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Objective-To measure serum leptin concentrations in the Polynesian population of Western Samoa and to examine epidemiological associations ofleptin with anthropometric, demographic, behavioural, and metabolic factors in this population with a high prevalence of obesity and non-insulin dependent diabetes mellitus.Design-Cross sectional study, leptin concentration being measured in a subgroup of a population based sample.Subjects-240 Polynesian men and women aged 28-74 years were selected to cover the full range of age, body mass index, and glucose tolerance.Main outcome measurements-Serum leptin, insulin, and glucose concentrations; anthropometric measures; physical activity; and area of residence.Results-Leptin concentrations were correlated with body mass index (r = 0.80 in men, 0.79 in women) and waist circumference (r = 0.82 in men, 0.78 in women) but less so with waist to hip ratio. At any body mass index, leptin concentration was higher in women than men (geometric mean adjusted for body mass index 15.3 v 3.6 pgIl, P<0.001). Leptin concentration also correlated with fasting insulin concentration (r = 0.63 in men, 0.64 in women) and insulin concentration 2 hours after a glucose load (r = 0.58 in men, 0.52 in women). These associations remained significant after controlling for body mass index; effects of physical activity and of rural or urban living on leptin concentration were eliminated after adjusting for obesity, except values remained high in urban men. 78% of variance in leptin was explained by a model including fasting insulin concentration, sex, body mass index, and a body mass index by sex interaction term. Similar results were obtained if waist circumference replaced body mass index.Conclusions-The strong relation of leptin with obesity is consistent with leptin production being proportional to mass of adipose tissue. The relation with insulin independent of body mass index suggests a possible role for leptin in insulin resistance or hyperinsulinaemia.

Background: The SARS-CoV2 virus pandemic pandemic has been characterized for its rapid global dispersion. Obesity is an independent risk factor for the most severe cases of COVID-19. The impact in Argentina differs from others since it was able to anticipate public health interventions in order to atten the contagion curve. Early quarantine achieved better control of the pandemic and, following the recommendations of scienti c societies in countries with higher affectation, elective bariatric surgeries (BS) and in-person consults were suspended. Objective: Bariatric surgeons were surveyed to assess the impact of the pandemic and the measures undertaken on the practice of BS in Argentina. Method: Between April 17 and 21, 2020, an online survey in Google forms was disseminated to bariatric surgeons residing in Argentina. It consists of 40 speci c and non-speci c questions regarding BS practice and COVID pandemic. Consent to participate was obtained from surgeons by completing the survey. Results: 83 surgeons averaging 47.17 years of age responded the survey. Together they performed 10515 BS in 2019. More than 65% stated that more than 50% of their income derives from this activity, and more than 40% depend on more than 75% of it. The average hospital stay was 1.6 days and 85% reported using Intensive Care Unit (ICU) in less than 1% of their patients. According to the scores of hospital affectation issued by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), 54% reported being in Phase I and 34% had not yet been affected by the pandemic. All, except one, suspended the elective BS 7.7 days on average before the appearance of the rst local case. 95.7% offer virtual consults, but 48% obtain no retribution for them. 26% would consider performing BS without a previous endoscopic evaluation. 90% of the surgeons surveyed (75) continue performing other types of surgeries via laparoscopy. In case of operating a patient without suspected SARS-CoV-2 virus infection, 80% would use N95 masks and 56.6% would use face protection shields; two thirds would use smoke lters for the pneumoperitoneum and only 10.8% would continue with the usual protection measures. To restart the elective activity, 56.6% proposed that the hospital should be in phase 0 or I, that the patient should meet certain characteristics for their selection and that the scienti c society must recommend the way to restart of the activity. Patient selection criteria with greater consensus were testing to rule out asymptomatic COVID-positive patients, epidemiology, absence of chronic lung disease, age under 60, and immunological integrity. 19.2% regard sleeve gastrectomy as the ideal BS during the pandemic, and 88% of the surgeons would not change their chosen BS technique based on infection risk. Conclusion: Elective BS is currently suspended in Argentina, although epidemiologically the conditions in the country are not unfavorable. Economic impact for those involved is signi cant. Short-term vision is pessimistic, but recommendations originati...

The European pattern of inequalities is being established in South Asian men and women, possibly at a different pace in different subgroups. Future studies of inequalities should be large, separate Indian, Pakistani and Bangladeshi populations, study men and women separately and track changes over time.