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

A 48-year-old woman underwent jejunoileal bypass surgery for obesity while hypercalcemic. Three years later, she developed symptomatic osteomalacia impairing her daily activities. Bone biopsy confirmed the clinical diagnosis of osteomalacia, and treatment with 8000 U daily of vitamin D and milk resulted in striking improvement of clinical symptoms and resolution of her osteomalacia both chemically and histologically. The patient, however, again became hypercalcemic and a parathyroid adenoma was subsequently removed with restoration of serum calcium values to normal. Neither the occurrence and successful treatment of gross symptomatic osteomalacia consequent to jejunoileal bypass surgery, nor the obscuration of primary hyperparathyroidism by osteomalacia has been hitherto well documented in the United States.
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PMID:Symptomatic osteomalacia after jejunoileal bypass surgery in a patient with primary hyperparathyroidism. A study of the change in bone morphology and vitamin D metabolites before and during treatment. 660 88

A 38-year-old woman, who 5 years earlier had undergone a jejunoileal bypass for gross obesity, fractured the distal forearm by a minor trauma. Circulating 25-hydroxycholecalciferol was undetectable without vitamin D3 supplement but increased to the lower normal range on a daily dose of 1200 units of vitamin D3. Serum 1,25-dihydroxycholecalciferol was, however, in the upper normal range, both without and with vitamin D supplement. After intestinal reanastomosis the fracture healed and the biochemical changes normalized. Malabsorption due to reduced amount of functioning intestine may cause severe metabolic bone disease, which may not always be reverted by a high-calcium diet and vitamin D supplementation.
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PMID:Delayed fracture healing following jejunoileal bypass surgery for obesity. 680 54

Fifteen patients who had undergone a 14 inches X 4 inches jejuno-ileal bypass operation for obesity, 3 to 4 years earlier, were investigated by iliac bone biopsy, radiology and routine biochemistry, including 25-hydroxy-vitamin D and parathyroid hormone estimations. Two patients had histological osteomalacia which was mild in one. A further 9 patients had abnormal bone biopsies, there being an excess of trabecular bone surface covered by osteoid with a normal or reduced amount of calcification front. Six of these 9 showed an increase in trabecular resorption, although in none were there excessive numbers of osteoclasts. The likely explanation for these findings is that these 9 patients had early osteomalacia with mild hyperparathyroidism, making a total of 11 patients out of 15 with osteomalacia. Radiology and blood chemistry were poor predictors of histological bone disease.
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PMID:Bone disease after jejuno-ileal bypass for morbid obesity. 687

With the aim of investigating bone mineral loss after intestinal bypass operation, bone mineral content (BMC) was measured by two-dimensional scanning photon absorptiometry on the distal part of the forearm in 23 consecutive patients who had undergone intestinal bypass operation for obesity. Eleven patients (group 1) were investigated before and 12 months after operation, and 12 (group 2), who had been operated on 2-7 years earlier, were investigated two times at an interval of 12 months. No patient received therapeutic calcium or vitamin D supply. The predominant biochemical findings postoperatively were decreased serum values of calcium, magnesium, albumin, and total protein; there was no change in inorganic phosphate or alkaline phosphatase. Mean BMC was normal in both groups postoperatively as well as in group 1 before operation; there was no significant change in mean BMC during 12 months of observation. However, in BMC measurements on extremely obese subjects, a correction for the excessive fat layer on the forearm was necessary because of different attenuation properties of fat and soft tissues. Neglect of this problem will give a systematic underestimation of BMC, and may lead to false conclusions in cross-sectional as well as longitudinal studies.
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PMID:Bone mineral content before and after intestinal bypass operation in obese patients. 722 14

Rheumatic symptoms are often associated with obesity. The usual symptom is pain in the knee due to gonarthrosis, of which one of the causes is obesity; there is a correlation between the degree of overweight and the severity of gonarthrosis. It is likely, though not demonstrated, that overweight aggravates the arthrosis of supporting joints. On the other hand, obesity limits the post-menopausal bone loss. The intestinal bypass created to obtain a loss of weight may generate complications, and in particular an inflammatory rheumatism due to proliferation of bacteria in a blind intestinal loop, and osteomalacia caused by disorders of vitamin D absorption sometimes develops. The risk of perioperative complications is increased in obese patients. The mid-term results of hip or knee surgical replacement seem to be good. In the present state of our knowledge, its seems to be rational to convince obese patients complaining of rheumatic illness that they should lose weight.
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PMID:[Osteoarticular pathology and massive obesity]. 831 Feb 46

Our views on paediatric nutrition have considerably changed during the last 20 years. Some hereditary metabolic diseases testify to the remarkable efficacy of a specific preventive dietetics avoiding the development of mental retardation. Although certain deficiencies (in iron, fluorine, folates, vitamin D) are persisting in France, the major problems concern the prevention in childhood of allergy, obesity, atherosclerosis, high blood pressure, osteoporosis and even certain cancers, all diseases which play a crucial role in the morbidity and mortality of adults. Numerous uncertainties still exist, but in the present state of our knowledge we can already develop some recommendations which should replace the much abusive publicity that prevails in the information given to the public.
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PMID:[Towards preventive dietetics in children]. 850 35

Many anticipate that application of findings in molecular genetics will help to achieve greater precision in defining high-risk populations that may benefit from chemopreventive interventions. We must recognize, however, that genetic susceptibility, environmental factors, and complex gene-environment interactions are all likely to be risk determinants for most cancers. Cohort studies of twins and cancer indicate that having "identical" genes is generally not a very accurate predictor of cancer incidence. Data from twin studies support the suggestion that environmental factors such as tobacco use significantly influence cancer risk. The complexities of the genetic contribution to disease risk are exemplified by the development of Duchenne muscular dystrophy in only one of monozygotic twin girls, hypothesized to be the result of X chromosome inactivation, with the distribution patterns of the X chromosome being skewed to the female X in the manifesting twin and to the male X in the normal twin. Evidence from transgenic and genetic-environmental studies in animals support the possibility of genetic-environmental interactions. Calorie restriction modifies tumor expression in p53 knockout mice; a high-fat, low-calcium, low-vitamin D diet increases prepolyp hyperplasia formation in Apc-mutated mice; and calorie restriction early in life influences development of obesity in the genetically obese Zucker rat (fafa). Such environmental modulation of gene expression suggests that chemoprevention has the potential to reduce risk for both environmentally and genetically determined cancers. In view of the growing research efforts in chemoprevention, the NCI has developed a Prevention Trials Decision Network (PTDN) to formalize the evaluation and approval process for large-scale chemoprevention trials. The PTDN addresses large trial prioritization and the associated issues of minority recruitment and retention; identification and validation of biomarkers as intermediate endpoints for cancer; and chemopreventive agent selection and development. A comprehensive database is being established to support the PTDN's decision-making process and will help to determine which agents investigated in preclinical and early phase clinical trials should move to large-scale testing. Cohorts for large-scale chemoprevention trials include individuals who are determined to be at high risk as a result of genetic predisposition, carcinogenic exposure, or the presence of biomarkers indicative of increased risk. Current large-scale trials in well-defined, high-risk populations include the Breast Cancer Prevention Trial (tamoxifen), the Prostate Cancer Prevention Trial (finasteride), and the N-(4-hydroxyphenyl) retinamide (4-HPR) breast cancer prevention study being conducted in Milan. Biomarker studies will provide valuable information for refining the design and facilitating the implementation of future large-scale trials. For example, potential biomarkers are being assessed at biopsy in women with ductal carcinoma in situ (DCIS). The women are then randomized to either placebo, tamoxifen, 4-HPR, or tamoxifen plus 4-HPR for 2-4 weeks, at which time surgery is performed and the biomarkers reassessed to determine biomarker modulation by the interventions. For prostate cancer, modulation of prostatic intraepithelial neoplasia (PIN) by 4-HPR and difluoromethylornithine is being investigated; similar studies are being planned for oltipraz, dehydroepiandrosterone, and vitamin E plus selenomethionine. The validation of biomarkers as surrogate endpoints for cancer incidence in high-risk cohorts will allow more agents to be evaluated in shorter studies that use fewer subjects to achieve the desired statistical power.
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PMID:Cancer risk factors for selecting cohorts for large-scale chemoprevention trials. 902 95

Although much has been written, little is known about the causes of prostate cancer. Variations between populations in the incidence of invasive cancers, together with changes in the incidence of invasive cancers in migrants, have pointed to environmental (lifestyle) factors that might be amenable to intervention. Conversely, there is a lack of international variation in the prevalence of microscopic tumours, so the essential question is: what causes only some of the common microscopic tumours to become aggressive? Dietary factors hold the most promise in this regard and have been the subject of recent reviews. The strongest and most consistent effects are positive associations with animal products such as red meats, eggs and dairy foods, and possibly by implication, fat. Evidence of a protective effect of fruit and vegetables is weak and inconsistent, as is the relationship with vitamin A and carotenoids, such as beta-carotene. There are some interesting leads. Lycopene, the carotenoid found in tomatoes, has been reported to be protective; alpha-tocopherol supplementation has shown a protective effect in one intervention study; and vitamin D has been shown to be protective in a prospective study. Interest is also growing in phytoestrogens and the extent to which dietary manipulation with these and other phytochemicals might influence prostate cancer by modifying male sex hormone levels or actions. There is limited evidence of associations with obesity. It is not known whether these are related to a particular dietary pattern or to possible physiological effects on the male's hormonal milieu. Associations with lean body mass are likely to be related to the action of androgens during growth and development. Dietary and nutritional effects on prostate cancer do not appear to be strong, but they may be subtle and attenuated by measurement error. To explore these aspects further will require large prospective studies that include improved (repeated) dietary measurements and also blood sampling, so that genetic polymorphisms can be adequately investigated. Such studies are underway.
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PMID:Diet, nutrition and prostate cancer. 920 14

The aim of the present study was to analyse the differences between the breakfast habits of obese/overweight (O) (those with body mass index [BMI] above the 75th percentile) and normal weight schoolchildren (N) (those with BMI equal to or below the 75th percentile). A seven consecutive days "food record" was used to record the intake of foods at breakfast and throughout the rest of the day. O subjects, and in particular female O subjects, omitted breakfast more frequently and took significantly smaller quantities of cereals than did N subjects. The energy supplied by breakfast, measured as a percentage of energy expenditure, was significantly lower in O subjects (17.0 +/- 8.5% in males and 14.6 +/- 6.1% in females) than in N subjects (20.9 +/- 9.4% in males and 17.6 +/- 6.5% in females). With respect to the energy and nutrients supplied by breakfast, O subjects took lower quantities of carbohydrates, thiamin, niacin, pyridoxine, vitamin D and iron than did N subjects. The energy profiles of O subjects breakfasts were more imbalanced than those of N subjects. A significant difference was seen between the amounts of energy supplied by carbohydrates. Without doubt, O subjects have less satisfactory breakfast habits than N subjects. This might be a reflection of whole diet that is less adequate, however, it is possible that an inadequate breakfast contributes to the making of poor food choices over the rest of the day, and, in the long term, to an increased risk of obesity.
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PMID:Difference in the breakfast habits of overweight/obese and normal weight schoolchildren. 956 28

Biliopancreatic diversion (BPD) has made reacceptable the malabsorptive approach to the surgical treatment of obesity. The procedure, in a series of 2241 patients operated on during a 21-year period, caused a mean permanent reduction of about 75% of the initial excess weight. The indefinite weight maintenance appears to be due to the existence of a threshold absorption capacity for fat and starch, and thus energy, and the weight loss is partly due to increased resting energy expenditure. Beneficial effects other than those consequent to weight loss or reduced nutrient absorption included permanent normalization of serum glucose and cholesterol without any medication and on totally free diet in 100% of cases, both phenomena being due to a specific action of the operation. Operative mortality was less than 0.5%. Specific late complications included anemia, less than 5% with adequate iron or folate supplementation (or both); stomal ulcer, reduced to 3.2% by oral H2-blocker prophylaxis; bone demineralization, increasing up to the fourth year and tending to decrease thereafter, with need of calcium and vitamin D supplementation; neurologic complications, totally avoidable by prompt vitamin B administration to patients at risk; protein malnutrition, which was reduced to a minimum of 3% with 1.3% recurrence, in exchange with a smaller weight loss, by adapting the volume of the gastric remnant and the length of the alimentary limb to the patient's individual characteristics. It is concluded that the correct use of BPD, based on the knowledge of its mechanisms of action, can make the procedure an effective, safe one in all hands.
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PMID:Biliopancreatic diversion. 971 19


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