Effect of very low-calorie ketogenic diet in combination with omega-3 on inflammation, satiety hormones, body composition, and metabolic markers. A pilot study in class I obese subjects

Purpose This study aims to evaluate the effects of a VLCKD combined with omega-3 supplementation (VLCKD diet only lasted for some weeks, and it was followed by a non-ketogenic LCD for the rest of the study period) on body composition, visceral fat, satiety hormones, inflammatory and metabolic markers. Methods It has been performed a pilot open label study lasted 90 days, in a cohort of 12 women with class I obesity aged 18 to 65 years. Data on body composition (evaluated by Dual X-Ray Absorptiometry—DXA), visceral fat, satiety hormones, inflammatory and metabolic markers were recorded. Results This study showed a body weight reduction mean difference over time of −13.7 kg and the waist circumference mean difference decrease of −13.3 cm. Also, the fat mass (FM) decreased—9.1 kg and visceral adipose tissue (VAT)—0.41 kg. No effects on fat-free mass (FFM) have been reported. Improvements were observed in the satiety hormones, with increased ghrelin and decreased leptin, and also in the metabolic profiles. Conclusions A VLCKD combined with omega-3 supplementation appears to be an effective strategy for promoting an high loss of FM with preservation of FFM in patients with class I obesity.

Markers of adipose tissue hypoxia are elevated in subcutaneous adipose tissue of severely obese patients with obesity hypoventilation syndrome but not in the moderately obese

It has been suggested that metabolic dysfunction in obesity is at least in part driven by adipose tissue (AT) hypoxia. However, studies on AT hypoxia in humans have shown conflicting data. Therefore we aimed to investigate if markers of AT hypoxia were present in the subcutaneous AT of severly obese individuals (class III obesity) with and without hypoventilation syndrome (OHS) in comparison to moderately obese (class I obesity) and lean controls. To provide a proof-of-concept study, we quantified AT hypoxia by hypoxia inducible factor 1 A (HIF1A) protein abundance in human participants ranging from lean to severly obese (class III obesity). On top of that nightly arterial O2 saturation in individuals with obesity OHS was assessed. Subjects with class III obesity (BMI > 40 kg/m2) and OHS exhibited significantly higher adipose HIF1A protein levels versus those with class I obesity (BMI 30–34.9 kg/m2) and lean controls whereas those with class III obesity without OHS showed an intermediate response. HIF1A gene expression was not well correlated with protein abundance. Although these data demonstrate genuine AT hypoxia in the expected pathophysiological context of OHS, we did not observe a hypoxia signal in lesser degrees of obesity suggesting that adipose dysfunction may not be driven by hypoxia in moderate obesity.

Association and Time-Varying Effects of Body Mass Index on All-Cause Mortality in Patients With Hypertension

BackgroundThe relationship between body mass index (BMI) and mortality in hypertension patients remains controversial. This study aimed to evaluate the association and the time-varying effects of different BMI categories on the risk of all-cause mortality in hypertension patients. MethodsThis retrospective cohort study was conducted among 212,394 Chinese people with hypertension. All deaths were identified based on Shanghai Vital Statistics. Cox model combined with time-by-covariate interactions was used to estimate the association and the time-varying effects of BMI on the risk of all-cause mortality. The potential non-linear effects across follow-up period for BMI were examined by the application of restricted cubic spline (RCS).ResultsOverall, 31,130 deaths occurred (14.7%) within an average follow-up of 8.24 years. Underweight (<18.5 kg/m2) showed a progressively weakening negative effect on all-cause mortality over time. For both sexes, overweight (23.0-24.9 kg/m2) and class I obesity (25.0-29.9 kg/m2) showed protective effects within 5 years after registration, but these became insignificant in later years. There was no significant difference in the effect on all-cause mortality between class II obesity (≥30.0 kg/m2) and normal weight. in the elderly patients, overweight, class I obesity and class II obesity had continuous protective effects on mortality.ConclusionsAlthough the effect of baseline body mass index on the risk of all-cause mortality varied at different follow-up periods, underweight persistently remained a risk factor for all-cause mortality in hypertension, whereas overweight and class I obesity had protective effects. Thus, in the long-term management of hypertension, more attention should be given to underweight patients.

Medication use and obesity in Brazil: results from the National Health Survey

Noncommunicable diseases (NCDs) associated with obesity generally require drug treatment. The use of medications in individuals with obesity has not been extensively investigated. The objective of this study was to analyze the relation between obesity and medication use. Data from the Brazilian National Health Survey 2013 was used, including 59,402 individuals. Weight and height measures were used to calculate body mass index (BMI) and categorized individuals according to BMI classification (exposure). The number of medications used for treating nine obesity-related NCDs was the outcome variable. Multinomial regression analyses were performed. The risk of use of medications to treat at least one NCD increased progressively with rising BMI, where this risk was even higher for treating two or more diseases. The risk of having to treat two or more NCDs with medications was approximately 70% greater among individuals with overweight (adjusted RR = 1.66; 95%CI 1.46–1.89), 170% greater in those with class I obesity (adjusted RR = 2.68; 95%CI 2.29–3.12), 340% greater for class II obesity (adjusted RR = 4.44; 95%CI 3.54–5.56) and 450% greater among individuals with class III obesity (adjusted RR = 5.53; 95%CI 3.81–8.02), compared with normal-weight subjects. Obesity was directly associated with drug utilization and the number of medications used to treat obesity-related NCDs.

EPID-24. OBESITY IN MALES WITH MENINGIOMA: A U.S. POPULATION-BASED STUDY

BACKGROUND The female predominance of meningiomas may reflect a hormonal influence on tumorigenesis. Obesity alters steroid synthesis and chronically exposes men to hyperestrogenemia. OBJECTIVE Identify differences in males undergoing craniotomy for meningioma compared to other tumors or aneurysms. METHODS The National Surgical Quality Improvement Program was retrospectively queried from 2013–2018 for cases of craniotomy for resection of meningioma, other tumor, and aneurysm by CPT code in male patients and confirmed with postoperative ICD-10 code. Height and weight data were used to create body mass index (BMI): underweight (&lt; 18.5), normal (18.5 to&lt; 25), overweight (25 to&lt; 30), class I obesity (30 to&lt; 35), class II obesity (35 to&lt; 40), and class III obesity (40+). RESULTS We identified 2,458 males who underwent craniotomy for meningioma, 9,889 for other tumor, and 386 for aneurysm. Using multivariable logistic regression, age (OR 1.01 per year, 95% CI 1.01-1.01, p&lt; 0.001), diabetes mellitus (OR 1.32, 95% CI 1.17–1.48, p&lt; 0.001), and increasing BMI (overweight: OR 1.55, 95% CI 1.36–1.76, p&lt; 0.001; class I: OR 2.00, 95% CI 1.75–2.30, p&lt; 0.0001; class II: OR 2.05, 95% CI 1.24–1.76, p&lt; 0.001; class III: OR 1.47, 95% CI 1.24–1.76, p&lt; 0.0001) were significantly and independently associated with craniotomy for meningioma compared to other tumor or aneurysm. For other tumor, higher BMI was associated with lower likelihood (overweight: OR 0.70, 95% CI 0.62–0.79, p&lt; 0.001; class I: OR 0.55, 95% CI 0.49–0.63, p&lt; 0.001; class II: OR 0.52, 95% CI 0.44–0.62, p&lt; 0.001; class III: OR 0.74, 95% CI 0.63–0.87, p&lt; 0.001). For aneurysm, there was no significant difference (overweight p=0.70; class I p=0.65; class II p=0.76; class III p=0.57). CONCLUSIONS BMI independently predicts having craniotomy for meningioma when compared to other tumor or aneurysm amongst US male patients.

Mild and Severe Obesity Reduce the Effectiveness of Lumbar Fusions: 1-Year Patient-Reported Outcomes in 8171 Patients

BACKGROUND Elevated body mass index (BMI) is a well-known risk factor for surgical complications in lumbar surgery. However, its effect on surgical effectiveness independent of surgical complications is unclear. OBJECTIVE To determine increasing BMI’s effect on functional outcomes following lumbar fusion surgery, independent of surgical complications. METHODS We retrospectively analyzed a prospectively built, patient-reported, quality of life registry representing 75 hospital systems. We evaluated 1- to 3-level elective lumbar fusions. Patients who experienced surgical complications were excluded. A stepwise multivariate regression model assessed factors independently associated with 1-yr Oswestry Disability Index (ODI), preop to 1-yr ODI change, and achievement of minimal clinically important difference (MCID). RESULTS A total of 8171 patients met inclusion criteria: 2435 with class I obesity (BMI 30-35 kg/m2), 1328 with class II (35-40 kg/m2), and 760 with class III (≥40 kg/m2). Increasing BMI was independently associated with worse 12-mo ODI (t = 8.005, P &lt; .001) and decreased likelihood of achieving MCID (odds ratio [OR] = 0.977, P &lt; .001). One year after surgery, mean ODI, ODI change, and percentage achieving MCID worsened with class I, class II, and class III vs nonobese cohorts (P &lt; .001) in stepwise fashion. CONCLUSION Increasing BMI is associated with decreased effectiveness of 1- to 3-level elective lumbar fusion, despite absence of surgical complications. BMI ≥ 30 kg/m2 is, therefore, a risk factor for both surgical complication and reduced benefit from lumbar fusion.

The features of psychological state, eating behavior, hormonal and adipokine regulation of metabolism in men with subcutaneous and abdominal fat distribution

BACKGROUND: development of obesity and obesity related conditions are directly associated with eating disorders and psychological state. There is increasing focus on the assessment the characteristics of these indicators in men with subcutaneous and central fat distribution, which are associated with various hormonal and adipokine mechanisms that effect on parameters of metabolism and eating behavior. AIMS: to study the characteristics of the psychologycal state, eating behavior and their relationship with hormonal and adipokine status in men with different fat distribution. MATERIALS AND METHODS: a single-center, cross-sectional study of 99 men aged 27 to 68 years was performed. 4 groups of men were formed after anthropometric examination. Group 1 (comparison) consisted of men with normal body weight. Group 2 consisted of overweight men, class I obesity and lower subcutaneous fat distribution (SFD). Group 3 consisted of overweight men, men with class I obesity and abdominal fat distribution (AFD); group 4 - men with class II obesity and class III obesity AFD. Eating behavior were determined with DEBQ questionnaire, severity of anxiety-depressive disorders were investigated with the Hospital Anxiety and Depression Scale; body image satisfaction was assessed with body image questionnaire. Serum glucose, triglycerides, insulin, leptin and adiponectin were estimated. RESULTS: it was shown, that men with AFD had severe metabolic disorders: hyperglycemia, hypertriglyceridemia, hyperinsulinemia and insulin resistance, hyperleptinemia and hypoadiponectinemia, than men with SFD. Men with AFD had an external type of eating behavior, with sever expressed depressive disorders and body image dissatisfaction. Men with SFD had an emotional type of eating behavior and higher body image satisfaction. A comparative analysis between men from 3 and 4 groups with AFD showed that in group 4 in men had higher hyperleptinemia and insulin resistance and there are no differences in severity of eating disorders, anxiety and depression between the groups. CONCLUSIONS: adipose tissue topography is associated with the psychophysiological, metabolic, hormonal and adipokine characteristics that underlie the development of primary obesity in men.