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

The present study deals mainly with the relationship between abnormal gamma-GTP level in serum on the one hand and obesity and ingestion of alcohol on the other hand on the basis of data for 1,493 cases (1,256 male cases, 237 female cases) who visited our clinic for their health check in the short-term human dry dock managed by the Fukuoka University Hospital. Abnormality in gamma-GTP serum level (> 60 mu/ml) was noted in 28.9% of men, which was second highest after 33.5% for the rate of triglyceride abnormality among the laboratory examinations performed in the human dry dock. In women the rate of abnormal LAP level in serum was the highest at 22.0%, while the rate of abnormal level of gamma-GTP was not more than 3%. The rate of abnormal gamma-GTP in serum increased with elevation in the obesity rate. Particularly in men there was a close relationship between the rate of abnormal gamma-GTP in serum and the amount of alcohol ingested, and the rate of abnormal gamma-GTP was 30.8% in men who take between 1 and 2 "gou" of Sake (1 "gou" of Sake contains 30g of alcohol) a day but reached 71.6% in case of the alcohol ingestion exceeding 2 "gou" of Sake. The relative risk ratio for abnormal gamma-GTP in serum was greater for alcohol than for obesity with 6.80 for those who are not obese but drink alcohol and 2.23 for those who are obese but do not drink alcohol. In both men and women, obesity plus ingestion of alcohol brought about a synergistic rather than additional effect. In men the relative risk ratio in the group having both obesity and ingestion of alcohol amounted to 11.5.
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PMID:[Studies on background of gamma-GTP abnormality in human multiphasic screening. (Part 1): Effect of obesity and ingestion of alcohol on gamma-GTP level in serum]. 790 14

In previous studies we reported that the abnormality of the gamma-GTP level was found not only in hepatobiliary diseases but also in obesity and ingestion of alcohol in healthy individuals. In relation to this results, the present study deals with the relationship between abnormal gamma-GTP level in serum on the one hand and obesity and ingestion of alcohol on the other hand on the basis of test data for 1493 cases (1256 male cases, 237 female cases) who were examined in the short-term human dry dock managed by the Fukuoka University Hospital. To observe how results of various measurements including the degree of obesity and the amount of alcohol ingested exert effects on one another, principle component analysis was done by means of SAS statistic package for computer analysis. In men, as the first principle main components, obesity rate, Hb, Ht, RBC, GPT, gamma-GTP, LAP, GOT, triglyceride and total protein were extracted. As the second main principle components, alcohol, gamma-GTP, MCH, MCV, and HDL were extracted. Theses result demonstrate that the obesity is accompanied by variations in Hb, Ht, RBC and triglyceride and that digestion of alcohol is accompanied by variations in MCH, MCV and HDL in male. In women, components related to erythrocyte and transaminase along with the degree of obesity were extracted as the first main principle components, and principle components related to erythrocyte and alcohol were extracted as the second main components. In either case, alcohol and gamma-GTP were not included.
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PMID:[Studies on background of gamma-GTP abnormality in human multiphasic screening. (Part 2): Principle component analysis by SAS statistic package for computer analysis]. 790 15

Multiple regression analysis in 1493 cases (1256 male cases, 237 female cases) who were examined in the short-term human dry dock managed by the Fukuoka University Hospital, was done with gamma-GTP as the dependent variable and other parameters as the independent variables. As the result, 16 variables including LAP, alcohol, GPT, triglyceride, HDL and obesity rate were selected as the variables explaining gamma-GTP by stepwise methods in men. The standard regression coefficient of alcohol is shown to be greater than that of obesity on gamma-GTP. On the contrary, neither alcohol nor the obesity rate was included in this regression formula in women.
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PMID:[Studies on background of gamma-GTP abnormality in human multiphasic screening. (Part 3): Multiple regression analysis by SAS statistic package for computer analysis]. 790 16

Weight loss programs, diets, and drug therapy have not shown long-term effectiveness in treating morbid obesity. A 1992 statement from the National Institutes of Health Consensus Development Conference affirmed the superiority of surgical over nonsurgical approaches to this condition. Bariatric surgical procedures work in 1 of 2 ways: by restricting a patient's ability to eat (restrictive procedures) or by interfering with ingested nutrient absorption (malabsorptive procedures). Many of these procedures can be performed by a laparoscopic approach, which has been shown to reduce operative morbidity. In the United States, the primary operative choice for morbidly obese patients has recently shifted from vertical banded gastroplasty (VBG) to the Roux-en-Y gastric bypass (RYGBP). VBG, a purely restrictive procedure, has fallen into disfavor because of inadequate long-term weight loss. RYGBP combines restriction and malabsorption principles, and has been shown to induce greater weight loss than VBG. Other procedures currently being offered include laparoscopic adjustable gastric banding; biliopancreatic diversion (BPD), including the duodenal switch (BPD-DS) variation; and distal gastric bypass (DGBP). Laparoscopic adjustable gastric banding with the LAP-BAND system (INAMED Health, Santa Barbara, CA), a restrictive procedure involving placement of a silicone band around the upper stomach, was introduced in the early 1990s and approved by the US Food and Drug Administration for use in the United States in June 2001. Outside the United States, LAP-BAND surgery is the most commonly performed operation for severe obesity. The BPD, BPD-DS, and DGBP are all malabsorptive procedures offered primarily by laparotomy. They have been shown to induce good long-term weight loss but have a higher rate of adverse nutritional complications. Many safe and effective surgical options for severe obesity are available. More scientific appraisals comparing different procedures and open and laparoscopic approaches are needed.
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PMID:Medical and surgical options in the treatment of severe obesity. 1252 44

Optimal patient selection for laparoscopic adjustable gastric banding with the LAP-BAND (INAMED Health, Santa Barbara, CA) enables maximization of results for patients most suited to the procedure and avoidance of unsatisfactory outcomes for inappropriate candidates. We have investigated potential predictors of outcomes in our patients to look for associations with weight loss. We have also reviewed published data for additional predictors. This analysis has revealed a number of conditions associated with a significantly lower percent excess weight loss (%EWL) than experienced in the overall group. These include increasing age, increasing body mass index (BMI), hyperinsulinemia, insulin resistance, type 2 diabetes, and polycystic ovary syndrome. There was also less weight loss if the SF-36 quality-of-life measure showed a poor physical activity score, high pain score, or poor general health score. However, in all these conditions, the effect was small in comparison with the benefits achieved by these patients, and was judged insufficient to preclude this approach to treatment of their obesity. A number of conditions were found to have no relation to weight loss after LAP-BAND placement. These included sex, presence of mental illness, most comorbidities except those linked to insulin resistance, previous bariatric surgery, and sweet-eating behavior. The value of psychologic assessment to predict outcomes could not be established. The superobese (BMI >50) achieved a lower %EWL at 1 year after LAP-BAND placement compared with those with BMI <50, but there were no differences at the 2-, 3-, and 4-year follow-ups.
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PMID:Selecting the optimal patient for LAP-BAND placement. 1252 45

Severe obesity is a chronic disease requiring continuing care. Optimal outcomes of laparoscopic adjustable gastric banding using the LAP-BAND (INAMED Health, Santa Barbara, CA) depend on accurate placement of the band and excellent postplacement care, which requires a long-term commitment from both the patient and the bariatric surgical team. Adjustability is a key feature of the LAP-BAND system, and knowing when and how much to adjust requires careful judgment. Two methods of approaching the art of adjustment are described: the office adjustment and the radiologic adjustment. A properly placed and adjusted band produces prolonged satiety after a small meal, facilitating a major reduction in dietary intake leading to weight loss. Healthy food choices, increased activity and exercise, and the behavioral changes necessary to achieve these are essential elements of all weight loss programs. The LAP-BAND program is no exception. Follow-up requires monitoring of the comorbidities of obesity and metabolic and nutritional status. Communication and collaboration with the patient's primary care provider are important. All of the elements above are necessary to provide the comprehensive care that contributes to optimal patient outcomes.
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PMID:Patient management after LAP-BAND placement. 1252 49

Following its introduction in 1993, the LAP-BAND (INAMED Health, Santa Barbara, CA) has been used extensively across the world for the treatment of obesity, and data on safety and effectiveness are now available. This review draws on the literature and our own clinical patient base to provide an overview of the early and late problems associated with LAP-BAND placement and its effects on weight loss. It has proved to be a remarkably safe procedure. A report analyzing international data on laparoscopic adjustable gastric bands identified 3 deaths in 5,827 patients (approximately 1 in 2,000). In our series of 1,120 patients, there have been no deaths and no life-threatening perioperative complications. Significant early complications occurred in 17 (1.5%) of our patients; late problems have been more common, particularly during our early experience. Prolapse of the stomach through the band occurred in 125 (25%) of our first 500 patients but has occurred in only 28 (4.7%) of our last 600 patients. Erosion of the band into the stomach occurred in 34 patients (3%); all occurred in the first 500 patients. No erosions have occurred in the last 600 patients. Both problems are treated laparoscopically by removal and replacement. Combined international data show that weight loss after LAP-BAND placement is characterized by steady progressive weight loss over a 2- to 3-year period, followed by stable weight out to 6 years. This pattern reflects the benefit of adjustability. For the international series, the percent excess weight loss (%EWL) at 2 years has been between 52% and 65%. In our series, %EWL at 5 years and 6 years was 54% and 57%, respectively. The LAP-BAND is proving to be extremely safe, able to facilitate good weight loss, and able to maintain weight loss over time.
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PMID:Weight loss and early and late complications--the international experience. 1252 50

Possibly the most important outcomes of bariatric surgery involve changes in obesity-related illness, quality of life (QOL), and psychologic well-being. Dramatic improvement or resolution of serious medical comorbidity accompanies the weight loss following laparoscopic adjustable gastric banding with the LAP-BAND (INAMED Health, Santa Barbara, CA). There are major improvements in the conditions of the metabolic syndrome, which is characterized by impaired glucose tolerance, dyslipidemia, and hypertension. Improvement in insulin sensitivity and pancreatic beta-cell function associated with weight loss induces remission in the majority of type 2 diabetics and reduces the risk of others developing type 2 diabetes. Improvement in dyslipidemia is characterized by raised high-density lipoprotein cholesterol and lower triglyceride concentrations. Together with lower blood pressure, these changes provide a substantial reduction in cardiovascular risk. Other medical conditions caused or aggravated by obesity are also significantly improved, including sleep apnea, daytime sleepiness, asthma, and gastroesophageal reflux. Weight loss is associated with improved fertility and more favorable pregnancy outcomes. All aspects of QOL improve substantially, especially physical disability, and post-weight-loss QOL measures approximate those of the general population. There are also major improvements in body image and reduction in depressive illness. These changes provide perhaps the most compelling data regarding the value of LAP-BAND surgery and underlie the great satisfaction experienced by patients.
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PMID:Changes in comorbidities and improvements in quality of life after LAP-BAND placement. 1252 52

The enzyme 11beta-hydroxysteroid dehydrogenase type 1 (11beta-HSD1) catalyzes the conversion of inactive to active glucocorticoids. 11beta-HSD1 plays a crucial role in the pathogenesis of obesity and controls glucocorticoid actions in inflammation. Several studies have demonstrated that TNF-alpha increases 11beta-HSD1 mRNA and activity in various cell models. Here, we demonstrate that mRNA and activity of 11beta-HSD1 is increased in liver tissue from transgenic mice overexpressing TNF-alpha, indicating that this effect also occurs in vivo. To dissect the molecular mechanism of this increase, we investigated basal and TNF-alpha-induced transcription of the 11beta-HSD1 gene (HSD11B1) in HepG2 cells. We found that TNF-alpha acts via p38 MAPK pathway. Transient transfections with variable lengths of human HSD11B1 promoter revealed highest activity with or without TNF-alpha in the proximal promoter region (-180 to +74). Cotransfection with human CCAAT/enhancer binding protein-alpha (C/EBPalpha) and C/EBPbeta-LAP expression vectors activated the HSD11B1 promoter with the strongest effect within the same region. Gel shift and RNA interference assays revealed the involvement of mainly C/EBPalpha, but also C/EBPbeta, in basal and only of C/EBPbeta in the TNF-alpha-induced HSD11B1 expression. Chromatin immunoprecipitation assay confirmed in vivo the increased abundance of C/EBPbeta on the proximal HSD11B1 promoter upon TNF-alpha treatment. In conclusion, C/EBPalpha and C/EBPbeta control basal transcription, and TNF-alpha upregulates 11beta-HSD1, most likely by p38 MAPK-mediated increased binding of C/EBPbeta to the human HSD11B1 promoter. To our knowledge, this is the first study showing involvement of p38 MAPK in the TNF-alpha-mediated 11beta-HSD1 regulation, and that TNF-alpha stimulates enzyme activity in vivo.
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PMID:Tumor necrosis factor-alpha upregulates 11beta-hydroxysteroid dehydrogenase type 1 expression by CCAAT/enhancer binding protein-beta in HepG2 cells. 1908 56

Brown adipose cells are specialized to dissipate chemical energy in the form of heat, as a physiological defence against cold and obesity. PRDM16 (PR domain containing 16) is a 140 kDa zinc finger protein that robustly induces brown fat determination and differentiation. Recent data suggests that brown fat cells arise in vivo from a Myf5-positive, myoblastic lineage by the action of PRDM16 (ref. 3); however, the molecular mechanisms responsible for this developmental switch is unclear. Here we show that PRDM16 forms a transcriptional complex with the active form of C/EBP-beta (also known as LAP), acting as a critical molecular unit that controls the cell fate switch from myoblastic precursors to brown fat cells. Forced expression of PRDM16 and C/EBP-beta is sufficient to induce a fully functional brown fat program in naive fibroblastic cells, including skin fibroblasts from mouse and man. Transplantation of fibroblasts expressing these two factors into mice gives rise to an ectopic fat pad with the morphological and biochemical characteristics of brown fat. Like endogenous brown fat, this synthetic brown fat tissue acts as a sink for glucose uptake, as determined by positron emission tomography with fluorodeoxyglucose. These data indicate that the PRDM16-C/EBP-beta complex initiates brown fat formation from myoblastic precursors, and may provide opportunities for the development of new therapeutics for obesity and type-2 diabetes.
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PMID:Initiation of myoblast to brown fat switch by a PRDM16-C/EBP-beta transcriptional complex. 1964 92


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