Weight loss
Weight changes, medical complications, and performance during an Ironman triathlon.

Sharwood KA, Collins M, Goedecke JH, Wilson G, Noakes TD.

UCT/MRC Research Unit for Exercise Science and Sports Medicine, P O Box 115, Newlands 7725, Cape Town, South Africa. sharwood sports.uct.ac.za

BACKGROUND: Subjects exercising without fluid ingestion in desert heat terminated exercise when the total loss in body weight exceeded 7%. It is not known if athletes competing in cooler conditions with free access to fluid terminate exercise at similar levels of weight loss. OBJECTIVES: To determine any associations between percentage weight losses during a 224 km Ironman triathlon, serum sodium concentrations and rectal temperatures after the race, and prevalence of medical diagnoses. METHODS: Athletes competing in the 2000 and 2001 South African Ironman triathlon were weighed on the day of registration and again immediately before and immediately after the race. Blood pressure and serum sodium concentrations were measured at registration and immediately after the race. Rectal temperatures were also measured after the race, at which time all athletes were medically examined. Athletes were assigned to one of three groups according to percentage weight loss during the race. RESULTS: Body weight was significantly (p<0.0001) reduced after the race in all three groups. Serum sodium concentrations were significantly (p<0.001) higher in athletes with the greatest percentage weight loss. Rectal temperatures were the same in all groups, with only a weak inverse association between temperature and percentage weight loss. There were no significant differences in diagnostic indices of high weight loss or incidence of medical diagnoses between groups. CONCLUSIONS: Large changes in body weight during a triathlon were not associated with a greater prevalence of medical complications or higher rectal temperatures but were associated with higher serum sodium concentrations.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15562165&dopt=Abstract weight loss



Weight loss
Debilitating diarrhoea and weight loss due to colitis in two RA patients treated with leflunomide.

Verschueren P, Vandooren AK, Westhovens R.

Department of Rheumatology, University Hospital Leuven, Belgium. patrick.verschueren uz.kuleuven.ac.be

Diarrhoea and weight loss are frequently reported adverse events in rheumatoid arthritis (RA) patients receiving the disease-modifying antirheumatic drug (DMARD) leflunomide. According to the available literature these side effects occur mostly during the first 6 months of treatment, are rather mild and rarely lead to treatment withdrawal. In this report, we describe the clinical, endoscopic and histologic findings in two RA patients with severe diarrhoea and important weight loss more than 12 months after starting treatment with leflunomide. In both cases the symptoms were caused by colitis, but one had ulcerative and the other microscopic colitis. Despite treatment with budesonide the complaints only improved after withdrawal of leflunomide, making a causal relationship between this drug and the pathogenesis of colitis probable. The heterogeneous histopathological findings in these two patients, however, do not allow us to draw any definitive conclusions about the mechanism by which leflunomide causes diarrhoea and weight loss in RA patients. We conclude that persistent diarrhoea or weight loss in patients taking leflunomide can be more serious than what is previously reported in the literature. In such cases leflunomide treatment should be stopped and an endoscopic examination of the colon is recommended. Given the long half-life of this drug a washout procedure with cholestyramine should be considered whenever the problem is severe or persistent.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15565393&dopt=Abstract weight loss



Weight loss
An integrated method to determine meaningful changes in health-related quality of life.

Crosby RD, Kolotkin RL, Williams GR.

Neuropsychiatric Research Institute, 700 First Avenue South, Fargo, North Dakota 58107, USA. rcrosby nrifargo.com

OBJECTIVE: We describe an integrated method for determining meaningful change in health-related quality of life (HRQOL) that combines information from anchor-based and distribution-based methods and illustrate this method using data aggregated from weight loss studies. STUDY DESIGN AND SETTING: A total of 1476 participants in weight loss studies were evaluated at baseline and at 6 months using the Impact of Weight on Quality of Life-Lite (IWQOL-Lite). Severity of baseline impairment was determined by comparing scores with those obtained from a normative sample of 534 normal/overweight individuals. The precision of the IWQOL-Lite was evaluated using standard error of measurement corrected for regression to the mean. Weight loss was used as an anchor for evaluating changes in IWQOL-Lite scores. RESULTS: Change in HRQOL varied as a function of weight loss and baseline severity of HRQOL. Using this integrated method, an improvement of 7.7 to 12 points (depending on baseline severity) on IWQOL-Lite total score is considered meaningful. CONCLUSION: Meaningful change in HRQOL can be determined using an integrated method that (1) combines information from anchor-based and distribution-based methods, (2) reconciles discrepancies between these two methods, and (3) adjusts for baseline severity and regression to the mean. This method may be applied to other types of HRQOL measures and conditions.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15567631&dopt=Abstract weight loss



Weight loss
Effect of vermiculite addition on compost produced from Korean food wastes.

Seo JY, Heo JS, Kim TH, Joo WH, Crohn DM.

Department of Environmental Engineering, College of Engineering, Changwon National University, Changwon 641-773, Republic of Korea. syseo sarim.changwon.ac.kr

To evaluate the effect of vermiculite addition on composting food wastes from Korean households, food wastes were composted in three small bins to which different additives were added. The following three bins were employed: in Case I, only recycled compost was composted; in Case II, food wastes with recycled compost; and in Case III, food wastes with recycled compost and vermiculite. In the experiment performed for 30 days, it was confirmed that the supplementary addition of vermiculite to the composting mixture did not significantly improve the weight loss rate and the decomposition rate of food wastes. Due to dilution through the use of inorganic vermiculite, the vermiculite addition reduced the organic matter concentration of the composting mixtures. Vermiculite addition did not raise the pH value. Weight losses of roughly 70% were observed based on calculating moisture loss as well as dry food waste loss and not considering additives, while dry food waste loss was 29.4% and 35.8% with and without the addition of vermiculite, respectively. For these experiments, the major portion of the weight loss was the loss of water. The results indicate a need to differentiate between weight loss percentages and decomposition percentages, and a need to indicate if either of these percentages includes or excludes the mass of additives.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15567663&dopt=Abstract weight loss



Weight loss
Change in beta(1)-adrenergic receptor protein concentration in adipose tissue correlates with diet-induced weight loss.

Rasmussen M, Belza A, Almdal T, Toubro S, Bratholm P, Astrup A, Christensen NJ.

Department of Endocrinology, Herlev Hospital, University of Copenhagen, 2730 Herlev, Denmark.

The aim of the present study was to examine gene expression and protein concentrations of beta(1)- and beta(2)-adrenergic receptors in subcutaneous adipose tissue in obese subjects in response to weight loss. Eighteen obese subjects were studied during diet-induced weight loss. beta-Adrenergic receptor mRNA levels were quantified by reverse transcription-PCR-HPLC. beta-Adrenergic receptor protein concentrations were measured by Western blotting using fluorescence laser scanning for detection. Subjects lost 12.8+/-0.8 kg (mean+/-S.E.M.) during diet treatment. There was a 34% decrease in the beta(1)-adrenergic receptor mRNA level (0.92+/-0.09 compared with 0.61+/-0.06 amol/mug of DNA; P<0.002). beta(2)-Adrenergic receptor mRNA did not decrease significantly. beta(2)-Adrenergic receptor protein concentration decreased 37% (25.5+/-7.1 compared with 16.0+/-5.6 arbitrary units/ng of DNA; P=0.008), whereas beta(1)-adrenergic receptor protein concentration did not decrease significantly. The degree of weight loss was correlated with the concentration of beta(1)-adrenergic receptor protein (r=0.65, P<0.003) and changes in receptor protein concentration (r=0.50, P=0.035) during the very-low-calorie diet. In conclusion, the present study demonstrates a relationship between beta(1)-adrenergic receptor protein concentration in adipose tissue and the degree of weight loss. This relationship is not directly related to energy expenditure and deserves further investigation.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15574119&dopt=Abstract weight loss



Weight loss
Weight loss reduces circulating asymmetrical dimethylarginine concentrations in morbidly obese women.

Krzyzanowska K, Mittermayer F, Kopp HP, Wolzt M, Schernthaner G.

Department of Internal Medicine I, Rudolfstiftung Hospital, 1030 Vienna, Austria. katarzyna.krzyzanowska wienkav.at

The endogenous nitric oxide-synthase inhibitor asymmetrical dimethyl-L-arginine (ADMA) is elevated in patients with increased risk for arteriosclerosis. Obesity is a risk factor for cardiovascular disease. We measured plasma ADMA concentrations in morbidly obese women before and after weight loss following gastroplastic surgery. ADMA and symmetrical dimethyl-L-arginine concentrations were analyzed by HPLC from 34 female patients (age 41 +/- 7 yr) with a body mass index (BMI) of 49 +/- 1 kg/m2 before and 14 months after vertical ring gastroplasty. Age-matched healthy women (BMI < 25 kg/m2; n = 24) were studied as controls. After gastroplastic surgery, BMI decreased to 34 +/- 1 kg/m2 in obese women (P < 0.00001), and ADMA concentrations were reduced from 1.06 +/- 0.06 micromol/liter at baseline to 0.81 +/- 0.04 micromol/liter after weight loss (P < 0.00001). Symmetrical dimethyl-L-arginine plasma levels were not affected. ADMA correlated with high-sensitivity C-reactive protein at baseline (r = 0.42; P < 0.05) and after weight loss (r = 0.56; P < 0.005). No association with blood pressure or plasma lipids could be observed. ADMA concentrations were lower in controls (0.68 +/- 0.04 micromol/liter; P < 0.05) compared with obese patients before or after weight reduction. The decrease of highly elevated ADMA concentrations in morbidly obese patients is paralleled by improvement of parameters associated with the metabolic syndrome after weight loss.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15579789&dopt=Abstract weight loss



Weight loss
Activity-induced GLP-1 release in lean and obese subjects.

Adam TC, Westerterp-Plantenga MS.

Department of Human Biology, Maastricht University, P.O. Box 616, Nutrition and Toxicology Research Institute Maastricht (NUTRIM), 6200 MD Maastricht, The Netherlands. T.Adam hb.unimaas.nl

The aim of the study was to determine whether physical activity stimulates GLP-1 release on the short-term in normal weight and in obese subjects compared to rest and, furthermore, whether modest weight loss affects GLP-1 release or sensitivity in the obese. Normal weight (n=28; 12 males, 16 females; BMI 22.9+/-1.4; age 35+/-12.7), as well as obese subjects (n=27; 21 males, 6 females; BMI 30.9+/-2.7; age 47.1+/-11.86) were tested in a resting and a physical activity condition. Obese subjects were matched over two groups for a weight loss period of 3 months. After weight loss, the tests were repeated. The area under the curve (AUC pmol/lxmin) for GLP-1 concentrations was significantly increased in the physical activity condition compared to rest in lean subjects (P=0.05) as well as in the obese subjects after weight loss (P<0.05), but not in the obese subjects before weight loss. Physical activity-stimulated GLP-1 release in lean and obese subjects after a weight loss period supports the idea of a neuroendocrine loop in addition to distal-intestinal stimulation of GLP-1 release. Modest weight loss might be effective for increasing GLP-1 sensitivity to acute stimulation.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15581668&dopt=Abstract weight loss



Weight loss
Psychobehavioral and nutritional predictors of weight loss in obese women treated with sibutramine.

Hainer V, Kunesova M, Bellisle F, Hill M, Braunerova R, Wagenknecht M.

Institute of Endocrinology, Obesity Management Centre, Prague, Czech Republic. vhainer endo.cz

OBJECTIVE: To reveal whether baseline body mass index (BMI), and psychobehavioral and nutritional markers were significant predictors of the change in BMI observed after 4 and 12 months in obese women enrolled in a weight reduction program, including low-energy diet, increased physical activity, cognitive behavior therapy and sibutramine. The impact of changes in psychobehavioral and nutritional markers observed after 4 and 12 months of treatment on BMI changes was also investigated. DESIGN: During a double-blind placebo-controlled 4-month period, subjects received either sibutramine (10 mg/day) or placebo. Then, an open phase with sibutramine administered to all patients continued until month 12. SUBJECTS: In total, 80 obese women (age: 43.9+/-10.6 y, BMI: 36.7+/-4.8 kg/m(2)). MEASUREMENTS: The dependent variable was change in BMI while baseline BMI, mode of treatment, the Beck depression score, the three items (dietary restraint, disinhibition and perceived hunger) of the Eating Inventory (EI), energy and macronutrient intakes were independent variables. At 1-week dietary records were analyzed using a computer software for assessing energy and macronutrient intake. RESULTS: Multiple regression analysis revealed that the BMI loss at month 4 was significantly influenced by mode of treatment and initial BMI, whereas a borderline negative relationship was observed with the baseline restraint score. Baseline BMI, depression score, restraint score and total energy intake predicted weight loss at month 12. These predictive variables accounted for 43.8% of the variance in BMI loss at 12 months. When relationships between the BMI loss and changes in all included psychobehavioral and nutritional parameters were considered after 12 months of treatment, a drop in the disinhibition score of the EI appeared the only significant factor affecting the BMI decrease. CONCLUSIONS: Our results suggest that psychobehavioral and nutritional characteristics can be used as predictors of weight loss in response to a comprehensive weight management program including pharmacological treatment with sibutramine.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15583700&dopt=Abstract weight loss



Weight loss
Human plasma ghrelin levels increase during a one-year exercise program.

Foster-Schubert KE, McTiernan A, Frayo RS, Schwartz RS, Rajan KB, Yasui Y, Tworoger SS, Cummings DE.

Department of Medicine, Division of Metabolism, University of Washington, Veterans Affairs Puget Sound Health Care System, Seattle, Washington 98108, USA.

Weight loss resulting from decreased caloric intake raises levels of the orexigenic hormone, ghrelin. Because ingested nutrients suppress ghrelin, increased ghrelin levels in hypophagic weight loss may result from decreased inhibitory input by ingested food, rather than from lost weight. We assessed whether ghrelin levels increase in response to exercise-induced weight loss without decreased caloric intake. We randomized 173 sedentary, overweight, postmenopausal women to an aerobic exercise intervention or stretching control group. At baseline, 3 months, and 12 months, we measured body weight and composition, food intake, cardiopulmonary fitness (maximal oxygen consumption), leptin, insulin, and ghrelin. Complete data were available for 168 women (97%) at 12 months. Exercisers lost 1.4 +/- 0.4 kg (P < 0.05 compared with baseline; P = 0.01 compared with stretchers) and manifested a significant, progressive increase in ghrelin levels, whereas neither measure changed among stretchers. Ghrelin increased 18% in exercisers who lost more than 3 kg (P < 0.001). There was no change in caloric intake in either group and no effect on ghrelin of exercise per se independent of its impact on body weight. In summary, ghrelin levels increase with weight loss achieved without reduced food intake, consistent with a role for ghrelin in the adaptive response constraining weight loss and, thus, in long-term body weight regulation.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15585547&dopt=Abstract weight loss