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Lean Belly Breakthrough

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Assessing Abdominal

For the most effective technique for assessing abdominal fat content, the panel considered measures of waist circumference, waist-to-hip ratio (WHR), magnetic resonance imaging (MRI), and computed tomography. Evidence from epidemiological studies shows waist circumference to be a better marker of abdominal fat content than WHR, and that it is the most practical anthropometric measurement for assessing a patient's abdominal fat content before and during weight loss treatment. Computed tomography and MRI are both more accurate but impractical for routine clinical use. Based on evidence that waist circumference is a better marker than WHR and taking into account that the MRI and computed tomography techniques are expensive and not readily available for clinical practice the panel makes the following recommendation The waist circumference should be used to assess abdominal fat content. Evidence Category C.

Dyslipidemia Diabetes Mellitus and the Metabolic Syndrome

The association between diabetes mellitus and gallstones is confounded by age, obesity, and a family history of gallstones.1 The link between diabetes, obesity, and gallstones most likely comes through the metabolic syndrome. The metabolic syndrome characterizes a specific body phenotype (abdominal obesity), insulin resistance (type 2 diabetes mellitus), and dyslipidemia (hypertriglyceridemia), all risks for cardiovascular disease. Insulin resistance predisposes to cholesterol gallstone disease,28,29 suggesting that hepatic insulin resistance must somehow affect cholesterol and bile salt metabolism.

Instructions for Measuring Waist Circumference According to Nhanes Iii Protocol

Nhanes Waist Circumference

To define the level at which waist circumference is measured, a bony landmark is first located and marked. The subject stands and the examiner, positioned at the right of the subject, palpates the upper hip bone to locate the right iliac crest. Just above the uppermost lateral border of the right iliac crest, a horizontal mark is drawn, then crossed with a vertical mark on the midaxillary line. The measuring tape is placed in a horizontal plane around the abdomen at the level of this marked point on the right side of the trunk. The plane of the tape is parallel to the floor and the tape is snug, but does not compress the skin. The measurement is made at a normal minimal respiration (see Figure 5). According to waist circumference. Although waist circumference and BMI are interrelated, waist circumference provides an independent prediction of risk over and above that of BMI. Waist circumference measurement is particularly useful in patients who are categorized as normal or overweight...

Box 1 The metabolic syndrome changes associated with insulin resistance

Adapted from Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet 2005 365 1420. Relationship of metabolic syndrome with cardiovascular disease, type 2 diabetes, and depression The metabolic syndrome is associated with an increased risk of both diabetes and cardiovascular disease. This association is not surprising because the definition of the syndrome comprises established risk factors for diabetes and cardiovascular disease. For cardiovascular disease, the relative hazard ratios range from 2 to 5 1 . The risk of diabetes is substantial also. The cumulative incidence of diabetes in subjects with impaired glucose tolerance (and obesity) who participated in the diabetes prevention studies was approximately 30 after 3 years of follow-up 4 . A large body of evidence supports an association between type 2 diabetes, cardiovascular disease, and, recently, metabolic syndrome and the occurrence of depression. Individuals who have diabetes are twice as likely to develop depression...

Decreases in Abdominal Fat With Weight Loss

Evidence Statement Weight loss is associated with decreases in abdominal fat, as measured by waist circumference. Evidence Category A. Rationale Six acceptable RCTs on weight loss that measured waist circumferences all show that weight loss is associated with reductions in waist circumference. 365, 369, 373, 375, 384, 399 Waist circumference is commonly used as a surrogate measure for abdominal visceral fat. 420, 421 Although no RCTs examined changes in visceral fat per se, one observational study 422 showed significant decreases in visceral fat with a mean weight loss of 12.9 kg (28.4 lb). In addition, many observational and non-RCT interventional studies have reported that weight loss caused by a variety of treatments reduces abdominal visceral fat levels. 417, 423-428 Fat located in the abdominal region is associated with greater health risks than that in peripheral regions, e.g., the gluteal-femoral area. 155-159, 429, 430 Many studies used the waist-to-hip ratio as the measure of...

Box 4 Measure Weight Height Waist Circumference Calculate BMI

Weight must be measured so that the BMI can be calculated. Most charts are based on weights obtained with the patient wearing undergarments and no shoes. BMI can be manually calculated (kg height in meters 2), but is more easily obtained from a nomogram (see Appendix V). Waist circumference is important because evidence suggests that abdominal fat is a particularly strong determinant of cardiovascular risk in those with a BMI of 25 to 34.9 kg m2. Increased waist circumference can also be a marker of increased risk even in persons of normal weight. The technique for measuring waist circumference is described on page 58. A nutrition assessment will also help to assess the diet and physical activity habits of overweight patients.

Box 5 BMI 25 OR Waist Circumference 88 cmF or 102 cmM

These cutpoints divide overweight from normal weight and are consistent with other national and international guidelines. The relation between weight and mortality is J-shaped, and evidence suggests that the right side of the J begins to rise at a BMI of 25. Waist circumference is incorporated as an or factor because some patients with BMI lower than 25 will have disproportionate abdominal fat, and this increases their cardiovascular risk despite their low BMI (see page 61). These abdominal circumference values are not necessary for patients with a BMI 35 kg m2.

Abdominal Fat Body Weight and Disease Risk

The influence of abdominal fat independent of total body fat on health risk needs to be further defined. More information is needed on the relationship between differential body fat compartments and increased risk, the distribution of body fat compartments among various racial group populations, and the relationship between abdominal fat and disease risk in racial groups. Weight loss studies should include measurements of abdominal fat, as well as cardiorespira-tory fitness, to better assess health improvement. Intentional weight loss treatments need to be examined in terms of their acute and chronic effect on the development and progression of diabetes, heart disease, and overall mortality. Large prospective studies are needed to examine the relationship of body mass index and body fat distribution to overall mortality.

Metabolic syndrome and newonset diabetes

The prevalence of obesity, the metabolic syndrome, and frank diabetes has doubled in the USA over the past decade. With more than 60 of adults and 30 of children classified as overweight or obese, the USA has become the fattest nation on earth. Approximately half of all overweight individuals have insulin resistance and 25 of the population of the USA has multiple risk factors for cardiovascular disease. Cardiovascular risk factors tend to cluster, and insulin resistance or diabetes, obesity, and hypertension are common in the same patient. Ever since the pioneering observation of Colin Dollery's team 59,60 more than 20 years ago, a variety of studies have documented that long-term diuretic therapy, particularly when combined with a beta-blocker, diminishes glucose tolerance and increases the risk of new-onset diabetes. Conversely, as has been revealed in more recent trials, treatment with antihypertensive drugs, such as blockers of the RAS or calcium antagonists, appears to decrease...

Sequelae of Altered Metabolism in Visceral

The proposed mechanism of action of fat patterning on metabolic syndrome is linked to In obesity and type 2 diabetes, there is an increased content of lipids within and around muscle fibers. Researchers have suggested that the accumulation of triaclyglycerols within the skeletal muscle may play an important role in insulin resistance. In obese individuals with elevated amounts of visceral adipose tissue, there is a strong correlation between visceral adipose tissue and insulin resistance independent of subcutaneous (abdominal and nonabdominal) adipose tissue and cardiovascular fitness. It has been suggested that the discrepancies in the literature regarding the independent effect of visceral or subcutaneous adipose tissue on insulin resistance are due to the large variations of abdominal obesity within the study populations.

C Abdominal

Evidence Statement Limited evidence suggests that decreases in abdominal fat correlate with improvements in the lipid Rationale Four RCTs testing the effects of weight loss on blood lipids also included measures of abdominal fat, as measured by waist circumference. 365-373-375- 399 In each study, waist circumference was reduced along with weight, and blood lipids were improved. These studies were not designed to test whether reductions in abdominal fat reduce blood lipids independent of weight loss. However, evidence exists from epidemiologic observational studies that abdominal fat is related to an adverse lipid profile, including higher levels of total cholesterol, LDL-cholesterol, and triglycerides, and lower levels of

Metabolic Syndrome X

Now that you have done the self-evaluation work in this chapter and chapter 4, you have all of the information you need to see if you suffer from the cluster of symptoms that doctors have labeled as Metabolic Syndrome X. One of the most dangerous problems with fat in the abdominal area, especially in men and women over age forty, is that it lays the groundwork for this syndrome. The main characteristic of Metabolic Syndrome X is an increasing resistance to insulin, eventually leading to type 2 diabetes and in some cases type 1 diabetes. According to the American Diabetes Association, type 2 diabetes and the distribution of fat in the abdominal area are directly related to cardiovascular disease and stroke. There are five main measurements that are listed as risk factors for Metabolic Syndrome X. To be at risk, you have to have three out of five of the symptoms listed below. If you do not know your blood pressure, you can either get it tested at your doctor's office or in most...

Dual energy Xray absortiometry DEXA A

Framingham Heart Study Study begun in 1948 to identify constitutional, environmental, and behavioral influences on the development of cardiovascular disease. Framingham data show that increased relative weight and central obesity are associated with elevated levels of risk factors (e.g., cholesterol, blood pressure, blood glucose, uric acid), increased incidence of cardiovascular disease, and increased death rates for all causes combined.

Effects of mediumchain triglycerides on body weight and body fat

The addition of MCT to hypocaloric diets displays variable effects. Yost and Eckel (1989) compared MCT and LCT feedings during and after 4 or 12 weeks of hypocaloric feedings in 16 obese women. It was concluded that MCT are safe, but fail to increase the rate or amount of weight loss. However, a major drawback in this study was that the authors did not measure EE or body composition. Another study tested the effects of a very low calorie diet supplemented with MCT versus a low-fat, high-carbohydrate regimen over 4 weeks (Krotkiewski, 2001). The MCT group showed a significantly greater decrease in body weight during the first 2 weeks compared with the group consuming the low-fat, high-carbohydrate diet. The contribution of body fat to the total weight loss was also higher while the contribution of fat-free mass was lower, as measured by dual-energy x-ray absorptiometry. Similarly, Nosaka et al. (2003) randomized 73 subjects into two groups and provided them with 2100-2400 kcal day of...

Michael J Devlin Stephen A Wonderlich B Timothy Walsh and James E Mitchell

Men anorexia nervosa and bulimia nervosa 5 Australian 69 mental health impairment in 69, 70 obesity in 5 prevalence of BED 5, 17, 71, 218, 224, 243 quality of life impairment in 74 risk factors for BED 219, 222 and the Stanford Model of dialectical behavior therapy 124 mental health impairment 69-72 metabolic abnormalities 5 metabolic syndrome 45 methylphenidate 32 Mexican Americans 17, 20 Mid-Treatment Evaluation Questionnaire in cognitive behavioral therapy 143, 144

Asthenia And Familial Hypertension And Diabetes

Ear Acupuncture Hypertension

It is noteworthy that co-morbidity of these diseases is particularly manifest in the metabolic syndrome which seems to affect an increasing number of people. According to the American Heart Association,6 for this syndrome to be diagnosed at least three of the following should be present Elevated waist circumference men - equal to or greater than 40 inches (102 cm) women - equal to or greater than 35 inches (88 cm). l Elevated triglycerides equal to or greater than 150 mg dL. An interesting phenomenon has been the observation, over time, in patients without metabolic syndrome of the loss of tenderness of these areas only when replacing white sugar with other sweeteners.

Marney A White and Loren M Gianini

The reasons for the elevations in medical problems are not fully understood, but point to binge eating behavior itself. Some research has found that BED is associated with increased risk of metabolic abnormalities, which may be attributed to the pattern of eating observed in BED. For example, eating large amounts of food in a discrete period of time (BED Diagnostic Criterion A1 in DSM-5) (American Psychiatric Association 2012) is associated with exaggerated insulin secretion, increased fasting glucose levels, decreased glucose tolerance, and elevated serum lipids (Jenkins et al. 1992 Taylor et al. 1999). Eating rapidly (Criterion B1) is associated with elevated serum lipids, higher waist-hip circumference ratio, and fatty liver in obese individuals (Kral et al. 2001). Irregular meal patterns, which are frequently observed in BED (Masheb and Grilo 2006 Masheb et al. 2011) and are described more below, are associated with the metabolic syndrome in the general population (Sierra-Johnson...

Clare Stevinson Kristin L Campbell Christopher M Sellar and Kerry S Courneya

There is limited research on the effect of physical activity on disease recurrence and mortality in cancer survivors, with data available from four studies so far. In a randomized trial of group psychotherapy in 66 metastatic breast cancer survivors, self-reported regular exercise was the only nonmedical variable to predict survival.28 In a recent cohort study, the amount of self-reported leisure-time physical activity was assessed in 41,528 Australians, among whom 526 cases of colorectal cancer were identified.29 Those who reported regular exercise (at least once a week) prior to diagnosis, had improved cancer-specific survival (73 5-year survival) compared with those not reporting regular exercise (61 5-year survival). In addition, cancer-specific mortality was higher in those with higher body weight, percent body fat, and waist circumference all factors that can be positively influenced by physical activity. The observed association between exercise and cancer-specific mortality...

Gender and Female Sex Hormones

Female gender is one of the most powerful influences on gallstone disease, with women almost twice as likely as men to form stones.1 This is especially true for women in their fertile years, with the gap narrowing into the postmenopausal period when men catch up. Women are also more likely to undergo cholecystectomy. The basis for this finding seems related to the female sex hormones, because parity, oral contraceptive use, and estrogen replacement therapy are risk factors for gallstone disease.24 During pregnancy, biliary sludge can appear in 5 to 30 of women gallstones develop in 2 to 5 .25 In the puerperium, sludge disappears in two-thirds whereas small gallstones (

The Classic Female Fat Pattern

While I would agree with the self-help authors who tell female readers that the key to self-esteem is to love your body, I believe that a woman should find a balance between accepting her body just as it is and paying serious attention to the significant health risks of being overfat. There is nothing life-affirming about having type 2 diabetes, painful and over-stressed joints, and an increased risk of heart disease after menopause. As we have seen, being overfat also increases the risk of certain types of cancers. For example, a recent report published by the National Cancer Institute showed that women with a Body Mass Index (BMI) of 30 or greater were twice as likely to develop cervical cancer. Women with the lowest waist-to-hip ratio, indicating a significant accumulation of abdominal fat, The classic female body type is the gynoid shape that is, fat storage below the waist in the hip and buttocks areas, causing a pear-shaped silhouette. Since weight below the waist presents less...

Examples of Nutrition Surveillance Activities

The assessment of nutritional status not only includes collecting dietary intake but also anthro-pometric measures, biochemical tests, and clinical examination. The measures of nutritional status collected in the different surveys vary considerably, as shown in Table 2. The simplest and most common anthropometric measures of nutrition status are height and weight, which are used to calculate body mass index, a widely accepted measure of overweight and obesity. Waist circumference and hip-to-waist ratio are also frequently measured to obtain an estimate of body fat distribution. Alternatively, a number of surveys have collected self-reported height and weight measures. Also, biological samples such as blood, urine, saliva, and hair have been collected, particularly in US surveys, as biomarkers of dietary intake to validate dietary data collection instruments, to relate to environmental exposure, and to study diet-health relationships. The selection of

Sources of further information and advice

Almustafa m, doyle f h, gutteridge d h, hand d j, davis t m, spinks t j, freemantle c and joplin g f (1992), 'Effects of treatments by calcium and sex hormones on vertebral fracturing in osteoporosis', Q. J. Med., 83, 283-294. azadbakht l, mirmiran p, esmaillzadeh a and azizi f (2005), 'Dairy consumption is inversely associated with the prevalence of the metabolic syndrome in Tehranian adults', Am. J. Clin. Nutr., 82, 523-530. barger-lux m j, davies k m, heaney r p, chin b k and rafferty k (2001), 'Calcium supplementation may attenuate accumulation of fat in young women', J. Bone Miner. Res., 16, S219. barr s i (2004), 'Calcium and obesity', in Mela D. (Ed.), 'Food, Diet and Obesity',

Brillat Savarin Jean Anthelme 17551826

The key was looking and being looked at as too fat or too thin. For men, the potbelly became a major indicator of the potential for illness for the observers of masculine obesity in the late nineteenth century. Indeed, of the 163,567 overweight men in the U.S.A. and Canada identified between 1870 and 1899 (for insurance purposes), abdominal obesity (the waist being of greater circumference than the chest) was present in about i3 percent (Kahn and Williamson 1994). This was taken as an absolute sign of increased morbidity and mortality. The projected deaths of these individuals were almost one-third less than their actual death rate. Omental fat in the

Fat Distribution and Disease Risk

Since fat distribution is correlated with age as well other risk factors for disease, such as smoking, alcohol consumption, physical activity, and menopause in women, it is important to control for the effects of these variables in order to obtain an estimate of the independent effect of central obesity on morbidity. The impact of some of these correlates of fat distribution may be subtle and unlikely to seriously distort relationships between fat patterning and disease. However, age, the ultimate risk factor for disease and death, is sufficiently highly correlated with fat distribution to result in substantial distortion. Similarly, cigarette smoking is related adequately strongly to fat patterning and to various diseases and outcomes to make analyses that do not adjust for smoking difficult to interpret. Researchers have found positive correlations between fasting glucose, insulin, blood pressure, total cholesterol, LDL cholesterol, and triaclyglycer-ols using imaging techniques,...

Joris PJ Slaets MD PhD

Earlier in this issue the highly complex interrelations between the multitude of factors that are active in the pathophysiology of the metabolic syndrome were described. Based on that an argument was made for an integrated approach, even though the current available research does not support such an approach to its full extent. From the patient's perspective, however, it seems more than justified to go for such an approach 1 . This article builds on this perspective and further elaborates on it in a specific, but highly important, population the frail elderly. Patients, who suffer by definition from several diseases or functional limitations of organ systems that interact, need integrated assessment and care for these reasons.

The Classic Male Fat Pattern

To better understand the dangers of abdominal fat, let's take a look at what body processes are involved in male fat storage. The classic male fat pattern is the apple or android shape weight above the waist. Therefore, the waist measurement in a man is one of the most accurate indicators of how much at risk he is for a variety of serious diseases. In 2002, when the American Heart Association published their revised Guide to the Primary Prevention of Cardiovascular Diseases in Circulation magazine, they warned that a waist measurement of 40 inches or more in a man indicated a greater chance of developing cardiovascular disease. Dr. Sidney C. Smith, the association's chief science officer, was quoted as saying, It's turned out that waist circumference is as good a predictor of risk as body mass index. In my Fat-Burning Metabolic Fitness Plan, I have found that waist circumference is a better indicator of health risks than BMI. For example, the waistline measurement is an especially...

Dietary fibres and food intake

Various types of DF may be of interest. Maeda et al. (2005) demonstrated that the addition of agar in the diet resulted in marked weight loss due to a reduction of food intake, and also improved cholesterol level, glucose and insulin response, and blood pressure. The Framingham Offspring Study reported that the prevalence of metabolic syndrome - defined following the National Cholesterol Education Program criteria - was improved by high cereal fibres intake (contributing to the beneficial effect of whole grain) (McKeown et al. 2004). Knowledge of the biochemical mechanism allowing DF to modulate satiety, glucose or lipid metabolism, and hypertension is essential when proposing key nutritional advice for specific disorders associated with the metabolic syndrome. In this context, the modulation of gastro-intestinal peptides by NDOs, such as fructans, is an interesting area of research, leading to an understanding of how events occurring in the gut participate in the control of food...

The Clinics Are Now Available Online

The Metabolic Syndrome, Depression, and Cardiovascular Disease Interrelated Conditions that Share Pathophysiologic Mechanisms 573 This article introduces the metabolic syndrome as a clinical pheno-type with consequences for diagnosis and treatment that go beyond the different clinical specialties involved. A life-course approach is suggested as a means of understanding the complex interrelations between the metabolic syndrome, depression, and cardiovascular disease. Pathophysiologic mechanisms that these conditions share are discussed in detail. These considerations provide arguments for a more integrative approach to patients in general that surpass the current disease-centered services such as endocrinology, psychiatry, and cardiology.

Human Clinical Trials

Current information regarding the effect of soy on body composition and body fat distribution is very limited. In a randomized, double-blind, placebo-controlled 3-month trial and a cross-sectional study of postmenopausal women, a diet high in soy decreased body mass index and waist circumference (Sites etal., 2007). By contrast, one randomized, placebo-controlled trial of soy on body composition performed in perimenopausal or postmenopausal women reported that soy did not affect body mass index (Kim et al, 2005). Inclusion of isoflavones in the diet of postmenopausal women with type 2 diabetes and metabolic syndrome has been shown to improve glycemic control, insulin resistance, and glycated hemoglobin (HbA1c) (Azadbakht et al., 2007 Jayagopal et al., 2002). In 42 postmenopausal women with the metabolic syndrome Total and subcutaneous abdominal fat decreased

Very lowdensity lipoprotein VLDL

Visceral fat One of the three compartments of abdominal fat. Retroperitoneal and subcutaneous are the other two compartments. Waist circumference To define the level at which the waist circumference is measured, a bony landmark is first located and marked. The subject stands, and the technician, positioned to the right of the subject, palpates the upper hip bone to locate the right ileum. Just above the uppermost lateral border of the right ileum, a horizontal mark is drawn and then crossed with a vertical mark on the midaxillary line. The measuring tape is then placed around the trunk, at the level of the mark on the right side, making sure that it is on a level horizontal plane on all sides. The tape is then tightened slightly without compressing the skin and underlying subcutaneous tissues. The measure is recorded in centimeters to the nearest millimeter. Waist-hip-ratio (WHR) The ratio of a person's waist circumference to hip circumference. WHR looks at the relationship between...

The contribution of reduced thermogenesis and fat oxidation to obesity and its metabolic complications

Besides and beyond contributing to increased fat mass (obesity), decreased fat oxidation and thermogenesis may result in an excess of available fatty acids to muscle, liver, pancreatic p cells and other non-adipose cells. Lipid accumulation can lead to functional impairments in these cells (lipotoxicity), and has been related to the development of insulin resistance, type 2 diabetes and other pathologies linked to obesity and the metabolic syndrome (reviewed in references 37 and 38). Because the activity of the UCPs may facilitate fat oxidation in the organism (see Section 4.2.1), it may help avoiding lipid accumulation in non-adipose cells and derived lipotoxic-ity. For instance, intramyocellular fat accumulation is highly correlated with

Noorden Carl Von 18581944 German Internist

Noorden was also very much attuned to the gender politics of his age. Thus, he advocates being very careful with the whims and fancies of our lady patients that, having given birth, are appalled at their abdominal fat. Radical reduction of such fat may lead, Noorden warns, to further medical complications even if changes of appearance are achieved (Noorden 1903 31). In pathological cases, the general tendency towards a weakness of

If I cannot exercise how will my surgeon assess my cardiac status prior to surgery

You're right At first this seems totally unfair. It seems that it maybe even defeats the purpose of considering the procedure. And it really does make preparation for the procedure hard work. That being said, there are a number of reasons that your surgeon may require weight loss, and not one of them is to discourage you. Most important, weight loss prior to surgery can diminish your abdominal fat and make it much easier for your surgeon to see your internal organs and perform your surgery safely. It is also true that losing weight (our center generally requires weight loss equaling

Substances reducing the rate of de novo lipogenesis and their possible therapeutic potential for the control of obesity

Therefore, whereas a reduction in food intake and body weight by HCA was shown in many rodent studies, the efficacy of HCA in humans appears to be inconsistent and variable effects of HCA on food intake, body weight, visceral fat accumulation or fatty acid oxidation have been reported in some (Lim et al. 2002, 2003 Westerterp-Plantenga and Kovacs 2002 Hayamizu et al. 2003 Tomita et al. 2003 Preuss et al. 2004), but not all (Kriketos et al. 1999 Mattes and Bormann 2000 van Loon et al. 2000 Kovacs et al. 2001a,b), studies. Different experimental designs or differences in the HCA preparations employed might explain the discrepant findings. For example, the bioavailability of various HCA preparations differs (Lim et al. 2005).

Regulation of Synthesis

HMG-CoA to mevalonic acid in the polyisoprenoid synthetic pathway. Peripheral tissue cholesterol synthesis is much less responsive to regulatory factors compared to the liver, which is controlled by a variety of dietary, hormonal, and physiological variables. Studies indicate that endogenous cholesterol synthesis is significantly increased in obesity and in patients with the metabolic syndrome. Obesity, insulin resistance, and diabetes have pronounced effects on both cholesterol absorption and synthesis. Findings in type 1 diabetes appear to be related to low expression of ABCG5 G8 genes, resulting in high absorption and low synthesis of cholesterol. Cholesterol absorption efficiency is lower and cholesterol synthesis is higher in obese subjects with type 2 diabetes compared to obese subjects without diabetes, suggesting that diabetes modulates cholesterol metabolism to a greater extent than obesity alone. Similarly, low cholesterol absorption and high synthesis appear to be part of...

Insulin Resistance and Hyperinsulinemia

'Insulin resistance' refers to the phenomenon of insensitivity of the cells of the body to insulin's actions. Different tissues may have different insulin sensitivities. For example, adipose tissue may be more sensitive to insulin than muscle tissue, thus favoring the deposition of fatty acids in adipose tissue and diminished fatty acid oxidation in muscle. Insulin resistance is usually associated with hyper-insulinemia. Hyperinsulinemia is an independent marker that predicts the development of atherosclerosis. A causal relationship between hypertension and hyperinsulinemia has not been well established. Hypertension associated with hyperinsulinemia could be due to increased renal sodium retention, increased intracellular free calcium, increased sympathetic nervous system activity, or increased intraabdominal pressure due to increased visceral fat deposition.

Anthropometric Techniques

Visceral Fat Area

Figure 2 Cross-sectional images of the abdomen obtained by MRI. (A) Small subcutaneous fat area and enlarged visceral fat area. (B) Small visceral fat area in comparison with subcutaneous fat depot. Figure 2 Cross-sectional images of the abdomen obtained by MRI. (A) Small subcutaneous fat area and enlarged visceral fat area. (B) Small visceral fat area in comparison with subcutaneous fat depot. waist-to-hip, waist-to-thigh, waist-to-height, and subscapular-to-triceps skinfolds. Skinfold thicknesses and skinfold ratios have not been found to be very well correlated with metabolic measurements or with visceral fat and are not recommended for use as indicators of fat patterning. Numerous equations using combinations of anthropometric measurements to predict the amount of visceral fat have not offered substantial improvement over the simpler measurements, and an accurate equation has yet to be developed. Waist circumference (WC) alone and waist-to-hip ratio (WHR) are the most popular...

Virginia Uhley and KL Catherine

The prevalence of obesity has become an epidemic. It is estimated that in the United States, 64.5 of the general population is either overweight, defined by body mass index BMI, body weight (kg) height (m)2 between 25.0 and 29.9 kg m2, or obese (BMI 30.0 kg m2).1 The major medical complications associated with obesity include metabolic syndrome, type 2 diabetes, cardiovascular disease, hypertension, and certain types of cancer,2 to name a few. Cancers strongly associated with obesity include kidney, esophagus, colon, gallbladder, pancreas, endometrial, ovary, and postmenopausal breast cancer.3,4 (2) Hyperinsulinemia insulin resistance. Hyperinsulinemia and insulin resistance are the cornerstones of metabolic syndrome and are commonly seen in obese individuals.7 Hyperinsulinemia insulin resistance reduces the production of insulinlike-growth factor binding protein-1 (IGFBP-1) and IGFBP-2, thus increases the level of free insulin-like growth factor-1 (IGF-1).8 Insulin and IGF-1 are...

Risk factors of youth type 2 diabetes mellitus

Natural Treatment For Ovarian Syndrome

Independent of total body adiposity and ethnicity, abdominal fat deposition (visceral adiposity) is considered a risk factor for insulin resistance in children 77,80,81 and T2DM in adults 82 . Obese children with IGT were found to have peripheral insulin resistance without compensatory insulin secretion 83 and higher visceral and intramuscular fat 83 . Most pediatric patients with T2DM in the United States belong to minority ethnic populations, which encompass Native Americans, Pima Indians, Mexican Americans, and African Americans 1,84,85 . Among the Pima Indians, more than 5 of the 15- to 19-year old children are affected 85 the pathogenesis of T2DM is attributed to a genetic predisposition to insulin resistance modified by lifestyle changes 86 . Epidemiologic and clinical studies indicate that black children are more hyperinsulinemic and insulin resistant than their white peers 87-90 . A study that used genetic admixture analysis suggested a genetic and environmental basis to these...

Body Composition Applications During Aging

In adults, excess abdominal or VAT is recognized as an important risk factor in the development of coronary heart disease and non-insulin dependent diabetes mellitus. Waist circumference and the waist hip ratio are commonly used to predict visceral fat accumulation in epidemiological studies. However, waist circumference is unable to differentiate VAT from SAT. As a result, persons with similar waist circumferences could have markedly different quantities of VAT and abdominal SAT. Skinfold thickness has been used as a continuous Caucasians 44 g IMAT kg TAT in Asians). Across race groups, VAT deposits also appear comparable in size at low levels of adiposity but with increasing adiposity VAT accumulates more in Asians and Caucasians compared to IMAT, although accumulation rates for IMAT and VAT do not differ in African-Americans. While the association between greater amounts of abdominal or VAT and increased insulin resistance and the metabolic syndrome is well established compared to...

Regulators of Lipolysis and Fat Storage

The processes of lipolysis and fat storage are regulated by hormonal factors, which either enhance or suppress the activities of HSL and LPL. Through the action of glucocorticoid receptors, glucocorticoids enhance LPL activity and promote abdominal deposition of fat. The density of glucocorticoid receptors is greater in the visceral abdominal depot than in the subcutaneous abdominal depot. Therefore, an increase in glucocorticoid secretion is associated with increases in abdominal fat deposition compared to other fat depots. An increased androgenic profile is associated with upper body fat accumulation in women, but studies on men are conflicting. Significant inverse associations between fat distribution and testosterone have been found in population studies on men. Reduced visceral fat has also been observed when testosterone treatment was administered to men. These findings challenge the hypothesis that an androgenic hormone profile contributes to a more 'male type' of fat pattern...

Intrauterine Growth Restriction IUGR

Possible adult disorders resulting from intrauterine growth restriction Interest in IUGR has been enhanced recently by retrospective epidemiological, clinical follow-up, and animal studies that indicate long-term consequences in adult life of IUGR offspring, including higher incidences of obesity, insulin resistance, impaired glucose tolerance, enhanced hepatic glucose production, pancreatic insulin secretion deficiency, type 2 diabetes mellitus, hypertriglyceridemia, and cardiovascular disease, particularly hypertension. These conditions, often called syndrome X or the metabolic syndrome, may represent an example of 'programing,' in which an insult, when applied at a critical or sensitive stage in development, produces lasting, even lifelong, effects on the structure or function of the organism. Mechanisms responsible for these later-life morbidities are not yet established. There is some evidence of diminished pancreatic growth and development, which might become manifest in later...

Integrated View of the Consequences of Childhood Obesity

There is accruing evidence that even the metabolic syndrome itself may be a consequence of how the brain processes environmental stimuli that are social in nature. For instance, the brain's response to stress may alter the hypothalamic-pituitary-adrenal (or gonadal) axis in a way that promotes central fat deposition and insulin resistance in adults (Bjorntorp, 2001). Because children also experience stress, the part of the brain that regulates emotion may not only influence whether a child overeats, but also the metabolic consequences of that excess energy.

Health Risks due to Overweight Obesity

Ethnicity has an impact on body fat distribution and adipose tissue metabolism. Overweight currently is defined as a body mass index (BMI) 25kgm-2 and obesity as a BMI 30kgm 2. The evidence for this is drawn from large population studies that suggest people with a BMI of 19-25 kg m-2 have the lowest mortality. However, there have been proposals to define race-specific standards according to ethnic background. Specifically, Asians have greater visceral fat and associated morbidity than do Caucasians. A BMI as low as 23kgm 2 may be associated with weight-related diabetes or insulin resistance in these groups. For any given weight category, the presence of certain complications moves the individual into a higher health risk category. Evaluation of such risks should be part of the intervention program.

KObesity and Womens Reproductive Health

Menstrual Function and Fertility Obesity in premenopausal women is associated with menstrual irregularity and amenorrhea. 112,116 As part of the Nurses' Health Study, a case control study suggested that the greater the BMI at age 18 years, even at levels lower than those considered obese, the greater the risk of subsequent ovulatory infertility. 117 The most prominent condition associated with abdominal obesity is polycystic ovarian syndrome, 118 a combination of infertility, menstrual disturbances, hirsutism, abdominal hyperandrogenism, and anovulation. This syndrome is strongly associated with hyper-insulinemia and insulin resistance. 119

Carbohydrate type glycaemic response and weight control

GI of the diet by giving brief instructions and a handout about dietary changes to the parents, resulted in a reduction of body mass index (BMI) Z-scores of the children (Young et al., 2004). A 5-week study in healthy men allocated to a high- or a low-GI diet reported both groups experienced an increase in lean body mass but no changes in BMI after the low-GI period (Bouche et al., 2002). A more marked effect was reported in a study of men with abdominal obesity given an ad libitum low glycaemic load or low-fat diet for 6 days there was a reduction in energy intake, bodyweight, and waist and hip circumference with the low glycemic load diet, but not with the low-fat diet (Dumesnil et al., 2001). Although these findings suggest a potential advantage of low-GI or low-GL diets, the definitive long-term study, where ad libitum intake is permitted but diets are similar in all aspects except the GI, has not yet been done.

Environmental Factors

Evidence of a strong environmental element to T2D has come from the studies of Barker and Hales. In a number of separate studies, a strong relationship of the development of glucose intolerance and other associated factors of the insulin resistance syndrome with low birth weight or thinness at birth has been demonstrated. Furthermore, these associations are not confined to those with growth retardation in utero but extend to the whole range of birth weights. As a consequence of these epidemiologic studies, the 'thrifty phenotype' hypothesis has been proposed, whereby nutritional deficiencies in utero lead to poor fetal and infant growth and the subsequent development of T2D in later life, especially when combined with obesity due to excess food intake and lack of physical activity. These changes are recognized to be due to insulin resistance, which is favorable for survival in the immediate postnatal period but plays a significant role in the progression to T2D and metabolic syndrome,...

Measurement of Degree of Overweight and Obesity

Patients should have their BMI and levels of abdominal fat measured not only for the initial assessment of the degree of overweight and obesity, but also as a guide to the efficacy of weight loss treatment. Although there are no RCTs that review measurements of overweight and obesity, the panel determined that this aspect of patient care warranted further consideration and that this guidance was deemed valuable. Therefore, the following four recommendations that are included in the Treatment Guidelines were based

Body Composition Applications During Growth

Fat or adipose tissue distribution is recognized as a risk factor for cardiovascular disease in both adults and children. An android or male fat pattern, with relatively greater fat in the upper body region, is associated with negative metabolic predictors whereas a gynoid or female fat pattern, with relatively greater fat in the hip and thigh areas, is associated with less metabolic risk. More and more studies are showing that the syndrome develops during childhood and is highly prevalent among overweight children and adolescents. While the concept of the metabolic syndrome referred initially to the presence of combined risk factors including VAT, dyslipidemia, hypertension, and insulin resistance

Sex Specific Measurements

Evidence from epidemiological studies indicates that a high waist circumference is associated with an increased risk for type 2 diabetes, dys-lipidemia, hypertension, and CVD. Therefore, the panel judged that sex-specific cutoffs for waist circumference can be used to identify increased risk associated with abdominal fat in adults with a BMI in the range of 25 to 34.9. These cutpoints can be applied to all adult ethnic or racial groups. On the other hand, if a For adult patients with a BMI of 25 to 34.9 kg m2, sex-specific waist circumference cutoffs should be used in conjunction with BMI to identify increased disease risks. Evidence Category C.

Antiadrenergic and diuretic combinations

Diuretic and antiadrenergic combinations were common a few years ago, but are sparingly used in this day and age. Most contain fairly high doses of diuretics and some have to be given twice a day (Figure 13). Antiadrenergic drugs, such as methyldopa, clonidine, guanabenz, and even reserpine, have a favorable effect on a variety of pathophysiologic findings of hypertensive cardiovascular disease. These drugs reduce LVH, vascular hypertrophy, vascular resistance, and proteinuria, maintain cardiac output, and preserve renal hemodynamics. Even in patients with metabolic syndrome, antiadrenergic drugs exert a favorable effect on abnormal endocrine metabolic findings. In low doses, these drugs are reasonably well tolerated. Unfortunately, at the dose at which their antihypertensive efficacy equals that of other drug classes, their adverse-effect profile often prohibits their use in patients with mild hypertension. The most common adverse effects are fatigue, depression, sexual dysfunction...

Applications To Health Promotion And Disease Prevention

The seeds of Irvingia gabonensis have, however, received the most attention in terms of therapeutic applications. These applications are linked to the chemical composition of IG, which is rich in fats, proteins, and fiber. These seeds have found applications in the management of the various components of metabolic syndrome. Ngondi and colleagues (2009), using a proprietary extract of Irvingia gabonensis (IGOB131) administered at 300mg day over a 10-week period to overweight and obese participants, observed a 12 kg decrease in weight (Figure 32.2). This weight loss was accompanied by an 11 cm decrease in waist circumference and a 4 decrease in body fat compared to the placebo group. These anthropometric changes could be a result of significant inhibition of adipogenesis in adipocytes, an effect that appears to be mediated through the down-regulated expression of adipogenic transcription factor (PPARg) and adipocyte specific protein (leptin) (Figure 32.3), and the up-regulation of...

Considering How Fibromyalgia Relates to Womens Ages

Women with fibromyalgia have an increased risk for metabolic syndrome Some studies have shown that women with fibromyalgia are more likely to be overweight or obese than other women and to have more medical problems. One study, reported in a 2007 issue of Metabolism Clinical and Experimental, found that among 109 women with FMS, they had a 5.6 times greater risk of having metabolic syndrome than women without FMS. Metabolic syndrome is a serious health condition that is characterized by abdominal obesity (a body shape like an apple instead of a pear), high triglycerides, high blood pressure, low levels of high-density lipoprotein (HDL, the good cholesterol), and high fasting glucose (blood sugar) levels. The researchers also found that higher urinary levels of norepinephrine and cortisol were associated with a risk for metabolic syndrome.

Abnormalities of Hormones and Other Circulating Factors

Syndrome, including abdominal obesity, insulin resistance, impaired glucose homeostasis, hypertension, and lipid abnormalities. These similarities led to the hypothesis that a dysregulation of the HPA axis in the form of functional hypercortisolism could potentially be a cause for abdominal obesity and its different metabolic consequences. High levels of emotional or physical stress are thought to increase cortisol secretion or turnover and thereby increase visceral obesity. are higher in obese people. Females have higher serum leptin levels than males, but this association does not appear to be due to estrogen levels. Leptin is found in greater concentrations in abdominal subcutaneous fat compared to visceral fat. The mechanisms for these differences are not known, but it is possible that this may play some role in the differential metabolic responses of subcutaneous and visceral fat.

Family History and Genetics

Familial and epidemiologic studies demonstrate that genetic susceptibility is important in the formation of gallstones.44 Occurrence within families can be a product of genetic and shared environmental factors. Familial studies reveal an increased frequency in family clusters (about 5 times more common in families of affected persons) and relatives of gallstone patients, but more convincingly in monozygotic (12 ) as opposed to dizygotic twins (6 ).45 Genetic effects account for 25 , shared environmental effects for 13 , while unique environmental effects for 62 of the phenotypic variance.46 The extraordinary susceptibility of American Indians might relate to thrifty genes that conferred a survival advantage when Paleo-Indians migrated across the land bridge from Asia to the Americas during the last great ice age (50,000-10,000 years ago). This might also explain their proclivity to acquire the metabolic syndrome and its sequelae.1

Cell Differentiation Proliferation and Apoptosis

Adipocytes have vitamin D receptors, and there is evidence that vitamin D may act as a suppressor of adipocyte development (Kawada et al., 1996). It has been suggested that vitamin D inadequacy may be a factor in the development of the metabolic syndrome ( syndrome X, the combination of insulin resistance, hyperlipidemia, and atherosclerosis associated with abdominal obesity). Sunlight exposure, and hence vitamin D status, may be a factor in the difference in incidence of atherosclerosis and myocardial infarction between northern and southern European countries in addition to effects on adipocyte development, calcitriol also enhances insulin secretion through induction of calbindin-D (Section, and there is some evidence vitamin D supplements can improve glucose tolerance (Boucher, 1998).

The interaction of insulin resistance and Bcell function

Metabolic syndrome The metabolic syndrome, also called the IR syndrome, has become the major health problem of this time. This clinical phenotype is characterized by abdomi- nal obesity, dyslipidemia, elevated blood pressure, IR, and a proinflammatory state and is one of the major risk factors for cardiovascular disease 51,52 . Although some single-gene defects affecting satiety or energy homeostasis have been shown to produce this syndrome, in most cases it is the consequence of the interaction of multiple genes with lifestyle factors of excessive carbohydrate and fat consumption and lack of exercise. IR as an integral part of the syndrome is likely both the cause and consequence of many of the metabolic alterations seen in this syndrome. It is not surprising that the metabolic syndrome is a risk factor for type 2 diabetes, because adding (-cell failure to the prevailing IR leads to loss of glucose homeostasis. Type 2 DM is the most common form of diabetes in adults, and its...

DCoronary Heart Disease

List Illness For Doctor

Observational studies have shown that overweight, obesity, and excess abdominal fat are directly related to cardiovascular risk factors, including high levels of total cholesterol, LDL-cholesterol, triglycerides, blood pressure, fibrino-gen and insulin, 86 and low levels of HDL-cho-lesterol. 42 Plasminogen activator inhibitor-1 causing impaired fibrinolytic activity is elevated in persons with abdominal obesity. 763 Overweight, obesity, and abdominal fat are also associated with increased morbidity and mortality from CHD. 1142155-161

Physiological Function Of Soy Proteins

The effects of LP-free b-conglycinin were assessed by supplementation of the diets of adults with high plasma TG. Intake of b-conglycinin (5 g day) normalized serum TG and reduced visceral fat in subjects with body mass indices between 25 and 30 (Kohno et al, 2006). Based on these findings, in 2007, soy b-conglycinin was approved as a food for specified health use in Japan.

Carrie Amazing Changes in Her Lipid Profile

Carrie was forty-eight years old when she started my plan because she wanted to lose about 20 pounds. Although she had once been very active, jogging and going to weekly yoga and dance classes, she had become fairly sedentary in the last seven years. Carrie was especially concerned about the amount of fat she had gained in her abdominal area because she had read about the health risks associated with abdominal fat. She wanted to halt the trend of her fat gain before it became a serious problem.

Obesity and Overweight

Definitions, Health Implications, and Controversies Obesity is defined as a body mass index (BMI) 30 kg m2 and overweight as a BMI of 25 kg m2 (World Health Organization WHO , 2006 National Institutes of Health National Heart, Lung and Blood Institute NIH NHLBI , 1998). Waist circumference is also used as a measure of relative risk for obesity-related morbidity with 40 inches ( 102 cm) for men and 35 inches (88 cm) for women constituting the cutoff point for increased health risk (NIH NHLBI, 2006). For children ages 2 to 19 years, the CDC uses the 95th percentile and greater of BMI by age and sex as a measure of overweight and explicitly avoids using the term obese (CDC, 2006a).

Module 1 Days 2 4 and

Core exercises will not only melt inches off your waistline. They will also improve your performance in other types of exercise because they increase power and flexibility in the central part of your body. Most men and women who carry abdominal fat suffer from constant pain in their lower back due to structural instability. Core exercises will help you to develop a strong functional pelvic area and live without chronic backaches. If you are always visiting the chiropractor because your back keeps going out of alignment, these kinds of exercises will keep you stable for longer and longer periods of time. My chiropractor and many others stress the importance of doing these kinds of exercises.

Determining the role of calcium in weight control

Zemel and co-workers (2000), who re-examined data from 380 women (of about 7000) from the NHANES III study, found less body fat and a lower risk for obesity in people with the highest calcium intake after controlling for energy intake and physical activity, and the risk of being in the highest BMI quartile was reduced by 85 at the highest quartile of calcium intake. The anti-obesity effect of calcium has been demonstrated in black and in white people of both sexes, although in the HERITAGE Family Study the strongest effects occurred in white women and black men (Loos et al., 2004) the former exhibited a significant inverse relationship between calcium and BMI, percentage body fat and total abdominal fat, the latter between calcium intake and leanness. Therefore it is particularly important that, in recent years, some studies have been published that test explicitly the effect of calcium on body weight, body fat and the efficacy of weight-reduction diets. An epidemio-logical,...

Assessment of Overweight and Obesity in Childhood

Waist circumference is widely used in adult assessment of obesity because high waist circumference is associated with increased abdominal fat and increased risk for the morbid complications of obesity in adult life. Consensus regarding cutoff points for normal waist circumference measurements in childhood has not been reached, but high (compared with age-related populations) waist circumferences do seem to predispose to developing obesity comorbidities.

Role of resistant starch in weight management 831 Weight management direct evidence

RS is associated with nutritional, metabolic and physiological changes that make it an attractive ingredient not only for weight management (Table 8.1), but also for other chronic diseases associated with the metabolic syndrome such as dyslipidemia, insulin resistance, type 2 diabetes, hypertension and coronary heart disease (Higgins, 2004). Previously a role for RS was attributed to reduced digestibility, and the impact of lower glucose absorption. More recent research, however, indicates a broader health impact of RS on metabolism, via fermentation of RS to SCFAs in the large bowel. Fermentable carbohydrates have their own unique fermentation profile, in terms of relative type and amount of SCFAs. Hence the metabolic impact of fermentation will differ between RS and other fiber types. The hypothesized interaction between fermentation by-products and target metabolic tissues will evolve as more mechanistic information becomes available. Insulin sensitivity Insulin is an important...

Box 12 Does the Patient Want to Lose Weight

All patients who are overweight (BMI 25 to 29.9), or do not have a high waist circumference, and have few (0 to 1) cardiovascular risk factors and do not want to lose weight, should be counseled regarding the need to keep their weight at or below its present level. Patients who wish to lose weight should be guided per Boxes 8 and 9. The justification for offering these overweight patients the option of maintaining (rather than losing) weight is that their health risk, while higher than that of persons with a BMI 25, is only moderately increased (page 62).

Validity of Alcohol Intake

Figure 7 Odds ratio for developing abdominal obesity (waist measure 102cm) among men. (Reproduced with permission from Vadstrup E et al. (2003) Waist circumference in relation to history of amount and type of alcohol Results from the Copenhagen City Heart Study. International Journal of Obesity 27 238-246.) Figure 7 Odds ratio for developing abdominal obesity (waist measure 102cm) among men. (Reproduced with permission from Vadstrup E et al. (2003) Waist circumference in relation to history of amount and type of alcohol Results from the Copenhagen City Heart Study. International Journal of Obesity 27 238-246.)

Using food and food components to control lipogenesis and thermogenesis

Studies in rodents have consistently reported that intake of n-3 PUFAs reduces adipose mass, preferentially visceral fat, in general without affecting body weight (see references in reference 87). Some studies in humans also reported an effect of dietary fish oil consumption increasing whole-body lipid oxidation and decreasing total body fat content,96 and specifically abdominal fat content.97 Most human studies, however, have so far examined the effect of PUFA intake on end-points related to cardiovascular health and insulin sensitivity, rather than to body weight and body fat control. There is a paucity of human studies specifically designed to ascertain whether the intake of PUFAs (or PUFA-rich foods such as fish oils and nuts) can assist in weight loss and or in weight maintenance after weight loss in the long-term. Studies in humans support the potential value of diacylglycerol for the management of excess body weight and related disorders. In one study, carried out in 38 healthy...

Safety issues 1241 In animals

With subjects having type 2 diabetes, the quantity of 10t,12c isomer in plasma was inversely correlated with changes in body weight and in serum leptin. Unfortunately no information was available on body composition and insulin sensitivity. Concerns were raised by the findings of the group of Smedman, who carried out studies on a high-risk group of abdominally obese men. None of the studies carried out by this group showed any effects of CLA on body weight or BMI even if CLA resulted in a slight decrease in body fat, particularly of abdominal fat in obese men. On the contrary, CLA isomer induced lipid peroxidation, as reported in Fig. 12.6. Administration of a CLA mixture to obese men at 4.2 g day for 1 month resulted in an increase of both 8-isoprostaglandin F2a (PGF2a) and of 15-oxo dihydro-PGF2a as indicators of non-enzymic and enzymatic arachidonic acid oxidation, respectively, (Basu et al., 2000) as compared with the control group. However, these peroxidation parameters went back...

Other food and food components of interest

Suppression of abdominal fat accumulation after dietary supplementation with licorice194 and, in a human trial, licorice administration was found to reduce body fat mass, without changing body mass index, in 15 normal-weight subjects under free-living conditions (no caloric restriction).195 The mechanism of action, safety and efficacy of licorice for weight loss is unknown.

Effects of structured lipids related to weight control

Human studies have been conducted with a variety of structured lipids as demonstrated in Table 14.3. Matsuo et al. (2001) examined the effects of a liquid diet supplement containing structured lipid composed of 10 MCFA and 90 LCFA as compared with a liquid formula containing LCT in 13 healthy male volunteers. Although body weight increased non-significantly in both groups, the rates of variation in body fat percentage were lower in the structured lipid group than in the LCT group throughout the 12-week study. Despite this, in another 12-week study comparing LCT with a diet supplemented with 14 g of structured fat containing only 1.7 g MCFA, results showed decreases in body weight, including subcutaneous and visceral fat as measured by air displacement methods (Kasai et al., 2003). Similarly, Takeuchi et al. (2002) examined the effects of 20 g of structured lipid containing MCFA and LCFA versus the same quantity of soybean oil for 3 weeks in 6 young men. The rate of variation in body...

Weight Maintenance at Lower Weight

Maintenance, the second phase of the weight loss effort, should take priority. Successful weight maintenance is defined as a weight regain of 3 kg (6.6 lb) in 2 years and a sustained reduction in waist circumference of at least 4 cm. If a patient wishes to lose more weight after a period of weight maintenance, the procedure for weight loss outlined above can be repeated.

Evaluation and Treatment Strategy

When physicians encounter patients in the clinical setting, the opportunity exists for identifying overweight and obesity and accompanying risk factors and for initiating treatment for both the weight and the risk factors, as well as chronic diseases such as CVD and type 2 diabetes. When assessing a patient for treatment of overweight and obesity, consider the patient's weight, waist circumference, and the presence of risk factors. The strategy for the evaluation and treatment of overweight patients is presented in Figure 6 (Treatment Algorithm). This algorithm applies only to the assessment for overweight and obesity and subsequent decisions based on that assessment. It does not reflect any initial overall testing for other conditions and diseases that the physician may wish to do. Approaches to therapy for cholesterol disorders and hypertension are described in ATP II and JNC VI, respectively. In overweight patients, control of cardiovascular risk factors deserves equal emphasis as...

Combined Therapy Diet and Physical Activity

Evidence Statement The combination of a reduced calorie diet and increased physical activity produces greater reductions in abdominal fat than either diet alone or physical activity alone, although it has not been shown to be independent of weight loss. Evidence Category B. Rationale Three RCTs 365, 375, 471that examined the combined effect of diet and physical activity on weight loss also had measures of abdominal fat, as measured by waist circumference. Two of the three RCTs showed that the combination intervention resulted in greater reduction in waist cir cumference than diet alone in men 365, 375 and (only one) in women. 375 In the other RCT, no differences in reduced waist circumference were observed. 471 Of the three RCTs comparing combination therapy to physical activity alone, one study reported a greater waist reduction of 2.7 to 3.8 cm in women and men, respectively, 375 and by less than 1 cm in another study. 365 The effects of combination therapy on abdominal fat in these...

Clinical model search citations by topic area 11268 total

Weight to abdominal fat abdominal fat to high blood pressure in abdominal fat to dyslipidemia in minority abdominal fat to diabetes in minority abdominal fat to cardiovascular disease abdominal fat to noncardiovascular mortality abdominal fat to cardiovascular mortality and What is the evidence that treatment directly affects abdominal fat What is the evidence that weight loss directly affects abdominal fat What is the evidence that a reduction of abdominal fat is directly related to cardiovascular disease What is the evidence that a reduction of abdominal fat is directly related to cardiovascular mortality and morbidity What is the evidence that a reduction in abdominal fat directly affects high blood pressure What is the evidence that a reduction in abdominal fat directly affects dyslipidemia (cholesterol) What is the evidence that a reduction in abdominal fat directly affects glucose tolerance Note The number of citations per topic do not add up to the total citations per top or...

Assessment of Risk Status

The patient's risk status should be assessed by determining the degree of overweight or obesity based on BMI, the presence of abdominal obesity based on waist circumference, and the presence of concomitant CVD risk factors or comor-bidities. Some obesity-associated diseases and risk factors place patients in a very high risk category for subsequent mortality. These diseases

Glossary of Terms

Abdominal fat Fat (adipose tissue) that is centrally distributed between the thorax and pelvis and that induces greater health risk. Central fat distribution The waist circumference is an index of body fat distribution. Increasing waist circumference is accompanied by increasing frequencies of overt type 2 diabetes, dyslipidemia, hypertension, coronary heart disease, stroke, and early mortality. In the body fat patterns called android type (apple shaped) fat is deposited around the waist and upper abdominal area and appears most often in men. Abdominal body fat is thought to be associated with a rapid mobilization of fatty acids rather than resulting from other fat depots, although it remains a point of contention. If abdominal fat is indeed more active than other fat depots, it would then provide a mechanism by which we could explain (in part) the increase in blood lipid and glucose levels. The latter have been clearly associated with an increased risk for cardiovascular disease...

Pathophysiologic mechanisms

The most accepted and unifying hypothesis to describe the pathophysi-ology of the metabolic syndrome is insulin resistance, although quantification of insulin action in vivo is not always strongly related to the presence of the syndrome 26 . Alterations that are not included in the diagnostic criteria for the metabolic syndrome but have been reported in association with insulin resistance are depicted in Box 1. Several studies have reported an association between insulin resistance and depressive disorder, although the association is not seen universally 27-30 .

Food stress and reward

From the previous discussion, it has become clear that some parts of the pathophysiologic basis for the association between depression, cardiovascular diseases, and the metabolic syndrome are gradually becoming clearer, but these associations are complex and should be modeled over the lifetime. Because exposure to various disease risks (ie, physical, psychosocial stress, 1 Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet 2005 365 1415-28. 2 Alberti KG, Zimmet P, Shaw J, for the IDF Epidemiology Task Force Consensus Group. The metabolic syndrome a new worldwide definition. Lancet 2005 366 1059-62. 3 Kahn R, Buse J, Ferrannini E, et al. The American Diabetes Association. European Association for the Study of Diabetes. The metabolic syndrome time for a critical appraisal joint statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2005 28 2289-304. 6 Kinder LS, Carnethon MR, Palaniappan LP, et al. Depression...

Endothelial dysfunction

Depression is associated with a heightened incidence of endothelial dysfunction (ie, impaired flow-mediated vasodilation) among various cohorts, including young and otherwise healthy depressed patients 40 . Impaired en-dothelial function is a putative mechanism that links insulin resistance and cardiovascular disease, including hypertension 41-43 . It comes as no surprise that endothelial function is found to be impaired in the metabolic syndrome as well 44 . endothelial dysfunction, and also potential synergy induced by peripheral effects. One such mechanism in the presence of the metabolic syndrome has recently been postulated as vasocrine signaling from perivascular fat that inhibits insulin-mediated capillary recruitment through the release of the adipocytokine tumor necrosis factor 45 .

Autonomic nervous system imbalance

Abnormalities in autonomic nervous system activity are consistent findings in depression, insulin resistance, and, more recently, the metabolic syndrome. Impaired autonomic function previously has been associated with elevated concentrations of serum insulin and decreased insulin sensitivity (markers of insulin resistance), independent of glucose levels 35,36 . Depressed patients commonly manifest higher resting heart rates than healthy controls and exhibit autonomic nervous system dysfunction, including diminished heart rate variability (HRV), baroreflex dysfunction, and increased QT variability, all of which have been linked to increased cardiac mortality, including sudden death 37 . It has been postulated that in the metabolic syndrome the sympathetic branch prevails in the thorax (heart and large vessels) and movement compartment (skeletal muscles), leading to high blood pressure and impaired glucose uptake by the muscle (ie, insulin resistance). In the intra-abdominal...

Activation of the hypothalamuspituitaryadrenal axis

Depression is often accompanied by hypercortisolemia. Associated findings include attenuation of the corticotropin response to the administration of corticotrophin-releasing factor and nonsuppression of cortisol secretion after dexamethasone administration. Hypercortisolemia in association with blunted growth and sex hormones promotes central obesity and contributes to increased insulin resistance and diabetes among depressed subjects 31 . The presence of hypercortisolemia in insulin resistance has been documented in some, but not all, studies. A small case-control study has shown some evidence for increased cortisol production in the metabolic syndrome as well 32 . Notably, a contributory role for cortisol metabolism in the pathogenesis of the metabolic syndrome has been postulated. Deregulation of 11 betahydroxysteroiddehydrogenase, an enzyme that converts cortisol into cortison (which cannot activate the glucocorticoid receptor), may result in excess cortisol exposure at the tissue...

Susceptibility to Mood Enhancement by Diet

There is another link between macronutrient intake, stress, and mood. Chronic dysfunction of the stress-sensitive hormone cortisol and its controlling hypothalamic pituitary adrenal (HPA) axis is associated with depression and anxiety and with abdominal obesity. Moreover, protein-rich meals that prevent a meal-induced fall in arousal also stimulate the release of cortisol in unstressed people, and the degree of this effect is positively correlated with the probability of poor psychological well-being. Chronically, a carbohydrate-rich diet is associated with better overall mood state and lower average plasma cortisol than a high-protein diet. Acutely, a carbohydrate preload, but not protein or fat load, enhances cortisol release during stress. This may be related to findings from both human and animal research that suggest that eating carbohydrate-rich and perhaps high-fat foods can help restore normal HPA axis function and gluco-corticoid stress responses. Raised levels of cortisol in...

Metabolic Characteristics of Visceral and Subcutaneous

Enzyme releases free fatty acids, which are then released into the bloodstream and taken up by tissues, with the exception of the brain and red blood cells, for energy use or storage. The rate of basal lipolysis is higher in gluteal-femoral fat tissue than in abdominal tissue in both men and women. This may be due to greater cell size in that region. In the abdominal area, basal lipolysis is higher in subcutaneous fat than in visceral fat. However, when stimulated hormonally, rates of lipolysis may differ between men and women. Lipolytic rates have been shown to be higher in the visceral compared to the subcutaneous region in men, whereas the opposite trend is seen in women.

Measures of Body Fatness

Dual-energy X-ray absorptiometry This method is based on the principle that transmitted X-rays at two energy levels are differentially attenuated by bone mass and soft tissue mass, and the soft tissue mass is subdivided into fat mass and lean mass. Reproducibility of dual-energy X-ray absorptiome-try (DXA) is approximately 0.8 for bone, 1.7 for fat, and 2.0 for body weight. One concern regarding DXA is whether changes in soft tissue hydration influence body fat estimates. A few studies have shown small but systematic and predictable errors in DXA soft tissue composition analysis with body fluid balance changes. Using DXA, it is possible to obtain abdominal fat estimates. Unfortunately, these cannot be separated into subcutaneous and visceral components. Anthropometric methods are also applicable as 'surrogate' measurements of visceral adipose tissue. Circumferences are more reliable than skinfolds, and in recent years the most widely used anthropometric technique has been the waist...

Intraabdominal Pressure

In severely obese people, the excess visceral fat is thought to increase intraabdominal pressure. Animal research shows that experimentally induced acute increases in intraabdominal pressure to the levels seen in the abdomens of very obese people cause increases in pleural pressure, intracranial pressure, and central venous pressure. The investigators postulated that in humans, increased intraabdominal pressure may contribute to hypertension, insulin resistance and type 2 DM, obesity-hypoventilation syndrome, pseudotumor cerebri, incisional hernia, and urinary incontinence. Massive weight loss following obesity surgery normalizes the increased intraabdominal pressure and reduces or eliminates all the symptoms listed previously.

Correlates and Possible Determinants of Fat Distribution

Consumption, physical activity, and ethnicity, are associated with either an android or a gynoid shape. The underlying reasons for the observed associations between these variables and fat patterning remain to be elucidated. Correlates of fat distribution are important to understand since they may confound relationships between fat patterning and physiological outcomes or morbidity or mortality outcomes. There is evidence that body shape and amount of visceral fat are partially determined by genetics. After eliminating effects of age and overall fatness, studies have shown that heritable factors can account for as much as 20-50 of the variability in waist-to-hip ratio. Aging is accompanied by changes in both weight and fat distribution. The largest increase in body weight occurs between young adulthood and middle adulthood. Independent of weight gain, abdominal fat increases with aging. This increase tends to be most pronounced between young adulthood and middle age in men and between...

Aging and Renal Function

The serum concentration of Pi increases with a physiological decline in renal function associated with aging (but not renal disease per se). Healthy individuals excrete approximately 67 of their absorbed phosphate via the urine and the remainder via the gut as endogenous secretions. As the glomerular filtration capacity of the kidneys declines, the serum Pi concentration increases and more Pi is retained by the body. PTH secretions increase but the typical serum PTH concentrations, although elevated, remain within the upper limits of the normal range, at least for a decade or so. Thereafter, however, serum Pi and PTH both continue to climb as renal function declines and increased rates of bone turnover lead to measurable bone loss. This situation probably affects millions in the United States each year as they enter the 50s and proceed into the 60s many of these individuals are overweight or obese and have the metabolic syndrome, which

How can I improve my symptoms of GERD

Immediately after you eat something, your body produces the greatest amount of acid for digestion of that food. Anytime you lie flat stomach acids can reflux into the esophagus. To reduce GERD symptoms, avoid eating late at night or wait at least 2 hours after you eat before you lie down. By coordinating your sleep habits and eating habits, you can allow ample time for the acid and food to pass through the stomach and can minimize reflux.

Underlying Chronic Diseases Liver disease

Cirrhosis is a well-established risk factor for gallstones particularly in the more advanced stages.54,55 The overall prevalence is much higher than the general population at 25 to 30 .56 Increasing Child-Pugh score and obesity are more likely associated with gallstones. Most stones in cirrhosis are of the black pigment type.57 The biologic mechanism likely relates to altered pigment secretion, abnormal gallbladder motility, or increased estrogen levels.1 The threat of these stones becoming symptomatic seems higher in women, those more advanced in age, and patients with viral hepatitis compared with alcohol-related cirrhosis.58 Gallstone disease is also associated with hepatitis C virus (even when not yet cirrhotic)59 and nonalcoholic fatty liver disease, the connection being the metabolic syndrome and obesity.60

Future Research Directions

A new concept has been proposed that interactions of 5 defects could play an important role in the formation of cholesterol gallstones (see Fig. 1), which are considered in terms of LITH genes (genetic defect), thermodynamics (solubility defect), kinetics (nucleation defect), stasis (residence time defect), and lipid sources (metabolic defect). Growing evidence from pathophysiological, physical-chemical, and genetic studies shows that disposition to the formation of cholesterol gallstones is multifacto-rial, and the overarching pathogenetic factor is hepatic hypersecretion of cholesterol into bile, and no mode of inheritance fitting to the Mendelian pattern could be found in most cases. Similar to atherosclerosis, the risk for cholesterol gallstone formation increases with aging, dyslipidemia, hyperinsulinemia, obesity, diabetes, and sedentary lifestyle. All these conditions are risk factors for the metabolic syndrome, of which cholesterol gallstone formation is just another...

Learn the Difference between Male and Female Fat Patterns

Vhere you carry your weight has serious health ramifications. The most dangerous type of weight is core body fat (abdominal obesity). People who carry weight more evenly distributed over their entire bodies are less at risk for disease than those who follow the more classic fat distribution patterns. Unfortunately, most men and women store excess weight above and below the waistline where it hurts the body the most. When obesity sets in, people often develop a reverse fat pattern. A man will not only have a huge belly but will start putting on considerable weight below the waist in the hips and buttocks. Women will not only store fat below the waist but will carry a large amount of abdominal fat, turning them

Fat Assessment in Adults

Even though BMI is considered a good estimate of body fat, it does misclassify elite athletes and bodybuilders as obese. Therefore, other measures have been created to better estimate body fat. Waist circumference (WC) is another measure that indicates an individual's relative risk for obesity related diseases. The indicator for obesity for males is a WC greater than 101.5 cm and for females a WC greater than 88.9 cm, and individuals with excess abdominal fat are at an increased risk for Type-2 diabetes, dyslipidemia, hypertension, and cardiovascular disease. WC is a specific measure of abdominal obesity, which is a stronger risk factor for many chronic diseases than other types of obesity. To determine WC, measure the circumference around the upper hipbone. The tape measure should be snug, but should not cause compressions on the skin. Measuring waist circumference is an inexpensive, convenient, and noninvasive method for estimating abdominal fat before and during weight-loss...

Physical Activity

Effect of contractions on insulin action is thought to increase insulin action and decrease circulating glucose and insulin concentrations. Further, by increasing muscle mass, decreasing total and abdominal obesity (Bjorntorp et al., 1979 Despr s et al., 1988), and diverting dietary carbohydrate to muscle for oxidation and glycogen repletion (Brooks et al., 2000), physical activity reduces the potential for energy intakes exceeding expenditures, leading to fat accumulation. Physical activity can reduce the risk of type 2 diabetes (Diabetes Prevention Program Research Group, 2002 Tuomilehto et al., 2001), and can also reduce total and abdominal obesity, both of which are risk factors for type 2 diabetes (Vessby, 2000).

Dietary Therapy

The panel reviewed 86 RCT articles to determine the effectiveness of diets on weight loss (including LCDs, very low-calorie diets (VLCDs), vegetarian diets, American Heart Association dietary guidelines, the NCEP's Step I diet with caloric restriction, and other low-fat regimens with varying combinations of macronutrients). Of the 86 articles reviewed, 48 were accepted for inclusion in these guidelines. These RCTs indicate strong and consistent evidence that an average weight loss of 8 percent of initial body weight can be obtained over 3 to 12 months with an LCD and that this weight loss effects a decrease in abdominal fat and, although lower-fat diets without targeted caloric reduction help promote weight loss by producing a reduced caloric intake, lower-fat diets with targeted caloric reduction promote greater

Syndrome X

One out of five Americans have the metabolic syndrome, a national survey reports.10 Among people in their 60s or 70s, the rate is two out of five. Also known as Syndrome X, the metabolic syndrome is a cluster of abnormalities that raise the risk of heart disease. You've got it if you have at least three of the following Natural Prescription for Health Exercise (even if you don't lose weight) and weight loss (even if you don't lose much) can reverse the metabolic syndrome. Replacing carbohydrates (like sweets, bread, and pasta) with small quantities of unsaturated fats (from nuts, oils, and salad dressing) may also help. If you have even one of the metabolic syndrome's five risk factors, put down the soft drink can and get off your duff. The older you get, the closer you'll be to having at least three of these symptoms.

The Best Meds

In an Italian study of 180 people with the metabolic syndrome, those who ate a healthy Mediterranean diet had less inflammation and insulin resistance. What's more, the Mediterranean group improved more than the control group on all measures of the metabolic syndrome large waist size, low HDL ( good ) cholesterol, and higher-than-optimal blood sugar, blood pressure, and triglycerides.17


Lately, much attention has been directed to inflammation as the central feature of atherosclerosis. The balance between inflammatory and anti-inflammatory activity in the vessel wall governs the progression of atherosclerosis, in close interactions with various metabolic factors of which lipid and products of lipid peroxidation are the most prominent 49 . Activated immune cells in the atherosclerotic plaque produce inflammatory cytokines (in-terferon-gamma, interleukin-1, and tumor necrosis factor) that induce the production of substantial amounts of interleukin-6. When these cytokines spill into the systemic circulation, interleukin-6 stimulates the production of large amounts of acute-phase reactants, including C-reactive protein, serum amyloid A, and fibrinogen, especially in the liver. The inflammatory process in the atherosclerotic artery thus may lead to increased blood levels of inflammatory cytokines and other acute-phase reactants. A moderately elevated C-reactive protein...

A Low Calorie Diets

Evidence Statement LCDs resulting in weight loss effect a decrease in abdominal fat. Evidence Category A. Four RCTs testing the effects of LCDs alone on weight loss also had measures of abdominal fat, as measured by waist circumference. 365, 369, 375, 399 The studies showed consistently that waist circumference decreases along with weight loss produced by LCDs. After 6 to 12 months, LCDs resulted in a mean weight loss of as little as 0.3 BMI unit to as much as 11 kg (24.3 lb) body weight, and a concomitant reduction in waist circumference of 1.5 to 9.5 cm compared to controls.

Effects on the Heart

Your expanding midsection is not due to an increase in the number of fat cells in there. No, when you're overweight, the number of cells remains more or less constant, but each cell increases in size. In other words, the fat cells themselves grow fat. When these cells expand, the insulin has trouble attaching to them properly and unlocking them. That's why, if you weigh too much, the sugar and fat levels in your bloodstream rise higher than they should. The insulin key takes longer to open the lock.

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