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

Detailed postmortem examination was carried out on five patients who died three months to four years after jejunoileal bypass for obesity. A spectrum of histological changes was observed in the liver, with pericentral fat deposition being a common feature. Evidence of previous and/or ongoing liver cell dropout with accompanying polymorphonuclear and mononuclear infiltration was seen in all cases, but Mallory hyalin was not detected. Liver function abnormalities included decreased plasma protein levels, decreased prothrombin activity, increased serum alkaline phosphatase levels, and variable elevations of the serum transaminases, bilirubin, and ammonia concentrations. The pattern of the hepatic disease does not resemble protein deficiency. An uncharacterized hepatotoxin or toxic effect of hepatic fat accumulation may play a significant role in the changes observed in these patients.
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PMID:Fatty metamorphosis of the liver associated with jejunoileal bypass. Report of five cases. 57 74

Two cases of rapidly progressive fatal liver disease in females after by-pass surgery for obesity are reported. Histologically the livers are similar to the florid cirrhosis of the alcoholic described by Popper and Szanto. It is postulated that the nutritional disturbance, including protein deficiency, and large amounts of fatty acids delivered to the liver from the fat depots, results in fatty metamorphosis, the Mallory bodies and finally cirrhosis. Bacterial toxins from the excluded loop of intestine may contribute to this process.
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PMID:Rapid development of micronodular cirrhosis following small bowel by-pass for obesity. A form of iatrogenic nutritional cirrhosis? 60 90

The nutritional status of 91 patients on four psychogeriatric wards was assessed by anthropometric measurements and determination of circulating proteins. The patients had low mean values for weight, arm muscle circumference, plasma albumin and serum transferrin. Indicators of malnutrition were combined to define the nutritional status in each individual. Energy and/or protein undernutrition was found in 30% and obesity in 4%. Energy undernutrition was more common than protein deficiency. Undernutrition was quite common during the first year of hospitalization and did not correlate with the duration of hospital stay. Subjects with their own teeth had a lower prevalence of undernutrition than edentulous patients. Food intake was similar in patients with and without undernutrition. The possible interactions between malnutrition and chronic psychiatric disorders in the elderly are discussed.
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PMID:Nutritional assessment of psychogeriatric patients. 724 41

Adipocyte lipid metabolism is primarily regulated by insulin and the catecholamines norepinephrine and epinephrine. Stimulation of the beta-adrenergic receptors (beta-AR) by catecholamines causes an increase in the rates of adipocyte lipid degradation and a decrease in the rates of lipid synthesis. These catabolic effects are in opposition to insulin, which causes net anabolic effects. Because most of the postnatal development of adipose tissue mass in pigs results from hypertrophy of adipocytes (rapid in first few weeks of life) caused by increased net synthesis of triacylglycerol, there is interest in the modulation of beta-AR in adipocytes of growing pigs. The beta-AR are characterized by measuring ligand binding to the receptor to ascertain the affinity of the ligand for the receptor and the receptor number. We found the affinity of the receptor did not vary with animal age (10, 28, and 75 d), with adipose tissue depot site, or in adipocytes of protein-deficient pigs. The beta-AR in obese pigs tended to have greater affinity than those in crossbred pigs of the same age and weight. The beta-AR number was not different when expressed per milligram of adipocyte membrane protein in pigs of different age, in obesity, in different adipose tissue depots, or during protein deficiency. The number expressed per cell or per unit adipocyte surface area did not differ between depots or during protein deficiency. The number per cell tended to be greater in the larger cells from 75-d-old pigs than in the smaller cells from 10- and 28-d pigs. It was greatest in obese pigs with the largest adipocytes. Under the various experimental conditions (age, obesity, depot, protein deficiency), the membrane fatty acid composition was greatly different, but in most cases there was no modulation of beta-AR affinity.
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PMID:Beta-adrenergic receptors in porcine adipocyte membranes: modification by animal age, depot site, and dietary protein deficiency. 870 10

BACKGROUND: There have been few articles about bariatric surgery for morbidly obese children. Nevertheless, children who suffer clinically severe obesity also suffer poor social acceptance and an inability to participate in sports or other life activities. Since 1983 the author has performed vertical banded gastroplasty (VBG), Roux-en-Y gastric bypass (RYGBP), or biliopancreatic diversion (BPD) on 22 children, ages 8 - 18 years. METHODS: This was a retrospective review of 22 children, 11 with sleep apnea and 11 without sleep apnea. There were nine males and 13 females. The procedures were VBG-5; RYGBP-14; and BPD-4. RESULTS: There were no operative deaths, infections, or other serious immediate complications. Body mass index (BMI) in those with sleep apnea decreased from a mean of 67.8 preoperatively to 46.5 kg/m(2) at an average follow-up of 32 months. Likewise, for those without sleep apnea, BMI decreased from 56.4 preoperatively to 35.5 kg/m(2) at an average follow-up of 50 months. All patients with sleep apnea had this condition resolve with adequate weight loss. Furthermore, these patients have been able to stay awake in school and have made better grades. Postoperative complications included protein deficiency in three BPD patients, and Vitamin A and D deficiency, folic acid deficiency, gallstones, kidney stones, postoperative laryngeal edema, and incisional hernia in one patient each. There were two late deaths; one at 15 months and one at 3.5 years postoperatively. CONCLUSIONS: Clinically severely obese children can safely undergo bariatric operations usually offered to adults. Furthermore, most patients have sustained significant weight loss. Those patients with sleep apnea have had resolution of their sleep apnea. Complications can be minimized with adequate vitamin, mineral, and trace element supplementation. Long-term results are not yet known.
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PMID:Obesity Surgery in Children. 1073 12

Thirteen patients, following a bilio-pancreatic diversion procedure for obesity, developed severe nutritional complications such as protein deficiency, anemia, hypocalcemia and/or gastrointestinal problems (uncontrollable diarrhea). They were subjected to a new therapeutic approach-the administration of pancreas extract tablets Viokase, containing protease, lipase and amylase. This, together with protein-rich food resulted after 2-4 weeks of treatment in a drastic reduction in the number of daily stools: from 10-12 per day to 4-6 per day, as well as the disappearance of the accompanying foul smell and the malodorous gas emissions. After a further 4-8 weeks of treatment of those patients with protein deficiency, the serum protein-albumin levels as well as the Hgb and Ca levels rose to near normal values: protein from 4.8-5.5 g % to 6-6.5 g %; albumin from 1.8-3 g % to 3.4 g % and above; Hgb from 7-9 g/di to 11-12 g/di; and Ca from 7.5-7.8 mg% to 8-9 mg%. None of the patients treated with pancreas extract for protein deficiency required rehospitalization for intravenous protein replacement, nor was there any need observed for operative revision or takedown in these patients.
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PMID:Treatment of Protein Malnutrition and Uncontrollable Diarrhea Following Bilio-pancreatic Diversion with Pancreas Extract Viokase. 1075 34

Intrauterine growth retardation, which reflects in large part maternal malnutrition in poorer communities, contributes to chronic disease risk through foetal programming, according to the early origins hypothesis of Barker. Foetal programming implies that during critical periods of prenatal growth, permanent changes in metabolism or structures result from adverse intrauterine conditions. Observational studies first showed an association between lower birth weights and higher rates of coronary disease in the 80s, in England and Scandinavia. The link between low birth weights, or other indicators of small birth size, and cardiovascular disease was later confirmed in many epidemiological studies, including in the USA and in India. Similarly, a reverse relationship of birth weight and systolic blood pressure was shown in men and women, in developed as well as developing countries, and in all age groups, although it was less consistent in adolescents. Insulin resistance and type-2 diabetes have also been found to be independently related to small size at birth in several studies around the world. Insulin resistance associated with small size at birth was frequently shown to be present at a young age. The association of small birth size with chronic disease tends to increase with catch-up growth and obesity, and usually persists after adjusting for confounding factors such as age, family history, and socio-economic status. Several, but not all, twin studies lend support to the hypothesis. There is a tendency for lighter members of twin pairs to have a higher blood pressure, and more diabetes. Observations in people exposed to the Dutch famine while in utero also tend to corroborate the hypothesis. Those who were exposed early in their intrauterine life did not have lower birth weights, but they were prone to becoming obese later on. In contrast, those exposed towards the end of gestation had lower birth weights, and showed a higher rate of impaired glucose tolerance, while having a lower risk of obesity. Dietary manipulations in animal models provide further support and mechanistic explanations, in particular protein deficiency in pregnant rats, which elevates blood pressure, impairs glucose tolerance, and increases the likelihood of obesity in the progeny. Although there are still controversial areas, there is at present sufficient scientific evidence for foetal programming to be regarded as an additional risk factor for chronic disease, in interaction with genetic and lifestyle risk factors. The fact that intrauterine growth retardation may predispose to nutrition-related chronic disease has serious implications for developing countries, particularly those undergoing rapid nutritional transition, as it may further increase the rates of obesity, cardiovascular disease and diabetes when diets and lifestyles are in themselves "atherogenic". The challenge is for programmes to simultaneously combat apparently opposite nutrition problems, malnutrition and "over-nutrition". Improving the nutrition of women is even more imperative when considering that it may contribute to preventing chronic diseases in the next generation, in addition to enhancing health and survival of mothers and children.
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PMID:[Foetal programming of nutrition-related chronic diseases]. 1194 39

Liver steatosis is a common human disease, most often caused by long-term alcohol consumption. Non-alcoholic steatohepatitis (NASH) is characterized by similar histopathological features to those observed in alcoholic liver disease, but occurs in the absence of significant alcohol consumption. Several aetiological factors contribute to NASH: obesity, type 2 diabetes mellitus, hyperlipidaemia, pregnancy, different chemical intoxications, parenteral nutrition, jejeuno-ileal bypass, chronic inflammatory bowel disease, nutritional protein deficiency and congenital metabolic disorders. Biochemically, oxidative stress and lipid peroxidation and their ensuing damage are implicated in the pathogenesis of NASH and alcoholic steatohepatitis (probably resulting from free fatty acids in the mitochondria, and induction of the cytochrome P450 isoform CYP2E1 in hepatocytes and Kupffer's cells). This paper deals with the pathomechanisms, clinical findings and currently available therapies for NASH. The potential use of metadoxine in the treatment of NASH is also discussed.
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PMID:A new approach to drug therapy in non-alcoholic steatohepatitis (NASH). 1470 19

Recent data in adults showed that C-reactive protein (CRP) level robustly predicts future coronary heart disease (CHD) and type 2 diabetes mellitus (T2DM). Although data in children are scarce, overweight, obesity, and insulin resistance were shown to be associated with elevated CRP concentrations. Preliminary data in children also show association of CRP with endothelial dysfunction and other cardiovascular risk factors. Adult Asian Indians, highly predisposed to develop CHD and T2DM, have significantly higher CRP levels than do Europeans. Recent studies show that nearly 13% of Asian Indian children and young adults in India have subclinical inflammation, and approximately 20% have insulin resistance, portending high risk for CHD in adulthood. Possible determinants of high CRP levels in Asian Indians might be excess body fat, including high subcutaneous fat, and physical inactivity. The relationships of recurrent infections, protein deficiency, and subclinical inflammation in Asian Indians remain uninvestigated. Finally, prevention of childhood adiposity is critical to decrease future risk for development of T2DM and CHD, particularly in highly predisposed ethnic groups such as Asian Indians and South Asians.
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PMID:C-reactive protein in young individuals: problems and implications for Asian Indians. 1510 38

Morbidly obese patients often have nutritional deficiencies, particularly in fat-soluble vitamins, folic acid and zinc. After bariatric surgery, these deficiencies may increase and others can appear, especially because of the limitation of food intake in gastric reduction surgery and of malabsorption in by-pass procedures. The latter result in more important weight loss but also increase the risk of more severe deficiencies. The protein deficiency associated with a decrease in the fat-free mass has been described in both procedures. It can sometimes require an enteral or parenteral support. Anemia can be secondary to iron deficiency, folic acid deficiency and even to vitamin B12 deficiency. Neurological disorders such as Gayet-Wernicke encephalopathy due to thiamine deficiency, or peripheral neuropathies may also be observed. Malabsorption of fat-soluble vitamins and other nutrients, especially if diagnosed after by-pass surgery, rarely cause clinical symptoms. However, some complications have been reported such as bone demineralization due to vitamin D deficiency, hair loss secondary to zinc deficiency or hemeralopia from vitamin A deficiency. A careful nutritional follow-up should be performed during pregnancy after obesity surgery, because possible deficiencies can affect the health of both the mother and child. In conclusion, increased awareness of the risk of deficiency and the systematic dosage of micronutrients are needed in the pre- and postoperative period in obese patients undergoing bariatric surgery. The case by case correction of these deficiencies is mandatory, and their systematic prevention should be evaluated.
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PMID:[Nutritional deficiencies associated with bariatric surgery]. 1748 73


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