Differential Effects of Abdominal Adipose Tissue Distribution on Insulin Sensitivity in Black and White South African Women

Black South African women are more insulin resistant than BMI‐matched white women. The objective of the study was to characterize the determinants of insulin sensitivity in black and white South African women matched for BMI. A total of 57 normal‐weight (BMI 18–25 kg/m²) and obese (BMI > 30 kg/m²) black and white premenopausal South African women underwent the following measurements: body composition (dual‐energy X‐ray absorptiometry), body fat distribution (computerized tomography (CT)), insulin sensitivity (S_I, frequently sampled intravenous glucose tolerance test), dietary intake (food frequency questionnaire), physical activity (Global Physical Activity Questionnaire), and socioeconomic status (SES, demographic questionnaire). Black women were less insulin sensitive (4.4 ± 0.8 vs. 9.5 ± 0.8 and 3.0 ± 0.8 vs. 6.0 ± 0.8 × 10^?5/min/(pmol/l), for normal‐weight and obese women, respectively, P < 0.001), but had less visceral adipose tissue (VAT) (P = 0.051), more abdominal superficial subcutaneous adipose tissue (SAT) (P = 0.003), lower SES (P < 0.001), and higher dietary fat intake (P = 0.001) than white women matched for BMI. S_I correlated with deep and superficial SAT in both black (R = ?0.594, P = 0.002 and R = 0.495, P = 0.012) and white women (R = ?0.554, P = 0.005 and R = ?0.546, P = 0.004), but with VAT in white women only (R = ?0.534, P = 0.005). In conclusion, body fat distribution is differentially associated with insulin sensitivity in black and white women. Therefore, the different abdominal fat depots may have varying metabolic consequences in women of different ethnic origins.     

Severely Obese Have Greater LPS‐stimulated TNF‐α Production Than Normal Weight African‐American Women

Obesity is associated with an increase in chronic, low‐grade inflammation which has been implicated in the development of type 2 diabetes mellitus and cardiovascular disease. The purpose of this study was to determine whether obesity was associated with an elevation of whole blood lipopolysaccharide (LPS)‐stimulated tumor necrosis factor‐α (TNF‐α) production. African‐American women were recruited from a larger study and assigned to one of five groups based on BMI: normal weight (NORM; BMI 20–25, n = 7), overweight (OVER; BMI 25–30, n = 12), class 1 obese (OB1; BMI 30–35, n = 19), class 2 obese (OB2; BMI 35–40, n = 10), or class 3 obese (OB3; BMI >40, n = 17). Body composition was determined via a whole body dual‐energy X‐ray absorptiometry (DXA) scan. Venous blood samples were collected following an overnight fast (>8 h), and stimulated with five doses of LPS (Salmonella enteriditis): 80, 40, 20, 10, and 5 µg/ml for 24 h in a 37 °C, 5% CO₂ incubator. Following stimulation, TNF‐α was measured using enzyme‐linked immunosorbent assay. OB3 produced 365% more TNF‐α than NORM at an LPS dose of 20 µg/ml (P < 0.05). When maximal TNF‐α production was assessed regardless of LPS dose, OB3 produced 230% more than NORM and OVER produced 190% more than NW (P = 0.001). Total and trunk fat mass and BMI were significantly correlated with maximal TNF‐α production and LPS = 20 µg/ml. Our findings are consistent with previous reports suggesting a relationship between increased adiposity and inflammatory marker production. This is one of the first studies to focus on African‐American women, who have higher rates of obesity.     

Relationships of cardiac autonomic function with metabolic abnormalities in childhood obesity

Objective: The objective was to examine cardiovascular autonomic (cANS) function and its potential relationships with leptin resistance, insulin resistance, oxidative stress, and inflammation in a pediatric sample with varying levels of obesity. Research Methods and Procedures: Participants were normal‐weight (NW; BMI <85th percentile, 6 male, 4 female), overweight (OW; 85th percentile < BMI <95th percentile, 6 male, 4 female), and obese children (OB; BMI >95th percentile, 6 male, 10 female) who had cANS function assessed via heart rate variability (HRV) methods during resting conditions. Standard time‐domain and frequency‐domain measures [high‐frequency normalized units (HFnu; measure of parasympathetic nervous system activity) and low frequency:high‐frequency ratio (LF:HF; overall sympathovagal balance)] of HRV were calculated. Fasting blood samples were drawn for measurement of glucose, insulin, lipids, 8‐isoprostane, leptin, soluble leptin‐receptor (sOB‐R), C‐reactive protein (CRP), interleukin‐6 (IL‐6), and tumor necrosis factor‐α (TNF‐α). Results were reported as mean ± standard error of the mean. Results: OB had significantly elevated LF:HF and decreased HFnu when compared with NW (p < 0.05), but no differences between OW and NW were observed. Measures of HRV were significantly related to leptin, insulin resistance, 8‐isoprostane, and CRP (p < 0.05), but these relationships were not significant after adjustment for fat mass. Discussion: When compared with NW, OB but not OW children are characterized by cANS dysfunction and increased leptin, insulin resistance, oxidative stress, and inflammation (CRP). The relationships between these factors seem to be dependent on quantity of fat mass and/or other factors associated with being obese.     

The Prevalence of Metabolically Healthy Obese Subjects Defined by BMI and Dual‐Energy X‐Ray Absorptiometry

Nearly one‐third of obese (OB) people are reported to be metabolically healthy based on BMI criteria. It is unknown whether this holds true when more accurate adiposity measurements are applied such as dual‐energy X‐ray absorptiometry (DXA). We compared differences in the prevalence of cardiometabolic abnormalities among adiposity groups classified using BMI vs. DXA criteria. A total of 1,907 adult volunteers from Newfoundland and Labrador participated. BMI and body fat percentage (%BF; measured using DXA) were measured following a 12‐h fasting period. Subjects were categorized as normal weight (NW), overweight (OW), or OB based on BMI and %BF criteria. Cardiometabolic abnormalities considered included elevated triglyceride, glucose, and high‐sensitivity C‐reactive protein (hsCRP) levels, decreased high‐density lipoprotein (HDL) cholesterol levels, insulin resistance, and hypertension. Subjects were classified as metabolically healthy (0 or 1 cardiometabolic abnormality) or abnormal (≥2 cardiometabolic abnormalities). We found low agreement in the prevalence of cardiometabolic abnormalities between BMI and %BF classifications (κ = 0.373, P < 0.001). Among NW and OW subjects, the prevalence of metabolically healthy individuals was similar between BMI and %BF (77.6 vs. 75.7% and 58.8 vs. 62.5%, respectively) however, there was a pronounced difference among OB subjects (34.0 vs. 47.7%, P < 0.05). Similar trends were evident using three additional definitions to characterize metabolically healthy individuals. Our findings indicate that approximately one‐half of OB people are metabolically healthy when classified using %BF criteria which is significantly higher than previously reported using BMI. Caution should therefore be taken when making inferences about the metabolic health of an OB population depending on the method used to measure adiposity.     

Comparison of the Classification of Obesity by BMI vs. Dual‐energy X‐ray Absorptiometry in the Newfoundland Population

Although BMI is the most widely used measure of obesity, debate still exists on how accurately BMI defines obesity. In this study, adiposity status defined by BMI and dual‐energy X‐ray absorptiometry (DXA) was compared in a large population to evaluate the accuracy of BMI. A total of 1,691 adult volunteers from Newfoundland and Labrador participated in the study. BMI and body fat percentage (%BF) were measured for all subjects following a 12‐h fasting period. Subjects were categorized as underweight (UW), normal weight (NW), overweight (OW), or obese (OB) based on BMI and %BF criteria. Differences between the two methods were compared within gender and by age‐groups. According to BMI criteria, 1.2% of women were classified as UW, 44.2% as NW, 34.2% as OW, and 20.3% as OB. When women were classified according to %BF criteria, 2.2% were UW, 29.6% were NW, 30.9% were OW, and 37.1% were OB. The overall discrepancy between the two methods for women was substantial at 34.7% (14.6% for NW and 16.8% for OB, P < 0.001). In men, the overall discrepancy was 35.2% between BMI and DXA (17.6% for OW and 13.5% for OB, P < 0.001). Misclassification by BMI was dependent on age, gender, and adiposity status. In conclusion, BMI misclassified adiposity status in approximately one‐third of women and men compared with DXA. Caution should be taken when BMI is used in clinical and scientific research as well as clinical practice.     

Effect of Weight Loss on High‐Molecular Weight Adiponectin in Obese Children

Our aim was to determine the influence of weight reduction on total (T‐) and high‐molecular weight (HMW‐) adiponectin in obese (OB) prepubertal children. Seventy OB prepubertal white patients were followed for 18 months and studied after reducing their BMI by 1 (n = 51) and 2 standard deviation scores (SDS) (n = 21) under conservative treatment, and 6 months after achieving weight loss (n = 44). Body composition dual‐energy X‐ray absorptiometry (DXA) and serum levels of T‐ and HMW‐adiponectin, resistin, leptin, leptin soluble receptor (sOB‐R), tumoral necrosis factor‐α and interleukin‐6 were determined. The control group consisted of 61 healthy prepubertal children. At diagnosis T‐adiponectin was higher (P < 0.01; confidence interval (+0.04) — (+0.15)) and HMW‐adiponectin lower (P < 0.001; confidence interval (?0.45) ? (?0.21)) in OB children than in controls. A reduction in body fat increased T‐ and HMW‐adiponectin and sOB‐R (all P < 0.001) and decreased leptin (P < 0.001) and interleukin‐6 levels (P < 0.05). After 6 months of sustained weight reduction a decrease in tumoral necrosis factor‐α (P < 0.01) occurred, whereas weight recovery increased leptin (P < 0.001) and decreased T‐adiponectin (P < 0.05). HMW‐adiponectin levels negatively correlated with homeostasis model assessment (HOMA) index and BMI in the whole cohort (both P < 0.001), as did T‐adiponectin levels and HOMA index in OB patients (P < 0.01), but neither T‐ nor HMW‐adiponectin correlated with body fat content (BFC) in OB children. We conclude that the impairment of T‐ and HMW‐adiponectin levels in childhood obesity is different to that in elder OB patients, showing closer relationship with carbohydrate metabolism parameters than with BFC, but increasing their levels after weight loss and in association with metabolic improvement.     

Higher protein intake preserves lean mass and satiety with weight loss in pre-obese and obese women

Objective: To examine the effects of dietary protein and obesity classification on energy‐restriction‐induced changes in weight, body composition, appetite, mood, and cardiovascular and kidney health. Research Methods and Procedures: Forty‐six women, ages 28 to 80, BMI 26 to 37 kg/m², followed a 12‐week 750‐kcal/d energy‐deficit diet containing higher protein (HP, 30% protein) or normal protein (NP, 18% protein) and were retrospectively subgrouped according to obesity classification [pre‐obese (POB), BMI = 26 to 29.9 kg/m²; obese (OB), BMI = 30 to 37 kg/m²). Results: All subjects lost weight, fat mass, and lean body mass (LBM; p < 0.001). With comparable weight loss, LBM losses were less in HP vs. NP (?1.5 ± 0.3 vs. ?2.8 ± 0.5 kg; p < 0.05) and POB vs. OB (?1.2 ± 0.3 vs. ?2.9 ± 0.4 kg; p < 0.005). The main effects of protein and obesity on LBM changes were independent and additive; POB‐HP lost less LBM vs. OB‐NP (p < 0.05). The energy‐restriction‐induced decline in satiety was less pronounced in HP vs. NP (p < 0.005). Perceived pleasure increased with HP and decreased with NP (p < 0.05). Lipid‐lipoprotein profile and blood pressure improved and kidney function minimally changed with energy restriction (p < 0.05), independently of protein intake. Discussion: Consuming a higher‐protein diet and accomplishing weight loss before becoming obese help women preserve LBM. Use of a higher‐protein diet also improves perceptions of satiety and pleasure during energy restriction.     

Circulating IL-6 concentrations and abdominal adipocyte isoproterenol-stimulated lipolysis in women

Objective: To examine the association of plasma interleukin‐6 (IL‐6) concentrations with adiposity and fat cell metabolism in women. Methods and Procedures: Omental (OM) and subcutaneous (SC) adipose tissue samples were obtained from 48 healthy women (age: 47 ± 5 years, BMI: 26.9 ± 5.3 kg/m²) undergoing gynecological surgeries. Total and visceral adiposity were assessed by dual‐energy X‐ray absorptiometry and computed tomography, respectively. Measures of adipocyte lipolysis (basal, isoproterenol‐, forskolin‐, and cyclic dibutyryl‐adenosine monophosphate (AMP)‐stimulated) and adipose tissue lipoprotein lipase (LPL) activity were obtained. Plasma IL‐6 was measured by radioimmunoassay. Results: Plasma IL‐6 was positively correlated with total body fat mass (r = 0.32, P < 0.05), SC adipose tissue area (r = 0.35, P < 0.05), SC adipocyte diameter (r = 0.30, P < 0.05), and a trend was observed with visceral adipose tissue area (r = 0.20, P < 0.07). Plasma IL‐6 was positively correlated with glycerol released in response to isoproterenol (10^?5 to 10^?8 mol/l) by isolated SC (0.31 ≤ r ≤ 0.65, P < 0.05) and OM (0.36 ≤ r ≤ 0.40, P < 0.02) adipocytes, independent of menopausal status. No correlation was found with LPL activity. A subsample of women with high plasma IL‐6 (n = 10) was matched with women with low plasma IL‐6 (n = 10) for total body fat mass. OM adipocyte glycerol release in response to isoproterenol (10^?5 to 10^?8 mol/l) was higher in the subsample of women with elevated plasma IL‐6 (P ≤ 0.07). Discussion: We observed that OM lipolysis was significantly higher in women with elevated plasma IL‐6 for a similar body fat mass and menopausal status. These results suggest that higher circulating IL‐6 concentrations are associated with increased isoproterenol‐stimulated lipolysis especially in OM abdominal adipocytes in women.     

Evaluation of Left Ventricular Synchronicity in Hypertensive Patients With Overweight or Obesity

The left ventricular synchronicity in hypertensive patients with overweight or obesity has not been well elucidated. This study was designed to evaluate the left ventricular synchronicity in these patients. Tissue Doppler imaging was performed in 126 hypertensive patients and 25 control subjects. The hypertensive patients were divided into three groups according to BMI: normal weight group (BMI <25 kg/m², n = 32, H‐NW group), overweight group (BMI 25–29.9 kg/m², n = 64, H‐OW group), and obese group (BMI ≥30 kg/m², n = 30, H‐OB group). Left ventricular systolic and diastolic synchronicity were determined by measuring the maximal differences in time to peak myocardial systolic contraction (T_s‐diff) and early diastolic relaxation (T_e‐diff) between any two of the left ventricular segments and the standard deviation of time to peak myocardial systolic contraction (T_s‐SD) and early diastolic relaxation (T_e‐SD) of all 12 segments. Compared with the control group, the indexes of synchronicity including T_s‐diff, T_s‐SD, T_e‐diff, and T_e‐SD were significantly prolonged in the hypertensive patients. Furthermore, although the indexes of blood pressure had no difference among the hypertensive groups, the impaired systolic and diastolic synchronicity including T_s‐diff, T_s‐SD, and T_e‐SD was obviously aggravated with the increasing BMI. Stepwise multivariate analysis revealed BMI as an independent predictor of T_s‐SD and T_e‐SD. Therefore, the impairment of left ventricular synchronicity was aggravated with increasing BMI in hypertensive patients. Overweight and obesity may be important factors to impact the left ventricular synchronicity.     

Sex difference in the relationship between the hypothalamic-pituitary-adrenal axis and sex hormones in obesity

Objective: This study was carried out to investigate the role of sex in the regulation of the hypothalamic‐pituitary‐adrenal (HPA) axis and its relationship with testosterone levels in male and female obesity. Research Methods and Procedures: Twenty‐two obese men (OB‐M) and 29 obese women (OB‐W) participated in the study. Two groups of normal weight men (NW‐M) and women (NW‐W), respectively, served as controls. In basal conditions, blood concentrations of major androgens, sex hormone—binding protein, and gonadotropins were assessed, and the free androgen index (testosterone ×100/ sex hormone‐binding globulin) was calculated. All subjects underwent a combined corticotropin‐releasing hormone plus arginine‐vasopressin stimulation test. Results: OB‐M and NW‐M had higher basal adrenal cortical tropic hormone (ACTH) and cortisol levels than their female counterparts. In addition, ACTH, but not cortisol basal, levels were significantly higher in obese than in normal weight controls in both sexes. OB‐W had a higher response than OB‐M to the combined corticotropin‐releasing hormone plus arginine‐vasopressin test of both ACTH and cortisol [expressed as incremental percentage of area under the curve (AUC%)]. The same finding was present between NW‐W and NW‐M. Basal luteinizing hormone levels were negatively correlated to ACTH_AUC% in both OB‐W and OB‐M. In the OB‐W, however, a positive correlation was found between cortisol_AUC% and testosterone (r = 0.48; p = 0.002), whereas a tendency toward a negative correlation was present in OB‐M. Discussion: In conclusion, we have shown a significant positive relationship between the activity of the HPA axis and testosterone in obese women, which suggests a partial responsibility of increased HPA axis activity in determining testosterone levels. In addition, it clearly seems that, as reported in normal weight subjects, a sex difference in the HPA axis activity still persists even in the presence of obesity.     

Postprandial Cytokine Concentrations and Meal Composition in Obese and Lean Women

The aim of this study was to compare the acute effect of (i) meals rich in saturated fat, oleic acid, and α‐linolenic acid and (ii) meals rich in starch and fiber on markers of inflammation and oxidative stress in obese and lean women. In a crossover study, 15 abdominally obese women (age, 54 ± 9 years; BMI, 37.3 ± 5.5 kg/m2) and 14 lean women (age, 53 ± 10 years; BMI, 22.9 ± 1.9 kg/m2) consumed meals rich in cream (CR), olive oil (OL), canola oil (CAN), potato (POT), and All‐Bran (BRAN) in random order. Blood samples were collected before and up to 6 h after the meals and plasma interleukin‐6 (IL‐6), IL‐8, tumor necrosis factor‐α (TNF‐α), lipid peroxides (LPOs), free‐fatty acids (FFAs), insulin, glucose, and cortisol were measured. Plasma IL‐6 decreased significantly 1 h after the meals then increased significantly above baseline at 4 h and 6 h in obese women and at 6 h in lean women. The incremental area under the curve (iAUC) for IL‐6 was significantly (P = 0.02) higher in obese compared with lean women and was significantly lower following the high fiber BRAN meal compared with a POT meal (P = 0.003). Waist circumference (R = 0.491, P = 0.007) and cortisol AUC (R = ?0.415, P = 0.03) were significant determinants of the magnitude of 6 h changes in plasma IL‐6 after the meals. These findings suggest that the postprandial response of plasma IL‐6 concentrations may be influenced by the type of carbohydrate in the meal, central adiposity, and circulating cortisol concentrations in women.     

Leptin Receptor Gene Variation Predicts Weight Change in Subjects with Impaired Glucose Tolerance

The leptin receptor (OB‐R) gene is a promising candidate gene for type 2 diabetes, because leptin and its receptor play an important role in insulin secretion and the development of obesity. Therefore, we studied whether the pentanucleotide insertion polymorphism of the 3′‐untranslated region (3′UTR) of the OB‐R gene has an influence on the conversion from impaired glucose tolerance (IGT) to type 2 diabetes in the STOP‐Noninsulin‐Dependent Diabetes Mellitus trial. The STOP trial was a longitudinal, double‐blind, placebo‐controlled randomized trial that included 1429 subjects with IGT from high‐risk populations. Using the restriction fragment length polymorphism method, we genotyped 770 subjects whose DNA was available for the insertion/deletion polymorphism of the 3′UTR of the OB‐R gene. We did not find a relationship between the OB‐R polymorphism and the conversion from IGT to type 2 diabetes (p = 0.747). However, the insertion allele was associated with a significant reduction in weight (p = 0.016), BMI (p = 0.009), and waist circumference (p = 0.006) in all subjects. Women carrying the I allele had a larger waist circumference change (p = 0.036), whereas men lost more weight and had a greater decrease in BMI. The pentanucleotide insertion/deletion polymorphism in the 3′UTR of the OB‐R gene did not influence the conversion to type 2 diabetes in obese patients with IGT. However, this polymorphism was associated with a significant weight change, suggesting that it may potentially modulate the risk for type 2 diabetes.     

ADIPOQ Polymorphisms,Monounsaturated Fatty Acids,and Obesity Risk: The GOLDN Study

Serum adiponectin levels have been positively associated with insulin sensitivity and are decreased in type 2 diabetes (T2D) and obesity. Genetic and environmental factors influence serum adiponectin and may contribute to risk of metabolic syndrome and T2D. Therefore, we investigated the effect of ADIPOQ single‐nucleotide polymorphisms (SNPs), ?11377C>G and ?11391G>A, on metabolic‐related traits, and their modulation by dietary fat in white Americans. Data were collected from 1,083 subjects participating in the Genetics of Lipid Lowering Drugs and Diet Network study. Mean serum adiponectin concentration was higher for carriers of the ?11391A allele (P = 0.001) but lower for the ?11377G allele carriers (P = 0.017). Moreover, we found a significant association with obesity traits for the ?11391G>A SNP. Carriers of the ?11391A allele had significantly lower weight (P = 0.029), BMI (P = 0.019), waist (P = 0.003), and hip circumferences (P = 0.004) compared to noncarriers. Interestingly, the associations of the ?11391G>A with BMI and obesity risk were modified by monounsaturated fatty acids (MUFAs) intake (P‐interaction = 0.021 and 0.034 for BMI and obesity risk, respectively). In subjects with MUFA intake above the median (≥13% of energy intake), ?11391A carriers had lower BMI (27.1 kg/m² for GA+AA vs. 29.1 kg/m² for GG, P = 0.002) and decreased obesity risk (odds ratio for ?11391A = 0.52, 95% confidence interval (CI); 0.28–0.96; P = 0.031). However, we did not detect genotype‐related differences for BMI or obesity in subjects with MUFA intake <13%. Our findings support a significant association between the ?11391G>A SNPs and obesity‐related traits and the potential to moderate such effects using dietary modification.     

A Single mri Slice Does Not Accurately Predict Visceral and Subcutaneous Adipose Tissue Changes During Weight Loss

Earlier cross‐sectional studies found that a single magnetic resonance imaging (MRI) slice predicts total visceral and subcutaneous adipose tissue (VAT and SAT) volumes well. We sought to investigate the accuracy of trunk single slice imaging in estimating changes of total VAT and SAT volume in 123 overweight and obese subjects who were enrolled in a 24‐week CB‐1R inverse agonist clinical trial (weight change, ?7.7 ± 5.3 kg; SAT change, ?5.4 ± 4.9 l, VAT change, ?0.8 ± 1.0 l). VAT and SAT volumes at baseline and 24 weeks were derived from whole‐body MRI images. The VAT area 5–10 cm above L₄—L₅ (A_+5–10) (R² = 0.59–0.70, P < 0.001) best predicted changes in VAT volume but the strength of these correlations was significantly lower than those at baseline (R² = 0.85–0.90, P < 0.001). Furthermore, the L₄—L₅ slice poorly predicted VAT volume changes (R² = 0.24–0.29, P < 0.001). Studies will require 44–69% more subjects if (A_+5–10) is used and 243–320% more subjects if the L₄—L₅ slice is used for equivalent power of multislice total volume measurements of VAT changes. Similarly, single slice imaging predicts SAT loss less well than cross‐sectional SAT (R² = 0.31–0.49 vs. R² = 0.52–0.68, P < 0.05). Results were the same when examined in men and women separately. A single MRI slice 5–10 cm above L₄—L₅ is more powerful than the traditionally used L₄—L₅ slice in detecting VAT changes, but in general single slice imaging poorly predicts VAT and SAT changes during weight loss. For certain study designs, multislice imaging may be more cost‐effective than single slice imaging in detecting changes for VAT and SAT.     

Vitamin D status and response to Vitamin D(3) in obese vs. non-obese African American children

Background: Serum 25‐hydroxyvitamin D (25(OH)D) is low in obese adults. Objective: To examine serum 25(OH)D in obese (BMI >95th percentile for age) vs. non‐obese (BMI = 5th–75th percentile for age) 6–10‐year‐old African American children and compare their differences in therapeutic response to vitamin D supplementation. Methods and Procedures: In an open label non‐randomized pre‐post comparison 21 obese (OB) and 20 non‐obese (non‐OB) subjects matched for age, sex, skin color, and pubertal maturation were treated with 400 IU of vitamin D₃ daily for 1 month. Serum 25(OH)D, 1,25‐dihydroxyvitamin D (1,25(OH)₂D), parathyroid hormone (PTH), leptin, and markers of bone turnover (serum bone‐specific alkaline phosphatase (BSAP), osteocalcin (OC), and urine n ‐telopeptide cross‐links of type 1 collagen (urine NTX)) were measured. Vitamin D deficiency was defined as serum 25(OH)D ≤20 ng/ml and insufficiency as 21–29 ng/ml respectively. Results: Vitamin D deficiency occurred in 12/21 (57%) OB vs. 8/20 (40%) non‐OB at baseline (P = 0.35) and persisted in 5/21 (24%) OB vs. 2/18 (11%) non‐OB (P = 0.42) after treatment. When the cohort was stratified by the baseline levels of 25(OH)D, there were differences in the response to treatment in the obese and non‐obese cohorts. Discussion: Vitamin D deficiency was common among OB and non‐OB preadolescent African American children, and 400 IU of vitamin D₃ (2× the recommended adequate intake) daily for 1 month was inadequate to raise their blood levels of 25(OH)D to ≥30 ng/ml.     

Relative contributions of adiposity and muscularity to physical function in community-dwelling older adults

Objective: To determine the relative contributions of adiposity and muscularity to multi‐dimensional performance‐based and perceived physical function in older adults living independently. Methods and Procedures: Data from 109 women and men, aged 60 or older, with low serum dehydroepiandrosterone (DHEA) sulfate levels were included in this cross‐sectional analysis of baseline measures from a single‐site, randomized, controlled trial of DHEA replacement therapy. Physical function was determined by means of performance on the 100‐point Continuous Scale‐Physical Functional Performance (CS‐PFP) test and by self‐reporting using the physical function subscale of the Medical Outcomes Short Form‐36 (SF36_PF). Body composition was measured by dual‐energy X‐ray absorptiometry (DXA). Linear regression analyses were used to determine the contributions of body mass index (BMI; kg body mass/m²), fat index (FI; kg fat/m²), and appendicular skeletal muscle index (ASMI; kg muscle/m²) to the CS‐PFP and SF36_PF scores, adjusted for age and sex. Results: Age‐adjusted regression analyses indicated that FI, but not ASMI, was a significant (P < 0.001) determinant of CS‐PFP (R ² = 0.54) and SF36_PF (R ² = 0.37). When adjusted for age and sex, BMI was nearly as good a predictor of CS‐PFP (R ² = 0.50) and SF36_PF (R ² = 0.34) as FI. Discussion: Adiposity was a stronger predictor of measured and self‐reported physical function than was muscularity in older adults living independently. BMI, adjusted for sex, is a reasonable substitute for adiposity in the prediction of physical function.     

Severe Obesity Is Associated With Impaired Arterial Smooth Muscle Function in Young Adults

The degree of arterial dilatation induced by exogenous nitrates (nitrate‐mediated dilatation, NMD) has been similar in obese and normal‐weight adults after single high‐dose glyceryl trinitrate (GTN). We examined whether NMD is impaired in obesity by performing a GTN dose‐response study, as this is a potentially more sensitive measure of arterial smooth muscle function. In this cross‐sectional study, subjects were 19 obese (age 31.0 ± 1.2 years, 10 male, BMI 44.1 ± 2.1) and 19 age‐ and sex‐matched normal‐weight (BMI 22.4 ± 0.4) young adults. Blood pressure (BP), triglycerides, high‐density lipoprotein (HDL), and low‐density lipoprotein (LDL)‐cholesterol, glucose, insulin, high‐sensitivity C‐reactive protein (hs‐CRP), carotid intima‐media thickness (CIMT), and flow‐mediated dilatation (FMD) were measured. After incremental doses of GTN, brachial artery maximal percent dilatation (maximal NMD) and the area under the dose‐response curve (NMD AUC) were calculated. Maximal NMD (13.4 ± 0.9% vs. 18.3 ± 1.1%, P = 0.002) and NMD AUC (54,316 ± 362 vs. 55,613 ± 375, P = 0.018) were lower in obese subjects. The obese had significantly higher hs‐CRP, insulin, and CIMT and lower HDL‐cholesterol. Significant bivariate associations existed between maximal NMD or NMD AUC and BMI‐group (r = ?0.492, P = 0.001 or r = ?0.383, P = 0.009), hs‐CRP (r = ?0.419, P = 0.004 or r = ?0.351, P = 0.015), and HDL‐cholesterol (r = 0.374, P = 0.01 or r = 0.270, P = 0.05). On multivariate analysis, higher BMI‐group remained as the only significant determinant of maximal NMD (r² = 0.242, β = ?0.492, P = 0.002) and NMD AUC (r² = 0.147, β = ?0.383, P = 0.023). In conclusion, arterial smooth muscle function is significantly impaired in the obese. This may be important in their increased cardiovascular risk.     

Mediators of Weight Loss and Weight Loss Maintenance in Middle‐aged Women

Long‐term behavioral self‐regulation is the hallmark of successful weight control. We tested mediators of weight loss and weight loss maintenance in middle‐aged women who participated in a randomized controlled 12‐month weight management intervention. Overweight and obese women (N = 225, BMI = 31.3 ± 4.1 kg/m²) were randomly assigned to a control or a 1‐year group intervention designed to promote autonomous self‐regulation of body weight. Key exercise, eating behavior, and body image variables were assessed before and after the program, and tested as mediators of weight loss (12 months, 86% retention) and weight loss maintenance (24 months, 81% retention). Multiple mediation was employed and an intention‐to‐treat analysis conducted. Treatment effects were observed for all putative mediators (Effect size: 0.32–0.79, P < 0.01 vs. controls). Weight change was ?7.3 ± 5.9% (12‐month) and ?5.5 ± 5.0% (24‐month) in the intervention group and ?1.7 ± 5.0% and ?2.2 ± 7.5% in controls. Change in most psychosocial variables was associated with 12‐month weight change, but only flexible cognitive restraint (P < 0.01), disinhibition (P < 0.05), exercise self‐efficacy (P < 0.001), exercise intrinsic motivation (P < 0.01), and body dissatisfaction (P < 0.05) predicted 24‐month weight change. Lower emotional eating, increased flexible cognitive restraint, and fewer exercise barriers mediated 12‐month weight loss (R² = 0.31, P < 0.001; effect ratio: 0.37), but only flexible restraint and exercise self‐efficacy mediated 24‐month weight loss (R² = 0.17, P < 0.001; effect ratio: 0.89). This is the first study to evaluate self‐regulation mediators of weight loss and 2‐year weight loss maintenance, in a large sample of overweight women. Results show that lowering emotional eating and adopting a flexible dietary restraint pattern are critical for sustained weight loss. For long‐term success, interventions must also be effective in promoting exercise intrinsic motivation and self‐efficacy.     

Feeding Frequency and Appetite in Lean and Obese Prepubertal Children

To determine the effect of feeding frequency on appetite in normal weight (NW) and obese (OB) prepubertal children, we carried out a prospective, randomized interventional study of 18 NW and 17 OB children ages 6–10. Children received three or five feedings in random order on separate days. Total calories, carbohydrate, protein, and fat composition on each day were equal. Two hours following the last feeding, children were offered ice cream ad lib. The major outcome variable was kilocalories ice cream consumed. A visual analog scale to assess fullness was also administered before consumption of ice cream. We observed that OB children consumed 73.0 ± 37.4 kcal more after five feedings than after three feedings whereas the NW children consumed 47.1 ± 27.8 kcal less. There was significant interaction between meal pattern and weight group indicating that this change in ice cream consumption differed significantly between groups (P = 0.014 by two‐factor analysis). Ice cream intake/kg was less in OB compared to NW subjects (P = 0.012). Fullness ratings before ice cream did not differ by meal pattern or weight group. However, pre‐ice cream fullness predicted ice cream intake in NW but not OB children. In summary, OB and NW children differed in appetite response to meal frequency. Our data suggest that: (i) satiety in OB children is related more to proximity of calories (larger supper) than to antecedent distribution of calories and; (ii) NW children may be more prone to restrict intake based on subjective fullness.     

Association of Pericardial Fat With Liver Fat and Insulin Sensitivity After Diet‐Induced Weight Loss in Overweight Women

Pericardial adipose tissue (PAT) is positively associated with fatty liver and obesity‐related insulin resistance. Because PAT is a well‐known marker of visceral adiposity, we investigated the impact of weight loss on PAT and its relationship with liver fat and insulin sensitivity independently of body fat distribution. Thirty overweight nondiabetic women (BMI 28.2–46.8 kg/m², 22–41 years) followed a 14.2 ± 4‐weeks low‐calorie diet. PAT, abdominal subcutaneous (SAT), and visceral fat volumes (VAT) were measured by magnetic resonance imaging (MRI), total fat mass, trunk, and leg fat by dual‐energy X‐ray absorptiometry and intrahepatocellular lipids (IHCL) by (¹)H‐magnetic resonance spectroscopy. Euglycemic hyperinsulinemic clamp (M) and homeostasis model assessment of insulin resistance (HOMA_IR) were used to assess insulin sensitivity or insulin resistance. At baseline, PAT correlated with VAT (r = 0.82; P < 0.001), IHCL (r = 0.46), HOMA_IR (r = 0.46), and M value (r = ?0.40; all P < 0.05). During intervention, body weight decreased by ?8.5%, accompanied by decreases of ?12% PAT, ?13% VAT, ?44% IHCL, ?10% HOMA2‐%B, and +24% as well as +15% increases in HOMA2‐%S and M, respectively. Decreases in PAT were only correlated with baseline PAT and the loss in VAT (r = ?0.56; P < 0.01; r = 0.42; P < 0.05) but no associations with liver fat or indexes of insulin sensitivity were observed. Improvements in HOMA_IR and HOMA2‐%B were only related to the decrease in IHCL (r = 0.62, P < 0.01; r = 0.65, P = 0.002) and decreases in IHCL only correlated with the decrease in VAT (r = 0.61, P = 0.004). In conclusion, cross‐sectionally PAT is correlated with VAT, liver fat, and insulin resistance. Longitudinally, the association between PAT and insulin resistance was lost suggesting no causal relationship between the two.