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 57,723 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Obesity has become an increasingly important public health problem. Recent evidence suggests that obesity has become a close second to tobacco use as a preventable cause of death in the United States. During the past decade an increase in the prevalence of type 2 diabetes in adolescents has been observed. The association of type 2 diabetes and obesity is well established and most adolescents with type 2 diabetes have body mass index (BMI) in a range that would already be considered obese in an adult. Childhood overweight is also associated with the atherosclerotic process. In the Bogalusa autopsy study, Berenson et al. found that the extent of fatty streaks and fibrous plaques in the aorta and coronary arteries was associated with BMI. There are three modalities currently available for the treatment of overweight in children and adolescents, including behavioral approaches, pharmacologic approaches, and surgical approaches. Surgical intervention may be considered if the BMI > or = 40 kg/m2 and a severe medical comorbidity including type 2 diabetes, obstructive sleep apnea or pseudotumor cerebri, or if the BMI is > or = 50 kg/m2 and comorbid conditions such as hypertension, dyslipidemia, or the metabolic syndrome are present. Behavioral intervention is usually made by a psychologist, behavioral therapist, dietician, or exercise physiologist. There is evidence that the effect of behavioral therapy for weight loss in childhood will be longer lasting than that seen in adults.
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PMID:Regulation of body mass and management of childhood overweight. 1570 Feb 53

The prevalence of overweight among children and adolescents has dramatically increased. There may be vulnerable periods for weight gain during childhood and adolescence that also offer opportunities for prevention of overweight. Overweight in children and adolescents can result in a variety of adverse health outcomes, including type 2 diabetes, obstructive sleep apnea, hypertension, dyslipidemia, and the metabolic syndrome. The best approach to this problem is prevention of abnormal weight gain. Several strategies for prevention are presented. In addition, treatment approaches are presented, including behavioral, pharmacological, and surgical treatment. Childhood and adolescent overweight is one of the most important current public health concerns.
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PMID:Overweight in children and adolescents: pathophysiology, consequences, prevention, and treatment. 1583 36

A 58-year-old woman presented with chronic cough felt to be multifactorial secondary to asthma, gastroesophageal reflux disease, and chronic sinusitis. Additional medical history included obstructive sleep apnea, type 2 diabetes, and hypertension. She had a 40- year history of tobacco use, but quit 10 years ago. Her examination was significant for obesity and cobble stoning of the oropharynx. Pulmonary function testing and arterial blood gases were unrevealing. Chest films were normal. High-resolution computed tomography revealed multiple focal lucencies in a mosaic pattern consistent with air trapping and small airways disease. Bronchoscopy revealed normal airways and a noninflammatory bronchoalveolar lavage. Transbronchial biopsies revealed inflammatory infiltrates of the peribronchiolar interstitium. Lung biopsy revealed pulmonary neuroendocrine cell hyperplasia with tumorlets that stained positive for neuroendocrine tissue. We present the case of a woman with chronic cough, multiple medical problems, and pulmonary neuroendocrine cell hyperplasia with tumorlets.
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PMID:The demonstration of pulmonary neuroendocrine cell hyperplasia with tumorlets in a patient with chronic cough and a history of multiple medical problems. 1597 15

Obstructive sleep apnea (OSA) is independently associated with glucose intolerance and insulin resistance, and recent studies have shown that continuous positive airway pressure (CPAP) improves insulin sensitivity. The objective of this study was to describe the change in glycosylated hemoglobin (HbA1c) after treatment with CPAP in patients with type 2 diabetes mellitus and OSA. To test this hypothesis, we performed a retrospective analysis of 38 patients seen in the sleep clinic of an urban public teaching hospital. All patients had OSA and type 2 diabetes mellitus, and their diabetic medication regimen had remained unchanged during the period of CPAP therapy. Sixty-one percent were men, body mass index was 42+/-9.5 kg/m(2), and the Apnea-Hypopnea Index was 53+/-36 per hour. HbA1c before therapy with CPAP was 7.8+/-1.4% and decreased to 7.3+/-1.3% after 134+/-119 days of therapy (p<0.001). Treatment with CPAP leads to a clinically significant drop in HbA1c in patients with type 2 diabetes mellitus and severe OSA.
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PMID:The effect of continuous positive airway pressure on glucose control in diabetic patients with severe obstructive sleep apnea. 1628 28

Overweight and obesity are associated with a high number of complications and co-morbidities. Obesity can affect almost all tissues and organs of the body. Obesity is associated with the components of the metabolic syndrome and is the leading cause of type 2 diabetes. Either obesity itself or co-morbidities of obesity are responsible for the increased cardiovascular risk. The increased overall mortality risk is due to cardiovascular and other complications like the higher prevalence and incidence of malignant tumors. Other complications of obesity like the polycystic ovary syndrome or the obstructive sleep apnea syndrome are relatively unknown but important and frequent. Medical care of people with obesity should focus not only on weight loss but also on complications and co-morbidities.
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PMID:[Comorbidities and complications of adiposis]. 1637 25

Obesity is becoming a global epidemic in both children and adults. It is associated with numerous comorbidities such as cardiovascular diseases (CVD), type 2 diabetes, hypertension, certain cancers, and sleep apnea/sleep-disordered breathing. In fact, obesity is an independent risk factor for CVD, and CVD risks have also been documented in obese children. Obesity is associated with an increased risk of morbidity and mortality as well as reduced life expectancy. Health service use and medical costs associated with obesity and related diseases have risen dramatically and are expected to continue to rise. Besides an altered metabolic profile, a variety of adaptations/alterations in cardiac structure and function occur in the individual as adipose tissue accumulates in excess amounts, even in the absence of comorbidities. Hence, obesity may affect the heart through its influence on known risk factors such as dyslipidemia, hypertension, glucose intolerance, inflammatory markers, obstructive sleep apnea/hypoventilation, and the prothrombotic state, in addition to as-yet-unrecognized mechanisms. On the whole, overweight and obesity predispose to or are associated with numerous cardiac complications such as coronary heart disease, heart failure, and sudden death because of their impact on the cardiovascular system. The pathophysiology of these entities that are linked to obesity will be discussed. However, the cardiovascular clinical evaluation of obese patients may be limited because of the morphology of the individual. In this statement, we review the available evidence of the impact of obesity on CVD with emphasis on the evaluation of cardiac structure and function in obese patients and the effect of weight loss on the cardiovascular system.
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PMID:Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. 1638 May 42

Obesity is a multifactorial disease of epidemic and global proportions that poses the most significant threat to the health of our younger generations. Those who are the most extremely affected bear the largest burden of health problems. In the US, extreme obesity affects approximately 9 million adults and 2 million children, and is associated with both immediate health problems and later health risk, including premature mortality. Present medical and behavioral interventions for extreme obesity in adults and children rarely result in the significant, durable weight loss necessary to improve health outcomes, prompting a search for more aggressive measures. Weight loss (bariatric) surgery has been advocated as an intervention for those with extreme obesity. In adults, bariatric surgery results in prolonged weight control and improvement in serious obesity comorbidities, namely type 2 diabetes, dyslipidemias, hypertension and obstructive sleep apnea syndrome. A surge in weight loss operations for adolescents has been observed recently, with a threefold increase in case volumes nationwide from 2000 to 2003. Current evidence suggests that after bariatric surgery, adolescents lose significant weight and serious obesity-related medical conditions and psychosocial status are improved. Thus it is reasonable to propose that bariatric surgery performed in the adolescent period may be more effective treatment for childhood-onset extreme obesity than delaying surgery for extremely obese youth until adulthood. This position has been echoed by a number of groups and an independent systematic review. Finally, it is conceivable that bariatric surgery performed in adulthood for childhood onset extreme obesity may not be as effective for comorbidity treatment as surgery performed earlier during adolescence. The purpose of this review is to examine the evidence, which supports early rather than later use of bariatric surgery in the treatment of extreme obesity, and to present this information in light of the medical and surgical risks of bariatric surgery.
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PMID:Bariatric surgery for pediatric extreme obesity: now or later? 1717 60

Restorative sleep is as essential for well-being as proper diet or exercise in persons with type 2 diabetes. However, sleep disorders such as insomnia, restless leg syndrome/periodic leg movements, and obstructive sleep apnea increase in prevalence with age and are very common in persons with type 2 diabetes. Disrupted sleep may result in weight gain, increased insulin resistance, and decreased daytime functioning. Although sleep disturbances have a major influence on health and quality of life, diagnosis and treatment can reduce their negative effects. Diabetes educators are pivotal in patient assessment, management, teaching, and collaborating with the primary health care provider to deliver holistic management of the patient with diabetes. This article will provide diabetes educators with various strategies for assessing sleep, including an easy 8-item questionnaire that can be used in the clinical setting. In addition, interventions to improve sleep hygiene that can be easily implemented by diabetes educators will be described.
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PMID:Understanding sleep in persons with diabetes. 1757 Aug 74

Obstructive sleep apnoea (OSA) and type 2 diabetes frequently co-exist and potentially interact haemodynamically and metabolically. However, the confounding effects of obesity have obscured the examination of any independent or interactive effects of the hypoxic stress of OSA and the hyperglycaemia of type 2 diabetes on haemodynamic and metabolic outcomes. We have developed a chronically catheterized, unhandled, lean murine model to examine the effects of intermittent hypoxic (IH) exposure and exogenous glucose infusion on the diurnal pattern of arterial blood pressure and blood glucose, as well as pancreatic beta-cell growth and function. Four experimental groups of adult male C57BL/J mice were exposed to 80 h of (1) either IH (nadir of inspired oxygen 5-6% at 60 cycles h(-1) for 12 h during light period) or intermittent air (IA; control) and (2) continuous infusion of either 50% dextrose or saline (control). IH exposure during saline infusion caused a sustained increase in arterial blood pressure of 10 mmHg (P < 0.0001), reversed the normal diurnal rhythm of blood glucose (P < 0.03), doubled corticosterone levels (P < 0.0001), and increased replication of pancreatic beta-cells from 1.5 +/- 0.3 to 4.0 +/- 0.8% bromodeoxyuridine (BrdU)-positive) beta-cells. The combined stimulus of IH exposure and glucose infusion attenuated the hypertension, exacerbated the reversed diurnal glucose rhythm, and produced the highest rates of apoptosis in beta-cells, without any additive effects on beta-cell replication. We conclude that, in contrast to the development of sustained hypertension, IH impaired glucose homeostasis only during periods of hypoxic exposure. IH acted as a stimulus to pancreatic beta-cell replication, but the presence of hyperglycaemia may increase the hypoxic susceptibility of beta-cells. This model will provide a basis for future mechanistic studies as well as assessing the metabolic impact of common comorbities in OSA, including obesity, insulin resistance and type 2 diabetes.
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PMID:Intermittent hypoxia reverses the diurnal glucose rhythm and causes pancreatic beta-cell replication in mice. 1803 15

Patients who have polycystic ovary syndrome (PCOS) present with infertility, recurrent miscarriages, menstrual irregularities, hirsutism, and acne. Many also have metabolic and hormonal abnormalities that can significantly increase risk for coronary artery disease, type 2 diabetes mellitus, and endometrial carcinoma. PCOS patients should be screened for obstructive sleep apnea. Early recognition may reverse physical signs of the disease, while correcting the metabolic abnormalities that can pose significant health risk if untreated. Although lifestyle modification and pharmacotherapy are used to treat PCOS, there are few long-term outcome data regarding benefits of metabolic interventional strategies. Insulin sensitizers can improve ovulatory function, lower insulin resistance, lower androgen levels, and increase the likelihood of becoming pregnant. Further studies should yield other treatment options.
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PMID:Polycystic ovary syndrome: a common reproductive and metabolic disorder necessitating early recognition and treatment. 1806 17


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