In High Spirits

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Pulmonary and chest wall function in obese adults

Obesity is frequently associated with breathing disorders. To investigate if and how the highest levels of obesity impact respiratory function, 17 subjects with obesity (median age: 49 years; BMI: 39.7 kg/m2, 8 females) and 10 normal-weighted subjects (49 years; 23.9 kg/m2, 5 females) were studied. The abdominal volume occupied 41% in the obese group, being higher (p < 0.001) than the normal-weighted group (31%), indicating accumulation of abdominal fat. Restrictive lung defect was present in 17% of subjects with obesity. At rest in the supine position, subjects with obesity breathed with higher minute ventilation (11.9 L/min) and lower ribcage contribution (5.7%) than normal weighted subjects (7.5 L/min, p = 0.001 and 31.1%, p = 0.003, respectively), thus indicating thoracic restriction. Otherwise healthy obesity might not be characterized by a systematic restrictive lung pattern. Despite this, another sign of restriction could be poor thoracic expansion at rest in the supine position, resulting in increased ventilation. Class 3 obesity made respiratory rate further increased. Opto-electronic plethysmography and its thoraco-abdominal analysis of awake breathing add viable and interesting information in subjects with obesity that were complementary to pulmonary function tests. In addition, OEP is able to localize the restrictive effect of obesity

Relationship between fatty liver and glucose metabolism: A cross-sectional study in 571 obese children

BACKGROUND AND AIMS: Early onset type 2 diabetes mellitus (T2DM) is associated with obesity, insulin resistance and impaired beta-cell function. Non-alcoholic fatty liver disease (NAFLD) may be an independent risk factor for T2DM. We investigated the relationship between NAFLD and glucose metabolism in a large sample of obese children. METHODS AND RESULTS: A total of 571 obese children (57% males and 43% females) aged 8-18 years were consecutively studied at a tertiary care centre specialised in paediatric obesity. Liver ultrasonography was used to diagnose NAFLD after exclusion of hepatitis B and C and alcohol consumption. Oral-glucose tolerance testing (OGTT) was performed; insulin sensitivity was evaluated by using the insulin sensitivity index (ISI) and beta-cell function by using the ratio between the incremental areas under the curve (AUC) of insulin and glucose (incAUCins/incAUCglu). A total of 41% of the obese children had NAFLD. Impaired glucose tolerance or T2DM was present in 25% of the children with NAFLD versus 8% of those without it (p<0.001). Children with NAFLD had higher body mass index (BMI), fasting glucose, 120-min OGTT glucose, incAUCins/incAUCglu and lower ISI as compared with children without NAFLD (p</=0.002). At bootstrapped multivariable median regression analysis controlling for gender, age, pubertal status and BMI, NAFLD was an independent predictor of 120-min OGTT glucose and ISI, but not of incAUCins/incAUCglu. Similar findings were obtained using continuous liver steatosis as the predictor, instead of dichotomous NAFLD. CONCLUSION: NAFLD was present in 41% of our obese children and was associated with higher insulin resistance, but not with impaired beta-cell function

Effects of a 3-Week In-Hospital Body Weight Reduction Program on Cardiovascular Risk Factors, Muscle Performance, and Fatigue : A Retrospective Study in a Population of Obese Adults with or without Metabolic Syndrome

Background: In clinical practice, there is the diffuse conviction that obese subjects with metabolic syndrome may be more difficult to treat. Objectives and methods: The aim of the present study was that to investigate the effectiveness of a 3-week in-hospital body weight reduction program (BWRP) in a large population of obese subjects with and without metabolic syndrome (n = 1922; 222 men and 1700 women, age range 18-83 yr). Outcomes such as body mass index (BMI), total (TOT) and HDL cholesterol, systolic and diastolic blood pressures (SBP and DBP, respectively), coronary heart disease (CHD) score, fatigue severity score (FSS), and stair climbing test (SCT) time were evaluated before and after the intervention (\u394). A sex-, BMI-, and age-related stratification of the obese population with or without metabolic syndrome was applied. Results: When compared to obese subjects without metabolic syndrome, at the basal conditions, obese subjects had a poorer cardiometabolic profile, as demonstrated by higher triglycerides, TOT-cholesterol, DBP, SBP, and CHD score, and a more compromised muscle performance (evaluated by SCT), associated with more perception of fatigue (measured by FSS). Nevertheless, obese subjects with metabolic syndrome obtained more benefits from BWRP than those without metabolic syndrome for some outcomes (i.e., \u394TOT-cholesterol, \u394SBP, and \u394CHD score). Despite these differences, the BWRP-induced weight loss was similar between the two groups (i.e., \u394BMI) as well as the gain of muscle performance (i.e., \u394SCT) and the reduction of fatigue (i.e., \u394FSS). Interestingly, the potentially deleterious fall in HDL-cholesterol levels after BWRP was less evident in obese subjects with metabolic syndrome than those without metabolic syndrome. When pooling all data, the \u394CHD score was associated with age, sex, and metabolic syndrome. The remaining outcomes, such as \u394BMI, \u394FSS, and \u394SCT time, were associated with sex and age but not with metabolic syndrome. Finally, \u394BMI was positively correlated with \u394CHD score, \u394FSS, and \u394SCT time in both obese subjects without metabolic syndrome and obese subjects with metabolic syndrome. Conclusions: When comparing obese subjects undergoing a BWRP, metabolic syndrome is not a negative predictive factor affecting the effectiveness of this intervention in terms of weight loss, muscle performance, and psychological well-being

Corrigendum: Effects of a 3-week inpatient multidisciplinary body weight reduction program on body composition and physical capabilities in adolescents and adults with obesity

A correction has been made to Funding. The correct Funding statement is: “Research funded by the Italian Ministry of Health.” The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated

Cardiometabolic Index (CMI) and Visceral Adiposity Index (VAI) Highlight a Higher Risk of Metabolic Syndrome in Women with Severe Obesity

Recent evidence shows that simple and inexpensive anthropometric measurements can be used to identify, at an early stage, women with obesity at increased risk of developing metabolic syndrome (MetS). Thus, the aim of this study was to compare the accuracy of five different indexes of adiposity and/or body composition in identifying MetS in a group of 876 women (mean age ± SD: 52.1 ± 13.8 years; body mass index (BMI): 43.6 ± 6.1 kg m−2). The following indexes were determined for each subject: waist-to-hip ratio (WHR), waist-to-height ratio (WtHR), body mass fat index (BMFI), visceral adiposity index (VAI), and cardiometabolic index (CMI). Overall, the presence of MetS was detected in 544 patients (62%). Pearson correlation coefficients were calculated to evaluate the relationships between body composition indexes and metabolic characteristics of the women. Receiver operating characteristic (ROC) analysis was used to determine the best predictor for each adiposity index among metabolic risk factors. The ROC analysis showed VAI (AUC = 0.84) and CMI (AUC = 0.86) showed the best performance in predicting MetS. Differences were found between the ROC area of CMI and VAI with all other indexes (p 0.92 for WHR, >0.76 for WtHR, >30.1 kg m−1 for BMFI, >1.94 for VAI, and >0.84 for CMI. In addition, VAI and CMI were the most sensitive and specific indexes compared with other indexes. In conclusion, VAI and CMI represent the most useful and reliable indexes to be used for detecting MetS in women suffering from obesity in clinical practice

The Appetite-Suppressant and GLP-1-Stimulating Effects of Whey Proteins in Obese Subjects are Associated with Increased Circulating Levels of Specific Amino Acids

The satiating effect of whey proteins depends upon their unique amino acid composition because there is no difference when comparing whey proteins or a mix of amino acids mimicking the amino acid composition of whey proteins. The specific amino acids underlying the satiating effect of whey proteins have not been investigated to date. Aims and Methods. The aim of the present study was to evaluate the appetite-suppressant effect of an isocaloric drink containing whey proteins or maltodextrins on appetite (satiety/hunger measured by a visual analogue scale or VAS), anorexigenic gastrointestinal peptides (circulating levels of glucagon-like peptide 1 (GLP-1) and peptide tyrosine tyrosine (PYY)) and amino acids (circulating levels of single, total [TAA] and branched-chain amino acids [BCAA]) in a cohort of obese female subjects (n = 8; age: 18.4 \ub1 3.1 years; body mass index, BMI: 39.2 \ub1 4.6 kg/m2). Results. Each drink significantly increased satiety and decreased hunger, the effects being more evident with whey proteins than maltodextrins. Similarly, circulating levels of GLP-1, PYY and amino acids (TAA, BCAA and alanine, arginine, asparagine, citrulline, glutamine, hydroxyproline, isoleucine, histidine, leucine, lysine, methionine, ornithine, phenylalanine, proline, serine, threonine, tyrosine, and valine) were significantly higher with whey proteins than maltodextrins. In subjects administered whey proteins (but not maltodextrins), isoleucine, leucine, lysine, methionine, phenylalanine, proline, tyrosine, and valine were significantly correlated with hunger (negatively), satiety, and GLP-1 (positively). Conclusions. Eight specific amino acids (isoleucine, leucine, lysine, methionine, phenylalanine, proline, tyrosine, and valine) were implicated in the appetite-suppressant and GLP-1-stimulating effects of whey proteins, which may be mediated by their binding with nutrient-sensing receptors expressed by L cells within the gastrointestinal wall. The long-term satiating effect of whey proteins and the effectiveness of a supplementation with these amino acids (i.e., as a nutraceutical intervention) administered during body weight reduction programs need to be further investigated

External Validation Of Equations To Estimate Resting Energy Expenditure In 14952 Adults With Overweight And Obesity And 1948 Adults With Normal Weight From Italy

Background & aims: We cross-validated 28 equations to estimate resting energy expenditure (REE) in a very large sample of adults with overweight or obesity. Methods: 14952 Caucasian men and women with overweight or obesity and 1498 with normal weight were studied. REE was measured using indirect calorimetry and estimated using two meta-regression equations and 26 other equations. The correct classification fraction (CCF) was defined as the fraction of subjects whose estimated REE was within 10% of measured REE. Results: The highest CCF was 79%, 80%, 72%, 64%, and 63% in subjects with normal weight, overweight, class 1 obesity, class 2 obesity, and class 3 obesity, respectively. The Henry weight and height and Mifflin equations performed equally well with CCFs of 77% vs. 77% for subjects with normal weight, 80% vs. 80% for those with overweight, 72% vs. 72% for those with class 1 obesity, 64% vs. 63% for those with class 2 obesity, and 61% vs. 60% for those with class 3 obesity. The Sabounchi meta-regression equations offered an improvement over the above equations only for class 3 obesity (63%). Conclusions: The accuracy of REE equations decreases with increasing values of body mass index. The Henry weight & height and Mifflin equations are similarly accurate and the Sabounchi equations offer an improvement only in subjects with class 3 obesity

Body water distribution in severe obesity and its assessment from eight-polar bioelectrical impedance analysis

Objective: To measure body water distribution and to evaluate the accuracy of eight-polar bioelectrical impedance analysis (BIA) for the assessment of total body water (TBW) and extracellular water (ECW) in severe obesity. Design: Cross-sectional study. Setting: Obesity clinic. Subjects: In all, 75 women aged 18-66 y, 25 with body mass index (BMI) between 19.1 and 29.9 kg/m(2) (ie not obese), 25 with BMI between 30.0 and 39.9 kg/m(2) (ie class I and II obese), and 25 with BMI between 40.0 and 48.2 kg/m(2) (ie class III obese). Methods: TBW and ECW were measured by (H2O)-H-2 and Br dilution. Body resistance (R) was obtained by summing the resistances of arms, trunk and legs as measured by eight-polar BIA (InBody 3.0, Biospace, Seoul, Korea). The resistance index at a frequency of x kHz (RIx) was calculated as height 2/R-x. Results: ECW: TBW was similar in women with class III (46 +/- 3%, mean +/- s.d.) and class I-II obesity (45 +/- 3%) but higher than in nonobese women (39 +/- 3%, P < 0.05). In a random subsample of 37 subjects, RI500 explained 82% of TBW variance (P < 0.0001) and cross-validation of the obtained algorithm in the remaining 38 subjects gave a percent root mean square error (RMSE%) of 5% and a pure error (PE) of 2.1 l. In the same subjects, RI5 explained 87% of ECW variance (P < 0.0001) and cross-validation of the obtained algorithm gave a RMSE% of 8% and a PE of 1.4 l. The contribution of weight and BMI to the prediction of TBW and ECW was nil or negligible on practical grounds. Conclusions: ECW: TBW is similar in women with class I-II and class III obesity up to BMI values of 48.2 kg/m(2). Eight-polar BIA offers accurate estimates of TBW and ECW in women with a wide range of BMI (19.1-48.2 kg/m(2)) without the need of population-specific formulae

Acute respiratory muscle unloading improves time-to-exhaustion during moderate- and heavy-intensity cycling in obese adolescent males

Obesity significantly impairs breathing during exercise. The aim was to determine, in male obese adolescents (OB), the effects of acute respiratory muscle unloading, obtained by switching the inspired gas from ambient air (AIR) to a normoxic helium + oxygen gas mixture (HeO2) (AIR \u2192 HeO2) during moderate [below gas exchange threshold (GET)] and heavy [above GET] constant work rate cycling. Ten OB [age 16.0 \ub1 2.0\ua0years (mean \ub1 SD); body mass index (BMI) 38.9 \ub1 6.1\ua0kg/m2] and ten normal-weight age-matched controls (CTRL) inspired AIR for the entire exercise task, or underwent AIR \u2192 HeO2 when they were approaching volitional exhaustion. In OB time to exhaustion (TTE) significantly increased in AIR \u2192 HeO2 vs. AIR during moderate [1524 \ub1 480\ua0s vs. 1308 \ub1 408 (P = 0.024)] and during heavy [570 \ub1 306\ua0s vs. 408 \ub1 150 (P = 0.0154)] exercise. During moderate exercise all CTRL completed the 40-min task. During heavy exercise no significant differences were observed in CTRL for TTE (582 \ub1 348\ua0s [AIR \u2192 HeO2] vs. 588 \ub1 252 [AIR]). In OB, but not in CTRL, acute unloading of respiratory muscles increased TTE during both moderate- and heavy-exercise. In OB, but not in CTRL, respiratory factors limit exercise tolerance during both moderate and heavy exercise