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

A comprehensive review of what was known of the epidemiology of breast cancer as of the early 1970s was published by MacMahon et al. in 1973. This review covers the major aspects of the epidemiology of breast cancer included in the 1973 review and, additionally, emphasizes recently reported work. Attention is directed to the following: magnitude of the problem in the U.S.; demographic characteristics of breast cancer cases; international variation; laterality of breast cancer; reproductive variables; benign breast diseases; multiple primary cancers involving the breast and other sites; familial aggregation and genetics; endogenous hormones (estrogens, progesterone, prolactin, androgens, and thyroid); exogenous estrogens; diet; body build; radiation; exposure to radiation in screening for breast cancer; mammographic parenchymal patterns; viruses; other exposures of current interest (reserpine, hair dyes); and breast cancer in males. The high incidence and mortality rates and the detrimental impact on the quality of life of those affected indicate that breast cancer in the U.S. continues to be a serious problem for women. An annual age-adjusted incidence rate of 84.9/100,000 women was reported for the 1973-1976 years; the annual age-adjusted mortality rate among women in the U.S. was 27.7/100,000 over this same time period. From these figures, it may be estimated that each year in the U.S. almost 100,000 cases of breast cancer are diagnosed, and over 30,000 deaths occur. Age specific incidence rates increase rapidly with age until about 45-50 years of age, after which they continue to increase but at a slower rate. In addition to age, a few other risk factors, including a history of bilateral premenopausal breast cancer in a 1st degree relative, a history of breast cancer in the contralateral breast, and residence from an early age in North America compared to Asia, are associated with large relative risks. Other risk factors, including whether or not an oophorectomy has been performed, age at 1st birth, a history of fibrocystic disease, previous exposure to high levels of radiation in the chest, socioeconomic status, obesity, and a previous cancer in the ovary or endometrium are associated with relative risks of at least 2 but less than 4-fold. Finally, age at menarche, age at menopause, marital status, place of residence, and the white compared to the black race are associated with small but real differentials in risk.
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PMID:A review of the epidemiology of human breast cancer. 39 70

Breast diseases in 792 women were studied by biopsy and histological evaluation. In all subjects glucose tolerance was examined by OGTT (100 g glucose). The diabetes frequency of 22% in 326 women with breast cancer was compared with the frequency in women with fibroadenoma (n = 101), papilloma (n = 80), fibrocystic disease (n = 107), lipoma, granuloma, fibrosis (n = 88), papilloma with proliferation (n = 32), mastopathy with proliferation (n = 33) and carcinoma in situ lobulare (n = 11). The statistical evaluation was done with an electronic data processing system. We used matched pairs according to age, height and weight. Diabetogenic factors like age and overweight were thus allowed for. These comparative statistics showed a frequency of diabetes twice or three times higher in women with breast cancer. This result cannot be regarded as a consequence of age, overweight and menopause. In groups with fibroadenoma, fibrocystic disease and lipoma, we found glucose tolerance in 1-3%, whereas the group with proliferation (including carcinoma in situ) showed an incidence of 7%. The remarkably high incidence rate of 14% in women with papilloma can be explained by the higher age and the more frequent obesity in this collective.
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PMID:Altered carbohydrate metabolism in breast cancer and benign breast affections. 98 70

Normative data for abdominal circumference:hip circumference ratio, of current interest as a possible health risk, are presented for a large number of healthy subjects aged 6-71 years. The ratio declines during childhood, and during adolescence, in females, while that for males remains about the same. In the adult years there is a rise in the ratios for both sexes, that for males preceding the rise for females. For most of the age span, the sex difference and the age trends are such that age and sex must be taken into consideration in evaluating data on patients with various disorders. Patients with diabetes mellitus and those with obesity tend to have elevated abdomen:hip ratios at all ages. Those with cystic fibrosis also tend to have higher ratios, but here the difference is due to a smaller hip circumference rather than a larger abdominal circumference, and the same is true for the younger diabetics. The ratios for athletes are in the normal range but exhibit much less variability; those for patients with anorexia nervosa are normally distributed.
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PMID:The abdomen: hip ratio normative data and observations on selected patients. 234 Dec 23

The membranes of mammalian cells are composed of an ordered array of lipids and proteins, the latter containing carbohydrate residues directed towards the exterior and important in the interaction of cells with each other and with external proteins. This external (plasma) membrane and other more simple membranes within the cell are damaged in all diseases which compromise the integrity of the cell. However, in many cases, chemical or functional changes in these membranes are central to the pathogenesis of the disease. These processes are illustrated, and a classification of membrane-related diseases is proposed. This includes: receptor-related diseases such as type II familial hypercholesterolaemia, Grave's disease, some lysosomal storage diseases and some forms of diabetes and obesity; structural instability as manifested by red cell abnormalities and multiple sclerosis; changes in lipid state as in muscular dystrophy and multiple sclerosis; altered permeability or transport as in cystic fibrosis, diseases associated with specific transport defects, and the action of many bacterial toxins, and abnormality of the cytoskeleton-membrane interface as in Chediak-Higashi disease and some diseases associated with red cell abnormalities. Different mechanisms can contribute to the membrane disorder in a single disease state and many of these are described to illustrate this diversity.
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PMID:Role of membranes in disease. 302 80

While deficient exercise performance of sick children results from hypoactivity and detraining, it can also be caused by specific pathophysiological factors. These can affect one or more components of physical fitness. A low maximal aerobic power will result from a low maximal stroke volume, as in aortic stenosis or cardiomyopathy; a low maximal heart rate, as in congenital complete heart block or intake of beta-blockers; a low O2 content of the arterial blood, as in anemia or advanced cystic fibrosis; and a high O2 content of mixed-venous blood, as in muscle atrophy or severe malnutrition. A high O2 cost of locomotion, as in advanced obesity or cerebral palsy, will cause the patient to exert at a high percentage of his maximal aerobic power and thus fatigue easily. A subnormal muscle strength, as in progressive muscular dystrophy or juvenile rheumatoid arthritis, is sometimes the primary factor that limits the walking ability or other daily functions. Recent data suggest that local muscle endurance, as assessed by the Wingate anaerobic test, is particularly deficient in some neuromuscular diseases. Examples are muscular dystrophies and spastic cerebral palsy. The ratio of peak anaerobic power to peak aerobic power seems lower in such patients than in able-bodied controls.
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PMID:Pathophysiological factors which limit the exercise capacity of the sick child. 372 7

This review of the epidemiologic and endocrinologic literature aims to improve understanding of the etiology of premalignant breast disease. Although there are inconsistencies regarding the clinical symptoms defined as benign breast disease, there are 2 major clinical categories: cysts treated by aspiration and solid lesions treated by excision or incision biopsy. A necessary research approach is to determine which patients with benign breast disease have an increased risk of breast cancer and study them to determine whether they carry any endocrine or biologic stigmata. Epithelial hyperplasia is the lesion with greatest premalignant potential. Both population and case-control studies have examined the association between benign breast disease and the risk factors of age, reproductive history, family history of breast cancer, obesity, socioeconomic status, race, oral contraceptive use, and methylxanthines. No clear or consistent endocrine or hormonal abnormalities have been detected in women with benign breast disease. On the other hand, cyst fluid studies have revealed high amounts of androsterone sulfate and DHA-sulfate compared with serum levels. Carcinoembryonic antigen levels are highest in women with fibrocystic disease. At this point, it is unclear whther the progression from normal epithelium through atypia and hyperplasia and then in in situ carcinoma or invasive carcinoma is under hormonal control. Inconsistencies within the research literature may reflect the heterogeneity of conditions encompassed within the benign breast disease category. Since epithelial hyperplasia is likely a forerunner of breast cancer, such patients should be monitored to determine whether they exhibit a consistently abnormal pattern of hormonal production, e.g., subnormal androgen levels or elevation of free estradiol.
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PMID:Epidemiology and endocrinology of benign breast disease. 390 25

Hypoxia is the major cause of pulmonary hypertension and right ventricular hypertrophy in chronic obstructive pulmonary disease, cystic fibrosis, kyphoscoliosis, chronic mountain sickness, and the obesity-hypoventilation and sleep apnea syndromes. Pulmonary hypertension develops in these patients because the long-standing vasoconstriction produced by hypoxia causes muscular hypertrophy of the pulmonary arteries and arterioles. These pathologic changes may regress if alveolar hypoxia is corrected and hypoxic pulmonary vasoconstriction is continuously inhibited. Intermittent inhibition of hypoxic pulmonary vasoconstriction does not reverse these pathologic changes. Since patient noncompliance with oxygen therapy makes it difficult to achieve continual relief of alveolar hypoxia, a drug that inhibits hypoxic vasoconstriction may be useful. Experimental findings indicate that hypoxic pulmonary vasoconstriction requires calcium influx and can be inhibited by certain slow-channel calcium blockers. Studies also demonstrate that slow-channel calcium antagonists can attenuate the pulmonary hypertension and right ventricular hypertrophy produced in rats by chronic hypoxia. Recently, two studies have shown that nifedipine inhibits hypoxic pulmonary vasoconstriction in patients with chronic obstructive pulmonary disease. If further studies demonstrate that these short-term effects are sustained, certain slow-channel calcium blockers may become a useful adjuvant to low-flow oxygen therapy in the treatment of hypoxic pulmonary hypertension.
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PMID:Calcium channel blockers in hypoxic pulmonary hypertension. 397 91

The gastric inhibitory polypeptide (GIP) is the main hormone of the incretin type acting on the entero-insular axis. It is released after fat, glucose or meal ingestion. The variations of this secretion are described in obesity and in some pancreatic and gastrointestinal diseases: it is increased in maturity onset diabetes mellitus, obesity or duodenal ulcer, variable according to the food taken and the severity of the pancreatic lesion in chronic pancreatitis and cystic fibrosis, normal in insulinoma and decreased in celiac disease. The impaired absorption of the food-stuffs and the defective feed-back regulation of GIP secretion by insulin are the major causes of these variations. To a lesser degree, gastric acid secretion, gastric emptying and vagal control may also influence GIP secretion.
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PMID:Clinical aspects of GIP secretion. 628 Apr 23

An 18-year-old man had cystic fibrosis (CF) and insulin-resistant carbohydrate intolerance characterized by (1) obesity, basal hyperinsulinemia, and hyperglucagonemia; (2) impaired oral glucose tolerance; (3) hyperinsulinemia in response to oral and intravenous (IV) administration of glucose and to IV administration of tolbutamide; (4) exaggerated gastric inhibitory polypeptide secretion following orally administered glucose; and (5) diminished sensitivity to insulin administered IV compared with other patients with CF. Both parents also demonstrate basal and stimulated hyperinsulinemia in response to orally administered glucose. The long-term outlook for patients with CF is improving, and more patients are surviving childhood. Thus, it should be recognized that an insulin-resistant form of carbohydrate intolerance may develop in patients with CF with obesity and/or genetic risk factors.
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PMID:Insulin resistance in a young man with cystic fibrosis. 637 49

Seventy-two long-surviving liver transplant recipients were evaluated prospectively, including a baseline allograft biopsy for weaning off of immunosuppression. Thirteen were removed from candidacy because of chronic rejection (n = 4), hepatitis (n = 2), patient anxiety (n = 5), or lack of cooperation by the local physician (n = 2). The other 59, aged 12-68 years, had stepwise drug weaning with weekly or biweekly monitoring of liver function tests. Their original diagnoses were PBC (n = 9), HCC (n = 1), Wilson's disease (n = 4), hepatitides (n = 15), Laennec's cirrhosis (n = 1), biliary atresia (n = 16), cystic fibrosis (n = 1), hemochromatosis (n = 1), hepatic trauma (n = 1), alpha-1-antitrypsin deficiency (n = 9), and secondary biliary cirrhosis (n = 1). Most of the patients had complications of long-term immunosuppression, of which the most significant were renal dysfunction (n = 8), squamous cell carcinoma (n = 2) or verruca vulgaris of skin (n = 9), osteoporosis and/or arthritis (n = 12), obesity (n = 3), hypertension (n = 11), and opportunistic infections (n = 2). When azathioprine was a third drug, it was stopped first. Otherwise, weaning began with prednisone, using the results of corticotropin stimulation testing as a guide. If adrenal insufficiency was diagnosed, patients reduced to < 5 mg/day prednisone were considered off of steroids. The baseline agents (azathioprine, cyclosporine, or FK506) were then gradually reduced in monthly decrements. Complete weaning was accomplished in 16 patients (27.1%) with 3-19 months drug-free follow-up, is progressing in 28 (47.4%), and failed in 15 (25.4%) without graft losses or demonstrable loss of graft function from the rejections. This and our previous experience with self-weaned and other patients off of immunosuppression indicate that a significant percentage of appropriately selected long-surviving liver recipients can unknowingly achieve drug-free graft acceptance. Such attempts should not be contemplated until 5-10 years posttransplantation and then only with careful case selection, close monitoring, and prompt reinstitution of immunosuppression when necessary.
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PMID:Weaning of immunosuppression in long-term liver transplant recipients. 783 42


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