The success of weight loss surgery in treating the complications associated with obesity is most probably related to the reduction of inflammatory mediators. While some aspects of bariatric physiology remain unclear, there appears to be a strong association between obesity and inflammation, thereby rendering obesity a chronic inflammatory state. A clearer understanding of the physiology of obesity will allow physicians who treat the obese to develop better strategies to promote weight loss and improve the well-being of millions of individuals.

Surgical weight loss results in significant improvement of liver morphology in severely obese patients. These beneficial changes may be associated with a significant reduction in the prevalence of the metabolic syndrome.

Objective: To determine arterial stiffness and b-amyloid (Ab) deposition in the brain of dementiafree older adults. Methods:We studied a cohort of 91 dementia-free participants aged 83-96 years. In 2009, participants completed brain MRI and PET imaging using Pittsburgh compound B (PiB; a marker of amyloid plaques in human brain). In 2011, we measured resting blood pressure (BP), mean arterial pressure (MAP), and arterial stiffness by pulse wave velocity (PWV) in the central, peripheral, and mixed (e.g., brachial ankle PWV [baPWV]) vascular beds, using a noninvasive and automated waveform analyzer.Results: A total of 44/91 subjects were Ab-positive on PET scan. Ab deposition was associated with mixed PWV, systolic BP, and MAP. One SD increase in baPWV resulted in a 2-fold increase in the odds of being Ab-positive (p 5 0.007). High white matter hyperintensity (WMH) burden was associated with increased central PWV, systolic BP, and MAP. Compared to Ab-negative individuals with low WMH burden, each SD increase in PWV was associated with a 2-fold to 4-fold increase in the odds of being Ab-positive and having high WMH.Conclusions: Arterial stiffness was associated with Ab plaque deposition in the brain, independent of BP and APOE e4 allele. The associations differed by type of brain abnormality and vascular bed measured (e.g., WMH with central stiffness and Ab deposition and mixed stiffness). Arterial stiffness was highest in individuals with both high Ab deposition and WMH, which has been suggested to be a "double hit" contributing to the development of symptomatic dementia. Neurology ® 2013;81:1711-1718 GLOSSARY Ab 5 b-amyloid; AD 5 Alzheimer disease; baPWV 5 brachial-ankle pulse wave velocity; BMI 5 body mass index; BP 5 blood pressure; cfPWV 5 carotid-femoral pulse wave velocity; CI 5 confidence interval; DBP 5 diastolic blood pressure; faPWV 5 femoral-ankle pulse wave velocity; GEMS 5 Ginkgo Evaluation of Memory Study; hfPWV 5 heart-femoral pulse wave velocity; ICC 5 intraclass correlation coefficients; MAP 5 mean arterial pressure; MCI 5 mild cognitive impairment; OR 5 odds ratio; PiB 5 Pittsburgh compound B; PWV 5 pulse wave velocity; SBP 5 systolic blood pressure; WMH 5 white matter hyperintensities; WMHv 5 white matter hyperintensities volume.Hypertension is linked to cognitive impairment and the pathologic features of Alzheimer disease (AD), including neurofibrillary tangles and b-amyloid (Ab) plaques, 1 as well as small-vessel disease and white matter hyperintensities (WMH) in the brain.2 Arterial stiffness appears to play a major role in the relationship between hypertension and its consequences in the brain; mounting evidence implicates arterial stiffness in the pathogenesis of impaired cognitive function and dementia in the elderly. 4 Except for APOE e4 genotype and aging, the risk factors and determinants of Ab deposition in brain are poorly understood.Recent studies show that blood pressure (BP) is associated with brain Ab deposition as measured by PiB-PET 5,6 ; thus, arterial stiffness may pla...

Our results show poor reproducibility of the OGTT in obese youth, in particular for the 2-h plasma glucose. Obese youth who have discordant OGTT results are more insulin resistant with higher risk of developing type 2 diabetes mellitus, as evidenced by a lower GDI. The implications of this remain to be determined in clinical and research settings.