Background: Obesity can resemble Cushing's syndrome not only with respect to some clinical and biochemical features such as visceral adiposity, hypertension and metabolic abnormalities but also in ...terms of increased urinary excretion of cortisol and cortisol metabolites. This has subsequently led to some confusion regarding activity level of the hypothalamic-pituitary axis in obesity. Here we re-examined this question using several tools developed after the evolution of the concept of "pseudo-Cushing in obesity," namely, the measurement of serum free cortisol, salivary cortisol and the dynamic changes of these measures in response to the low dose lug ACTH test. Methods: Total, free and salivary cortisol were tested at the basal state and after a standard challenge with 1 ug ACTH in 60 healthy obese subjects (mean BMI = 39) and 54 healthy lean controls (mean BMI = 23). Results: Mean (+/-SD) basal state total cortisol was significantly lower in obese than in lean subjects (13.1 ± 4.8 vs. 15 ± 4.4 ug/dl, p = 0.019) as was also basal state salivary cortisol (0.27 ± 0.03 vs. 0.39 ± 0.07 ug/dl, p = 0.003), but not basal state serum free cortisol (0.61 ± 0.14 vs 0.67+/-0.1 ug/dL, ns). Additionally, baseline total cortisol was inversely related to BMI (r = -0.23; p = 0.01), to waist circumference (r = -0.26; p < 0.01) and to triglycerides (r = -0.23; p < 0.05). When exposed to a lug ACTH challenge, the area under the response curve indicated a tendency for a lower total cortisol response in obese individuals compared to lean subjects. Concordant with these findings peak post-lug ACTH total serum and salivary cortisol levels were lower in the obese relative to the lean subjects (24.1 ± 5.5 vs. 26.4 ± 4.5 ug/dl, p < 0.05; 1.09 ± 0.38 vs. 1.27 ± 0.61 ug/dl, p < 0.05, respectively). Conclusions: Basal state as well as peak stimulated cortisol and integrated post-lug ACTH-stimulated total serum and salivary cortisol levels, while within the test-defined normal range, were significantly lower in obese subjects. Obesity is not associated with higher basal cortisol or ACTH-stimulated cortisol reserve and indeed is linked to diminished circulating cortisol which is negatively related to body mass index and waist circumference. In fact, increased serum or salivary cortisol is atypical for obesity and should not be viewed as probable "pseudo-Cushing syndrome."
Weigh More, Lose Less Bone Tai, Brurya; Shefer, Gabi; Sack, Jessica ...
Obesity (Silver Spring, Md.),
11/2023, Letnik:
31
Journal Article
Recenzirano
Background: Several reports indicated that intentional weight loss can result in reduction in bone mineral density (BMD), particularly in postmenopausal women, and older individuals. This is a ...post-hoc analysis of a prospective multidisciplinary weight loss trial, in search of predictors of bone loss in the Metabolic Syndrome (MS). Methods: 73 MS subjects (ATPIII criteria; F/M = 34/39) participated in a 1-year intensive multidisciplinary treatment, based on personalized physical training and a low calorie/high protein Mediterranean diet. Baseline (±SD): age 53.3 ± 11.2 years; weight 98.6 kg ± 16.8; BMI 34.4 ± 3.8 kg/m2; lean body mass (LBM) 55.48 kg ± 11.66 kg; Spine BMD 1.21 ± 016 g/cm2, femur neck BMD 0.99 ± 0.13 g/cm2. Results: By the end of 1-year BMI declined by 9.1% (p < 0.001); LBM declined by 2.68% (p < 0.001). There were no significant overall changes in spine or femur BMD; no difference in the change in BMD between participants under the age of 50 years or above 51 years, and between male and female subjects. Despite the lack of overall change in BMD during weight loss, when individual changes in spinal BMD were analyzed, participants who clustered above the median post-treatment versus pre-treatment BMD level, showed a higher initial BMI compared to participants whose change in spinal BMD was below the median level (BMI 35.6 ± 3.6 vs. 32.5 ± 3.52 kg/m2, respectively (p < 0.0001). Conclusions: In subjects with MS undergoing intensive and closely supervised multidisciplinary intentional 1 year weight loss program, higher initial weight is associated with lesser spine bone loss.
Background: Proopiomelanocortin (POMC; including biallelic variants in PCSK1) and leptin receptor (LEPR) deficiency are associated with hyperphagia and early-onset, severe obesity. Treatment with the ...melanocortin-4 receptor agonist setmelanotide for 1 year results in significant and sustained improvements in weight (POMC, -25.6%; LEPR, -12.5%), hunger, and quality of life. We used the metabolic syndrome Z score based on body mass index (MetS-Z-BMI) to assess the effect of setmelanotide treatment on long-term risk of cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). Each 1.0-point increase in MetS-Z-BMI increases the odds of future CVD and T2DM by 9.8 and 2.7, respectively, when assessed in children and by 2.4 and 2.8, respectively, when assessed in adults. Methods: Parameters from Phase 3 trials of patients with POMC (NCT02896192) or LEPR (NCT03287960) deficiency were used to calculate MetS-Z-BMI score change after 1 year of setmelanotide. Long-term clinical responders to setmelanotide were defined as achieving >10% weight loss (if >18 years old) or >0.3-point BMI Z score reduction (if <18 years old) after 1 year. Results: Eighteen patients (56% female, 11-36 years old) were evaluated. A decrease in mean (SD) MetS-Z-BMI was observed in clinical responders after 1 year of setmelanotide (n = 14; -1.31 0.84). Non-responders (n = 4) achieved minimal decrease in MetS-Z-BMI (-0.17 0.23; difference between groups, -1.13, p = 0.0187). Responders with POMC (n = 9) and LEPR deficiency (n = 5) had changes in MetSZ-BMI of -1.63 (0.84) and -0.72 (0.48), respectively. MetS-Z-BMI change was similar in female and male responders. Conclusions: Clinical response to setmelanotide led to decreases in MetS-Z-BMI in patients with POMC and LEPR deficiency associated with reduced risk of developing CVD and T2DM in other populations. These data suggest that early initiation of setmelanotide may reduce future risk of T2DM and CVD.
Background: Isolated elevation of y-glutamyltransferase (GGT), a microsomal membrane-bound protein, is commonly observed in non-obese Koreans without diabetes, and its clinical implications are not ...well-known. Therefore, we aimed to investigate the longitudinal effect of isolated GGT on the incidence of ischemic heart disease (IHD) risk in a large cohort of lean non-diabetic Koreans. Methods: Data were obtained from the Health Risk Assessment Study (HERAS) and Korea Health Insurance Review and Assessment (HIRA) datasets. The participants were divided into four groups according to the GGT quartile after the exclusion of those participants with diabetes, a body mass index (BMI) ≥ 25 kg/m2, alanine aminotransferase (ALT) ≥ 40 IU/L, and aspartate aminotransferase (AST)/ALT ≥1.5, as well as those positive for hepatitis В surface antigen or hepatitis C antibody. We prospectively assessed the hazard ratios (HRs) with 95% confidence intervals (Cis) for IHD using multivariate Cox proportional hazard regression models over a 50-month period. Results: During the follow-up period, 183 individuals (1.85%) developed IHD. After setting the lowest GGT quartile as a reference group, the HRs of IHD for GGT quartiles 2-4 were 1.66 (95% CI 0.95-2.89), 1.82 (95% CI 1.05-3.16), and 1.98 (95% CI 1.12-3.50), respectively, after adjusting for age, sex, body mass index, smoking status, alcohol consumption, physical activity, mean arterial blood pressure, fasting plasma glucose, and dyslipidemia. Conclusions: An isolated high GGT may be an additional measure for assessing and managing future IHD risks among lean Koreans without diabetes.
Summary With this systematic review we aimed to determine the prevalence of OSA in adults in the general population and how it varied between population sub-groups. Twenty-four studies out of 3,807 ...found by systematically searching PubMed and EMBASE databases were included in this review. Substantial methodological heterogeneity in population prevalence studies has caused a wide variation in the reported prevalence, which, in general, is high. At ≥5 Apnea-Hypopnea Index (AHI), the overall population prevalence ranged from 9% to 38% and was higher in men. It increased with increasing age and, in some elderly groups, was as high as 90% in men and 78% in women. At ≥15 AHI, the prevalence in the general adult population ranged from 6% to 17%, being as high as 49% in the advanced ages. OSA prevalence was also greater in obese men and women. This systematic review of the overall body of evidence confirms that advancing age, male sex, and higher body-mass index increase OSA prevalence. The need to (a) consider OSA as having a continuum in the general population and (b) generate consensus on methodology and diagnostic threshold to define OSA so that the prevalence of OSA can be validly compared across regions and countries, and within age-/sex-specific subgroups, are highlighted.
IntroductionBulimic behaviors (BB) are a major public health problem, due to their prognosis and serious psychological, somatic, and social consequences. The exact etiopathogenesis of BB is still ...poorly understood, and the literature suggests the interaction of multiple factors.ObjectivesThe aim of our study was to estimate the prevalence of BB in the Tunisian general population and to identify the associated risk factors.MethodsWe conducted a cross-sectional, descriptive, and analytical study of Facebook group members, using an online questionnaire, from February 17, 2023, to May 26, 2023. All respondents over the age of 18 were included in the study. All participants filled out a socio-demographic questionnaire. Body mass index (BMI) was calculated from weight and height. The Bulimic Investigatory Test, Edinburgh (BITE) was used to screen and assess the intensity of bulimic behaviors.ResultsA total of 528 responses were included in the study. The mean age of the sample was 33.3±11.95 years, and the M/F sex ratio was 0.41. Subjects were unmarried in 63.4% of cases, of low socio-economic status in 19.5%, with a university education in 75.2%, and with a psychiatric history in 25.6% of cases. The mean BMI was 25.15±4.98. The mean BITE score was 10.76±6.85, and 6.6% of our population were at high risk of developing BB.In the bivariate study, female gender (p<0.001), unmarried marital status (p=0.001), university education (p<0.001), and the presence of a psychiatric history (p<0.001) were significantly associated with a high risk of developing BB. Moreover, the BITE score was negatively correlated with age (r=-0.231; p<0.001) and positively correlated with BMI (r=0.307; p<0.001).ConclusionsThis study highlighted the magnitude of the risk of bulimic behaviors in the Tunisian general population and the need to set up programs to prevent and control these disorders.Disclosure of InterestNone Declared
Objective: The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), American ...Society for Metabolic and Bariatric Surgery (ASMBS), Obesity Medicine Association (OMA), and American Society of Anesthesiologists (ASA) Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists. Methods: Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. Results: New or updated topics in this CPG include: contextualization in an adiposity-based chronic disease complications-centric model, nuance-based and algorithm/checklist-assisted clinical decision-making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). Conclusions: Bariatric procedures remain a safe and effective intervention for higher-risk patients with obesity. Clinical decision-making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues.
Abstract
Introduction
Late night eating has been associated with higher odds of being overweight or obese. This study aims to evaluate the relationship between late night eating and body mass index ...in a nationally representative sample.
Methods
Actigraphy was used to estimate the average bedtime, waketime, duration and midpoint of sleep in the National Health and Nutrition Examination Survey 2003-04 and 2005-06 cohorts. Given the circular nature of clock time, the average was calculated to be the point that minimized the sum of squares of differences between time points. Dietary data was collected through two detailed interviews of the participants. Nighttime calories were defined as the average amount of calories consumed between the average bedtime and the average midpoint of time-in-bed, based on the data recorded during the dietary interviews.
Results
Higher average nighttime caloric consumption (in units of 100 kcal) was associated with higher BMI B(95% CI): 0.062 (0.003, 0.121); this remained significant after adjustment for age, gender, and race B(95% CI): 0.084 (0.026, 0.142). Higher nighttime caloric consumption (as a percentage of total average daily calories consumption) was associated with higher BMI B(95% CI): 1.522 (0.312, 2.733). This remained significant after adjustment for age, gender, and race B(95% CI): 1.718 (0.505, 2.931).
Conclusion
Higher nighttime caloric consumption, both in average amount (in units of 100 kcal) and as a percentage of average daily calories consumption, was associated with higher BMI. Additional study is needed to further elucidate the relationship between nighttime eating habits and body mass index.
Support
NHLBI T32HL110952
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