Weight loss
Effects of acute and chronic administration of the melanocortin agonist MTII in mice with diet-induced obesity.

Pierroz DD, Ziotopoulou M, Ungsunan L, Moschos S, Flier JS, Mantzoros CS.

Division of Endocrinology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.

High-fat diet-induced obesity (DIO) in rodents is associated with hyperleptinemia and resistance to leptin, but the response to agents acting downstream of leptin receptors remains unknown. We assessed the response of mice with DIO to treatment with MTII, an alpha-melanocyte-stimulating hormone analog. MTII delivered four times daily by intraperitoneal injection to C57BL/6J mice produced a dose-responsive effect on food intake, body weight, leptin, corticosterone, insulin, and free fatty acids. In DIO mice, administration of MTII 100 microg q.i.d. i.p. markedly suppressed feeding during the first 4 days of treatment, with food intake returning to control levels at day 5. Progressive weight loss also occurred over the first 4 days, after which weight plateaued at a level below control. After 8 days of treatment, MTII-treated DIO mice had major suppression of both leptin and insulin levels. Central administration of MTII for 4 days (10 nmol/day) in DIO mice significantly suppressed food intake, induced weight loss, and increased energy expenditure. These results indicate that 1) MTII administration to DIO mice causes suppression of food intake and body weight loss, and decreased food intake is primarily responsible for weight loss; 2) peripheral MTII improves insulin resistance in DIO mice; 3) "tachyphylaxis" to the effect of chronic MTII treatment on food intake occurs; and 4) at least some of the effects of MTII are exerted centrally. In conclusion, treatment with a melanocortin agonist is a promising therapeutic approach to DIO and associated insulin resistance.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11978628&dopt=Abstract weight loss



Weight loss
The effect of rate of weight loss on erythrocyte glutathione concentration and synthesis in healthy obese men.

Faber P, Johnstone AM, Gibney ER, Elia M, Stubbs RJ, Duthie GG, Calder AG, Lobley GE.

Rowett Research Institute, Greenburn Road, Bucksburn, Aberdeen AB21 9SB, Scotland, UK. faber doctors.org.uk

Obesity is commonly associated with a high incidence and prevalence of dyslipidaemia, cardiovascular disease and Type II diabetes. Interestingly, studies have also reported decreased antioxidant levels in obese subjects. This may constitute an independent risk factor in the pathogenesis of coronary artery disease as obese subjects would have a decreased capacity to prevent the oxidative modification of low-density lipoproteins, which is a mechanism suggested as central to the development of atherogenesis. As part of a study to investigate responses to weight loss, we have assessed the effects on GSH status of a decrease in body mass of 5%, either after 6 days of complete starvation or 11 days of a very low calorie diet (2.55 MJ/day). There were significant differences between the two groups in the synthesis rate of erythrocyte GSH in response to weight loss. Both the fractional and the erythrocyte synthesis rate of GSH decreased significantly (P<0.01) in the starvation group by 22% and 16% respectively. In contrast, no change in synthesis rates was observed in the very low calorie diet group (P>0.05). Total erythrocyte concentration of GSH was unaffected by the weight loss within both groups. These results suggest that erythrocyte GSH synthesis is depressed in response to a very rapid weight loss induced by fasting. An acute reduction in GSH synthesis in response to a rapid weight loss may constitute a risk factor during periods of increased GSH demands.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11980577&dopt=Abstract weight loss



Weight loss
Body mass index, weight loss and energy intake of old Danish nursing home residents and home-care clients.

Beck AM, Ovesen L.

Danish Veterinary and Food Administration, Moerkhoej Bygade 19, DK-2860 Soeborg, Denmark. be fdir.dk

Low body mass index (BMI) and weight loss is common among old home-care clients and nursing home residents in many countries - often in spite of an apparent sufficient intake of energy. The aim of this study was to assess whether a similar problem exists in Denmark. Information regarding height, body weight, BMI, and energy intake was collected. Besides this, 24 residents were weighed regularly during 1 year. The study was carried out in five nursing homes and two home-care districts situated in the area of Copenhagen. A total of 180 residents and 200 clients 65+ years of age participated. Main outcome measures were prevalence of BMI < 20 kg/m2, BMI < 18.5 kg/m2, acute weight loss and median energy intake. Thirty-three and thirty per cent of the residents and clients had a BMI < 20 kg/m2 and, 22 and 12% had a BMI < 18.5 kg/m2. Of the residents, who were weighed regularly, 38% had a weight loss above 5%. The median intake of energy was equal to or above the estimated median energy requirement. Hence, the prevalence of low BMI and weight loss among old Danish nursing home residents and home-care clients is high and similar to that found in other countries. There is a need for increased focus on nutritional state and risk factors in these settings.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11985754&dopt=Abstract weight loss



Weight loss
Ghrelin: a gut-brain hormone: effect of gastric bypass surgery.

Geloneze B, Tambascia MA, Pilla VF, Geloneze SR, Repetto EM, Pareja JC.

Endocrinology Service, University of Campinas, UNICAMP, SP, Brazil. Bgeloneze aol.com

BACKGROUND: Ghrelin is a newly recognized gastric hormone with orexigenic and adipogenic properties, produced primarily by the stomach. Ghrelin is reduced in obesity. Weight loss is associated with an increase in fasting plasma ghrelin. We assessed the effect of massive weight loss on plasma ghrelin concentrations and its correlation with serum leptin levels and the presence of type 2 diabetes mellitus (DM) in severely obese patients. METHODS: A prospective study was conducted on 28 morbidly obese women (BMI 56.3 +/- 10.2 kg/m2) who underwent gastric bypass, divided into 2 groups: 14 non-diabetics (NGT) and 14 type 2 diabetics (DM2). Ghrelin and leptin were evaluated before silastic ring transected vertical gastric bypass, and again 12 months postoperatively. RESULTS: Fasting plasma ghrelin concentrations were 56% lower in NGT and 59% lower in DM2 compared with a lean control group (P < 0.001). There was no difference in ghrelin levels between NGT and DM2 groups before and after surgery (P > 0.05). Ghrelin was negatively correlated with leptin before gastric bypass surgery (r = 0.51, P < 0.01). The mean plasma ghrelin concentration decreased significantly after surgery in both groups (P < 0.001). CONCLUSION: Ghrelin was inversely related to leptin concentrations. Presence of diabetes did not affect the ghrelin pattern. Reduced production of ghrelin after gastric bypass could be partly responsible for the lack of hyperphagia and thus for the weight loss.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12630608&dopt=Abstract weight loss



Weight loss
Partitioned weight loss and body composition changes during a mountaineering expedition: a field study.

Tanner DA, Stager JM.

Department of Kinesiology, Indiana University, Bloomington 47405, USA.

Weight loss and changes in body composition are recognized phenomena associated with high-altitude mountaineering expeditions. Attempts to partition the weight loss between fat mass (FM) and fat-free mass (FFM) have been inconclusive. Therefore, five male subjects, average age 40.0 +/- 5.5 years, were studied prior to, during, and following a 21-day expedition between 2200 m and 4300 m on Mt. McKinley, Alaska. Pre- to postexpedition body composition changes were determined by densitometry, skinfold thickness (12 sites), body girth measurements (14 sites), and cross-sectional area from magnetic resonance imaging (MRI) (three sites). Data analysis by Student's t-test (p < 0.05(1) tail) indicated decreases in body weight (4.2 +/- 2.8 kg, 220 g/day, 5.4% of initial weight), total skinfold thickness (10.8%), total body girth (2.8%), and percentage of fat by densitometry (15%). Total cross-sectional area of the three MRI slices (upper arm + thigh + calf) decreased 4.7%, muscle area decreased 9.1%, and fat area decreased 3.9%. The three methods used to partition the weight loss between FM and FFM did not agree: 77% FM vs 23% FFM by densitometry, 25% FM vs 75% FFM by skinfolds, and 38% FM vs 62% FFM by MRI. Energy intake (3640 +/- 1250 kcal/day) was negatively correlated (Pearson r > 0.88(2) tail) with losses in weight (r = -0.89), skinfolds (r = -0.93), and girths (r = -0.88), ie the greater the intake the less the decline. Therefore, insufficient energy intake appeared primarily responsible for the weight loss and changes in body composition during the expedition.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11990186&dopt=Abstract weight loss



Weight loss
Malabsorptive gastric bypass in patients with superobesity.

Brolin RE, LaMarca LB, Kenler HA, Cody RP.

Department of Surgery, St. Peter's University Hospital, New Brunswick, NJ 08903, USA. rbrolin saintpetersuh.com

Weight loss in superobese patients has been problematic after conventional gastric restrictive operations including conventional Roux-en-Y gastric bypass (RYGB). The goal of the present study was to compare weight loss in patients with superobesity (body mass index > or =50 kg/m(2)) using a distal RYGB (D-RY) in which the Roux-en-Y anastomosis was performed 75 cm proximal to the ileocecal junction (N = 47) vs. patients who had Roux limbs of 150 cm (N = 152) and 50 to 75 cm (N = 99). All operations incorporated the same gastric restrictive parameters. Minimum follow-up was 3 years and ranged to 16 years. Weight loss and reduction in body mass index were significantly greater after D-RY vs. both RYGB-150 cm and short RYGB and in RYGB-150 cm vs. short RYGB through 5 years. Mean percentage of excess weight loss peaked at 64% after DRY, at 61% after RYGB-150 cm, and at 56% after short RYGB. Weight loss maintenance through 5 years was correlated with Roux limb length with D-RY greater than RYGB-150 cm greater than short RYGB. More than 95% of obesity-related comorbid conditions improved or resolved with weight loss. There was no difference in the early postoperative morbidity rates: 9% after D-RY; 8% after RYGB-150 cm; and 2% after short RYGB with one death (0.3%). All D-RY patients had at least one postoperative metabolic abnormality. Anemia was significantly more common after D-RY vs. the shorter RYGB with no difference in the incidence of metabolic sequelae between RYGB-150 cm and short RYGB. No operations were reversed or modified for nutritional complications. Two D-RY patients required total parenteral nutrition for protein malnutrition. These results show that Roux limb length is correlated with weight loss in superobese patients. However, the greater incidence of metabolic sequelae after D-RY vs. RYGB-150 cm calls into question its routine use in superobese patients undergoing bariatric surgery. We conclude that some degree of malabsorption should be incorporated into bariatric operations performed in superobese patients to achieve satisfactory long-term weight loss.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11992805&dopt=Abstract weight loss



Weight loss
Weight management and weight loss strategies of professional jockeys.

Moore JM, Timperio AF, Crawford DA, Burns CM, Cameron-Smith D.

School of Health Sciences at Deakin University, Burwood, Victoria, Australia.

Jockeys are required to maintain very low body weight and precise weight control during competition. This study examined the weight loss and weight management strategies of professional horseracing jockeys in the state of Victoria, Australia. An anonymous, self-completed questionnaire was administered (55% response rate, n = 116). Almost half (43%) reported that maintaining riding weight was difficult or very difficult, with 75% routinely skipping meals. In preparation for racing, 60% reported that they typically required additional weight loss, with 81% restricting food intake in the 24 hours prior to racing. Additionally, sauna-induced sweating (29%) and diuretics (22%) were frequently employed to further aid in weight loss prior to racing. These rapid weight loss methods did not differ between the 51% of jockeys who followed a weight management plan compared to those who did not. The impact of these extreme weight loss practices on riding performance and health remains unknown.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11993617&dopt=Abstract weight loss



Weight loss
FFAs and QT intervals in obese women with visceral adiposity: effects of sustained weight loss over 1 year.

Corbi GM, Carbone S, Ziccardi P, Giugliano G, Marfella R, Nappo F, Paolisso G, Esposito K, Giugliano D.

Department of Geriatrics and Metabolic Diseases, Second University of Naples, Naples 80138, Italy.

We evaluated 66 obese patients grouped by waist-to-hip ratio (WHR) into group A (WHR > 0.85, n = 30) and group B (WHR < or = 0.85, n = 36), before and after 1 yr of diet-induced weight loss compared with 25 nonobese women. Before diet, the longest values of QT intervals and the highest levels of FFA and catecholamines were in group A (P < 0.01). In obese women (both groups), the corrected QT (QTc); interval correlated with plasma FFA (P < 0.01) and catecholamine (P < 0.02) concentrations. After 1 yr of diet, at the same levels of body weight reduction, the decrement of the QTc interval (P < 0.02), FFA (P < 0.01) and catecholamine (P < 0.02) levels were significantly greater in-group A than group B. In multivariate analysis, the decline of the QTc interval after weight loss was associated with changes in plasma FFA independently of changes in WHR and plasma catecholamines. Our data suggest that the QTc interval is tightly correlated with plasma FFA levels; shortening of cardiac repolarization times in the course of long-lasting weight reduction may reduce the risk of ventricular electrical instability, especially in women with abdominal adiposity.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11994344&dopt=Abstract weight loss



Weight loss
Reduced testosterone levels in human immunodeficiency virus-infected women with weight loss and low weight.

Huang JS, Wilkie SJ, Dolan S, Gallafent JH, Aliabadi N, Sullivan MP, Grinspoon S.

Neuroendocrine Unit and Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, Boston 02114, USA.

Risk factors for hypoandrogenemia among low-weight, human immunodeficiency virus (HIV)-infected patients are not known. Testosterone levels of 69 HIV-infected women with low weight and weight loss were compared with levels for 25 healthy, age- and body mass index-matched control subjects. HIV-infected subjects were of low weight, with a mean (+/- standard deviation) weight loss of -17.6% +/- 9.7% from preillness maximum, and 42% of HIV-infected subjects had a body mass index of <20 kg/m(2). Forty-nine percent of the HIV-infected population versus 8% of the control population exhibited low free testosterone levels (P<.001). Among HIV-infected women, when we controlled for chronic hepatitis status, age, and time of blood sampling, weight loss of >10% of maximum weight was a significant predictor of low free testosterone levels. Free testosterone levels did not differ by drug class or antiretroviral regimen. In conclusion, decreased androgen levels are common among HIV-infected women reporting significant weight loss, independent of exposure to antiretroviral medications.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12567309&dopt=Abstract weight loss



Weight loss
Gastric bypass is an effective treatment for obstructive sleep apnea in patients with clinically significant obesity.

Rasheid S, Banasiak M, Gallagher SF, Lipska A, Kaba S, Ventimiglia D, Anderson WM, Murr MM.

Department of Surgery, Interdisciplinary Obesity Group, University of South Florida, College of Medicine, Tampa, FL, USA.

BACKGROUND: We have demonstrated that obstructive sleep apnea (OSA) is prevalent in 60% of patients undergoing bariatric surgery. A study was conducted to determine whether weight loss following bariatric surgery ameliorates OSA. METHODS: All 100 consecutive patients with symptoms of OSA were prospectively evaluated by polysomnography before gastric bypass. Preoperative and postoperative scores of Epworth Sleepiness Scale (ESS), Respiratory Disturbance Index (RDI), and other parameters of sleep quality were compared using t-test. RESULTS: Preoperative RDI was 40 +/- 4 (normal 5 events/hour, n = 100). 13 patients had no OSA, 29 had mild OSA, while the remaining 58 patients were treated preoperatively for moderate-severe OSA. At a median of 6 months follow-up, BMI and ESS scores improved (38 +/- 1 vs 54 +/- 1 kg/m2, 6 +/- 1 vs 12 +/- 0.1, P < 0.001, postoperatively vs preoperatively). To date, 11 patients have completed postoperative polysomnography (3-21 months) after losing weight (BMI 40 +/- 2 vs 62 +/- 3 kg/m2, P < 0.001). There was significant improvement in ESS (3 +/- 1 vs 14 +/- 2), minimum O2 saturation (SpO2 86 +/- 2 vs 77 +/- 5), sleep efficiency (85 +/- 2% vs 65 +/- 5%), all P < 0.001, postop vs preop; and RDI (56 +/- 13 vs 23 +/- 7, P = 0.041). Regression analysis demonstrated no correlation between preoperative BMI, ESS score and the severity of OSA; and no correlation between % excess body weight loss and postoperative RDI. CONCLUSION: Weight loss following gastric bypass results in profound improvement in OSA.The severity of apnea cannot be reliably predicted by preoperative BMI and ESS; therefore, patients with symptoms of OSA should undergo polysomnography.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12630614&dopt=Abstract weight loss