Pregnancy and obesity: a review and agenda for future research

At present, more than 60% of American women of childbearing age are either overweight or obese. As the obesity epidemic in the United States and many other countries continues to grow unchecked, there is greater interest in the relationship between obesity and other major health issues. This paper reviews the literature on the relationship between obesity and pregnancy. We begin with a discussion of the relationship between excess body weight and fertility and then turn to the relationship between maternal body weight and pregnancy-related complications. The role of pregnancy as a possible risk factor for the development of obesity is noted. The studies investigating the efficacy of behavioral interventions to control excessive weight gain during pregnancy or help women lose weight after childbirth are then reviewed. The paper concludes with an agenda for future research examining the relationship between obesity and pregnancy.     

Psychiatric Diagnoses and Psychiatric Treatment Among Bariatric Surgery Candidates

Background: This study investigated the psychiatric diagnoses and psychiatric treatment histories of 90 bariatric surgery candidates. Methods: Prior to surgery, all participants completed the Weight and Lifestyle Inventory, the Questionnaire on Eating and Weight Patterns, and the Beck Depression Inventory-II. Participants also underwent a behavioral/psychological evaluation with a psychologist, which reviewed responses to the measures and provided further assessment of participants' psychiatric status. The evaluation also was used to produce a recommendation on the patients' psychological appropriateness for surgery. Results: Almost two-thirds of patients received a psychiatric diagnosis, the most common of which was major depressive disorder. Nearly two-fifths of all participants, and more than half of those given a psychiatric diagnosis, were engaged in some form of psychiatric treatment at the time of the evaluation. Nevertheless, 64% of patients were unconditionally approved for surgery; 31% were recommended for additional psychiatric or nutritional counseling prior to surgery. Three patients were not recommended for surgery. Conclusion: Results of this study provide important information on the preoperative psychiatric status and treatment histories of bariatric surgery candidates. Given the increasing population of bariatric surgery patients, evaluation of patients' preoperative psychiatric status may play an important role in maximizing successful postoperative outcomes.     

Adult height in women with early-treated congenital adrenal hyperplasia (21-hydroxylase type): relation to body mass index in earlier childhood

To investigate if obesity, as judged by increased body mass index (BMI), during childhood is associated with impaired adult stature in patients with 21-hydroxylase-type congenital adrenal hyperplasia (CAH), a retrospective analysis was carried out on outpatient records of 30 girls with CAH who had reached adult height. Height SD score for age (HtSDS(ca)), HtSDS for bone age (HtSDS(ba)), BMI and steroid dosage in early childhood (3.2-4.6 years) and later childhood (7.2-9.1 years), were compared with adult HtSDS (HtSDS(adlt)), adult HtSDS less mid-parental HtSDS (HtSDS(adlt) - HtSDS(mp)), predicted adult height SDS (HtSDS(pdct)), adult height SDS less predicted adult HtSDS (HtSDS(adlt) - HtSDS(pdct)) and age at menarche. Mean (SD) for HtSDS(adlt) was -1.13 (1.05), mean HtSDS(pdct) -0.12 (0.9) and mean age at menarche 13.5 (1.9) years. BMI in childhood was not correlated with HtSDS(adlt) but showed negative correlations with HtSDS(adlt) - HtSDS(mp) (r = -0.43; p < 0.02) and HtSDS(adlt) - HtSDS(pdct) (r - 0.45; p < 0.02). BMI in later childhood showed negative correlations with HtSDS(adlt) - HtSDS(pdct) (r = -0.61; p < 0.001) and age at menarche (r = -0.63; p < 0.001). We conclude that in girls with early-treated CAH, a high BMI during early childhood is associated with loss of genetic height potential, and in later childhood with over-prediction of adult height and early menarche. Adult stature, body mass index, congenital adrenal hyperplasia (21-hydroxylase type), predicted adult height
DB Grant, Medical Unit, Institute of Child Health, Guilford Street, London WC1N 1EH, UK     

Obese women's perceptions of their physicians' weight management attitudes and practices

BACKGROUND: Obesity has reached epidemic proportions in the United States. Primary care physicians will see increasing numbers of patients with long-term weight management problems. OBJECTIVE: To examine obese women's perceptions of their physicians' weight management attitudes and practices. DESIGN AND SETTING: Women who participated in obesity trials at a university clinic completed a questionnaire that assessed their views of weight control provided by their primary care physician. PARTICIPANTS: The patients were 259 women whose age was 44.0 +/- 10.0 years; weight, 96.7 +/- 13.2 kg; and body mass index (calculated as weight in kilograms divided by the square of height in meters), 35.2 +/- 4.5 (all data given as mean +/- SD). MAIN OUTCOME MEASURES: Using 7-point scales (1 indicates low; and 7, high), patients rated their satisfaction with care provided for their general health and that for their obesity. They also identified methods their physician recommended for weight management and the frequency of negative interactions with their physician concerning weight control. RESULTS: Participants were generally satisfied with the care they received for their general health and with their physicians' medical expertise (mean scores, 6. 1 and 6.2, respectively). They were significantly (P<.001) less satisfied with care for their obesity and with their physicians' expertise in this area (mean scores, 4.1 and 4.3, respectively). Almost 50% reported that their physician had not recommended any of 10 common weight loss methods, and 75% indicated they looked to their physician a "slight amount" or "not at all" for help with weight control. Only a small minority of patients (0.4%-8.0%) reported frequent, negative interactions with physicians concerning their weight. CONCLUSIONS: The last finding helps allay concerns that obese patients are routinely treated disrespectfully by physicians when discussing weight. The challenge, however, for primary care physicians appears to be providing patients better assistance with weight management.     

Clinical evaluation of 0.5% ferric hyaluronate adhesion prevention gel for the reduction of adhesions following peritoneal cavity surgery: open-label pilot study

The objective of this study was to assess the safety and to make a preliminary assessment of the efficacy of 0.5% ferric hyaluronate adhesion prevention gel in reducing adhesions in patients undergoing peritoneal cavity surgery by laparotomy, with a planned 'second-look' laparoscopy. The study was a randomized, open-label, placebo- controlled, parallel-group design in patients desirous of fertility at the Women's and Children's Hospital, Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles, California. Female patients aged 24 to 41 years received 300 ml 0.5% ferric hyaluronate adhesion prevention gel or lactated Ringer's solution as an intraperitoneal instillate at the completion of the laparotomy procedure. At second-look laparoscopy 4-12 weeks after the laparotomy, the presence of adhesions was evaluated. Haematology and serum chemistry were determined throughout the study interval. All patients tolerated the procedures well and did not manifest any serious adverse events. At second-look laparoscopy, patients treated with 0.5% ferric hyaluronate adhesion prevention gel had significantly fewer adhesions than control patients. When adhesions did form, they were significantly less extensive and less severe in patients who received 0.5% ferric hyaluronate adhesion prevention gel. In conclusion, 0.5% ferric hyaluronate adhesion prevention gel was safe and highly efficacious in the reduction of the number, severity and extent of adhesions throughout the entire abdomen following peritoneal cavity surgery.      

Structure and sequence variation at the human leptin receptor gene in lean and obese Pima Indians

The cloning of human and mouse cDNAs from brain that encode high affinity leptin receptors was recently reported. We have physically localized the human leptin receptor gene (LEPR) to a region at 1p31, between the anonymous microsatellite markers D1S515 and D1S198. The genomic structure of the human leptin receptor gene, corresponding to the published human brain cDNA sequence, spans over 70 kb and includes 20 exons. Since the leptin receptor gene is a candidate gene for obesity, and because of its proximity to D1S198, a marker previously linked to insulin secretion, the LEPR gene was sequenced in 20 non- diabetic Pima Indians chosen for extremes in percent body fat and in their acute insulin response to intravenous glucose. Seven polymorphic sites were identified. Two of these polymorphisms, Lys109Arg and Gln223Arg, are amino acid substitutions in the extracellular domain of the leptin receptor, one polymorphism is a silent substitution, and four occur in non-coding regions of the leptin receptor. Four of these sites are in linkage disequilibrium with one another. Nucleotides at three noncoding polymorphic sites were found exclusively in obese Pima Indians. This demonstrates an association between variation at the leptin receptor gene and obesity in humans.      

伊贝辛的分离和鉴定

从吉林栽培的伊贝母(Fritillaria pallidiflora Schrenk)鳞茎中分离出两种介藜芦胺类生物碱Ⅰ和Ⅱ。碱Ⅱ是一个新的甾体生物碱,定名为伊贝辛(yibeissine),结构为22,26-imino-17,23-oxidojerv-12-en-6-oxo-3β,11α-diol,碱Ⅰ是一个已知化合物,结构为11-deoxo-6-oxo-5α,6-dihydrojervine。