amounts of appropriate multiple behaviors provided an additional benefit. It is important for children to meet recommended behavioral guidelines or recommendations. Interventions that aim to improve awareness of and compliance with these guidelines are needed in future.