Treatment of obesity: need to focus on high risk abdominally obese patients

Després, Jean‐Pierre; Lemieux, Isabelle; Prud’homme, Denis

doi:10.1136/bmj.322.7288.716

Cited by 684 publications

(496 citation statements)

References 21 publications

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“…28 The finding that the gene for cytoprotective and anti-inflammatory enzyme heme oxygenase-1 is less upregulated in visceral compared with subcutaneous adipose tissue lead us to the question whether visceral obesity affects HMOX1 expression within visceral adipose tissue. Owing to high interindividual variation of adipose tissue HMOX1 expression (Figure 2a), we related visceral adipose tissue expression to that in subcutaneous adipose tissue taking subcutaneous adipose tissue as an individual standard.…”

Section: Regulation Of Heme Oxygenase-1 Expression In Obesitymentioning

confidence: 99%

Diminished upregulation of visceral adipose heme oxygenase-1 correlates with waist-to-hip ratio and insulin resistance

et al. 2009

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Objective: Insulin resistance in visceral obesity is substantially driven by adipose tissue inflammation, particularly by macrophages accumulating in obese adipose tissue. In contrast, adipose tissue macrophages express the hemoglobin scavenger receptor (CD163) and heme oxygenase-1 (gene: HMOX1) that together protect from oxidative stress. Our aim was to evaluate the expression of CD163 and HMOX1 in intra-abdominal visceral (omental) and subcutaneous adipose tissue as well as circulating soluble CD163 concentrations in human obesity and its association with adipose tissue inflammation, body fat distribution and insulin resistance. Methods: CD163, HMOX1 and CD68 mRNA expression in visceral and subcutaneous adipose tissue, serum concentration of soluble CD163 in morbidly obese patients (body mass index (BMI) 440 kg m À2 ), who underwent laparoscopic surgery for gastric banding (n ¼ 20), matched for age and sex to controls (BMIo30 kg m À2 ; n ¼ 20) was analyzed. Results: CD163 expression was highly upregulated in human adipose tissue and soluble CD163 serum concentration was elevated in obese vs lean subjects. HMOX1 was upregulated in adipose tissue by obesity as well and expressed predominantly in macrophages. Although CD163 expression strictly correlated with macrophage abundance, HMOX1 was additionally upregulated within macrophages. This upregulation was significantly lower in visceral compared with subcutaneous adipose tissue. Strikingly, relative visceral adipose tissue expression of HMOX1 negatively correlated with waist-to-hip ratio and the homeostasis model assessment of insulin resistance (both P ¼ 0.024). Conclusions: Visceral obesity is associated with defective upregulation of heme oxygenase-1 in visceral adipose tissue. A lack of this antioxidative and anti-inflammatory enzyme in visceral adipose tissue could contribute to the development of insulin resistance.

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Section: Regulation Of Heme Oxygenase-1 Expression In Obesitymentioning

confidence: 99%

Diminished upregulation of visceral adipose heme oxygenase-1 correlates with waist-to-hip ratio and insulin resistance

et al. 2009

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“…CCK analysis used Phoenix Peptidese RIA (RK-069-04) for CCK octapeptide (CCK [26][27][28][29][30][31][32][33]. The standard RIA protocol was applied but without extraction of the peptides before the assay.…”

Section: Clinical Indicesmentioning

confidence: 99%

Oat β-glucan supplementation does not enhance the effectiveness of an energy-restricted diet in overweight women

et al. 2009

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Epidemiological evidence shows an inverse relationship between dietary fibre intake and body weight gain. Oat b-glucan, a soluble fibre alters appetite hormones and subjective satiety in acute meal test studies, but its effects have not been demonstrated with chronic consumption. The present study aimed to test the effects in women of two different doses of oat b-glucan on weight loss and hormones associated with appetite regulation. In a 3-month parallel trial, sixty-six overweight females were randomised into one of three 2 MJ energy-deficit diets: a control and two interventions including 5 -6 g or 8 -9 g b-glucan. Anthropometric and metabolic variables (blood glucose level, insulin, total cholesterol (TC), LDL, HDL, TAG and leptin), together with markers of appetite regulation (cholecystokinin (CCK), glucagon-like peptide-1 (GLP-1), ghrelin, peptide YY (PYY) and PYY 3-36 ) were measured at baseline and at 3 months. After 3 months, all groups lost weight (P,0·001) and showed a reduced waist circumference (P,0·001). The study sample also showed reductions in TC, LDL, HDL, leptin, PYY, GLP-1 values (all P, 0·001) and an increase in CCK levels (P,0·001). No significant differences were noted between the groups for all outcome values except PYY levels (P¼ 0·018). In broad terms, the addition of oat b-glucan did not enhance the effect of energy restriction on weight loss in mildly overweight women, although wide variations in observed results suggests that individual responsiveness may be an issue. b-D-Glucan: Weight loss: Weight control: Appetite hormonesLarge bodies of epidemiological data show an inverse relationship between dietary fibre intake and body weight (1 -5) so that the logic and simplicity of including fibre in an energy-controlled diet remains tantalising. As a component of food, fibres are found in a fermentable (soluble) or non-fermentable (insoluble) form, but early research has been unable to show benefits from including either form in short term (3 -4 weeks) ad libitum diets (6) . This was also the case when the form of fibre was mixed linkage b-glucan, a soluble fibre delivered by oats (7) , well recognised for its cholesterol (8) and glucose lowering (9) actions. In order to better expose the advantages apparent from epidemiological studies, more work is required in understanding the physical features of fibre, the food delivery system, and how these may work together to affect mechanisms associated with weight management, such as satiety, particularly over longer periods of time.It is accepted that soluble fibre, by its viscous nature will not only increase upper gastrointestinal transit time, but also stimulate cholecystokinin (CCK) that will increase peristalsis (10) . The effects of other hormones are less clear, but the ileal brake formed by undigested foods in the distal gut (occurring with high fibre foods), in addition to the fermentation of soluble fibres in the large bowel are all seen as positive benefits of fibre. Meal studies are able to expose these mechanisms of action. This i...

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“…1 Some recent prospective studies have also shown that increased TG level may be an independent CVD risk factor in European [10][11][12] and US populations. 13 In recent years, Després et al 15 coined the term 'hypertriglyceridemic waist' (HTGW) to emphasize the potential predictive value of the combined increase in WC and TG in relation with CVD risk. 14,15 These authors showed that men with HTGW were at increased risk for coronary artery disease (CAD) and suggested that the HTGW phenotype could represent a simple and inexpensive tool to screen for high-risk subjects.…”

Section: Introductionmentioning

confidence: 99%

“…13 In recent years, Després et al 15 coined the term 'hypertriglyceridemic waist' (HTGW) to emphasize the potential predictive value of the combined increase in WC and TG in relation with CVD risk. 14,15 These authors showed that men with HTGW were at increased risk for coronary artery disease (CAD) and suggested that the HTGW phenotype could represent a simple and inexpensive tool to screen for high-risk subjects. 14,16 Similar findings were reported in a few other cross-sectional studies.…”

Section: Introductionmentioning

confidence: 99%

Hypertriglyceridemic waist and 7.5-year prospective risk of cardiovascular disease in asymptomatic middle-aged men

et al. 2006

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Background: Few studies suggest that the combined increase in plasma triglycerides (TG) and in waist circumference (WC), termed 'hypertriglyceridemic waist' (HTGW), is an interesting marker of risk for cardiovascular disease (CVD). Objective: Using cutoffs used for defining HTGW, we examined the prospective association of HTGW with CVD risk in a French cohort of men. Design: Men were participants in the SU.VI.MAX study, an intervention trial testing the impact of an antioxidant supplementation on chronic diseases. Data were collected in 1994-1996 in 3430 men followed up for 7.5 years. Cutoffs used for defining HTGW were WC X90 cm and TG X2 mmol/l. We assessed the relative risk (RR) (95% confidence interval (CI)) of CVD in groups defined according to both WC and TG levels. Results: In this population, 41.2% of the subjects were classified as low WC/low TG, 43.2% as high WC/low TG, 3.5% as low WC/high TG and 12.1% as HTGW. During follow-up, 122 subjects had a CVD event. In this group, HTGW prevalence was 26.2%. After adjustment for age, RR (95% CI) for CVD for the HTGW group showed the highest association with CVD risk: 2.13 (1.21-3.76), using low WC/ low TG as the reference group. Conclusion: HTGW was associated with the risk of CVD after 7.5 years of follow-up in a low-risk middle-aged men population. This marker may be used as a useful clinical tool to screen for men at risk of CVD.

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Treatment of obesity: need to focus on high risk abdominally obese patients

Cited by 684 publications

References 21 publications

Diminished upregulation of visceral adipose heme oxygenase-1 correlates with waist-to-hip ratio and insulin resistance

Diminished upregulation of visceral adipose heme oxygenase-1 correlates with waist-to-hip ratio and insulin resistance

Oat β-glucan supplementation does not enhance the effectiveness of an energy-restricted diet in overweight women

Hypertriglyceridemic waist and 7.5-year prospective risk of cardiovascular disease in asymptomatic middle-aged men

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