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

Massive obesity may be accompanied by severe and sometimes lethal respiratory complications. The restrictive ventilatory deficit which results from a decrease in thoracic wall compliance and perhaps also from diaphragmatic dysfunction is more severe in males and in subjects with abdominal obesity. Diurnal hypoxaemia results from 2 mechanisms: diminution of the ventilation/perfusion ratio at the base of the lung, and alveolar hypoventilation. Hypercapnia is a fairly frequent complication of massive obesity. Although usually moderate, hypercapnia is a major indicator as it is very often associated with sleep apnoea syndrome. The most severe respiratory complication of massive obesity is this syndrome which must be looked for systematically by questioning the patient and her husband or his wife before serious cardiopulmonary and neuropsychic disorders appear. The effects of weight loss of nocturnal apnoea are inconsistent and variable. Continuous positive pressure ventilation by means of a nasal mask is the choice treatment of sleep apnoea syndrome, especially since the results of rhino-laryngeal surgery are often disappointing.
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PMID:[Respiratory function in massive obesity]. 831 Feb 44

Insulin secretion, clearance dynamics, and their relationship to peripheral plasma insulin and glucose levels were monitored during three 12-h periods of overnight rest, intake of three meals, and continuous enteral feeding of mixed nutrients. The low-frequency ultradian and the high-frequency insulin secretion pulsatility characteristics during the steady-states of overnight rest and continuous enteral feeding were also examined. In abdominally obese subjects, the insulin secretion rate was consistently higher than normal by 2.3-fold. Peripheral plasma insulin levels were increased by 3.4-fold during the overnight period and by 4- to 5-fold during the two fed states. Endogenous insulin clearance was significantly reduced during feeding. Both low- and high-frequency insulin secretory pulsatilities were detected in the abdominally obese subjects. Pulse periods were within the normal range. Pulse maxima, nadirs, and absolute amplitudes were increased concomitant with the increase in insulin secretion. Ultradian relative pulse amplitudes, however, were blunted. A significantly higher pulse-to-pulse variability was observed in the abdominally obese subjects compared with normal subjects. Furthermore, a significantly higher level of interindividual variability in the nutrient-stimulated insulin secretion and in the ultradian pulse characteristics was observed. Thus in abdominal obesity, the increase in pancreatic insulin output is limited and the secretory pulsatilities are aberrant, suggesting a defect in the insulin secretory process. Diminished insulin clearance contributes to the degree of peripheral hyperinsulinemia compensating for the insulin resistance characteristic of this form of obesity.
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PMID:Splanchnic insulin dynamics and secretion pulsatilities in abdominal obesity. 831 21

Obesity can result in alterations in cardiac structure and function even in the absence of systemic hypertension and underlying organic heart disease. Increased total blood volume creates a high cardiac output state that may cause ventricular dilatation and ultimately eccentric hypertrophy of the left (and possibly the right) ventricle. Eccentric left ventricular (LV) hypertrophy produces diastolic dysfunction. Systolic dysfunction may ensue due to excessive wall stress if wall thickening fails to keep pace with dilatation. This disorder is referred to as obesity cardiomyopathy. The presence of systemic hypertension in obese individuals facilitates development of LV dilatation and hypertrophy. Congestive heart failure may occur in such individuals, and may be attributable to LV diastolic dysfunction or to combined LV diastolic and systolic dysfunction. The sleep apnea/obesity hypoventilation syndrome occurs in 5% of morbidly obese individuals and is potentially life-threatening. Treatment of obesity cardiomyopathy consists of weight loss, salt restriction, and diuretics. Digitalis and vasodilators may be useful in selected cases. Central obesity is probably a risk factor for the development of coronary heart disease. Alterations in lipid and insulin metabolism may facilitate development of coronary heart disease in obese patients.
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PMID:Obesity and the heart. 836 92

Despite numerous reports that abdominal obesity is related to disease risk, the study of body-fat distribution remains a largely empirical science. Elucidation of the pathophysiologic linkage between abdominal obesity and disease would be better served by generating hypotheses and testing them--the process of deductive science. Physiologists have proposed that adipose tissue of the intra-abdominal compartment (that drained by the portal vein) contributes strongly to atherosclerosis. If this is so, then the volume of the intra-abdominal fat depot might be better correlated with disease states than a less specific anthropometric index such as the waist-to-hip girth ratio. Alternative abdominal-obesity indices (e.g. sagittal abdominal diameter divided by thigh girth) could be tested in epidemiologic studies to improve our pathophysiologic understanding of how body-fat distribution is related to atherosclerosis and other diseases.
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PMID:Choosing an index for abdominal obesity: an opportunity for epidemiologic clarification. 189 Apr 38

The relationship between body fat indices and cardiovascular risk was analyzed in 97 Japanese women aged 36-72 years. The variables used were anthropometric measures of body fatness, blood lipids and blood pressure. Total adipose tissue weight (TATW) was estimated from bioelectrical impedance measurements. Subcutaneous adipose tissue weight (SATW) was calculated by measuring subcutaneous fat thickness at 14 sites using a skinfold caliper. The indices of body fat distribution were the ratios of waist to hip circumference (WHR) and abdominal to hip circumference (AHR). Blood pressure and serum lipid levels were determined in all subjects after an overnight fast. The correlations among the various body fat indices were high, and all were strongly correlated with WHR and AHR; only % SATW and percentage internal adipose tissue weight (%IATW) were not correlated with WHR and AHR. Significant positive associations were found between WHR, triglycerides and systolic blood pressure (SBP). Negative associations were found between WHR and HDL-cholesterol (HDL-ch.) and the ratio of HDL-ch. to total cholesterol (HDL-ch./T-ch.). On the other hand, significant positive associations were found between AHR, T-ch., LDL-cholesterol, free fatty acid and SBP. A negative association was found between AHR and HDL-ch./T-ch.. Partial correlations were used to determine further associations between cardiovascular risk factors and fat distribution indices. SBP was associated with WHR or AHR after removing the effects of age. Similarly, HDL-ch./T-ch. was associated with WHR or AHR after removing the effects of age and degree of obesity (BMI). These results suggest that the WHR and AHR are equally valid estimates of body fat distribution with respect to their relationship with cardiovascular risk. These relationships occurred independently of age or BMI in Japanese women. These findings emphasize the importance of intra-abdominal obesity as a metabolic risk factor for cardiovascular disease associated with a high WHR and AHR.
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PMID:Relationship of anthropometric indices of body fat to cardiovascular risk in Japanese women. 837 70

Diabetes is more common in Aborigines than in other Australian populations, even in groups that have lived in contact with Europids for 150 years. Prevalence data on hyperinsulinaemia and obesity from urbanized south eastern Australian Aborigines are presented with Europid comparisons. Aborigines had higher mean insulin levels than Europids. In females, mean fasting insulin was 15.5 mU/l in Aborigines, compared with 9.5 mU/l in Europids (P < 0.001). The means for males were 15.1 mU/l (Aborigines) and 8.3 (Europids) (P < 0.005). Obesity was more prevalent in Aborigines. In Aboriginal females aged 25-64 years, 41/108 (38%) had BMI > 30.0, compared with 37/208 (18%) Europids (P < 0.001). In males, the difference in the prevalence of obesity in Aborigines (17/69, 25%) and Europids (34/195, 17%) was not statistically significant. Waist-hip ratio was significantly greater among Aboriginal females (mean 0.87 in persons aged 25-64 years) than among Europids (mean 0.81, P < 0.001). In males, the mean ratio in Aborigines and Europids was the same (0.94). Abdominal obesity was most prevalent among Aboriginal females. For females aged 20-49 years, 83/110 (75%) Aborigines had a waist-hip ratio > 0.80, compared with 71/165 (43%) Europids (P < 0.001). Being overweight or obese is perceived with least accuracy by Aboriginal males of the four ethnicity/gender groups. Comparisons with national data suggest a gradient in the prevalence of obesity, lowest in urban groups, more in the country, and higher still among Aborigines, which is in reciprocal order to socio-economic status. In multivariate analyses, the association of BMI with insulin was highly significant. Hyperinsulinaemia in an Aboriginal group after many years of contact with Europids may result from environmental as well as genetic influences. Relative hyperinsulinaemia is not found among those Aborigines who have developed glucose intolerance, which could be explained by earlier pancreatic exhaustion in this group.
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PMID:Hyperinsulinaemia and obesity in aborigines of south-eastern Australia, with comparisons from rural and urban Europid populations. 837 69

The measurement of fat distribution has become an important issue in obesity research. Numerous techniques have been developed to assess visceral fat because this fat seems to be most strongly associated with metabolic disorders. This review focuses on methods for the direct and indirect assessment of visceral fat ranging from multiple-scan computerized tomography to anthropometric measurements. The principles of techniques, their accuracy and reproducibility as well as aspects of costs and safety are discussed. Comparison of the different methods shows that imaging techniques, such as computerized tomography and magnetic resonance imaging, are the optimal techniques available for accurate assessment of visceral fat. Methods other than imaging techniques have limited potential in the measurement of changes in visceral fat deposition. Anthropometric measurements can be useful to classify subjects into different types of fat distribution for diagnosis of abdominal obesity, and for general application in epidemiological studies. The choice of a particular technique should be based on a balance of practical and financial considerations and the aim of the study. Involvement of ionizing radiation exposure may be an important element in the decision-making process.
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PMID:Techniques for the measurement of visceral fat: a practical guide. 813 39

Central obesity is a strong predictor of higher prevalence of diabetes, hypertension and coronary artery disease among Indian immigrants to Britain. To test this hypothesis in Indians, 1569 adults, between 25 and 64 years of age, from 750 randomly selected households (representative of 0.52 million population of Trivandrum city, Kerala) were selected for this study. The response rate was roughly 95% and the sample consisted of 1497 individuals (737 males and 760 females). The survey methods included dietary diaries for 7-day food intake record, blood pressure measurements using a mercury sphygmo-manometer and anthropometric measurements. The prevalence rates of hypertension between 25 and 64 years was 189/1000 (95% confidence limits 85-360) and between 45 and 64 years was 335/1000 (95% confidence limits 210-460) which is higher than in Western populations. The prevalence was higher in males than females in the younger age groups and comparable in both sexes in the upper age groups. The prevalence of central obesity was significantly higher among male (77.2 vs. 48.9%) and female (84.0 vs. 51.4%) hypertensives compared to non-hypertensive subjects; however, mean body weight, body mass index and waist-hip ratio (WHR) were lower among Indian men compared to a British comparison group. Thus, comparison of Indian men with Britons showed that obesity, salt and alcohol intake, sedentariness, smoking and dietary fat intake do not explain the cause of higher prevalence of hypertension among South Indian men from Kerala.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Diet, central obesity and prevalence of hypertension in the urban population of south India. 852 15

The aim of this study was to investigate the role of body fat distribution on steroid hormone serum concentrations in obese adolescent girls before and after weight reduction. Ninety-two girls (age, 15.1 +/- 0.7 yr) with a mean body mass index of 31.2 +/- 4.6 kg/m2 participated in this 6-week intervention study. Initially, girls with abdominal obesity (waist to hip ratio, > 0.86; n = 30) had higher levels of total and free testosterone and lower levels of sex hormone-binding globulin as well as lower morning levels of total and free cortisol than girls with gluteal-femoral obesity (waist to hip ratio, < 0.80; n = 31) independent of their body mass index. After a mean weight loss of 8.3 +/- 2.6 kg by a standardized weight loss program, significant reductions were observed in estradiol, total and free testosterone, dehydroepiandrosterone sulfate, and the ratio of LH to FSH, whereas sex hormone-binding globulin and free cortisol levels increased significantly. Decreases in total and free testosterone and increases in total and free cortisol were significantly greater in the girls with abdominal obesity than in the girls with gluteal-femoral obesity. Our results suggest that obese girls with an abdominal pattern of fat distribution exhibit more pronounced steroid hormone aberrations, in particular a high androgenic activity, than girls with a gluteal-femoral pattern of fat distribution. The reduction of excess body weight by a conventional treatment regimen is associated with a remarkable improvement of steroid hormone abnormalities in this particular subtype of obese adolescent girls.
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PMID:Body fat distribution and steroid hormone concentrations in obese adolescent girls before and after weight reduction. 853 May 85

Overweight and obesity have an underestimated impact on public health and therefore on national economic costs. The rising prevalence of overweight and obesity is inextricably linked to the increase in the average BMI and its population distribution. English activity patterns have probably fallen over 20 years by an average of 800 kcal/day; the remarkable changes in eating patterns reflect the pervasive physiological suppression of intake by about 750 kcal/d. The resulting small positive energy balance explains the secular increase in average adult weight. Similar changes and discrepancies occur with aging. Together these changes can explain the accelerating skewness of BMI distribution and particular propensity of women to obesity. The genetically susceptible probably dominate the upper BMI range and seem to reflect subtle discrepancies in energy balance in an inactive society on a high fat diet. Maternal programming of gene expression in utero may amplify intergenerational increases in weight but also amplify a stress-mediated susceptibility to abdominal obesity. The needed transformation in thinking on transport, environment, work facilities, education, health and food policies and perhaps in social and economic policies is unlikely when governments are wedded to individualism but without these changes to enhance physical activity and alter food quality societies are doomed to escalating obesity rates.
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PMID:A public health approach to the problem of obesity. 858 Oct 75


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