Effects of recombinant human growth hormone (rhGH) administration on body composition and cardiovascular risk factors in obese adolescent girls

Background: Obesity is associated with a relative deficiency of growth hormone, which is predictive of greater visceral fat and markers of cardiovascular risk. The study’s purpose was to use recombinant human growth hormone (rhGH) as a physiologic probe to assess the effects of reversing obesity-related GH deficiency on body composition, cardiovascular risk markers, and insulin resistance. Methods: 22 obese girls 13–21 years old were followed for a randomized 6-month trial of rhGH vs. placebo/no treatment. At baseline and 6-months, DXA was performed for body composition, MRI to measure visceral, subcutaneous and total adipose tissue (VAT, SAT and TAT), and fasting blood drawn for IGF-1, inflammatory cardiovascular risk markers [soluble intercellular adhesion molecule (sICAM), high sensitivity CRP], lipids and HbA1C. An oral glucose tolerance test (OGTT) was performed. Twelve girls completed the 6-month visit. Baseline and mean 6-month change were compared between the groups using the Student t-test and the relationship between variables was determined through multiple regression analysis. Results: After 6-months, the rhGH group maintained IGF-1 levels, and had decreases in total cholesterol (p = 0.03), sICAM-1 (p = 0.04) and HbA1C (p = 0.03) compared to placebo/no treatment. The rhGH group trended towards greater decreases in LDL and 2-hour OGTT glucose. Glucose tolerance did not worsen with rhGH administration. Conclusions: Administering rhGH in small doses is able to stabilize IGF-1 levels in obesity. We have also shown that rhGH administration leads to an improvement in some markers of cardiovacular risk with without adversely affecting glucose tolerance. Trial registration Clinical Trial Registration Number: NCT01169103

Low bone mineral density is found in low weight female youth with avoidant/restrictive food intake disorder and associated with higher PYY levels

BACKGROUND: Avoidant/restrictive food intake disorder (ARFID) is a restrictive eating disorder commonly associated with medical complications of undernutrition and low weight. In adolescence, a critical time for bone accrual, the impact of ARFID on bone health is uncertain. We aimed to study bone health in low-weight females with ARFID, as well as the association between peptide YY (PYY), an anorexigenic hormone with a role in regulation of bone metabolism, and bone mineral density (BMD) in these individuals. We hypothesized that BMD would be lower in low-weight females with ARFID than healthy controls (HC), and that PYY levels would be negatively associated with BMD. METHODS: We performed a cross-sectional study in 14 adolescent low-weight females with ARFID and 20 HC 10–23 years old. We assessed BMD (total body, total body less head and lumbar spine) using dual x-ray absorptiometry (DXA) and assessed fasting total PYY concentration in blood. RESULTS: Total body BMD Z-scores were significantly lower in ARFID than in HC (− 1.41 ± 0.28 vs. − 0.50 ± 0.25, p = 0.021). Mean PYY levels trended higher in ARFID vs. HC (98.18 ± 13.55 pg/ml vs. 71.40 ± 5.61 pg/ml, p = 0.055). In multivariate analysis within the ARFID group, PYY was negatively associated with lumbar BMD adjusted for age (β = -0.481, p = 0.032). CONCLUSION: Our findings suggest that female adolescents with low-weight ARFID may have lower BMD than healthy controls and that higher PYY levels may be associated with lower BMD at some, but not all, sites in ARFID. Further research with larger samples will be important to investigate whether high PYY drives bone loss in ARFID

Markowitz Optimization of Malaysia's Economy: A Proposed Strategy for U.S. Developmental Investment in Malaysia

While the ties between foreign investment strategy and U.S. economic strength have been a national priority for centuries, recent changes to global status quo have ushered in a new era of economic power concentration and competition. The rapid growth of the Chinese economy, coupled with recent authority-granting legislation, presents great opportunity for the creation of development-focused investment strategies to further United States foreign policy objectives. The 2018 passage of the Better Utilization of Investment Leading to Development (BUILD) Act, which allows for a strengthening and modernization of American developmental finance capabilities, offers new capacity, specialized focus, and new agencies for the implementation of strategic foreign investment. As a result of these updates, the United States government is at an exciting turning point in history, where developmental finance can be used as a strong tool to further U.S. foreign policy and national security objectives. Comparing goals stated in U.S. legislation with regional issues surrounding certain aspects of Chinese investment strategy, this paper aims to propose an optimal portfolio for U.S. investment in Malaysia based on sector analysis of investment opportunities, current socioeconomic conditions and economic best practices inherited from past U.S. developmental projects. The investment strategy will be the result of a variation on the traditional Markowitz optimization model which takes industrial sectors as inputs (rather than traditional stocks), and also adds in variables to account for these additional factors. The end result of this project should read as an in-depth analysis of Malaysia’s current climate for American developmental investment, and a proposed strategy by which the United States government could use its new capacity to optimize investment opportunities and positive international influence

Markowitz Optimization of Malaysia's Economy: A Proposed Strategy for U.S. Developmental Investment in Malaysia

While the ties between foreign investment strategy and U.S. economic strength have been a national priority for centuries, recent changes to global status quo have ushered in a new era of economic power concentration and competition. The rapid growth of the Chinese economy, coupled with recent authority-granting legislation, presents great opportunity for the creation of development-focused investment strategies to further United States foreign policy objectives. The 2018 passage of the Better Utilization of Investment Leading to Development (BUILD) Act, which allows for a strengthening and modernization of American developmental finance capabilities, offers new capacity, specialized focus, and new agencies for the implementation of strategic foreign investment. As a result of these updates, the United States government is at an exciting turning point in history, where developmental finance can be used as a strong tool to further U.S. foreign policy and national security objectives. Comparing goals stated in U.S. legislation with regional issues surrounding certain aspects of Chinese investment strategy, this paper aims to propose an optimal portfolio for U.S. investment in Malaysia based on sector analysis of investment opportunities, current socioeconomic conditions and economic best practices inherited from past U.S. developmental projects. The investment strategy will be the result of a variation on the traditional Markowitz optimization model which takes industrial sectors as inputs (rather than traditional stocks), and also adds in variables to account for these additional factors. The end result of this project should read as an in-depth analysis of Malaysia’s current climate for American developmental investment, and a proposed strategy by which the United States government could use its new capacity to optimize investment opportunities and positive international influence

Markowitz Optimization of Malaysia's Economy: A Proposed Strategy for U.S. Developmental Investment in Malaysia

While the ties between foreign investment strategy and U.S. economic strength have been a national priority for centuries, recent changes to global status quo have ushered in a new era of economic power concentration and competition. The rapid growth of the Chinese economy, coupled with recent authority-granting legislation, presents great opportunity for the creation of development-focused investment strategies to further United States foreign policy objectives. The 2018 passage of the Better Utilization of Investment Leading to Development (BUILD) Act, which allows for a strengthening and modernization of American developmental finance capabilities, offers new capacity, specialized focus, and new agencies for the implementation of strategic foreign investment. As a result of these updates, the United States government is at an exciting turning point in history, where developmental finance can be used as a strong tool to further U.S. foreign policy and national security objectives. Comparing goals stated in U.S. legislation with regional issues surrounding certain aspects of Chinese investment strategy, this paper aims to propose an optimal portfolio for U.S. investment in Malaysia based on sector analysis of investment opportunities, current socioeconomic conditions and economic best practices inherited from past U.S. developmental projects. The investment strategy will be the result of a variation on the traditional Markowitz optimization model which takes industrial sectors as inputs (rather than traditional stocks), and also adds in variables to account for these additional factors. The end result of this project should read as an in-depth analysis of Malaysia’s current climate for American developmental investment, and a proposed strategy by which the United States government could use its new capacity to optimize investment opportunities and positive international influence

Bone Density, Geometry, Structure and Strength Estimates in Adolescent and Young Adult Women with Atypical Anorexia Nervosa versus Typical Anorexia Nervosa and Normal-Weight Healthy Controls

Our objective was to characterize bone outcomes in adolescent and young adult women with atypical anorexia nervosa (AAN) compared to typical AN and normal-weight healthy controls (HC) based on DSM-5 criteria. Four hundred thirty-two participants (141 AN, 131 AAN and 160 HC), ages 12–21 years, underwent dual-energy X-ray absorptiometry for areal BMD, and a subset had high-resolution peripheral quantitative CT assessment of the distal radius and tibia for volumetric BMD (vBMD), bone geometry and microarchitecture, and microfinite element analysis for estimated strength. The groups did not differ for age, pubertal stage, menarcheal age or physical activity. BMI and bone outcomes overall were intermediate in AAN compared with AN and HC. This applied to spine, total hip and femoral neck BMD measures and many distal tibial measures. However, the mean whole-body less head BMD Z-score did not differ between AAN and AN, and it was lower in both vs. HC. Similarly, many distal radius measures did not differ between AAN vs. AN or HC but were lower in AN than HC. Lower BMI, lean mass and bone age, older menarcheal age and longer illness duration correlated with greater impairment of bone outcomes. These data indicate that individuals with AAN overall have bone outcomes that are intermediate between AN and HC

Medical comorbidities and endocrine dysfunction in low-weight females with avoidant/restrictive food intake disorder compared to anorexia nervosa and healthy controls

To improve our understanding of medical complications and endocrine alterations in patients with low-weight avoidant/restrictive food intake disorder (ARFID) and how they may differ from those in anorexia nervosa (AN) and healthy controls (HC)

Neural activation of regions involved in food reward and cognitive control in young females with anorexia nervosa and atypical anorexia nervosa versus healthy controls

Abstract Anorexia nervosa (AN) and atypical AN (AtypAN) are complex neurobiological illnesses that typically onset in adolescence with an often treatment-refractory and chronic illness trajectory. Aberrant eating behaviors in this population have been linked to abnormalities in food reward and cognitive control, but prior studies have not examined respective contributions of clinical characteristics and metabolic state. Research is needed to identify specific disruptions and inform novel intervention targets to improve outcomes. Fifty-nine females with AN (n = 34) or AtypAN (n = 25), ages 10–22 years, all ≤90% expected body weight, and 34 age-matched healthy controls (HC) completed a well-established neuroimaging food cue paradigm fasting and after a standardized meal, and we used ANCOVA models to investigate main and interaction effects of Group and Appetitive State on blood oxygenation level-dependent (BOLD) activation for the contrast of exposure to high-calorie food images minus objects. We found main effects of Group with greater BOLD activation in the dorsal anterior cingulate cortex (dACC), dorsolateral prefrontal cortex (DLPFC), hippocampus, caudate, and putamen for AN/AtypAN versus HC groups, and in the three-group model including AN, AtypAN, and HC (sub-)groups, where differences were primarily driven by greater activation in the AtypAN subgroup versus HC group. We found a main effect of Appetitive State with increased premeal BOLD activation in the hypothalamus, amygdala, nucleus accumbens, and caudate for models that included AN/AtypAN and HC groups, and in BOLD activation in the nucleus accumbens for the model that included AN, AtypAN, and HC (sub-)groups. There were no interaction effects of Group with Appetitive State for any of the models. Our findings demonstrate robust feeding-state independent group effects reflecting greater neural activation of specific regions typically associated with reward and cognitive control processing across AN and AtypAN relative to healthy individuals in this food cue paradigm. Differential activation of specific brain regions in response to the passive viewing of high-calorie food images may underlie restrictive eating behavior in this clinical population