scholarly journals Levothyroxine Replacement in Obese Adults: The Role of Metabolic Variables and Aging on Thyroid Testing Abnormalities

2019 ◽  
Vol 104 (12) ◽  
pp. 6265-6274 ◽  
Author(s):  
Chiara Mele ◽  
Maria Antonella Tagliaferri ◽  
Loredana Pagano ◽  
Davide Soranna ◽  
Massimo Scacchi ◽  
...  
Keyword(s):  
Body Composition ◽  
Care Center ◽  
Tertiary Care ◽  
Primary Hypothyroidism ◽  
Fat Free Mass ◽  
Obese Patients ◽  
Obese Adults ◽  
Levothyroxine Replacement ◽  
Multivariable Analyses ◽  
Main Determinants

Abstract Context General rates of over- and underreplacement in levothyroxine (LT4) users with primary hypothyroidism are variably high. No information on LT4 adequacy exists in obesity. Objective We explored rates and factors relating to LT4 adequacy in obese patients with primary hypothyroidism. Setting Tertiary care center. Design Among 4954 consecutive obese patients admitted between 2011 and 2014, 691 hypothyroid patients receiving LT4 therapy and 691 body mass index (BMI)-, age-, and sex-matched euthyroid controls underwent analysis of thyroid function, glucolipid profile, body composition, and indirect calorimetry. LT4 users were classified into low TSH (<0.27 mU/L), euthyroid (0.27 to 4.2 mU/L), and high TSH (>4.2 mU/L). Results LT4 users constituted 13.9% of the incident population. TSH was low in 7.5%, high in 17.2%, and normal in 75.2% of LT4 users. Overtreatment decreased with aging and more LT4 users ≥65 years of age had normal TSH than those <65 years of age (P < 0.05). Compared with the euthyroid obese group, LT4 users showed higher adiposity, similar insulin resistance, but a healthier lipid profile. In multivariable analyses, LT4 dose was predicted by fat-free mass, hypothyroidism cause, and sex (P < 0.0001 to < 0.05). Risk of LT4 overreplacement increased with younger age (OR 0.96; 95% CI 0.94 to 0.99), higher LT4 dose (OR 2.98; 95% CI 1.44 to 6.14), and lower BMI (OR 0.93; 95% CI 0.88 to 0.99). Male sex increased the likelihood of LT4 underreplacement (OR 2.37; 95% CI 1.10 to 5.11). Conclusions Obesity is associated with milder rates of inadequate LT4 treatment compared with nonobese populations. LT4 adequacy increases with aging. Age, body composition, and sex are main determinants of LT4 requirements in obesity.

Abstract 075: Differences In Body Composition At Baseline And In Response To Exercise Training By Metabolic Health And Weight Status

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Alexis Jones ◽  
Jacob L Barber ◽  
James S Skinner ◽  
Claude Bouchard ◽  
Mark A Sarzynski
Keyword(s):  
Body Composition ◽  
Exercise Training ◽  
Visceral Fat ◽  
Weight Status ◽  
Normal Weight ◽  
Metabolic Health ◽  
Fat Free Mass ◽  
Obese Adults ◽  
Change Models ◽  
Metabolically Healthy

Background: Body composition is known to differ across metabolic health and weight phenotypes. Regular exercise improves body composition, yet little is known about differences in exercise response across metabolic health and weight phenotypes. Methods: Normal weight (n=376) and overweight/obese (OWOB) adults (n=456) from the HERITAGE Family Study (56% female, 38% Black) completed a 20-week endurance training program. Four groups based on baseline BMI and metabolic risk were created: metabolically healthy normal weight, MHNW; metabolically unhealthy normal weight, MUNW; metabolically healthy OWOB, MHO; and metabolically unhealthy OWOB, MUO. Unhealthy was defined as having ≥2 metabolic syndrome components. General linear models tested for differences in baseline and change in measures of body composition (fat mass [FM], fat-free mass [FFM], % body fat [%BF], visceral fat) after adjusting for age, sex, and ethnicity (and baseline value in change models). Results: Table 1 shows adjusted mean baseline and change in body composition values by group. Baseline body composition tended to track with weight status, with NW adults having lower FM, %BF, and visceral fat compared to obese adults (p<0.05), regardless of metabolic health. However, the MHO group had lower baseline values of these traits compared to MUO (p<0.05). Body composition measures significantly improved with exercise training in all groups, however, the magnitude of change differed between groups. For example, both NW groups had larger decreases in %BF compared to the obese groups, with MUNW showing the largest decrease. Conversely, MHNW showed the largest decrease in visceral fat, which was greater than both obese groups, but change in visceral fat was similar between MHO and MUNW. Conclusions: Normal weight adults tended to have better body composition profiles at baseline and larger improvements with exercise compared to obese adults, regardless of metabolic health. Within weight groups, body composition improved regardless of metabolic health status.

Resting Energy Expenditure in Obese Women with Primary Hypothyroidism and Appropriate Levothyroxine Replacement Therapy

2020 ◽  
Vol 105 (4) ◽  
pp. e1741-e1748 ◽  
Author(s):  
Emanuele Muraca ◽  
Stefano Ciardullo ◽  
Alice Oltolini ◽  
Francesca Zerbini ◽  
Eleonora Bianconi ◽  
...  
Keyword(s):  
Body Composition ◽  
Energy Expenditure ◽  
Replacement Therapy ◽  
Resting Energy Expenditure ◽  
Primary Hypothyroidism ◽  
Normal Serum ◽  
Fat Free Mass ◽  
Model Assessment ◽  
Obese Women ◽  
Resting Energy

Abstract Context Growing evidence suggests that appropriate levothyroxine (LT4) replacement therapy may not correct the full set of metabolic defects afflicting individuals with hypothyroidism. Objective To assess whether obese subjects with primary hypothyroidism are characterized by alterations of the resting energy expenditure (REE). Design Retrospective analysis of a set of data about obese women attending the outpatients service of a single obesity center from January 2013 to July 2019. Patients A total of 649 nondiabetic women with body mass index (BMI) &gt; 30 kg/m2 and thyrotropin (TSH) level 0.4–4.0 mU/L were segregated into 2 groups: patients with primary hypothyroidism taking LT4 therapy (n = 85) and patients with normal thyroid function (n = 564). Main outcomes REE and body composition assessed using indirect calorimetry and bioimpedance. Results REE was reduced in women with hypothyroidism in LT4 therapy when compared with controls (28.59 ± 3.26 vs 29.91 ± 3.59 kcal/kg fat-free mass (FFM)/day), including when adjusted for age, BMI, body composition, and level of physical activity (P = 0.008). This metabolic difference was attenuated only when adjustment for homeostatic model assessment of insulin resistance (HOMA-IR) was performed. Conclusions This study demonstrated that obese hypothyroid women in LT4 therapy, with normal serum TSH level compared with euthyroid controls, are characterized by reduced REE, in line with the hypothesis that standard LT4 replacement therapy may not fully correct metabolic alterations related to hypothyroidism. We are not able to exclude that this feature may be influenced by the modulation of insulin sensitivity at the liver site, induced by LT4 oral administration.

scholarly journals Body Composition Changes After Very-Low-Calorie Ketogenic Diet in Obesity Evaluated by 3 Standardized Methods

2016 ◽  
Vol 102 (2) ◽  
pp. 488-498 ◽  
Author(s):  
Diego Gomez-Arbelaez ◽  
Diego Bellido ◽  
Ana I. Castro ◽  
Lucia Ordoñez-Mayan ◽  
Jose Carreira ◽  
...  
Keyword(s):  
Weight Loss ◽  
Body Composition ◽  
Fat Mass ◽  
Bioelectrical Impedance ◽  
Fat Free Mass ◽  
Obese Patients ◽  
Body Composition Assessment ◽  
Visceral Mass ◽  
Low Calorie ◽  
Composition Changes

Abstract Context: Common concerns when using low-calorie diets as a treatment for obesity are the reduction in fat-free mass, mostly muscular mass, that occurs together with the fat mass (FM) loss, and determining the best methodologies to evaluate body composition changes. Objective: This study aimed to evaluate the very-low-calorie ketogenic (VLCK) diet-induced changes in body composition of obese patients and to compare 3 different methodologies used to evaluate those changes. Design: Twenty obese patients followed a VLCK diet for 4 months. Body composition assessment was performed by dual-energy X-ray absorptiometry (DXA), multifrequency bioelectrical impedance (MF-BIA), and air displacement plethysmography (ADP) techniques. Muscular strength was also assessed. Measurements were performed at 4 points matched with the ketotic phases (basal, maximum ketosis, ketosis declining, and out of ketosis). Results: After 4 months the VLCK diet induced a −20.2 ± 4.5 kg weight loss, at expenses of reductions in fat mass (FM) of −16.5 ± 5.1 kg (DXA), −18.2 ± 5.8 kg (MF-BIA), and −17.7 ± 9.9 kg (ADP). A substantial decrease was also observed in the visceral FM. The mild but marked reduction in fat-free mass occurred at maximum ketosis, primarily as a result of changes in total body water, and was recovered thereafter. No changes in muscle strength were observed. A strong correlation was evidenced between the 3 methods of assessing body composition. Conclusion: The VLCK diet-induced weight loss was mainly at the expense of FM and visceral mass; muscle mass and strength were preserved. Of the 3 body composition techniques used, the MF-BIA method seems more convenient in the clinical setting.

scholarly journals Personalized Diet in Obesity: A Quasi-Experimental Study on Fat Mass and Fat-Free Mass Changes

Healthcare ◽  
2021 ◽  
Vol 9 (9) ◽  
pp. 1101
Author(s):  
Manuel Reig García-Galbis ◽  
Diego I. Gallardo ◽  
Rosa María Martínez-Espinosa ◽  
María José Soto-Méndez
Keyword(s):  
Experimental Study ◽  
Body Composition ◽  
Fat Mass ◽  
Overweight And Obesity ◽  
The Body ◽  
Fat Free Mass ◽  
Obese Adults ◽  
Quasi Experimental ◽  
Clinically Significant ◽  
Composition Changes

Considering that the prevalence of overweight and obesity in Southeast of Spain is high, the aim of this work was to analyze the relation between the adherence to a personalized diet and the effectiveness of changes in the body composition in overweight and obese adults in this region. This quasi-experimental study presents the following selection criteria: attendance at the consultation between 2006 and 2012, subjects ≥ 19 years of age with overweight or obesity. In total, 591 overweight or obese individuals were involved in this study, attending 4091 clinic consultations in total. Most of the sample consisted of subjects who attended >3 consultations (>1.5 months), and were females aged 19–64 years who obtained clinically significant changes in fat mass (FM, ≥5%) and recommended changes in fat-free mass (FFM, ≥0%). Based on the results obtained and the experience gained from this research, the following recommendations are established: (i) record fat mass and fat-free mass index as a complement to body mass index; (ii) use FM and FFM to evaluate effectiveness of interventions with the aim of obtaining body composition changes; (iii) use personalized diet to achieve significant changes in FM and avoid non-recommended changes in FFM.

scholarly journals Testosterone Treatment in Infants With 47,XXY: Effects on Body Composition

2019 ◽  
Vol 3 (12) ◽  
pp. 2276-2285 ◽  
Author(s):  
Shanlee M Davis ◽  
Regina M Reynolds ◽  
Dana M Dabelea ◽  
Philip S Zeitler ◽  
Nicole R Tartaglia
Keyword(s):  
Body Composition ◽  
Fat Mass ◽  
Tertiary Care ◽  
Treated Group ◽  
Fat Free Mass ◽  
Healthy Male ◽  
Penile Length ◽  
Serious Adverse Events ◽  
Testosterone Treatment ◽  
Z Scores

Abstract Context Boys with XXY have greater adiposity and a higher risk of cardiovascular disease. Infants with XXY have lower testosterone concentrations than typical boys, but no studies have evaluated adiposity in infants with XXY or the physiologic effects of giving testosterone replacement. Objective To determine the effect of testosterone on body composition in infants with XXY. Design Prospective, randomized trial. Setting Tertiary care pediatric referral center. Participants 20 infants 6 to 15 weeks of age with 47,XXY. Intervention Testosterone cypionate 25 mg intramuscularly monthly for three doses vs no treatment. Main Outcome Measures Difference in change in adiposity (percent fat mass z scores); other body composition measures, penile length, and safety outcomes between treated and untreated infants; and comparison with typical infants. Results The increase in percent fat mass (%FM) z scores was greater in the untreated group than in the treated group (+0.92 ± 0.62 vs −0.12 ± 0.65, P = 0.004). Increases in secondary outcomes were greater in the testosterone-treated group for total mass, fat-free mass, length z score, stretched penile length, and growth velocity (P < 0.002 for all). At 5 months of age, adiposity in untreated infants with XXY was 26.7% compared with 23.2% in healthy male infants of the same age (P = 0.0037); there was no difference in %FM between the treated XXY boys and controls. Reported side effects were minimal and self-limited; no serious adverse events occurred. Conclusions Adiposity of untreated infants was 15% greater than that of male controls by 5 months of age. Testosterone treatment for infants with XXY resulted in positive changes in body composition.

Multivariable Analysis of the Association between Antenatal Depressive Symptomatology and Postpartum Visit Attendance

2018 ◽  
Vol 36 (10) ◽  
pp. 1009-1013 ◽  
Author(s):  
Jessica Y. Shim ◽  
Elisabeth L. Stark ◽  
Carolyn M. Ross ◽  
Emily S. Miller
Keyword(s):  
Depressive Symptomatology ◽  
Care Center ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Antenatal Depression ◽  
Postpartum Visit ◽  
Patient Health ◽  
Multivariable Analyses ◽  
Publicly Insured ◽  
Racial Ethnic

Objective We sought to evaluate whether antenatal depression was associated with postpartum visit nonattendance. Study Design This retrospective cohort study included women who received prenatal care at the academic outpatient offices of a single tertiary care center between March 1, 2009, and December 31, 2014. Women were screened for antenatal depression using the Patient Health Questionnaire-9. Attendance at the postpartum visit was compared between women with and without antenatal depressive symptomatology using bivariate and multivariable analyses. Results Of the 2,870 women who met the inclusion criteria, 566 (19.7%) did not attend the postpartum visit. Women who did not attend a postpartum visit were younger and more likely to be a racial/ethnic minority, publicly insured, or multiparous; they were more likely to have a higher body mass index, as well as a vaginal delivery. Compared with those without antenatal depressive symptomatology, women with antenatal depressive symptomatology were significantly less likely to attend their postpartum visit (18.6 vs. 29.2%, p < 0.001). This association persisted even after controlling for potential confounders (adjusted odds ratio: 0.69, 95% confidence interval: 0.48–0.99). Conclusion Antenatal depressive symptomatology is significantly associated with nonattendance at the postpartum visit.

scholarly journals Obesity and chronic obstructive pulmonary disease

2011 ◽  
Vol 139 (5-6) ◽  
pp. 322-327 ◽  
Author(s):  
Ivan Cekerevac ◽  
Zorica Lazic
Keyword(s):  
Quality Of Life ◽  
Body Composition ◽  
Airflow Obstruction ◽  
Fat Free Mass ◽  
Chronic Obstructive ◽  
Obese Patients ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Prevalence Of Obesity

Introduction. Nutritional abnormalities have one of the most important systematic effects on chronic obstructive pulmonary disease (COPD). A relationship between COPD and obesity has been observed and recognized. In COPD patients, beside changes in the total body weight, changes in body composition are also possible with the loss of fat-free mass (FFM). Objective. This study was undertaken to evaluate the impact of obesity and the change of body composition on the pulmonary function, dyspnoea level and the quality of life in COPD patients. Methods. Seventy-nine patients in the stable state of COPD were evaluated. Pulmonary function and arterial blood gas analysis were assessed. Nutritional status was analyzed according to Body Mass Index (BMI). Body composition was evaluated by using anthropometric measurement by fat free mass index (FFMI). Quality of life was assessed using the St. George Respiratory Questionnaire (SGRQ). The Visual Analogue Scale (VAS) was used to evaluate dyspnoea. Results. The highest prevalence of obesity (50.0%) was found in patients with mild COPD, while the lowest prevalence was detected in very severe COPD patients (10.0%). The loss of FFM occurred in 22.2% patients with normal body weight and in 9.0% of overweight COPD patients. The quality of life was lower in obese patients compared to other COPD patients. A higher dyspnoea level was also present in obese patients. The lowest airflow obstruction was in obese patients (p=0.023). We found a significant positive correlation between forced expiratory volume in the first second (FEV1%) and BMI (r=0.326, p=0.003), FEV1% and FFMI (r=0.321, p=0.004). Conclusion. The highest prevalence of obesity was in patients with mild COPD. Obese patients with COPD had the lowest level of airflow obstruction, higher dyspnoea level and lower quality of life in comparison to other COPD patients.

scholarly journals Resting energy expenditure is not increased in mildly hyperglycaemic obese diabetic patients

2006 ◽  
Vol 96 (5) ◽  
pp. 945-948 ◽  
Author(s):  
M. Ryan ◽  
A. Sallé ◽  
G. Guilloteau ◽  
M. Genaitay ◽  
M. B. E. Livingstone ◽  
...  
Keyword(s):  
Body Composition ◽  
Energy Expenditure ◽  
Resting Energy Expenditure ◽  
Glycated Haemoglobin ◽  
Fat Free Mass ◽  
Diabetic Patients ◽  
Obese Patients ◽  
Obese People ◽  
Resting Energy

Resting energy expenditure (REE) is believed to be increased in type 2 diabetes, an increase that is associated with deteriorating glucose tolerance during its development. Meanwhile, insulin resistance, a state linked to obesity and observed in all type 2 diabetic patients, is associated with reduced REE. Our aim was to compare REE in obese patients with and without diabetes. REE, body composition (total body water, density, percentage fat and fat-free mass: 3-compartment model) and metabolic control were assessed in fifty obese Caucasian patients with diabetes (glycated haemoglobin level 7·6 (sd 1·5) %) and fifty obese patients who were non-diabetic. Despite being more overweight and younger, obese non-diabetic patients had an absolute REE (7·73 (sd 1·44) v. 8·12 (sd 1·37) MJ; P=0·17) and percentage fat-free mass similar to those of obese diabetic patients. Even when adjusted for differences in body composition, REE remained similar in both groups. Furthermore, REE (absolute and adjusted) was unaffected by both glucose level and control (glycated haemoglobin), with fat-free mass being the only determinant of REE. We conclude that REE is not necessarily increased by the presence of diabetes in obese people.

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