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Query: UMLS:C0028754 (obesity)
 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Obesity is a prevalent metabolic disorder associated with high morbidity and mortality rates. Medical treatment rarely succeeds, and bariatric surgery has been proposed as an alternative therapy. The purpose of this non-controlled retrospective study was to evaluate time-course changes in body weight in severely obese patients who underwent vertical ring gastroplasty or adjustable silicone gastric banding, and to assess the prevalence and potential reversibility of several of the biological abnormalities associated with morbid obesity. From an initial cohort comprising 658 patients, regular body weight measurements and biological data were obtained in 505 patients [419 females, 86 males; age 36 +/- 11 years; body mass index 42.7 +/- 6.9 kg/m2; (mean +/- SD)] with a mean follow-up of 26 +/- 14 months. Mean weight loss was 32 +/- 16 kg. Most weight reduction occurred within the first 6 months, followed by near-stabilisation or even slight weight regain. Most biological parameters were obtained before surgery and after at least 6 months of follow-up. The high prevalence and severity of metabolic disturbances associated with the insulin resistance syndrome (hyperglycaemia, hyperinsulinaemia, decreased HDL cholesterol, hypertriglyceridaemia, elevated fibrinogen levels and hyperuricaemia) before gastroplasty were significantly decreased after weight loss. No major biological deficiencies were observed following gastroplasty, except low iron serum levels. It is concluded that marked weight loss associated with gastroplasty involved a remarkable reduction in the prevalence and severity of several biological abnormalities classically considered as cardiovascular risk factors.
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PMID:Effects of gastroplasty on body weight and related biological abnormalities in morbid obesity. 980 47

This paper provides a broad overview of the epidemiological and genetical aspects of common multifactorial diseases in man with focus on three well-studied ones, namely, coronary heart disease (CHD), essential hypertension (EHYT) and diabetes mellitus (DM). In contrast to mendelian diseases, for which a mutant gene either in the heterozygous or homozygous condition is generally sufficient to cause disease, for most multifactorial diseases, the concepts of genetic susceptibility' and risk factors' are more appropriate. For these diseases, genetic susceptibility is heterogeneous. The well-studied diseases such as CHD permit one to conceptualize the complex relationships between genotype and phenotype for chronic multifactorial diseases in general, namely that allelic variations in genes, through their products interacting with environmental factors, contribute to the quantitative variability of biological risk factor traits and thus ultimately to disease outcome. Two types of such allelic variations can be distinguished, namely those in genes whose mutant alleles have (i) small to moderate effects on the risk factor trait, are common in the population (polymorphic alleles) and therefore contribute substantially to the variability of biological risk factor traits and (ii) profound effects, are rare in the population and therefore contribute far less to the variability of biological risk factor traits. For all the three diseases considered in this review, a positive family history is a strong risk factor. CHD is one of the major contributors to mortality in most industrialized countries. Evidence from epidemiological studies, clinical correlations, genetic hyperlipidaemias etc., indicate that lipids play a key role in the pathogenesis of CHD. The known lipid-related risk factors include: high levels of low density lipoprotein cholesterol, low levels of high density lipoprotein cholesterol, high apoB levels (the major protein fraction of the low density lipoprotein particles) and elevated levels of Lp(a) lipoprotein. Among the risk factors which are not related to lipids are: high levels of homocysteine, low activity of paraoxonase and possibly also elevated plasma fibrinogen levels. In addition to the above, hypertension, diabetes and obesity (which themselves have genetic determinants) are important risk factors for CHD. Among the environmental risk factors are: high dietary fat intake, smoking, stress, lack of exercise etc. About 60% of the variability of the plasma cholesterol is genetic in origin. While a few genes have been identified whose mutant alleles have large effects on this trait (e.g., LDLR, familial defective apoB-100), variability in cholesterol levels among individuals in most families is influenced by allelic variation in many genes (polymorphisms) as well as environmental exposures. A proportion of this variation can be accounted for by two alleles of the apoE locus that increase (ε4) and decrease (ε2) cholesterol levels, respectively. A polymorphism at the apoB gene (XbaI) also has similar effects, but is probably not mediated through lipids. High density lipoprotein cholesterol levels are genetically influenced and are related to apoA1 and hepatic lipase (LIPC) gene functions. Mutations in the apoA1 gene are rare and there are data which suggest a role of allelic variation at or linked LIPC gene in high density lipoprotein cholesterol levels. Polymorphism at the apoA1--C3 loci is often associated with hypertriglyceridemia. The apo(a) gene which codes for Lp(a) is highly polymorphic, each allele determining a specific number of multiple tandem repeats of a unique coding sequence known as Kringle 4. The size of the gene correlates with the size of the Lp(a) protein. The smaller the size of the Lp(a) protein, the higher are the Lp(a) levels. (ABSTRACT TRUNCATED)
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PMID:Ionizing radiation and genetic risks. VI. Chronic multifactorial diseases: a review of epidemiological and genetical aspects of coronary heart disease, essential hypertension and diabetes mellitus. 987 81

The aim of our study was to estimate selected parameters of hemostasis and fibrinolysis in diabetic patients with vascular complications and obesity. The investigation was carried out in 23 type 1 diabetic subjects aged 17-56 ys, in 25 type 2 diabetic patients aged 41-69 ys and in 38 healthy persons: 16 "young"--aged 32.5 +/- 13.2 ys and 22 "old"--aged 56.2 +/- 9.4 ys. The following parameters were determined: glycaemia, HbA1c, blood level fibrinogen, euglobulin clot lysis time, plasminogen activator inhibitor (PAI-1) activity, microalbuminuria, triglyceride, total, HDL- and LDL-cholesterol concentration. Plasma fibrinogen level was elevated in type 2 diabetic subjects, and the highest concentrations were noted in patients with retinopathy or arterial hypertension, in overweight persons and--surprisingly--in type 1 diabetic subjects with nephropathy and coronary vascular disease (CVD). There were also positive correlations between fibrinogen level and systolic blood pressure (r = 0.3413, p < 0.02), diastolic blood pressure (r = 0.3809, p < 0.002) and microalbuminuria (r = 0.3552, p < 0.05). The mean euglobulin clot lysis time was prolonged in type II diabetics in comparison to the control group, especially in obese subjects. The highest activity of PAI-1 was found in overweight controls (28.87 +/- 6.24 Au/ml, p < 0.002). PAI-1 activity was also slightly increased in type 1 diabetic patients, especially with the symptoms of diabetic neuropathy, nephropathy or CHD, in comparison to the other groups. Our results seem to confirm the disturbed balance between coagulation and fibrinolysis--towards and increased risk of a prothrombotic state --in both--obese and diabetic patients--especially with advanced vascular complications.
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PMID:[Some parameters of hemostasis and fibrinolysis in diabetic patients]. 1010 28

Insulin resistance is associated not only with the classic cardiovascular risk factors of hypertension and dyslipidemia, but also with several disorders of coagulation and fibrinolysis. Elevated concentrations of the fibrinolytic inhibitor plasminogen activator inhibitor-1 are associated with insulin resistance. In experimental systems, increased expression and secretion of plasminogen activator inhibitor-1 by hepatocyte and endothelial cell lines can be induced by insulin, proinsulin-like molecules, triglyceride-rich lipoproteins and oxidized LDL, as well as by inducing insulin resistance in isolated hepatocytes. Concentrations of the endothelial cell protein von Willebrand factor are elevated in insulin-resistant states, suggesting that abnormalities of capillary endothelium, as well as those reported for endothelium-dependent vasodilatation, may play a role in the etiology of insulin resistance. Levels of a third coagulation factor, fibrinogen, are elevated in insulin-resistant subjects, an association that suggests a possible role for acute-phase cytokines in the abnormalities of coagulation and endothelial function. It is proposed that the recent observations of secretion of interleukin-6 by adipose tissue, combined with the actions of adipose tissue-expressed tumor necrosis factor-alpha in obesity-induced insulin resistance, could underlie the associations of insulin resistance with endothelial dysfunction, coagulopathy, and coronary heart disease.
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PMID:Abnormalities of coagulation and fibrinolysis in insulin resistance. Evidence for a common antecedent? 1018 59

324 patients operated on the organs of abdominal cavity small pelvis and retroperitoneal space were examined by the method of I-125-fibrinogen accumulation and contrast phlebography. In 109 (33.6%) patients thrombosis of deep veins of lower extremities was diagnosed, among which in 24 cases (7.5%) it was proximal. In most cases thrombosis was predisposed by postthrombotic disease and chronic venous insufficiency of lower extremities, circulatory disturbances of the 2-3 degree, tumors, obesity, preoperative thrombophilia. Combination of 2 and more risk factors increased possibility of intravascular thrombosis. The rate of clinically registered pulmonary artery embolism (14,833 general surgical patients were avau label) made up 1.2%; in 54 (0.3%) of operated patients it was the cause of death. Postoperative lethality of embolism made up 13%. Four risk levels of development of thrombo-embolic complications were established: low (common rate of thrombosis--10.3%, proximal--1.4%, clinically evidenced pulmonary artery embolism--0.7%, with lethal outcome--0.02%), medium (28.5; 6.5; 2; 0.76%, respectively), high (80.4; 17.8; 6; 2.8%, respectively) and very high (93.3; 26.6; approximately 8; approximately 4, respectively). The prevalence of thrombo-embolic complications in patients urge surgeons and reanimatologists to carrying out prophylactic to reduce the risk of intravascular thrombosis in pre- and postoperative period.
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PMID:[Postoperative deep venous thrombosis of legs and pulmonary embolism]. 1021 60

To examine the lipoprotein(a) (Lp(a)) level in the Taiwanese population and its association with cardiovascular risk factors, 1703 men and 1899 women aged 35 years and above were enrolled in a community-based study cohort established between 1990 and 1991. The distributions of Lp(a) levels were skewed to the right, and females were more likely than males to have Lp(a) levels greater than 30 mg/dl (14.3% versus 11.6%, P < 0.05). The Lp(a) level increased with age. Socioeconomic status did not seem to have consistent influence on the level of Lp(a). Smoking and alcohol use also had no effect on Lp(a) levels. Multivariate analysis indicated that older age and high level of low-density-lipoprotein cholesterol corresponded to an elevated Lp(a) level, while hypertriglyceridemia, low high-density-lipoprotein cholesterol level, obesity and high insulin resistance corresponded to a lower Lp(a) level. In univariate analysis, hyperinsulinemia was negatively associated with Lp(a) level (-0.107, P < 0.01) only in males. In females, use of oral contraceptive lowered Lp(a) levels, but menopause did not change Lp(a) levels. We also found that different correlation patterns existed for selected coagulation profiles between sexes. There was a significant correlation between Lp(a) and fibrinogen levels in males (0.154, P < 0.001) but not in females (0.007, P > 0.05). These data provided clues for investigating atherosclerotic risk factors and coagulation parameters for the Taiwanese population.
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PMID:Lipoprotein (a) level in the population in Taiwan: relationship to sociodemographic and atherosclerotic risk factors. 1021 55

Few studies have examined fibrinogen in Chinese populations in which the incidence of coronary heart disease (CHD) is lower than that in the West. This study aimed to examine the relationship between fibrinogen and other CHD risk factors in Hong Kong Chinese. Fibrinogen was measured by the Clauss method in 1359 men and 1405 women aged 25-74 years, randomly selected from the Hong Kong population. Mean fibrinogen level increased with age, from 2.22 g/l in those aged 25-34 years to 2.76 g/l in 65-74 years in men, and from 2.42 to 2.94 g/l respectively in women. The most important factors associated with fibrinogen were age, obesity and blood lipid levels in both genders. In men, smoking was associated with higher fibrinogen levels and cessation of smoking with lower levels. Prospective studies are needed to examine the role of fibrinogen in CHD in Chinese and other Asian populations.
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PMID:The relationship between fibrinogen and other coronary heart disease risk factors in a Chinese population. 1021 71

Most people with the Metabolic Syndrome die from thrombotic complications superimposed to degenerative arterial vascular lesions, mostly myocardial infarction. Type-2-Diabetes is a risk factor per se for such complications, but often clusters with dyslipoproteinemia, hypertension and obesity. This is referred to as "Metabolic Syndrome" and often operates on a genetically programmed susceptibility which accelerates the pathogenesis of coronary artery disease in front of a much wider diabetes specific cardiopathy. From a pathophysiological point of view none of these associated risk factors explains the pathogenetic series of events leading to the precipitation of an occlusive thrombus at sites of complicated coronary plaques. In patients with the Metabolic Syndrome the coagulation system is switched towards a prethrombotic state, involving increased plasmatic coagulation, diminished fibrinolysis, decreased endothelial thromboresistance and predominantly platelet hyperreactivity ("diabetic thrombocytopathy"). Some of these factors are associated with an increased coronary risk (e.g. fibrinogen, PAI-1, platelets), but are also directly linked to the pathogenesis of "atherothrombosis". Altered cardiac remodelling together with adhesion and coagulation mechanisms appears suitable to explain decreased functional performance of infarcted organs, decreased success of acute (reduced fibrinolytic response, no reflow phenomenon) and longterm intervention strategies for vessel patency (PTCA, CABG) in Diabetes. Glucose adjustment alone will not adequately neutralize these complex mechanisms, but in the situation of myocardial infarction eumetabolization with parenteral glucose-insulin-potassium infusion appears mandatory similar to non-diabetics. On the longterm a multidimensional interventional repertoire is required particularly in patients with the Metabolic Syndrome including antihypertensive, antidyslipoproteinemic and antithrombotic drugs, customized according to the individual patients needs as assessed by early diagnostic measures ("early secondary prevention").
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PMID:[The heart and metabolic syndrome]. 1035 72

Non-metropolitan areas have a higher mortality from cardiovascular disease than metropolitan areas. The study's aim was to establish the prevalence of cardiovascular disease risk factors in a rural area and identify their sociodemographic determinants. Adults, randomly selected from Ballarat's electoral rolls, were invited to complete a questionnaire and have their height, weight, blood pressure and fasting lipids measured. Three hundred and thirty-eight eligible persons participated (67% response). The data were analysed using logistic and multiple regression analyses. Increasing age was associated with hypertension, high plasma cholesterol, overweight/obesity, high plasma triglyceride levels and increasing plasma fibrinogen. Women were less likely to be overweight/obese and have a high plasma triglyceride. Not having completed high school was associated with hypertension, high plasma cholesterol and triglyceride levels and physical inactivity. Smoking was associated with employment and being in a non-professional/managerial occupation. Rural health promotion initiatives should take account of the needs of these population subgroups.
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PMID:Prevalence and sociodemographic determinants of cardiovascular risk in a rural area. 1037 12

Nowadays besides the commonly accepted atherogenic risk factors a special emphasis is laid on the significance of testosterone in atherogenesis in men which physiologic deficit during "andropause" is able to promote this pathology. An elevated estradiol:testosterone ratio seems to be an independent risk factor of atheromatous heart complications. There is a proved positive correlation between free testosterone, total testosterone, dihydrotestosterone and HDL-cholesterol, apoA1 apolipoprotein. The relationship between LDL-cholesterol, VLDL-cholesterol, total cholesterol and total and free testosterone seems to be unanimous, but in certain studies the beneficial influence of testosterone on the mentioned lipids has been observed. The discussed hormone is also functionally connected with coagulation and fibrynolisis; a positive correlation was found between endogenous testosterone and tPA-Fx and a negative correlation between testosterone and PAI-1, fibrinogen, D-dimers, alpha 2-antiplasmin. Testosterone is a functional regulator of the vascular tonus and influences on reological properties of microcirculation (the application of testosterone infusion into canine coronary arteries causes the dilatation of main and the small vessels, through NO syntetase induction and ATP-dependent K(+)- channel activation). A statistically significant positive correlation between testosterone and insulin has been stated (an elevated oestradiol:testosterone ratio is connected with the insulin resistance). Additionally a negative relationship between testosterone and android obesity has been observed. Although nowadays there are more and more facts proving the benefits of the retaining the proper testosterone levels in aging men, the final influence of the testosterone supplementary therapy on atherogenesis is not solved.
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PMID:[Testosterone and atherosclerosis in males during andropause]. 1039 Oct 62


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