THE EFFECTS OF PROLONGED STARVATION AND REFEEDING ON 24-HR. URINARY INSULIN LEVELS IN OBESE SUBJECTS

1970 ◽  
Vol 47 (1) ◽  
pp. 73-79 ◽  
Author(s):  
M. D. HELLIER
Keyword(s):  
Calorie Intake ◽  
Striking Difference ◽  
Obese Patients ◽  
Normal Pattern ◽  
Initial Rise ◽  
Pancreatic Insulin ◽  
Total Starvation ◽  
Obese Subjects ◽  
Low Levels ◽  
Insulin Excretion

SUMMARY Six obese patients, three men and three women, underwent a period of prolonged total starvation with subsequent refeeding. During starvation 24 hr. urinary insulin excretion fell in five of the six patients, and reached abnormally low values in four. On refeeding there was an immediate rise in urinary insulin excretion in all the patients and in four abnormally high levels were reached. After the initial rise the amounts of urinary insulin again fell despite continued and increasing calorie intake, and in three patients returned to the previously low levels. It is suggested that on refeeding there is preferential release of recently formed 'pro-insulin' from a pancreas depleted of normal insulin stores by starvation, and that restoration of a normal pattern of insulin secretion can occur only after normal pancreatic insulin stores have been repleted. A striking difference in response to starvation was observed between men and women.

scholarly journals Obstructive sleep apnea syndrome in non-obese patients

2021 ◽  
Author(s):  
Caterina Antonaglia ◽  
Giovanna Passuti
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Obstructive Sleep Apnea Syndrome ◽  
Sleep Apnea Syndrome ◽  
Obese Patients ◽  
Obstructive Sleep ◽  
Obese Subjects ◽  
Apnea Syndrome ◽  
Symptoms And Signs

AbstractObstructive sleep apnea syndrome (OSAS) is characterized by symptoms and signs of more than 5 apneas per hour (AHI) at polysomnography or 15 or more apneas per hour without symptoms. In this review, the focus will be a subgroup of patients: adult non-obese subjects with OSA and their specific features. In non-obese OSA patients (patients with BMI < 30 kg/m2), there are specific polysomnographic features which reflect specific pathophysiological traits. Previous authors identified an anatomical factor (cranial anatomical factors, retrognatia, etc.) in OSA non-obese. We have hypothesized that in this subgroup of patients, there could be a non-anatomical pathological prevalent trait. Little evidence exists regarding the role of low arousal threshold. This factor could explain the difficulty in treating OSA in non-obese patients and emphasizes the importance of a specific therapeutic approach for each patient.

Abstract 052: Short-acting Hypnotic Drugs Increase Mortality and Obese Patients are Particularly Vulnerable

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Robert D Langer ◽  
Daniel F Kripke ◽  
Lawrence E Kline
Keyword(s):  
Excess Mortality ◽  
Poor Sleep ◽  
Obese Patients ◽  
Cox Models ◽  
Short Acting ◽  
Hypnotic Drug ◽  
Hazard Ratios ◽  
Levels Of Use ◽  
Low Levels ◽  
Hypnotic Drugs

Background: An estimated 6% – 10% of U.S. adults took a hypnotic drug for poor sleep in 2010. At least 18 studies have reported significant (p<0.05) associations of hypnotic usage with increased mortality. However, most lacked data on newer, supposedly safer, short-acting drugs, and had limited control for confounding by health status. Furthermore, little is known regarding potentially heightened risks in specific vulnerable populations. Objective: The present study was designed to test whether newer short-acting hypnotic drugs were associated with increased mortality after controlling for comorbid conditions, and to assess risks within subgroups of patients with specific medical conditions. Methods: Using electronic medical records from a large U.S. health system the authors conducted a one-to-two matched-cohort survival analysis of associations between hypnotic drug use and mortality. Records were extracted for 10,529 hypnotic users and 23,676 matched controls with no hypnotic prescriptions, mean age 54 years, followed for an average of 2.5 years between 2002 and 2006. Hazard ratios (HR) for death were computed from Cox models controlled for risk factors and stratified on comorbidites. Results: The short-acting drugs zolpidem (41%) and temazapam (20%) accounted for the majority of use. Patients prescribed any hypnotic had substantially elevated hazards of dying compared to non-users. Importantly, the death hazard was evident even in the lowest tertile, 1 to 18 pills per year, HR 3.60 (95% Confidence Interval, 2.92 – 4.44). HRs for the remaining tertiles were 4.43 (3.67 – 5.36) and 5.32 (4.50 – 6.30), demonstrating a dose-response association. HR were robust within subgroups restricted to users and non-users with identical comorbidity, implying that selective use of hypnotics by patients in poor health was an unlikely explanation for the excess mortality. Obesity emerged as a marker of increased vulnerability. Among 2206 patients with a diagnosis of obesity, (mean BMI 38.8), the mortality HRs by hypnotic tertile were 8.07 (3.64 – 17.89), 6.37 (2.73 – 14.88), and 9.34 (4.47 – 19.52). Additional models were fitted for patients with the combination of Obesity + Diabetes + Hypertension to evaluate the possibility that this risk was driven by metabolic syndrome. HRs for that combination were slightly lower than those for obesity alone, suggesting that obesity was the primary factor. Conclusions: Short-acting hypnotics were associated with a more than 3-fold increased hazard of death that, even at low levels of use. Obese patients appear particularly vulnerable, perhaps through interaction with sleep apnea. Emerging evidence for substantial harm, even with limited exposure to hypnotics, should be weighed against any benefits.

Pyridostigmine enhances, but does not normalise, the GH response to GH-releasing hormone in obese subjects

1990 ◽  
Vol 122 (3) ◽  
pp. 385-390 ◽  
Author(s):  
R. C. Castro ◽  
J. G. H. Vieira ◽  
A. R. Chacra ◽  
G. M. Besser ◽  
A. B. Grossman ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Acetylcholinesterase Inhibitor ◽  
Random Order ◽  
Normal Subjects ◽  
Obese Patients ◽  
Releasing Hormone ◽  
Gh Secretion ◽  
Obese Subjects ◽  
Higher Doses ◽  
Hormone Responsiveness

Abstract Obese patients are characterised by several neuroendocrine abnormalities, including characteristically a decrease in growth hormone responsiveness to GH-releasing hormone. In normal subjects, the GH response to GHRH is enhanced by the acetylcholinesterase inhibitor, pyridostigmine. We have studied the effect of this drug on GH secretion in gross obesity. Twelve obese patients were studied (mean weight 156% of ideal) and compared with a group of 8 normal volunteers. Each subject was initially studied on two occasions, in random order, with GHRH (1–29) NH2 100 μg iv alone and following pretreatment with pyridostigmine 120 mg orally one hour prior to GHRH. In obese patients, the GH response to GHRH was significantly blunted when compared to controls (GH peak: 20 ± 4 vs 44 ± 16 μg/l; mean ± sem). After pyridostigmine, the response to GHRH was enhanced in the obese subjects, but remained significantly reduced compared to non-obese subjects treated with GHRH and pyridostigmine (GH peak: 30 ± 5 vs 77 ± 20 μg/l, respectively). In 6 subjects, higher doses of GHRH or pyridostigmine did not further increase GH responsiveness in obese patients. Our results suggest that obese patients have a disturbed cholinergic control of GH release, probably resulting from increased somatostatinergic tone. This disturbed regulation may be responsible, at least in part, for the blunted GH responses to provocative stimuli.

scholarly journals Abdominal subcutaneous fat quantification in obese patients from limited field-of-view MRI data

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Sophia Michel ◽  
Nicolas Linder ◽  
Tobias Eggebrecht ◽  
Alexander Schaudinn ◽  
Matthias Blüher ◽  
...  
Keyword(s):  
Gender Differences ◽  
Adipose Tissue ◽  
Goodness Of Fit ◽  
Imaging Techniques ◽  
Subcutaneous Fat ◽  
Field Of View ◽  
Coefficient Of Determination ◽  
Obese Patients ◽  
Obese Subjects ◽  
Surrogate Measures

Abstract Different types of adipose tissue can be accurately localized and quantified by tomographic imaging techniques (MRI or CT). One common shortcoming for the abdominal subcutaneous adipose tissue (ASAT) of obese subjects is the technically restricted imaging field of view (FOV). This work derives equations for the conversion between six surrogate measures and fully segmented ASAT volume and discusses the predictive power of these image-based quantities. Clinical (gender, age, anthropometry) and MRI data (1.5 T, two-point Dixon sequence) of 193 overweight and obese patients (116 female, 77 male) from a single research center for obesity were analyzed retrospectively. Six surrogate measures of fully segmented ASAT volume (VASAT) were considered: two simple ASAT lengths, two partial areas (Ap-FH, Ap-ASIS) and two partial volumes (Vp-FH, Vp-ASIS) limited by either the femoral heads (FH) or the anterior superior iliac spine (ASIS). Least-squares regression between each measure and VASAT provided slope and intercept for the computation of estimated ASAT volumes (V~ASAT). Goodness of fit was evaluated by coefficient of determination (R2) and standard deviation of percent differences (sd%) between V~ASAT and VASAT. Best agreement was observed for partial volume Vp-FH (sd% = 14.4% and R2 = 0.78), followed by Vp-ASIS (sd% = 18.1% and R2 = 0.69) and AWFASIS (sd% = 23.9% and R2 = 0.54), with minor gender differences only. Other estimates from simple lengths and partial areas were moderate only (sd% > 23.0% and R2 < 0.50). Gender differences in R2 generally ranged between 0.02 (dven) and 0.29 (Ap-FH). The common FOV restriction for MRI volumetry of ASAT in obese subjects can best be overcome by estimating VASAT from Vp-FH using the equation derived here. The very simple AWFASIS can be used with reservation.

Erythrocyte 2,3-Diphosphoglycerate as Related to Diabetes and Obesity

1975 ◽  
Vol 21 (10) ◽  
pp. 1414-1415 ◽  
Author(s):  
Anastasios Kalofoutis ◽  
Gérard Jullien ◽  
Antonios Koutselinis ◽  
Constantinos Miras
Keyword(s):  
Healthy Subjects ◽  
Diabetic Patients ◽  
Obese Patients ◽  
Obese Subjects ◽  
Diabetes And Obesity

Abstract 2,3-Diphosphoglycerate was determined in the erythrocytes of 17 diabetic and 18 obese patients. Results for obese subjects were significantly (P &lt; .01) different from those obtained for 21 healthy subjects. Results for obese and diabetic patients also differed significantly (P &lt; .01), but not those for diabetic and healthy subjects. Hemoglobin, hematocrit, or bicarbonate measurements did not differ among the three groups.

Problems of the Irradiation of the Pelvis Cancers in Obese Patients

1966 ◽  
Vol 52 (5) ◽  
pp. 319-334 ◽  
Author(s):  
Lorenzo Magno
Keyword(s):  
Gamma Rays ◽  
Normal Subjects ◽  
Correct Choice ◽  
The Body ◽  
Treatment Technique ◽  
Obese Patients ◽  
Obese Women ◽  
Moving Beam ◽  
Choice Of Treatment ◽  
Obese Subjects

The irradiation of the pelvis in obese patients meets biological and technical difficulties sometimes considered insuperable. Chiefly when it is necessary to irradiate a very large volume of tissues (for instance, in the case of the irradiation of the pelvis in uterus and ovary cancers) radiotherapy is sometimes considered unsuitable because of considerations concerning the integral dose to be reached, the acute or late reactions expected, difficulties in the choice of the irradiation technique and the execution itself of the therapy. Actually the irradiation of the pelvis in obese patients is clinically possible: it has been performed without complications by the author up to integral doses of 6 × 107 grads in 50 days. The most important problem is the correct choice of treatment technique: when Co 60 gamma rays are employed, obese patients must be irradiated by means of moving beam techniques. The author brings into evidence that obese women, bearing uterus carcinomas, can be irradiated by means of biaxial pendular techniques, employing the same parameters (field at axis, arc width, position of the axis) as in normal subjects. In effect the pelvis in obese subjects is in the center of the corporal section, as in thin subjects. The shape of isodoses in pendular axial irradiations, for Co 60, does not dipend from the dimensions of the body irradiated. The properties of high voltage moving beam radiotherapy turn to the advantage of obese patients. Technical difficulties, which are not negligible, may always be overcome with proper devise.

Defining echocardiographic reference values of LV volume indices and biventricular strain in obese patients with normal ejection fraction in different cardiac remodeling patterns – a single center study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Badawy ◽  
R Jadav ◽  
M Anastasius ◽  
V Jain ◽  
A Zahid ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Reference Values ◽  
Cardiac Remodeling ◽  
Normal Ejection Fraction ◽  
Obese Patients ◽  
Lv Remodeling ◽  
Obese Subjects ◽  
Lv Volumes ◽  
Lv Volume ◽  
Remodeling Pattern

Abstract Background The left ventricle (LV) in obese patients undergoes different patterns of remodeling in order to normalize wall stress. However, little is known about how LV volume indices, LV global longitudinal strain and right ventricular free wall strain (GLS) vary according to the pattern of LV remodeling. Aim To define the echocardiographic reference values of LV volumes and biventricular GLS across the different LV remodeling patterns in obese patients with a preserved ejection fraction. Methods 2393 adult obese patients (1428 females, 965 males) with a normal ejection fraction who underwent echocardiography from January 2008 to December 2018 were selected. They were categorized according to 4 cardiac remodeling groups defined by LV mass index (102g/m2 in males, 88g/m2 in females) and relative ventricular wall thickness (0.42): normal geometry (NG), eccentric hypertrophy (EH), concentric remodeling (CR) and concentric hypertrophy (CH). Obese subjects were further categorized by BMI class (30–35, 35–40, &gt;40 kg/m2). Obese subjects were gender matched to controls with a normal BMI (18.5–25 kg/m2) and normal cardiac geometry. Mean ± SD, One-way Anova and Tukey- Kramer HSD were applied. P&lt;0.05 is considered significant. Results The mean age of controls and obese patients' were 50±16 and 57±13.6 years respectively (P&lt;0.0001). LV GLS for controls compared to obese subjects with NG, EH, CR and CH was −21.1±2 vs. −20.2±1.9, −19.6±2.8, −18.5±2.9, −17.5±3.4 respectively (p&lt;0.0001 for all), and for RV GLS it was −27.9±4 vs −26.7±3.9, −25.1±5, −23.5±5.5, −24.1±5.2 respectively (p&lt;0.01 for all, except for NG where p=0.2). The distribution of LV indices according to cardiac remodeling subtypes is shown in the figure. Indexed end diastolic and end systolic volumes were smaller in NG, CH and CR compared to controls (p&lt;0.001 for each respectively). LV GLS and ejection fraction were higher in females, while indexed LV volumes were higher in males within each remodeling category (P&lt;0.0001). No significant difference in LV GLS or indexed LV volume was seen across BMI categories within each remodeling pattern (P&gt;0.05). Obese subjects with CH had the highest incidence of the cardiovascular risk factors hyperlipidemia, hypertension and history of myocardial infarction or stroke, compared to those with other remodeling patterns (p&lt;0.0001 for each, vs. NG, EH and CR). Conclusion To our knowledge, this is the largest study to define LV volumes and left and right ventricular GLS according to LV remodeling pattern and BMI category. The Lowest GLS was noted in CH. Ejection fraction was similar across the LV remodeling patterns. There were no differences in GLS and LV indexed volumes across BMI categories within each remodeling group. These results can be applied as a reference values for the obese population with a normal LV ejection fraction. Funding Acknowledgement Type of funding source: None

scholarly journals Metabolic observations during the treatment of obese patients by periods of total starvation

Metabolism ◽  
1964 ◽  
Vol 13 (4) ◽  
pp. 291-302 ◽  
Author(s):  
H.G. van Riet ◽  
F. Schwarz ◽  
P.J. der Kinderen ◽  
Miss W. Veeman
Keyword(s):  
Obese Patients ◽  
Total Starvation

scholarly journals Effect of dexfenfluramine on gastric emptying of a mixed solid-liquid meal in obese subjects

1990 ◽  
Vol 63 (3) ◽  
pp. 447-455 ◽  
Author(s):  
Michael Horowitz ◽  
Anne Maddox ◽  
Judith Wishart ◽  
Jane Vernon-Roberts ◽  
Barry Chatterton ◽  
...  
Keyword(s):  
Gastric Emptying ◽  
Side Effects ◽  
Obese Patients ◽  
Solid Meal ◽  
Liquid Meal ◽  
Placebo Capsule ◽  
Obese Subjects ◽  
Treatment Of Obesity ◽  
Solid Liquid ◽  
Double Isotope

Recent studies suggest that dexfenfluramine (D-fenfluramine), because of its pure serotonergic effect, may be a more potent anti-obesity agent, associated with fewer side-effects than the racemate DL-fenfluramine. The effect of dexfenfluramine on gastric emptying of a mixed solid and liquid meal was assessed with a double-isotope scintigraphic technique in eleven obese patients. Each subject took a placebo capsule on the morning and evening of the day before, and on the morning of the first gastric emptying measurement. Dexfenfluramine was then taken at a dose of 15 mg twice daily and gastric emptying measurements were performed at 5 and at 29 d after the initiation of active treatment. Dexfenfluramine significantly slowed gastric emptying of the solid meal at both 5 and 29d when compared with the placebo (P < 0.05) and also delayed emptying of solid food from the proximal stomach (P < 0.01), but no significant effect on liquid emptying was observed. No significant side-effects were reported and there was a marginal weight loss (P< 0.005) during treatment. We conclude that inhibition of gastric emptying may contribute to the efficacy of dexfenfluramine in the treatment of obesity.

Sign in / Sign up

Export Citation Format

Share Document