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

From all nutritional variables optimal energy supply is considered as most vital for human performance. It is postulated that lack of energy homeostasis is the basic problem in the development of overtraining. Most if not all clinical symptoms are directly or indirectly related to the physiological mechanisms of energy homeostasis. The rapidly increasing knowledge in the field of body weight control with several new regulatory neuro-peptides such as leptin, will give new opportunities to tackle this unbalance between training load and energy availability. The central role of leptin and insulin as adiposity signals has focussed attention on the anti-obesity aspects of leptin. However as member of the cytokine family, leptin is also closely linked to the immune and reproductive system. New data indicates clearly the dual function of leptin at both ends at the energy balance; starvation vs. overfeeding. It links also nutrition to the reproductive system. Lack of available energy has a much greater impact on leptin levels than exercise stress. It is suggested that application of the rapidly increasing knowledge in the obesity field will benefit the research on the mechanisms involved in the derailment of the delicate balance between training load and energy homeostasis in athletes.
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PMID:The concept of energy homeostasis for optimal health during training. 1189 92

The increasing prevalence of obesity in the Western world has stimulated an intense search for mechanisms regulating food intake and energy balance. A number of appetite-regulating peptides have been identified, their receptors cloned and the intracellular events characterized. One possible energy-dissipating mechanism is the mitochondrial uncoupling of ATP-synthesis from respiratory chain oxidation through uncoupling proteins, whereby energy derived from food could be dissipated as heat, instead of stored as ATP. The exact role of the uncoupling proteins in energy balance is, however, uncertain. We show here that mitochondrial F1F0-ATP synthase itself is a target protein for an anorectic peptide, enterostatin, demonstrated both after affinity purification of rat brain membranes and through a direct physical interaction between enterostatin and purified F1-ATP synthase. In insulinoma cells (INS-1) enterostatin was found to target F1F0-ATP synthase, causing an inhibition of ATP production, an increased thermogenesis and increased oxygen consumption. The experiments suggest a role of mitochondrial F1F0-ATP synthase in the suppressed insulin secretion induced by enterostatin. It could be speculated that this targeting mechanism is involved in the decreased energy efficiency following enterostatin treatment in rat.
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PMID:Mitochondrial ATP synthase--a possible target protein in the regulation of energy metabolism in vitro and in vivo. 1204 76

300 women attending an obstetrics and gynecology clinic in the city of Oman, Algeria, were interviewed concerning their psychological attitudes and reactions to different contraceptive methods. 33% of the sample were employed. 60% were from a lower, 30% from a middle, and 10% from a higher socioeconomic strata. 50% were illiterate or had primary education, 40% had secondary education, and 10% had university education. 60% had 2 or more children. None of the women cited economic reasons for using contraception, but several mentioned the need to work and 50% stated that having a child is not a duty. Fatigue and poor health were the main maternal reasons cited for not having another child. No woman mentioned advanced age of either spouse as a reason for using contraception. 2/3 of the respondents stated that the value of a child lies in assuring family security; a childless woman has no familial or social security. 2/3 of the women expected to have 2-3 children, and 90% wanted 4 or fewer. It was stated that spacing childred enables the parents to bring them up better and preserves the beauty and health of the mother. The husband's prohibition or religious disapproval were viewed as influencing contraceptive practice. 84% of the women wanted to use contraception and 2/3 had already had experience with a method. 84% preferred the pill and 16% the IUD. The need for a doctor's prescription for the pill was not viewed as a disadvantage but rather as a form of authorization of contraceptive use which excused the woman from any guilt. 33 women mentioned reasons why they had discontinued previous pill use, such as side effects, obesity, or menstrual difficulties. The IUD appeared to be acceptable mainly when side effects or contraindications precluded pill use. 50% of women were unfamiliar with it, 17% believed it to be effective, and 33% believed it to be ineffective. It was rejected among other reasons because of the manner of insertion, fear of intervention, and fear of losing it. 16 women had discontinued IUD use for a variety of reasons.
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PMID:[Psychological attitudes of Algerian women to contraception (author's transl)]. 1233

Sleep-related breathing disorders (SRBDs) represent a spectrum of abnormalities that range from simple snoring to upper airway resistance syndrome to sleep apnea. The clinical presentation may include obesity, snoring, neuropsychological dysfunction, and daytime hypersomnolence and tiredness. The acute hemodynamic alterations of obstructive sleep apnea include systemic and pulmonary hypertension, increased right and left ventricular afterload, and increased cardiac output. Earlier reports attributed the coexistence of SRBDs with cardiovascular diseases to the shared risk factors such as age, sex, and obesity. However, recent epidemiologic data confirm an independent association between SRBDs and the different manifestations of cardiovascular diseases. Possible mechanisms may include a combination of intermittent hypoxia and hypercapnia, repeated arousals, sustained increase in sympathetic tone, reduced baroreflex sensitivity, increased platelet aggregation, and elevated plasma fibrinogen and homocysteine levels. The strength of the association, its pathogenesis, and the impact of treatment of SRBDs on the health outcome of patients with cardiovascular diseases are issues to be addressed in future studies.
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PMID:Cardiovascular consequences of sleep-related breathing disorders. 1235 Feb 42

New Zealanders of Polynesian origin have a higher prevalence of obesity and type 2 diabetes mellitus than those of European origin. Risk factors for type 2 diabetes mellitus--decreased energy expenditure, increased body fat mass, and central body fat--in 30 normoglycemic Maori, Pacific, and European men were studied. Biochemical measures of risk for type 2 diabetes mellitus included an oral glucose tolerance test, insulin, lipids, and glycosylated hemoglobin. The groups did not differ significantly in BMI, height, body mass or fat mass (DEXA), or adjusted resting metabolic rate (indirect calorimetry), but the European subjects had significantly lower subscapular to triceps skinfolds and fat-free mass than the Maori and Pacific groups. Central obesity by anthropometry and DEXA showed strong associations with the biochemical measures for type 2 diabetes risk. These findings emphasize the association between body composition and central fat distribution with risk of diabetes independent of ethnicity.
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PMID:Central obesity and risk for type 2 diabetes in Maori, Pacific, and European young men in New Zealand. 1236 20

Sixty children, in the age span 6-17 years originally divided into two groups, matched by age, sex and height--30 obese subjects [15 girls/15 boys; body mass index (BMI) = 27.4 +/- 4.5 m kg-2; ideal body weight (IBW) range = 122-185%] and 30 controls (BMI = 18.8 +/- 2.7 m kg-2) performed incremental treadmill exercise test. Perceived exertion was assessed by means of Category-Ratio Borg scale. The duration of the exercise for the children in the obesity group was significantly shorter than controls (P = 0.010) but obese children have greater absolute values for oxygen uptake (VO2peak ml min-1 = 1907 +/- 671 versus 1495 +/- 562; P = 0.013) and ventilatory variables (VE, VT), which adjusted for body mass decrease significantly (VO2/kg ml min-1 kg-1 = 29.2 +/- 3.8 versus 33.6 +/- 3.5; P < 0.001). Among the various methods for 'normalizing' absolute values of VO2peak for body size, dividing it by body surface area (BSA) yielded the best results (VO2/BSA ml min-1 m-2 = 43.5 +/- 4.6 versus 44.7 +/- 5.6; P = 0.335). The ventilatory efficiency determined either as a slope of VE versus VCO2 or as a simple ratio at anaerobic threshold did not differ between obese and non-obese children in the incremental and recovery periods of exercise. There was a negative correlation of VE/VCO2 slope with age and anthropometric parameters. Obese children rated perceived exertion significantly higher than controls despite the standard workload (Borg score = 6.2 +/- 1.2 versus 5.2 +/- 1.1; P = 0.001). In conclusion, the absolute metabolic cost of exercise is higher in the obesity group compared with the control subjects. Both groups have similar ventilatory efficiency but an increased awareness of fatigue that furthermore limits their physical capacity.
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PMID:Ventilatory efficiency and rate of perceived exertion in obese and non-obese children performing standardized exercise. 1240 47

Patients with suprasellar lesions develop profound hypothalamic obesity and listlessness with no effective treatment. We added triiodothyronine (T(3)) supplementation in 3 such patients and present their response. All had previous nutritional counseling without benefit. All were treated for diabetes insipidus (DI) and hypopituitarism; serum free thyroxine (T(4)) level was normal. A 24-year-old woman (pineal tumor and astrocytoma) had weight gain (4.7 kg/yr for 3 years), cold intolerance, fatigue, dry skin, and constipation; after T(3), she lost 14 kg over 27 months and reported overall improvement. Her bone mineral density also improved. A 10.6-year-old boy (optic glioma) was gaining 6 kg/yr for 4 years; after T(3) supplement, he lost 4.3 kg over 11 months. A 12-year-old girl (mixed germ cell tumor) had weight gain (8.3 kg/yr for 3 years) and listlessness; after T(3), she lost 8.1 kg over 16 months and had improved alertness. All patients were asymptomatic despite supraphysiologic T(3) levels. We suggest that T(3) may serve as a simple and effective supplement, which can promote weight loss and improve the well being of these patients with hypothalamic obesity.
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PMID:Triiodothyronine supplementation for hypothalamic obesity. 1240 83

The sleep apnea syndrome (SAS), which is defined by more than 5 apneas or hypopneas per hour of sleep (9), is quite a frequent affection which concerns 1.4 to 10% of general population (1.7). The major daytime complaints of the SAS are daytime sleepiness, memory and attention disorders, headaches and asthenia especially in the morning, and sexual impotence (9). The nocturnal manifestations are dominated by sonorous and generally long standing snoring, increased by dorsal decubitus and intake of alcohol, with repeated interruptions by respiratory arrests. These manifestations are always noted but rarely spontaneously reported. The sleep, non refreshing, is agitated and perturbed by numerous awakenings. The findings of the clinical examination are poor: obesity is found in 2/3 of the cases and arterial hypertension in 1/2 of the cases (20). Polygraphic recording during sleep only permits an absolute diagnosis. This frequent affection is a real problem of public health because of its numerous complications (3, 10, 12, 13, 18, 21). Symptoms of depression are often found when a patient with a SAS is examined and conversely, symptoms which evoke a SAS can be found in the clinical examination of depressed patients. We decided so to study the thymic and anxious status of 24 patients investigated for a SAS and submitted to a polygraphic recording during sleep. Four clinical parameters were studied: DSM III-R diagnosis criteria, Montgomery and Asberg Depression Rating Scale (MADRS), Hamilton Anxiety Rating Scale (HARS) and thymasthenia rating scale of Lecrubier, Payan and Puech. We also reported Total Sleep Time (TST = 6.5 +/- 1.5), Apnea Hypopnea Index (AHI = 26.7 +/- 21.6), number (2.1 +/- 2.8/h) and duration (174.2 +/- 150.8 s/h) of hypoxic events. Results showed that among 24 patients, 8 were depressed according to DSM III-R diagnosis criteria and had MADRS > 25, 22 were anxious, 11 had a major anxiety (HARS > 15) and 15 presented thymasthenia (SET > 15). Significative correlations existed between anxiety and depression (r = 0.82; p < 0.0001), depression and thymasthenia (r = 0.77; p < 0.0001) and thymasthenia and anxiety (r = 0.75; p < 0.0001). Among the 8 depressed patients a correlation existed between AHI and depression (r = 0.72; p = 0.04), but no correlation was found between depression and hypoxic events. These results were comparable to those of Guilleminault (10), Reynolds (21), Kales (12), Bliwise (3), Klonoff (13) and Millman (18) who studied relations between SAS and depression. The evaluation of thymasthenia gave a more precise typology of the depressive state associated to SAS: the type of the mood disorder is more "blunted" and "anhedonic" than "sorrowful", particularly characterised by asthenia, lack of energy, reduction of interests (leisures, libido, work), loss of initiative, difficulties to organise tasks, fall of performances and reduction of pleasure usually felt in pleasant events (15). The physic symptomatology dominated the psychic one. The sleep disorganization, more than metabolic consequences of apneas, could be involved in this associated depressive state. Other neuropsychiatric troubles can be associated to the SAS. In fact, cognitive troubles (2, 8, 14, 16, 19, 22, 24) and personality disorders (12, 18) have been described. Our data confirm previous observations suggesting a frequent association between SAS, depression, fatigue and anxiety. Clinicians should consequently be aware that a depression with severe complaints of fatigue should deserve an investigation oriented towards SAS. Conversely, when a SAS is diagnosed, it is necessary to look for a possible depression in order to set up the most appropriate treatment. The frequency of SAS, like depression's one, increases with age. Prescription and consummation of sedative psychotropic drugs increase too with age. Since respiratory depressant effects of these drugs have been clearly demonstrated, it is important to evoke SAS when depressive and/or anxious states are diagnosed and not to aggravate it. An efficacious treatment of SAS can also cure the associated depressive state, but this one can persist. It is necessary, in this case, to select a non sedative antidepressant.
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PMID:[Depressive symptomatology and sleep apnea syndrome]. 1240 78

Four basic control mechanisms of breathing (brainstem respiratory centre, peripheral and central chemoreceptors, intero- and exteroceptive reflexes and suprapontine influences), as well as their sleep-related disorders are analysed. A decrease in central chemoreceptor sensitivity to CO2 and an increase in upper airway resistance during sleep result in hypoventilation and mild hypoxaemia already in physiological conditions. Compensatory increase in ventilatory effort with synchronous inhibition of pharyngeal dilators during sleep reduces the upper airway lumen manifesting with snoring, upper airway resistance syndrome, and OSA. The resulting hypoxaemia may cause marked cardiovascular, neuro-psychic, endocrine-metabolic and behavioural disorders. The augmented ventilatory effort and hypoxaemia evoke reflex dilation of airways and arousal from sleep, stimulating the sympatho-adrenal system, which provokes autoresuscitation by gasping preventing fatal asphyxia. Failure of this autoresuscitation mechanism seems to cause SIDS. Elimination of voluntary breathing by sleep either in Ondine's curse induced by lesions of respiratory centre, or in congenital central hypoventilation syndrome caused by insufficient central chemoreceptors result in respiratory failure and death. Nocturnal attacks of bronchial and cardiac asthma, lung oedema and other consequences of pulmonary congestion are also discussed. The pathomechanism of extreme daytime sleepiness, chronic fatigue, and disorders of memory, cognitive and other brain functions, are also analysed. Severe cardiovascular consequences of SAS may manifest acutely as angina pectoris, myocardial infarction. dysrhythmias, transient ischaemic attacks and even stroke or sudden cardiac death. OSAS may result also in development of hypertension, central obesity, diabetes mellitus, erectile dysfunction, depression, and various behavioural disorders.
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PMID:[Regulation of respiration and its sleep-related disorders]. 1244 39

In recent years, the prevalence of type 2 diabetes has increased alarmingly worldwide, giving diabetes the dimension of an epidemic. Striking parallel increases in the prevalence of obesity reflect the importance of body fatness as a contributing factor to diabetes incidence. Moreover, it has been estimated that up to 75% of the risk of type 2 diabetes is attributable to obesity. Recent clinical trials and observational epidemiologic studies demonstrate the efficacy of lifestyle changes, including decreased energy intake, decreased fat intake, and weight loss, as well as regular participation in physical activity, in improving insulin sensitivity (SI) and reducing the risk of diabetes. This review evaluates evidence of the effect of diet on insulin resistance, insulin secretion, and glucose tolerance, and reflects on directions for future work toward primary prevention of type 2 diabetes.
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PMID:Nutrition and prevention of type 2 diabetes. 1262 86


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