Effects of Weight Loss Among Metabolically Healthy Obese Men and Women

OBJECTIVE

Weight loss among metabolically healthy obese (MHO) individuals may be unnecessary or result in elevated cardio-metabolic risk. We studied the effects of exercise- or diet-induced weight loss on cardio-metabolic risk among MHO and metabolically abnormal obese (MAO) adults.

RESEARCH DESIGN AND METHODS

Participants were 63 MHO and 43 MAO adults who took part in 3 to 6 months of exercise- or diet-induced weight loss intervention. Changes in anthropometry, adipose tissue distribution, and cardio-metabolic risk factors were assessed.

RESULTS

Body weight, waist circumference, and total abdominal and visceral adipose tissue were reduced in all subjects (P < 0.05). Improvements in insulin sensitivity were observed in MHO and MAO men and women (P < 0.05), but were greater in the MAO individuals (P < 0.05). Fasting insulin was the only other cardio-metabolic improvement among MHO individuals (P < 0.05).

CONCLUSIONS

Lifestyle-induced weight loss among MHO subjects is associated with a reduction in total and abdominal obesity and improvement in selected cardio-metabolic risk factors.Weight loss among metabolically healthy obese (MHO) individuals characterized by low cardio-metabolic risk and low prospective risk of type 2 diabetes and cardiovascular disease may be unnecessary and paradoxically may actually increase health risk (1,2). That weight reduction may be contraindicated for MHO individuals is at odds with the standing recommendation from leading health authorities that weight loss be the primary treatment strategy for all obese patients, regardless of cardio-metabolic status (3). We sought to investigate the effects of exercise- and diet-induced weight reduction on cardio-metabolic risk factors among MHO and metabolically abnormal obese (MAO) adults.     

运动疗法对超重或肥胖孕妇孕期并发症和妊娠结局影响的Meta分析

目的 探讨运动疗法对超重或肥胖孕妇孕期并发症和妊娠结局的影响.方法 计算机检索PubMed、Cochrane Library、Embase、Web of Science、中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方数据库.全面检索运动疗法对超重或肥胖孕妇孕期并发症和妊娠结局影响的相关研究.采用Cochrane系统评价方法,对纳入文献进行质量评价,并使用RevMan 5.3软件对资料进行Meta分析.结果 共纳入9篇随机对照试验,1 444例患者. Meta分析结果显示:运动疗法可降低妊娠期糖尿病的发生率(RR=0.52,95%CI:0.39～0.68,P＜0.001)、妊娠期高血压疾病的发生率(RR=0.62,95%CI:0.45～0.84,P=0.002)、剖宫产发生率(RR=0.83,95%CI:0.70～0.98,P=0.030)、早产发生率(RR=0.55,95%CI:0.31～0.98,P=0.040),产后出血发生率(RR=0.28,95%CI:0.15～0.52,P＜0.001)、巨大儿发生率(RR=0.15,95%CI:0.08～0.27,P＜0.001)、新生儿窒息发生率(RR=0.33,95%CI:0.18～0.60, P＜0.001).结论 运动疗法可降低超重或肥胖孕妇孕期并发症的发生,改善不良妊娠结局.     

Changes on the Physiological Lactonase Activity of Serum Paraoxonase 1 by a Diet Intervention for Weight Loss in Healthy Overweight and Obese Women

Low caloric diet (LCD) is used for weight loss. Paraoxonase 1 (PON-1) is associated with the antioxidant functions of high-density lipoprotein (HDL). Among limited data on the relationships between obesity and PON-1, there has been no study on the effects of a stand-alone LCD on the physiological lactonase activity of PON-1. We investigated the prospective effects of LCD intervention (2 months) for weight loss on serum PON-1 activities (lactonase, arylesterase [mono-esterase] and tri-esterase) and HDL cholesterol (HDL-C), and their association with low-density lipoprotein cholesterol (LDL-C) in overweight and non-morbidly obese but otherwise healthy women (n = 30; mean age, 50.3 years; mean body mass index [BMI], 28.5 kg/m²). In addition to the data such as BMI, blood pressure, blood glucose and lipids, PON-1 activities were examined between pre- and post-intervention. The intervention reduced all metabolic outcomes, and PON-1 lactonase activity (determined with 5-[thiobutyl]butyrolactone) significantly decreased by 6.1%, paralleled by arylesterase (by 7.3%) and tri-esterase (by 7.8%). In multiple regression analysis, the percent change of PON-1 lactonase was significantly, positively and independently correlated to that of LDL-C (β = 0.51), HDL-C (β = 0.40), and BMI (β = 0.37). Our results showed that the solo diet treatment on weight loss might reduce serum PON-1 lactonase activity with reduced HDL-C and LDL-C. The relationship between the lactonase and LDL-C may be adaptive, plausibly hypothesizing less need for PON-1 activity as an antioxidant property to protect lipoproteins. Further research is needed to confirm this prediction.     

Effects of Weight Loss,Weight Cycling,and Weight Loss Maintenance on Diabetes Incidence and Change in Cardiometabolic Traits in the Diabetes Prevention Program

OBJECTIVE

This study examined specific measures of weight loss in relation to incident diabetes and improvement in cardiometabolic risk factors.

RESEARCH DESIGN AND METHODS

This prospective, observational study analyzed nine weight measures, characterizing baseline weight, short- versus long-term weight loss, short- versus long-term weight regain, and weight cycling, within the Diabetes Prevention Program (DPP) lifestyle intervention arm (n = 1,000) for predictors of incident diabetes and improvement in cardiometabolic risk factors over 2 years.

RESULTS

Although weight loss in the first 6 months was protective of diabetes (hazard ratio [HR] 0.94 per kg, 95% CI 0.90, 0.98; P < 0.01) and cardiometabolic risk factors (P < 0.01), weight loss from 0 to 2 years was the strongest predictor of reduced diabetes incidence (HR 0.90 per kg, 95% CI 0.87, 0.93; P < 0.01) and cardiometabolic risk factor improvement (e.g., fasting glucose: β = −0.57 mg/dL per kg, 95% CI −0.66, −0.48; P < 0.01). Weight cycling (defined as number of 5-lb [2.25-kg] weight cycles) ranged 0–6 times per participant and was positively associated with incident diabetes (HR 1.33, 95% CI 1.12, 1.58; P < 0.01), fasting glucose (β = 0.91 mg/dL per cycle; P = 0.02), HOMA-IR (β = 0.25 units per cycle; P = 0.04), and systolic blood pressure (β = 0.94 mmHg per cycle; P = 0.01). After adjustment for baseline weight, the effect of weight cycling remained statistically significant for diabetes risk (HR 1.22, 95% CI 1.02, 1.47; P = 0.03) but not for cardiometabolic traits.

CONCLUSIONS

Two-year weight loss was the strongest predictor of reduced diabetes risk and improvements in cardiometabolic traits.     

Long-Term Weight Loss and Metabolic Health in Adults Concerned With Maintaining or Losing Weight: Findings From NHANES

More than two-thirds of American adults are overweight or obese, with many attempting to lose weight to avoid adverse health outcomes and improve well-being. Achieving long-term weight loss (LTWL) success, defined as reaching at least a 5% to 10% weight loss goal, is challenging, yet important for overall metabolic health. It is currently unclear whether achieving higher thresholds of LTWL is associated with improved health. Therefore, the purpose of this study was to examine the association between LTWL thresholds (5%-9.9%, 10%-14.9%, 15%-19.9%, ≥20%) and metabolic health (metabolic syndrome and metabolic risk z score) among 7670 US adult respondents to the National Health and Nutrition Examination Survey (2007-2014) who were overweight or obese (past or present), were not underweight in the past year, not pregnant, and attempting to lose or maintain weight. A subsample of 3362 participants was used in the analysis of the metabolic risk z score. Multivariable regression models were constructed adjusting for covariates. Results indicate that the lowest and the 2 highest LTWL thresholds were related to lower odds for metabolic syndrome; for example, greater than or equal to 20% LTWL (odds ratio=0.52; 95% CI, 0.23-0.44; P<.001). All LTWL thresholds were significantly associated with the metabolic risk z score, with the largest effect among the 2 highest LTWL thresholds, that is, 15% to 19.9% LTWL (β=?0.45; 95% CI, ?0.54 to ?0.36; P<.001) and greater than or equal to 20% LTWL (β=?0.35; 95% CI, ?0.53 to ?0.17; P<.001). In conclusion, although achieving the currently recommended LTWL target was related to improved metabolic health, the 15% LTWL threshold was associated with more favorable outcomes.     

Caloric Restriction and Weight Loss Are Primary Factors in the Early Tissue-Specific Metabolic Changes After Bariatric Surgery

OBJECTIVETo evaluate changes in insulin sensitivity, hormone secretion, and hepatic steatosis immediately after caloric restriction, vertical sleeve gastrectomy (VSG), and Roux-en-Y gastric bypass (RYGB).RESEARCH DESIGN AND METHODSObese subjects were assessed for 1) insulin sensitivity with hyperinsulinemic-euglycemic clamp with glucose tracer infusion, 2) adipokine concentrations with serum and subcutaneous adipose interstitial fluid sampling, and 3) hepatic fat content with MRI before and 7–10 days after VSG, RYGB, or supervised caloric restriction.RESULTSEach group exhibited an ∼5% total body weight loss, accompanied by similar improvements in hepatic glucose production and hepatic, skeletal muscle, and adipose tissue insulin sensitivity. Leptin concentrations in plasma and adipose interstitial fluid were equally decreased, and reductions in hepatic fat were similar.CONCLUSIONSThe improvements in insulin sensitivity and adipokine secretion observed early after bariatric surgery are replicated by equivalent caloric restriction and weight loss.     

Comparing the Effects of Thought Suppression and Focused Distraction on Pain-Related Attentional Biases in Men and Women

Increasing attentional focus away from pain can affect pain experience, suggesting that cognitive strategies that move attentional allocation may be a moderator of pain. In a pre-post-design, the present study examined the effects of 2 cognitive strategies used in pain contexts, thought suppression and focused distraction, on subsequent pain-related attention. Thought suppression was hypothesized to increase pain-related attention, whereas focused distraction was expected to reduce it. Influences of both anxiety and sex were also considered, as secondary questions. 139 (86 women, 53 men) healthy, pain-free participants were randomly assigned to use either thought suppression or focused distraction during a mild cold pressor test (CPT). Pain-related attention was examined using a dot-probe and an attentional blink task, pre-and post-CPT. Questionnaires about relevant cognitive and emotional aspects, demographics, and pain were completed. Results showed no difference in the effect of the 2 pain inhibition strategies on pain-related attention. The hypothesized rebound effect in thought suppression on pain-related attention did not emerge. However, thought suppression showed a short-term benefit in comparison to focused distraction regarding reported pain and perceived threat during the cold pressor test. Few sex differences were found. Thus, the cognitive strategies affected pain outcomes, but did not influence pain-related attention.PerspectiveCognitive strategies could help with pain through changing attention allocation. In this study, the effects of the 2 cognitive strategies thought suppression and focused distraction on pain-related attention in men and women were examined. Elucidating mechanisms that lie behind pain strategies that focus on changing attention may help improve treatments.     

超重孕妇肥胖抑制素、炎症因子水平及相关性研究

目的 探讨妊娠超重孕妇肥胖抑制素(obestatin)水平及其与胰岛素抵抗(insulin resistance,IR)、炎症因子的关系。方法 收集2016年12月～2018年3月上海市宝山区大场医院产科行常规产前检查的孕妇超重组69例、肥胖组36例,及同期健康孕妇66例,诊断标准参照《中国成人超重和肥胖症预防控制指南》。以生化免疫分析法检测胰岛素、肥胖抑制素、肿瘤坏死因子-α(TNF-α)、白介素6(IL-6)、C-反应蛋白(CRP)等相关实验指标。结果 超重组及肥胖组与对照组肥胖抑制素水平为304±58,275±57 vs 317±80 ng/L,差异具有统计学意义(F=4.235,P<0.05); 肥胖组与对照组CPR,TNF-α和IL-6水平为29.4±10.3 mg/L,56.8±9.0 pg/ml,36±8.1pg/ml vs 10.5±5.2 mg/L,40.3±10 pg/ml,28±8.4pg/ml,差异有统计学意义(F=3.10,3.24,3.31,均P<0.05); 超重孕妇肥胖抑制素水平与BMI,空腹血糖、胰岛素和HOMA-IR呈明显负相关(r=-0.41,-0.38,-0.35,-0.40,均P<0.01)。血清肥胖抑制素水平与CPR,TNF-α,IL-6水平呈负相关(r=-0.34,-0.36,-0.33,均P<0.05)。多元逐步回归分析,BMI和HOMA-IR是妊娠肥胖血清Obestatin水平的独立危险因素,差异有统计学意义(F=2.273,P=0.035)。结论 妊娠超重孕妇肥胖抑制素水平减低,炎症因子水平升高,其改变与胰岛素抵抗相关联。     

Cardiorespiratory Fitness and Metabolic Syndrome in Older Men and Women: The Dose Responses to Exercise Training (DR's EXTRA) study

OBJECTIVE

We studied the association of maximum oxygen uptake (Vo_2max) with the development and resolution of metabolic syndrome (MetS) for 2 years in older individuals.

RESEARCH DESIGN AND METHODS

Subjects were a population sample of 1,226 men and women aged 57–78 years. We assessed Vo_2max directly by respiratory gas analysis during maximum exercise testing and used dichotomous and continuous variables for MetS.

RESULTS

One SD increase in baseline Vo_2max associated with 44% (95% CI 24–58) decreased risk of developing MetS. Individuals in the highest third of baseline Vo_2max were 68% (37–84) less likely to develop MetS than those in the lowest third. One SD increase in Vo_2max increased the likelihood to resolve MetS 1.8 (1.2–2.8) times. Individuals in the highest Vo_2max third were 3.9 (1.5–9.9) times more likely to resolve MetS than those in the lowest third.

CONCLUSIONS

Higher levels of cardiorespiratory fitness protect against MetS and may resolve it in older individuals.Cross-sectional population studies have shown an inverse association between cardiorespiratory fitness (CRF) and the metabolic syndrome (MetS) in middle-aged and older men and women (1,2). There are few prospective population studies on the association between CRF and the development of MetS (3–6) and no such studies on the resolution of MetS. None of these studies have been conducted in older men and women. Evidence of the association between changes in CRF and metabolic risk rely on relatively small prospective studies among middle-aged or high-risk individuals (6,7). We therefore studied the association of maximum oxygen uptake (Vo_2max) with the development and resolution of MetS and changes in Vo_2max and metabolic risk in a population sample of older men and women.     

绝经后骨丢失的初步探讨及体重指数对骨密度的影响

目的　探讨绝经后妇女不同年龄及不同绝经年限骨丢失的特点及体重指数对骨密度的影响。方法　对３６２ 例绝经后妇女（ 均为自然绝经） 分别超声测定右下肢胫骨中点骨密度。结果　①绝经后骨密度在４５ ～５０ 岁时最高,５０ 岁以后随年龄的增长明显下降,７０ 岁以后趋于平稳。②骨密度在绝经后１ ～４ 年内下降幅度较小,５ ～７ 年下降幅度较大,７ ～１０ 年较平稳,１０～２０ 年再次下降,２０ 年以后下降幅度较小。③当体重指数＜ ３０ 时,骨密度随体重指数的增加而上升,＞ ３０ 时,骨密度下降。结论　绝经后妇女骨密度随年龄的增加而下降,与绝经年限呈非线性相关,呈两次下降,适当的体重对绝经后妇女的骨丢失有保护作用。     

Comparison of the Effects of Exercise Participation on Psychosocial Risk Factors and Cardiovascular Disease in Women

[Purpose] The aim of this study was to research the association of Type D personality with CVD risk factors and psychology through comparison of the association of exercise participation with CVD risk factors and psychological risk factors in women with Type D. [Subjects] This study included 416 middle-aged women. All participants completed the 14-item Type D Scale (DS14) to assess Type D personality. The DS14 consists of two subscales, NA and SI, both of which comprise 7 items. The research subjects were randomly assigned to four groups: Type D+Exercise (n=12), Type D+non-Exercise (n=12), non-Type D+Exercise (n=12), non-Type D+non-Exercise (n=10). The study consisted of 46 participants. [Methods] An aerobic exercise program and meditation were conducted in parallel for 10 months. Stretching was performed for 10 min as a warm-up, and then walking and running were performed on a treadmill at the HRmax 60–70% level for 40 min; this was done three times a week. Blood samples were processed according to standard laboratory procedures. The concentrations of TG and HDL-cholesterol were determined enzymatically on a clinical chemistry analyzer. Blood glucose was measured by the hexokinase method. [Results] Weight, percent fat, social support, and waist circumference showed a significant difference between times in the Exercise groups, and the values were significantly lower than those of the non-Exercise groups. Anxiety and depression showed a significant interaction effect between groups. The average number of CVD risk factors in subjects showed a significant difference between groups. [Conclusion] In conclusion, there were significant differences between groups in terms of CVD risk factors and psychological risk factors in women with Type D personality.Key words: Psychological, Personality, Exercise     

Effects of a Stimulant-Free Dietary Supplement on Body Weight and Fat Loss in Obese Adults: A Six-Week Exploratory Study

Background: Obesity is a well-established risk factor for cardiovascular disease, diabetes, hyperlipidemia, hypertension, osteoarthritis, and stroke. Stimulants, such as ephedrine and caffeine and their herbal counterparts, have proved effective in facilitating body weight loss, but their use is controversial due to their undesired effects. Other nutraceuticals have shown moderate success in reducing body weight, whereas several other compounds have demonstrated little or no effect. Therefore, a tolerable and effective nutraceutical that can increase energy expenditure and/or decrease caloric intake is desirable for body weight reduction.Objective: The primary purpose of this study was to assess the tolerability and effectiveness of a novel, stimulant-free, dietary supplement containing glucomannan, chitosan, fenugreek, Gymnema sylvestre, and vitamin C on body weight and fat loss and change in body composition in obese adults.Methods: In this single-center, prospective, randomized, double-blind, placebo-controlled study conducted at the University of Guelph (Guelph, Ontario, Canada), obese adults (aged 20-50 years; body mass index [BMI], ≥30 kg/m²) were randomized to the treatment or placebo group. The treatment group received 6 capsules of a dietary supplement containing a proprietary blend of glucomannan, chitosan, fenugreek, G sylvestre, and vitamin C daily for 6 weeks, and the placebo group received 6 capsules of rice flour daily for 6 weeks. Body weight; percentage of body fat; absolute fat mass; lean body mass; BMI; upper abdominal, waist, and hip circumference; and anthropometric measurements were recorded at baseline and at study end. Patients completed daily dietary intake records on days 1 to 3 and days 40 to 42. They also completed weekly activity logs throughout the study.Results: Twenty-four subjects (mean [SD] age, 37.0 [8.2] years [range, 21-48years]; mean [SD] BMI, 35.7 [6.2] kg/m² [range, 28.9-50.9 kg/m²]) were assigned to the treatment group (8 women, 4 men) or the placebo group (9 women,3 men). Two subjects (8.3%; 1 patient [8.3%] from each group) dropped out for personal reasons unrelated to the study. No significant changes in the consumption of total calories; the percentage of calories ingested as carbohydrates, fat, or protein; or activity levels were found in either group throughout the study. Compared with the placebo group, the treatment group lost significantly more body weight (−2.3 kg vs 0.0 kg; P<0.01), percentage of body fat (−1.1% vs 0.2%; P<0.05), and absolute fat mass (−2.0 kg vs 0.2 kg; P<0.001). The treatment group also experienced a significantly greater reduction in upper abdominal circumference (−4.5 cm vs −0.7 cm), waist circumference (−4.1 cm vs 0.1 cm), and hip circumference (−2.9 cm vs 0.6 cm) compared with the placebo group (P<0.05 for all). No significant changes in heart rate or blood pressure were found in either group. Both the treatment and the placebo were well tolerated.Conclusion: Within the context of this study, the novel combination of glucomannan, chitosan, fenugreek, G sylvestre, and vitamin C results in significant body weight and fat loss in obese adults.Disclosure: Derek E. Woodgate, MSc, is president and owner of NxCare Inc., which produces the dietary supplement containing glucomannan, chitosan, fenugreek, Gymnema sylvestre, and vitamin C (trade name Calorie-Care™).     

运动疗法联合饮食指导对孕妇血糖控制及妊娠结局的影响

目的探讨运动疗法联合饮食指导对妊娠期糖尿病(GDM)孕妇血糖控制及妊娠结局的影响。方法选择2013年1月~2014年1月在院建档产检并诊断为GDM的孕妇120例,随机分为治疗组和对照组,各60例。治疗组采用运动疗法联合饮食指导。对照组采用常规护理。观察两组血糖控制情况及母婴并发症发生率。结果治疗组餐前30min、餐后2h、零点血糖达标率均高于对照组,两组比较有显著性差异(P0.01)。治疗组母婴并发症发生率明显低于对照组,两组比较有显著性差异(P0.01)。结论运动疗法联合饮食指导对GDM孕妇临床疗效显著,明显降低了母婴并发症的发生几率。     

The Effects of Elbow Joint Angle Change on the Elbow Flexor Muscle Activation in Pulley with Weight Exercise

[Purpose] This research investigated the effect of angular variation of flexion of the elbow joint on the muscle activation of elbow flexor muscles. [Subjects] The research subjects were 24 male college students with a dominant right hand who had no surgical or neurological disorders and gave their prior written consent to participation with full knowledge of the method and purpose of this study. [Methods] The subjects'' shoulder joints stayed in the resting position, and the elbow joint was positioned at angles of 55°, 70°, and 90°. The angle between the pulley with weights and forearm stayed at 90°. Surface electromyography was used to measure muscle activities. Three measurements were made at each elbow angle, and every time the angle changed, two minutes rest was given. [Result] The muscle activities of the elbow flexors showed significant changes with change in the elbow joint angle, except for the biceps brachii activities between the angles of 55° and 70° of elbow flexion. The muscle activities of the biceps brachii and brachioradialis showed angle-related changes in the order of 55°, which showed the biggest value, followed by 70° and 90°. [Conclusion] In order to improve muscle strength of the elbow flexor using a pulley system, it seems more effective to have a 90° angle between the pulley with weights and the forearm when the muscle is stretched to a length 20% greater than its resting position.Key words: Pulley with weight exercise, Joint angle, Muscle activation     

Effects of Exercise Program on Physical Fitness, Depression, and Self-Efficacy of Low-Income Elderly Women in South Korea

ABSTRACT Objective: This study aimed to examine the effects of exercise programs on physical fitness, depression, and self-efficacy in low-income elderly women (age≥75).
Design and Sample: A pretest-posttest experimental research design with a control group was used. The sample consisted of 26 women in the exercise group and 22 women in the wait-list control group in Seoul, Korea.
Measures: The measures of physical fitness included body mass index, cardiopulmonary endurance (blood pressure and heart rate), muscle strength (hand grip strength), flexibility (degree of bending of the upper body), and balance (duration of time for which the subject could stand on one foot). Depression and self-efficacy were measured by the Center for Epidemiological Studies Depression scale and a modified form of Lee's scale, respectively. All measures were obtained twice: at baseline and at the completion of the exercise program.
Intervention: The exercise program consisted of 4 weeks of education along with 8 weeks of physical exercise.
Results: After the intervention, significant improvements were found in depression, self-efficacy, and all measures of physical fitness, except heart rate and flexibility, in the experimental group.
Conclusion: The exercise program may be recommended as a method to maintain and promote the health of low-income elderly women.