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

In the present work I focus on the pathophysiological mechanisms that may explain the association between high sodium intake, obesity and high blood pressure. Despite epidemiological and etiological controversies on the link between excess sodium in the diet and elevated arterial pressure, the association could be explained on the basis of three different pathophysiological mechanisms: (1) abnormal electrolyte transport across cell membranes, a defect that alters sodium/potassium exchange and also sodium/calcium exchanges, increasing the concentration of intracellular calcium ions that heightens vessel wall tension and the smooth muscle process, (2) increased sympathetic nervous system activity and (3) altered cellular sodium concentration that induces waterlogging in the peripheral arteriolar walls. These mechanisms increase peripheral resistance and enhance arterial pressure. Early epidemiological studies documented a strong association between obesity and hypertension; and a greater incidence of high blood pressure and diabetes was reported in persons with upper body obesity (high waist/hip ratio). Researchers have explained obesity-related hypertension accordingly with various mechanisms. Hyperinsulinemia and vascular resistance may trigger the metabolic and adrenergic changes described in obese hypertensive patients in several ways. Insulin may increase absorption of sodium in the diluting segment of the distal nephron with consequent water retention. Alternatively, insulin might alter sodium/potassium distribution thus causing increased vascular peripheral resistance. The increased sodium stimulates adrenergic activity. The water retention in obese subjects increases absolute volume that is predominantly redistributed in the cardiopulmonary area, leading to augmented venous return and cardiac output. These changes in association with a total peripheral resistance considered inappropriately normal, are the main hemodynamic characteristics of obesity-related hypertension.
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PMID:Sodium and obesity in the pathogenesis of hypertension. 215 2

Obesity is known to be associated with diabetes, hypertension and hyperlipidemia in the majority of the patients. There could be inaccuracy in measuring the blood pressure in obesity, therefore a cuff of sufficient size is important in blood pressure measurement. All parameters of obesity have been found to have a correlation with hypertension and it has been suggested that change in weight would cause a change in blood pressure. A weight reduction of 12 kg results in a blood pressure fall of 21/13 mm Hg. Such changes in blood pressures have been noted in untreated hypertensives. A few studies have negated the role of change in weight to have any influence on hypertension. Obesity causes a higher cardiac output and higher blood volume leading to hypertension. There may be increased intracellular sodium and reduced sodium-potassium-ATPase activity in obesity which causes increased sodium loading in hypertension. Abnormalities related to the insulin-carbohydrate metabolism and the renin-angiotensin aldosteron system have also been demonstrated in obese patients. Weight reduction also causes reduced dietary salt intake and diminished sympathetic activity. The benefits of weight reduction appear to be directly related to the amount of weight lost.
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PMID:Effect of obesity and weight reduction in hypertension. 218 Feb 41

The aims of this study were to determine whether chronic hyperinsulinemia, comparable to that found in obese hypertensives, elevates mean arterial pressure (MAP) or potentiates the hypertensive effects of angiotensin II (ANG II). Studies were conducted in conscious dogs with kidney mass reduced by 70% in order to increase their susceptibility to hypertensive stimuli. Insulin infusion (0.5 or 1.0 mU.kg-1.min-1 iv) for 7 days with plasma glucose held constant raised plasma insulin more than fivefold but did not increase MAP in four dogs on 138 meq/day Na intake. In seven dogs maintained on a high Na intake (319 meq/day), insulin infusion (1.0 mU.kg-1.min-1) for 28 days raised fasting insulin from 9.8 +/- 1.5 to 56-78 microU/ml but did not increase MAP, which averaged 106 +/- 2 mmHg during control and 102 +/- 2 mmHg during 28 days of insulin infusion. Insulin caused transient sodium and potassium retention followed by renal "escape" that was associated with increased glomerular filtration rate (12-27%). Plasma renin activity and plasma aldosterone were not altered by insulin. In five dogs infused with ANG II (2.0 ng.kg-1.min-1) to cause mild hypertension, insulin infusion (1.0 mU.kg-1.min-1) for 6-28 days did not increase MAP further. Thus chronic hyperinsulinemia did not elevate MAP, even when kidney mass was reduced, and did not potentiate the hypertensive effects of ANG II. These findings suggest that additional factors besides hyperinsulinemia per se are responsible for obesity-associated hypertension.
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PMID:Chronic hyperinsulinemia and blood pressure regulation. 218 Mar 21

Endogenous factors cross-reacting with antidigoxin antibodies have been found in several tissues and body fluids of animals and humans, using commercially available digoxin radioimmunoassay or enzyme immunoassay methods. The chemical characteristics of these endogenous factors are, at present, unknown, although it has been suggested that they could be substances with low molecular weight. Experimental studies and theoretical considerations indicate that endogenous digitalis-like factors (DDLFs), in addition to the ability to react with antibodies, might also bind to the specific cellular receptor of the cardiac glycosides and thus inhibit the membrane Na+/K(+)-ATPase (sodium pump). Therefore, EDLF can be an endogenous modulator of the membrane sodium-potassium pump and several authors have suggested that EDLF could play a role in the regulation of fluids and electrolytes, muscular tone of myocardial and also in the pathogenesis of arterial hypertension. In this review, the authors discuss the hypothesis that, in metabolic diseases such as diabetes mellitus, obesity and acromegaly, the sodium retention and volume expansion, possibly due to exaggerated sodium intake, and/or exogenously induced peripheral hyperinsulinemia and high levels of growth hormone, could trigger a sustained release of EDLF, which in turn increases the blood pressure.
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PMID:Is the endogenous digitalis-like factor the link between hypertension and metabolic disorders as diabetes mellitus, obesity and acromegaly? 222 23

The purpose of the present study was to test the validity of the electrical impedance method for estimation of total body water and lean body mass in adult Danes with large differences of obesity and fat distribution, and to develop algorithms for estimation of body water, lean body mass and fat from measurement of impedance. The results of the electrical impedance method were compared in 139 Danes aged 35-65 years, to those of a four-compartment-model based on measurements of both total body potassium (whole body counting) and total body water (dilutometry). The comparison confirmed the validity of the impedance method. Equations for predicting body water and lean body mass in Danes are given. A significant difference was found between two instruments of the same model. In spite of the fact that the test resistance supplied by the manufacturer gave identical measurements, measurements on humans diverged on average by 31 ohm. A cross-validation study showed that most of the algorithms found in the literature for predicting lean body mass from impedance yield reliable results.
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PMID:Prediction of body water and fat in adult Danes from measurement of electrical impedance. A validation study. 222 10

Standardised data on blood pressure, 24 h urinary electrolyte excretion, body mass index (BMI) and alcohol intake were collected as part of the INTERSALT study in 598 men and women aged 20-59 years, selected randomly from three population groups in the United Kingdom. For the three centres combined, mean systolic blood pressure was 121.4 mm Hg and diastolic pressure 72.1 mm Hg, urinary sodium excretion 152.1 mmol/24 h, urinary potassium excretion 61.0 mmol/24 h, urinary sodium/potassium ratio 2.64 and BMI 25.2 kg/m2. Prevalence of heavy alcohol drinking in men (greater than or equal to 300 ml/week) was 27.5 per cent. Applying overall INTERSALT regression coefficients to the United Kingdom data suggested that modest changes in average sodium and potassium intakes, together with reductions in the prevalence of obesity and (in men) of heavy alcohol drinking could lead to important reductions in average population blood pressures and the prevalence of hypertension. The potential of this multifactorial approach to blood pressure control was illustrated by stratifying individuals within each of the United Kingdom centres by sodium and potassium excretion, BMI and alcohol intake. The 20 (out of 299) men considered at 'lower risk' for high blood pressure with respect to the above variables had systolic pressure lower by 11 mm Hg (P less than 0.01); for the 27 (out of 299) 'lower risk' women, systolic pressure was lower by 5 mm Hg (P = 0.06). These non-pharmacological approaches towards more favourable blood pressure levels could be accompanied by reductions in mortality from stroke and coronary heart disease.
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PMID:Sodium, potassium, body mass, alcohol and blood pressure in three United Kingdom centres (the INTERSALT study). 226 96

As part of a physical anthropological and linguistic research in the Cook Islands, blood pressure levels, the degree of obesity, and urine cation excretion were measured in the residents of Rarotonga (the most westernized) and Mangaia (a less westernized island) in 1986. The rise of blood pressure with age was observed in both sexes in each island, with the mean systolic pressures of the oldest male group (155.8 vs. 137.3 mmHg) significantly higher, and those of older female groups (137.4 vs. 127.1 and 154.7 vs. 145.9 mmHg) relatively higher in Rarotonga than in Mangaia. The mean body mass index was much the same between the two islands, but mean skinfolds at triceps and subscapular sites were thicker in Rarotonga than in Mangaia in each sex and age group. The mean sodium to potassium excretion ratio fell with age (2.97 to 0.94 in males, 2.24 to 1.09 in females) in Rarotonga, and was consistently low (1.09 to 0.73) in Mangaia. Body mass index correlated with both systolic and diastolic pressures in each sex and island group but indeces of sodium excretion did not. Obesity was considered a more important risk factor for hypertension than sodium-intake in the surveyed population, and skinfolds, related to daily physical activity, probably associated with the difference in blood pressure levels observed between the two islands.
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PMID:Blood pressure, obesity and urine cation excretion in two populations of the Cook Islands. 235 47

The low-energy protein diet providing 1559 kJ is the first accurately defined diet for the treatment of obesity in the CSSR. The daily amount contains 4.0 g fat, 33.0 g protein, 50.0 g carbohydrate, 5.6 g fibre and daily recommended allowances of vitamins. The diet is enriched with potassium, magnesium and iron. The low-energy protein diet was used for a period of 28 days in the treatment of 49 obese patients aged 40.49 +/- 1.39 years whose initial weight was 110.14 +/- 3.41 kg and the BMI 39.44 +/- 1.13. The therapeutic regime comprised in addition to the diet adequate physical exercise of aerobic character and training of correct eating behaviour. Four weeks treatment led to a significant decline of body weight (by 10.60 +/- 0.46 kg) and a significant drop of the BMI (by 3.65 +/- 0.16). Men lost more weight than women. In women a substantial drop of the body weight (90.5%) was due to reduction of body fat, while in men adipose tissue participated by 60.0% in the loss. During the fourth week of treatment a positive nitrogen balance was achieved, obviously due to adequate physical exercise. The waist/hip ratio was not affected by treatment in either group. The therapeutic regime influenced favourably some risk factors of ischaemic heart disease. In addition to a significant drop of the systolic and diastolic blood pressure a significant decline of total cholesterol, triacylglycerols and serum insulin occurred. There was a concurrent decline of the urinary C-peptide excretion. The therapeutic regime involving the low-energy protein diet was well tolerated by the patients. The incidence of side effects during treatment was less frequent than in treatment by intermittent fasts. No disorders of the cardiac rhythm were recorded during treatment.
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PMID:[A Czechoslovak low-energy protein diet in the treatment of obesity]. 235 13

In this double-blind trial, the clinical and biochemical side-effects of cicletanine 150-200 mg/day were compared with those of indapamide 2.5 mg/day in a population of hypertensive with such metabolic disorders as diabetes mellitus, obesity, hyperlipidaemia or hyperuricaemia. Sixteen patients received cicletanine and 15 indapamide; 2 patients in the indapamide group were excluded, one for undesirable effect, the other for unexpected effect. The two treatments did not produce any significant change in natremia, glycaemia, uricemia, creatininemia or blood lipid level. Kalemia remained stable under cicletanine but was significantly reduced under indapamide, requiring supplementation with potassium salts in 5 patients. Both cicletanine and indapamide proved to be effective as antihypertensive drugs, although blood pressure levels at inclusion were different in each of the two groups.
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PMID:[Cicletanine tolerance in hypertensive patients with metabolic disorders]. 251 53

Obesity, diet and alcohol consumption constitute major environmental determinations of blood pressure elevation. The long term setting of blood pressure in response to these factors will be determined by genetic susceptibility, and interactions with effects of physical fitness and smoking. Dietary changes which independently influence both atherosclerosis and hypertension are likely to be of greatest value in helping to control morbidity and mortality from hypertensive cardiovascular disease. Recommendations should focus on diets low in total and saturated fat intake and high in fruit and vegetables, containing potassium and fibre, coupled with weight control, alcohol moderation to less than two drinks per day in drinkers and regular physical exercise. Sodium restriction will help lower blood pressure in older hypertensives in particular. The role of dietary calcium or fish oils in blood pressure regulation is still uncertain. Dietary and related recommendations on smoking and exercise should be 'first line' treatment in mild hypertensives, and complimentary to therapy in all patients requiring drugs.
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PMID:Diet, alcohol and hypertension. 255 47


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