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ABSTRACT: The effects of combination naltrexone/bupropion on body composition and visceral adipose tissue mass were examined in a subset (n=107) of obese subjects from a Phase 2 trial that compared the efficacy and safety of placebo, naltrexone monotherapy, bupropion monotherapy, or 1 of 3 naltrexone/bupropion dose combinations for 24 weeks. Body composition data were obtained using dual-energy x-ray absorptiometry and computed tomography. Eighty subjects completed the substudy. Naltrexone/bupropion resulted in weight loss and a greater reduction in body fat (-14.0±1.3%) than placebo (-4.0±2.0%), naltrexone monotherapy (-3.2±2.5%), and bupropion monotherapy (-4.1±2.9%; all p<0.01). Reduction in visceral adipose tissue (VAT) mass was also greater with naltrexone/bupropion (-15.0±1.8%) than placebo (-4.6±2.7%), naltrexone monotherapy (-0.1±3.5%), and bupropion monotherapy (-2.3±4.2%; all p<0.01). Reductions in body fat and VAT mass with naltrexone/bupropion were proportional with weight loss. Weight loss with naltrexone/bupropion was not associated with a greater relative reduction in lean mass than placebo or the monotherapies.
Diabetes Obesity and Metabolism 03/2013; · 3.38 Impact Factor
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ABSTRACT: Obesity has a multifactorial etiology. Although obesity is widespread and associated with serious health hazards, its effective prevention and treatment have been challenging. Among the currently available treatment approaches, lifestyle modification to induce a negative energy balance holds a particularly larger appeal due to its wider reach and relative safety. However, long-term compliance with dietary modifications to reduce energy intake is not effective for the majority. The role of many individual nutrients, foods, and food groups in inducing satiety has been extensively studied. Based on this evidence, we have developed sample weight-loss meal plans that include multiple satiating foods, which may collectively augment the satiating properties of a meal. Compared to a typical American diet, these meal plans are considerably lower in energy density and probably more satiating. A diet that exploits the satiating properties of multiple foods may help increase long-term dietary compliance and consequentially enhance weight loss.
Advances in food and nutrition research 01/2013; 69:105-82.
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ABSTRACT: OBJECTIVES: Obesity affects approximately one-third of the US adult population. Although more black adults are considered to be obese compared to white adults, black adults are less likely to undergo bariatric surgery for weight loss. Black adults typically lose less weight and are more prone to adverse events following bariatric surgery than white adults. The objectives of this study were to compare weight loss, payment methods, and early postoperative complications between black and white adults. DESIGN: A retrospective chart review of 420 Roux-en-Y gastric bypass (RYGB) patients and 454 sleeve gastrectomy (SG) patients (all female) was conducted. A mixed-model analysis was used to assess statistical significance of differences in weight loss between surgeries and races. A Chi-square test was used to assess racial differences in payment method (insurance or private pay) and postoperative complications by operation. Statistical significance was set as P > 0.05. RESULTS: RYGB patients lost significantly more weight at 26, 52, 78, and 104 weeks postoperatively compared to SG patients. White females (WF) lost significantly more weight than black females (BF) at 26, 52, 78, and 104 weeks postoperatively. WF experienced more minor and major complications in the perioperative period than BF, but BF experienced more minor and overall complications in the postoperative period than WF. A greater percentage of black patients had insurance coverage compared to white patients for both surgeries. CONCLUSION: WF appear to lose more weight than BF regardless of surgery, but both races experience surgical complications. Black patients may be less likely to undergo bariatric surgery without insurance coverage.
Advances in Therapy 11/2012; · 2.11 Impact Factor
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Obesity Surgery 09/2012; 22(11):1783-4. · 3.29 Impact Factor
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ABSTRACT: We evaluated the effects of mixed meals differing in glycemic index (GI) and carbohydrate content on postprandial serum glucose and insulin response, hunger, and satiety over the course of a 12-h day.
In this randomized crossover trial, 26 overweight or obese adults received four diets in random order (high GI, high carbohydrate [HGI-HC]; high GI, low carbohydrate [HGI-LC]; low GI, high carbohydrate [LGI-HC]; and low GI, low carbohydrate [LGI-LC]). All meals were prepared by a metabolic kitchen. Participants received breakfast, lunch, and dinner over the course of a 12-h day. Primary outcomes were postprandial serum glucose and insulin quantified as area under the curve. Hunger, fullness, and satiety were assessed by visual analog scale.
The HGI-LC, LGI-HC, and LGI-LC diets significantly reduced glucose and insulin area under the curve compared with the HGI-HC diet (P < 0.001 for all comparisons). There were no significant differences in ratings of hunger, fullness, or satiety between the different dietary treatments.
Reducing the GI or carbohydrate content of mixed meals reduces postprandial glycemia and insulinemia, and these changes can be sustained over the course of an entire day. However, there were no differences in subjective hunger and satiety ratings between the diets. These results demonstrate that maintaining a low GI or glycemic load diet is an effective method of controlling serum glucose and insulin levels.
Diabetes care 06/2012; 35(8):1633-7. · 8.09 Impact Factor
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ABSTRACT: Intervention strategies that harness the body's appetite and satiety regulating signals provide a means of countering excessive energy intake.
Eighty-two subjects were enrolled (18-60 years, body mass index: 25-40 kg/m(2)) in a randomized, placebo-controlled, double-blind, parallel trial. During a 12-week period, the effects of Olibra™ fat emulsion (2.1 g twice daily) on food intake, appetite, satiety, weight, and body composition were compared with those of a twice daily administered placebo (1.95 g milk fat). On days -7, 0, and 28, Olibra or the placebo added to 200 g of yogurt was served at breakfast and lunch. Food intake, appetite, and satiety were assessed after lunch and dinner. Body weight was measured on days -7, 0, 14, 28, 56, and 84. Body fat, waist circumference, and waist-hip ratio were determined on days 0 and 84. The Eating Inventory was administered at screening and on day 28. Data relating to 71 subjects were analyzed using analysis of covariance.
At 12 weeks, body weight was reduced in the test group (2.17 ± 0.46 kg standard error of the mean, p < .0001) and the control group (1.68 ± 0.42 kg, p < .0001). Waist circumference decreased by 2.93 ± 0.85 cm in the test group (p = .001) and by 1.78 ± 0.74 cm in the control group (p = .02). Differential weight and waist circumference reductions were not significant. Hunger scores (Eating Inventory) decreased more in the test group (p = .0082). Differential group effects were not significant for body fat, waist-hip ratio, food intake, appetite, and satiety.
At this dose, Olibra did not exert a consistent effect on food intake, appetite regulation, body weight, or body composition.
Journal of diabetes science and technology 01/2012; 6(3):695-708.
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ABSTRACT: Type 2 diabetes (T2D) accounts for the majority of diagnosed cases of diabetes in adults in the United States. Many of these individuals are also morbidly obese and choose to undergo bariatric surgery to lose weight and gain glycemic control. The Roux-en-Y gastric bypass (RYGB) has been shown to resolve diabetes before substantial weight loss occurs. Several studies suggest that the vertical sleeve gastrectomy (VSG), a newer bariatric operation, may result in comparable weight loss and rapid diabetes control.
We conducted a retrospective chart review of 262 patients diagnosed with diabetes who underwent either the RYGB or the VSG between 2002 and 2010. Medication usage before and after surgery was recorded. Patients who discontinued all medications postoperatively were considered "resolved" of T2D, and those who reduced the number of medications were considered as "showing improvement" in their T2D. Peri- and postoperative complications were also recorded for each operation.
At 8 weeks postoperatively, follow-up data were available for 38 RYGB patients and 71 VSG patients. Approximately 79% of RYGB patients and 83% of VSG patients remained off their diabetes medication. VSG patients experienced a significantly lower incidence of major and minor complications both peri- and postoperatively compared with RYGB patients.
Both operations appear to equally resolve T2D in an obese, adult population; however, the incidence of both major and minor complications is much lower in the VSG patient group. Therefore, the VSG should also be considered as a treatment option for obese individuals with T2D.
Diabetes Technology & Therapeutics 09/2011; 14(1):30-4. · 1.93 Impact Factor
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ABSTRACT: Phentermine is the most widely used antiobesity drug in the United States. Although no evidence of phentermine addiction has been published, fear that phentermine has addiction potential has contributed to curtailment of its worldwide use in clinical practice. The aim of this study was to evaluate the abuse and addiction potential of long-term phentermine pharmacotherapy in patients in a weight management program. Thirty-five patients in a weight management program who abruptly stopped taking prescribed phentermine on their own initiative were examined using the 18-item Kampman Cocaine Selective Severity Assessment scale modified for phentermine. The Kampman Cocaine Selective Severity Assessment scale has also been modified by McGregor for amphetamines to assess withdrawal from amphetamine in amphetamine-addicted subjects. For comparison, 35 new patients were examined with the same scale before any treatment was initiated. Data from the treated and untreated groups were compared by t test with each other and with published data from amphetamine-addicted subjects. There were no significant differences in individual items or total scores between the patients who stopped phentermine abruptly and the patients who had never taken phentermine. There was a striking and significant difference in individual and total scores between the phentermine-treated subjects and the amphetamine-dependent subjects. Cravings for the substance abused, the hallmark characteristic of substance dependence and withdrawal, were entirely absent in the phentermine-treated subjects. Abrupt cessation of long-term phentermine therapy does not induce amphetamine-like withdrawal. Long-term phentermine therapy does not induce phentermine cravings. Symptoms observed after abrupt phentermine cessation represent loss of therapeutic effect and are not withdrawal.
American journal of therapeutics 07/2011; 18(4):292-9.
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ABSTRACT: It is well established that abdominal obesity or upper body fat distribution is associated with increased risk of metabolic and cardiovascular disease. The purpose of the present study was to determine if a 24 week weight loss program with orlistat 60 mg in overweight subjects would produce a greater change in visceral adipose tissue (VAT) as measured by computed tomography (CT) scan, compared to placebo. The effects of orlistat 60 mg on changes in total fat mass (EchoMRI-AH and BIA), ectopic fat (CT) and glycemic variables were assessed. One-hundred thirty-one subjects were randomized into a multicenter, double-blind placebo controlled study in which 123 subjects received at least one post baseline efficacy measurement (intent-to-treat population). Both orlistat-and placebo-treated subjects significantly decreased their VAT at 24 weeks with a significantly greater loss of VAT by orlistat treated subjects (-15.7% vs. -9.4%, P < 0.05). In addition, orlistat-treated subjects had significantly greater weight loss (-5.93 kg vs. -3.94 kg, P < 0.05), total fat mass loss (-4.65 kg vs. -3.01 kg, P < 0.05) and trended to a greater loss of intermuscular adipose tissue and content of liver fat compared with placebo-treated subjects. This is the first study to demonstrate that orlistat 60 mg significantly reduces VAT in addition to total body fat compared to placebo treated subjects after a 24 week weight loss program. These results suggest that orlistat 60 mg may be an effective weight loss tool to reduce metabolic risk factors associated with abdominal obesity.
Obesity 06/2011; 19(9):1796-803. · 4.28 Impact Factor
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ABSTRACT: We saw 2 patients who lost their sense of taste, which was restored by pharmacologic doses of biotin. The key objective is to describe the 2 case reports and suggest a potential treatment for unexplained loss of taste.
The first patient was a 67-year-old woman who lost her sense of taste taking Juvenon, a dietary herbal supplement containing acyl-L-carnitine, lipoic acid, calcium, phosphorus, and biotin 300 μg per day. The second patient was a 60-year-old man who lost his sense of taste after a sleeve gastrectomy for obesity.
The first patient did not respond to 5 mg per day of biotin, but taste was restored with 10 mg of biotin per day. Biotin was prescribed based on information that lipoic acid bound to the biotin transporter. Baseline urine gave no evidence of a pre-existing biotin deficiency. The second patient did not have restoration of taste after taking biotin 5 mg per day for 7 weeks but did have taste restoration on biotin 20 mg per day. Neither subject had an abnormal biotinidase level.
Further research into the relationship of biotin to taste is clearly indicated. Loss of taste was very distressing and significantly altered the quality of life for both patients. Since biotin up to 40 mg per day has been shown to be safe, a therapeutic trial of pharmacologic doses of biotin should be considered as a potentially curative treatment in patients who present with a loss of taste that has no obvious cause.
Journal of the American College of Nutrition 06/2011; 30(3):178-81. · 2.29 Impact Factor
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ABSTRACT: To determine contributions of trunk and extremity adiposity to cardiometabolic risk factors (blood pressure, fasting blood glucose, HDL cholesterol, and triglycerides) among white and African American adults.
The sample consisted of 1,129 white women, 779 African American women, 1,012 white men, and 300 African American men.
Higher trunk adiposity was significantly associated with an increased risk of having two or more cardiometabolic risk factors among African American and white men and women. After adjustment for trunk and arm adiposity, higher leg adiposity was significantly associated with a decreased risk of having two or more cardiometabolic risk factors among white men and women and African American women.
In contrast with adverse risk with high trunk adiposity, high leg adiposity is associated with a decreased risk of having two or more cardiometabolic risk factors in both African American and white adults.
Diabetes care 06/2011; 34(6):1415-8. · 8.09 Impact Factor
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ABSTRACT: Low-level laser therapy (LLLT) is commonly used in medical applications, but scientific studies of its efficacy and the mechanism by which it causes loss of fat from fat cells for body contouring are lacking. This study examined the effectiveness and mechanism by which 635–680 nm LLLT acts as a non-invasive body contouring intervention method.
Forty healthy men and women ages 18–65 years with a BMI <30 kg/m2 were randomized 1:1 to laser or control treatment. Subject's waistlines were treated 30 min twice a week for 4 weeks. Standardized waist circumference measurements and photographs were taken before and after treatments 1, 3, and 8. Subjects were asked not to change their diet or exercise habits. In vitro assays were conducted to determine cell lysis, glycerol, and triglyceride release.
Data were analyzed for those with body weight fluctuations within 1.5 kg during 4 weeks of the study. Each treatment gave a 0.4–0.5 cm loss in waist girth.Cumulative girth loss after 4 weeks was −2.15 cm (−0.78 ± 2.82 vs. 1.35 ± 2.64 cm for the control group,p < 0.05). A blinded evaluation of standardized pictures showed statistically significant cosmetic improvement after 4 weeks of laser treatment. In vitro studies suggested that laser treatment increases fat loss from adipocytes by release of triglycerides, without inducing lipolysis or cell lysis.
LLLT achieved safe and significant girth loss sustained over repeated treatments and cumulative over 4 weeks of eight treatments. The girth loss from the waist gave clinically and statistically significant cosmetic improvement.
Obesity Surgery 06/2011; 21(6):722-9. · 3.29 Impact Factor
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ABSTRACT: There is a perception that phentermine pharmacotherapy for obesity increases blood pressure and heart rate (HR), exposing treated patients to increased cardiovascular risk. We collected data from phentermine-treated (PT) and phentermine-untreated (P0) patients at a private weight management practice, to examine blood pressure, HR, and weight changes. Records of 300 sequential returning patients were selected who had been treated with a low-carbohydrate ketogenic diet if their records included complete weight, blood pressure, and HR data from seven office examinations during the first 12 weeks of therapy. The mean time in therapy, time range, and mode was 92 (97.0), 12-624, and 52 weeks. 14% were normotensive, 52% were prehypertensive, and 34% were hypertensive at their first visit or had a previous diagnosis of hypertension. PT subjects systolic blood pressure/diastolic blood pressure (SBP/DBP) declined from baseline at all data points (SBP/DBP -6.9/-5.0 mm Hg at 26, and -7.3/-5.4 at 52 weeks). P0 subjects' declines of SBP/DBP at both 26 and 52 weeks were -8.9/-6.3 but the difference from the treated cohort was not significant. HR changes in treated/untreated subjects at weeks 26 (-0.9/-3.5) and 52 (+1.2/-3.6) were not significant. Weight loss was significantly greater in the PT cohort for week 1 through 104 (P = 0.0144). These data suggest phentermine treatment for obesity does not result in increased SBP, DBP, or HR, and that weight loss assisted with phentermine treatment is associated with favorable shifts in categorical blood pressure and retardation of progression to hypertension in obese patients.
Obesity 04/2011; 19(12):2351-60. · 4.28 Impact Factor
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ABSTRACT: The purpose of this study was to examine sex and race differences in the relationship between anthropometric measurements and adiposity in white and African-American (AA) adults. Visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) areas were measured with computed tomography (CT). Fat mass (FM) was measured with dual-energy-X-ray absorptiometry (DXA). Correlation coefficients were used to assess the relationship of waist circumference (WC) and BMI to VAT, SAT, and FM within sex-by-race groups. General linear models were used to compare relationships between WC or BMI, and adiposity across sex and race, within age groups (18-39 and 40-64 years). The sample included 1,667 adults (men: 489 white; 120 AA; women: 666 white, 392 AA). WC and BMI correlations were highest for FM and SAT compared to VAT. Women had higher FM levels than men regardless of WC, but the sex difference in FM was attenuated in younger AA adults with a high BMI. For a given level of WC or BMI, women had higher levels of SAT than men; however, significant interactions indicated that the relationship was not consistent across all levels of BMI and WC. Sex and race differences in VAT varied significantly with WC and BMI. In general, white adults had higher levels of VAT than AA adults at higher levels of BMI and WC. Sex differences, and in some instances race differences, in the relationships between anthropometry and fat-specific depots demonstrate that these characteristics need to be considered when predicting adiposity from WC or BMI.
Obesity 02/2011; 19(2):402-8. · 4.28 Impact Factor
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ABSTRACT: In preclinical reports, restriction of dietary methionine intake was shown to enhance metabolic flexibility, improve lipid profiles, and reduce fat deposition. The present report is the outcome of a "proof of concept" study to evaluate the efficacy of dietary methionine restriction (MR) in humans with metabolic syndrome.
Twenty-six obese subjects (six male and 20 female) meeting criteria for metabolic syndrome were randomized to a diet restricted to 2 mg methionine/kg body weight per day and were provided capsules containing either placebo (n = 12) or 33 mg methionine/kg body weight per day (n = 14). Energy expenditure, body composition, insulin sensitivity, and biomarkers of metabolic syndrome were measured before and after 16 wk on the respective diets.
Insulin sensitivity and biomarkers of metabolic syndrome improved comparably in both dietary groups. Rates of energy expenditure were unaffected by the diets, but dietary MR produced a significant increase in fat oxidation (MR, 12.1 ± 6.0% increase; control, 8.1 ± 3.3% decrease) and reduction in intrahepatic lipid content (MR liver/spleen attenuation ratio, 8.1 ± 3.3% increase; control ratio, 2.2 ± 2.1% increase) that was independent of the comparable reduction in weight and adiposity that occurred in both groups.
Sixteen weeks of dietary MR in subjects with metabolic syndrome produced a shift in fuel oxidation that was independent of the weight loss, decreased adiposity, and improved insulin sensitivity that was common to both diets.
The Journal of clinical endocrinology and metabolism 02/2011; 96(5):E836-40. · 6.50 Impact Factor
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ABSTRACT: Objective: In preclinical reports, restriction of dietary methionine intake was shown to enhance metabolic flexibility, improve lipid profiles, and reduce fat deposition. The present report is the outcome of a "proof of concept" study to evaluate the efficacy of dietary methionine restriction (MR) in humans with metabolic syndrome. Methods: Twenty-six obese subjects (six male and 20 female) meeting criteria for metabolic syn-drome were randomized to a diet restricted to 2 mg methionine/kg body weight per day and were provided capsules containing either placebo (n 12) or 33 mg methionine/kg body weight per day (n 14). Energy expenditure, body composition, insulin sensitivity, and biomarkers of metabolic syndrome were measured before and after 16 wk on the respective diets.
The Journal of clinical endocrinology and metabolism 01/2011; 70808(96):E836. · 6.50 Impact Factor
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ABSTRACT: BMI and waist circumference (WC) are used to identify individuals with elevated obesity-related health risks. The current thresholds were derived largely in populations of European origin. This study determined optimal BMI and WC thresholds for the identification of cardiometabolic risk among white and African-American (AA) adults. The sample included 2096 white women, 1789 AA women, 1948 white men, and 643 AA men aged 18-64 years. Elevated cardiometabolic risk was defined as ≥2 risk factors (blood pressure ≥ 130/85 mm Hg; glucose ≥100 mg/dl; triglycerides ≥150 mg/dl; high-density lipoprotein-cholesterol <40 mg/dl (men) or <50 mg/dl (women)). Receiver Operating Characteristic (ROC) curves were used to identify optimal BMI and WC thresholds in each sex-by-ethnicity group. The optimal BMI thresholds were 30 kg/m2 in white women, 32.9 kg/m2 in AA women, 29.1 kg/m2 white men, and 30.4 kg/m2 in AA men, whereas optimal WC thresholds were 91.9 cm in white women, 96.8 cm in AA women, 99.4 in white men, and 99.1 cm in AA men. The sensitivities at the optimal thresholds ranged from 63.5 to 68.5% for BMI and 68.4 to 71.0% for WC and the specificities ranged from 64.2 to 68.8% for BMI and from 68.5 to 71.0% for WC, respectively. In general, the optimal BMI and WC thresholds approximated currently used thresholds in men and in white women. There are no apparent ethnic differences in men; however, in AA women the optimal BMI and WC values are ~3 kg/m2 and 5 cm higher than in white women.
Obesity 01/2011; 19(6):1272-8. · 4.28 Impact Factor
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R Krishnapuram,
E J Dhurandhar,
O Dubuisson,
H Kirk-Ballard,
S Bajpeyi,
N Butte,
M S Sothern,
E Larsen-Meyer,
S Chalew,
B Bennett, [......],
W Johnson,
M Brashear,
G Reinhart,
T Rankinen,
C Bouchard,
W T Cefalu,
J Ye,
R Javier,
A Zuberi,
N V Dhurandhar
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ABSTRACT: Drugs that improve chronic hyperglycemia independently of insulin signaling or reduction of adiposity or dietary fat intake may be highly desirable. Ad36, a human adenovirus, promotes glucose uptake in vitro independently of adiposity or proximal insulin signaling. We tested the ability of Ad36 to improve glycemic control in vivo and determined if the natural Ad36 infection in humans is associated with better glycemic control. C57BL/6J mice fed a chow diet or made diabetic with a high-fat (HF) diet were mock infected or infected with Ad36 or adenovirus Ad2 as a control for infection. Postinfection (pi), systemic glycemic control, hepatic lipid content, and cell signaling in tissues pertinent to glucose metabolism were determined. Next, sera of 1,507 adults and children were screened for Ad36 antibodies as an indicator of past natural infection. In chow-fed mice, Ad36 significantly improved glycemic control for 12 wk pi. In HF-fed mice, Ad36 improved glycemic control and hepatic steatosis up to 20 wk pi. In adipose tissue (AT), skeletal muscle (SM), and liver, Ad36 upregulated distal insulin signaling without recruiting the proximal insulin signaling. Cell signaling suggested that Ad36 increases AT and SM glucose uptake and reduces hepatic glucose release. In humans, Ad36 infection predicted better glycemic control and lower hepatic lipid content independently of age, sex, or adiposity. We conclude that Ad36 offers a novel tool to understand the pathways to improve hyperglycemia and hepatic steatosis independently of proximal insulin signaling, and despite a HF diet. This metabolic engineering by Ad36 appears relevant to humans for developing more practical and effective antidiabetic approaches.
AJP Endocrinology and Metabolism 01/2011; 300(5):E779-89. · 4.75 Impact Factor
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ABSTRACT: The model developed by Forbes (1987) of how body fat mass (FM) and fat-free mass (FFM) change during periods of weight loss or gain (Δ body weight (BW)) assumed that they change in relationship to a constant C = 10·4, where ΔFFM/ΔBW = 10·4/(10·4+FM). Forbes derived C based on aggregated, cross-sectional data from a small sample of women. The objective of the present study was to reanalyse the relationship described by Forbes and to explore whether this relationship is consistent across ethnicity and sex groups using cross-sectional data from a large sample of white and African-American men and women. Baseline data from white and African-American men and women aged 18-60 years, who participated in a clinical study at the Pennington Biomedical Research Center since 2001 and who underwent dual-energy X-ray absorptiometry scans, were available for analysis. To overcome differences in BMI distributions among the ethnicity-by-sex groups, a stratified random sample of participants was selected within each group such that numbers in each BMI category ( < 25, 25-29·9, 30-34·9, 35-39·9, 40+ kg/m2) were proportional to those within the group with the smallest sample size, yielding a sample of 1953 individuals. Linear regression models assessed the FM-FFM relationship across the four ethnicity-by-sex groups. The FM-FFM relationship varied little by ethnicity (P = 0·57) or by sex (P = 0·26). The constant describing the FM-FFM relationship was estimated to be 9·7 (95 % CI 9·0, 10·3). In conclusion, results from our large, biethnic sample of men and women found a FM-FFM relationship very close to that originally described by Forbes, absent of significant variability by ethnicity or sex.
The British journal of nutrition 12/2010; 105(8):1272-6. · 3.45 Impact Factor
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ABSTRACT: Cardiovascular disease (CVD) is the leading cause of death worldwide. Understandably, cardiometabolic risk assessment is an integral component of every adult health evaluation. Customary assessment measures are, however, inadequate: as two-thirds of sudden cardiac deaths occur in clinically healthy individuals. Novel indicators favoring early recognition of adverse cardiometabolic risk in disease-free adults are clearly needed. Clinically healthy disease-free adults with prehypertension (PreHTN: BP120-139/80-89 mm Hg) have an adverse cardiometabolic risk profile. A statistical analysis of disease-free adult NHANES participants was conducted from 1999 to 2006. Overall prevalence of PreHTN in disease-free adults was 36.3%. Prevalence was higher in men (P<0.001) increasing with age up to 70 years (P<0.001). Prevalence correlated strongly with indicators of adverse cardiometabolic risk profile: it was higher with increasing body mass index (BMI) and waist circumference (WC) (P<0.001 for both). Means were significantly higher for BMI, WC, glucose, insulin, hemoglobin A1c, homeostasis model assessment, pulse pressure, C-reactive protein, total cholesterol and triglycerides in subjects with PreHTN (vs. desirable BP: P<0.05 for all). Prevalence of two or more unfavorable risk factors (other than high BP) was 30% higher in disease-free adults with PreHTN vs. desirable BP (prevalence ratio: 1.30; 95% CI: 1.22, 1.39). Detection of PreHTN (a precursor for subsequent HTN), during annual health maintenance in disease-free adults, (especially with one or more of the recognized CVD risk correlates), could become an early marker of adverse cardiometabolic risk profile. Clinical care designed to prevent progression from PreHTN to HTN (JNC 7 recommendation) may attenuate risk.
Hypertension Research 09/2010; 33(9):905-10. · 2.58 Impact Factor
