International Journal of (2007) 31, S106–S174 & 2007 Nature Publishing Group All rights reserved 0307-0565/07 $30.00 www.nature.com/ijo POSTER SESSION: TRACK 3 – DISEASE AND TREATMENT T3:PO.01 T3:PO.02

N-Terminal pro-B-type natriuretic peptide and echocardiographic abnormalities in Presenting a new model for weight control severely obese patients: correlation with visceral fat 1 Corsi Massimiliano Marco1, Marocchi Alessandro2, Ambrosi Bruno3, Malavazos Movahedi Ahmadreza Alexis Elias3 1University, Isfahan, Iran 1Institute of General Pathology, University of Milan; 2Dept of Laboratory Medicine, Niguarda Hospital; 3Endocrinology Unit, IRCCS Policlinico San Donato Hospital, The purpose of this study was to establish a metabolic dietary program University of Milan for or gain in which hypothalamus may not be stimulated in decline or increase Basal Metabolic Rate.18 healthy male and female (25 Many studies have confirmed NT-proBNP as a sensitive marker for left ventricular (LV) hypertrophy and/or asymptomatic left ventricular dysfunction and it is to 50 years old) were assigned to three groups. Group A experienced particularly reliable because of its high negative predictive value To our weight loss metabolic program, they decreased 10% of their normal daily knowledge, recent findings on the relation between NT-proBNP and morphologic food amount for three days (action phase) and returned to their normal and dynamic cardiac abnormalities in obesity are still inconsistent and daily food amount for one day (return phase). They observed it for controversial. We measured NT-proBNP concentrations in 27 severely obese twelve days. The decrease for the remained each twelve -day period was women with no complications and 15 normal-weight patients. All subjects were 15%, 20%, 25%, 30%, for the action phases and 5%, 5%, 10%, 10%, for young with normal renal function, pre-menopausal, normotensive, normoglycemic, the changing return Phases alternatively. The program went on so that at not dyspneic, drug-free women; thus excluding the possibility that high NT- proBNP concentrations may be associated with and . All the last twelve -day period the food amount decrease for action phases patients and controls underwent echocardiography. Visceral (VAT) was 30% and for the changing return phases was 10%.Group B followed and subcutaneous adipose tissue (SAT) areas in the obese group were assessed by metabolic program just like the program for weight loss computed tomography. Serum NT-proBNP concentrations were measured using group except that they increased the percents instead of decrease. Group the proBNP (Roche) assay on an Elecsys 2010 analyzer (Roche). Obese women C was as control group. The total period for the experimental and control had higher mean NT-proBNP concentrations than controls (P<0.001). NT-proBNP 2 groups was 60 days. To analyze data T test was used. Results: Group A concentrations were correlated with the VAT area (r =0.60, P<0.0001), VAT/SAT decreased their body weight from 86.5 kg to 79.33 kg (sig =.001). (r2=0.38, P<0.001) but not with SAT (P= -0.61). Fifteen obese patients with a greater amount of visceral fat (VAT >130 cm2) had higher mean NT-proBNP Group B gained 2.16 kg (sig = .003). No significant change in body concentrations than those with VAT less than 130 cm2 (n= 12) (P<0.02). The most weight was seen in control group (sig =.822 ). novel finding in our study is the significant correlation between NT-proBNP and echocardiographic parameters in an homogeneous population, even after correction for increased VAT (P<0.05). This may indicate that NT-proBNP itself could serve as an indicator of LV morpho-functional changes.

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Effect of weight loss on plasma lipids and glucose in patients with type 2 Effect of training on plasma eotaxin levels diabetes Kim Seon Mee1, Choi Kung Mook2, Han Jee Hye3, Park Hye Soon4 Faghih Shiva1, Ansari Negin1 1Department of Family Medicine, Korea University Medical Center, 1Islamic Azad University-Ahvaz Branch, Tehran, Iran Korea; 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Medical Center, Korea; Objective: To determine the effect of weight loss on plasma triglyceride, 3Department of Family Medicine, Eulji University School of Medicine, cholesterol and fasting plasma glucose in obese patients with type 2 Korea; 4Department of Family Medicine, University of Ulsan College of diabetes. Methods: A total of 68 free-living obese patients with type 2 Medicine, Korea diabetes were randomized to either a low calorie or a normal diet groups. FPG, Tg, cholesterol, weight and height of subjects were Context: Recent study revealed that eotaxin, which is an important measured before the intervention and after one month. chemokine in extrinsic asthma, is associated with obesity in mice and Results: Mean ± SD of weight, BMI, Tg, cholesterol, and FPG of LCD humans. Exercise training exerts beneficial effects on metabolic and group were 98.97 ± 18.5(Kg), 35.42 ± 6.20(), 236.88 ± 65.21(), 240.97 ± vascular risk factors in obese patients. 63.13(), and 215.08 ± 72.39() respectively, which fell to 94.80 ± Objectives: We have investigated whether exercise can alter the plasma 17.02(Kg), 33.94 ± 5.80 (), 176.11 ± 45.50(), 176.22 ± 29.77(), and eotaxin levels in non-diabetic subjects. 129.37 ± 41.61() after a month (P < 0.001 for all).No significant Design and Patients: In a prospective study, forty-seven Korean women different was seen in control group. In this study there were significant (age 47.1 ± 6.5, (BMI) 27.0 ± 2.9 kg/m2) were correlations between rate of weight loss and Tg (P< 0.001, r = 0.52) and included. Fating plasma eotaxin levels and metabolic parameters were cholesterol (P<0.01, r = 0.45) reduction. measured in a supervised aerobic exercise program for eight weeks. Conclusion: Even small amount of weight loss can lead to a significant Results: At baseline, plasma eotaxin concentrations were elevated in reduction in serum Tg, cholesterol and glucose. So we can use it as a subjects with central obesity (waist circumference < 80 cm, 73.6 ± 17.8 suitable treatment to reduce the risk of coronary-heart diseases. pg/ml) compared to those without central-obesity (waist circumference < 80 cm, 64.2 ± 4.2 pg/ml, P = 0.005). In multiple regression analysis, eotaxin levels were independently associated with waistto- hip ratio and body weight (R2 = 0.330). After exercise program, eotaxin levels were significantly decreased from 72.0 ± 16.7 to 66.9 ± 14.3 pg/ml (P = 0.038) without change of insulin resistance. Conclusions: Regular exercise training with weight loss induced a reduction of plasma eotaxin levels. Abstracts S107 T3:PO.05 T3:PO.06

Effects of 6 months of exercice and isoflavones on risk Lupinus angustifolius (sweet lupin) seed protein - an anti-obesity protein found factors in obese postmenopausal women 1 Rahman Mohammed 1 Aubertin-Leheudre Mylene 1Bangladesh Agricultural University

1Research Center on Aging, University of Sherbrooke The effects of raw sweet lupin (Lupinus angustifolius) meal on the growth and N utilization of rats were determined from five N balance experiments. Sweet lupin seed Objective: To investigate if 6 months of exercise with isoflavones could grown in Western Australia, obtained as meal, either unsupplemented (LMU) or fully supplemented with required amino acids (360 g kg-1)(LMFS), was tested. Rats fed improve clinical risk factors that predispose to CVD in obese postmenopausal -1 lactalbumin (130 g kg )(LACT) were used as positive controls, while rats fed a women. nonprotein diet (NPC) were used as negative controls. In addition, seed protein, extracted Design: Randomised double blind controlled trial. at pH 7.0 with water and insoluble after dialysis at pH 7.0 against distilled water (LPADI; Subjects: Fifty healthy obese postmenopausal women were divided in 2 124 g kg-1), was also used. Details of chemical analyses were carried out and found that groups and submitted during 1 year on a supplementation (25 in isoflavones LPADI is the storage protein of lupin seed. Sodium dodecyl sulphate polyacrylamide gel (ISO) and 25 in placebo (PLA)) and followed during the last 6 months an electrophoresis (SDS-PAGE had shown that LPADI contains three polypeptides with exercise program (3 times by week)) to compare CVD risk factors. molecular weights between 30 and 36 kDa which are similar to lectins obtained from Measurements: Body composition (DXA), resting energy expenditure Phaseolus vulgaris, Abrus precatorius and Ricinus communis. cal analyses The diets contained the same amounts of energy and protein and were supplemented with essential (indirect calorimetry), daily energy expenditure (accelerometry) and dietary amino acids, vitamins and minerals to target requirements for rats. Inclusion of LPADI in intake (3-day dietary record), metabolic profile (blood lipids, fasting insulin, the diet of growing rats caused urinary losses of N, almost all as urea, hypoproteinaemia fasting glucose, SHBG, CRP) at baseline and 12 months. and increase in body water that resulted in the lowest NPU values, N balance and growth Results: We observed a significant effect of the intervention on body weight, rate as compared with other diets used. These rats developed atrophy of the spleen (low total and abdominal FM in kg and %, BMI and gain appendicular FFM, and dry weight) and had a comparatively smaller thymus gland than those given raw meals. It FFM/FM ratio in ISO group but not in PLA group. ISO group presented a is possible that the toxic protein component in the sweet lupin, which has negligible in vitro haemagglutination properties and is extremely toxic in vivo, exerts toxicity by significantly greater level of SHBG compared to PLA group. No difference interfering with protein synthesis in the liver, while the immune responses are secondary was observed on other biochemical characteristics for both groups except for to azotaemia (high level of urea in the blood) or cytotoxicity action on lymphocytes. The QUIKI. Moreover, we observed a tendency of treatment effect for BMI (P = unusual depletion of fat from the body, however, was due to the failure of absorbed 0.07), absolute (P = 0.07) and percent (P = 0.053) abdominal FM. amino acids to assimilate as proteins, creating dietary protein restriction and leading to Conclusion: As compared to an aerobic exercise program alone, 70 mg/day lipolysis. It is therefore tentatively suggested that sweet lupin seed contains a lectin-like of isoflavones combined to exercise showed significant improvements on protein that is concentrated in this fraction and may have wide scale use to combat obesity. How much this result do correspond to the human being is a matter of matter of body composition parameters which are recognised to influence CVD risks in solution of obesity epidemic or not is not known. Therefore, further purification and postmenopausal women. biological evaluation with obese mice to establish the exact nature of this protein and its Acknowledgment: This study is supported by CIHR (CHP 69439) and total physiological effects is warranted. Research Centre on Aging. MAL, IJD are supported by CIHR and AK is supported by FRSQ.

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A conventional interdisciplinary obesity management program: single center Triglycerides and BMI are associated with systolic dipping in the Oman Family experience with 300 patients Study

1 2 2 Müller Susan1, Ludescher Gerd1, Klatte Tobias2 Lopez-Alvarenga Juan Carlos , Jaju Deepali , Al-Yahyahee Saeed , Al-Barwani Sulayma2, Al-Hinai Ali2, Bayoumi Riad2, Hassan Mohamed2, Comuzzie Anthony 1 1 2 G Health Center, Schlosspark-Klinik, Berlin, Germany; University of California, Los Angeles, CA, United States 1Southwest Foundation For Biomedical Research, Texas, USA; 2Sultan Qaboos University, Oman Purpose: The represents a challenge. Here, we present 1-year results of an interdisciplinary, conventional approach. A more than 10% falling of daytime blood pressure (BP) during restful sleep is a Patients and methods: From 1999 to 2005, 300 patients were accrued to this normal physiological process (BP dip). Recent studies have shown that subjects prospective open-label study, which examined the effects of the conventional with a reduction in sleep BP dip (non-dippers) are at higher risk of cardiovascular obesity management program Optifast-52 (Novartis, Germany). There were complications. The is also known risk of increased 210 women and 90 men with a mean age of 46.9 years (SD, 12.1). The results cardiovascular complications. We examined the association between the were evaluated on week 0 and after 12 months. For statistical analysis, we components of metabolic syndrome and BP dipping in subjects of the Oman used a t-test, U-test and multivariate regression analysis. Family Study. Results: Mean weight loss was 20 kg (SD, 5; P<0.001). The mean BMI The study included 1124 subjects from 5 large Omani Arab pedigrees who have decreased from 40 kg/m2 (SD, 7) to 33 kg/m2 (SD, 6) (P<0.001). The mean witnessed a dramatic change in the lifestyle over the last 30 years. All subjects underwent anthropometric and biochemical measurements and 24 hour ambulatory serum concentration of triglycerides (164 mg/dl to 129 mg/dl, P<0.001), total BP monitoring (ABPM). Non-dippers were defined subjects who had less than cholesterol (226 mg/dl to 215 mg/dl, P<0.001) and low density lipoprotein 10% of systolic BP dip of daytime ABPM. cholesterol (138 mg/dl to 133 mg/dl, P<0.001) decreased, while the mean Multivariate analysis of variance was used to determine the effect of the concentration of high density lipoprotein cholesterol (HDL) significantly components of metabolic syndrome on systolic BP dip. Sex and pedigree were used increased (53 mg/dl to 57 mg/dl, P<0.001). The blood pressure decreased as blocks for stratification. Triglyceride measurement, waist circumference, fasting significantly (140/80 mmHg to 128/81 mmHg, P<0.001). The mean glucose serum glucose, HOMA, age, and BMI were included as independent variables. level dropped from 107 mg/dl to 94 mg/dl (P<0.001). In patients with Triglycerides and waist circumference showed important association (P<0.001) diabetes mellitus type 2 (n=34, 12%), the decrease in fasting plasma glucose with non systolic BP dip, however, waist circumference lost the effect in presence was pronounced (159 mg/dl to 123 mg/dl; P=0.01). Multivariate regression of BMI. HOMA had no effect on dipping. These findings support the hypothesis analysis revealed the baseline BMI and the weeks of program participation as that triglyceride is the most important metabolic component influencing systolic independent factors for BMI reduction. BP dip, and this may add to the cardiovascular burden of the metabolic syndrome. Conclusion: The conventional, interdisciplinary obesity management 1. Conflict of Interest: None Disclosed. program Optifast-52 showed significant long-term results. Patients with high 2. Funding: Research relating to this abstract was funded by Sultan Qaboos baseline BMI and diabetes mellitus type 2 benefited most. University, Oman.

International Journal of Obesity Abstracts S108 T3:PO.09 T3:PO.10

Patients with class III obesity given 15 mg/day sibutramine lose weight Impact of Weight Loss on Inflammatory Proteins in Obese Women

in amounts proportional to those in classes I and II, but waist 1 2 3 circumferences does not decrease proportionally Nasseri Esmat , Hosseini Mostafa , Dorosti Motlagh Ahmadreza , Djalali Mahmood3, Keshavarz S.Ali3 1 2 Lopez-Alvarenga Juan Carlos , Vargas-R Jose Antonio , Schneider- 1 2 2 1 National Nutrition And Food Technology Research Institute, Shaheed Ehrenberg Oliver Paul , Gonzalez Jorge , Comuzzie Anthony G , 2 2 Beheshti University Of Medical Science,Tehran, Iran; Department of Martinez Jose Luis Statistic, School of Public Health, Tehran University of Medical 3 1 2 Science,Tehran, Iran; Department of Nutrition and Biochemistry, School of Southwest Foundation For Biomedical Research; Altana Pharma SA De Public Health, Tehran University of Medical Science, Tehran, Iran CV, Nuclapan De Juarez, Mexico Background: Obesity increases the prevalence of the metabolic syndrome. Objective. Etiology, comorbidity, metabolism, and response to treatment Recent findings demonstrate closely relationship of inflammatory proteins vary across obesity class I, II and III. We evaluated the relationship with insulin resistance, and cardiovascular disease. It seems between obesity class and efficacy and tolerance to a daily dose of 15 mg weight loss would have beneficial effects on these proteins and enhancing of sibutramine. health. The aim of this study was to evaluate the impact of a hypocaloric diet Materials and methods. We analyzed a convenience sample of 701 on serum changes of inflammatory proteins in women. individuals from 47 health centers. All subjects received 15 mg Methods: Forty_two obese women (BMI 32.9 + 3.02; age 35.79 + 7.48 sibutramine daily for 8 weeks. Weight, height, and waist circumference years) without any additional disease were investigated. Body composition were measured at day 0 and weeks 4 and 8. was measured by bioimpedance analysis. Serum concentration of Results. Patients in all obesity classes lost proportional amounts of Adiponectin, TNF_ , IL_6 and CRP were analyzed before and after 10 weeks weight (P=0.86), but those with class III obesity had a lesser reduction in of a weight loss diet. waist circumference than those in classes I and II (P=0.003). Side effects Results: Subjects lost a mean of 5.01+ 2.3 kg (P<0.001) in response to the hypocaloric diet. Body mass index, waist circumference, waist to hip ratio of sibutramine were rarely observed. People with class III obesity and percent body fat all decreased significantly (P <0.001 and P <0.05). The exhibited even fewer side effects. reduction of IL_6 (5.9+1.7 vs 5.1+1.8; P <0.002), TNF_ (4.1+1.4 vs 3.8+1.3; Discussion. The lack of association between weight reduction and P <0.05) and increase in Adiponectin (9.81+4.1 vs 10.7+5.1; P <0.05) were decreased waist circumference across obesity classes could be related to significant. The CRP concentration After 10 weeks intervention decreased but differences in the sympathetic nervous system or the biodistribution of failed to reach to significant level. Fasting insulin, insulin resistance, sibutramine. Subjects with BMI greater than 40 may require a higher triglyceride level (P<0.001),total cholesterol, HDL_C and LDL_C (P<0.05) dose of sibutramine to lose the same proportion of abdominal fat as those decreased significantly. in other obesity classes. Conclusion: and weight loss improves a range of metabolic 1. Conflict of Interest: Altana Pharma supported this study, they are syndrome risk factors and enhancing health. distributors of sibutramine in Mexico.

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Four year follow-up of children and adolescents participating in an obesity Diet and lipids in the blood: which correlation? Appraisal on one Coorte intervention program of Italian subject

1 2 3 Reinehr Thomas , Kersting Mathilde , Tosche Michael Vanotti Alfredo1, Gini Anna1, Ponti Giada1

1 Vestische Hospital For Children And Adolescents, University Of 1 2 U.O. Clinical Nutrition And Dietetic ASL Como, Italy Witten/Herdecke; Research Institute of Child Nutrition Dortmund, University of Bonn; 3King’s College London, Division of Health and Social Care Research, UK Obesity increases the risk of cardiovascular diseases and acute coronary events. Different scientific investigations agree in supporting that diet Background: Since obesity affects children’s health and their social and weight decrease are closely associated with decrement of total integration, treatment concepts with long-term efficiency have to be cholesterol (TC),Triglycerides( TG )and LDL-C. developed. Important improvements in LDL-C and TG levels have been found in the Methods: We analyzed changes of weight status as standard deviation score first 2 months of weight decrease and are correlated to the percentage of of BMI (SDSBMI) quarterly in the first year and once a year during the next lost weight, while the recovery of the lost weight leads to one fallen back 3 three years in all obese children participating in the one-year outpatient of the concentrations of LDL-C and TG. intervention program “Obeldicks”, which was based on physical exercise, We analyzed 50 patients who followed a dietetic treatment. The results nutrition education, and behavior therapy. All analyses were performed on have been estimated after nearly 6 months: the medium weight decrease the intention-to-treat approach. is -9,20 kg, the medium reduction of the circumference life is -7,94 cm; Results: 170 children (mean age 10.5 years, 51% female, mean BMI 26.9 the medium reduction of the CT is -17,10 mg/dl, the medium reduction kg/m², mean SDSBMI 2.54) attended the “Obeldicks” intervention program. of TG is -27,02 mg/dl while the HDL-C hasn’t shown important Nineteen (11%) children dropped out during the intervention and nine (5%) in improvements (+ 1,11 mg). While between loss of weight and reduction the follow-up period. 131 children (77%) reduced their overweight at the end of TC and reduction of waist circumference and reduction of TG the of intervention and 122 (66%) 3 years after end of intervention (mean SDS- BMI reduction 0.41 at end of intervention, and mean SDS-BMI reduction correlation was not meaningful, more closely is the correlations between 0.48 3 years after end of intervention). The reduction of overweight 3 years loss of weight and reduction of TG (P < 0, 1) and between reduction of after end of intervention was independent of the child’s gender, age at circumference life and TC. The most interesting result is the correlation baseline, and parental age and BMI. Reduction of 0.33 SDS-BMI in the first 3 between reduction of TC and reduction of TG (P < 0,05). Therefore to months was the best predictor for long-term success (95% predictive value). obtain the best result and to improve the levels of blood’s lipid it is Conclusions: Participating in the one-year outpatient obesity intervention necessary to follow a diet with a controlled contribution of fat acids program “Obeldicks” was associated with a decrease of overweight, which saturate, cholesterol and carbohydrates and not only a generic decrease was sustained 3 years after end of intervention independent of age, gender, of weight. and parental weight status. Reduction of overweight in the first 3 months of the intervention was highly predictive for long-term success.

International Journal of Obesity Abstracts S109 T3:PO.13 T3:PO.14

Childhood trauma and obesity Serum Ghrelin, Leptin and Adiponectin Levels before and after Weight Loss: Comparison of Three Methods of Treatment 1 1 García De Amusquibar Ana María , Finkelsztein Carlos Alberto , Job 1 2 1 Alfredo1, De Simone Cecilia Jorgelina1 Kotidis Efstathios , Koliakos George , Baltzopoulos Vasilios , Ioannidis Konstantinos1, Yovos John3, Papavramidis Spiros1 1 Hospital Italiano de Buenos Aires, Argentina 1 Aristotle University of Thessaloniki, AHEPA University Hospital-Third Department of Surgery; 2Aristotle University of Thessaloniki, Department of Objective: to evaluate the frequency of childhood sexual abuse (C.S.A) and Biochemistry; 3Aristotle University of Thessaloniki, AHEPA University Hospital- family violence (F.V) in obese patients comparison with psychiatric First Department of Internal Medicine disorders´patients (DSM-IV). Method: 50 obese patients (group I: 31 females, mean age 45.7 years, B.M.I: Background: Ghrelin is a peptide hormone with orexigenic properties, primarily 48.04) and 50 patients (group II: 36 females, mean age: 44.3, BMI: 23.62) produced by the stomach. Leptin and adiponectin are the two adiposity products with psychiatric disorders (sleep disorders, mood disorders, anxiety disorders that participate in body weight control. Leptin always decreases and adiponectin and adjustment disorders) were interviewed. C.S.A. was considered as any increases after weight loss. Different changes in fastingghrelin levels have been sexual experience that included physical contact with a minor. Voyeurism, reported following . In this study, we compare the changes in exhibitionism and covert sexual abuse were excluded. Family Violence (FV) fastingghrelin, leptin and adiponectin levels in 3 groups of patients who achieved was defined as direct or indirect physical abuse against a child or at any other weight loss by either diet, MacLean vertical banded gastroplasty(VBG) or member of the family in child’s presence. Psychological abuse was excluded. biliopancreatic diversion with duodenal switch (BPD-DS). Results: 22% (n= 11) of obese and 6% (n= 3) of psychiatric patients had Methods: Serum fastingghrelin, leptin and adiponectin concentration was history of C.S.A. 34% (n= 17) of obese and 18% (n=9) of psychiatric patients measured in 40 obese patients who achieved weight loss by either diet (n=14), had history of F.V. C.S.A. showed a statistically significant difference VBG (n=13) or BPD-DS (n=13), before and after weight loss. The follow-up period was 18 months for BPD-DS and VBG and 6 months for diet. Serum ghrelin between the groups (P < 0,05). The statistical analysis showed a moderate level was measured by ELISA. trend for F.V. between the groups (P= 0,10). Results: BMI was significantly decreased in all 3 groups: 9.2±2.4% (P<0.01) Conclusions: C.S.A. and F.V. produce psychological, biological and social following diet, 38.47±7.26% (P<0.01) after VBG, and 42.88±9.09% after BPD-DS short and long-term effects. These childhood traumatic experiences may (P<0.01). Serum fastingghrelin level increased after diet (110.45±117.84%, increase the vulnerability to obesity. Childhood trauma research is essential to P=0.002) and VBG (65.48±92.93%, P=0.001), but decreased after BPD-DS (- understand the multifactor aetiology of obesity and to design the specific 21.63±28.63%, P=0.019). Leptin concentration decreased and adiponectin treatment. increased in all groups. -Buser A. et al. Outcome following gastric Bypass surgery- impact of Past Conclusions: Unlike after diet or gastric restrictive surgery, BPD-DS is associated Sexual Abuse. Obesity Surgery, 14, 2004, 170-174. with markedly suppressed ghrelin levels, possibly contributing to the weight- -Mc. Elroy S.; Allison D.; Bray G. Obesity and Mental Disorders. Taylor & reducing effect of this operation. Sleeve gastrectomy seems to be the main cause of Francis Group. New York. 2006. this reduction.

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Contour I treatment for non-invasive body contouring: Asian experience with Resting metabolic rate measurement in children: methodological issues 61 cases Amorim Paulo1,2,3, Byrne Nuala1,2, Hills Andrew1,2 1 1 1 1 Suh Dong-Hye , Son Ho-Chan , Chang Ka-yeun , Rhue Ji-Ho , Lee Sang- 1 2 Jun1, Eun Hwo-Won2 Institute of Health And Biomedical Innovation - QUT, Australia; ATN Centre for Metabolic Fitness, Australia; 3Biological Science Centre, Viçosa Federal 1 2 University, Brazil Anacli Dermatologic Clinc; Department of Raiology, College of Medicine, Ewha Womans University Objective: To verify the combined effect of body position, apparatus and

TM distraction on children’s resting metabolic rate (RMR). Contour I is a newly developed device for non-invasive body contouring. Methods: Experiments were carried out on 14 children aged 8-12 (mean age = This device uses the technology based on focused therapeutic ultrasound that 10.1 years ± 1.4). Each participant completed 2 test sessions, one week apart under selectively destroys fat cells without damaging other tissues. Destroyed and three different situations: a) using mouthpiece and nose-clip (MN) or facemask residual fat tissue is cleared from the body through natural processes. In this (FM); b) sitting(SEAT) or lying(LY) and c) TV viewing(TV) or no TV viewing. study, we present the clinical, radiological results of the Contour ITM In the first session, following 20 min rest and watching TV, the protocol was: LY: treatment. 61 healthy individuals with no underlying medical problems were 20 min – stabilization; 10 min using MN and 10 min using FM. Body position was treated with the Contour ITM. All volunteers have received only Contour ITM then changed to seated: 20 min stabilization; 10 min using FM; 10 min using MN. treatment. The body resion treated was abdomen. Patients were evaluated for In the second session FM and MN order was changed and participants did not treatment safety and efficacy. For safety evaluation, blood and urine analysis watch TV. Data were analysed according to the eight combinations among the and liver ultrasonography were performed at baseline and at 2months after three studied parameters. treatment. For efficacy evaluation, abdominal circumferences and body Results: Repeated measures ANOVA indicated statistically significant differences for VO (P=0.01) and RMR (P =0.02), with TVMNSEAT showing higher values weight were measured, and photographs were taken at baseline and each 2 than TVFMLY. Bland-Altman analysis showed a bias for VO2, VCO2, RQ and follow-up visit for 5 months. Twenty subjects were examined with computed RMR between TVFMLY and TVMNSEAT, respectively, of -17.8±14.5 (ml min), - tomography(CT) at baseline and 6 weeks and measured the area of 8.8±14.5 (ml min), 0.03±0.05 and -115.2±101.9 (kcal/day). subcutaneous fat layer. All blood and urine tests were within normal ranges Conclusion: There were no differences in RMR measurements due to body and liver ultrasonography revealed no pathological changes. Reduction in position and apparatus when each variable was isolated. Analyses of distraction in abdominal circumferences was noted in most participants. At 2 months after three of four combinations indicated no difference between TV and no TV. treatment, 4-6cm reduction was measured in 9 patients (14.8%), 2–4cm Different parameter combinations can result in increased bias and variability and reduction was measured in 40 patients (65.6%), and 0-2cm was measured in thereby reported differences in children’s RMR measurement. 12 patients (19.6%). At 5 months after treatment, 4–6 cm reduction was 1. Conflict of Interest: None Disclosed. measured in 4 patients (17.4%), 2–4cm reduction was measured in 14 patients 2. Funding: Research relating to this abstract was funded by CAPES BEX 1550 0 (60.9%), and 0–2cm was measured in 5 patients (21.5%). With CT scan, the 20. area of subcutaneous fat layer were reduced in all subjects.

International Journal of Obesity Abstracts S110 T3:PO.17 T3:PO.18

Prediction of the long-term success of the weight loss therapy in obese Evaluation of referral to Weight Watchers patients Poulter Jennifer1, Hunt Paula1 Jorga Jagoda1, Avramovic Dusan1 1Nutrition Works! Maidstone, UK 1School of Medicine, Belgrade, Serbia The aim of the present pilot study was to evaluate weight loss outcomes AIM: This study aims to answer if there exist a set of parameters that from a scheme enabling health professionals to refer their overweight can predict the long-term success of the different weight-reduction patients to Weight Watchers (WWs). During 2004 and 2005, 155 methods. individuals from 3 health regions in England were referred through METHOD: 99 adult obese patients (86 female and 13 male) were general practice for a course of WWs meetings (10–13 weeks). The followed-up for average 33 (30–36) months. Beside anthropometric health service subsidised patients’ attendance. Core selection criteria measurements, different parameters included restrained eating, included BMI (≥28kg/m²), age (≥18years), not pregnant or not taking depression and health related habits were recorded. at the beginning of anti-obesity medication. 134 (87.5%) of the referred patients enrolled at the therapy, at the end of the therapy. They were divided in four WW’s meetings. This sample comprised of 18 males; 116 females aged subgroups according to short term and long term success. SPSS between 20–80 years (mean 49.1 years) with a mean referral BMI of statistical package was applied for analyzing the data. RESULTS: Lower 39.2 kg/m². 78% of this group were obese. Overall, weight gain was baseline body mass (F(1,97) =7.166, P=0.009), the absence of co- halted in 122 patients (91% of those who enrolled and 79% of those morbidities(c2= 4.244; df=1; P=0.039), continued dieting (c2=7.421, referred). A total of 41 patients (31% of enrolled and 27% of referred df=1, P=0.006) and recreational physical activity (c2=12.299, df=3, patients) lost clinically significant amounts of weight (more than 5% P=0.006) after the therapy, as well as higher grade of the cognitive- initial weight). Mean weight loss of the enrolled group was - 3.8kg ± restrained eating (F(3,95)=4.487, P=0.005), are in statistically significant 4.41. Patients who regularly attended meetings lost more weight (-6.0kg relation to the long-term success in weight maintenance. ± 5.1) than those who attended less regularly (-1.4kg ± 2.8). The results CONCLUSION: According to data obtained in this study, factors that corroborate other studies, which suggest that weight loss results from can predict successful weight maintenance in obese person are: the lower Primary Care interventions are modest and that different approaches suit grade of obesity (lower baseline body mass, lower baseline Body mass different people. Clearly there is a need for well designed long term index, younger age with shorter duration of the obesity), lifestyle randomised trials of referral schemes like this. changes (dieting and regular physical activity after the therapy), and higher degree of the cognitive-restrained eating.

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A comparison of air displacement plethysmography and bioelectrical Relationship between Serum Lipid Profile and Bone Mineral Density impedance analysis in overweight and obese children and Serum Biochemical Marker in Pre and Postmenopausal Women

Radley Duncan1, Griffiths Claire1, Cooke Carlton1, Mackreth Peter1, Shin JinHee1, Song SangWook1, Hwang Yuna1 Gately Paul1 1The Catholic University Of Korea, St. Vincent's Hospital 1Leeds Metropolitan University Background: Many clinical studies have suggested that osteoporosis is Objective: The aim of the present study was to compare percentage associated with and cardiovascular diseases and the well body fat (PF) estimates using bioelectrical impedance analysis (BIA) known hypothesis is the effect of oxidized lipids on osteoblastic and with that determined by air displacement plethysmography in overweight osteoclastic cells. The purpose of this study was to evaluate the and obese children. relationship between bone mineral density and serum lipid profile, serum Methods: All participants had standardised BMI values >85th centile biochemical marker in pre and postmenopausal women. according to National Centile Charts. 302 males: age 13.9±1.7 y, BMI Methods: We evaluated 137 women who had undertaken health 32.8±6.6 kg.m-2, PF ADP 40.8±9.6 %, and 354 females: age 14.5±1.8 y, screening including BMD measurement and did not have any disease BMI 33.8±6.2 kg.m-2, PF ADP 44.2±7.2 %, were assessed. BIA PF affecting lipid or bone metabolism from November 2005 to May 2005 at estimates were obtained at 50 kHz using a foot-plate system device a health promotion center. (Tanita TBF-310) and the inbuilt manufacturer prediction equations. We surveyed information concerning the past history and the amount of ADP PF measurements were obtained using the child-specific thoracic exercise et al by means of the self-questionnaire records. And serum gas volume prediction equations of Fields (2004) and the age and ALP, osteocalcin as bone formation marker, urine deoxypyridinoline as gender-specific body density conversion equations of Lohman (1989). bone resorption marker and bone mineral density by DXA were Results: BIA estimates of PF were significantly correlated with those of measured. ADP (males r=0.80, females r=0.68; both P<0.001). BIA significantly Results: There was no significant relationship between serum lipid underestimated mean PF compared to ADP (males -3.6 %, females -1.7 profile and BMD regardless of menopause in multi regression analysis. %; both P<0.001). According to the methods of Bland and Altman, the In menopausal women, TC and LDL-C were positively correlated with ±95 % limits of agreement were slightly higher in males (±12.0 %) than urine deoxypyridinoline (P=0.042, 0.031), and LDL-C was positively females (±10.4 %). Further, correlation on the Bland and Altman plots correlated with serum ALP (P=0.020). revealed a significant bias as a function of increasing PF in females (r = - Conclusion: There was no correlation between serum lipid profile and 0.45; P<0.001). BMD regardless of menopause, and LDL-C was positively correlated Conclusion: On an individual basis there may be large discrepancies with some of biochemical markers in postmenopausal woman. The between BIA and ADP PF estimates. Results from devices are therefore larger prospective study will be required to get more proper conclusions. not interchangeable in overweight and obese children.

International Journal of Obesity Abstracts S111 T3:PO.21 T3:PO.22

White blood cell count as a marker of metabolic syndrome in obese women Sleep-Wake Cycles in Obese Children with and without Binge Eating Episodes Bayraktaroglu Taner1, Sertkaya Cikim Ayse1, Dogan Azezli Adil1, Orhan 1 Yusuf Latzer Yael1, Tzischinsky Orna2, Givon Miri3

1 Istanbul University Istanbul Faculty Of Medicine Endocrinology And 1Faculty of Social Welfare and Health Studies, University of Haifa Haifa, Metabolism 2 Israel; Department of Behavioral Studies, Emek Yezreel College, Emek 3 INTRODUCTION Yezreel, Israel; Eating Disorders Clinic, Psychiatric Division, Rambam Studies observed an association between the WBC count and obesity. The Medical Center, Haifa, Israel decreement in WBC count with loss of weight in obese subjects was reported. In this study, we aimed to evaluate WBC value and its association with Objective: The aim of the study was to assess binge-eating episodes and metabolic syndrome (MSX) in overweight and obese Turkish women. to characterize sleep-wake cycles among obese children. MATERIAL AND METHODS Method: The Obese group consisted of 36 children. All participants The study population consisted of 2531 women with BMI of 25 kg/m2 or received a diagnosis of primary obesity, with no psychiatric or organic greater, classified as overweight (BMI>=25 kg/m2, n=472) or obese background. The Obese group was subdivided into two groups: Obese 2 (BMI>=30 kg/m , n=2059) by National Institutes of Health and WHO with Binge Eating and without Binge Eating. A Normal Weight control criteria. We used The Adult Treatment Panel III (ATP III) criteria, which group was comprised of 25 normal weight children. Sleep-wake patterns have been proposed bye the National Cholesterol Education Program for were monitored for one week, using mini-actigraphs and self-report diagnosis of MSX. They divided two groups according to median WBC questionnaires. counts. Demographic and antropometric characteristics, blood glucose, Results: Thirty-seven percent of the obese children reported insulin and lipid concentrations, and the indices of insulin resistance and uncontrolled binge eating episodes. Actigraphic monitoring revealed iflammation were determined and compared between groups. significant differences in sleep quality between all three groups. Self- FINDINGS Median WBC value was 7.200/ uL. Therefore, our patients were divided two report questionnaires presented significantly more sleep disturbances in groups according to median WBC counts; group 1(women with low WBC the Obese group with Binge Eating and Obese group without Binge count < 7.200/uL) and group 2 (women with high WBC > 7.200/uL). The Eating than in the Normal Weight group. relationship between MSX and WBC count demostrated in groups. Discussion: sleep disruption in Obese children with Binge Eating is CONCLUSION significantly more severe than in both Obese non-Binge Eating children In this study, patients with overweight and obesity, we observed that high and Normal Weight controls. WBC group showed more metabolic anomalies than low WBC group. The values of metabolic variables in high WBC group were significantly higher than those of low WBC group. In conclusion, WBC count may be considered as a marker of metabolic syndrome in Turkish overweight and obese women.

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Thiamin status after bariatric surgery according to intervention Long term thiamin, folate and B12 status after adjustable gastric banding (AGB)

1 1 2 2 2 Andrieux Severine , Seguy David , Arnalsteen Laurent , Tone Florian , Pattou François , 1 1 2 2 1 Andrieux Severine , Seguy David , Arnalsteen Laurent , Eberle Carole , Romon Romon Monique Monique1, Pattou François2

1 2 Nutrition Unit Universitary hospital Lille; Endocrine surgery unit Universitary hospital 1Nutrition Unit Universitary Hospital Lille; 2Endocrine Surgery Unit Universitary Lille hospital Lille Objective: Early complications such as neuropathies and Gayet-Wernicke encephalopathies are not uncommon both after restrictive and malabsorptive bariatric Objective: Adjustable gastric banding(AGB) is considered as a safe procedure surgery. The aim of this study is to compare the influence of 3 types of intervention: because of the lack of iatrogenic induced malabsorption; The aim of this study is to adjustable gastric banding (AGB), gastric by-pass (GBP) and bilio-intestinal by-pass follow vitamin B12, folate and thiamin status of massive obese subjects for 5 years (BIB) on thiamin status in the first year post operative. after gastricbanding. Methods: a prospective follow up of 334 obese subjects BMI=49,8 ± 7,7 (260 females), Methods: Prospective follow up of 190 massive obese subjects (159 females), age 41,2 ± 9,2 year-old, who had undergone bariatric surgery between 1998 and 2004 : 190 40,9 ± 9 year-old who had undergone an AGB between 1998 and 2004. Thiamin, AGB, 60 GBP and 84 BIB. Weight and serum thiamin levels were assessed folate and B12 levels were evaluated before and at 3, 6, 12, 24 and 60 months after preoperatively and at 3, 6 and 12 months after surgery. Comparison were calculated with surgery. ANOVA for repeated measures was used for comparisons. ANOVA for repeated measures for two factors, time post op and intervention Results: At 60 mo, BMI decreased from 47.7(5.9) to 37.6(7.2). B1:and B12 Results: At 12mo, weight loss did not differ between interventions.There was a decreased significantly : B1: 133 (27) to 109 (25) nmol/l (p= .0001) and B12 : 0.40 significant effect of intervention (p=0.012): thiamin status decreases after AGB and GBP, (0.17) to 0.30 (0.22) ng/ml( p< 0,001). Folates levels did not change. but not after BIB.

Thiamin (nmol/l) PO 3 mo 6mo 12mo P Table: Percent of patient in the deficient range

AGB( SD) 123 (27) 114 (27)117 (29)115 (21) 0.002 % patient in GBP (SD) 130 (33) 85 (23) 93 (20) 106 (26) <0.0001 deficient range 0 3 mo 6 mo 12 mo 24 mo 60 mo BIB (SD) 113 (26) 121(26) 119 (28) 121 (27) NS Thiamin 11 25 17 16 25 31 Folates 5 5 7 5 3 6 At 6 months, 70% of subjects after GBP and 26% of subjects after AGB were in the B12 8 11 10 11 15 16 deficient range (<95nmol/l) . Conclusion: Early thiamin deficiency risk occurs after restrictive surgery but not after Conclusion: Long term vitamin deficiencies are not uncommon after AGB, long malabsortive surgery, it thus could be due to decreased food intake. These results suggest term B12 supplementation and screening for thiamin levels are necessary. that thiamin supplementation should be systematic at least the first six months after restrictive surgery.

International Journal of Obesity Abstracts S112 T3:PO.25 T3:PO.26

Effects of multidisplinary therapy on eating disorders in obese Short-term changes on the NAFLD prevalence in obese adolescents submitted a multidisciplinary therapy with metformin adolescents Tock Lian1, Prado Wagner1, Caranti Danielle1, Piano Aline de1, Lofrano Mara1, Cristofalo Carnier June1, Prado Wagner1, Caranti Danielle1, Piano Aline1, Lofrano Dejaldo1, Lederman Henrique1, Tufik Sergio1, Mello Marco1, Dâmaso Ana1 1 1 1 1 1 Mara , Tock Lian , Mello Marco , Tufik Sérgio , Nascimento Cláudia , 1 Oyama-Dâmaso Leila-Ana1 Federal University Of São Paulo - Paulista Medicine School, Brazil Introduction: Despite the increasing prevalence of non-alcoholic 1 Federal University Of São Paulo - Paulista Medicine School, Brazil (NAFLD), its pathogenesis and clinical significance remain poorly defined and there is no better treatment. Although there is no accepted pharmacological treatment that can Eating disorders are often associated with obesity. Some investigators reverse fatty liver disease, all patients should be given a low fat diet, insulin resistance- lowering agents and encouraged to practice exercise. fear that dieting may precipitate binge eating and other adverse behavior Objective: The purpose of this study was to assess the short-term (12 weeks) changes on consequences in obese. The aim of this study was to examine the effect the NAFLD prevalence and insulin resistance in obese adolescents. of multidisciplinary therapy on eating disorders in obese adolescents. Methods: The inclusion criteria were primary obesity(IMC>30 wt/ht2), insulin Twenty obese adolescents (12 girls and 8 boys) aged between 14 and 19 resistance and/or NAFLD diagnostic. 21 obese adolescents were submitted a 2 multidisciplinary lifestyle intervention (aerobic exercise and nutrition)plus metformin y, with simple severe obesity with BMI > 30 Kg/m (36.93 + 4.14) were (500mg twice daily). The visceral/subcutaneous adiposity and NAFLD were measured at submitted to short-term multidisciplinary therapy (nutrition, psychology, pre and post-intervention by ultrasonography. Fasting blood samples were collected to exercise and clinical support) during 12 weeks. It is important to notice, measured glucose and insulin. Test t assessed the differences between times for dependent that nutritional therapy was not based in energy restriction but in samples. nutritional education. Bulimic behavior and binge eating were measured Results: Control Metformin by bulimic investigation test Edinburgh (BITE) and binge eating scale Before After Before After (BES) respectively. After program the entire group reduced body mass BMI (wt/ht2) 36.16 ± 3,24 34.62±3.32* 34.41 ± 3.90 33.30±3.91* (101.04 + 11.18 to 94.79 +10.94 Kg), BMI (36.93 + 4.14, to 34.27 + NAFLD % 75 33* 50 25* 2 4.78 Kg/m ), fat % (41.96 + 6.28 to 39.14 + 7.62 %) and leptin (20.12 + HOMA 4.31 ± 1.63 3.61 ± 1.45* 5.10 ±1.63 4.45 ± 1.04* 6.47 to 16.68 + 8.08 ng/ml). At baseline 62.50% of the boys and 25% of Visceral (cm) 4.33 ± 1.46 3.49 ± 1.15* 3.99 ± 1.01 3.43 ± 1.53* the girls presented some symptom of bulimic behavior and post therapy Subcut (cm) 3.40 ± 0.66 2.91 ± 0.72* 3.22 ± 0.60 2.97 ± 0.87* we verified a decrease to 25% and 10% in both genders. Symptoms of Conclusion: Our results suggest that short-term multidisciplinary therapy with or without metformin use can be improve and prevent NAFLD and insulin resistance associated to binge were observed in all (100%) of the subjects at obesity in adolescents. baseline and the treatment promoted a reduction in these values to 62.5% and 70% in boys and girls respectively. In this way, short-term multidisciplinary therapy was effective to improve body composition and eating disorders in obese adolescent.

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The effects of 12-week Low Glycemic Load Diet based on Low Glycemic Index foods in Variation in postprandial peptide YY3-36 status following ingestion of high overweight / obese children carbohydrate, high fat and high protein meals in male subjects with metabolic Fajcsak Zsuzsanna1, Kovacs Viktoria1, Gabor Anita1, Szamosi Tamas2, Martos Eva3 syndrome

1 1 1 1 1Semmelweis University, Faculty of Physical Education Sport Sciences, Budapest, Hwalla Nahla , El Khoury Dalia , Obeid Omar , Kalopissis Athina , Chambaz Hungary; 2Semmelweis University II. Childrens Clinic Budapest Hungary; 3National Jean1 Institute for Food Safety and Nutrition Budapest Hungary 1American University Of Beirut, Beirut, Lebanon Objective: To evaluate the effectiveness of a 12-week low Glycemic Load (GL) diet intervention based on low Glycemic Index (GI) foods on body weight, body composition, metabolic risk factors and satiety in overweight/obese pre-pubertal children. The purpose of this study was to investigate the postprandial response of Methods: 13 healthy, 11.46 ± 1.94 yr old, Caucasian, pre-pubertal overweight/obese peptide YY3-36 (PYY3-36) to varied macronutrient composition, in adult (BMI=28.38±5.86 kg/m2) children participated in Low-GL diet intervention; was based males with metabolic syndrome. Nine adult males with metabolic syndrome on the replacement of at least 50% of the high GI foods with Low-GI foods and received, on separate occasions, a high carbohydrate (HC), a high protein participation in weekly nutrition consultations. Dietary changes were made based on (HP) and a high fat (HF) meal. PYY3-36 levels increased significantly weekly 4-day food-diaries. following the three meals. The HC meal induced a significantly higher Results: There was a significant (p<0.05) reduction in Body weight (BW) (68.08 ± 22.03 vs. 65.64 ± 22.12 kg), BMI (28.38 ±5.86 vs. 27.09 ± 6.2kg/m2), fat mass (26.02 ±12.8 vs. increase in postprandial PYY3-36 levels (10.00±1.837pg/ml), as compared to 23.64 ±12.8 kg) % body fat (36.82 ± 6.1 vs. 33.81 ± 7.4), Waist circumference (WC) HP (3.68±0.990pg/ml) and HF (0.05±2.269pg/ml) meals (P < 0.05). Changes (95.73 ± 14.01 vs. 90.76 ± 14.26 cm), hip circumference (97.23 ± 13.37 vs. 93.34 ± 18.80 of PYY3-36 from baseline, at different time points, showed that the HC meal cm), thigh circumference 59.08 ± 7.9 vs. 56.80 ± 8.1 cm), fasting blood glucose (4.85 ± resulted in a significantly higher peak of PYY3-36 (22.19±5.226pg/ml), at 0.24 vs. 4.46 ± 0.31 mmol/l) and insulin 18.51 ± 7.80 vs. 12.30 ± 6.44 mU/ml). There time 30min, as compared to HP (9.39±2.448pg/ml) and HF was a significant decrease in self-reported hunger level 3.46 ± 0.92 vs. 1.51 ± 1.11. There (10.44±2.563pg/ml) meals (P < 0.05). At 240min, HP meal maintained was a strong correlation between BW and WC (r=0.97), after the study (P<0.05). significantly higher mean PYY3-36 levels (56.845±pg/ml) than baseline as Conclusions: 12-week Low-GL diet consultations significantly reduced BW, improved body composition, circumference measures, fasting glucose, insulin and hunger levels, compared to HF meal (-10.144±pg/ml) (P < 0.05). Postprandial insulin levels with cardiovascular risk factors in overweight/ obese children and showed practical, increased significantly higher following the HC meal and the HP meal effective approach treat obesity in children. (+95.28±15.323uU/ml and +91.69±13.508uU/ml, respectively) than the HF 2. Funding meal (+52.17±10.288uU/ml) (P<0.05). A positive correlation was found Research relating to this abstract was funded by Dr Viktoria Kovacs. between PYY3-36 and insulin. These results indicate that a relationship exist between nutrient composition of meals and extent and duration of increase of the satiety hormone PYY3-36, and that, in metabolic syndrome, carbohydrates promote a greater increment in postprandial PYY3-36 response than protein and fat, while protein maintains a longer-term postprandial elevation of PYY3-36 than fat. Results, also, support a role for insulin in meal-induced PYY3-36 release. This study was supported by the American University of Beirut.

International Journal of Obesity Abstracts S113 T3:PO.29 T3:PO.31

Exercise or exercise-induced weight loss improves insulin sensitivity in The effects of weight reduction therapy at 5 – and 10 – year follow-up overweight or obese children? Zahorska-Markiewicz Barbara1, Olszanecka-Glinianowicz Magdalena1, Pilch 1 1 Kovacs Viktoria1, Fajcsak Zsuzsanna1, Gabor Anita1, Martos Eva1 Anna , Koceak Piotr

1 1Semmelweis University, Budapest, Hungary Department Of Pathophysiology Medical University Of Silesia Introduction: The weight reduction program consist of 5 booklets for each OBJECTIVE: Although multiple studies have showed the beneficial effect successive visit during the 3 months slimming treatment, with following of exercise on glucose metabolism, the mechanisms are still not clear. The components: nutrition, behaviour modification, physical activity, self assessment HOP (Hungarian Obesity Prevention) Programme was planned to describe the and social relationships. associations between exercise-induced changes in body composition, The aim of present study was to asses the effects of “ The weight reduction cardiovascular fitness and insulin sensitivity. DESIGN Selfcontrolled, pre- program” at 5 and 10 – year follow – up. post study. Material and methods: The study was carried out on 804 obese subjects treated in PARTICIPANTS: 38 previously inactive overweight or obese children (20 Metabolic Outpatient Clinic in 1993-1995 years. Then, in 1999, a questionnaire girls, 18 boys; 10.0 ± 1.3 yrs, fat mass 34.6 ± 5.3 %) took part in the trial. concerning actual body mass and lifestyle habits was send to patients. 10 – year INTERVENTIONS: Children attended a 15-week-long after-school follow – up was obtained by phone contact. endurance training programme (3 days/week, 60 minutes/session, 70-85% Results: 366 persons ( 45,5%) answered to questionnaire at 5 and 10 – year contact HRmax). The participants received no dietary intervention during this period. with 205 persons (25,5%) was obtained. MAIN OUTCOME MEASUREMENTS: At baseline and after 15 weeks body composition, anthropometric indexes, fasting glucose and insulin, After n n subjects % of the % of the HOMA-IR and cardiovascular fitness (CVF) based on time to exhaustion and study study subjects population aerob capacity were measured. - ∆ + ∆ - + - + RESULTS: Exercise increased muscle mass (P=0.006) and CVF (P=0.008) kg kg and decreased waist circumference (P=0.0001). There were no significant 5years 366 254 - 6.0 112 5,0 69.4 30.6 32.0 14.0 10years 205 82 - 6.3 123 8,4 40.0 60.0 10.0 15.0 changes in BMI, body fat (BF), fasting insulin or in HOMA-IR, although all these parameters were affected favorable. Change in BMI showed a - decrease weight, + increase weight significant positive correlation with change in fasting insulin (r=0.42; We observed that such factors as age, obesity in the members of family, results of previous weight loss treatment had no influence on the appearance of the yo-yo P=0.01) and with change in HOMA-IR (r=0.45; P=0.006). effect. However such factors as preference for meat and sweets, eating meal at CONCLUSION: Although limited by the small number of participants and night, low physical activity and cessation of paid work significantly influenced the no control group, our results suggest that decrease in BMI is required to have probability of weight gain. effect yo-yo. positive effect of endurance training on glucose metabolism in overweight or Conclusions: We observed lower body mass than before treatment after 5 – year in obese children. 30% and after 10 – year in 10% population include to the program.

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Effects of high-sucrose diet on plasma glucose and leptin levels in lean and The combined effect of adiposity, fat distribution and age on cardiovascular risk factors overweight women and motor disability in a cohort of obese women (aged 18–83)

1 1 2 1 1,2 2 2 2 Sartorio Alessandro , Agosti Fiorenza , Adorni Fulvio , Silvestri Piergiancarlo , Lafortuna Bressan Josefina , Hermsdorff Helen , Viana Mirele , Volp Ana Carolina , Claudio3 Santos Rosana2 1Italian Institute for Auxology, Milan & Verbania, Italy; 2ITB, CNR, Milan, Italy; 3IBFM, 1University Of Navarra, Spain, 2Federal University of Viçosa, Brazil CNR, Milan, Italy

The leptin may be influenced by macronutrient content of diet and by uptake The study aims to evaluate the combined effect of degree of adiposity, body fat distribution and age on selected cardiovascular risk factors and functional motor disability and utilization of glucose on adipose tissue. This study investigated the effect in obese women. A multivariate analysis of variance is employed to estimate the of sucrose and lipid loads in weight-maintaining diets in lean (LG) and combined impact of BMI, WHR and age on systolic and diastolic blood pressure (SBP overweight (OG) women. Subjects were LG (n= 13, 22.5 ± 2.1 years; 22.2 ± and DBP), total and HDL cholesterol (T-CH and HDL-CH), coronary heart disease 2 ± ± 2 (CHD) risk, leg power output (W& ) and subjective general fatigue in a cohort of 463 1.9 kg/m ) and OG (n= 7, 21.8 2.8 years; 28.4 3.2 kg/m ). The women 2 completed 14 days with high sucrose diet (23% energy meal) (HSD) or high obese women (BMI range: 30.2–66.7 kg/m ). High WHR and older age, but not BMI, are to a variable degree related to unfavourable values of parameters which contribute to the fat diet (46% energy meal) (HFD). Anthropometry and body composition by cardiovascular risk. WHR in the high range is associated with higher values of SBP bioelectrical impedance were evaluated before and after test diet intake. (P<0.001) and CHD risk scores (P<0.001), and lower levels of HDL-CH (P=0.01), while Blood sampled in fasting, and 30, 60, 180 and 240 minutes after of the meal older age is associated with higher SBP (P<0.001), T-CH (P<0.001) and CHD risk scores intake. The leptin values were larger for OG during in fast and postprandial, (P<0.001). A significant interaction between age and WHR was detected in the effect on compared with LG (P<0.05). In addition, all leptin concentration postprandial DBP (P=0.01), the negative role of high WHR values being apparent in older women (age associated positively with the glucose concentration of 30 (P<0.01) and 60 ≥ 51 yr.) but not in younger ones (age < 51 yr.). Although not significantly related to (P<0.05) minutes postprandial after HSD intake. The difference of plasma CHD risk scores, BMI interacted significantly with WHR in determining high risk score values (P=0.01), the negative effect of a high WHR being apparent in women with a high leptin concentration between the groups confirms the relationship of plasma 2 degree of obesity (BMI ≥ 40 kg/m2) but not in those with a low one (BMI < 40 kg/m ). In leptin and body fat according to scientific literature. The association between contrast, WHR did not significantly affect W&, which appeared to be mainly dependent glucose and leptin concentration only after HSD suggests that higher on age (P<0.001) and also on BMI (P<0.001), when considered in terms of unit body carbohydrate intake, with consequent glucose concentration increase, might mass. Subjective global fatigue, however, was unaffected by any of the factors stimulate the insulin secretion that would mediate the glucose uptake and considered. Older age and excessive abdominal fat distribution appear to be significant utilization in the adipose tissue and would stimulate the leptin secretion, factors in relation to increased cardiovascular disease risk, irrespective of BMI, while while HLD would have weak effect on secretion. The manipulation of the diet older age and higher levels of overall adiposity are associated with functional motor derangement irrespective of body fat distribution. This suggests that obesity increases composition, associated to endocrine alterations appears to be an important metabolic risk and induces motor dysfunction by means of different biological factor on the prevention or control of obesity. mechanisms and with a different impact within the obese female population. Research relating to this abstract was funded by CAPES/FAPEMIG. None Disclosed.

International Journal of Obesity Abstracts S114 T3:PO.34 T3:PO.35

Dietary carbohydrate and alcohol are associated with a reduced prevalence of the Weight loss, metabolic improvement and reduction of liver volume in obese metabolic syndrome women after gastric banding

1 1,2 2 1,2 Skilton Michael , Laville Martine , Moulin Philippe , Bonnet Fabrice Giannetti Monica1, Santini Ferruccio1, Fierabracci Paola1, Anselmino Marco2, 2 1 1 1 1 2 Solito Biagio , Scartabelli Giovanna , Marsili Alessandro , Ricco Ilaria , Galli Centre de Recherche en Nutrition Humaine Rhone-Alpes, Lyon, France; INSERM Giulia1, Pinchera Aldo1 U449-INRA 1235, Lyon, France 1Department Of Endocrinology And Metabolic Diseases, University Hospital Background: We sought to examine the association of the proportion of dietary 2 carbohydrates, protein, fat (including fatty acid subtypes) and alcohol with the Of Pisa, Italy; Department of General Surgery, University Hospital of Pisa, metabolic syndrome (MetS) and its components. Italy Methods: We studied 1628 patients (mean age=52.1y, 61% males), with at least one cardiovascular risk factor. Dietary intake was assessed via a seven-day dietary A strong relationship between liver enlargement and various cardiovascular recall. Multivariate nutrient density substitution models were used to examine the risk factors has been demonstrated in obese women, supporting the view that associations between macronutrients and the MetS. These demonstrate the effects liver steatosis should be included among the many facets of the metabolic of “substituting” one macronutrient for another under isocaloric conditions. syndrome. Results: Increases in carbohydrates offset by equicaloric decreases in either fat or The aim of this study was to evaluate the relationship between reduction of protein were associated with a decreased prevalence of the MetS (OR=0.87 body weight, abdominal adiposity and liver volume, and the improvement of [95%CI 0.81–0.94], P=0.002 & OR=0.70 [95%CI 0.62–0.80], P<0.0001 metabolic parameters, which follows weight loss achieved by gastric banding. respectively). Increased intake of dietary fat at the expense of dietary protein also Twenty-five severely obese women (mean age 45 ± 10 yr; mean BMI 44 ± 5 decreased the prevalence of the MetS (OR=0.81 [95%CI 0.70–0.93], P=0.002). Kg/m2) were enrolled. Subjects underwent adjustable gastric banding and the These were mediated via abdominal obesity and impaired fasting glucose. There postoperative follow-up was 16 ± 8 months. On average, a significant were no statistically significant differences between fatty acid subtypes (P>0.10). Consumption of up to one standard alcoholic drink per day reduced the probability reduction of the following parameters was observed: BMI (22%), ultrasound of the MetS compared with non-drinkers (OR=0.63 [95%CI 0.47–0.84], P=0.002), measured abdominal sagittal diameter (35%) and hepatic left lobe volume however these benefits were weakened with increased intake (P=0.09 for both 2–3 (44%), serum glucose (12%), triglyceride (24%), uric acid (20%), AST & more than 3 drinks). These were due to reductions in the prevalence of (21%), ALT (35%), GGT (37%), ALP (11%), insulin (36%) and leptin abdominal obesity and low HDL cholesterol. None of these findings were (48%). The reduction of BMI was independently related to the reduction of ≥ serum leptin, while the reduction of liver volume was independently influenced by age, sex or physical activity (PHETEROGENEITY 0.10). Conclusions: A diet high in carbohydrates, low in fat and protein and associated with reduction of serum glucose, triglyceride, uric acid, AST, supplemented with low-to-moderate alcohol intake may be protective against the ALT, GGT, ALP and insulin. No significant independent association was MetS. found between the abdominal sagittal diameter and various serum parameters. Skilton was supported by a fellowship from the Fondation pour la Recherche In conclusion: Ultrasound measurement of hepatic left lobe volume is a Médicale. simple, reliable and low-cost tool for estimation of liver volume in obese subjects. Reduction of liver volume is a powerful indicator of metabolic improvement after weight loss achieved by gastric banding.

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Nutritional status and oral diet assessment of patients with chronic viral Frequency of cardiovascular diseases in obese perimenopausal women Hepatitis C with high fasting glycemia

1 1 Irnius Algimantas , Gaveliene Edita Izmozherova Nadezhda1, Popov Artem1, Tagiltseva Natalia1, Andreyev Arkady1 1Vilnius University Hospital 1The Urals State Medical Academy The aim was to estimate the nutritional status and composition of oral diet of patients with viral hepatitis C (VHC). Patients: 65 males and 59 females with chronic VHC, 25-60 year of age, with normal blood proteins, cholesterol and glucose, without ascitis and edemas. High fasting glycemia (HFG) and Impaired Glucose Tolerance (IGT) Nutritional status assessment (NSA) was performed by anthropometric have been reported to be more frequent than type 2 diabetes mellitus measurements: body mass index (BMI), mid-arm muscle circumference (DM). HFG and IGT increase the risk of 2 type diabetes mellitus 4 – 9% (MAMC), triceps skin fold (TSF). Personal dietary history was obtained a year. using a dietary recall technique. The questionnaire, provide information on Aim: to assess cardiovascular diseases frequency in perimenopausal food intake, eating habits before diagnosis of VHC and after, food variety. women with HFG. Results. 47,7 % males and 50,8 % females were normally nourished (BMI Methods: 367 women (median age 54) gave informed consent to take =20-25). 6,2% males and females were malnourished (BMI<20) and 12,3% part in a case-control study. The main group consisted of 133 patients males and 11,9% females were obese (BMI >30). Severe depletion of with HFG (WHO 1999 criteria). The control group included 266 women subcutaneous fat mass (TSF <7,5 mm for males and <9,9 mm for females) without glucose metabolism impairment adjusted by age and was estimated for 27,7% males and 10,1% females. Half of participants postmenopause longevity. Anthropometry, lipids and glucose changed there eating habits to regular and healthier eating after disease was metabolism parameters, frequency of arterial hypertension (AH), diagnosed. 63,1% males and 76,3% females consumes fish and sea products coronary heart disease (CHD), myocardial infarction (MI), chronic heart les then twice a week. 27,7%males and 22,1% females consumes milk and milk products les then twice a week. About 90% of participants vegetables failure (CHF), cerebrovascular events (CVE) were registered. and fruits consumes every day. Results: median waist circumference was 92.0 (25%–75%: 84.0÷98.0) Conclusions. The results emphasize the importance of NSA for the patients cm in the main group and 84.0 (78.0÷91.0) cm in the control group with VHC to prevent and obesity. (<0.001). HFG patients had more severe menopausal symptoms and Diet, which is adequate in healthy individuals, may not be adequate in the significantly higher frequency of CHD (17.3%) and CHF (42.9%). presence of viral hepatitis. For these reason, every patient must be informed Meanwhile, in the control group CHD was diagnosed in 7.6% (P=0.008) about necessity of various, well balanced, palatable diet with adequate intake and CHF was found in 32.4% (P=0.027) of patients. of calories, protein, vitamins and minerals. Conclusion: HFG in perimenopausal women is associated with more severe menopausal symptoms and increased frequency of cardiovascular diseases.

International Journal of Obesity Abstracts S115 T3:PO.38 T3:PO.39

Study of plantar pressure distribution on the feet of obese school-age Baroreflex sensitivity in obese patients with and without features of children metabolic syndrome

Pavlaèková Jana1, Hlaváèek Petr1, Baïurová Jitka1, Janušková Petra1, Svacinova Hana1, Necasova Jana1, Rosenbergova Blanka1, Siegelova Sixtová Petra1 Jarmila1, Fiser Bohumil1, Svoboda Ladislav1, Zeman Dalibor1

1Tomas Bata University 1Faculty Hospital St. Anna, Masaryk University Brno, Czech Republic

Aims: Obesity is one of the causes overburdening the organisms of Objective: The aim of the present study was the evaluation of baroreflex children, which may result in the occurrence of various orthopaedic sensitivity (BRS) in obese patients (OB), in obese patients with difficulties. The goal of our study was to determine the impact of obesity hypertension (OBH) and with hypertension and diabetes mellitus type 2 on the occurrence of plantar pressures on obese children’s feet and to (DM). compare the acquired results with the non-obese child population. Design and Methods: BRS was evaluated altogether in 58 obese Methods: According to body weight and height, 40 girls and 40 boys patients, in three groups: OB (n =13, age 51,7± 8years, BMI 35,7±5), in were selected in age from 8 to 10 years of age, in such a way as to OBH (n = 20, age 56±6, BMI 36,7±4,9) and in DM (n = 25, BMI 34±5, provide equal representation of subjects among normal, increased, age 54,6±6). BRS was determined by spectral analysis of spontaneous excessive weight and obese subjects. For each subject, the fluctuations of systolic blood pressure and cardiac intervals (Finapres, 5 anthropometric characteristics of the feet were measured. The Emed min record, metronome-controlled breathing at frequency 0,33Hz). system was used to measure plantar pressures on the feet. In addition to Statistical analysis of the data: unpaired t-test; P<0.05 was considered pressures, the contact areas of the feet and the energy applied to them statistically significant. All groups were age and BMI matched. were evaluated. These monitored values were also determined for the so- Results are presented as a mean (±SD). Differences in BRS (ms/mmHg) called masks describing the children’s feet. between OB (6,9±3,6) and OBH (6,6±3) were not significant. The Results: For overweight or obese subjects, not only were higher average comparison of DM (4,7 ± 2,5) vs. OB and OBH shows the statistically plantar pressures determined but also maximum pressures were also significant differences in BRS. noted in comparison with subjects with normal body weight. Also Conclusion: Baroreflex sensitivity was significantly lower in obese recorded was a higher occurrence of flat foot among obese subjects. The patients with diabetes mellitus and hypertension than in obese foot is proportionately larger with increasing body weight. normotensives or obese with hypertension.. There no difference between Conclusions: The status of stress on children’s feet may still worsen obese normotensives and obese with treated hypertension. with defective or inappropriate footwear, which are standard in design Supported by MSM 0021622402. for the so-called “average foot”. This alters the requirements for fitting, i.e. shape and size of footwear.

T3:PO.40 T3:PO.41

Beneficial effects of a five-week low-glycemic index regimen on weight Prevention of obesity: Are sessions for improving maintenance of weight loss control and cardiovascular risk factors in overweight non-diabetic subjects effective? –Preliminary results de Rougemont Alexis1, Normand Sylvie1, Nazare Julie-Anne1, Skilton Metz Karin1, Bergmann Sandra1, Shaw Rose1, Kröhl Claudia1 Michael R.1, Sothier Monique1, Vinoy Sophie2, Laville Martine1 1IFT Institut Für Therapieforschung, Munich, Germany 1Centre de Recherche en Nutrition Humaine Rhone-Alpes; 2Danone Vitapole Background: About 60% of the German adult population is overweight and The glycemic index (GI) has been developed in order to classify food nearly 20% are obese. Long term effects of cognitive-behavioural programs according to the post-prandial glycemic response. This parameter is of are unsatisfied. interest, especially for people prone to glucose intolerance, however the Aims: Optimizing treatment for overweight people. Therefore the aim of the effects of a low-GI diet on body weight, carbohydrate and lipid metabolism study is to describe an optimized intervention including four additional remain controversial. We studied the effects of either low-GI (LGI) or high- stabilization sessions after weight loss. The hypothesis exists that a program GI (HGI) diet on weight control and cardiovascular risk factors in with stabilization sessions (EG1) shows better long term effectiveness than a overweight, non-diabetic subjects. The study was a randomized 5-week program without this sessions (EG2). intervention trial. The 38 subjects (BMI: 27.3 ±1.5 kg/m²) were given dietary Method: 120 participants with a BMI between 25 and 35 take part in either advice to replace ad libitum usual starch with either LGI or HGI starch. Mean the EG1 (n=60) or the EG2 (n=60). Treatment is randomly assigned to body weight decrease was significant in the LGI group (-1.1 ±0.3 kg, trainers. EG1 lasts 12 sessions, EG2 16 sessions. Participation is voluntary. P=0.004) and was significantly greater than in the HGI group (-0.3 ±0.2 kg, Data (weight, nutrition, eating, exercise behaviour and quality of life) is P=0.04 between groups). Satiety scales showed a trend towards a decreased collected before treatment (t0), at the end of intervention (t1) and at 12 in hunger sensation before lunch and months follow-up (t2). ITT analyses are used. dinner in the LGI group when compared to HGI group (P=0.09). No Results: Baseline mean weight did not differ between conditions (EG1: 93.6 significant increase in insulin sensitivity was noticed. The LGI diet also kg, SD=18.1; EG2: 94.9, SD=20.7; t (84) = -0.28, P = n. s.). Mean weight decreased total cholesterol by 9.6% (P<0.001), LDL-cholesterol by 8.6% loss at t1 in the EG1 was 5.2 kg (SD: 3.0) and 4.0 kg (SD: 4.1) in EG2. There (P=0.01) and both LDL- to HDL-cholesterol ratio (10.1%, P=0.003) and total is no significant difference between conditions according to weight loss (t to HDL-cholesterol ratio (8.5%, P=0.001) while no significant changes were (84) = -1.29, P = n. s.). Data of nutrition, eating, exercise behaviour and observed in the HGI group. Lowering the GI of daily meals with simple quality of life will be also reported. dietary recommendations results in increased weight loss and improved lipid- Conclusions: Soon there will exist a scientifically evaluated cognitive- profile, and is relatively easy to implement with few constraints. These behavioural based program, which provide modest short term weight loss. potential benefits of consuming a LGI diet can be useful to develop practical Long term follow-up will show the effect of the stabilization sessions. dietetic advices for overweight/obese subjects and diabetics. Research relating to this abstract was funded by the Federal Center for Health Education (Germany).

International Journal of Obesity Abstracts S116 T3:PO.42 T3:PO.43

Sustained weight loss after an 18 month period of intensive obesity Follow-up study of a cognitive behavioral therapy program for overweight intervention and the successful use of pro-BNP to exclude cardiac disease and obese children

Van Der Merwe Tessa1, Logan Murray1, Pieters Jenny2, Sammi Yoshi3, van den Akker Erica1,2, Puiman Patrycja1,2, Groen Mieke3, Timman Reinier4, Pepper Michael1 Jongejan Mieke2, Trijsburg Wim4

1Molecular And Metabolic Medicine Research Group; 2Unitas Hospital, 1ErasmusMC-Sophia Children's Hospital; 2Sint Franciscus Hospital, Pretoria; 3Roche, Isando Department of Pediatrics, Rotterdam; 3Sint Franciscus Hospital, Department of Medical Psychology, Rotterdam; 4ErasmusMC, Department of Medical Aims: 1. Assessing the long term efficacy of an 18 month intervention trial Psychology and Psychotherapy, Rotterdam with pharmacotherapy (Topiramate) and lifestyle modification on sustained weight loss after 3 years. 2. Determining whether pro-BNP can be used to Objective: In this article we present the 1 year follow-up results of a exclude cardiac risk in the obese patient population. multidisciplinary, cognitive behavioral therapy treatment program for Materials and Methods: 50 patients (2001) with a mean BMI of 104.8kg ± overweight and obese children. 1.2 (mean ± SEM), without cardiovascular disease, (ECG and Study design: Seventy children between the ages of 8 and 15 years echocardiograms). Anthropometric measurements were recorded and re-done participated in this prospective study. The program aims at reduction of the 3 years later (2004). BMI standard deviation score (BMI-SDS), adapting a healthy lifestyle and Results: A sustained weight loss of 7.3kg was observed 3 years after the creating a positive self-image and higher self-esteem, using a group approach intervention trial. Various indices (2004) correlated with pro-BNP (Immune and parental involvement. Reduction in BMI-SDS and percent overweight assay Nterminal Roche Elecsys and MODULAR ANALYTICS) (67.6pg/ml ± were measured and analysed using repeated measures of ANCOVA and the 0.3: normal range <150): age (47yrs, P<0.02); weight (97.5kg ± 1.1 P<0.05); Pearson Chi-Square test. waist circumference (110cm ± 0.8, P<0.01) and height (166cm ± P< 0.04), Results: The participants achieved a 0.6 BMI-SDS reduction, comparable to but Pro-BNP remained within the normal range. Pro-BNP also correlated a weight loss of 18.7% after one year (P<0.0001). The proportion of drop- (linear regression) with the mean blood pressure and biochemical variables outs was 30%. Analysis showed that the drop-outs were older, more severely observed in 2001 (P < 0.004). obese at baseline and less successful in weight reduction. Conclusion: Education on lifestyle management combined with Conclusions: This treatment program has a positive effect on BMI-SDS in pharmacotherapy (Topiramate) resulted in a sustained weight loss of 7.3 kg overweight and obese children at 1 year follow-up. Differences between the after 3 years. Pro-BNP is a reliable assay to exclude cardiac risk in the obese characteristics of the drop-out and follow-up group may reflect predictor patient, despite observations that it may be decreased in the obese population. variables for the success of this kind of treatment. Conflict of interest: 1. The first and the third author were trialists for J & J. 2. Financial support was given by Roche South Africa towards the Pro BNP kit.

T3:PO.44 T3:PO.45

An Audit of a Hospital-Based Obesity Clinic – 6 Years On Assessing powers of diverse metabolic syndrome definitions in predicting Cope Christopher P1, Seevaratnam Nandini1, Tan Garry D1 type 2 diabetics at risk for cardiovascular event

1 1Queen's Medical Centre Nottingham University Hospital Al-Daghri Nasser

1 Background: Obesity is an increasing health and financial burden on King Saud Univeristy society, raising demands on specialist care. A specialist obesity clinic Background: Metabolic syndrome (MS) is a recently accepted was established in Nottingham in 1999. Here we examine the change in cardiovascular risk factor, yet few studies have highlighted the relation of the pattern of referrals to this clinic between 1999 and 2005. metabolic syndrome to cardiovascular disease on the basis of different Methods: A retrospective audit of referrals currently under the care of a definitions established. This study aims to assess the powers of the different teaching hospital–based obesity clinic in the UK from August 2005– definitions of metabolic syndrome in predicting risks of a hard cardiovascular August 2006. Results were compared to data from a previous audit from event among diabetic Saudis, considered first in the Arab population. March 1999-November 2000. Subjects and Methods: A total of 305 (160 males and 145 females) adult Results: 75 patients (39% male) were referred. Compared to referrals in type2 diabetic Saudis participated in this prospective and cross-sectional 1999, this cohort was older (age: 49.7±1.4y (mean±SEM) in 2005, study. Anthropometric parameters were measured and blood parameters compared to 41.1±1.1 in 1999; P=0.016) and more obese (body mass determined through routine lab procedures. Each participant was screened for index: 48.4±1.5 kg/m2 in 2005 v 44.9±0.7 kg/m2 in 1999, P<0.001). metabolic syndrome based on the definitions of WHO, NCEP-ATPIII and However, 42% of referrals were from hospital practitioners compared to IDF. They were also screened for cardiovascular risk using the Framingham only 23% in 1999. 58% of referrals were from primary care (77% in cardiovascular risk score. 1999). Results: IDF criteria holds the most number of MS patients [190 cases In 2005, 89% of patients had weight-related co-morbidities at the time of (62.3%)] in both males [197 (67.9%)] and females [83 (57.2%)]. Only 14 subjects were considered high risk individuals (CVD score >30) from which referral (compared to 40% in 1999). 44% had diabetes, 39% 13 are males and only 1 female. Patients whose CVD scores fall under > 10, hypertension, 18% obstructive sleep apnoea (compared to 8%, 25% and > 20 and > 30 have a significantly higher probability of being identified using 17% respectively in 1999). the WHO definition [OR 6.15 (2.64-14.32) P – 0.00; OR 7.82 (1.75-34.93) P Mean weight loss was 4.8±2.3 kg. Interventions during this period – 0.01; OR 9.10 (0.64-129.12) P – 0.10 respectively]. included pharmacotherapy (orlistat, 44%; sibutramine, 24%), exercise Conclusion: WHO-defined metabolic syndrome can significantly predict intervention (23%), specialist psychological therapy (15%) and obesity patients at-risk for CVD among the diabetic Saudi population and can thus be surgery referrals (28%). utilized as a promising gross alternative to the conventional CVD risk scoring Conclusion: Over the last 6 years the profile of patients referred to a in clinical practice. specialist medical obesity service has become more complex. On referral, patients are older, more obese and have more co-morbidities, reflecting an increase in referrals from secondary care.

International Journal of Obesity Abstracts S117 T3:PO.46 T3:PO.47

Correlation of sleep and obesity among Saudi girls Adipocytokine profile in metabolic syndrome as defined by various criteria

1 Al-Daghri Nasser1, Al-Rubeaan Khalid2, Bawazir Nahla2 Al-Attas Omar

1 1King Saud University; 2King Abdul-Aziz University Hospital King Saud Univeristy Background: Studies on assessing predictive powers of the different definitions of Background: Sleeping pattern is associated to obesity probably due to metabolic syndrome to clinical conditions were identified. Its relation to decreased levels of leptin and increased levels of ghrelin. This study aims to adipocytokines and inflammatory markers however has not been documented. Such investigate the relationship between diet and hours of sleep to incidence of markers are potential therapeutic targets for both diabetes and cardiovascular overweight and obese Saudi girls. disease. This study aims to correlate the definitions of metabolic syndrome to Subjects and Methods: 1143 Saudi girls aged 9–17 years participated in this pathological levels of leptin, adiponectin, resistin, TNF-@, and CRP among type 2 prospective study. Each subject completed a questionnaire which included diabetic patients. medical history, sleeping habits, daily activities and diet. Anthropometrics Subjects and Methods: 305 (160 males and 145 females) type2 diabetic Saudis included height, weight, and waist-hip ratio. They were stratified into 3 participated in this prospective and cross-sectional study. Anthropometrics were groups: <12 years old, 12–15 years old, and ≥ 16 years old and were further measured and blood parameters by routine lab procedures. Leptin, adiponectin, classified among those with continuous sleep and sleep disturbance. resistin, TNF-@ and CRP were analyzed using enzyme-linked immunosorbent Results: Subjects who had sleeping disturbance (<5 hours) had significantly assays (ELISA). Each participant was screened for metabolic syndrome based on ≥ definitions of WHO, NCEP-ATPIII and IDF. higher BMI for subjects 16 years old compared to those who had Results: IDF criteria identified most patients [190 cases (62.3%)] in both males continuous sleep of the same age (pvalue 0.023). In all cases, 60% of obese [197 (67.9%)] and females [83 (57.2%)]. In males, leptin and adiponectin were subjects were consuming ≥ 3 meals/day and 16.3% of obese cases eat ≥ 3 higher [1.97 (0.51-7.57); 2.49 (0.3-21.76) respectively] using the criteria set by times/week outside their homes. Stepwise linear regression revealed positive NCEP-ATPIII. Resistin and CRP however were most elevated [1.28 (0.32-5.04); correlation between sleeping pattern and (%) body fat (R2 0.02; P- 0.001); 2.04 (0.46-9.04) respectively] using the WHO definition. In females, IDF-defined waist circumference was strongly associated with sleep pattern (standardized has the strongest association in 3 of 4 parameters analyzed compared to other ß- 0.16; P- 0.02) and significantly correlated to (%) body fat and hip criteria: leptin [2.09 (0.14-30.71)]; adiponectin [6.00 (0.47-76.17)] and CRP [3.07 circumference (R2 0.67; P- 0.001) in all groups. (0.21-45.10)]. The risk of hyperresistinemia on the other hand was highest using Conclusion: Non-continuous sleep among Saudi girls coupled by increased NCEP-ATPIII [0.53 (0.20-1.37)]. frequency of meals contributes to the growing number of obese children in Conclusion: Gender differences exist in assessing risk of various the kingdom, predisposing them to obesity-related diseases at an early age. metabolic abnormalities in relation to different metabolic syndrome Lifestyle modifications and nutritional awareness involving the family as a criteria. Proper selection of definition is essential for more accurate whole are strongly encouraged. health care strategies and intervention.

T3:PO.48 T3:PO.49

Sustained life-style change. Findings of a 5 year real practice study Food choice and delay of gratification: An experimental investigation in obese, overweight and normal-weight primary school children Gonczi Judit1

1 1 2 2 1Hsso Vögele Claus , Gibson Leigh , Ogden Jane , Brown Kerry

Objective: To induce sustained behavioral changes by an interactive weight loss 1Roehampton University; 2University of Surrey program (IWLP), utilising the special bond between patient and practitioner (GP). Subjects and Methods: Of 133 regularly attending obese adults (24–80years, One of the main factors in predicting is parental 37males, 96females ) 65 accepted treatment with IWLP which evokes weight. Some of this transmission between parent and child can be responsibility to maintain regular follow-up, an libitum, low fat diet and pedometer accounted for by genetics. However, research has also highlighted a recorded exercise within activities of daily living. Only recommendation of low fat diet, increased exercise (standard care, SC) was accepted by 68 patients. IWLP and social hereditary pathway through which parents, in particular, may SC groups were subdivided into compliant (IWLPC and SCC) and non-compliant contribute to childhood obesity. IWLPN and SCN (n=31,27, and 34, 41, mean BMI= 33.89, 32.96, and 33.22, The present study is part of a larger project in which parents (n=564) 33.83, respectively) based on adherence to requirements of treatments. Monthly provided questionnaire data on their own and their children’s (age range: anthropometric measurements, dietary- and pedometer diary reviews and 6 monthly 4–6 years) food attitude and intake, measures of parental control, aspects plasma biochemistry were done up to years. of parent-child relationship and children’s snacking behaviour. A sub- Results: Weight loss was significantly greater for IWLPC than for IWLPN, SCC, sample of 51children (20% overweight or obese) attended the single and SCN, (13.33%, 7.73%, 4.4% and 2.11%, respectively) by 16-65 months.. IWLPC patients lost weight more efficiently than IWLPN patients achieving target experimental session during which they were asked to rank their weight (n=11) and sustained weight loss (n=7) for 20-56 months. 20 patients are favourite snack foods with both their parent present and while being on still on treatment. All anthropometric data and biochemical paramaters decreased their own. We also assessed children’s capacity for delay of gratification significantly while HDL increased for IWLPC compared to other groups . by presenting a large and a small portion of their most favoured snack Conclusion: GPs can achieve metabolic risk reduction by utilising the regular item with the instruction that the large portion would only be available opportunities of patient presentation to promote long-lasting behavioural training. after the investigator’s return (5 minutes). If they asked for the IWLP, being educational with flexible control of eating and physical activity investigator to return early children would receive only the small portion. behaviour was found to be significantly more efficient than standard care. Standard care when supportive results in modest but sustained weight loss. Results from the ranking task support the hypothesis that parents affect a child’s choice of favourite snack foods. However, this effect is dependent on order of presentation and our results indicate that this effect can be carried over even when the parent is no longer present. Results from the delay of gratification task suggest a deficit in obese children, and this may be due to the stronger incentive value of (unhealthy) snack foods.

International Journal of Obesity Abstracts S118 T3:PO.50 T3:PO.51

Retrospective body weight analyses by some elements of metabolic Orlistat in the treatment of obesity: better effect on body weight and risk syndrome (obesity, hypertension, diabetes) factors in responders

1 2 1 Rurik Imre1,2 Stokic Edita , Srdic Biljana , Tomic-Naglic Dragana

1 1 2 Department of Endocrinology, Diabetes and Metabolic Disorders, Institute Dept. Of Family Medicine, Semmelweis University, Budapest; Primary 2 for Internal Medicine, Novi Sad, Serbia; Department of Anatomy, Medical Centre, Budapest Faculty, Novi Sad, Serbia

Obesity, diabetes and hypertension are in close relationship, often Similar to other chronic diseases, careful choice of those patients who will affecting the same patients. Cross sectional study, including benefit most from pharmacotherapy is of great importance in the treatment of retrospective elements were performed in primary care setting in obesity. The aim of the study was to evaluate therapeutic effects of 24-week Budapest, Hungary. Consecutively selected 266 elderly people (109 men hypocaloric diet and orlistat therapy in obese patients who lost 1 5% of their and 157 women), were divided, according to recent body mass index initial weight after 12 weeks of treatment. [BMI]: normal [BMI< 25 kg/m2], overweighed [BMI 25–30], obese Methods: The examined group consisted of 38 obese patients who began a [BMI>30], having hypertension (181) and diabetes (73) or not. hypocaloric diet and orlistat therapy during 6 months. Body weight, height Questionnaire on eating habits and life style were completed, and waist circumference, systolic and diastolic pressure, serum lipids levels anthropometric measurements, medical check-up were performed. and glycaemia were assessed at the beginning of the study and after 24 Retrospective body-weight data from 20y by each life decades were weeks. compared and analyzed. Obese men already had 8kg, overweighed had Results: The group of responders was made of 22 patients (57.89%) who 3kg surplus on average at their twenties. The greatest weight gain was achieved the weight loss 1 5% after 12 weeks of treatment. Compared to the recorded between 40y–50y by overweighed, between 50y–60y by obese whole group, during the 24 weeks, larger number of responders achieved a 1 1 men, and by women between 30–40y and 40–50y, respectively. weight reduction of 5% and 10%. Responders also experienced greater Hypertonic men had higher body weight at their youth by about 3kg, and weight loss (-15.88 vs. -12.72%) and waist circumference (-15.66 vs. - at sixties by 1–2kg, women had lower body weight at their youth and 13.83%) decreasing. Significant improvement of obtained risk factors was more obvious in the group of responders for total (-25.70 vs. -22.49%), LDL- this trend turned only about sixty. Diabetic women had higher; men had cholesterol (-31.62 vs. -26.63%), triglycerides (-16.98 vs. -16.38%), lower body weights in their youth. The greatest weight gains were glycaemia (-10.38 vs. -7.68%), systolic (-12.99 vs. -9.68%) and diastolic registered between 50–60y. It seems that the two genders have different blood pressure (-10.13 vs -9.01%). Our results confirmed effectiveness of diet characters, and the increase of body weight and blood-pressure is not and orlistat therapy in prediction long-term benefits. Recommended criteria parallel. It is also hard to analyse because of frequent co-morbidity. for weight reduction of 15% after 12 weeks of treatment in our study really Further evaluations and more reliable records are needed to make better selected those patients who achieved a better response to therapy with comparison. The primary care staffs have to care better their patients minimal adverse effects. becoming overweighed.

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Study of the effect of zinc supplementation and weight status on lung Apolipoprotein B is a better marker than non-HDL-Cholesterol for the function in asthmatic patients in Tehran Rassol Akram Hospital Metabolic Syndrome

1 1 1 Egtesadi Shahryar , Pouramjad Mouna , Moosavi Ali Javad , Han Jee Hye1, Kim Seon Mee2, Park Hye Soon3 Nourmohammadi Issa1 1 2 3 1 Eulji University, Seoul, Korea; Korea University, Seoul, Korea; Ulsan Iran University of Medical Sciences, Tehran, Iran University, Seoul, Korea Objectives: In the context of the hypothesized key interrelated issues such as Inflammation, Asthma, Zinc and Body weight the objective of present study Background: Apolipoprotein B (apoB) reflects atherogenic particle and were to investigate the effect of zinc supplementation and body weight status is closely associated with the atherosclerosis. We investigated the on lung function in asthmatic patients. relationship between apoB and the metabolic syndrome (MetS), and Materials and Methods: A cross sectional clinical trial was conducted on analyzed the cutoffs of apoB for detection of the MetS. two groups consisting of case (29 stable asthmatic patients) who received 50 Methods: Healthy Korean subjects (n=3335) who participated in health mg zinc supplement every other day and matched control who received screening test (mean age, 45.2 years) were examined. Anthropometry, placebo pills, for period of 8 weeks. 10 ml blood samples were drawn prior blood pressure, fasting glucose, lipid profiles and apoB were measured. and after the period of supplementation to measure serum zinc concentration. The MetS was defined by modified National Cholesterol Education Body weight, BMI and Repiratory function parameters including Forced Adult Treatment Panel III. Expiratory Volume in 1 seconds(FEV1), Forced Vital Capacity(FVC),Vital Results: The MetS was present in 22.1% of men and 16.1% of women. Capacity(VC) and FEV1:FVC ratio(using Spirometer) were measured before The strongest correlation was shown between apoB and triglycerides and after supplementation. Dietary intake was obtained by 24-hour recall among components of the MetS. In both sexes, apoB increased quetionnaires prior and after treatment. significantly with the number of MetS components. When apoB and Results: There were no significant changes in body weight, BMI, food and non-HDL-cholesterol (non-HDL-C) were mutually adjusted, only apoB nutrient intakes during period of zinc supplementation.The serum zinc was predictive of the MetS; the ORs for the MetS in the highest quartile concentration of treated patients were 0.68±0.16mg/l vs 0.91±0.11 mg/l of control group, which shows significant difference (P=0.000).The differences of apoB were 5.38 (95% CI 3.16–9.17) in men and 13.41 (95% CI 5.02– of FEV1,FVC,VC, FEV1:FVC were not statistically significant. 35.79) in women. The cutoff for detection of the MetS was 90 mg/dL of Conclusions: Serum zinc levels of asthmatic patients was remarkably low apoB in both men and women. and improved significantly through zinc supplementation. No significant Conclusions: The ability to identify the MetS was greater for apoB than changes of body weight, BMI and respiratory factors observed through zinc for non-HDL-C. ApoB is a good marker for prediction of the MetS. treatment.

International Journal of Obesity Abstracts S119 T3:PO.54 T3:PO.55

Effects of rapid, diet-induced weight loss on sexual function and lower The screening of the metabolic syndrome: a compulsory task for practitioners urinary tract symptoms in obese men Nita Cristina1, Hancu Nicolae1, Roman Gabriela1, Bala Cornelia1, Cerghizan 2 Wittert Gary1, Piantadosi Cynthia1, McAinch Andrew1, Worthley Anca Stephen1 1'Iuliu Hatieganu' University, Cluj Napoca, Romania; 2Diabetes Clinical 1 Center Cluj Napoca, Romania University Of Adelaide, Australia Objective: Inspite of the fact that there are a lot of controversies regarding This study determined the effects of rapid weight loss on erectile the definition and diagnosis criteria of the Metabolic Syndrome (MetS), few function (EF), sexual desire (SD), and lower urinary tract symptoms data are available regarding the importance of the screening of MetS. The (LUTS) in 35 obese men of (mean±SEM) age 43.3±9.9 yrs, BMI first step of the screening would be the widespread incorporation of waist 2 37.1±4.6 kg/m and waist circumference 111.2 ± 12.6cm. Baseline BP circumference measurements at the routine physical examination. In the was elevated (1 140/90) in 6 and fasting glucose elevated in 3. Weight- previous studies we have suggested that hypertensive waist (HTW) is a loss was induced with Kicstart™ (~800 Kcal/day) over 8 weeks. Before frequent pathogenetic combination in persons with MetS. The objective of and after weight loss EF (international index of erectile function (IIEF)), this study was to analyse the importance of HTW in the screening of the SD (sexual desire inventory 2 (SDI-2)), and LUTS (international prostate MetS. symptom scale (IPSS)) were evaluated. Total testosterone (TT), SHBG, Methods: From October 2002 to November 2003, we screened for MetS INSL3, glucose, insulin and lipids were measured in fasting plasma and 2928 persons, aged 15 years or older, randomly selected from the general free T (FT) calculated. Average weight-loss was 13.1 ± 4.78 kg population. The clinical and anthropometric data were assessed. Plasma blood (P<0.01). IIEF improved in 31 men. IPSS and SDI improved in all. The glucose, triglycerides, total and HDL cholesterol were also measured. IDF mean IIEF 17.91 ± 1.15; SDI-2 71.46 ± 2.45, and IPSS 18.86 ± 1.44 at 2005 criteria for MetS have been used to interpret the results. Results: The prevalence of large waist was 50%. High blood pressure was baseline, improved post weight loss: IIEF 20.0 ± 1.19, P<0.0001; SDI-2 found in 28.2% of the subjects. The prevalence of IFG was 48%. The MetS 80.54 ± 2.19, P<0.0001; and IPSS 12.14.0 ± 1.74, P< 0.0001. Mean TT was found in 36.6%. The most frequent clinical couple was HTW (35.5%), (P=0.001) but not FT or INSL3 increased. Systolic (P<0.001) and followed by hypertriglyceridemic waist (19.1%). Comparing the prevalence diastolic BP (P=0.032), total cholesterol (P=0.003) and insulin of HTW and MetS we found a significant correlation between these 2 (P<0.001) but not glucose (P=0.069) decreased. Improvements in EF parameters (P<0.001). The presence of HTW was significantly correlated related to changes in TT and INSL3 (P=0.052). Functional outcomes did with higher cardiovascular risk (P=0.052). not relate to improved adiposity, metabolic profile or androgens. Conclusions: Based on the frequency and easy-to-determine clinical Improved SDI and IPSS were related (P=0.011). Rapid, diet induced parameters, the clinical couple HTW could be use as starting point to screen weight loss, improved EF and LUTS, and sexual desire without being for the MetS. directly related to the amount of weight loss or changes in metabolic state.

T3:PO.56 T3:PO.57

Long-term results of FaCts-diet, the combination of very low-fat and Metabolic syndrome prevalence and body composition changes following very low-carb diet 10% and 25% weight loss in severe obese patients treated with laparoscopic surgery Adam Olaf1, Gawron Eva1, Lassnack Bettina1 Pasanisi Fabrizio1, del Genio Federica1, Lucia Alfonsi1, Marra Maurizio1, De 1 2 2 1 Caprio Carmela , del Genio Gianmattia , Rossetti Gianluca , del Genio Walther-Straub Institute, Ludwig-Maximilians University Of Munich 2 1 Alberto , Contaldo Franco

Introduction: We aimed to improve nutritional adequacy, health effects, 1Federico II University, Naples, Italy; 2Second University, Naples, Italy long-term weight reduction, and patient’s adherence of commonly used slimming diets by the periodically separated given combination of a very Bariatric surgery is considered the most effective treatment for reducing low-carb and very low-fat diet. excess weight and maintaining weight loss in patients with clinically severe Material and Methods: 453 obese patients took part in weekly patient obesity. There are limited data evaluating metabolic and body composition classes for 10 weeks, providing information on how to separate as far as changes following different period after bariatric surgery in type III obese possible fat and carbohydrates in the diet, nutritional behaviour, physical patients (BMI>40 kg/m2). Eighteen patients (11 M, 7 F; age 42.6±5.6 years; activity and psychological background of obesity. Participants were BMI 48.7±5.2 kg/m2), treated with laparoscopic gastric bypass, have been asked to follow a very low-fat diet for breakfast and lunch, and after an evaluated before treatment and following 10% and 25% weight loss, obtained interval of 4 hours switch to a very low-carb diet for dinner, and take two on average six weeks and thirty weeks after bariatric surgery respectively. snacks per day (FaCts=Fat, Carbohydrate, timed snacks). Thereafter Metabolic Syndrome (MS) was evaluated using ATPIII/AHA criteria. Body participants were offered monthly visits for 6 months; follow-up composition was assessed with bioimpedance analysis (BIA). Prevalence of examinations were done for 6 years. MS was 61.1 and 72.2% (using ATPIII and AHA criteria respectively) at baseline. After surgery MS prevalence significantly decreased to 33.3% Results: Out of 453 participants 71 did not complete patient classes. following 10% weight loss and to 22.2% following 25% weight loss using According to intention-to-treat-analyses participants lost 5.8 ± 3.5 kg both criteria. At entry free fat mass (FFM) was 54.5± 5.4% and fat mass (FM) within 10 weeks, and had a weight reduction after 1, 2, 3, 4, 5 and 6 45.6±5.4 %. Following 10% weight loss body composition remained years of 6.7 ± 5.9 kg, 6.1 ± 5.3 kg, 6.0 ± 5.3 kg, 5.4 ± 4.8 kg, 5.2 ± 4.8 unchanged (FFM 52.8±5.2%, P=NS and FM 47.2±5.2%, P=NS) and kg and 5.7 ± 5.0 kg (mean ± SD). Dietary protocols attested the following 25% weight loss body composition significantly improved (FFM participants a balanced diet and laboratory findings revealed an 63.2±8.5%, P=0.01 and FM 37.2±8.5%, P=0.02) Following weight loss improvement of metabolic parameters. obtained with surgical intervention, MS prevalence progressively decreases Summary: FaCts-diet is an easy to learn and more balanced nutrition, as despite different effects on body composition. In particular FM shows a compared to low-fat or low-carb diets, and improves long-term weight significant decrease at later time. Further investigations are needed to reduction and obesity associated risks. evaluate long term effects of body composition changes on metabolic parameters in patients undergoing bariatric surgery.

International Journal of Obesity Abstracts S120 T3:PO.58 T3:PO.59

Influence of waist circumference on glucose metabolism evaluated with Morphologic and systemic alterations in obese and overweight subjects oral glucose tolerance test in a group of obese patients after a physical activity intervention program

Disoteo Olga1, Pizzi Gianluigi2, Muratori Fabrizio1, Grossrubatscher Magalhaes Pedro1, Costa Maria1, Lopes Vitor1, Duarte José2 Erika1, Dalino Paolo1, Oppizzi Giuseppe1, Fossati Carlo2, Loli Paola1 1Bragança Polytechnic Institute; 2Faculty of Sport - Oporto University 1Niguarda Hospital - Endocrine Unit; 2Niguarda Hospital - Diabetologic Unit There are some evidences that exercise training reduces total and abdominal fat and some systemic variables with improve health benefits. Aim of this study was to evaluate the relation between waist The aim of this study was to analyse the variation of some morphologic circumference (WC) and glucose metabolism in obese subjects. We and systemic variables in 16 (age=64.5±7.2) obese and overweight evaluated 132 consecutive obese subjects (20 men and 112 women, (BMI=31.4±5.7) type 2 diabetic patients, of both gender, during a median age 46 yr) for metabolic syndrome. The subjects underwent body regular physical exercise program, which consists of 3 5 minutes of fast mass index (BMI), WC and oral glucose tolerance test (OGTT) with walking every days of the week, during 8 months, and no diet determination of fasting insulin and plasma glucose (FPG) and plasma intervention. The change was analysed with MANOVA. In total glucose at 120’. The cut off for impaired glucose tolerance (IGT) and cholesterol, LDL, HDL, TG and Insulin the changes were analysed in a 4 diabetes was glucose at 120’ > 140 mg/dL and > 200 mg/dL months period and in weight, BMI, waist and blood pressure were respectively. Homeostasis model assessment-insulin resistance (HOMA analysed in an 8 months period. There was significant decreases on IR) was assessed. Correlation analyses were determined by calculating weight [F(1, 15) = 6.688; P = 0.021], BMI [F(1, 15) = 7.396; P = 0.016], the Spearman’s coefficient. A Stepwise multiple regression analysis was waist [F(1, 15) = 43.032; P = 0.000] and LDL [F(1, 7) = 14,264; P = performed to determine which variables predicted FPG. The values 0.007]. It could be concluded that the participation in this physical recorded were BMI 37,1 kg/m2 ± 5,38, WC 109,8 cm ± 11,14, FPG 93,6 activity program enables the subjects to improve their morphologic and mg/dL ± 15,05, 120’ plasma glucose 115,6 mg/dL ± 44,02, basal insulin systemic parameters without alterations in their diet. 13,2 mU/L ± 5,10, HOMA-IR 3,12 ± 1,58. The prevalence of impaired fasting glucose (IFG) (FPG > 100 mg/dL) was of 25,7% (34 pts), of IGT was 18% (24 patients) and of DM was of 6% (8 patients). Linear correlation was significant between WC and FPG (r = 0,24 P=0,04), but not among WC and other variables. In multiple regression FPG was linked to fasting insulinemia (P 0,013) and WC (P 0,05). The present data supported that visceral obesity evaluates with WC is a risk factor for IFG. In contrast with previous reports, these data do not suggest a role for WC in IGT.

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The beta-adrenergic antagonist propranolol partly abolishes thermogenic response Adipocyte fatty acid-binding protein - a biomarker associated with the metabolic of bioactive food ingredients syndrome and/or an indicator of weight change?

1 1 1 1 1 Belza Anita1, Gille Maj-Britt1, John Sarah1, Kondrup Jens1 Ebenbichler Christoph , Engl Julia , Ciardi Christian , Tatarczyk Tobias , Kaser Susanne , Laimer Markus1, Weiss Helmut2, Aigner Franz2, Tilg Herbert3, Patsch Josef 1The Royal Veterinary And Agricultural University, Department Of Human Nutrition 1Medical University Innsbruck, Department Of Internal Medicine, Clinical Division Of General Internal Medicine; 2Department of Surgery, Medical University Innsbruck, Background: A combination of tyrosine, capsaicin, catechines, and caffeine has Austria; 3Department of Medicine, Academic Teaching Hospital Hall, Austria been shown to possess a pronounced thermogenic effect in humans. Objective: To investigate whether the thermogenic response to the bioactive Background: Adipocyte fatty-acid binding protein (A-FABP) is a plasma biomarker combination (BC) could be diminished or abolished by propranolol. recently associated with the metabolic syndrome. Aim of these studies was to investigate Design: Twenty-two men (BMI: 26.0±3.6 kg/m2, mean±SD) participated in a 4- changes of A-FABP during profound weight loss induced by laparoscopic adjustable way randomized, double-blind, placebo-controlled crossover study. The following gastric banding. 4 treatments were tested: 1. placebo; 2. BC; 3. BC + 5 mg propranolol; 4. BC + 10 Subjects and methods: In study one 29 severely obese female subjects were examined mg propranolol. Resting metabolic rate (RMR), respiratory quotient, and the before and one year after surgical treatment. In study two patients were investigated in thermogenic response were measured for 5 hours post-intake, whilst systolic and three months intervals. Metabolic parameters were determined using standard methods diastolic blood pressure (SBP and DBP, respectively), heart rate (HR) and appetite and A-FABP was detected with a commercially available ELISA. Results: Mean weight loss after one year was 24.9 kg (P<0.001), mainly due to a ratings were assessed. decrease in fat mass. Metabolic parameters improved substantially. However, serum Results: BC increased RMR by 5% (73 (36;110) kJ/5-h (mean (95%CI), AFABP remained stable. In study two ten patients we examined quarterly to determine P<0.0001) compared to placebo. Both propranolol doses blunted the thermogenic the time course of A-FABP changes. Quarterly measurement of serum A-FABP were response by 50% compared to placebo (P<0.01). Propranolol (5 or 10 mg) reduced significantly higher than baseline levels with the highest A-FABP value after the first fat oxidation by 5% (P=0.001) and by 7% (P=0.0002) compared to placebo, three month, where patients had highest weight loss. respectively. BC increased SBP by 3% (4±1.0 mmHg, P=0.003) compared to Conclusions: In summary, our results in study one confirm that A-FABP serum levels are placebo. The effect of BC on SBP was reduced by 25% by propranolol (P=0.07). elevated in obese subjects and closely associated with obesity and the metabolic BC (with or without propranolol) increased DBP by 6% (4±1 mmHg, P=0.0002). syndrome. However, one year after pronounced weight loss A-FABP levels remained Propranolol decreased HR by 5% (3±1 bpm (P<0.0001)) compared to placebo and unchanged. In study two time course analyses revealed maximum increase of serum BC. No effects were observed on appetite ratings. AFABP in parallel to highest weight loss. We conclude that A-FABP serum levels are a Conclusion: The study confirms the thermogenic properties of BC. The 50% biomarker of metabolic syndrome and additionally an indicator of weight loss, reduction of the thermogenic response by propranolol indicates that beta-adrenergic demonstrating the current lipolytic activity in adipose tissue. pathways are partly responsible for the thermogenic response. 1. Conflict of Interest: None disclosed. 2. Research relating to this abstract was funded by OeNB Grant 11172. 1. Conflict of Interest: None disclosed. 2. Research relating to this abstract was funded by Ideasphere Inc, Grand Rapids, MI, USA.

International Journal of Obesity Abstracts S121 T3:PO.63 T3:PO.62 Treatment of obese hypertensive patients

Inverse association between vitamin A intake and obesity related markers in 1 young people Barna Istvan

1 Zulet Maria Angeles1, Navarro Carlos1, Puchau Blanca1, Martinez J.Alfredo1 Semmelweis University First Dept. of Medicine

1 Obesity is the impairment of metabolic processes caused bygenetic, neurologic, University Of Navarra hormonal and exogenous effects. It can be characterized by the increase of food and/or the decrease of energy consumption, a chronic, recurrent disease, which necessitates medical intervention. Population explosion and many of its Background: The objective of this study was to investigate the possible consequences are in favour of the occurrence of obesity and leads to a formation of association between the intake of antioxidant vitamins and minerals and a worldwide “epidemic”. In diagnosing obesity height, weight and BMI (normal: < anthropometric measures in young people. 25 kg/m2) gives a fair estimate about the nutritional state of an individual. One of Methods: Forty three participants (31 females and 12 males) with a mean age the most important risk factors in the development of hypertension is obesity. of 18.5 ± 0.93 years were included in this study. Anthropometrical measures Higher blood pressure occurs twice as much in the overweight population included weight and height, tricipital skinfold thicknesses (ST), waist and hip compared to an age, gender, life-style etc. matched normal population. The most circumference. Body mass index (BMI=Kg/m2) and waist-to-hip ratio important medical advice to obese hypertensive patients is a healthy diet and the reduction of body weight, ideally to normal. The optimum target BMI to high risk (WHR) were calculated. Body composition was analyzed by bioimpedance 2 (Tanita TBF-215). The dietary pattern was registered throughout a validated patients is less than 25 kg/m . The National Society of Hypertension on its food-frequency questionnaire (SUN). Congress held in November, 2005, decided the guidelines upon the available evidence of the recommended antihypertensive therapy to obese patients. Results: All participants showed a situation of normoweight (BMI 20–25 2 We analyzed the first data (ABPM results and antihypertensive treatment) of kg/m ). However, men had higher values of BMI (P<0.001) and WC patients suffering from essential hypertension who appeared at the I.Dept of (P<0.01). The results of the food frequency questionnaire showed that for Internal Medicine in our Laboratory of Circulation (n = 2760) between 1996 and both genders, fat (38.5%) and protein (17%) consumption were higher that 2004, according to their BMI. 37 % of patients had normal BMI, 39 % has a value recommendations, while carbohydrate intake was lower (43%), while no between 25 and 30 and the BMI was over 30 in 24 % of the cases. We analyzed the differences in total energy and macronutrients consumption were found. The medication of the population who reached the target blood pressure values intake of vitamin A, C, E, selenium and zinc was also higher that compared to those, who did not, upon the body mass index. A majority of the recommendations. Vitamin A consumption was two-fold in women as patients treated with ACE inhibitors and diuretics produced better results. Obese compared to men (p<0.01). Interestingly, the correlation analysis in the total diabetic and hypertensive patients, with high BMI seldom reached optimal blood group of participants showed a negative association between vitamin A intake pressure, compared to normal body weight counterparts. Those who did not reach with weight (r=-0.371; P=0.014) and BMI (r=-0.380; P=0.012). target blood pressure values more often received vasodilators and less frequently Conclusion: These results show a negative association between vitamin A diuretics. In case of a higher BMI multiple combined antihypertensive treatment intake with both weight and BMI, as previously have been found for vitamin was more often (>75 %) intiated. This was valid for essential hypertensive patients and diabetics, as well. According to this cross-sectional study, if the recommended C. More research is necessary to evaluate the implication of oxidative status guidelines were more strictly kept, the obese hypertensive patients could have been in the development of pathologies such as obesity. better treated.

T3:PO.64 T3:PO.65

Weight management in general practice: survey of general practitioners and nurses The effects of nutrition knowledge and eating behavior of main care- in the UK givers on intellectual disabilities in Taipei city organization

1 1 2 1 3 Nanchahal Kiran , Townsend Joy , Haslam David , Wellings Kaye , Letley Louise , 1 2 Haines Andrew1 Lee Chen-Hui , Chin Linda

1London School of Hygiene & Tropical Medicine; 2Watton Place Clinic; 3MRC 1Taipei City Hospital; 2Fu-Zen University & Taipei City Hospital General Practice Research Framework Data revealed that life style of the intellectual disabilities (ID) increase Objectives: To describe current provision of services for the management of the risk of their chronic diseases. The aim of this study was to investigate weight in general practice and to assess the need for structural, educational and other support for primary care professionals. whether the eating behavior and nutritional status of the ID were Design: Cross sectional questionnaire survey. Setting Primary care across the UK. correlated with the nutrition knowledge, eating behavior and attitude of Participants General practitioners and nurses in 388 randomly selected general treating ID among their main care-givers (MCG). A total of 93 main- practices in the Medical Research Council General Practice Research Framework. care givers of which 55.8% being mothers, 19.0% being fathers, and Main outcome measures: Level of current provision of in 19.2% being sisters, brothers or teachers of ID completed the primary care, attitudes and knowledge of GPs and practice nurses and requirements questionnaires, of which include nutrition knowledge, eating behavior for training. and attitude in this study. We found that the score of nutrition knowledge Results: Almost eight out of ten GPs and nurses (225/287, 78.4%) thought that of MCG are significantly correlated to their own education level (r=0.41, obesity should be treated by the National Health Service. One in five practices (72/291, 24.7%) currently had a weight management programme. The majority of P<0.01) and body mass index (BMI) of ID (r=0.33, P<0.01). Their both GPs and nurses said they considered obesity to be mainly a social or eating behavior affect their own attitude of treating ID (r=0.40, P<0.01), psychological problem rather than a medical one. Nearly half the GPs (67/46) and and both of the dietary behavior (r=0.59, P<0.01) and attitude of treating 82% of the nurses (119/145) said that they would like training for weight ID (r=0.54, P<0.01) significantly correlated to the eating behavior of ID management of their patients. respectively. The BMI between main-care givers and ID was also Conclusions: General practice is a considerable un-tapped resource for the significantly correlated (r=0.32, P<0.01). All the data let us realize that management of obesity and overweight. Despite the success in advising on reinforcement of nutritional education to the MCG of ID can promote the smoking cessation, few practices currently provide services for weight management. Although the majority of GPs and nurses did not consider obesity to health of both of them. be a medical problem, they were in favour of providing services to their patients for weight management and would like appropriate training for this. 1. Conflict of Interest: There is no conflict of interest. 2. Funding: Research relating to this abstract was funded by the British Heart Foundation.

International Journal of Obesity Abstracts S122 T3:PO.66 T3:PO.67

Orlistat reduces the percentage of obese patients and the anthropometric parameters Effect of two doses of a mixture of soluble fibres on body weight and metabolic

1 variables in overweight or obese patients: randomised, parallel group, double-blind Bellido Guerrero Diego placebo controlled clinical trial

1 Hospital Arquitecto Marcide, El Ferrol (A Coruña), Spain Salas-Salvadó Jordi1, Farrés Xavier2, Luque Xavier2, Narejos S2, Borrel M2, Basora Josep2, Anguera Ana3, Bullo Monica1, Balanza Rafel1 INTRODUCTION Obesity is an excess of body fat accompanied by an increase in body weigh. Orlistat 1Rovira I Virgili University; 2Grup d'atenció primaria per l'estudi de la fibra en blocks the absorption of approximately 30% of dietary fat. The study’s objective was to 3 study the evolution of obesity grades and anthropometric parameters. l'obesitat; Research Department Madaus, SA METHODS The patients included in the study were type II overweigh or obese. They were treated Aims: To compare the effect of a mixture of fibres on weight loss, satiety, during 3 months at the least with low-calorie diet and orlistat at doses of 120 mg 3 times a tolerance, lipid profile and glucose metabolism in overweight or obese patients. day with the food or 1 hour after meals. Data was evaluated at the beginning of the study Patients and methods:

(VB) and after 3 months (VT). Overweight or obesity patients were included in a parallel, double-blind, RESULTS randomized placebo controlled, multicenter clinical trial. 166 patients were The treatment reduced the number of obese patients and the anthropometric parameters. randomized to receive for 16 weeks two dose levels of a mixture of fibre (Plantago At V 86.87% patients was obese and 66.20% at V . The mean reductions in VAT, weigh, B T Ovata + glucomannan) or placebo, and advised to follow a diet with a reduction of BMI and abdominal perimeter (AP) were 11.62%, 7.3%, 7.88% and 5.52%, respectively. 600 Kcal/day compared to their current diet. Body weight loss, self-assessment of satiety and adherence to diet and treatment, lipid profile, fastingglucose and REDUCTION REDUCTION MEAN (SD) BASAL V FINAL V insulin, oral glucose tolerance and fastingglycosilated haemoglobin were (units) (%) 2 determined. VAT (cm ) 172.0 (45.55) 150.6 (39.15) 20.8 (18.17) 11.62 (8.69) Results: Weight-loss tended to be higher in both fibre dose supplement Weight (Kg) 91.4 (14.63) 84.7 (13.63) 6.8 (4.01) 7.3 (3.95) intervention groups (-4.52±0.56 and -4.60±0.55 kg) than in placebo (- AP (cm) 106.3 (12.81) 100.0 (11.45) 6.0 (4.82) 5.52 (4.18) 3.79±0.58kg), but no significant differences in changes between goups were BMI (Kg/cm2) 34.4 (4.70) 31.6 (4.16) 2.7 (1.55) 7.88 (4.23) observed (P=0.43). Satiety post lunch and post diner increases in both fibre groups. The decrease in plasma total cholesterol tended to be greater in both fibre groups. A positive correlation was established in the reduction in the VAT and AP, weigh and The decrease in the plasma LDL-c levels was higher in both fibre supplemented BMI. In general, the relation between the anthropometric parameters reductions and groups (p=0.03). In relation to HDL-Cholesterol, basal glucose and insulin obesity grade was linear. concentrations, glucose tolerance and glycosilated haemoglobin, no significant CONCLUSIONS differences in changes between fibre and placebo groups were observed. Orlistat was effective decreasing the anthropometric parameters and the percentage of Conclusions: the administration for 16 weeks, of a supplement of a soluble fibre in obese patients. There was a positive relation between the reduction in percentage of the overweight or obese patients is well tolerated, induces satiety and has some healthy anthropometric parameters and the obesity grade. benefits on cardiovascular risk factors. The most important effect observed is a significant decrease in plasma LDL-C concentrations.

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Results of one year follow-up and changes in eating habits with and without Orlistat treatment in The influence of the Mediterranean diet on the development of the Metabolic obese patients Syndrome in a sample of young Greek Navy recruits Kyriazis Ioannis1, Zervas Eleftherios2, Lalousis Athanasios2, Drecoudis Paris2, Michas Dimitrios2, Paraskevopoulos Kostantinos2, Apostolos Manias2, Partheniou Christos2 Makrilakis Konstantinos1, Doupis John1, Dimosthenopoulos Charilaos1, 1 1 1 1 2 Perrea Despoina , Diamanti Konstantina , Katsilambros Nicholas Obesity Outpatient Clinic - Korinthos General Hospital; Internal Medicine Dpt. - Korinthos General Hospital 1First Department Of Propaedeutic Medicine, Athens University Medical Introduction: Obesity is a serious, chronic medical disease with many treatment strategies. The School, Laiko General Hospital, Athens, Greece main aim of therapeutic management of obesity is weight loss. Aim: To record the results on weight loss, after one year dietary intervention with and without Orlistat treatment in obese patients. Aims: The Metabolic syndrome (MS) is a cluster of associated conditions Materials and methods: In 82 obese patients(M:12/F:70), age: 49.5(13.1) years old, that increase the cardiovascular risk. Its prevalence and its association with BMI:40.6(7.8), Waist: 118(16.6)cm, a year long hypocaloric diet was given(minus 700 Kcal/day) the Mediterranean diet (MD) was investigated in a sample of young Greek as well as an exercise program(half an hour of strenuous walking every day), while in 57 of Navy recruits. them(obese with co-morbidities) an Orlistat regimen was added. Results: Methods: We studied demographic, lifestyle, dietary and clinical information in 832 male Greek Navy recruits (22.5±2.7 years old). Dietary habits were Diet group Diet group+Orlistat recorded through a validated quantitative food-frequency questionnaire. Beginning 36,9(8,7) 42,3(7) Based on the inherent characteristics of the MD, a special diet score (range 0– Males/Females 44,7(11,6)/35(6,8) 42,5(3,1)/42,2(7,4) 73) was developed that assessed the participants’ adherence to it. BMI at 12 months 33,5(7,4) 37,1(6,5) Males/Females 39,6(9,1)/32 (6,3) 38(3,7)/37(6,9) Results: The vast majority of the participants were away from the MD P value <0,0001 <0,00001 pattern (maximum score achieved: 47, mode: 30). Those closer to it (upper P value P<0.05 tertile) did not differ regarding age, BMI, waist circumference, SBP, DBP, Beginning Waist(cm) 112,1(19,5) 121,4(14,4) serum lipids and glucose levels from those with moderate (middle tertile) or Males/Females 133,8(27)/106,7(13,1) 134,3(9,6)/119,6(14,2) low adherence (lower tertile). Around 11% of the participants fulfilled the Waist(cm) at 12 106,4(17,4) 112,7(13,5) months 124,2(24,8)/101,9(12,3) 125,3(8,5)/110,9(13,2) IDF criteria for the presence of the MS, while only 5% fulfilled the NCEP Males/Females criteria (these rates did not differ according to adherence to the MD). In a P value <0,001 <0,0001 multivariate logistic regression model, the MD did not significantly predict P value P<0.05 the presence of the MS, with either of the criteria used. All values are given as mean value and standard deviation: mean(SD). Conclusions: The dietary pattern of this young Greek cohort is In both groups we had a statistically significant weight loss with the Orlistat group however, disappointingly away from the traditional MD. The MS is more prevalent who had more obese patients, having better results statistically in BMI and Waist measurements. according to the IDF criteria than the NCEP criteria. The MD did not Conclusion: In conjunction with a hypocaloric diet and moderate exercise, orlistat is an effective significantly influence the presence of the MS, presumably due to the overall well tolerated drug for use in the management of obesity in adults. Most importantly, it is low adherence of the cohort to this dietary pattern. imperative to realize that all these anti-obesity agents are only indicated for use when combined with lifestyle modifications.

International Journal of Obesity Abstracts S123 T3:PO.70 T3:PO.71

Impact of a herbal supplement on control of eating and body weight Sex specific central obesity and co-morbidity of arterial hypertension in type 2 diabetes patients Ruxton Carrie1, Kirkwood Lesley1, McMillan Brian2 Kyriazis Ioannis1, Zervas Eleftherios2, Lalousis Athanasios2, Michas 2 2 2 1Nutrition Communications; 2University of Leeds Dimitrios , Paraskevopoulos Konstantinos , Manias Apostolos , Mparlas Konstantinos2, Parthenioy Christos2

A controlled trial in 47 subjects (1) previously demonstrated that a 1 2 Obesity Outpatient Clinic - Korinthos General Hospital; Internal Medicine commercially-available herbal supplement (Zotrim) significantly Dpt. - Korinthos General Hospital reduced weight by 5.1 kg over 45 days compared with a placebo (0.3 kg). The suggested mechanism was increased satiety via slower gastric Introduction: Arterial hypertension(AH) and diabetes mellitus(DM) emptying (as measured by ultrasound). The present study investigates represent important risk factors for cardiovascular disease. On the other hand, this further in 72 healthy overweight or obese nurses. sex specific central (abdominal) obesity(SSCO) constitutes an additional risk Following ethical approval, subjects were given Zotrim for 6 weeks. No factor for both these disorders. other lifestyle changes were required. Subjects were followed at baseline Aim: To correlate SSCO with co-morbidity from AH in type 2 diabetes and weeks 1, 4 and 6. Multivariate and univariate ANOVA tests were patients. applied to changes. Weight, waist and hip circumference reduced by 2.3 Materials and methods: Out of total of 720 type 2 diabetes patients kg, 3.4 cm and 3.7 cm respectively (P<0.001). Between-meal hunger, (M:327/F393, age 65.1+0.4 years old), 454(63.18% had AH whereas reported using the Likert scale, fell (P<0.05), while fullness after meals 543(75.4%) had SSCO. Having AH showed a positive statistical correlation increased (P<0.005). Afternoon and evening snacking reduced (P<0.01). with age (P<0.01) and SSCO (P<0.01) while its regulation was independent Subjects were asked to respond to a series of questions on eating control, of these factors. Of the patients having AH, 431(94.9%) were under e.g. “When I get upset, I find myself overeating high calorie foods” or antihypertensive treatment, but only 65.6% of them had controlled their “Late night snacking is a problem for me”. McNemar’s tests revealed arterial blood pressure. The majority of antihypertensive drugs were Angiotensin-converting Enzyme (ACE) Inhibitors (61.4%) followed by - that the proportion of subjects agreeing with each statement significantly blockers (31.1%), Angiotensin II receptor antagonists (30.6%), reduced between baseline and week 6 (P<0.001) indicating better diuretics(29.6%) and calcium channel blockers (28.5%) . Of the hypertensive control. patients 57.7% were under a combined drug therapy:( 36% two and 14.7% This study adds support to previous research and suggests that Zotrim three medications). The most important combinations were: Angiotensin- helped to reduce weight and waist size by increasing satiety and converting Enzyme (ACE) Inhibitors and -blockers (73 patients) and improving perceived control over eating behaviour. Angiotensin-converting Enzyme (ACE) Inhibitors and calcium channel 1. Andersen, T. & Fogh, J. (2001) J. Hum. Nutr. Diet 14, 243–250. blockers ( 71 patients). This study was funded by a grant from Natures Remedies Ltd whose Conclusion: Type 2 diabetes patients of an advanced age with SSCO have an employees or agents played no role in the collection or analysis of data. increased risk of developing AH as a consequence its complications.

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Weight loss with diet, exercise and orlistat enables kidney transplantation in The relationships of metabolic syndrome with sex hormone and sex obese patients with chronic kidney disease hormone binding globulin in Japanese postmenopausal women with type 2 diabetes mellitus MacLaughlin Helen1, Cook Sharlene1, Kariyawasam Deepa1, van Niekerk 1 1 Marcelle , Macdougall Iain C Koga Satsuki1, Kisimoto Hiroyo1, Sasaki Haruka2, Kumagai Shuzo3

1 King's College Hospital 1 Graduate School of Human-Environment Studies, Kyushu University, Fukuoka Japan; 2Division of 2nd Internal Medicine, Chikushi Hospital, A multidisciplinary weight management clinic (WMC) was established to 3 determine whether obese patients with chronic kidney disease (CKD) could Fukuoka University, Fukuoka Japan; Institute of Health Science, lose sufficient weight to become eligible for kidney transplantation. 32 Kyushu University, Fukuoka, Japan (20M;12F) obese patients (mean BMI 35.7±4.5 kg/m2) with CKD followed individualised diet and exercise regimens with Orlistat therapy for 12 months. The serum level of sex hormone binding globulin (SHBG) has been Changes in body weight (BW), blood pressure (BP), waist circumference reported effective marker for lipid and glucose metabolism, and simple (WC), and exercise performance (6 minute timed walk test (6MTWT), sit to good predictor for the incidence of diabetes mellitus. However, there are stand 60 (STS60), timed up and go (TUAG), rate of perceived exertion of not reports concerning on the relationships of metabolic syndrome with hardest daily task (RPEHDT) and the Duke’s functional activity status index) sex hormone, SHBG in postmenopausal women with type 2 diabetes were measured. BW and BP were measured in 20 (12M; 8F) age- and mellitus. Therefore we investigated the serum levels of sex hormones weight-matched control patients with CKD. In the WMC group, mean BW (LH, FSH, estradiol, dehydroepiandtrosteron-sulfate, and free and total and WC decreased by 6.6% (P<0.001) and 12.1 cm (P<0.001) respectively, testosterone) and SHBG between the groups with metabolic syndrome and systolic and diastolic BP reduced by 12 mmHg (P<0.01) and 4 mmHg (MS, MS+) and without MS (MS-) group classified by the WHO (P<0.05) respectively at 6 months. All improvements were maintained at 12 diagnosis criterion in newly diagnosed postmenopausal women with type months. Functional capacity increased progressively throughout the study; 2 diabetes mellitus. Significant differences were not observed in age, the 6MTWT improved by 45% (P<0.001), STS60 by 30% (P<0.001), TUAG obese indices (BMI and visceral fat area) and cardioresiratory fitness by 37% (P<0.001), RPEHDT by 11% (P<0.05), and Duke’s by 50% (VO max) between both groups. Total and free testosterone levels were (P<0.001) after 12 months. There was no change in BW or BP in the control 2 group at 6 or 12 months. Eight patients have been listed for kidney significantly lower in MS+ group as compared with MS- group. On other transplantation since reaching weight loss goals and two of these have hand, SHBG level in MS+ group was lower as compared with MS- received transplants. This programme achieved significant weight loss, group. It was suggested that relative androgenicity might be associated improved functional ability, reduction in cardiovascular risk factors and with presence of MS in postmenopausal women with type 2 diabetes listing for kidney transplantation in patients with CKD. mellitus. Funding received from Roche Products Ltd and Amgen Ltd.

International Journal of Obesity Abstracts S124 T3:PO.74 T3:PO.75

The effect of biliopancreatic diversion with sleeve gastrectomy and duodenal The effects of hypocaloric and hypolipidic diet on metabolic syndrome patients switch on fasting serum ghrelin, leptin and adiponectin levels. Is there a 1,2 1,2 1,2 2 hormonal contribution to the weight reducing effect of this procedure? Rusu Emilia , Radulian Gabriela , Vladica Maria , Dragomir Andreea

1 2 Kotidis Stathis1, Koliakos George2, Papavramidis Theodosios3, Papavramidis "Carol Davila" Medicine University, Bucharest, Romania; Institute Diabetes Spiros1 Nutrition and Metabolic Disease

1 Aims: This study was designed to measure the impact of an educational program 3rd Department of Surgery, AHEPA University Hospital, Aristotle involving a diet therapy and physical on metabolic syndrome patients. University of Thessaloniki, Greece; 2Department of Biochemistry, Aristotle 3 Methods: A number of 69 patients, 37 male and 32 female, with an average University of Thessaloniki, Greece; 1st Propedeutic Surgical Department, 62,14±7 years with metabolic syndrome (diagnosed using ATP III criteria) were AHEPA University Hospital, Aristotle University of Thessaloniki, Greece included into educational program. All patients completed at baseline, 1 month and 2 month a food frecvency questionnaire and they was educate to keep a diary food Background: Ghrelin is a peptide hormone with orexigenic properties, weekly for 2 month. Body weight, blood presure, lipidic profile, proinflamatory primarily produced by the stomach. Different changes in fasting ghrelin levels state and prothrombotic state were measured at all visits. Each recording was have been reported following bariatric surgery. In this study, we investigate analyse in a individual meeting and they recived professional advice. the hypothesis that since ghrelin is mainly produced by the fundus of the Results: An average weight loss of 4.3±1.6 kg of the initial weight was recorded stomach, biliopancreatic diversion with sleeve gastrectomy with total parallel with decreased in calories consumption (P<0.05). Triglycerides decreased resection of the gastric fundus, and duodenal switch (BPDDS) will cause from 267±62 mg/dl to 143±71 mg/dl (P<0.05), total cholesterol dropped from 244 substantial decrease in circulating ghrelin levels. ± 34 mg/dl to 207±68 mg/dl (P<0.05), and HDL-cholesterol increased from 35±4 Methods: Serum fasting ghrelin, leptin and adiponectin concentration were mg/dl to 37±15 mg/dl (P<0.05), after 2 months. Systolic BP dropped from 145±30 to 130±20 mm Hg (P<0.05). Diastolic BP decreased from 95±15 mm Hg to 85±15 measured by ELISA in 13 patients with morbid obesity who achieved weight mmHg (P<0.05). Fibrinogen, plasminogen activator inhibitor, C-reactiv protein loss by BPDDS, before the operation and 18 months after. decreased but we not found significant statistically differences. Results: After BPDDS, BMI decreased significantly, from 59.15±15.82 2 This reduction is explained decreasing amount of glucoses and fats; quantity of kg/m2 to 32.91±6.46 kg/m , (P=0.001). Serum fasting ghrelin level decreased proteins was similar. Decrease consumption of dairy integral produces, saturated from 1.44±0.77 ng/ml to 0.99±0.35ng/ml (P=0.019). Serum leptin level fats, rafined carbohidrates, sugar, alcohol simultaneos with increase in consumption decreased from 1.81±0.38ng/ml to 1.65±0.32 ng/ml, (P=0.196), and from dairy produces low fat, fruits and vegetables was associated with improve in adiponectin level increased from 37.85±11.24 µg/ml to 39.84±16.27 µg/ml body weight and lipidic profile. (P=0.422). Conclusions: The present study establishes the positive impact of a educational Conclusions: BPDDS is associated with markedly suppressed ghrelin levels, program in management of patients with metabolic syndrom. possibly contributing to the long lasting weight reducing effect of the procedure. Leptin levels decreased and adiponectin increased, as expected, after weight loss. Sleeve gastrectomy with resection of the gastric fundus seems to be the main cause of the postoperative reduction in ghrelin levels.

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Beneficial postprandial effect of orlistat on triglycerides and leptin Obesity is associated with aortic enlargement and increased stiffness – an echocardiographic study Sanz París Alejandro1, Rodriguez Valle Ana2, Navarro Maria Antonia3, 1 3 1 Caverni Alberto , Osada Jesus , Alvarez Ballano Diego , Albero Gamboa Csajbok Eva1, Nemes Attila2, Gavaller Henriette2 Ramón1 1 1 2 Dept. of Endocrinology, University Of Szeged, Hungary Miguel Servet Hospital. Endocrinology Unit; Miguel Servet Hospital. 2 3 2nd Department of Medicine and Cardiology Centre, University of Clinical Biochemistry; Molecular Biochemistry. Zaragoza University Szeged Objective: Orlistat is a gastrointestinal lipase inhibitor drug used effectively and safely in the treatment of obesity. The objective of this study was to Background. Obesity may be associated with early vascular changes. evaluate its effect on postprandial triglycerides response to two different Some data suggest that body weight and fat distribution are related to breakfasts with different fat content. arterial stiffness. The current study was designed to assess the Methods: We studied 16 normolipemic obese hyperglycaemic menopausal relationship between obesity characterized by body mass index and women. Written informed consent was obtained. Eight patients consumed a aortic stiffness in two biracial populations, one aged 14 to 40 years and breakfast with 11g of fats and eight consumed a breakfast with 50g of fats. one aged 41 to 64 years. After an overnight fast blood samples were taken baseline and after breakfast Patients and methods. The study complied 123 subjects, all of them every hour for 5h. Measurements were made of levels of glucose, underwent a physical examination, two-dimensional transthoracic triglycerides, cholesterol, free fatty acids, insulin, C peptide, high sensitivity echocardiography and blood pressure measurement. During C- reactive protein and leptin. After a week we repeated the test but a single echocardiographic examinations, aortic stiffness index (beta) as a dose of 120 mg orlistat was given before breakfast test. Statistics for repeated characteristic of aortic elasticity was evaluated from ascending aortic measures analysis of variance with Wilcoxon test. diameter and blood pressure data. Results: After breakfast with 11g of fats ingestion the concentration of Results. Systolic (SD) and diastolic (DD) aortic diameters and beta plasma triglyceride (P<0.03), free fatty acids (P< 0.01) and leptin (P<0.02) were significantly lower 1 hour after orlistat administration and maintained index were increased in patients with obesity. SD, DD and beta were for 5 hours. Conversely, the subjects received the 50 g breakfast did not show similarly increased in obese young patients compared to non-obese older any significant difference at the 5 hour time point after orlistat administration subjects. End-diastolic diameters were larger, while interventricular because responses variation among individuals was high. None subject septum and posterior wall thickness were increased in obese subjects. reported faecal urgency after orlistat treatment. Conclusion. The present study has clearly shown that aortic stiffness is Conclusions: Orlistat has a beneficial effect on postprandial lipaemia that altered among patients with obesity even in young adults. Young obese may depend on the amount of dietary fat. The effects on leptin plasma levels patients have similarly increased aortic stiffness than in older subjects appear from the first hour of treatment. without severe obesity. Both SD and DD are increasing with age, but subjects within similar age group have larger SD and DD suggesting early vascular remodelling in obesity.

International Journal of Obesity Abstracts S125 T3:PO.78 T3:PO.79

Quality of life of female bariatric patients before and after vertical banded Short-term results of standard recommendations on nutrition in preobese and obese gastroplasty female adolescents

Dziurowicz-Kozlowska Agnieszka Hanna1, Wierzbicki Zbigniew1, Lisik Wojciech1, Plavsic Ljiljana1, Zdravkovic Dragan1, Sedlecki Katarina1 Wasiak Dariusz1, Kosieradzki Maciej1, Trzebicki Janusz1 1Mother And Child Health Care Institute Of Serbia 1The Medical University of Warsaw, Poland Introduction Background: The measurement of general quality of life allows one to look at the Regarding its growing frequency and possible complications, obesity is one of the patient’s subjective perceptions related to his/her obesity and to monitor the most serious social-health problems today, which has negative effects on life’s character of changes taking place as a consequence of therapeutic interventions quality and expectancy. Reduction of weight is recommended for most obese aiming at weight reduction. The research question is: what is the range and adolescents. The main method of prevention and obesity treatment is changing the character of changes within quality of life (QL) of morbidly obese patients who existing nutrition pattern, along with increasing everyday physical activity. underwent Vertical Banded Gastroplasty (VBG) in the period of three and six Aim months after surgery? Evaluation of the short-term results of recommendations on nutrition according to Methods: Patients were tested three times: before surgery (n=44, 100% females, the reduction of BM in female adolescents with different obesity degrees. age 37.48 ± 7.85, BMI 48.26 ± 6.54 kg/m²), as well as three (n=43, BMI 39.87 ± Methods 6.04 kg/m²) and six months after VBG (n=41, BMI 34.85 ± 6.13 kg/m²). The Polish Study group consisted of 33 female adolescents 16.2±3.7 years old (12.5-19.9) who version of WHOQOL-BREF questionnaire was used as an indicator of QL. had other abnormalities besides obesity: menstrual disorders (75.7%), hirsutismus Results: QL of bariatric patients treated with VBG improved significantly in two (9.1%) and hypertension (6.1%). Nutrition level was estimated by using body mass out of four WHOQOL-BREF areas: physical (P<.0001) and psychological health index (BMI) according to NHANES 2000 standards. Written recommendations (P<.05). Positive changes in physical functioning appeared earlier (3 months after about balanced hypocaloric nutrition with detailed oral instructions were given, surgery) and had a wider effect than positive changes in psychological functioning correlating with their age, psychological characteristics, socioeconomic family (6 months after surgery). Among other improvements were the patient’s status, education and lifestyle. The results were evaluated after three months subjectively felt: general quality of life (P<.05) and general health state according to: 1. anamnesis of compliance and 2. BMI. (P<.001). Results Conclusions: The reduction of weight following VBG surgery, apart from health There were 22 (66.67%) preobese (BMI 85-98 percentile) and 11 (33.33%) obese benefits, brings a rapid and significant improvement in the QL among bariatric (BMI >95 percentile) female adolescents. Reduction in weight 0.3-11.8 kg (X = patients with reference to both physical functioning and frame of mind. However, it 3.1 kg) was registered in 30 girls (90.9%) after three months. Significant statistical is easier to rid oneself of obesity as a health problem than to discard the negative correlation between compliance with recommendations and weight reduction was consequences of psychosocial character. proved in 26 girls. Conclusion Accepting and proceeding nutritive recommendations is an effective method which results in initial weight reduction in preobese and obese female adolescents. Poor results in some patients indicate the necessity for other therapeutic measures in obesity treatment.

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The influence of bariatric surgery on bone mass in patients with morbid obesity Do BMI changes influence the level of satisfaction of female bariatric patients with their weight and appearance following vertical banded gastroplasty? Walicka Magdalena1, Czerwinska Ewa1, Talalaj Marek1, Wasowski Michal1, Marcinowska-Suchowierska Ewa1, Lisik Wojciech2, Wierzbicki Zbigniew2 Dziurowicz-Kozlowska Agnieszka Hanna1, Zbigniew Wierzbicki1, Wojciech Lisik1, Wasiak Dariusz1, Kosieradzki Maciej1, Trzebicki Janusz1 1Postgraduate Medical School, Department of Family and Internal Medicine; 2The Medical University of Warsaw, Department of General and Transplant Surgery 1The Medical University of Warsaw, Poland

Aim: Background To evaluate the effect of surgical-induced weight loss on the skeleton using the One of the most important psychological consequences of obesity is dislike of DXA technique in patients with morbid obesity. one’s . Body image consists of two elements: body percept (body size Patients and methods: evaluation) and body concept (body satisfaction evaluation). 62 patients with morbid obesity with a mean age of 36.5y and BMI of 46.2kg/m2 The study question is: do BMI changes influence the level of satisfaction of selected for the bariatric surgery of the stomach (BS) were included into the bariatric female patients with their weight and appearance after Vertical Banded prospective study. Bone mineral density (BMD) in the lumbar spine, proximal Gastroplasty (VBG)? femur and total skeleton and bone mineral content (BMC) as well as fat mass (FM), Methods fat mass % (FM%) and (LM) were measured by dual energy X-ray Patients were tested three times: before surgery (stage I: n=38, 100% females, age absorptiometry (DXA) before BS. The same procedures were repeated after weight 37.69 ± 7.58, BMI 49.56 ± 6.39 kg/m²) as well as three (stage II: n=42, BMI 40.01 reduction in 31 patients who reached six-months observation period and in 10 ± 6.21 kg/m²) and six months after VBG (stage III: n=40, BMI 34.92 ± 5.84 patients who reached twelve-months observation period after BS. kg/m²). Seven-grade Likert scale was used to check the level of patients’ Results: satisfaction with their weight and appearance. Mean BMD in the morbidly obese was within the upper limit of the age-matched Results reference range. Following the operation mean BMI decreased by 12.7kg/m2, FM BMI changes did not correlate with the patients’ satisfaction with their weight and by 24.4kg, FM% by 9.1 and LM by 11.2kg in six months. Mean BMC decreased appearance at any of the three stages. High positive correlations between the by 57.5g, p<0.01 and BMD in lumbar spine increased by 0.054g/cm2, p<0.005. patients’ satisfaction with their weight and appearance were observed at stage I 12 months after BS there was a further reduction in BMI (by 3.6kg/m2), FM (by (r=0.70, P<.0001), stage II (r=0.75, P<.0001), stage III (r=0.79, P<.0001). 9.3kg) and FM% (by 7.9). BMD in proximal femur decreased by 0.041g/cm2, Significant differences between patients’ satisfaction with their weight and p<0.05. appearance were observed when comparing the mean values of stage I with the Conclusions mean values of stages II (P <.0001) and III (P <.0001). No significant differences 1. BMD in patients with morbid obesity does not differ from the upper reference were observed between stages II and III. age-matched population data. Conclusions 2. Abrupt weight loss in six months after BS is accompanied by the increase in In our sample, dissatisfaction with one’s looks is connected with the very presence BMD only in the lumbar spine. In twelve months after BS the decrease in BMD in of obesity and not its scale. Satisfaction clearly improves three months after proximal femur is observed. operation but remains rather stable between stages II and III.

International Journal of Obesity Abstracts S126 T3:PO.82 T3:PO.83

Mini-open Roux-en-Y Gastric Bypass; safe surgical treatment of morbid obesity, Rapid weight loss and non-alcoholic steatohapatitis (NASH): changes in liver experience with 1000 patients histology in high risk individuals

1 1 1 Halmi Denis , Anez Osvaldo , Kolesnikov Evgeni Colles Susan1, Dixon John1, Bhathal Prithi2, Marks Paul3, O'Brien Paul1

1 Obesity Surgery Center 1Monash University Centre For Obesity Research And Education, Melbourne, Australia; 2Department of Pathology, University of Melbourne, Melbourne, BACKGROUND: Morbid obesity is becoming a significant public health problem 3 worldwide. Bariatric surgery offers the most effective long term weight control at Australia; Radiology Department, The Avenue Hospital, Melbourne, present time. Success depends on the operative procedure and on the perioperative Australia care of this high risk group of patients. MATERIALS AND METHODS: Between October 2000 and February 2006, Background: Non-alcoholic steatohepatitis (NASH) is an increasingly 1000 consecutive morbidly obese patients (female: 868, male: 132) underwent common and potentially progressive liver disease. Strong links exist between Mini Open Roux-en-Y Gastric Bypass operation in a single institution. Our NASH, obesity, and the metabolic syndrome. Weight loss (WL) is the modification of the surgical procedure through a 7–8 cm midline incision is cornerstone of management in obese persons with NASH, but research described. Average age: 40.5 years (16–67), average Body Mass Index: 46kg/m2 suggests rapid WL can instigate or exacerbate liver dysfunction. (35–80). Standard protocol was followed for patient selection, preoperative workup Method: A prospective observational study of 8 morbidly obese subjects and surgical technique. A postoperative pathway was utilized for prevention of deemed high risk for NASH, using a VLED for 6 weeks. Percutaneous liver deep vein thrombosis, pulmonary embolism, rhabdomyolysis and respiratory biopsy was taken before and after WL (during laparoscopic surgery). Other complications. Long term monitoring of weight loss, health status and quality of outcomes included change in body weight, liver volume (LV), visceral life was done through office visits, questionnaires, support group meetings and adipose tissue (VAT), and a series of biochemical parameters. internet communication. RESULTS: Mortality: 0.1% (pulmonary embolism), Postoperative morbidity: Results: Subjects included 2M and 6F, mean age 49.5+9.4y, weight 4.8%, Reoperations within 30 days: 0.6%, Average hospital stay: 3.1 days (2-23). 127.9+25.3kg and BMI 44.8+6.0kg/m². The median (IQR) baseline steatosis Late complications requiring surgery: 2.9%. An average excess body weight loss of score was 4.0 (2.0). NASH was diagnosed in 6 subjects (75%). Following a 77% and 71% was achieved at one year and three years after surgery, respectively. total WL was 9.8+5.4kg (P=0.001) median steatosis score improved to 2.0 CONCLUSION: Roux-en-Y Gastric Bypass is one of the most effective treatment (3.0) (P=0.038), but there were mixed changes in liver inflammation and modalities of morbid obesity. The Mini-open surgical technique is cost-effective fibrosis. Liver enzymes rose at week-2, were stable to week-4, but declined and a relatively simple alternative to the laparoscopic approach. With careful below baseline by week-6. Mean LV (P=0.027), VAT (P=0.029), GGT patient selection and proper perioperative care using standardized protocols and (P=0.029), fasting glucose (P=0.022), HbA1c (P=0.033), cholesterol multidisciplinary approach this complex procedure can be done safely, efficiently (P=0.008), and LDL-cholesterol (P=0.017) reduced from baseline to week-6. and with low morbidity and mortality. Conclusion: Rapid weight loss reduces liver steatosis and improves metabolic functioning. An immediate, transient rise in liver enzymes can occur, but this is followed by an overall decline. Mixed changes in inflammation and fibrosis were observed, and call for some caution in persons high risk for NASH. Further exploration is required.

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Binge eating and : measures of psychological distress are The use of a frequent, electronic, weight management newsletter as an graded according to binge volume and loss of eating control, but not binge adjunct to monthly group visits: a six month experience from a no-cost, frequency low-budget, obesity clinic in San Antonio, Texas Colles Susan1, Dixon John1, O'Brien Paul1 Tanton, M.D. Damon1, Watson, R.N. Nina1 1Monash University Centre For Obesity Research And Education, Melbourne, Australia 1United States Air Force

Background: Binge eating disorder (BED) involves loss of control during Background Established in August 2004, the Wilford Hall Obesity Clinic consumption of an objectively large amount of food, teamed with marked psychological distress, which occurs on average twice/week over 6 months. is a no -cost, low-budget, multi-disciplinary clinic that has been Limited research has assessed characteristics of binge eaters who do not meet these successful in helping patients achieve an average weight loss of 2.4% criteria. (18 month data presented at ICO 2006 in Sydney, Australia). In an effort Method: Cross-sectional data on BED, symptoms of depression, body image to maintain this success, we have initiated a six month trial, the purpose distress (BID), and quality of life (QoL) were collected via validated of which is to determine if email correspondence can be successfully questionnaires. Diagnoses were confirmed by phone interview and comprised: full utilized as an adjunctive tool in the management of weight. BED, subthreshold BED (SthBED) =1

International Journal of Obesity Abstracts S127 T3:PO.86 T3:PO.87

Fasting plasma glucose and metabolic syndrome among South Korean adults The role of primary care physician in management of obesity

1 2 1 3 Park Jin Ho , Choi Jae Kyung , Lee Cheol Min , Kwon Hyuk Tae , Cho Cikac Tatjana1 Belong3 1Private Primary Care Physician 1Seuol Nat. University Hospital Gangnam Center, Korea South; 2Konkuk University Hospital, Korea South; 3Seoul National University Hospital, Korea South Objectives: To review the efficacy of GP’s individual intervention in weight loss management by gaining new lifestyle habits, increased daily OBJECTIVES - To assess the optimal cut-off point of fasting plasma physical activity and pharmacotherapy. glucose(FPG) to detect the metabolic syndrome(MS) among South Korean Method: The patient participated voluntarily individual 10 months adults. program. The program was carried out by the GP through a 15 minutes RESEARCH DESIGN AND METHODS - We evaluated the optimal point consulting two times per month. of the FPG to detect MS in 5849 subjects from the Korean National Health The educational program consisted of balanced diet, lifestyle and Nutrition Examination survey 2001. The components of MS, as defined modification, physical activity and pharmacotherapy. Patient recorded by the National Cholesterol Education Program Adult Treatment Panel-III food intake and took note of her physical activity. and the American Heart Association/National Heart, Lung, and Blood Results: At the beginning of the program patient’s baseline measures Institute were used. The risk of MS according to FPG groups was estimated were: weight 114 kg, height 164 cm, BMI 43 kg/m2, waist circumference using logistic regression adjusted for age, sex, alcohol intake, smoking, 114 cm and blood pressure 130/80 mmHg. physical activity, and obesity. The linear trend in odds and likelihood ratio During the whole program patient was prescribed a 1200–1500 kcal diet test for trend were evaluated using the trend test. Receiver operator and was exercising for 30 minutes every day. characteristics curve analysis was performed to investigate the optimal value Pharmacotherapy included Sibutramin 5 mg daily during the first week of FPG for detecting more than 2 or 3 metabolic components except for FPG. of the program, 10 mg from 2nd to 5th week and 15 mg from 6th to 24th RESULTS - We observed a significant and progressive increase of odd ratio week. After 10 months outcome measures were: weight - 83 kg, BMI -31 for more than 2 or 3 metabolic components except for FPG in groups with 2 FPG above 100 mg/dL as compared with the bottom quartile of normal group. kg/m , waist circumference 90 cm. We identified a lower FPG limit of about 100 mg/dL to more than 2 or 3 metabolic components except for FPG as the fasting category that gave the Conclusion: GP can successfully manage overweight and obesity best combination of sensitivity and specificity. through lifestyle modification, dietary management and by supporting CONCLUSIONS - We found that FPG 100mg/dL was the optimal cut-off his/her increased physical activity. Pharmacotherapy is necessary for a point to detect MS among South Korean adults. successful treatment of overweight and obesity. A primary-care physician has to increase patients awareness and make them feel that they can do something for themselves. Primary care physician can facilitate their efforts.

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Maintaining a weight loss at 5 years: an outpatient psycho-educational Effect of a 12-week dietician-implemented Cognitive Behavioral Therapy (CBT) programme on adiposity, dietary habits and physical activity patterns of overweight approach children

Bruchez Vanessa1, Picco Nathalie1, Delétraz Michel1, Golay Alain1 Bathrellou Eirini1, Yannakoulia Mary1, Papanikolaou Katerina2, Pehlivanidis Artemios3, Pervanidou Panagiota2, Kanaka-Gantenbein Christina2, Tsiantis John2, Chrousos George2, 1 1Service Of Therapeutic Education For Chronic Diseases - Geneva Sidossis Labros University Hospital 1Harokopio University, Athens, Greece; 2University of Athens Medical School, “Agia Sophia” Children's Hospital, Athens, Greece; 3University of Athens Medical School, Weight loss maintenance remains difficult. The aim of our study is to Eginition Hospital, Athens, Greece propose a psychoeducational programme to maintain weight loss during Background: Current consensus indicates that treatment of childhood obesity needs to be 5 years in order to evaluate potential factors influencing further weight family-based and to focus on behavioural changes with respect to diet and physical loss or weight regain. activity. However, parental role and type of dietary and physical activity intervention Methods: 40 obese patients (57 ± 2 years old) with a BMI of 40.1 ± 1.5 have not been fully explored. kg/m2, followed a weight loss programme during six months (Mean of Aim: To investigate the efficacy of a CBT programme implemented by dieticians in treating childhood obesity and the role of parents in this respect. weight loss : -5.6 ± 0.8 kg). Moreover, a 5-year outpatient nutritional Methods: Twenty overweight and obese children (IOTF BMI cut-offs), aged 7-11 years, psycho-educational approach was proposed consisting of 15 to 20 were randomly assigned to one of two groups: “child alone” (A) or “child and parent as individual or group sessions. helper” (B). All children attended 12 weekly individual sessions. By using CBT Results: 33 patients completed the study and 7 dropped out. Among techniques, children were encouraged to adopt healthy eating habits and a physically these 33 patients, 18 lost further 9.9 ± 1.9 kg, 5 remained stable (-2.4 ± active lifestyle. Results: Both groups decreased significantly the percent of overweight after the 1.5 kg) and 10 gained +3.5 ± 1.1 kg. It was shown that the most striking intervention, by 4% in group A and 2.5% in group B (P=0.003). The children factors influencing weight evolution were psychosocial difficulties significantly improved their meal pattern, e.g. more frequent breakfast consumption, (P=0.0007), food management (P<0.001), eating behaviour (P<0.001), better quality snacks, more balanced meals (all P<0.05). The time spent on sedentary sedentarism (P<0.007) and motivation (P<0.001). activities was reduced (group A: -54 min/d, group B: -37 min/d, P=0.032) and that spent on physical activities was increased (P=0.057). The two groups did not differ with respect Conclusion: more than 50 % of obese patients lost weight or maintained to the anthropometric, dietary and physical activity responses to the programme. a weight loss after 5 years of psycho-educational follow-up. A particular Conclusion: A CBT programme implemented by dieticians is effective in reducing effort must be undertaken to put into practice motivational interviewing overweight in children and promoting healthy eating and physical activity habits. as well as cognitive-behavioural therapies in order to maintain a long- Preliminary results suggest that parental participation may not be a key factor modulating the response to treatment in the short-term. term weight loss. Abbreviations: CBT= Cognitive Behavioural Therapy, IOTF= International Obesity Task Force, BMI= Body Mass Index

International Journal of Obesity Abstracts S128 T3:PO.91 T3:PO.92

Obesity and non-alcoholic fatty liver disease Standard tools used to assess eating patterns in obese populations do not encourage the reporting of night eating behaviour 1 1 1 Asatiani Ketevan , Giorgadze Ellen , Chachibaia Vasil , Mirianashvili 1 1 2 2 Ketevan1, Bochorishvili Ketevan1, Surmava Arkadi1 Cleator Jacqueline , Wilding John , Sutton Chris , Judd Pat

1 1 University of Liverpool Diabetes & Endocrinology Clinical Research Group; N4 Clinical Hospital, Department Of Endocrine Disorders 2 Lancashire School of Health and PG Medicine, University of Central Lancs, Preston Background: Obesity is a chronic disease which is associated with various comorbidities that contribute to insulin resistance, dyslipidemia, Introduction hypertension, and multiple organ dysfunction - which include the Night eating is a covert behaviour which obese individuals may find difficult to gastrointestinal disorders and especially non-alcoholic fatty liver disease disclose. Food diaries, used widely in the assessment of eating patterns, often (NAFLD). The aim of the study was to reveal the incidence of NAFLD in appear to encourage individuals to report a standard eating pattern, whilst generally patients with obesity and to evaluate the role of the weight loss in its ignoring night eating behaviour. treatment. Materials and methods Methods: Blood lipid profile, plasma aminotransferase concentartions (ALT, 36 food diaries used with obese patients in a variety of clinical, research and AST), oral glucose tolerance test, ultrasound of abdomen was done in all of commercial settings were examined for the presence of both ‘mealtime’ prompts the subjects. and ‘starting’ and ‘ending’ time prompts. Results: From 350 obese patients: overweighted were-24%, I degree – 20%, Results II degree –30%, III degree- 26%. Hypertrigliceridaemia, Two designs were identified. Twenty diaries (55%) contained mealtime prompts hypercholesterinaemia, high levels of low-density lipoproteins and low levels such as ‘breakfast’ and 16 were blank sheets with a column heading of ‘time’, of high-density lipoproteins were observed in most of the patients and were instructing individuals to record the time of eating along with the food eaten. Of these 16 ‘time’ diaries, only 10 (62 %) could be considered truly neutral without redoubled according to weight gain. Disturbed plasma aminotransferase any prompts; 6 others gave a starting time example (between 8-9 am), of which 4 concentartions were observed mostly in the patients with II and III degree of also gave ending times (7.30pm – 9 pm). obesity. The ultrasound of abdomen revealed liver steatosis in overweighted – Of those containing mealtime prompts, 5 diaries out of 20 (25%) included ‘night’, 26,47%, I degree –34%, II degree- 57%, III degree –69%. To all of the although this was not categorised separately. Categories included ‘later evening patients were prescribed the low-calorie diet and the medication was added if and through the night’; ‘snacks up to bed time and during the night’ (example needed. After the 1,5-2 months of the treatment and the weight loss finishes at 10 pm); ‘later evening and last thing at night’ and ‘supper and night- approximately 10-12 kg the tendency of the normalization of the plasma time munchies’. aminotransferase concentartions and the ultrasound sizes of the liver was Conclusion observed. Only 5 (14%) of the diaries encouraged the reporting of night eating. ‘Time’ Conclusions: The liver steatosis is an important complication of the metabolic diaries, which have a more neutral design, do not bias the individual towards given syndrome.The hypocaloric diet is probably the basis in the treatment of the time points, but may not be directive enough to encourage disclosure of disordered obesity and liver steatosis. eating.

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Occurrence and diagnosis of Type II Diabetes in an obese population Dietary fiber intake and metabolic syndrome in middle-aged French adults

1 2 1 2 1 1 1 2 Vergnaud Anne-Claire , Lairon Denis , Arnault Nathalie , Planells Richard , Rolland Catherine , Hession Michelle , Oomen John , Murray Susan , Czernichow Sébastien1, Hercberg Serge1, Bertrais Sandrine1 Wise Alan1, Broom John1 1INSERM U557 / INRA U1125 / CNAM / Paris 13; 2INSERM U476 / INRA 1Robert Gordon University; 2LighterLife U1260 / University of Marseille, Paris

Obesity is the primary aetiological factor in the development of Type 2 Objective: To examine associations between the type and source of dietary fiber Diabetes Mellitus (T2DM). The National Diabetes Audit (NDA) (2006) intake and metabolic syndrome (MS) in French adults aged 45–60 y participating stated that 20% of people expected to have T2DM remain undiagnosed. in the SUVIMAX study. Material & Methods: We conducted a cross-sectional analysis in 1774 men and Data from Health of the Nation surveys suggest an expected prevalence 2 1586 women, separately. Habitual dietary intakes were assessed through six 24- of T2DM in an obese population (BMI >30kg/m ) to be 20%. In the hour dietary records of each subject. Participants were classified into 3 groups counterweight study (C/W), audit data suggested underdiagnosing of according to the number of MS components (0, 1–2, 3 and more), as defined by the T2DM in the obese population was a major problem. National Cholesterol Education Program (NCEP) criteria. Dietary fiber intakes In an ongoing randomised controlled trial of a high protein ketogenic were compared between groups by using analysis of covariance and tests for linear diet (HP) and a very low calorie diet (LighterLife Programme) versus a trend across groups were performed. high carbohydrate energy-deficient diet (-600kcal) in patients with a Results: After adjustment for potential confounding factors, including age, lifestyle 1 2 and other dietary characteristics, intakes of total and nonsoluble fiber decreased BMI 35kg/m , 87 patients underwent an oral glucose tolerance test with increasing number MS components in women. No such trend was observed in (OGTT) at entry to the study and patients with T2dM identified as were men. Fiber from fruits significantly increased from women who had no those with impaired glucose tolerance (IGT) or impaired fasting components of NCEPdefined MS to women who had at least 3 MS components. In glycaemia (IFG). both sexes, fiber from dried fruits was also inversely associated with the number of 120 (20 males: 100 females) were recruited; age range 18-68 (mean: MS components. Similar relationships were observed by classifying subjects 41.2, SD: 11.7); BMI range 35-66 (mean: 44.6, SD: 6.8); and initial according to the new International Diabetes Federation MS criteria (no abdominal obesity, abdominal obesity and 1 other risk factor, abdominal obesity and at least 2 weight range 85.3-174.5kg (mean: 119.4, SD: 20.1). Of the 87 patients other risk factors). who had an OGTT at presentation 13 had T2DM, only 1 was previously Conclusion: Our results suggest that dietary fiber intake are independently diagnosed. 12 patients were previously undiagnosed (13.8%). associated with the prevalence of metabolic syndrome in women and emphasize the These data confirm the under diagnosis of T2DM in the obese population importance of promoting the consumption of fiber-rich products, especially fruits. confirming the previous suggestion from the C/W study. 1. Conflict of Interest: In addition 34 patients (39%) had IGT and 8 patients (9%) had IFG. None Disclosed. 2. Funding Research relating to this abstract was funded by a grant of the Ministère de la Santé et des Solidarités and a grant of INSERM (appel d’offres Cohortes).

International Journal of Obesity Abstracts S129 T3:PO.95 T3:PO.96

Effect of rosuvastatin on CRP level and Endotoxin (LAL) dynamics in C-reactive protein in overweight patients with metabolic syndrome patients with II-III FC CHF and obesity Maksimovic Milos1, Sevic ljiljana2, Djurisic Nebojsa2, Davidovic Dragana1, Arutyunov Gregory1, Chernyavskaya Tatiana1, Dzidzariya Marina1, Bylova Jorga Jagoda1 Nadezda1, Guseva Anna1 1School Of Medicine; 2Railway Health Care Institute 'Beograd' 1Russian State Medical University The aim of this study was to show relationships between C-reactive protein Current guidelines on management of patients with cardiovascular diseases and metabolic syndrome in overweight patients. The research involved 72 imply multimodality influence on the factors leading to development of patients 40.21±13.52 years old who referred to the outpatient Nutrition Unit disease. Atherosclerotic changes of vessels bear a systemic nature and in order to get a dietetic advice or nutritional medical therapy. Nutritional associated with systemic inflammation. status was assessed by BMI (kg/m²), calculated from measured body weight Aim: Studying efficacy and safety of rosuvastatin as a part of multimodality and height, by waist circumference and . Levels of total treatment II-IV FC CHF and obesity. cholesterol (TC), serum triglycerides (TG) and high-density lipoprotein Materials and methods: Open-label, randomized study on 97 patients with II- cholesterol (HDL-C) were estimated using commercial kits (Abbot, IL,USA) III FC CHF of ischemic genesis, BMI>30 kg/m2, absence of chronic diseases on an automated analyzer (AEROSETTM, Abbot, IL, USA). Levels of CRP and conditions affecting the CRP level, baseline level of total cholesterol <6.5 were measured by using Immunoturbidimetric fixed time test. Data were mmol/l. The first group (n=48) received a standard drug therapy for CHF. analyzed using SPSS package version 9. From all 72 overweight patients, The second group (n=49) received standard drug therapy and rosuvastatin 10 13.89% were found to have metabolic syndrome. Although they have s higher mg daily. Patients were evaluated (CRP dynamics; endotoxin (LAL) after 14 serum CRP than patients without it, it was not significant (F=3.265; p=0.075). days, 1, 3, 6, 9 and 12 months of therapy. The only significant difference was found in patients with abdominal type of Results: At baseline CRP level was 11.2 ± 0.3 mg/l in the first group and 12.3 fat distribution (2.39±2.86 mg/L vs 4.01±3.53 mg/L; F=4.530; ± 0.2 mg/l in the second group. In the follow-up period, n the first group 14.4 P=0.037).When data were anlyzed according to the presence of some of the ± 0.3 mg/l (28.5%) and in the second group 9.9 ± 0.3 mg/l (-19.6%) at 12 metabolic syndrome features such as high blood pressure, high glucose, high months. Analyses of blood from patients with II-III FC CHF revealed trigliceryde or low HDL levels compared to overweight patients without significantly ( <0.05) higher levels of endotoxin: 1.2+0.02 EU/ml in the first metabolic abnormalities, CRP levels were not statistically different.These group and 1.2+0.04 EU/ml in the second group. In the follow-up period, in results suggest that abdominal obesity is the most prevalent component of the the first group 1.4+0.02 EU/ml (16.6%) and in the second group 0,94+0.02 MetSy which is on the other hand followed by increased levels of CRP. CRP EU/ml (-22.7%) at 12 months. levels should be detected in all overweight patients, specially those with Conclusion. Statins attenuate severity of systemic inflammation in patients abdominal obesity to identify subjects at higher risk for obese and their with CHF and obesity, slow down levels of Endotoxin and CRP. consequences.

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Lipid profile and comorbidities following Roux-en-Y Gastric Bypass in morbidly obese Effect and safety of long-term, dosed exercise on CRP levels in patients with patients II-III FC CHF and obesity

1 1 1 Paluszkiewicz Rafa , Kalinowski Piotr , Remiszewski Piotr , Biaobrzeska-Paluszkiewicz 1 1 1 Janina2, Kosiewicz-Latoszek Longina2, Zborowska Hanna3, Krawczyk Marek1 Arutyunov Gregory , Chernyavskaya Tatiana , Volgina Olga

1 1Chair And Department Of General, Transplant And Liver Surgery, Medical University Russian State Medical University Of Warsaw, Poland; 2Metabolic Outpatient Clinic, Food and Nutrition Institute, Warsaw, 3 Poland; Central Laboratory, Medical University of Warsaw Central Hospital, Warsaw, Patients with CHF and obesity need multimodality treatment including, Poland besides of drug therapy, non-drug approaches. Regular exercise training Background: Roux-en-Y Gastric Bypass (RYGB) is a method of surgical treatment of results in a steady increase of stroke volume, which affects systemic morbid obesity that combines restriction and malabsorption. hemodynamics. Aim: The purpose of the study was to evaluate changes in lipid plasma concentration and Aim: Evaluating efficacy and safety of long-term exercise training as a part of comorbidity status in patients with morbid obesity following RYGB. multimodality treatment of patients with II-III FC CHF and obesity. Methods: Between January 2002 and November 2005, 42 patients (24 females and 18 Materials and Methods: Open-label, randomized study on 167 patients with males) with morbid obesity underwent RYGB. Patients’ average age was 37.7±9.4 years, II-III FC CHF of ischemic genesis, BMI>30 kg/m2, absence of average body weight was 145.8±27.9kg and average Body Mass Index (BMI) was musculoskeletal diseases. Patients of group 1 (n=84) received a standard drug 49.2±7.0. The following obesity related comorbidities were found: dyslipidemia in 23 patients, with average plasma levels of lipid fractions: total cholesterol (TC) therapy. Patients of group 2 (n=83) received standard therapy and long-term 4.9±0.8mmol/l, triglycerides (TG) 1.9±0.7mmol/l, HDL-cholesterol 1.1±0.3mmol/l, regular exercise. Exercise was performed in the regimen of “free choice of LDL-cholesterol 2.9±0.8mmol/l, arterial hypertension in 23, type 2 diabetes mellitus in 7, load”. Patients were evaluated (CRP level; results of 6-min test) after 36 in 9. The patients were evaluated preoperatively, 6 and 12 months after months of therapy. surgery. Results: At baseline CRP level was 6.4 ± 1.2 mg/l in the first group and 6.6 ± Results: During the follow-up period there was a significant change in average body 1.4 mg/l in the second group. In the follow-up period, in the first group 6.8 ± weight, BMI, lipid profile and improvement in comorbidities. Six months after the 0.2 mg/l (26.5%), in the second group 6.1 ± 0.2 mg/l (-4.7%). operation average body weight was 112.3±23.1kg, BMI 37.5±23.1, TC 4.5±0.7mmol/l, TG 1.4±0.6mmol/l, HDL 1.3±0.3mmol/l, LDL 2.6±0.7mmol/l. Twelve months after the In group 1 mean results of the 6-min test increased from 307.4±61.3 m to operation average body weight was 99.4±17.7kg, BMI 33.3±4.1, TC 4.3±0.7mmol/l, TG 311.4±44.7 m (1.3%). In group 2 increased from 316.4±51.4 m to 364.1±39.4 1.2±0.5mmol/l, HDL 1.4±0.3mmol/l, LDL 2.3±0.6mmol/l. In the postoperative period the m (15.2%). symptoms of concomitant diseases alleviated and the patients required medications in There were a total of 127 hospitalizations and 25 fatal cases in group 1 and 95 reduced doses. hospitalizations and 19 fatal cases in group 2 (P<0.005). Conclusions: Roux-en-Y gastric bypass in patients with morbid obesity is a safe way to Conclusion. Long-term, dosed exercise improves parameters of 6-min test in achieve excellent weight loss and causes significant improvement in lipid profile and comorbidities. patients with II-III FC CHF and obesity, does not change the CRP level.

International Journal of Obesity Abstracts S130 T3:PO.99 T3:PO.100

Influence of epicardial adipose tissue and adipocytokine levels on cardiac Effects of weight loss and sea food consumption on circulating leptin levels in overweight abnormalities in visceral obesity individuals

1 2 3 1 Malavazos Alexis Elias1, Ermetici Federica1, Coman Calin2, Corsi Massimiliano Ramel Alfons , Kiely Mairead , Martinéz J. Alfredo , Thorsdottir Inga 3 1 1 Marco , Ambrosi Bruno , Morricone Lelio 1 Unit for Nutrition Research, Landspitali – University Hospital and University of Iceland, 2 1 Iceland; Department of Food and Nutritional Sciences, University College Cork, Ireland; Endocrinology Unit, Department Of Medical And Surgical Sciences, IRCCS 3The Department of Physiology and Nutrition, University of Navarra, Spain Policlinico San Donato, University of Milan, Italy; 2Echocardiographic Unit, 3 IRCCS Policlinico San Donato, San Donato Milanese, Italy; Institute of General Title Effects of weight loss and sea food consumption on circulating leptin levels in Pathology, Laboratory of Clinical Pathology, University of Milan, Italy overweight individuals. SEAFOODplus – YOUNG. Background Leptin may contribute to hypertension and atherosclerosis in obese This study was aimed to add some information on the possible relationships individuals. Leptin levels are associated with body fat and decrease during energy between adipocytokines, cardiac abnormalities and epicardial fat (EF) in obesity. restriction. Human studies on the interactive effects of weight loss and sea food We studied 42 subjects, 27 severely obese (OB) women without complications consumption on leptin are lacking. (33.3±8.3 years, BMI 43.5±4.8 kg/m²) and 15 normal-weight patients (36.8±8.2 Aim To investigate the effects of weight loss and sea food consumption on leptin levels. years). Plasma MCP-1, IL-6, sIL-6R levels were measured (ELISA method, R&D Methods This 8 weeks randomized controlled trial of energy-restricted diet varying in Systems, USA). All patients and controls underwent echocardiography (M-mode fish and fish oil content included 324 overweight subjects (20-40 yrs) from Iceland, Spain color-Doppler), with measurement of EF thickness on the free wall of right and Ireland. Subjects were randomized into: (1) control (sunflower oil capsules, no ventricle from both parasternal long- and short-axis views. VAT (visceral adipose seafood), (2) lean fish (450g cod/week), (3) fatty fish (450g salmon/week), (4) fish oil (DHA/EPA capsules, no seafood). The macronutrient composition of the diets was tissue) and subcutaneous adipose tissue (SAT) areas in the OB group were assessed similar. Anthropometrical variables and leptin were measured at baseline and endpoint. by CT at the L4-L5 level. In OB patients, EF thickness was significantly greater Results Leptin levels were higher in women (baseline: 38.2±18.2 vs.13.4±5.5, P<0.001), than in healthy subjects (6.5±0.8 vs 1.3±0.2 mm, P<0.0001), and significantly and decreased more in women than men during the intervention (∆leptin = 12.5±12.9 vs. correlated with the following echocardiographic parameters: left ventricular mass 5.7±4.6, P<0.001), also when considered per each percent body fat loss (∆leptin = indexed for height, septum, posterior and relative wall thickness, isovolumetric 8.41±28.08 vs. 2.26±6.21, P<0.001). Body fat loss during intervention was positively relaxation time and myocardial performance index. EF thickness was also associated with ∆leptin. ∆Leptin was not significantly different in the four groups. positively correlated with VAT (r=0.80, P<0.0001) and VAT/SAT (r=0.74, Conclusion Leptin levels decrease during a weight loss intervention, and more P=0.0001). The novel finding of our results is a significant correlation between the pronounced in women than in men. Body fat loss partly explains the leptin decrease increase of EF and that of MCP-1 levels (r=0.80) and sIL-6R/IL-6 complex during a weight loss intervention. Sea food consumption in moderate amounts does not (r=0.52). Plasma MCP-1 levels and sIL-6R/IL-6 complex most closely correlated influence the decrease in leption observed during weight loss. with EF (P=0.001) than with VAT/SAT (P=0.005). A role of MCP-1 and sIL- 1. Conflict of Interest: 6R/IL-6 complex as a link between the increased EF and cardiac remodeling might None Disclosed. be hypothesized. It is suggested that, when EF augments, a long-lasting exposition 2. Funding to inflammatory stimuli might be responsible for a gradual impairment of both Research relating to this abstract was funded by the EC through the 6th Framework diastolic function and cardiac morphology. Programme Contract No FOOD-CT-2004-506359.

T3:PO.101 T3:PO.102

Body weight, fat distribution and 10-year risk of cancer in a French population of middle- Dyslipidemic relations to anthropometric indexes of visceral obesity in aged men and women metabolic syndrome 1 1 1 Grigioni Sébastien , Vergnaud Anne-Claire , Czernichow Sébastien , Oppert Jean- 1 Michel2, Galan Pilar1, Hercberg Serge1, Bertrais Sandrine1 Subeska Stratrova Slavica

1Research Unit on Nutritional Epidemiology INSERM U557 / INRA U1125 / CNAM / 1Clinic Of Endocrinology, Diabetes And Metabolic Disorders PARIS 13, Human Nutrition Research Center of Ile de France, UFR SMBH Paris 13, 2 Paris-Bobigny, France; University Pierre et Marie Curie - Paris 6, Nutrition Department, Visceral obesity and dyslipidemia are the main characteristics of the Hotel-Dieu Hospital, Paris, France metabolic syndrome. The relationship of sagital diameter to thigh Objective: To investigate the relations between global and regional adiposity and 10-year circumference ratio (STR) with anthropometric indexes of visceral obesity incidence of cancer in participants of the French SU.VI.MAX. nutritional prevention trial. waist circumference (WC) and waist hip ratio (WHR) was determined as well Materials & methods: 3218 men (45–60 y.) and 4538 women (35–60 y.) were included as their association with lipid levels. Triglyceride (TG), cholesterol (C), in the present study. Body weight, height, waist and hip circumferences were measured in HDLch, LDLch. levels, LDL/HDL, C/HDL as well as WC, WHR and STR 1995/1996. Body mass index (BMI) and waist-to-hip ratio (WHR) were calculated. were determined in 240 healthy women divided into 3 groups according to Cancers were validated by histologic reports. Cox proportional hazards models were body fat distribution by their WHR values: 1st WHR<0,85; 2nd WHR (0,85- performed in men and women separately to estimate relative risk (RR) and 95% rd confidence intervals for total cancer, and for prostate and breast cancers specifically. 1,0) and 3 gr. WHR>1,0. STR correlated significantly positively with TG Results were adjusted for age, intervention group, educational level, smoking status, and C (P<0,0001), LDL (P<0,006), LDL/HDL and C/HDL (P<0,0001), also alcohol consumption, family history of cancer, and menopausal status. Physical activity with WC and WHR (P<0,0001), and negatively with HDL (P<0,0001). WC rd level was not related to cancer risk in both sexes. and STR levels were significantly higher in the 3 gr. (123,16±14,26cm; Results: Men who were obese (BMI≥30kg/m²) at baseline had an increased 10-year risk 0,49±0,39), compared to the 2nd gr. (108,87±13,93cm; 0,39±0,44) and the 1st of total cancer compared to men with BMI<25kg/m² (RR=1.77 [1.16–2.66]). The total gr. (87,27±16,59cm; 0,33±0,36) (P<0,0001). TG levels in the 3rd gr and prostate cancer risks were higher in men having an abdominal obesity (waist (1,86±0,75ng/ml) were significantly higher (P<0,0001) compared to the 1st gr circumference>102cm): RR=2.22 [1.42–3.48] and RR=2.57 [1.28–5.15] respectively after (1,02±0,43ng/ml) and 2nd gr (1,74±0,93ng/ml), HDL in the 3rd gr. was adjustment for BMI. In women, no significant association was found between (0,96±0,24ng/ml) significantly lower compared to the 1st gr. (1,23±0,28ng/ml) anthropometric characteristics and cancer risk, except that the risk of breast cancer in nd women who were initially non-menopausal was decreased when they initially had a (P<0,001) and 2 gr.(1,07±0,43ng/ml) (P<0,028). LDL, C/HDL, LDL/HDL rd WHR>0.85 (RR=0.54 [0.29–1.00]). and WC levels were also significantly higher in the 3 group. It was Conclusion: Our results support the hypothesis that abdominal obesity increases the total confirmed that visceral obesity is characterized with increased values of cancer risk in men, and particularly the risk of prostate cancer. WHR, WC and STR, which are positively related to dyslipidemic profile. 1. Conflict of Interest Positive relation of STR with atherogenic lipids, atherogenic indexes, WHR None Disclosed. 2. Funding and WC, and negative relation with HDL, confirmed it as an important Research relating to this abstract was funded by the Direction Générale de la Santé diagnostic parameter of visceral obesity in metabolic syndrome. (DGS).

International Journal of Obesity Abstracts S131 T3:PO.103 T3:PO.104

Baroreflex sensitivity, cardiac autonomic nervous system function and arterial The effect of low resistance circuit weight training (CWT) on weight reduction, maximal aerobic compliance alternations in morbidly obese women after Gastric Bypass power and serum cholesterol in obese adults

1,2 1,2 1,2 1,2 2 1 1 1 Kaikkonen Hannu , Kaikkonen Kaisu , Vanhala Marja , Korpelainen Raija , Keinänen- Diamandis Theodoros , Skrapari Ioanna , Tentolouris Nicholas , Perrea Despoina , 2,3 2 1 2 Kiukaanniemi Sirkka Bacoyiannis Christos , Katsilambros Nicholas , Bastounis Elias 1 2 1 Department Of Sports Medicine, Deaconess Institute Of Oulu; Department of Public Health First Department of Propaedeutic Medicine, Athens University Medical School, Laiko Science and General Practice, University of Oulu; 3Oulu Health Center General Hospital, Athens, Greece; 2First Department of Surgery Athens University Medical School, Laiko General Hospital, Athens, Greece Introduction: Obesity is an increasing public health problem all over the world. The major health consequences associated with obesity are type 2 diabetes and coronary heart disease. The present Background: Impaired baroreflex sensitivity (BRS) is associated with increased study investigated the effects of heart rate controlled low resistance CWT at different phases of cardiovascular mortality. Data suggest that BRS is blunted in obesity. No evidence exits weight reduction process on maximal aerobic power and serum cholesterol in obese adults. about baroreflex behaviour in morbidly obese patients after, gastric bypass (GPS)- Methods: Voluntary obese subjects (n=116), 24 men and 92 women , mean age 44 years (SD10), induced, weight loss. were randomized into four study groups; CWT1 (12 weeks training at 0 -3months), CWT2 (12 Aim: To examine the effect of weight loss after GPS on BRS, cardiac autonomic nervous weeks training at 6–9 months), BM (behaviour modification and support only) and CON (control group). Weight, maximal aerobic power (VO2max) were measured and serum samples collected system (ANS) activity and arterial compliance in morbid obesity. 2 at 0, 3 and 9 months. The 40 min training sessions were performed 3 times a week with the heart Methods: In 20 women with BMI> 40 kg/m we assessed at baseline and two months rate of 70–85%HRmax using air resistance machines (HUR Ltd., Finland). CWT1 trained at after GBS, BRS using the sequence technique, cardiac ANS activity using short-term weight reduction phase and CWT2 at weight maintaining phase. Both training groups received spectral analysis of heart rate variability (HRV) and central arterial compliance using also behaviour modification and support. applanation tonometry. Results: The mean BMI of the subjects was 36 (SD 3). All in tervention groups lost weight Results: GPS resulted in BMI reduction (49.0±6.6 vs. 37.8±7.0kg/m2, P<0.001). compared to the CON group at 3 and at 9 months (CWT1 -8% and -9%, CWT2 -6% and -8%, Significant increase was noted in BRS (8.9±5.1 vs. 19.8±11.9msec/mmHg, P<0.001) and BM -10% and -9%, respectively) (P<0.001). All groups improved VO2 max at 3 and at 9 months in cardiac parasympathetic nervous system (PNS) activity [High frequency (HF) and compared to 0 months (CWT1 17% and 19%, CWT2 11% and 25%, BM 18% and 18%, CON relative HF power of HRV 442.3±692.5 vs. 2051.9±2360.9 msec2, P<0.001 and 13% and 13%)(P<0.005), but the difference was not significant between the CON and 49.2±22.8 vs. 73.9±14.5 normalized units (nu), P=0.001 respectively]. Cardiac intervention groups. LDL cholesterol decreased in CWT1 (-6,5% vs. 5,5%, P=0.036) and in sympathetic nervous system function (SNS) was reduced [relative Low Frequency (LF) CWT2 (-10,4% vs. 5,5%, P=0.009) at 9 months compared to the CON group. HDL cholesterol power and LF/HF 50.7±22.84nu vs. 26.1±14.52nu, P<0.001 and 2.1±1.3 vs. 0.48±0.3, increased in all intervention groups at 9 months compared to the CON group (CWT1 17% vs.1%, P=0.006; CWT2 18% vs.1%,P=0.002 and BM 13% vs. 1%, P=0.033). P<0.001 respectively]. LF power, which reflects both PNS and SNS activity, increased Discussion: Training intervention at the beginning of weight reduction process had similar (262.1±257.9 vs. 490.4±246.2msec2, P<0.01). No significant change in arterial positive effects on weight and ae robic power as behaviour modification and support. With compliance was noted. Regression analysis after controlling for heart rate, blood pressure, training at weight maintenance phase the positive trend continued, while other groups remained BMI, blood glucose, triglycerides, LDL cholesterol, LF/HF and aortic augmentation, at 3 month level. Based on these results training especially at the weight maintenance phase is revealed HF power increment as independent predictor of BRS amelioration after GPS recommended in obese adults. (beta=0.74, P=0.01). Conclusion: Even moderate BMI reduction in the first two months after GPS was accompanied by a marked BRS improvement in an extent strongly and independently associated with the magnitude of PNS function amelioration.

T3:PO.105 T3:PO.106

Randomized trial of weight-loss-diets for young adults varying in fish and fish oil content Inclusion of fish or fish oil to weight-loss-diets for young adults; effects on blood lipids. SEAFOODplus –YOUNG Thorsdottir Inga1, Tomasson Helgi2, Gunnarsdottir Ingibjorg1, Gisladottir Elva1, Kiely Mairead3, Parra M. Dolores4, Bandarra Narcisa M.5, Schaafsma Gertjan6, Martinéz J. Gunnarsdottir Ingibjorg1, Tomasson Helgi2, Kiely Mairead3, Martinéz J. Alfredo4, Alfredo4 Bandarra Narcisa M.5, Morais Maria G.6, Thorsdottir Inga1

1Unit For Nutrition Research; 2Faculty of Economics and Business Administration, 1Unit for Nutrition Research, Landspitali-University Hospital & Department of Food University of Iceland; 3Department of Food and Nutritional Sciences, University College Science and Human Nutrition, University of Iceland; 2Faculty of Economics and Business Cork, Cork, Ireland; 4The Department of Physiology and Nutrition, University of Navarra, Administration, University of Iceland; 3Department of Food and Nutritional Sciences, Navarra, Spain; 5The National Research Institute on Agriculture and Fisheries Research, University College Cork, Ireland; 4The Department of Physiology and Nutrition, Lisbon, Portugal; 6TNO Nutrition and Food Research, the Netherlands & Wageningen University of Navarra, Spain; 5The National Research Institute on Agriculture and University, Wageningen, The Netherlands Fisheries Research, Lisbon, Portugal; 6Faculty of Medical Sciences of Lisbon, Portugal

Objective: To investigate the effect of including seafood and fish oils as part of an Objective: To investigate the effect of fish or fish oil intake on blood lipids during energy-restricted diet on weight loss in young overweight adults. weight loss in young overweight adults. Subjects & Design: 324 men and women (20–40 years, BMI 27.5–32.5 kg/m2) were Subjects & Design: 324 men and women (20–40 years, BMI 27.5–32.5 kg/m2) were randomized to one of 4 groups (1) control (sunflower oil capsules, no seafood), (2) lean randomized to one of 4 groups (1) control (sunflower oil capsules, no seafood), (2) lean fish (3 x 150g portions of cod/week), (3) fatty fish (3 x 150g portions of salmon/week), fish (3 x 150g portions of cod/week), (3) fatty fish (3 x 150gportions of salmon/week), (4) fish oil (DHA/EPA capsules, no seafood) and followed an energy-restricted diet for 8 (4) fish oil (DHA/EPA capsules, no seafood) and followed an energy-restricted diet for 8 weeks. Anthropometric data were collected at baseline, midpoint and endpoint. weeks. Anthropometric data were collected at baseline, midpoint and endpoint. Total Confounding factors were accounted for with linear models for repeated measures with cholesterol, HDL cholesterol, LDL cholesterol and triglycerides were measured at two-way interactions. baseline and endpoint. Anthropometric data were collected at baseline, midpoint and Results: In four weeks, from baseline to midpoint, an average man (95 kg having 1600 endpoint. kcal/day) lost 3.55 kg (95%CI:3.14–3.97) on diet (1), 4.35 kg [95%CI:3.94–4.75] on diet Results: The most significant diet impact was seen on triglycerides. When compared with (2), 4.50 kg [95%CI:4.13–4.87] on diet (3) and 4.96 kg [95%CI:4.53–5.40] on diet (4). the control group log triglycerides decreased -0.04 (SE 0.02) mmol/L (P=0.092) ,-0.06 The weight-loss from midpoint to endpoint was 0.45 [0.41–0.49] times the observed (0.02) mmol/L(P=0.006), and -0.04 (SE 0.02) mmol/L (P=0.09) more on the cod diet, weight-loss from baseline to midpoint. The diets did not differ in their effect on weight- salmon diet and fish oil diet, respectively, adjusting for country, gender, triglyceride loss in women. Changes in measures of body composition were in line with changes in concentration at baseline and weight loss. The dietarygroups including cod or salmon body weight. (fish) resulted in about 0.15 mmol/L greater reduction in total cholesterol than the control Conclusion: In young, overweight men, the inclusion of either lean or fatty fish, or fish group, although not statistically significant. The cholesterol lowering effect of the cod oil as part of an energy-restricted diet resulted in ~1 kg more weight-loss after four diet diet was at least partly due to lowering in HDL. HDL tended to decrease less in the weeks, than did a similar diet without seafood or supplement of marine origin. The diet groups consuming the highest amount of omega-3 fatty acids (salmon diet and fish addition of seafood to a nutritionally balanced energy-restricted diet may boost weight oil diet). loss. Conclusion: Fish intake has beneficial effects on the lipid profile during weight loss. 1. Conflict of Interest: None Disclosed. 1. Conflict of Interest: None Disclosed. 2. Funding: Research relating to this abstract was funded by the EC through the 6th 2. Funding: Research relating to this abstract was funded by the EC through the 6th Framework Programme Contract No FOOD-CT-2004-506359. Framework Programme Contract No FOOD-CT-2004-506359.

International Journal of Obesity Abstracts S132 T3:PO.107 T3:PO.108

Severe obesity: a comparison of different eating behaviours and Two common polymorphisms in leptin and adiponectin genes are not associated with psychopathological traits preeclampsia in Czech population 1 1 2 1 1 Bienertova Vasku Julie , Kankova Katerina , Dostalova Zuzana , Bienert Petr , Vasku Micanti Fausta Anna1

1Faculty Of Medicine 'Federico II' Naples- Neuroscience Departement Unit 1Masaryk University, Medical Faculty, Institute of Pathol Physiol; 2Clinics of Obstetrics Of Psychoterapy and Gynecology, University affiliated Hospital, Brno

The present study evaluates impaired eating behaviour of severe obese Introduction Leptin and adiponectin are both adipocyte-derived hormones that regulate food intake and patients. They all take part to a diet and life-style correction program for 2 have also autocrine-paracrine effects. Leptin has been previously reported to control the weight reduction. We selected 440 severe obese patients (BMI> 40kg/m ) integrity of fetoplacental unit by virtue of its immunomodulatory property mediated via attending to psychotherapy unit for Eating Disorders. They underwent to T-lymphocytes. Dysregulation of complex interactions of various adipokines is supposed Eating Disorder tests and clinical interview. We compared the Eating to be implicated in the pathogenesis of recurrent miscarriage, gestational diabetes or Disorder Inventory-2 (EDI-2) with Eating Behaviour assessed by clinical preeclampsia. In this study, we investigated whether two common polymorphisms in interview in order to identify psychological traits connected to treatment leptin and adiponectin gene were associated with preeclampsia and its related variables (blood pressure, proteinuria, glucose concentrations, and anthropometric parameters of compliance. The EDI-2 items are: Drive for Thinness, Bulimia, Body the newborns). Dissatisfaction, Ineffectiveness, Perfectionism, Interpersonal Distrust, Methods Interceptive Awareness, Maturity Fears, Asceticism, Impulse Regulation, A total of 140 preeclamptic women and 153 healthy controls were genotyped for the Social Insecurity. Our sample was divided into 5 groups based on eating T94G in the adiponectin (APM1) gene exon 2 and the G-2548A in the leptin (LEP)gene behaviour: 1) Binge eaters (n=91), 2) nibbling (n=54), 3) snacker (n=147), 4) promoter. sweeteaters (n=50) and 5) gorging (n=98). Binge eater behaviour’s scores are Results significantly higher than the others in almost all the subscales of EDI-2. The allelic frequency of G allele of LEP G-2548A was 0.541 in preeclamptic women vs. 0.583 in age-matched healthy pregnant controls (pa=0.316); the frequency of G allele of Gorging behaviour shows a lower score than the other groups. Perfectionism APM1 T94G was 0.073 in preeclamptic cases and 0.079 in healthy controls (pa=0.762), and Maturity fears items did not show any significant difference between respectively. No significant associations were detected between the two SNPs evaluated groups. Nibbling appear similar to Binge Eaters sample, differing just for and the anthropometric variables including BMI, blood pressure, glucose, fibrinogene Impulse regulation, Bulimia and Interoceptive Awareness. Snacker and concentrations and the birth length and weight of the newborns from these pathological Sweeteaters show intermediates profiles, demonstrating different quality of vs. physiological pregnancies. eating behaviour. Our study underlines that specific psychopathological traits Conclusion To conclude, the APM1 T94G and LEP G-2548A polymorphisms do not seem to be exist for each eating behaviour. Psychic traits seem predictive for treatment major genetic determinants of preeclampsia in the Czech Caucasian population. compliance. Severe obese patients suffering from BED are not compliant to Acknowledgements diet and require a psychiatric program. The other groups should able to These population surveys were supported by the project CEZ J07/98:141100002 from the undergo integrated care (diet, lifestyle and psycho-therapy). Ministry of Education, Youth and Physical Education of the Czech Republic.

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T.O.M. (Therapy of obesity with motivation) an outpatient program for obese Metabolic Syndrome And Risk for Cardiovascular Diseases in Obese children Women in Vojvodina

1 2 Chen-Stute Annette , Kopczynski Sascha Tomic Naglic Dragana1, Stokic Edita1, Srdic Biljana2, Ivkovic Lazar Tatjana1 1Adipositas-Zentrum; 2Fakultät für Sportwissenschaft Ruhr Universität Bochum 1 2 Clinic Of Endokrinology Clinical Center Novi Sad, Serbia; Institute of Introduction: Obesity is a growing health problem in children and anatomy, Medical Faculty, University of Novi Sad, Serbia adolescents. Risk profile includes impaired glucose metabolism, hypertension, dyslipoproteinaemia, low cardio-respiratory fitness and Background and aims: Having the metabolic syndrome doubles a depressive disorders. person’s risk of developing cardiovascular diseases. Prevalence of Method: T.O.M.-Program is a long -term therapy for 8-17 years old children metabolic syndrome in Vojvodina is about 30 %. The aim of this together with their parents for up 3 years. 1.year includes physical activity 3 investigation was to examine the association and connetion between times/week;1/week education and behaviour by a nutitionist and psychologist metabolic sindrom e in a group of obese women in Vojvodina and with current healthy eating guidelines. Booster session take place once a cardiovasculare risk. month in 2nd year and 2x in 3rd year, accompanied with privat sports. Metreials and Methods: The examination group consisted of 305 obese Results: Till today 361 children (>97 the BMI-SDS) take part in the female examinees. All examinees underwent the following programm, 95% finish the 1., 78% the 2 and 75% the year 3. examinations: basic anthropometric measurements, body composition Echocardiography revealed normal cardiac dimension, spirometry maximal analysis by method of bioelectric impedance, systolic and diastolic blood workload was 2,0+0,4 W/kg bodyweight, after 1 year 2,5+0,4 W/kg. pressure analysis, metabolic parameters analysis (lipid status, fasting Ventilatory anaerob threshold reached at workload 1,2+0,3 W/kg after 3:45 glycemia, fasting insulinemia and uric acid), as well as the fibrinogen minutes; after 1 year 1,6+0,3 W/kg after 5:30 minutes. BMI-SDS of girls level. Cardiovascular risk was calculated for all sub ject of investigation. decreased from 2,6+0,5kg/m² to 1,8+0,8 kg/m² (P=0,001), boys from 2,8+0,4 kg/m² to 1,9+0,5 kg/m² (P=0,001) after 3 years. Hypercholesterinaemia in Results: According to our results, examinees with metabolic syndrome 31% of the children, after 3 years only 2,7%; the same positive changes were had increased cardiovascular risk, calculated by AHA/ACC, for 138%, seen hyperglycaemia and d. m. 2 from 5,6% to 08%, the same success was for calculated by PROCAM for 85%, whereas examinees with metabolic liverstatus and NASH. syndrome had increased Fatal cardiovascular risk for 170 %. As Conclusion: The results indicate that long term weight control is successful, examinees with increased values of body mass index presented with we have positive changes in risk factors, better self- confidence. more frequent metabolic syndrome. Conclusions: The data suggest that obese women in Vojvodina with metabolic syndrome have higher cardiovascular risk than those without this syndrome and indicate intensive and carefull treatment of high risk patients.

International Journal of Obesity Abstracts S133 T3:PO.111 T3:PO.112

Plasma adipocyte and epidermal fatty acid binding protein in obesity before Prevalence and predictors of Non-Alcoholic Fatty Liver Disease (NAFLD) in morbidly and after weight loss following laparoscopical adjustable gastric binding obese patients undergoing bariatric surgery 1 1 2 1 1 2 Ballesteros Pomar Maria D. , Urioste Fondo Ana M , Gonzalez De Francisco Tomas , Haider Dominik Georg , Schindler Karin , Bohdjalian Arthur , Prager 3 2 3 1 1 3 1 Olcoz Goñi Jose Luis , Gonzalez Herraez Luis , Bailador Carmen , Cano Rodriguez Gerhard , Luger Anton , Wolzt Michael , Ludvik Bernhard Isidoro1

1 1Endocrinology and Nutrition Department. Complejo Asistencial De Leon; 2Department Medical University of Vienna, Department of Internal Medicine 3; 3 2Department of Surgery, Division of General Surgery; 3Department of of Surgery; Department of Gastroenterology Clinical Pharmacology INTRODUCTION: NAFLD and its most aggressive forms (non-alcoholic steatohepatitis –NASH-, fibrosis and cirrhosis) are highly prevalent in morbidly obese patients. This Background: Plasma adipocyte (A-FABP) and epidermal fatty acid-binding disease spectrum has been associated with the metabolic syndrome, and with protein (EFABP) are considered as modulators of insulin sensitivity. The anthropometric and biochemical predictors. respective circulating concentrations have been linked to obesity, but the OBJECTIVES: To investigate the prevalence of NAFLD, NASH and fibrosis among our influence of weight loss remains unknown. In this study we investigated morbidly obese patients undergoing bariatric surgery. To evaluate predictors for NAFLD whether plasma A-FABP and E-FABP concentrations are altered by weight and the relationship with the metabolic syndrome. PATIENTS AND METHODOLOGY: 1. PATIENTS: Seventy-one patients undergoing loss in obese patients. biliopancreatic diversion who had a concurrent intraoperatory liver biopsy. Patients and methods: In a prospective study, fasting plasma A-FABP and 2. OUTCOME MEASURES: Weight, body mass index, waist and hip circumferences; E-FABP concentrations were measured before and 6 months after gastric biochemical data. The metabolic syndrome was defined following the IDF 2005 criteria, banding in 33 morbidly obese patients aged 40±11 years, with a body mass diabetes as ADA criteria and hepatic lesion as the scoring system proposed by Brunt. 2 index (BMI) of 46±5 kg/m .11 healthy subjects, aged 30±5 years, with a RESULTS: 84% of the patients were women. Mean age 40 years (SD 11,42), weight 2 BMI<25 kg/m , served as controls. 134,29 kg (SD 22,34), BMI 52 (SD 8,22), waist 132,22 (SD 13,35) and hip 152,00 (SD 13,05). 43% had hypercholesterolemia, 33% hypertriglyceridemia, 35% diabetes, 66% Results: A-FABP and E-FABP plasma concentrations were higher in obese hypertension and 71% metabolic syndrome. Steatosis was found in 98,6% of biopsies, subjects (36.7±6.7 and 3.7±0.7 ng/ml, respectively) than in controls (18.1±0.6 NASH in 47,9% and fibrosis in 35,2%. Weight was a predictor for NASH and high and 2.6±0.5, respectively, P<0.01). Gastric banding reduced BMI to 40±5 triglyceride levels for the presence of steatosis (P<0,05), but no other risk factors were kg/m2, A-FABP to 32.9±5.6 ng/ml and E-FABP to 1.9±0.7 ng/ml (all found. Neither a significant relationship between metabolic syndrome or diabetes and P<0.05) after 6 months. Insulin sensitivity as estimated by the Homeostasis hepatic dysfunction could be shown. Model Assessment (HOMA) insulin resistance-index was unchanged. A- CONCLUSIONS: Asymptomatic NAFLD is common among morbidly obese patients. Only initial body weight and triglyceride levels, but not the presence of the metabolic FABP concentrations were significantly associated with BMI before and 6 syndrome, were significantly associated with the hepatic disease. months after surgery (P<0.05, r=0.42 and r=0.37, respectively). Conclusion: Elevated plasma A-FABP and E-FABP concentrations in morbidly obese subjects are reduced after weight loss. It remains to be determined, whether these alterations exert systemic metabolic effects as suggested by animal experiments.

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Short-term exposition to saturated fatty acids inhibits adrenergic alpha2- Insulin resistance is an independent predictor of early diastolic myocardial antilipolytic effect in human adipose tissue dysfunction in uncomplicated obesity

Polak Jan1, Moro Cédric2,3, Bessière David2,3, Hejnova Jindra1, Marquès Marie- Muscelli Elza1, Camastra Stefania1, Kozakova Michella1, Morizzo Carmella1, adeline2,3, Bajzova M1, Crampes François2,3, Lafontan Max2,3, Berlan Michel2,3,4, Vittone Francesca1, Astiarraga Brenno D1, Malshi Elena1, Palombo Carlo1, Stich Vladimir1 Ferrannini Ele1

1INSERM, Franco-Czech Laboratory For Clinical Research On Obesity; 2INSERM, 1University of Pisa, Italy U586, Obesity Research Unit, Toulouse, France; 3Paul Sabatier University, Louis Bugnard Institute IFR31, Toulouse, France; 4Faculty of Medicine Purpan, Obesity is an insulin resistant (IR) state associated with increased susceptibility to Laboratory of Medical and Clinical Pharmacology, Toulouse, France heart failure. Whether IR is a determinant of early, subclinical left-ventricular (LV) dysfunction in uncomplicated obesity is still controversial. The aim of the study was to investigate in vitro and in vivo the acute effect of Aim: to investigate the associations between IR and echocardiographic indices of saturated fatty acids (FA) on the regulation of adrenergic lipolysis in human LV performance in otherwise healthy obese subjects. adipose tissue. Methods: 44 subjects (17M/27F; 18-68y, BMI 18-51kg/m2: normal[NL]=11; We tested first in vitro on isolated fat cells, the effect a 2-hours treatment with overweight[OW]=11; obese[OB]=22) free of heart disease, hypertension, diabetes saturated FA. Then, in vivo, 8 healthy lean and 6 obese males’ subjects performed and dyslipidemia were studied. LV mass index, geometry and function were a 45 min exercise bout at 50% of their maximal oxygen uptake either after an assessed by conventional echocardiography, and myocardial performance by overnight fast or 3 hours after ingestion of a high fat meal (HFM) (95 % fat and 5 tissue-Doppler imaging (TDI)- of the mitral annulus and the middle part of the % carbohydrates). Subcutaneous adipose tissue lipolysis was measured by interventricular septum. microdialysis in the presence or absence of an alpha-blocker (phentolamine). Results: As compared to NL, OW and OB had higher BP (118±11/69±8, Dialysate glycerol concentration was taken as an index of lipolysis. 124±11/78±6, 131±9/83±6 mmHg), heart rate (60±6, 67±11, 74±12bpm), waist In vitro, the results show that acute treatment of fat cells with 200 µM of saturated circumference, and insulin resistance (P<0.05-0.01). Fastingglucose, LV mass FA enhances the lipolytic effect of epinephrine by suppression of the antilipolytic index, and cardiac index were normal and comparable across groups. Peak systolic alpha2-adrenergic effect. In vivo, HFM increased plasma non-esterified fatty acid myocardial velocity did not differ amonggroups (6.9±1.1, 6.6±0.6, 7.3±1.4 cm/s) level by 2-fold in lean and obese subjects. In both group, HFM ingestion do not and increased with fasting insulin (r=0.41; P<0.01). The myocardial E’/A’ ratio alter glycerol kinetic and hormonal response to exercise. In fasting condition, the was lower in OW and OB (1.2±0.4 and 1.2±0.4 vs. NL 1.7±0.3, P<0.001) and alpha2-adrenergic antilipolytic effect was more pronounced in obese than in lean correlated inversely with age (r=-0.64), waist (r=- 0.45), LV mass (r=-0.36), subjects. HFM totally suppressed the alpha2-adrenergic antilipolytic effect during fasting glucose (r=-0.35), fasting insulin (r=-0.35) (P<0.05- 0.01), and directly exercise in lean and obese subjects. with insulin sensitivity (r=0.43; P<0.001). In multivariate analysis, age and insulin The present result demonstrates that saturated FA per se, in vitro as well as in vivo, resistance (r2=0.55) were independent negative predictors of E’/A’. suppresses alpha2-adrenergic mediated antilipolysis in adipose tissue. This is Conclusions: In otherwise healthy subjects over a wide BMI range, IR is an another mechanism whereby fat-rich food may contribute to dysregulation of lipid independent predictor of mild, subclinical LV diastolic dysfunction in the face of metabolism. preserved systolic function.

International Journal of Obesity Abstracts S134 T3:PO.115 T3:PO.116

Studying of prevalence of overweight and obesity among inhabitants of Results of reduction diet in Zagrebs middle-age subjects Ukraine, using select elimination diet for treatment and precautions Leppée Marcel1, Štimac Danijela1, Poli4-Vižintin Marina1, Mari4-Bajs Maja1, 5ulig Josip1

Mikhnova Nataliya1, Shvets Oleg1, Martynchuk Alexandr1 1Zagreb Institute of Public Health, Croatia

1Ukrainian Research Institute Of Nutrition, Ukraine Introduction: To assess the effects of 6 -month reduction diet in overweight individuals. Patients and methods: The study included 419 middle-aged subjects of both sexes (203 male and 216 female), baseline body weight 90–100 (mean 94,8) kg in male and 75–85 The aim: to study prevalence of overweight and obesity among (mean 80,3) kg in female. Restriction diet with daily food intake restricted to 130 0 Cal Ukrainian people, correction nutrition by using select elimination diet was used for 6 months. All study subjects were residents of the City of Zagreb or Zagreb based on results Antigen Leukocyte Cellular Antibody Test (LCA). County, and obesity was diagnosed by their family physician. Results: The mean weight loss due to restriction diet was 8,3 kg(8,8%) in male and 8 ,6 Material: 835 patients have been included in research. Middle age - kg (10,7%) in female subjects. Individual differences ranged from 4,9% to 18,6% of 37±2,5 year, women - 452, men - 383. baseline body weight. Mann-Whitney Rank Sum test yielded no sex differences. Methods: we calculated body-mass index (BMI), quantity of fat - device Conclusion: Reduction diet was found to have quite uniform effects, leading to 10% OMRON BF 302 to all patients, parameters were estimated each 3 weight loss on an average, with only minor variation. There was no statis -tically significant sex difference in body weight reduction. months. We corrected nutrition to patients with overweight and obesity Introduction: To assess the effects of 6 -month reduction diet in overweight individuals. based on results of LCA – device ROBOCAT II; elimination diet was Patients and methods: The study included 419 middle -aged subjects of both sexes (203 determined for 3 and 6 months. male and 216 female), baseline body weight 90 -100 (mean 94,8) kg in male and 75–85 Results: we distributed patients on 3 groups. 268 persons were in the (mean 80,3) kg in female. Restriction diet with daily food intake restricted to 1300 Cal first, BMI did not exceed 25; 417 - in the second, BMI within the limits was used for 6 months. All study subjects were residents of the City of Zagreb or Zagreb County, and obesity was diagnosed by their family physician. of 26-30; 150 - in the third, BMI exceeded 30. After 6 months Results: The mean weight loss due to restriction diet was 8,3 kg(8,8%) in male and 8,6 observance elimination diet according ALCAT at 354 patients in the kg (10,7%) in female subjects. Individual differences ranged from 4,9% to 18,6% of second group BMI did not exceed 25, at 26 was within the limits of 26– baseline body weight. Mann-Whitney Rank Sum test yielded no sex differences. 28. In 108 patients at the third group BMI was lower 26, and at 23 was Conclusion: Reduction diet was found to have quite uniform effects, leading to 10% weight loss on an within the limits of 26–28. average, with only minor variation. There was no statistically significant sex difference in Conclusion: have been discovered high prevalence of overweight among body weight reduction. inhabitants of able-bodied age in Ukraine - 50 %, obesity - 18 % is revealed; we diagnosed this pathology at women is more often (62%), than for men (38%). LCA is an new, effective method in our country which gives proof effect of normalization and stabilization of weight.

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Psychological variables as potential predictors of successful outcomes Effects of bariatric surgery on preclinical myocardial alterations in severe obesity for weight loss programs following laparoscopic adjustable silicone Pucci Andrea1, Vitantonio Di Bello2, Andrea Di Cori2, Enrica Talini2, Guido gastric banding Salvetti1, Alessandro Marsili1, Biagio Solito3, Paola Fierabracci1, Ferruccio Santini1, Aldo Pichera1 Lippi Chita1, Santini Ferruccio1, Santalucia Alessia1, Malanima Giulia1, Calderone Alba2, Anselmino Marco3, Armani Antonella2, Fierabracci 1Department of Endocrinology and Metabolism; 2Cardiothoracic Department; 3IV Paola1, Cassano Giovanni Battista2, Pinchera Aldo1 Division of General Surgery

1Department of Endocrinology, University of Pisa, Pisa, Italy; Obesity is an established risk factor for Congestive Heart Failure (CHF) and may 2 3 determine several preclinical left ventricular functional alterations, detectable Department of Psychiatry, University of Pisa, Pisa, Italy; IV Division through new ultrasonic technologies such as Integrated Backscatter (IBS) and of General Surgery, University Hospital of Pisa, Pisa, Italy Color Doppler Myocardial Imaging (CDMI). These early myocardial alterations could anticipate the evolution toward CHF. The aim of this study was to evaluate Laparoscopic adjustable silicone gastric banding (LASGB) is a the effect of weight loss achieved by bariatric surgery on structural and functional therapeutical approach to achieve a stable body weight reduction in myocardial alterations in severely obese subjects. Thirteen consecutive obese severe obesity. The aim of this study was to evaluate presurgical patients (2 males, 11 females, mean age (± SD)=39±12.9 yr, BMI=47.1±8.4) were psychological and psychopathological characteristics that could predict enrolled. Subjects underwent conventional 2D-Colordoppler echocardiography. The new ultrasonic techniques were: a) IBS for the analysis of myocardial the success of LASGB in obese subjects. One-hundred and fiftyseven reflectivity, referred to pericardial interface, as expression of myocardial structure subjects (20 males and 134 females, aged 40.4 ± 11.3 yr, preoperative (increase in collagen content), and of Cyclic Variation Index (CVI), as expression BMI 42.9 ± 5.2 and postoperative BMI 35.7 ± 4.4) were administered of intrinsic myocardial contractility, b) CDMI for the analysis of strain and strain Minnesota Multiphasic Personality Inventory-2 (MMPI-2), before rate (myocardial deformability). All subjects were resubmitted to surgical intervention. Data were correlated with the degree of weight loss echocardiographic examination 6 to 24 months after bariatric surgery. The mean expressed as % BMI reduction at 6 months follow up. MMPI-2 scores weight loss, expressed as % reduction of BMI, was 27.4±14.7%. An improvement showed an inverse association with weight loss (P<0.05) in the of myocardial functional and structural alterations was observed both at IBS and CDMI examinations. In particular, CVI at septum level increased from 14.6±11.3 following scales: Depression (D), Paranoia (Pa), Social Introversion (Si), to 24±11.6, P<0.02. Septal mean reflectivity significantly decreased from: Obsessiveness (OBS), Low Self Esteem (Lse), Work Interference 55.8±10.7 to 47.4±11.4, P<0.03. The strain at septum level was significantly (WRK), Negative Treatment Indicators (TRT), Addiction Admission improved after surgery (- 11.2±2.5 vs -19.5±5.6, P<0.0001). In conclusion, weight (AAS) and Marital Distress (MDS). In conclusion, depression, loss achieved after bariatric surgery is associated with an improvement of obsessiveness, low self esteem, introversion and a low compliance are myocardial structure and function. The mechanisms underlying these modifications negative predictors of LASGB success in obese subjects. These data remain to be clarified. point to the role of a careful presurgical evaluation to obtain better patients selection for bariatric surgery, and to adopt specific treatments on disturbances that could negatively influence surgical outcome.

International Journal of Obesity Abstracts S135 T3:PO.119 T3:PO.120

Effect of a high-protein diet on weight loss, appetite and mood in overweight Dietary glycaemic index (GI) in relation to metabolic risk factors in a Dutch population at and obese children risk for diabetes and cardiovascular disease 1 2 1 3 4 1 1 2 1 Du Huaidong , Du Huaidong , van der A D.L. , van Bakel M. , van der Kallen C. , Dekker Humphrey Lauren , Radley Duncan , Hill Andrew , Gately Paul J. M.5, Stehouwer C.D.A.4, Feskens E.J. M.6

1Leeds Metropolitan University, UK; 2Leeds University, UK 1National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; 2Department of Human Biology, Nutrition and Toxicology Research 3 Objective: To compare the effects of energy-restricted high-protein (HP) or Institute of Maastricht (NUTRIM), Maastricht, The Netherlands; Nutrition and Hormones Group, International Agency for Research on Cancer (IARC), Lyon, France; standard-protein (SP) diets on subjective appetite and mood sensations in 4Department of Internal Medicine, Cardiovascular Research Institute (CARIM), overweight and obese children attending a residential weight-loss camp. Maastricht University, Maastricht, The Netherlands; 5Institute for Research in Extramural Methodology: Participants: 101 overweight and obese children (BMI Medicine, VU University Medical Center, Amsterdam, The Netherlands; 6Division of 2 34.1±5.9 kg/m , age 14.5±1.9 years). Intervention: An eight-week (max) Human Nutrition, Wageningen University, Wageningen, The Netherlands programme of physical activity, reduced-energy intake and behaviour change education. Campers were randomly assigned to one of two isocaloric diets Background: Little information is available regarding the association between the (SP: 15% protein, 30–35% fat, 50–55% CHO; HP: 25% protein, 30–35% fat, glycemic index (GI) and the consumption of individual foods in the general Dutch population. Furthermore, the association between GI and metabolic factors is not fully 40-45% CHO), based on individually estimated energy requirements. elucidated yet. Assessments: Campers were assessed at the start and end of camp for Objective: To examine the association of GI with food intake and levels of metabolic anthropometric variables. Visual analogue scales of appetite (hunger, fullness, factors including glucose, insulin and lipid profiles and an indicator of low –grade desire to eat) and mood (happiness, sadness, tiredness) were completed on the inflammation, CRP. first 3 consecutive weekdays of each week participants attended the camp. Research design and methods: We analysed data from the CODAM study and the Results: Overall, campers lost 5.2±3.0 kg in body weight (P<0.001). The Hoorn follow-up study, both consisting of a sample of the general population over - represented by subjects with impaired glucose metabolism and type 2 diabetes. Cross - high-protein diet group had no greater effect on BMI loss, or changes in sectional associations were assessed using Spearman correlation and multiple linear appetite or mood when compared to the standard diet group. However, regression. ratings of desire to eat increased significantly over the duration of the Results: The combined study population included 976 subjects who had a mean (SD) GI intervention (P<0.001), irrespective of diet. of 58 (3.7). GI was most strongly correlated with the consumption of dairy products Discussion: This study has shown that long-term consumption of a diet (energy-adjusted r (radj)=-0.62), fruits (radj=-0.41), cereals (radj=0.39) and potatoes (radj containing higher protein did not confer any greater impact on subjective =0.38). These four groups together explained 65% of the variation in GI. After adjustment appetite or mood in overweight or obese children. Nor did it improve weight for potential confounders including study, age, gender, BMI, smoking, total energy intake and dietary fibre etc., GI was positively associated with fasting insulin (P=0.02), HOMA- loss in this setting. Further work is warranted into whether higher levels of IR (P=0.01) and CRP (P=0.01). A positive association between GI and fastingglucose dietary protein are feasible or effective in the treatment of childhood obesity. was found but among never smokers only (P=0.002). Conclusion: In this Dutch population, a low GI diet, high in dairy and fruits but low in potatoes and cereals, is associated with a favourable diabetic and cardiovascular risk profile as indicated by low levels of fasting insulin, HOMA -IR and CRP.

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Evaluation of cardiovascular risk in obese women Insulin sensitivity, VO2max and body composition in Swedish obese children and adolescents Salvetti Guido1, Santini Ferruccio1, Fierabracci Paola1, Scartabelli Giovanna1, 1 1 1 2 Berndtsson Gunilla1, Norgren Svante1, Mattsson Eva2, Evers Larsson Ulla2, Marcus Valeriano Rocco , Pucci Andrea , Galli Giulia , Virdis Agostino , Antonio 1 Salvetti2, Pinchera Aldo1 Claude

1 1 2 Karolinska Institutet, National Childhood Obesity Centre, Karolinska University Department of Endocrinology and Metabolism, Pisa, Italy; Department of Hospital Huddinge, Stockholm, Sweden; 2Karolinska Institutet, Dept of Internal Medicine, Pisa, Italy Neurobiology, Care Sciences and Society, Karolinska University Hospital Huddinge, Stockholm, Sweden Obesity represents a clinical condition frequently associated with complications leading to an increased cardiovascular risk. Aim of this study Objectives: The aim of this study was to describe the correlation between insulin was to calculate the risk to develop a cardiovascular event in 10 years, among sensitivity (SI), VO2max, participation in organized physical activity, and body obese women eligible for bariatric surgery. composition in obese Swedish children and adolescents. We evaluated 86 women, (mean age 47.3±8.5 years; age range 35-67), whose Methods: Two hundred and twenty-eight obese children and adolescents (119 girls body weight was 113.4±20.8 Kg (78-173), with BMI 44.4±7.6 Kg/m2 (32,2- and 109 boys, aged 8–16 yrs, body mass index (BMI) 23.2–57.0 kg·m-2, body mass 66), waist circumference (WC) 127 ± 15,7 cm (94-178), hip circumference index standard deviation score (BMI SDS) 2.8–11.4 performed a frequently (HC) 134 ± 15,8 cm (105-190) and waist-to-hip ratio (WHR) 0,95 ± 0,09 sampled intravenous glucose tolerance test (FSIVGTT), a sub maximal bicycle (0,74-1,15). Visceral fat (VF) thickness was measured by echography. ergometry test, a semi-structured interview concerning participation in organized Cardiovascular risk, evaluated according to Framingham algorithm for LDL- physical activity, and a dual-energy X-ray absorptiometry (DEXA). cholesterol, evidenced values between 2% and 33% (12 ± 7,4). Results: Multiple regression analysis with SI as dependent variable explained 26% Cardiovascular risk evaluated according to the algorithm of Progetto Cuore of the variance in SI. In this model SI was not correlated with absolute VO2max, negatively correlated with BMI SDS (P<0.001), positively correlated with evidenced values between 0.1% and 9.9% (2,24 ± 2,15). A multivariate participation in organized physical activity (P<0.01), and body composition, analysis showed that WHR and VF were the only independent positive measured as total fat (%), (P<0.05). When relative VO2max (per kg body weight or predictors of cardiovascular risk according to both algorithms (P<0.005; per kg fat free mass) was used instead of absolute a positive correlation with SI (P< p<0.05 respectively). 0.01 _ P< 0.001) was found. However, SI was significantly correlated with relative In conclusion, among Italian obese women, the cardiovascular risk may vary VO2max only among boys, among girls SI was not correlated with any VO2max depending on the algorithm that is used for calculations. The risk value is not measures. associated with body weight or BMI, a finding suggesting that obesity per se Conclusion: Depending on how VO2max was derived and expressed, in absolute or is not a risk factor. VF and WHR are two independent anthropometric relative terms the correlation with SI varied. Absolute VO2max was not correlated predictors of calculated cardiovascular risk. These results indicate that in with SI in contrast to relative VO2max. VO2max, participation in organized obese women, both the amount of visceral fat and muscular and subcutaneous physical activity, and body composition could only partially explain the variance in adipose mass distribution are associated with cardiovascular risk. Further SI in obese Swedish children and adolescents. studies are needed to better clarify the pathogenic and clinical implications of those findings.

International Journal of Obesity Abstracts S136 T3:PO.123 T3:PO.124

The mogenic effects of alpha-lipoic acid drive losses in lean body mass The effect of a high-protein diet on parameters of glucose and lipid and not in fat mass metabolism in patients with type 2 diabetes (T2DM) on insulin therapy

1 1 1 Gayathri Yepuri1, Brown Clive Martin1, Montani Jean Pierre1, Dulloo Tripp Barbara , Schindler Karin , Ludvik Bernhard 1 Abdul 1 Department of Medicine 3, Medial University of Vienna, Austria 1Department of Medicine / Physiology, University of Fribourg Background: The optimal macronutrient composition of a diet for T2DM remains a matter of controversy. This study investigated the metabolic effects α-lipoic acid, a widely marketed dietary supplement with potent of a high-protein diet predominantly from vegetables in type 2 diabetic antioxidant properties, has recently been reported to possess weight- patients on insulin therapy. reducing and anti-diabetogenic properties in rodents. We investigated Patients and methods: 44 patients with T2DM were randomly assigned whether the reported thermogenic and insulin-sensitizing properties of α- either to a high protein diet (PR: n=22; P:CHO:F=30:40:30%, age: 61.0±5.7

lipoic acid could be of value in countering the suppression of years, body weight: 94.1+15.6kg, insulin dose: 57.3+26.6IU/day, HbA1c: thermogenesis that accelerates fat deposition and that drives insulin 7.8+1.4%), or a standard diet (ST: n=22, P:CHO:F=15:55:30%, age: 63.7±5.2 resistance during weight recovery - with potential implications for the years, body weight: 91.5+20.2kg insulin dose: 52.7+28.8IU, HbA1c: management of catch-up growth and obesity relapse. 7.6+0.9%). Parameters of glucose- and lipid metabolism and anthropometric Using a rat model of semistarvation-refeeding showing hyperinsulinemia parameters were evaluated at baseline and after 3 months. The main outcome and catch-up fat driven by suppressed thermogenesis, we show here that variables were daily insulin requirements and metabolic control. Results: Body weight decreased in boths groups after 3 months (PR: to during isocaloric refeeding on low-fat or high-fat diets for 2 wks, dietary 91.0+15.7; to 90.5+19.4kg,P<0.05), albeit to a higher extent in PR α supplementation with -lipoic acid (0.25 %) resulted in significant (P=0.0042). In PR, insulin dose was reduced (P<0.05) from 57.3+26.6 to reductions in weight gain (-20%, P<0.01) and in diminished plasma 48.2+30.8IU/day, HbA1c from 7.8+1.4 to 7.5+1.4%, FPG from 203.2+56.9 to insulin responses to a glucose load. Analysis of data on energy balance 160.0+47.7mg/dl, triglycerides from 186.9+114.9 to 140.7+55.6mg/dl. and body composition revealed that α-lipoic acid supplementation led to Diastolic blood pressure showed a significant decrease from 83.2+7.2 to an increase in energy expenditure, but that the reduced weight gain 76.9+8.7mmHg (P<0.05). Fat mass showed a significant (P<0.05) reduction resulted entirely from lower gain in lean body mass, with the high rate of from 29.1+8.2 to 26.7+6.2kg. No specific changes were seen in ST except for fat gain being unaltered. an increase in insulin dose (P<0.05). These studies indicate that the stimulatory effects of α-lipoic acid on Conclusion: In this study we could demonstrate beneficial effects of a high- protein diet on glycemic parameters and insulin requirement in type 2 diabetic energy expenditure lead to diminished gain in lean tissue mass rather patients over 3 months compared to a standard diet. These changes seem to be than in fat mass, and hence underscore the need for human studies that related to the greater weight loss and require confirmation over longer would address the potential effects of this widely marketed dietary observation periods. supplement as a protein catabolizer.

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Predictive factors of success of laparoscopic adjustable silicone gastric Is total body fat an independent variable to heart rate recovery in banding in obese women untrained men?

1 1 1 1 Scartabelli Giovanna , Fierabracci Paola , Galli Giulia , Ricco Ilaria , Pucci 1 1 1 1 1 1 2 Ripari Patrizio , Di Blasio Andrea , Berchicci Marika , Di Giacinto Andrea , Salvetti Guido , Valeriano Rocco , Lamacchia Michele , Santini Gabriella1, D'Ercole Alessandro1, Bertollo Maurizio1 Ferruccio1, Pinchera Aldo1 1 1 2 Faculty of Human Movement Science, Chieti-Pescara University, Italy Department of Endocrinology And Metabolism, Pisa, Italy; IV Division of General Surgery, Pisa, Italy BACKGROUND: Waist circumference (WC) and excess body fat are Obesity is a prevalent condition associated with high morbidity and mortality important predictors of morbidity and mortality because linked with rates. The extent of weight loss after laparoscopic adjustable silicone gastric insulin resistance, hypertension and cardiovascular disease (CVD). Since banding (LASGB) is variable, depending on multiple biological and heart rate recovery (HRR) is an independent risk factor for CVD and psychological factors that have been only partially clarified. mortality, we investigated its association with Metabolic Syndrome. The aim of this study was to identify predictive indicators of success of METHODS: We investigated WC and body fat at rest and HRR after a laparoscopic adjustable silicone gastric banding in obese women. standardized graded cycle stress test in 10 untrained lean healthy men One hundred and thirty two morbidly obese women (mean age 42 + 11, range (mean age 42.2±5.5) and in 10 untrained men with Metabolic Syndrome: 20–64 years; mean BMI 43,1 + 5,7, range 35 - 69,9) were enrolled. Each insulin resistance, essential hypertension and WC 1102 cm were evaluation consisted of clinical and anthropometric measurements. requested (mean age 44.8±4.8). Criterions of inclusion have also been Preoperative fasting blood samples were collected for assay of several the absence of pharmacological treatments influencing heart rate. metabolic and hormonal parameters. RESULTS: A multivariate analysis showed that the HHR decreased At 12 months follow up a mean BMI reduction = 22 + 7% was obtained significantly with the severity of WC (P=.000) and of FAT% (P=.000) (excess weight loss = 45 + 12 %). A positive correlation between weight loss (expressed as % BMI reduction) and preoperative body weight (P=0,005) or only in men with Metabolic Syndrome. There was not significative hip circumference (P= 0,009) was observed. A negative correlation between difference between two groups in heart rate at rest. weight loss and preoperative values of vitamine B 12 (P=0,02) was observed. CONCLUSION: If the poor HRR strongly predict CVD and mortality, No significant associations were found between weight loss and the other the inverse relation among waist circumference, fat and HRR suggest the metabolic and hormonal parameters measured. necessity to weight loss for improving heart health in subjects with In conclusion, preoperative weight, distribution of adipose tissue and serum Metabolic Syndrome. vitamine B12 are possible predictive factors of the extent of weight loss after bariatric surgery by LASGB.

International Journal of Obesity Abstracts S137 T3:PO.127 T3:PO.128

Change in body composition after laparoscopic adjustable silicone Heritability of obesogenic eating styles in 9-11 year olds gastric banding (LASGB) Carnell Susan1, Haworth Claire2, Semmler Claudia1, Wardle Jane1 1 1 1 Ricco Ilaria , Fierabracci Paola , Scartabelli Giovanna , Valeriano 1 2 Rocco1, Salvetti Guido1, Marsili Alessandro1, Pucci Andrea1, Rossi University College London, London, United Kingdom; King's College Mauro2, Santini Ferruccio1, Pinchera Aldo1 London, London, United Kingdom

1 2 Background: Environmental factors promoting positive energy balance are Department Of Endocrinology And Metabolism, Pisa, Italy; IV ubiquitous, yet population variation in adiposity persists. This may be partly Division of General Surgery, Pisa, Italy explained by interactions between the ‘obesogenic’ food environment and individuals’ genetic susceptibility to this environment in the form of Laparoscopic adjustable silicone gastric banding (LASGB) is a characteristic eating styles. Although some evidence in adults suggests that therapeutical approach to achieve a stable body weight reduction in eating-disordered styles of consumption could be partly genetic, no existing severe obesity. studies have tested whether obesogenic eating styles show genetic influence The aim of this study was to evaluate body composition by Dual-Energy in childhood. X-ray Absorptiometry (DEXA) and endocrine and metabolic features in Method: The Child Eating Behaviour Questionnaire (CEBQ) is a morbidly obese patients before and after LASGB. psychometric, parent-report instrument assessing eating styles in children. We studied 18 obese subjects before and 1-2 years after surgery (13 We administered two CEBQ scales measuring eating styles that have been women, 5 men; aged 19-63 years: mean + SD age 39.3+13.5; BMI 37- linked with obesity (Satiety Responsiveness, SR; Enjoyment of Food, EF) to 49.5 Kg/m2:mean + SD 43 + 4.0). over 5000 parents of 9-11 year old twins in TEDS. After LASGB, a significant decrease was observed in mean BMI Results: The intra-class correlation for SR was 0.62 for MZ (identical) and (20.7+7.5% , P<0.0001) and waist circumference (18.6+8.7% P<0.001). 0.08 for DZ (non-identical) twin pairs. For EF the correlations were 0.80 for DEXA examination showed a significant (P<0.0001) decrease of total MZ and 0.35 for DZ pairs. ACE model-fitting analyses demonstrated 0.63 additive genetic influence, 0.21 shared environmental influence, and 0.16 (31.9+12.8%), trunk (35.2+16.0%) and peripheral fat mass non-shared environmental influence for SR. Figures were similar for EF (28.8+12.0%), whereas total lean mass was only partially affected (0.75, 0.10 and 0.15 respectively). (12.3+7.5%). Serum leptin levels significantly decreased of 50.2+30.0% Conclusions: Our results indicate substantial heritability and modest (P<0.003). A significant decrease of serum insulin (P<0.0001) and environmental influences on two obesogenic eating traits among 9-11 year serum triglyceride (P= 0.05) and a significant increase of serum HDL olds. Higher EF is likely to promote weight gain in a permissive cholesterol (P<0.05) was also observed. In conclusion, our results environment, while SR could protect against it. This evidence for confirm previous studies indicating that LASGB induces a significant genetically-influenced eating behaviours early in life suggests we could decrease of body weight and a redistribution of body composition with a identify high-risk individuals in childhood and intervene to prevent excessive prevalent decrease of fat mass and an improvement of some weight gain. Our results will also inform molecular research into obesity. cardiometabolic risk factors associated with severe obesity.

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The evaluation of a holistic approach to obesity management for primary care Relation between leptin, leptin soluble receptor and coronary atherosclerosis practitioners 1,2 1 3 1,3,4 1,2,3 2 2 1,2,3 Hoefle Guenter , Saely Christoph H. , Risch Lorenz , Rein Philipp , Koch Brown Jenny , Wimpenny Peter , West Bernice , Broom Iain Lorena3, Schmid Fabian3, Aczél Stefan1, Marte Thomas 1,3, Langer Peter3, Drexel 1,3,4 1 2 Heinz NHS Grampian, Scotland; The Robert Gordon University, Aberdeen, Scotland; 3ACERO, Aberdeen, Scotland 1Department of Internal Medicine, LKH Feldkirch, Austria; 2Department of Internal Medicine, LKH Hohenems, Austria; 3Vorarlberg Institute for Vascular Background: The prevalence of obesity (BMI>30Kg/m²) in Scotland is rising at an 4 alarming pace. The lack of sustained success in treatment demands that new strategies be Investigation and Treatment, LKH Feldkirch, Austria; University of Human explored to improve patient outcomes (Harvey et al. 2005). The aim of this research was Sciences in the Principality of Liechtenstein, Triesen, Principality of Liechtenstein to evaluate, holistic, evidence based practice materials for both nurses and patients working in partnership to encourage self-care. Background The adipose tissue-related hormone leptin plays an important role in Methodology: Previous work by the researcher provided the evidence for the the regulation of body weight. The associations of leptin and leptin soluble receptor development of materials. Scottish-based practice nurses recruited patients after (sOb-R) with coronary artery disease (CAD) are not clear. receiving a booklet on weight management and a minimum of one hour's education. Design We therefore measured leptin and sOb-R in 543 consecutive patients (379 Quantitative and qualitative data was collected through field notes, patient data, men, 164 women) referred for coronary angiography for the evaluation of satisfaction questionnaires and booklets, plus nurse questionnaires and interviews. established or suspected CAD. Coronary artery stenoses with lumen narrowing of Results: Of the 28 patients recruited by 9 nurses, 5 were lost to follow-up during the 3 50% or more were considered significant. month longitudinal study. Weight loss data was available for 23 subjects: 0–5% weight Results Serum leptin correlated significantly with body mass index (BMI; loss (14); >5% weight loss (4); weight gain (5). Key concepts in the implementation were autonomy, holism, partnership and education. rs=0.443), with insulin resistance (HOMA-IR, rs=0.339), with serum triglycerides Conclusion: The findings of this pilot study suggest that obesity is complex and requires (rs=0.181), with systolic as well as diastolic blood pressure (rs=0.170 and rs=0.133, a holistic approach to management through partnership working between nurse and respectively) and, inversely, with sOb-R (rs=-0.346; P<0.01 for all correlations). patient. Primary care nurses are ideally placed to address obesity. However, they Coronary angiography revealed significant coronary artery stenoses in 331 (61.0%) recognise their need of appropriate tools and education. These results suggest that both of our patients. Serum concentrations of leptin were significantly lower in patients nurses and individuals in their care who took ownership of this approach had successful with significant coronary artery stenoses than in patients without such lesions outcomes not just in weight loss but also in quality of life improvement. Further research (8.5±7.8 vs. 13.2±12.2 ng/ml; P<0.001). Multivariate logistic regression analysis is required to confirm or refute these findings. adjusting for age, gender, high-density lipoprotein cholesterol, low-density HARVEY, E.L., GLENNY, A.M., KIRK, S.F.L. and SUMMERBELL, C.D., 2005. lipoprotein cholesterol, triglycerides, BMI, diabetes, hypertension and smoking Improving health professionals' management and the organisation of care for overweight proved serum leptin inversely and independently associated with the presence of and obese people. Cochrane Database of Systematic Reviews, 4. significant coronary artery stenoses, with a standardized adjusted odds ratio (OR) Conflict of Interest of 0.746, 95% confidence interval (CI) 0.566–0.983, P=0.038. In contrast to serum None disclosed. concentrations of leptin, serum concentrations of sOb-R did not significantly differ Funding Research relating to this abstract was funded by NHSG Endowments, The Robert Gordon between patients with significant stenoses and those without such lesions (22.4±8.3 University and the Burdett Trust for Nursing. vs. 23.1±12.1 ng/ml; P=0.655). Conclusions Serum leptin but not sOb-R is significantly lower in patients with angiographically determined CAD.

International Journal of Obesity Abstracts S138 T3:PO.131 T3:PO.132

Impact of serum resistin concentrations on the incidence of vascular events in patients Impact of posttransplant weight gain on cardiac allograft vasculopathy undergoing coronary angiography 1,2,3 2 1 1 1,2 1 3 3 3 Hoefle Guenter , Saely Christoph H. , Martinelli Michele , Hullin Roger , Meier Hoefle Guenter , Saely Christoph H. , Risch Lorenz , Koch Lorena , Schmid Fabian , Bernhard1, Carrel Thierry4, Seitz Michael3, Villiger Peter M.3, Mohacsi Paul1 Aczél Stefan1, Berchtold Sabine4, Marte Thomas1,3, Langer Peter3, Drexel Heinz1,3,5 1 1 Department of Cardiology, Swiss Cardiovascular Center Bern, University Department of Internal Medicine, Academic Teaching Hospital Feldkirch, Austria; 2 2Department of Internal Medicine, LKH Hohenems, Austria; 3Vorarlberg Institute for Hospital, Bern, Switzerland; Vorarlberg Institute for Vascular Investigation and 4 Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Vascular Investigation and Treatment, Feldkirch, Austria; LMZ laboratories, Schaan, 3 Principality of Liechtenstein; 5University of Human Sciences in the Principality of Department of Rheumatology and Clinical Immunology/Allergology, University 4 Liechtenstein, Triesen, Principality of Liechtenstein Hospital, Bern, Switzerland; Department of Cardiovascular Surgery, University Hospital, Bern, Switzerland Objective: The adipose tissue-related hormone resistin is predominantly secreted by inflammatory cells. We assessed the impact of circulating resistin on the prevalence of Background Excessive weight gain and obesity are commonly reported after heart significant coronary artery stenoses and on the incidence of vascular events. transplantation (HTx). Currently, it is not clear whether weight gain is a risk factor Design: Cross-sectional and prospective study. of cardiac allograft vasculopathy (CAV) in heart transplant recipients. Patients: 547 patients (376 men, 171 women) with suspected or established coronary Methods We studied all patients (n = 95; mean age 50 ± 13 years) who underwent artery disease. orthotopic cardiac transplantation at the Swiss Cardiovascular Center Bern since Measurements: Serum resistin, insulin resistance, lipids, high-sensitivity C-reactive 1994 and survived for > 1 year. Vascular risk factors were registered before protein (hsCRP) and coronary angiography. Coronary artery stenoses with a lumen transplantation and at regular follow-up visits. Coronary angiography was narrowing of 50% or more were regarded significant. We also recorded vascular events over a follow-up of 4.0±0.7 years. performed yearly for the evaluation of CAV. The follow-up period was 6 ± 3 years. Results Serum resistin correlated significantly with hsCRP (rs=0.228; P<0.001). From Results Baseline body mass index (BMI) was 24 ± 3 kg/m² and increased to 28 ± 4 our patients, 330 (60%) had significant coronary artery stenoses. Serum resistin was not kg/m² at follow-up year 10 (+4; P<0.001). Weight gain proved inversely associated significantly different in patients with significant coronary artery stenoses compared with with incident CAV (hazard ratio 0.78, 95% confidence interval (CI) 0.64 – 0.94; patients without coronary artery stenoses (4.8±2.4 vs. 4.7±2.9 ng/ml; P=0.265). P=0.01) in Cox regression analysis adjusting for type 2 diabetes, BMI preHTx, Multivariate logistic regression analysis adjusting for conventional vascular risk factors hypertension, recipient ischemic heart disease preHTx, number of cardiac allograft (age, gender, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, rejection episodes, lipids, statin use, recipient age and gender. In contrast, recipient triglycerides, hsCRP, glomerular filtration rate, body mass index, type 2 diabetes, preHTx ischemic heart disease was positively predictive of the incidence of CAV hypertension and smoking) showed no significant association of serum resistin with the (hazard ratio 7.22; 95% CI 1.70 – 30.61; P<0.01). No significant associations presence of significant coronary artery stenoses (standardized adjusted odds ratio of between hypertension, lipid parameters, gender, type 2 diabetes, or recipient age at 0.927, 95% confidence interval (CI) 0.741 – 1.161; P = 0.510). Furthermore, after the time of HTx with CAV were observed. multivariate adjustment Cox regression exhibited no significant association of serum Conclusions Weight gain after heart transplantation is common but does not resistin with vascular events (hazard ratio 0.936, 95% CI 0.753 – 1.162; P = 0.549). necessarily reflect a risk factor for CAV in heart transplant recipients. Recipient Conclusions: Serum resistin is neither associated with the presence of significant coronary artery stenoses nor with vascular events in patients undergoing coronary preHTx ischemic heart disease is positively predictive of the incidence of CAV. angiography.

T3:PO.133 T3:PO.134

No early effect of Roux-en-Y gastric bypass on insulin-resistance in morbidly Autonomic and Endocrine Dysregulation in Patients with non-binge Obesity and obese non-diabetic subjects Bulimia. First Results of the BANAANS (Binge eating and Neurohormones in Bulimia, Adiposity and Autonomic Tone) Study Camastra Stefania1, Muscelli Elza1, Anselmino Marco2, Bonuccelli Sandra1, Scartabelli Giovanna3, Santini Ferruccio3, Santini Eleonora1, Rossi Mauro2, Laederach-Hofmann Kurt1, Engesser Claudia1, Lemmenmeier Eva1, Messerli Pinchera Aldo3, Ferrannini Eleuterio1 Nadine2

1Department Of Internal Medicine, University Of Pisa, Italy; 2IV Surgery Unit- 1Dept. of Obesity & Eating Disorders, Inselspital, University of Berne, Switzerland; Bariatric Surgery Division, Santa Chiara Hospital, Pisa, Italy; 3Dept. of 2Psychological Institute, University of Berne, Switzerland Endocrinology, University of Pisa, Italy Although studies on anorexic and obese individuals showed differences in Weight loss after bariatric surgery improves insulin resistance (IR). Recent autonomic functions, nothing is known for bulimic patients. The aim of the study evidence has shown that biliopancreatic diversion, a predominantly malabsorptive was to define autonomic differences between obese and bulimic women. procedure, restores peripheral insulin sensitivity early after surgery before Patients and methods: Twelve female patients with (binge-purge significant weight loss. Roux-en- Y gastric bypass (RYGB), a predominantly type, BMI 23.1±5.6 kg/m2, aged 24.4±5.7 yrs.) and 13 with morbid non-binge restrictive surgery, also has been associated with hormonal changes and improved obesity (BMI 39.8±5.8 kg/m2, aged 35.1±7.1 yrs.) were included in this study IR – as estimated by HOMA – prior to substantial weight loss. However, there are approved by the local ethical committee. Investigations included a non-invasive no data regarding the early effect of RYGB on insulin sensitivity as measured by assessment of the autonomic nervous system (Task Force ® Monitor; CN-Systems the gold standard method. Inc., Graz, AT) during resting, mental stress (Stroop), and recovery phases and a The aim of this work was to evaluate, using the euglycemic hyperinsulinemic (240 blood draw to determine leptin, insulin, and plasma glucose levels. pmol.m-2.min-1) clamp technique, the effect of RYGB on insulin sensitivity in Results: Resting and mental stress values of sympathetic (MFHR) and nondiabetic subjects early after surgery before any effect of weight loss might parasympathetic activity(HFHR), and baroreceptor values were not significantly occur. different between the two groups. However, HFHR was significantly different in We studied eight morbidly obese non-diabetic subjects (age 41±3 years, recovery phase with 2.98±0.70 for bulimic, vs. 3.53±0.51 ms2 for obese patients BMI=53±3 kg.m-2) before and 18±1 days after RYGB. After surgery, body weight (P=0.036) representing a disturbed recovery in the latter. Due to significant had decreased by 4.2±0.9% (147±8 vs 141±8 kg, P=0.01) and fat-free mass (FFM) differences in age (P<0.001) and body mass index (P>0.001) an ANCOVA with by 5.5±1.3% (72±5 vs 68±5 kg, P=0.02). At this time, there was no change in both variables as covariates showed significant differences for MFHR, HFHR, total plasma levels of glucose (5.12±0.13 vs 5.04±0.08 mmol/l, P=ns), adiponectin power HRV and baroreceptor values (P>0.001 for all). Multivariate correlationw (5.09±1.11 vs 5.19±0.65 mg/l, P=ns) or interleukin-6 (3.16±0.46 vs 3.96±0.44 (corrected for age and BMI) were significant for plasma glucose total power HRV pg/ml, P=ns). In contrast, fasting plasma insulin levels were significantly reduced (r=-0.462, P=0.046), and leptin with total power HRV (r=-0.503, P=0.023). (124±21 vs 89±11 pmol/l, P=0.02). However, on the clamp insulin sensitivity was Conclusions: Autonomic activity is different in non-binge obese compared to binge unchanged (M value=25.7±4.1 vs 27.8±3.4 µmol.min- 1.kgFFM -1, P=ns) as was purge bulimic patients. Additionally, different levels of leptin, glucose and insulin insulin clearance (978±64 vs 1032±68 ml/min, P=ns). levels seem to be involved in autonomic adaptation. We conclude that in morbidly obese non-diabetic subjects, RYGB decreases plasma insulin but does not improves insulin sensitivity until substantial weight loss has occurred.

International Journal of Obesity Abstracts S139 T3:PO.135 T3:PO.136

Changes in children’s food intake in Family-Based Behavioural Treatment (FBBT) Ferritin, and not visceral fat, is a good predictor of liver function disturbances in for childhood obesity overweight and obese men and women

1 1 1 1 Croker Helen1, Nicholls Dasha2, Viner Russell2, Wardle Jane1 Verrijken An , Mertens Ilse , Francque Sven , Van Gaal Luc

1 1University College London, UK; 2Great Ormond Street Hospital, UK Antwerp University Hospital, Antwerp, Belgium Introduction Background Non alcoholic fatty liver diseases are associated with obesity, insulin resistance, and Pilot work evaluating FBBT of obesity in British children has shown significant excessive visceral fat accumulation. We wanted to analyze the possible influence of the reductions in overweight. Additionally, FBBT appears to improve mood and self- amount of visceral adipose tissue (VAT) on liver function markers in overweight and esteem, and does not harm children’s attitudes to eating or weight. The specific obese subjects. dietary changes that children make have not been examined. Methods Participants and methods Anthropometry, body composition (BIA), CT-measured VAT, and liver function markers An ethnically and socially diverse sample of 33 children (8-13 years) took part in (AST, ALT, alkaline phosphatase and -GT) were assessed in overweight and obese FBBT between 2002 and 2003. FBBT is a multidisciplinary group programme subjects (n=582), with mean age 41±13 years and mean BMI 34.9±6.3 kg/m². comprising: i) advice for improving the home micro-environment to encourage Results healthier eating and activity patterns and ii) a structured behavioural programme to In 41.4% of the subjects, one or more of the liver function markers were above the upper modify child and family behaviour. Dietary intake was assessed using a validated limit of normal. VAT was positively related to AST (r=0.18, P<0.001), ALT (r=0.27, P<0.001), alkaline phosphatase (r=0.17, P<0.001) and -GT (r=0.38, P<0.001). food frequency questionnaire (FFQ) before and after treatment and at 3 month Comparing subjects with high (VAT<117cm²) and low (VAT<117cm²) levels of VAT, follow-up. Foods were grouped into high-fat, high-fibre, snack, vegetable, fruit, we found significant differences for AST (26±11 U/l vs 24±15 U/l, P<0.001), ALT and fizzy drink categories. Individual foods were scored according to frequency of (36±19 U/l vs 33±36 U/l, P<0.001), alkaline phosphatase (78±21 U/l vs 73±26 U/l, consumption, and category scores were created by combining these. P<0.001) and -GT (36±30 U/l vs 27±32 U/l, P<0.001). After adjusting for BMI, the Results difference in alkaline phosphatase disappeared. When adjusting for ferritin, this was also Children made substantial changes to their dietary patterns over treatment. the case with AST. A stepwise multiple regression analysis, with the anthropometric and Consumption of high-fat foods, snacks and fizzy drinks significantly reduced, and metabolic variables most significantly correlated with liver function markers as consumption of high-fibre foods and vegetables significantly increased (P<0.05). independent variables and liver function markers as dependent variables, showed ferritin Fruit intake did not change significantly. In children with FFQ data at 3 month and CRP, and not VAT, as the most important determinants of liver function markers. follow-up (n=13), reductions in snack and fizzy drink consumption were Conclusions maintained, fruit and vegetable intake was higher than at baseline, but consumption These results suggest that VAT is linked with different liver function markers, but ferritin of high-fat and high-fibre foods had returned to baseline levels. seems to be a more important determining factor. This work is part of the project "Hepatic Conclusions and adipose tissue and functions in the metabolic syndrome" (HEPADIP, see http://www.hepadip.org/), which is supported by the European Commission as an Children made significant dietary changes over a 4 month programme and Integrated Project under the 6th Framework Programme (Contract LSHM-CT-2005- maintained most of these changes over 3 month follow up. 018734).

T3:PO.137 T3:PO.138

Exenatide provides HbA1c reductions comparable to insulin with the additional Intake of trans fatty acid-rich hydrogenated fat diet during pregnancy and effect of weight reduction lactation altered litter metabolism and adiponectin gene expression

1 2 3 4 5 Ivanyi Tibor , Kim Dennis , Brodows Robert , Trautmann Michael , Festa Andreas Oller Do Nascimento Claudia1, Pisani Luciana1, Missae Lila2, Bueno Allain1, Albuquerque Kelse1, Carvalho Carla1, Tavares do Carmo Maria das Graças3 1Eli Lilly – Hungary; 2Amylin Pharmaceuticals; 3Lilly Research Laboratories – US; 4 5 Lilly Research Laboratories – Germany; Lilly Research Laboratories -- Austria 1 2 São Paulo Federal University - Physiology Department; São Paulo Federal 3 When treatment of type 2 diabetes (T2D) with oral medications fails to achieve University - Department of Health Science - Campus Baixada Santista; Rio glucose control, treatment alternatives include addition of insulin or an incretin de Janeiro Federal University - Institute of Nutrition mimetic. Body weight can be a consideration when choosing treatments. Comparator trials were conducted to test whether exenatide was noninferior to In the fetus occurs a metabolic programming, which is in accordance with the insulin glargine (IG, Trials A and B) and biphasic insulin aspart (BIA, Trial C) mother’s nutritional status. This programming can be altered by the income of with respect to change in HbA1c. Body weight change and self-monitored glucose nutrients and cause physiological and metabolical disfunctions in the adult profiles were secondary endpoints. Trial A was a 26-week parallel-group trial in life. It has been reported that long-term intake of high amounts of partially patients treated with MET and SU (n=549), Trial B was a 32-week crossover trial hydrogenated vegetable oils and fats and, hence, of trans fatty acids (TFA) in patients treated with MET or SU (n=114 completers), and Trial C was a 52-week increases the risk of metabolic pathologies. The aim of this study was to parallel-group trial in patients treated with MET and SU (n=501). Exenatide was a evaluate whether maternal intake of trans fatty acids (TFA)-rich hydrogenated fixed 10µg BID SC injection, and insulin was titrated regularly, administered QD fat during pregnancy and lactation affects the serum hormones and for IG, BID for BIA. Exenatide demonstrated mean HbA1c reductions (range, -1.0 metabolites levels and the adipose tissue content of insulin receptor (IR) and to -1.4%) comparable to insulin (-0.9 to -1.4%). Exenatide was associated with adiponectin mRNA of litter at the 21st day of life. Throughout pregnancy and mean weight reductions (range, - 2.3 to -2.5kg), compared to weight gain with insulin (+0.8 to +2.9kg). Exenatide reduced postprandial glucose more than insulin, lactation, Wistar rats ingested isocaloric/ normolipidic diets with either while insulin reduced fasting glucose more than exenatide. Nocturnal soybean oil (control - C) or vegetal-derived hydrogenated fat (T) as fat hypoglycaemia occurred less frequently with exenatide (Trials A and C). The most source. Blood and white adipose tissue samples were removed for IR and common adverse event associated with exenatide was mild-to-moderate nausea. adiponectin mRNA determinations. No changes were observed in glicaemia, Gastrointestinal side effects were not a significant cause of weight reduction. In insulinaemia and IR The T group presented higher triacylglycerol, cholesterol clinical trials with over 1000 patients with T2D studied, exenatide provided HbA1c and leptin serum concentrations; the adiponectin mRNA and serum reductions comparable to insulin, with the additional effect of progressive weight concentration were lower. These results suggest that the early reduction. (intrauterine/perinatal) exposure to TFA-rich hydrogenated fat could increase Funded by Eli Lilly and Company and Amylin Pharmaceuticals, Inc. the risk of insulin resistance development and atherosclerosis, since Disclosure: Tibor Ivanyi is an employee of Eli Lilly and Company. adiponectin has an anti-atherogenic effect and increase insulin sensitivity. Research supported by FAPESP and CAPES.

International Journal of Obesity Abstracts S140 T3:PO.139 T3:PO.140

Longterm effects of carob pulp preparations in insoluble fiber on metabolism, Is it possible to manage diabetes without weight gain? Ten-year follow-up body weight and leptin levels in rats study

Burget Lukas1, Bai Yinlong1, Caton Samantha1, Spangler Lothar1, Gruendel Krahulec Boris1, Mesarosova Dasa1, Strbova Lujza1, Waczulikova Iveta2 Sindy2, Koebnick Corinna2, Bidlingmaier Martin1 1Second Internal Clinic of Medicine, Faculty Hospital, Comenius University; 1Medical Department - Innenstadt, LMU Muenchen, Munich, Germany; 2Department of Biomedical Physics, Faculty of Mathematics, Physics, and 2Department of Clinical Nutrition, German Institute of Human Nutrition Informatics, Comenius University Potsdam-Rehbruecke, Germany Aim: was to evaluate changes in the body weight of out-patient-clinic Obesity is one of the most health influencing diseases and some attention has diabetics during a 10-year follow-up period at the Diabetes Clinic of Medical been given to food supplements like Carob, a dietary fiber and rich in Faculty Hospital. insoluble fibers and polyphenols. Carob has beneficial effects on metabolic Patients and methods: Data were collected from 86 patients with no drug parameters (cholesterol, triglycerides) and it is hypothesized to enhance fat therapy of obesity (43 female, 43 male; 29 type 1, 57 type 2; median age 51, utilization and increasing energy expenditure. In this study 24 male Wistar IQR 42-60 years; duration of diabetes 5 (IQR, 1-13) years. Metabolic control rats were grouped (n=8) and either a carob pulp diet (CD), a polyphenol diet was estimated by measuring HbA1c levels. Differences in body mass index

(PD) or a control diet (CO) was served for 21 days ad libitum, with no (BMI) and HbA1c levels were statistically analysed. 2 difference in caloric contents. Energy expenditure (EE) and respiratory Results: Baseline characteristics (mean ± SD): BMI 27.8 ± 4.4 kg/m ; HbA1c quotient (RQ) were measured by spirometric measurement at baseline and 8.1 ± 1.5 %. After 10 years, there were no significant changes in mean BMI 2 after the feeding period for 48 hours each and body weight gain was (27.4 ± 4.4 kg/m ) and HbA1c (7.9 ± 1.3 %). However, the proportion of monitored constantly. After the study, blood was collected. Post-experimental patients with decreased BMI (59.3 %) was significantly different when body weight gain (mean ± SE) was 59, 31 ± 5,15 g (CD), 54,68 ± 13,94 g compared to the proportion of worsened patients (P = 0.016). Analysis after (PD) and 49,08 ± 10,48 g (CO); (P>0,05). CD animals showed a mean RQ of stratification of patients into obese and normal-weight on the basis of BMI 0,99 ± 0 ,1, PD animals 1,02 ± 0,19 and CO animals 1,02 ± 0 ,16 (P>0,05). values of >30 revealed that the originally obese patients (26) exhibited EE was 6,69 ± 1,97 kcal/kg*h for PD animals, 6,73 ± 1,63 kcal/kg*h for CD significantly decreased BMI (1 kg/m2, P = 0.029) whereas BMI in the animals and 6,85 ± 1,69 kcal/kg*h for CO animals (P>0,05). Mean leptin normal/over-weight patients tended to be higher (mean BMI gain 0.35 kg/m2).

levels were 2,97 ± 0,6 ng/ml for CD animals, 2,62 ± 0,78 ng/ml for PD No linear correlation or any other simple association between BMI and HbA1c animals and 2,74 ± 0,64 ng/ml for CO animals (P>0,05). We conclude that was found. food supplements such as carob dietary fiber and polyphenols itself have no Conclusion: Obese patients showed a significant weight reduction after 10 statistically relevant effect on body weight, energy expenditure, respiratory years. We assume that a non-medicament (behavioral) approach may be an quotient and leptin levels in rats when given over a longer period. effective long-term method in managing obesity, and recommend a medical treatment only if the patient is non-compliant. Grants: VEGA 1/3037/06, APVT: 51-027404.

T3:PO.141 T3:PO.142

Accuracy of HOMA, QUICKI and FGIR indexes in visceral obese patients The ambiguity of weight loss among subjects treated for obesity

Muratori Fabrizio1, Disoteo Olga 1, Vignati Federico1, Pizzi Gianluigi2, Loli Rugseth Gro1, Engelsrud Gunn1, Tonstad Serena2 Paola1 1Section Of Health Science, University Of Oslo, Norway; 2Ullevaal 1Endocrine Unit Niguarda Hospital Milan, Italy; 2Diabetologic Unit Niguarda University Hospital, Oslo, Norway Hospital Milan, Italy Relevance: Obesity treatment is meant to support people in their efforts to Aim: was to evaluate changes in the body weight of out-patient-clinic change lifestyle and lose weight, but it is evident that most people who lose diabetics during a 10-year follow-up period at the Diabetes Clinic of Medical weight regain it. Faculty Hospital. Purpose: The project uses a phenomenological approach to explore how Patients and methods: Data were collected from 86 patients with no drug people, treated for obesity, experience fatness before and during an obesity therapy of obesity (43 female, 43 male; 29 type 1, 57 type 2; median age 51, treatment group. IQR 42-60 years; duration of diabetes 5 (IQR, 1-13) years. Metabolic control Methods: Eight women and two men were interviewed prior to their was estimated by measuring HbA1c levels. Differences in body mass index participation in an obesity treatment program. Eight informants were also

(BMI) and HbA1c levels were statistically analysed. observed at each of 17 group sessions over one year. The treatment was 2 Results: Baseline characteristics (mean ± SD): BMI 27.8 ± 4.4 kg/m ; HbA1c organized in a hospital setting and based on cognitive behavior therapy. 8.1 ± 1.5 %. After 10 years, there were no significant changes in mean BMI Results: Weight loss is experienced as ambiguous; while strongly desired it is 2 (27.4 ± 4.4 kg/m ) and HbA1c (7.9 ± 1.3 %). However, the proportion of also connected to a sense of insecurity and discomfort. Losing weight alters patients with decreased BMI (59.3 %) was significantly different when relationships with others and is associated with being smart, good-looking compared to the proportion of worsened patients (P = 0.016). Analysis after and determined. However, the interviewees described several negative and stratification of patients into obese and normal-weight on the basis of BMI unwanted implications of weight loss. None of this ambiguity was discussed values of >30 revealed that the originally obese patients (26) exhibited during the group sessions. significantly decreased BMI (1 kg/m2, P = 0.029) whereas BMI in the Conclusion: Obesity is often approached as though it exists simply in an normal/over-weight patients tended to be higher (mean BMI gain 0.35 kg/m2). objective sense and solely as a problem. Several key issues concerning being

No linear correlation or any other simple association between BMI and HbA1c fat are given little or no attention during weight loss treatment. From the was found. participant’s perspective, being fat is felt as both desirable and unwanted. Conclusion: Obese patients showed a significant weight reduction after 10 1. Conflict of Interests: years. We assume that a non-medicament (behavioral) approach may be an None disclosed. effective long-term method in managing obesity, and recommend a medical 2. Funding: treatment only if the patient is non-compliant. Research relating to this project was funded by: Fond for etter- og Grants: VEGA 1/3037/06, APVT: 51-027404. videreutdanning av fysioterapeuter, Norway.

International Journal of Obesity Abstracts S141 T3:PO.143 T3:PO.144

Changes in plasma lipid transfer proteins (CETP, PLTP) during weight reduction The effects of food deprivation leading to weight loss on food hedonics and and their association with LDL and HDL subclasses the relative-reinforcing value of food

1 1 1 Tzotzas Themistoklis , Triantos Athanassios , Kaklamanou Mirto , Pidonia-Manika Cameron Jameason1, Cyr Marie-Josée1, Doucet Éric1 Iphigenia1, Apartoglou Io2, Lagrost Laurent3 1University of Ottawa, Canada 1Department of Biochemistry-Aristotle, University of Thessaloniki, Greece; 2Department of Clinical Biology, Panagia General Hospital, Thessaloniki, Greece; 3INSERM U498, Université de Bourgogne, Dijon, France Background: There is strong evidence that when animals are chronically deprive d of calories, the reward of a food s timulus becomes more salient. Introduction: Plasma lipid transfer proteins (LTPs) CETP and PLTP exchange Recently leptin has been implicated in food reward. lipids between lipoproteins, more influencing HDL size. CETP increases small Objective: To examine whether plasma leptin concentrations were related to HDL3 and PLTP large HDL2. LTPs, as new factors for cardiovascular (CV) food hedonics and food reinforcement and to elucidate the effect of weight disease, are often elevated in obesity. loss on these variables. Aim: To determine changes of plasma CETP and PLTP levels and LDL and HDL Design: Fourteen apparently healthy obese adults (n= 9 women and 5 men; subclasses during weight loss. age =33.5± 7.8) with BMI between 30-45 kg/m2 were subjected to 8 we eks Patients-Methods: 44 obese women, age 41±11.7y, BMI:36.8±5.4 were evaluated of caloric deprivation ( - 700kcal/day). Plasma leptin (ELISA), body weight at baseline and ,most of them, after 4 and 16 weeks(w) of a low-calorie diet of and composition (DEXA), food reinforcement and food hedonics were 1251±210kcal/d. Anthropometry (BMI, WC, BF% by BIA), basic lipids and measured pre - and post-intervention. apolipoproteins, HOMA index, and HDL subclasses (2b,2a,3a,3b,3c), and plasma Results: Body weight decreased by 6.4 ± 2.5 kg (P<0.01) while leptin decrea CETP and PLTP (ELISA) were measured at the 3 time-points and buoyant(b) and sed by 34.2±29.7% (P<0.01). Post weight loss palatability was rated small dense(sd) LDLs at 0’ and 16w. Results: A mean decrease of BMI by 4.1% at 4w and by 10,5% at 16w was significantly higher for the food reinforcers than that measured pre weight associated with a decrease in CETP (0’:2.76±0.79, 4w:2.31±0.69, 16w:2.52±0.62 loss (P<0.01). No significant effect of the chronic food deprivation was noted mg/l, P<0.001) and in PLTP levels (0’:9.01±0.76, 4w:8.35±2.57, 16w:8.19±2.29 for the reinforcing value of food. A significant negative correlation was mg/l, P=0.002). Changes in CETP and PLTP correlated positively between each observed between changes in palatability and those in body weight expressed other and with obesity indices, but neither with the nutrients of the diet nor with as relative changes (r = -.62; P<0.05). No significant correlations were noted HOMA index. Total and bLDL decreased at 16w(P<0.001 and <0.005 between changes in leptin and those in palatability or the r einforcing value of respectively) and correlated positively with CETP. Changes HDL2 subclasses food. However, in a subgroup that lost the greatest percent of initial body decreased significantly at 4 w(P<0.05) whereas HDL3 increased at 16 weeks weight (7 -8%), food was more reinforcing post in tervention (P<0.05). (P=0.05)compared to their initial levels. Conclusions: Chronic caloric deprivation can positively affect the hedonic Conclusions: In obese women, weight loss reduced significantly plasma CETP and value of the food stimulus. The subgroup may be a caveat illustrating that a PLTP, 2 emerging CV risk factors. In terms of HDL subclasses, the impact of greater relative weight loss can lead to food becoming more rewarding. reduced PLTP activity was prominent.

T3:PO.145 T3:PO.146

Abdominoplasty in patients after bariatric surgery Vardenafil improves sexual function in patients with metabolic syndrome Wierzbicki Zbigniew1, Lisik Wojciech1, Wasiak Dariusz1, Kosieradzki Maciej1, Dziurowicz-Kozłowska Agnieszka2, Trzebicki Janusz3, Chmura Andrzej1 Adamidis Sotiris1, Nastos Alex1, Adamidi Sofia1, Greka Athena1, 1 2 1Department Of General And Transplantation Surgery, Medical University Of Tsikkinis Giankos , Panos George Warsaw, Poland; 2Department of Medical Physiology, Medical University of Warsaw, Poland; 3Department of Anesthesiology and Intensive Care, Medical 1Athens Medical, Athens, Greece; 21st IKA Hospital, Athens, Greece University of Warsaw, Poland Objective: To study the effects of vardenafil on Erectile Dysfunction in Background: Single center experience with abdominal tegument reconstruction in patients with significant weight reduction after bariatric surgery has been patients with metabolic syndrome. Method: 24 subjects with metabolic presented. syndrome (ATP - III definition criteria) and erectile dysfunction Methods: 139 patients (110 women, 28 men, mean BMI - 48.1 kg/m2, mean body (IIEFscores) were studied. Satisfaction rate with erection hardness fat – 51,3%, mean age - 39yo) were operated in our department between 2001 and ,intercourse satisfaction, orgasmic function and overall satisfaction with 2006. 48 RYGBs and 91 VBGs were performed by an upper midline incision. 35 sexual experience ,weight , height, BMI,, blood pressure , CPK, liver patients ( 85% females) were scheduled for abdominoplasty 18-24 months after enzymes ,fasting plasma glucose, sodium, potassium, lipid profile were bariatric surgery (after stabilization of body weight). measured. All of the patients meeting the criteria for Met S were also At admissions for surgery mean BMI was 27.8 kg/m2 and mean total body fat – 28.3%. An apron-shaped skin flap caused dermatological complications in all of diagnosed as having ED. After 14 days on vardenafil 10 mg daily use, all measurements were repeated. Patients age was 55+/- 12 years and their the patients. An excess of the skin and subcutaneous tissue were removed by the 2 Pfannenstiel’s incision, an excision of midline and an umbilicus transposition. An BMI was 33+/- 2.2 kg/m 20% had impaired fasting glucose ,50% had average weight of removed tissue was 2.2 kg. Wound drainage and antibiotic low HDL -C , 86% had hypertriglyceridaemia, and 66% central obesity . prophylaxis were administered routinely. Patients psychological profile has been SBP was 142+/- 12.2 DBP 99+/- 8.4.No other medication was in use assessed before and after abdominoplasty. during the study period.16 of men studied regained their sexual activity Results: Incisional abdominal hernia has been found in 10 patients (28.6%). In this and significant improvement in the satisfaction rate with erection group herniorrhaphy with mesh was performed during abdominoplasty. Prolonged hardness were demonstrated in 87 % of men studied .Overall satisfaction serous discharge after surgery has been noticed in 6 cases and impaired wound healing in 4 cases. Mean hospital stay was 3.5 days. Outpatient examination with sexual experience was significant. Vardenafil was generally well shoved significant improvement in patients quality of life and resolution of tolerated (common adverse effects headache, epipephycitis) The rest of dermatitis. the studied variables remained unchanged. Conclusion: Patients with adequate weight loss following bariatric surgery can be Conclusions: Erectile dysfunction is more commonly seen in men with candidates for abdominoplasty. Abdominoplasty improved quality of life and various components of Met S (risk marker of the metabolic prevented dermatological complications due to presence of skin excess. syndrome).Daily use of vardenafil during 14 days significantly improved key aspects of the sexual experience important to patient quality of life in men with metabolic syndrome.

International Journal of Obesity Abstracts S142 T3:PO.147 T3:PO.149

Management of follow up after gastric banding in center with excess of Angiotensin rezeptor antagonism with Valsartan decreases arterial stiffness in 4000 Patients hypertensive patients with metabolic syndrome

1 2 Matussiere Yann1, Vicard Pierre1, Frering Vincent1, Fontaumard Eric1 Rushentsova Uliana , Zinovieb Alex

1 1 Medical University, Departament of Nephrology And Hypertension; Espace Medico Chirurgical De La Sauvegarde 2 Hospital 25, Departament of Endocrinology, Nishny Novgorod, Russia

Background: bariatric surgery is recognised as a safe procedure for the Background: Angiotensin II (AT II) plays a key role in the development of control of obesity. Among surgical teams pre-operative care and follow vascular disease. Arterial stiffness is an important, independent predictor of up may be provided in various ways. This report details organisation of a cardiovascular risk. We investigated the long-term effects of selective AT1 bariatric centre dealing with an excess of 4000 patients. receptor blockade with valsartan on arterial stiffness in patients with Methods: Our centre provides different bariatric procedures including hypertension and metabolic syndrome (MS). Gastric Banding commenced in 1997 and Gastric Bypass in 2004. Actually, more than 800 patients per a year are referred for bariatric Study design and methods: We have examined 30 patients (16 males and 14 surgical procedures and follow up. We describe the patient pathway and females, aged 47±1 years, BMI 29-46 kg/m2) with the MS and mild essential organisation of the delivery of care from initial referral, specially for hypertension in the double blind, placebo controlled study. We measured follow-up organisation. brachial blood pressure (BD, mmHg), brachial-ankle pulse wave velocity Results: From January 1997 to December 2005, 4660 patients were (baPWV, cm/s) and the augmentation index (Aix, %) by using tonometry, referred for bariatric procedures. 90,3 % for first intention, 9,7 % volume-plethysmography and Doppler ultrasonography before and after 20 following previous VBG. This study excludes p Gastric banding was weeks of treatment with valsartan (40 to 160 mg/day). Statistical significance done in 4620 and 40 had Gastric By Pass since it can be achieved. An was assessed by t-test or two-way ANOVA of the dose responses curves. efficient team atients from other centres who were referred for follow up Results: After 20 weeks of treatment with valsartan, baPWV and Aix were reduced: mean delta systolic BP 12±1.6 mmHg (P=0.02 vs. baseline), care only and effective organisation is required to complete a mean of 30 diastolic BP 5.1±1.8 mmHg (P<0.0001 vs. baseline), mean BP 7.5±2.7 surgical procedures per week, 75 band adjustment, 25 programmed mmHg (P=0.003 vs. baseline), baPWV 2.4±0.03 cm/s (P=0.02 vs. baseline), consultation and 10 emergency consultations per week. Medical Aix 23±8% (P=0.002 vs. baseline). Delta baPWV was significantly higher in consultation in follow up focus on: Clinical tolerance, diet, the group of female patients with the MS (F/M: 2.9±0.02 cm/s vs. 2.1±0.05 comorbidities, and carrences. cm/s, P=0.003). Conclusion: Specialist bariatric centres with high throughput need Conclusion: AT1 receptor antagonism reduced the arterial stiffness in structural organization from the outset and should include a full. This hypertensive patients with MS, and may provide new therapeutic strategies organisation can provide high level in detection of complications and for cardiovascular risk reduction. better results with surgical procedure.

T3:PO.150 T3:PO.151

Obesitiy and co-morbidity, obesity management Does size matter?! The effects of portion size on nutrition Kovács Ferenc1, Halmy Eszter2, Marosvölgyi Csilla3, Halmy László4? Lelovics Zsuzsanna1 1Department of Rheumatology, Central Hospital; 2Hungarian Association for Overweight and Obese; 3Centre for Hypertension and Lipid Metabolism, Central Hospital, Budapest, 1Hungarian Dietetic Association Hungary

Introduction: The effective body weight loss suppose the good lower limb function. Introduction: Adult women in Europe consume 335kcal (1407kJ), Epidemiologic data show, that knee (OA) - the most frequent (30%) more, and men 168kcal (706kJ) more food than in 1971. This amount of rheumatologic complication of obesity, which obstruct the realization of moving program. energy is not only realized on our body but also on our plates. In 2000, Aim: Measure the change of walking distance by OMRON HJ-113-E step counter of the 702kg food consumption was measured per person in Hungary and in the obese patients with knee OA in complex weight management. Material and Methods: OA has been diagnosed in 24 cases (22,2%, 10 men and 14 neighboring countries, while this value was only 609kg/person/year 35ys women) in 108 obese patients treated during the last 2 years at our department. OA was ago. diagnosed by physical examination and X-ray. The mean age in men was 47 years (28- Aims: To trace the changes in the size of portions, and to find trends. 64), in women 58 years (52-69). The mean body weight was 136.8 kg (SD:28,0) in men The impact study of portion size among 166 young adults (54 men, 112 and 104,7 kg (SD:32.6) in women. The mean BMI in man was 41.9 kg/m² (SD:10), in women 40,0 kg/m² (SD: 10,3). Patients had daily underwater exercises, gymnastics and women, average age 24.1±9.7ys). brisk walking during a 21-day treatment with 800-1200 kcal/day diet. We measured Results: Based on the data analysis, it can be concluded that the size of walking distance, step/day and daily energy expenditure. most restaurant and commercial portions increased significantly (for example the increase in the energy value of a doughnut is 150%, of Results: hamburgers 77%, of a small bottle soft drink 165%, of a plate of men women 0. day 21. day 0. day 21. day spaghetti 105%). 41% of the people asked said that the single brisk walking 2.1 5.1 1.8 3.7 consumption quantity is determined by how hungry they are; 17% thinks km/day that available (packaged) portion size is the recommended single steps/day 3848 7576 3504 6143 consumption quantity; 34% eats the amount (s)he is used to from the given foods; and 8% said that the most important factor is how much energy exp. 4480 6617 (s)he gets on the plate. (kcal) Summary: The size of portions increased in case of every food, and energy intake exceeds the value measured 35ys ago significantly. It is Conclusion: After gradual loading (underwater exercise and gymnastic) the walking evident that in packaging and in commerce larger portions are more distance of obese patients significantly extended. advantageous, however this affects the portion sizes at home, hence our patients have to be informed about this.

International Journal of Obesity Abstracts S143 T3:PO.152 T3:PO.153

Short-term effects of a very low carbohydrate diet in comparison to a high Short-term effects of a very low carbohydrate diet in comparison to a high carbohydrate, low fat diet on mood and cognitive function carbohydrate, low fat diet on biomarkers of oxidative stress and DNA damage

Halyburton Angela1, Brinkworth Grant1, Wilson Carlene1, Buckley Jon2, Noakes Kenyon Rosalie1, Brinkworth Grant1, Fenech Michael1, Buckley Jon2, Noakes Manny1, Keogh Jennifer1, Clifton Peter1 Manny1, Keogh Jennifer1, Clifton Peter1

1CSIRO Human Nutrition, Adelaide, Australia; 2ATN Centre for Metabolic Fitness, 1CSIRO Human Nutrition, Adelaide, Australia; 2ATN Centre for Metabolic Fitness, University of South Australia, Adelaide, Australia University of South Australia, Adelaide, Australia

Introduction: Very low carbohydrate diets are increasingly used to promote Introduction: Very low carbohydrate diets are increasingly used to promote weight loss. We investigated the short-term effects of a very low carbohydrate diet weight loss. We investigated the short-term effects of a very low carbohydrate diet (VLCARB) and a conventional high carbohydrate, low fat diet (HCARB) on mood (VLCARB) and a high carbohydrate, low fat diet (HCARB) on oxidative stress and and cognitive function in obese men and women. DNA damage markers in obese men and women. Subjects and Methods: 92 subjects (age: 50.4 ± 0.8; BMI 33.6±0.4 kg/m2) were Subjects and Methods: 61 subjects (age: 49.0 ± 1.1; BMI: 33.6 ± 0.5 kg/m2) were randomly assigned to either an energy restricted (~6-7 MJ, 30% deficit), planned randomly assigned to the consumption of either an energy restricted (~6-7 MJ, 30% isocaloric VLCARB or HCARB with mixed carbohydrate sources (age: 49.8±1.3 deficit), planned isocaloric VLCARB or HCARB with mixed carbohydrate sources yrs; BMI 33.8±0.6) for 8 weeks. Body weight and psychological well-being for 8 weeks. Total antioxidant status (TAS), malondialdehyde (MDA, a marker of (Profile of Mood States, Beck Depression Inventory and Spielberger State Anxiety oxidative stress - assessed prior to and after an exhaustive exercise bout) and Inventory) were measured at baseline and fortnightly. Cognitive functioning lymphocyte DNA damage measured using the cytokinesis block micronucleus (working memory and speed of processing) was assessed at baseline and Week 8. assay were assessed at baseline and Week 8. Results: VLCARB resulted in significantly greater weight loss compared to Results: There was no change in TAS or resting MDA in either diet group during HCARB (VLCARB 7.7 ± 0.4 kg, HCARB 6.4 ± 0.4kg, P=0.03). Both groups the intervention. Plasma MDA increased significantly after the maximal exercise demonstrated improvements in psychological well-being during the 8-week bout (P<0.001), but the increases were not different between diets at Week 0 or 8 treatment period (P<0.01 for time), with the greatest effect occurring after 2 weeks, (P=0.16). In both groups there were significant reductions with weight loss for but the improvement were not different between groups. There were no between- necrosis (P<0.05), micronucleus (P<0.05) and nuclear bud (P<0.05) frequencies, group differences for working memory (P=0.68), but there was a significant time x but there was no difference between groups. diet interaction for speed of processing (P=0.04), such that this measure improved Conclusions: These results suggest that the short-term consumption of both a to a greater extent in HCARB compared with VLCARB. VLCARB and HCARB weight loss diet do not alter oxidative status at rest or Conclusion: Both dietary patterns significantly reduced body weight and were during exercise but may provide benefits for genome health. The long-term effects associated with improvements in mood. There was some evidence for a greater of these diets should be examined. relative improvement in cognitive functioning in HCARB for speed of processing, Funding: This work was funded by research grants from the National Heart but further studies are required to determine the replicability of this finding. Foundation of Australia and the National Health and Medical Research Council of Funding: This work was funded by research grants from the National Heart Australia. Foundation of Australia and the National Health and Medical Research Council of Australia.

T3:PO.154 T3:PO.155

Weight loss and risk of early complications after vertical banded gastroplasty and Effect of multisciplinary therapy in metabolic and nutritional profile of obese Roux-en-Y gastric bypass adolescents with and without non-alcoholic fatty liver disease (NAFLD)

Lisik Wojciech1, Wierzbicki Zbigniew1, Domienik Justyna1, Wasiak Dariusz1, De Piano Aline1, L do Prado Wagner1, A Caranti Danielle1, Tock Lian1, Lofrano Kosieradzki Maciej1, Dziurowicz-Kozlowska Agnieszka2, Trzebicki Janusz3, Mara1, Carnier June1, Lederman Henrique1, de Mello Marco Túlio1, Tufik Sérgio, R Chmura Andrzej1 Dâmaso Ana1

1Department of General and Transplantation Surgery, Medical University of 1Federal University Of São Paulo – UNIFESP, Brazil Warsaw, Poland; 2Department of Medical Physiology, Medical University of Warsaw, Poland; 3Department of Anesthesiology and Intensive Care, Medical Background: NAFLD is increasing due to its prevalence in obesity, diabetes and University of Warsaw, Poland insulin resistance syndrome. The best treatment protocol for NAFLD has not been determined. However, there is evidence that exercise and nutritional intervention The aim of this study was to compare the outcome of open bariatric surgery with can improve and prevent it. Roux-en-Y Gastric Bypass (RYGB) or Vertical Banded Gastroplasty (VBG). Objective: To evaluate the diet and metabolic profile of obese adolescents with Methods: Comparison enclosed results of 106 patients selected for either VBG or NAFLD who participated in a multidisciplinary program. RYGB (mean body weight 142 kg, mean BMI 48.2 kg, mean body fat 51.2 %, Methods: We studied 43 adolescents aged 15-19 y (17.18y+1.66) with BMI > 30, mean age 42.6 yo, 88 women, 18 men) consisting of 30 patients without NAFLD (BMI = 35.80+3.44 kg/m2) and 13 with Results: 48 patients (mean BMI of 49.5 kg/m2, mean body fat of 52.8 %, mean age NAFLD (BMI= 33.47+2.34 kg/m2). The NAFLD diagnosis was determined by 41,4 y/o) underwent open RYGB and 58 (mean BMI of 45.9 kg/m2, mean body fat ultrasonography. Blood samples were collected to analyze glycemia, hepatic of 50.6 %, mean age 43,2 y/o). All patients were screened by a psychologist before transaminase (ALT) and lipid profile. Insulin resistance was measured by HOMA- the procedure. Mean follow-up was 42 +/- 10 months after RYGB and 32 +/- 8 IR. The analyses of baseline and post-intervention food intake were made by 3 days months after VBG. Early morbidity rate was 8.6% after VBG (1 leakage from the recordatory inquiry. stapler line, 3 atelectasis, 1 pulmonary embolism) versus 25% after RYGB (3 Results: At baseline conditions, the patients with NAFLD showed significant anastomosis leaks, 3 pneumonia, 5 atelectasis, 1 pulmonary embolism); p<0.01. differences in body mass, BMI, visceral and subcutaneous fat. Glucose, visceral Mean weight loss peaked at 30 +/- 13 kg at 12 months after VBG and 47 +/- 15 kg and subcutaneous fat presented a significant reduction after treatment in patients at 18 months after RYGB; P < 0.01. 28 of 58 VBG patients (48%) lost > 50% of with NAFLD. Analyzing the food intake, at baseline conditions, we observed a their excess weight versus 43 of 48 RYGB patients (89.6%); P < 0.001. Late positive correlation between the visceral obesity and lipid consumption only in surgical revision of VBG was performed in 6 of 58 patients (10.3%) for poor patients with NAFLD. We also observed significant decrease in energy and weight loss, whereas only 1 of 48 patients who underwent RYGB required surgical cholesterol consumption in patients with NAFLD after the multidisciplinary revisions for this reason; P < 0.003. therapy. Conclusions: RYGB patients had significantly better controlled weight loss after Conclusion: The intervention promoted a decrease in the prevalence of NAFLD, a surgery in long term follow-up with higher, but still acceptable risk of early significant decrease in the visceral obesity, improved HOMA-IR, glycemia and complications after surgery. lipids serum levels that are risk factors for NAFLD. In summary, the multidisciplinary program is essential in the treatment and prevention of NAFLD.

International Journal of Obesity Abstracts S144 T3:PO.156 T3:PO.157

Using self-determination theory and motivational interviewing for obesity Treatment of pediatric obesity. A systematic review and meta-analysis of randomized trials

treatment: 1-year results from a randomized controlled trial 2 3 1 2 2 McGovern Lauren Marie , Kamath Celia , Paulo Remberto , Hettinger Allison , Singhal Vibha , Johnson Jonathan2, Erwin Patricia3,4, Montori Victor3 Silva Marlene1, Vieira Paulo1, Minderico Claudia1, Castro Margarida1, Teixeira Pedro1 1Division Of Pediatric Endocrinology, Mayo Clinic College Of Medicine, Rochester, Minnesota, USA; 2Department Of Pediatrics, Mayo Clinic College Of Medicine, Rochester, Minnesota, 1 USA; 3Knowledge And Encounter Research Unit, Division Of Endocrinology And Internal Exercise And Health Department, Faculty of Human Movement, Technical 4 University of Lisbon, Portugal Medicine, Mayo Clinic College Of Medicine, Rochester, Minnesota, USA; Mayo Clinic College Of Medicine Libraries, Rochester, Minnesota, USA

Goal: The goal of this study was to analyze 1-year change in body weight and Objective and design: We performed a systematic review of randomized trials to estimate the exercise related mediators in a randomized controlled trial (RCT) designed to test efficacy of non-surgical interventions for pediatric obesity. Self-Determination Theory (SDT) and Motivational Interviewing (MI) for long- Eligibility criteria: Eligible studies were individual or group (family, school, and community) term weight management. randomized trials assessing the effect of pharmacological or lifestyle interventions on obesity Methods: 169 women (age, 37.2±7.5 y; BMI, 31.8±4.1 kg/m2) were assigned to outcomes. Data Sources: Librarian-designed search strategies of 10 electronic databases from inception intervention/control groups. The intervention group attended 30 weekly sessions until February 2006, review of reference lists from published reviews, and content expert advice designed to follow SDT, with an emphasis on promoting intrinsic, self-regulated provided potentially eligible studies. motivation for exercise and weight control. Key techniques from MI were used Data Collection: Independently and in duplicate, reviewers assessed the quality of each trial and throughout the program. Assessments included treatment climate (autonomy- vs. collected data on interventions and outcomes. control-supportive) and several SDT variables adapted to the exercise domain Data Synthesis: Of 76 eligible trials, 61 had complete data for meta-analysis. Short-term medications were most effective, including sibutramine (random-effects pooled estimate of body (exercise motivation, causality orientations, behavioral self regulation). 2 mass index (BMI) loss of 2.4 kg/m (95% confidence interval (CI) 1.8, 3.1, proportion of Results: At 1 year, compared to controls, women in the intervention group reported between-study inconsistency not due to chance (I2) = 84%) and orlistat (BMI loss 0.7 kg/m2 (CI more autonomous forms of self-regulation (identification and integration, P≤0.001) 0.3, 1.2), I2 = 0%). Trials that measured the effect of physical activity on adiposity (i.e., percent ≤ body fat) found a moderate treatment effect (effect size -0.44, CI -0.64, -0.24, I2 = 0%) while and higher perception of autonomy-promoting treatment climate (P 0.001), 2 ≤ trials measuring the effect on BMI found no significant effect (effect size 0.0, CI -0.19, 0.20, I = internal locus of causality for exercise (P 0.001), exercise perceived competence 0%). Combined lifestyle interventions (24 trials) led to small changes in BMI. and intrinsic motivation (P≤0.001), and psychological and fitness exercise motives Conclusions: Limited evidence supports the short-term efficacy of medications and lifestyle (P≤0.01). Effect sizes for theoretical mediators ranged between 0.38 and 1.38 interventions. The long-term efficacy and safety of obesity treatments on the health of children (P≤0.01), favoring intervention. Key theoretical mediators also distinguished and adolescents remains unclear. ≤ ≤ Conflict of Interest: None Disclosed. weight loss success groups (>-2% vs. -5% of initial weight, P 0.001). Funding: The work herein was funded by a contract from the Endocrine Society, USA. The Conclusions: This SDT- and MI-based intervention significantly impacted central Endocrine Society decided to formulate clinical practice guidelines for the management of theoretical mediators. Importantly, results clearly support the use of SDT for pediatric obesity. In doing so, it formed a Task Force to develop these recommendations. This weight management, particularly through its effect on exercise-related constructs; Task Force asked the Mayo Knowledge and Encounter Research Unit, under contract to perform more self determined motivation and more autonomous forms of self-regulation evidence syntheses with the Endocrine Society, to conduct a systematic review of the literature predicted greater weight loss success at 1 year. Subjects are now being followed for on the treatment of pediatric obesity. 2 additional years, to assess weight maintenance results. Funding: FCT and CMO Portugal.

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Early increase of insulin sensitivity after bariatric surgery is procedure dependent for a Plasma levels of adipocytokines and insulin sensitivity during 10 % weight comparable level of BMI decrease and related to lipid profile improvement in morbid obese reduction in obese women patients

1 1 1 Vázquez Luis Alberto1, Pazos Fernando1, Fernández-Escalante Carlos2, Domínguez-Díez Micic Dragan , Sumarac-Dumanovic Mirjana , Kendereski Aleksandra , Cvijovic Agustín2, García-Unzueta María Teresa1, García-Gómez María Castañar1, Piedra-León María1 Goran1, Stamenkovic-Pejkovic Danica1, Georgiev Maja1, Zoric Svetlana1, Jorga Freijanes Julio1, Amado José Antonio1 Jagoda1, Casanueva Felipe2, Dieguez Carlos2

1 2 S. Endocrinología. H.U.M. Valdecilla - Univ. Cantabria; S. Cirugía General II. H.U.M. 1Institute of Endocrinology, Diabetes and Diseases of Metabolism, Clinical Center Valdecilla - Univ. Cantabria 2 of Serbia, Belgrade, Serbia and Department of Endocrinology; University of Insulin sensitivity (IS) is decreased in obesity. In morbid obese patients bariatric surgery has Santiago de Compostela, Santiago de Compostela, Spain shown to increase IS, perhaps not only related to weight loss; different surgical techniques may modulate IS changes in different ways. Mechanisms of these differences are not well elucidated. It was recently demonstrated that visfatin exerts insulin -mimetic effects in cell Aim: To compare the effect of two bariatric surgical procedures, vertical banded gastroplasty culture and has a potent activity on adipogenesis as much as that of insulin. (VBG) and biliopancreatic diversion (BPD), in IS, BMI and lipid profile in a group of non- Physiologic and pathologic significance of that phenomenon and its effect on diabetic morbid obese patients. Thirty one patients (27 female, 4 male) with BMI 46.5±1.2, were evaluated before and 110.3±2.5 days after bariatric surgery. Twenty of them underwent VBG insulin sensitivity are not fully elucidated. The aim of study was to investigate the whereas in 11 BPD was performed. IS was assessed by QUICKI. BMI decreased to a effect of 10% reduction in BW on plasma adipocytokines (visfatin, leptin, comparable extent in both groups after surgery. Differences between groups were found in adiponectin) and insulin sensitivity in obese women. Six obese women who changes in IS, triglyceride and LDL-cholesterol circulating levels. QUICKI changes were reduced 10% of BW (age: 34.67±3.74 yrs; BMI before vs. after: 36.9±2.55 vs. significantly correlated with the ones in BMI, LDL-cholesterol and triglycerides (r= –0.53; r= – 33.42±2.42 kg/m2, p <0.05) were studied. Plasma visfatin (EIA Phoenix, ng/ml), 0.48; r= –0.66 respectively), but no correlations were found between changes in BMI and in lipid adiponectin and leptin (Linco RIA, ng/ml), insulin (RIA Inep, mU/l) were profile. measured before and after reducing 10% of BW on hypocaloric diet. Insulin

2 sensitivity(M index: mg/kg BW/min) using euglycemic 2hr clamp was measured BMI (kg/m ) QUICKI Triglycerides LDL- (mg/dL) cholesterol before and after weight reduction. There were no difference before and after weight (mg/dL) reduction in plasma visfatin (78.42±3.91 vs. 79.01±7.69, P>0.05) and adiponectin VBG –8.8±0.7 +0.059±0.008 –24.3±8.5 +9.8±4.3 (7.51 ±2.71 vs. 10.56±2.80, P>0.05). There were significant reduction in leptin BPD –9.9±0.9 (ns) +0.105±0.014 –64.9±13.0* –51.4±7.8* (38.12±6.81 vs. 22.64±3.83, P<0.05) and insulin (14.93±2.02 vs. 9.63±1.27, * P<0.05). There was tendency toward increase in insulin sensitivity after weight Comparison of changes pre-post bariatric surgery between both groups. *p<0.03 reduction (M index: 5.20±1.01 vs. 6.47±1.79, P>0.05). There was significant Our study confirms that in the short term, both VBG and BPD obtain comparable weight loss but negative correlation between visfatin and insulin sensitivity (r= -0.683, P<0.05). the latter induces a greater increase in IS paralleled by a more important decrease in plasma No correlation was obtained between visfatin and BMI, BW, adiponectin, insulin triglyceride levels. A lower intestinal absorption of fat promoted by BPD might be partially responsible of the greater improvement of IS. and leptin. Our data indicate possible interrelationship between visfatin and insulin sensitivity in obese women. Lack of significant changes in measured adipocytokines could be due to small number of patients or degree of weight reduction.

International Journal of Obesity Abstracts S145 T3:PO.160 T3:PO.161 Effects of a high saturated fat diet on endothelial function during weight PEACH RCT: a family-focused weight management program for 5-9 year loss olds – impact on maintenance of reduction in adiposity 6 months post intervention Keogh Jennifer1, Brinkworth Grant1, Noakes Manny1, Belobrajdic Damien1, Clifton Peter1 Daniels Lynne1, Perry Rebecca2, Magarey Anthea2, Baur Louise3, Steinbeck 3 1 Kate , Hills Andrew 1CSIRO Human Nutrition 1Queensland University Technology, Brisbane, Australia; 2Flinders University, Adelaide, Australia; 3University Sydney, Sydney, Australia Objective: Our aim was to determine whether weight loss on a low carbohydrate/ high saturated fat, diet impaired endothelial function The Parenting Eating and Activity for Child Health (PEACH) study aimed to compared with a conventional high carbohydrate diet. evaluate the effectiveness of adding standardized, validated parenting skills Design: Randomised parallel design of two energy restricted diets in an training (Triple P®) to an intensive family-focused healthy lifestyle (diet and outpatient setting. physical activity) program for weight management of pre-pubertal children. Subjects: 80 subjects (BMI >27, <40 kg/m2) were randomised to a low We examined BMI z-score change six months after completion of the 6- carbohydrate/high saturated fat (LC) or a high carbohydrate/low month intervention and no further program contact. 168 (56% female) saturated fat diet (LF). children (baseline BMI z score2.7±0.6, age 8.2±1.2years; NS by group) were Measurements: Flow mediated dilatation (FMD), fasting glucose, randomized to parenting + lifestyle (P+DA) or lifestyle alone (DA) programs. insulin, lipids, adiponectin and adhesion molecules were measured at Parents attended healthy lifestyle (n=8) and parenting (n=4) sessions while baseline and after 8 weeks of weight loss. children participate in structured, physical activity sessions. Intention-to-treat Results: FMD did not change on either diet, 5.3±3.3 to 5.3±3.3% (LC) and linear mixed model analysis were used. At 6 months (end of intervention) and 6.2±3.7 to 6.3±4.3% (LC) despite weight loss of 8% and 7%, LC BMI z-score had reduced by -0.31 ±0.28 (12%) in P+DA and -0.19±0.25 (7.5%) in DA (N=136; time P<0.01; group p=0.8; group x time P= 0.6). 123 and LF respectively. Adiponectin did not change with weight loss children completed measures at 12 months. At 12 months, after controlling 5.6±2.2 to 6.0±2.2 ug/ml. Adhesion molecules fell, ICAM1 15%, E- for baseline BMI z-score, age and sex, there was no significant difference selectin 32% & P-selectin 6% (all P<0.01). PAI-1 ng/ml also fell (43%, between the groups in change in BMI z-score (P+DA -0.01 ±0.21; DA P<0.001). There were no effects of diet. +0.01±0.26) over the 6 monthspost intervention. Thus reduction in adiposity Conclusion: Short term weight loss on a high saturated fat diet does not was maintained 6 months post intervention without further program contact. impair FMD. Novel cardiovascular risk factors improved after weight However, the addition of parenting skills training did not enhance longer term loss. effectiveness of the PEACH diet and physical activity program. Analysis of Conflict of Interest: None. broader health outcomes and longer term anthropometric follow-up to 5 years Funding: Research relating to this abstract was funded by the Australian is underway. National Health & Medical Research Council. Jennifer Keogh is supported by the Janet Bryson PhD scholarship from the Australian Society for the Study of Obesity.

T3:PO.162 T3:PO.163

Biomarkers of Adiponectin, Asymmetric dimethelarginin and High Sensitive Body composition is related to physical activity in daily life as measured C-reactive protein in adult Men Metabolic Syndrome Patients using a tri-axial accelerometer

1 1 2 1 Sartika Cynthia Retna , Fattah Miswar , Lukito Widjaja , Widjaja Andi Den Hoed Marcel1, Westerterp Klaas R1

1 Clinical Chemistry, University of Hasanuddin, Makassar, Indonesia; 1 2 Maastricht University, Maastricht, The Netherlands SEAMEO TROPMED, University of Indonesia, Jakarta, Indonesia

Recent studies reported the relations between MetS, inflammation and Background: Activity related energy expenditure is the most variable endothelial dysfunction. Adiponectin modulated inflammatory reactions in component of total energy expenditure and thus a potentially important vascular wall. Obesity induces oxidative stress which exacerbates determinant of energy balance. The objective of this study was to pathological processes with inflammation and endothelial dysfunction, which determine whether body composition is related to physical activity in this process is also indicated by elevated hsCRP level and ADMA in plasma. daily life. This study aims to measure new biomarkers like adiponectin, ADMA and hs- Methods: Sixty-one healthy subjects were recruited (54 women, 7 men; CRP in MetS and investigate their interplays in an attempt to explain the aged 20 ± 2 years; BMI 22.3 ± 2.6). Physical activity was measured for pathobiology of MetS using a model of correlation between inflammation and two periods of 2 weeks using a tri-axial accelerometer for movement endothelial dysfunction. We performed a case control study in 36 MetS and registration (Tracmor). Body fat percentage (BF%) was determined with 36 non MetS Indonesian male adults, aged 40 – 60. This study showed that underwater weighing and deuterium dilution according to Siri’s three- hypoadiponectinemia and high level of ADMA and hsCRP (P<0,0001) in compartment model. serum was associated with MetS. Adiponectin was correlated negatively (r=- Results: As observed previously, the subject characteristics height, age, 0,396, P<0,0001), ADMA was correlated (r= 0,689, P<0,0001) with MetS body mass and gender together explained a substantial part of the and hsCRP was correlated (r= 0,616, P<0,0001) with MetS. Adiponectin was variation in BF% (R2 = 0.65, SEE = 3.6%). Nevertheless, adding correlated negatively with waist circumference, ADMA, and hsCRP r=- 0,436, r=0,418, and r=0,466 (P<0,0001) respectively, The Odds Ratio of physical activity to this model significantly increased the explained adiponectin, ADMA and hsCRP in MetS was analyzed by logistic binary test, variation in BF% (R2 = 0.72, SEE = 3.2%, P = 0.004). they were 5.5 (P=0,006), 17.8 (P<0,0001)and 4 (P<0,0001). Odd Ratio for Conclusion: The results of this study indicate that body composition is Adipoectin:ADMA Ratio 10 and Adiponectin:hsCRP ratio 14. related to physical activity in daily life. Moreover, Tracmor assessed These finding suggested that hypoadiponectinemia, elevated ADMA and physical activity improves the estimate of BF% when a subject’s hsCRP are associated with MetS. Measurement of adiponectin, ADMA and characteristics are taken into account. hsCRP levels, therefore, might be beneficial to detect of MetS and could be represent a marker of MetS. ADMA is better marker for MetS. Adiponectin:hsCRP ratio is better predicted risk of MetS than adiponectin, hsCRP alone.

International Journal of Obesity Abstracts S146 T3:PO.164 T3:PO.165

Prooxidant antioxidant balance in obese diabetic 2 patients The effect of statin on serum phospholipid saturated fatty acid composition in overweight/obese patients Paletas Konstantinos1, Hamidi Alamdari Daryoush1, Sarigianni Maria1, 1 1 1 Tsapas Apostolos , Befani Christina , Koliakos George Ristic-Medic Danijela1, Postic Marija1, Suzic Slavica2, Tepsic Jasna1, Arsic Aleksandra1, Glibetic Marija1 1Aristotle University Of Thessaloniki, Greece 1Institute For Medical Research; 2Institute for physiology, School of Introduction: Obesity often coexists with other diseases such as diabetes mellitus type 2, arterial hypertension, dyslipidemia and cardiac diseases. Medicine Recent studies propose that oxidative stress is the possible mechanism that links obesity to the above mentioned diseases. Prooxidants derived either Lowering of serum total cholesterol levels with statins reduces the risk of from normal metabolic processes or external sources can potentially react coronary heart disease in patients with hyperlipidemia. Our preliminary with the body's own molecules and damage them. Antioxidants mop up the results showed that hyperlipidemia altered fatty acid (FA) profile of excess amount of the prooxidants before they damage the essential molecules. phospholipids (PL). The aim of this study was to evaluate the effects of Oxidative stress is the consequence of an unbalance between many pro- statin therapy on serum PL saturated fatty acids (SFA) in oxidant and antioxidant factors. overweight/obese patients with hyperlipidemia. The study involved 20 Methods: The prooxidant-antioxidant balance was measured in the sera of patients until now (aged 64±7yr, BMI=29.56±2.9kg/m2, total normal volunteers and obese type II diabetes patients. The results were cholesterol>5.2mmol/l and/or triglycerides>1.7mmol/l.). They were compared with clinical and biological parameters. The prooxidant antioxidant compared with 17 normal weight patients (aged 61±8yr, balance was measured before and after one day, one and two months of BMI=29.56±2.9kg/m2) with hyperlipidemia. Patients were treated with vitamin C and E administration. 20mg simvastatina and followed an AHA-Step-diet for 12 weeks. Serum Results: An increase in the prooxidant-antioxidant balance was found in the PL was separated by one dimensional thin-layer chromatography and FA patients’ group as compared to normal controls and correlated with composition was determined using gas-liquid chromatography. After parameters, such as waist circumference, BMI, blood pressure, HbA , fasting 1c statin therapy, levels of palmitic (16:0), stearic (18:0) acids and total insulin, triglycerides, HDL- cholesterol, ESR, CRP, fibrinogen, WBC. A significant shift of the balance in favour of antioxidants was observed in SFA significantly (P<0.01) decreased in overweight/obese patients and patients receiving antioxidant vitamins one day after vitamin administration, in normal weight patients with hyperlipidemia. Our results indicate but the balance remained unchanged after one month of antioxidant therapy importance of PL SFA profile for prevention atherosclerosis in patients and changed marginally in favour of prooxidants in the second month of the with hyperlipidemia. Some investigations have suggested that SFA acid therapy. intake is associated with increase in BMI. Started SFA profile in our Conclusions: These results indicate that the measurement of the prooxidant patients is not different according to obesity. We could conclude that antioxidant balance may be useful to identify and follow up obese diabetic phospholipids are biochemical parameter that reflected not only dietary patients that need antioxidant therapy. SFA consumption.

T3:PO.166 T3:PO.167

High calcium diet with whey protein attenuates weight gain and promotes Erythrocyte fatty acid composition in overweight premenopausal weight loss in a model of diet induced obesity women-pilot study

1,2 1,2 1,3 Pilvi Taru , Korpela Riitta , Mervaala Eero Postic Marija1, Ristæ-Mediæ Danijela1, Glibetic Marija1, Blazencic- Mladenovic Vera1, Arsic Aleksandra1 1Institute Of Biomedicine, Pharmacology, University Of Helsinki, Finland; 2 3 Foundation for Nutrition Research, Helsinki, Finland; Department of 1 Institute For Medical Research Pharmacology and Toxicology, University of Kuopio, Finland

Dairy calcium intake has been found to inversely correlate with BMI and In some studies despite isocaloric feeding weight gain was different in calcium has been suggested to affect adipocyte metabolism via suppressing rats fed the more highly saturated than in those fed either the high 1,25(OH)2-D3 and decrease fat absorption by forming insoluble fat-calcium monounsaturated fatty acid (FA) or the high n-6, n-3 FA diet. We soaps. We studied if calcium in combination with milk proteins; whey and explored if there is any difference in erythrocyte FA composition, that is casein has an effect on body weight (BW) in C57Bl/6J mice. 9-week-old partly determined by dietary intake, in overweight/obese compared to C57Bl-mice (n=10/group) received high-fat diet containing 1.8% CaCO3 and normal weight patients. 18% kcal either casein or whey for 21 weeks. Control group (n=40) received Thirty nine premenopausal, healthy women with normal lipemia were high-fatlow- calcium diet (0.4% CaCO3). After 14 weeks 30 mice from included in our pilot study. Two groups were formed: group of control group were put on 30% energy restriction and divided into control and overweight/obese women (BMI>25kg/m2) (n=12) and normal weight treatment groups (1.8% CaCO3, 18% kcal casein or whey) for 7 weeks. Fecal 2 group (BMI=18.5-25kg/m ) (n=27). Total erythrocyte lipids were fat excretion and body fat content (by DXA) were measured at the end of the treatment periods. The final BW (44.1±1.1g) and body fat content (41.6± extracted and phospholipid fraction isolated by thin layer 0.6%) after the weight gain period were significantly lower (P<0.05) in whey chromatography. FA methyl esters were separated by gas than in control group (48.1±0.8g and 44.9±0.8%), but there was no significant chromatography. difference between casein and control groups. The weight reduction was In overweight/obese patients saturated FA were higher (P≤0.001) while greater in both whey (17.9±1.7% of weight gain, P<0.01) and casein groups monounsaturated FA (P≤0.05), n-6 (P≤0.05), n-3(P≤0.05) and total (15.1±3.8%, P<0.05) than in control group (5.5±2.1%), but reduction in body polyunsaturated FA lower (P≤0.05) compared to normal weight group. fat was significantly greater only in whey group (10.1±1.1 percentage units The greatest difference in individual fatty acids level comparing groups vs. 3.5±1.4 in control group, P<0.05). Fat excretion was increased in both ≤ whey and casein groups during weight gain and energy restriction and this were found for palmitic, stearic and linoleic acid (P 0.01). could partly explain the results. However whey protein seems to have Our results indicate that dietary fatty acids intake, that can modify additional effects, which need to be studied further. erythrocyte FA composition, could influence weight gain in Conflict of interest: None disclosed. premenopausal women. Funding: Research relating to this abstract was funded by Valio Ltd and Foundation for Nutrition Research, Helsinki, Finland.

International Journal of Obesity Abstracts S147 T3:PO.168 T3:PO.169

Effects of a fibre-enriched milk-drink on blood glucose and insulin levels and Effects of a high protein fibre-enriched dairy product on postprandial glucose subjective satiety in healthy subjects levels and subjective satiety in healthy subjects

Kekkonen Riina1,2, Lummela Netta1, Järvenpää Salme3, Tuure Tuula1, Eriksson 1,2 1 3 1 4 1,2,5 Kekkonen Riina , Lummela Netta , Järvenpää Salme , Tuure Tuula , Johan , Korpela Riitta Eriksson Johan4, Korpela Riitta1,2,5

1 2 Valio Ltd, Research Centre; University of Helsinki, Institute of Biomedicine, 1 2 3 4 5 Valio Ltd, Research Centre; University of Helsinki, Institute of Pharmacology; Medcare Foundation; University of Helsinki; Foundation for 3 4 Nutrition Research Biomedicine, Pharmacology; Medcare Foundation; University of Helsinki; 5Foundation for Nutrition Research Milk products raise blood insulin more than could be expected by their glucose response. Dietary fibre has favourable effects on blood glucose and insulin Dietary fibre has favourable effects on glucose and insulin metabolism and metabolism and may aid in control of energy intake. The aim of this study was to may aid in control of energy intake. Dairy products are rich in protein and compare the effects of normal milks and a novel fibre-enriched milk-drink on blood may increase satiety. The aim was to study the effects of a novel high protein glucose and insulin levels and satiety in a randomized block design. fibre enriched dairy product on postprandial glucose levels and satiety in a After an overnight fast, 26 healthy volunteers ingested the drinks (200ml) on three randomized block design. After an overnight fast, 12 healthy volunteers different days. The tested drinks were fat-free milk, fat- and lactose-free milk and a ingested the tested products on three different days. The tested products were very low-caloric polydextrose and calcium enriched fat- and lactose-free milk- ® low caloric, fat-free, polydextrose-fibre enriched and high protein cottage drink (Valio ProFeel Valio Ltd). Venous serum glucose and insulin levels and cheese quark (Valio ProFeel®, CottiFrutti, Valio Ltd), commonly available subjective satiety ratings (Visual Analogue Scale) were measured before ingestion low-fat rice pudding and ingested glucose. Capillary glucose levels and of the study products and after 20, 40, 60, 120 and 180 minutes. The calculated subjective satiety ratings (Visual Analogue Scale) were measured before area under curves (AUC) for glucose, insulin and subjective satiety were used to compare the study products by the ANOVA for repeated measures. There were no consumption of the products and after 15, 30, 45, 60, 90 and 120 minutes. differences in the AUC values for glucose between the study drink. However the The calculated area under the curve (AUC) of glucose and subjective satiety glucose curve for the fibre-enriched milk-drink was more stable than for the normal (hunger, fullness, desire to eat, prospective food consumption) were used to milks. AUC values for insulin differed significantly (P=0.001) between the study compare the tested products by the ANOVA for repeated measures after products. The fibre-enriched milk-drink had significantly lower AUC for insulin subtraction of baseline values. The AUC minus baseline value for glucose than normal fat-free milk or fat- and lactose-free milk (7.4 vs. 10.3, p=0.014 and differed significantly between the products (P<0.001). The study product had 7.4 vs. 10.2, P=0.001). There were no differences in the subjective satiety ratings. significantly lower response for glucose than the control product or glucose Enrichment of milk with polydextrose fibre helps to balance glucose and insulin drink (0.15 vs. 0.71, P=0.001 and 0.15 vs. 1.06, P<0.001). There were no levels. differences in the subjective satiety ratings. High protein and fibre enriched Conflict of Interest: None Disclosed. dairy products may help to regulate postprandial glucose levels. Funding: Research relating to this abstract was funded by Valio Research Centre. Conflict of Interest: None Disclosed. Funding: Research relating to this abstract was funded by Valio Research Centre.

T3:PO.170 T3:PO.171

Sub-clinical binge eating tendency in normal weight women associated with Expectations of outcomes and individuals’ framing of the benefits and effort increased BMI, weakened satiety response and enhanced liking for high-fat sweet required in diet and exercise food Owen Kate1, Haas Marion1, Viney, Rosalie1, Pettman Tahna2, Misan Garry2 Arlotti Agathe2, Finlayson Graham1, King Neil1, Blundell John1 1 1 University Of Technology Sydney, Australia University of Leeds, UK

Introduction: The tendency to binge eat is a known risk factor for weight gain and Individuals’ intentions for self-change are often accompanied by unrealistic obesity. Poor perceived control over eating and craving for sweet foods can predict expectations of the outcomes they will achieve and underestimation of t he binge episodes in women with and without binge eating disorder. The present study effort and duration of the process. Read, et. al. (1999) argue how individuals’ examined hedonic and homeostatic processes of appetite regulation in normal bracket their choices influence the extent to which they achieve their goals weight women with a range of binge eating scores. and modify their behaviour. In broad bracketing individuals take account of Subjects and methods: 34 healthy female subjects (24.3 ± 0.9 years, BMI: 22.3 ± all the consequences of their actions while, in narrow bracketing, each choice 0.8kg/m2) completed the Binge Eating Scale (BES) and attended two test sessions is made in isolation and cumulative effects are ignored. comprising a fixed preload followed by an ad-libitum buffet. Energy intake, food Evidence suggests that success is more likely when individuals use narrow selection, subjective sensations of appetite and hedonic response were measured. In bracketing for difficult choices (daily exercise & diet compliance) and b road addition, novel procedures to measure satiety quotient (Green et al. 1997) and bracketing for positive outcomes (cumulative weight loss). processes of food liking, wanting and preference (Finlayson et al. 2006) were We explore how expectations and bracketing combine to influence employed. individuals’ preferences for elements of diet and exercise programmes and Results: BES score correlated with BMI [P<0.01]. High BES (N=13) subjects how these change with participation in a diet and lifestyle intervention. were heavier than low BES (N=12) [P<0.01]. High BES were hungrier after the A total of 120 adults suffering metabolic syndrome were recruited to preload [P<0.01], consumed more during the buffet [P<0.05] and reported higher hedonic ratings for high-fat sweet foods [P<0.05]. High BES were also participate in an exercise and diet intervention. Those allocated to characterised by a lower satiety quotient, enhanced liking for food and greater experimental groups attended weekly sessions promoting modest dietary preference for high-fat sweet food. changes and increased exercise. Preferences were elicited at baseline, and at 4 Conclusion: Even within a group of young women with normal BMI, BES scores months through responses to a set o f 16 scenarios containing hypothetical had the capacity to differentiate high and low BMI plus a range of appetite exercise and diet programmes that incorporated expected costs and outcomes responses related to motivation to eat, food preference and tendency to over over a 4 -month period. The scenarios were developed from a fractional consume. BES scores could be a useful predictor of weight gain and later obesity. factorial design with programme attributes manipulated to elicit trade-off Funding: Supported by Medical Research Council (CASE) Award #G78/8223 in behaviour amongst them. conjunction with NRC, Lausanne; and INAP-G, Paris. Results at baseline indicated three distinct profiles among participants including: goal only focus with little consideration of process, high structure focus, and social focus.

International Journal of Obesity Abstracts S148 T3:PO.172 T3:PO.173

Effects of a fiber enriched milk drink and fat-free milk on blood glucose Uncoupling the reduction in body weight from the health benefits of exercise: levels in healthy subjects 12 weeks of exercise is associated with improved health despite poor weight loss Kekkonen Riina1,2, Jauhiainen Tiina1,2, Lummela Netta1, Tuure Tuula1 Hopkins Mark1, Caudwell Phillipa1, Stubbs James2, King Neil1, Blundell John1 1 2 Valio Ltd, Research Centre; University of Helsinki, Institute of 1 2 University of Leeds, UK; Rowett Research Institute, Aberdeen, UK Biomedicine, Pharmacology Introduction: Exercise is widely promoted to give rise to health benefits and Dietary fibre has favourable effects on blood glucose and may aid in reduce body weight. There is wide variability in the body weight response to energy intake control. The aim of the study was to compare the effects of exercise. The purpose of this study was to examine whether improvements in fat-free milk and a novel fibre enriched milk drink on blood glucose generalised health are dependent on a marked reduction in body weight. levels after a standardized meal in a randomized, placebo-controlled Subjects & Methods: Thirty five sedentary overweight/obese individuals setting. After an overnight fast 12 healthy volunteers ingested 250 ml of (BMI 31.7 ± 4.0kg/m2) participated in a 12 week supervised aerobic exercise glucose water as a standard meal. Immediately after this, they drank 200 programme (70% heart rate max, 5 times a week, 500kcal per session). Body ml of fat-free milk or very low-caloric polydextrose and calcium composition, anthropometry, aerobic capacity, blood pressure, affective enriched fat- and lactose-free milk drink (Valio ProFeel®, Valio Ltd, response to exercise, insulin resistance and sensitivity were measured at Helsinki, Finland) within 15 minutes on different study days. Glucose weeks 0, 4, 8 and 12. water was used as a reference. Blood glucose levels were measured Results: Mean reduction in body weight was -3.73 ± 3.62kg (P < 0.01). before ingestion of the study products and after 15, 30, 45, 60, 90 and However, 18 of the 35 participants failed to attain the theoretical weight loss 120 minutes. The calculated area under the curve (AUC) of glucose was estimated from total exercise-induced energy expenditure. Their mean weight used to compare the tested products by the ANOVA for repeated loss was only -1.27 ± 1.97kg (P = 0.01). Despite lower than estimated weight reduction, these individuals experienced increased aerobic capacity (6.35 ± measures after subtraction of baseline values. AUC values for blood . -1. -1 6.41mlkg min ; P < 0.01), decreased systolic (-5.5 ± 9.61mmHg; P = 0.02) glucose between the products differed significantly (P=0.05): the very and diastolic blood pressure (-4.44 ± 6.81mmHg; P = 0.01) and waist low-caloric fibre enriched fat-free milk drink had significantly lower circumference (-2.6 ± 2.9cm; P < 0.01). In addition, these individuals AUC for blood glucose than reference glucose water or normal fat-free experienced a 13% increase in exercise-induced positive mood after 12 milk (0.431 vs. 0.796, P=0.019 and 0.431 vs. 0.732, P=0.042). weeks. Therefore, exercise produced a range of physical and psychological Enrichment of milk with polydextrose fibre helps to balance blood benefits despite a lower than calculated weight loss. glucose levels after a standardized meal. Conclusion: These data demonstrate that significant and meaningful health Conflict of Interest: None Disclosed. benefits can still be achieved even in the presence of lower than expected Funding: Research relating to this abstract was funded by Valio exercise-induced weight loss. Research Centre. Funding: This study forms part of a larger project funded by the Biotechnology and Biological Sciences Research Council (BBS/B/05079).

T3:PO.174 T3:PO.175

Case studies of individuals who gain weight despite an increase in exercise- Determinants of remnant like particle metabolism in obesity induced energy expenditure Van Hees Anneke MJ1, Saris Wim HM1, Hul Gabby B1, Blaak Ellen E1, Hopkins Mark1, Caudwell Phillipa1, Stubbs James2, King Neil1, Blundell John1 NUGENOB Consortium

1University of Leeds, UK; 2Rowett Research Institute, Aberdeen, UK 1Maastricht University, Maastricht, The Netherlands

Introduction: For some individuals exercise does not produce the expected Background and aim: Elevated plasma concentrations of remnant-like weight loss probably due to partial compensation for the increased energy particles (RLP) are atherogenic. Factors that determine RLP metabolism are expenditure (EE). not well understood. This study intended to evaluate what factors affect RLP- Subjects & Methods: Two obese men and two obese women (BMI 31.9 cholesterol in the basal and postprandial state, using a multiple regression +1.0kg/m2) participated in 12 weeks of supervised exercise at 70% heart rate model in a large cohort of lean (n=96) and obese subjects (n=638). max for 5 times a week. A range of anthropometric, physiological and Methods: Subjects from eight European centers underwent a test meal behavioural measures were performed at weeks 0 and 12. challenge containing 95 en% fat (energy content 50% of predicted resting Results: Despite a significant increase in exercise-induced EE, mean weight metabolic rate). Fasting and postprandial concentrations of circulating gain was 1.0kg, which differed from a significant loss of 4.5kg experienced metabolites and hormones were measured over a 3h period. Obese subjects by the remainder of exercising subjects (n=31). Control subjects who (n=614) participated in a 10-week weight loss program, being assigned to remained inactive during 12 weeks experienced a weight gain of 1.1kg. either a low-fat or a moderate-fat diet (intake 600 kcal below requirement, Indirect calorimetry measurements of the exercise EE predicted a mean 20–25 vs 40–45 en% fat). RLPc was measured using an immunoseparation weight loss of 3.5kg. The differential between predicted and actual mean assay. weight loss of 4.5kg is equivalent to approximately 400 kcal/d (7700 kcal = Results: Postprandial RLPc was predicted by fasting RLPc, age, waist-hip 1kg). Therefore, these weight gainers overcompensated, on average, by ratio and the degree of insulin resistance (HOMAIR, adj.R2=0,70), 400kcal/d. The mean increase in total energy intake on the test meal probe independent of BMI and gender. These factors also predicted fasting RLPc, days was 350kcal/d. All four experienced a slight increase in resting next to gender (P<0.001) and physical activity (P=0.012). In addition, metabolic rate (102kcal/d). At baseline these subjects had relatively low triglycerides and LDL-cholesterol were positively and HDLcholesterol was dietary Restraint (4.5 +1.3) and high dietary Disinhibition (8.5 +4.4) TFEQ negatively related to RLPc. The weight loss program resulted in significantly scores, which may have predisposed them to overeating. decreased concentrations of fasting RLPc, independently mediated by weight Conclusion: These case study data demonstrate that some individuals loss, improvement in insulin sensitivity and the fat content of the diet actually gain body weight in response to exercise. They also indicate the (adj.R2=0,42). potency of compensatory eating and show that a hyperphagic response to Conclusion: In obesity, both fasting and postprandial RLPc concentrations exercise can reverse the expected weight loss benefits. are mainly determined by the degree of insulin resistance, body fat Funding: This study forms part of a larger project funded by the distribution and age. Interestingly, a moderate-fat diet showed to be more Biotechnology and Biological Sciences Research Council (BBS/B/05079). beneficial in improving fasting RLPc levels than a low-fat diet.

International Journal of Obesity Abstracts S149 T3:PO.176 T3:PO.177

Reproducibility of maximal fat oxidation in active young men The effect of a long-term high-protein or high-carbohydrate ad libitum diet on weight maintenance, hormonal, glucose and lipid profiles 1 2 3 2 Bagdasarianz Rachel , Lecoultre Virgile , Borrani Fabio , Schutz Yves Claessens Mandy1, van Baak Marleen1, Monsheimer Sandy1, Saris Wim1

1Institute of Human Movement Sciences And Sport, ETH Zürich, Switzerland; 1Maastricht University 2Dept. of Physiology, University of Lausanne, Switzerland; 3Institute of Sports Sciences and Physical Education, University of Lausanne, Switzerland Introduction: Obesity is characterized by impaired hormonal secretion and reduced satiety. Dietary proteins stimulate insulin and glucagon secretion and induce satiety. This study investigated the effect of a long-term ad libitum high-protein (HP) diet compared to a high- Introduction - Knowing maximal rates of fat oxidation (MFO) and the relative carbohydrate (HC) diet on weight maintenance, hormonal and metabolic profiles. exercise intensity (%VO2 max) at which it occurs (Fatmax) may be important for Design: 49 healthy obese subjects followed a very low caloric diet for 6 weeks followed by a metabolic screening and exercise prescriptions for different populations, in weight maintenance (WM) period for 12 weeks: subjects were randomly divided in 3 groups: 2 particular persons seeking to lose fat mass. This information is more valuable, HP (intact casein or whey supplementation) and 1 HC (maltodextrin supplementation) diet group. however, if its reproducibility is known. Results: Since no differences were found between the casein and whey supplemented HP groups, Aim - To determine the intraindividual variability of MFO and Fatmax using results from these groups were combined. HP group consumed 35 En% protein and 42 En% CHO, HC group 16 En% protein and 63 En% CHO. repeated measurements. Method - 11 healthy active male volunteers of different training levels performed 4 Table 1: Changes after WM HC diet HP diet P incremental exercise tests on a cycle ergometer beginning at a workload Weight (kg) +1.2 ± 0.9 -1.1 ± 0.6 0.04 corresponding to 30% of their previously determined. VO max The workload was BF (kg) +0.24 ± 0.70 -1.96 ± 0.52 0.02 2 Glucose (mM) 0.13 ± 0.10 0.41 ± 0.06 0.02 increased every 6 min to elicit 10% more of their VO2 max until respiratory exchange ratio = 1. Tests were conducted on different days in fasted conditions Insulin (µU/mL) 2.5 ± 2.1 -1.0 ± 1.1 0.10 Glucagon (pg/mL) 12.4 ± 3.6 2.8 ± 2.2 0.02 after a day of standardized diet. Fat oxidation was measured during the last 2 min Triglycerides (mM) 0.56 ± 0.29 -0.05 ± 0.06 0.01 of every stage (steady state) by indirect calorimetry neglecting protein oxidation. Total cholesterol (mM) 0.73 ± 0.18 0.58 ± 0.10 0.43 Results - Mean MFO was 0.33 g/min (range 0.13 – 0.73 g/min) and occurred at a HDL (mM) 0.10 ± 0.04 0.20 ± 0.03 0.08 mean of 40% VO2 max (range 29 – 60%). Intraindividual variability in MFO was substantial. Expressed as coefficient of variation, it ranged from 10 to 60% (mean Conclusions: In the present study the ad libitum HP diet was associated with less weight regain 26%). Intraindividual variability of Fatmax expressed as SD ranged from 0.4 to than the HC diet. The reduced insulin, glucagon and triglyceride levels resulting from weight loss are preserved better after a HP than HC diet. 17% (mean 7.6%). Funding: Research related to this abstract was funded by Kerry Bio-Science, Almere, The Conclusion - The notion of a fixed Fatmax for all subjects must be challenged on Netherlands. the basis of the huge intraindividual variability.

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Validity and Reliability of Body Composition Parameters Measured by Moderate weight reduction by short-term administration of phentermine increased DXA, Near Infrared and Calipers high molecular weight adiponectin without superiority to placebo Kim Kyoung Kon1, Kang Hee-Cheol2, Lee Kyu-Rae1, Lee Duk-Chul2 Maes Christophe1, Ferdinande Ann2, Poriau Stefaan2, Bruels Leen3 1Gachon Medical School Gil Medical Center; 2College of Medicine, Yonsei 1Mensana, Sijsele-Damme, Belgium; 2Rehabilitation Centre, Sijsele- University Damme, Belgium; 3Catholic University, College Department Bruges, Belgium Adiponectin exists in circulation as a series of multimers. Although weight reduction is known to increase adiponectin, few studies have been done on the change of adiponectin multimerization. We aimed to find out the effect of short - Body composition in patients with obesity can be evaluated with a term moderate weight reduction using phentermine on total and high molecular number of techniques that employ different methodologies. We assessed weight (HMW) adiponectin. The study was a randomized, double-blind, placebo - the validity and reliability of three methods: DXA Lunar Prodigy controlled study with 14 weeks of treatment period including 2 -week single-blind Advance (GE Healthcare); Near Infrared Interactance Futrex 6100/XL placebo run -in period. A total of 68 (13 men and 55 women) obese people and skin calipers. Fifty-six subjects participated in this study (age range (age≤20, BMI≤25kg/m2) without co -morbidities except hypertension and 20-63 years). Twenty-six subjects had a BMI _ 25 (17 female, 9 male dyslipidemia, participated in the course of weight reduction using phentermine HCl subjects); 30 subjects had a BMI < 25 (17 female, 13 male subjects). 37.5 mg daily. There was a greater mean reduction of body weight in phentermine- NIR assessment was performed at the biceps, while skin caliper treated subjects ( -7.2±2.7kg) to subjects in placebo group ( -1.9±2.7kg). In phentermine group, there was a greater mean reduction of total (P= 0.029) and measurements were taken at supra pubis region, crista iliaca, sub- subcutaneous abdominal fat (P= 0.008). However, the difference of the amount of scapular, infra mid clavicula region, biceps and triceps. Total body and visceral fat decrease was not significant between both groups. The level of total regional DXA lean and fat mass results were reported. Lean body mass (phentermine, 7.19±4.85 to 9.28± 5.10 ≤g/mL; placebo, 7.16±3.39 to 9.04±3.81 (LBM), Fat body mass (FBM) and %fat results were assessed with all ≤g/mL) and HMW adiponectin (phentermine, 5.80±5.18 to 6.77±5.16≤g/mL; three methods. The same measurements were repeated within two days placebo, 5.58±3.48 to 6.54±4.09≤g/mL) increased significantly. However, HMW of the original measurement. In two male subjects the NIR and DXA adiponectin in percent decreased (phentermine, 71.21±21.45 to 65.92±20.6 0%; %fat values differed by up to 10%. Both of these subjects had high %fat placebo, 71.88±16.81 to 66.69±16.88%). There was no significant difference in the at the abdomen, and low %fat at their muscular upper arms. The NIR patterns of adiponectin change between both groups. Between the changes of total technique had the disadvantage of only measuring at one site, the biceps. and HMW adiponectin, there was strong positive correlation (r=0.880 ). Although We conclude that DXA is the preferred method to follow obese subjects. both of total and HMW adiponectin level s increased during weight reduction using phentermine, these increases were not superior to those of placebo. The DXA scan gives information on total body and regional fat Funding: Research relating to this abstract was partially funded by Kwang-dong distribution, lean mass and bone density. Furthermore it is an accessible Pharmaceuticals Ltd. technology with very low radiation dose and rapid assessment.

International Journal of Obesity Abstracts S150 T3:PO.181 T3:PO.182

Body Composition During Weight Loss in Obese Patients Measured by Lunar Effects of high meal frequency on body weight loss and appetite Prodigy DXA (GE Healthcare) 1 1 1 Maes Christophe1, Legrand Lieve2, Poriau Stefaan2, Corstjens Els1 Cyr Marie-Josée , Cameron Jameason , Doucet Éric

1 1Mensana, Sijsele-Damme, Belgium; 2Rehabilitation Centre, Sijsele-Damme, University Of Ottawa, Canada Belgium Background: Increasing meal frequency (MF) has been proposed to Clinical evaluation of body fat and lean tissue is recommended when monitoring impact favorably on appetite control. Whether increasing MF leads to obese patients under treatment. The methodology used should be precise, accurate, greater weight loss remains to be determined . accessible, and rapid. We studied the clinical utility of body composition assessment with dual-energy x-ray absorptiometry (DXA) in a group of patients Objective: The purpose of this study was to investigate the effect of treated for obesity. high MF (HMF) on body weight loss and appetite in healthy obese men Eight subjects (five women and three men; age 56±7 years; BMI range 28,3–33,9) and women. were followed during obesity treatment for 6 months. Lean body mass (LBM), fat Methods: Sixteen obese individuals were randomized to an 8-week body mass (FBM), and %fat were measured with a Lunar Prodigy DXA (GE equicaloric energy restriction (-700 kcal/day) that either consisted of Healthcare) at baseline and 6-month follow-up. Average subject weight decreased HMF (3 meals/day and 3 snacks/day; age= 34.63±9.50 y and BMI = from 88,94kg to 78,50kg after six months. Gynoid and android regional %fat 37.1±4.6 kg/m²) or low MF (LMF) (3 meals/day; age=36.3±7.4 y and values decreased during treatment. Lean mass was also monitored and training schedules adapted when a significant decreases in lean mass was detected. We BMI=34.8±4.0 kg/m²). Ingestion of the pre-lunch and dinner snacks for conclude that DXA is a highly useful clinical tool for following patients under the HMF group was set at specific times for each subject. This time was treatment for obesity. The Lunar Prodigy provides information on total body and determined before weight loss based on the delay to achieve peak regional fat distribution, lean mass and bone density. Evaluation of regional fat and fullness in response to a test meal of 300 kcal. Baseline energy needs lean values (e.g. android and gynoid), in addition to total body results, can help the were determined with indirect calorimetry. Appetite (VAS) and body clinician adapt individual diet and treatment programs. DXA body composition composition (DEXA) were assessed before and after weight loss. offers an accessible technology with very low radiation dose and rapid assessment. Results: Body weight was significantly decreased in both groups (P<0 Table 1: Body composition values: baseline and 6-month follow-up .001), but no significant difference was found between conditions Baseline 6 Month Follow-up (P>0.05). As expected, BMI, waist circumference, fat mass, lean mass Average weight (kg) 88,94±10,81 78,50±10,98 were all significantly reduced over time (P<0.01) yet no significant Average %fat 39,99±7,88 33,65±7,53 difference was found between conditions (P>0.05). Appetite levels were Android %fat 48,88±8,26 40,86±8,73 comparable across conditions and remained unchanged over time. Gynoid %fat 41,90±9,35 36,71±9,08 Conclusion: These findings suggest that increasing MF under conditions Fat–mass (kg) 33,62±6,63 25,20±6,73 of equicaloric energy restriction does not increase weight loss. Further, Lean–mass (kg) 51,00±10,53 49,74±9,57 no favorable effects of increased MF on appetite were noted.

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Visceral and Subcutaneous Fat Measurement with Dual-Energy X-ray Cardiorespiratory fitness in obese children and adolescents Absorptiometry Brückner Albrecht1, Nielinger Jens2, Fusch Christoph1 1 1 1 1 1 1 Del Rio L , Di Gregorio S , Delgado E , Arribas C , Ibañez L , Sole C , 1 Ferrer A1, Bonel E1, Rosales J1 Department Of Neonatology And Paediatric Intensiv Care, Ernst-Moritz- Arndt University Greifswald; 2Fachklinik CJD Garz/Rügen, Germany 1CETIR, Group Mèdic, Barcelona, Spain Aim of study: Develop standardized reference data for cardiorespiratory function in otherwise healthy obese children. Computed tomography (CT) and magnetic resonance imaging (MRI) are Subjects: 184 obese children (BMI>97th percentile), 85 males (age 13,6±1,9 two gold - standard techniques to assess abdominal fat. While dual years) 99 females (age 14,2±2,0 years). SDS-BMI +2,52±0,43 (male) and energy X -ray absorptiometry (DXA) is commonly used to measure total +2,62±0,45 (female). body fat, more recent studies have explored the ability of DXA to Methods: BMI, SDS-BMI, standard bodyweight (SBW) defined as weight accurately measure regional fat distribution. We assessed the capability corresponding to the 50th BMI percentile were calculated. A ramp protocol on

of DXA to measure abdominal subcutaneous and visceral fat by a cycle ergometer was used. Maximum O2-uptake (VO2max), heart rate comparing CT, MRI, and DXA measurements performed on the same (HRmax), work rate (Wmax) and oxygen transport per heart beat day. A total of 91 subjects participated (84 females, 7 males; mean age (O2pulsmax) were measured. Ventilatory anaerobic threshold (VAT) was 24.8 ± 10.4, BM I range 16.9 - 41.8). CT and MRI slices were acquired determined with V-slope method. Regression equations were calculated for at the L3 -L4 level with 10mm thickness. DXA visceral and VO2max, VAT, Wmax and O2pulsmax as function of SBW. subcutaneous fat mass (g) in the abdomen was calculated using two Results: Regression equations were as follows - customized regions. DXA values were highl y correlated with CT and (males) MRI results, ranging from r = 0.718 to r = 0.794 for visceral fat, and r = Wmax=2,4*SBW+5,6 (r=0,77); 0.871 to r = 0.922 for subcutaneous fat. Based on this study we conclude VO2max=40,1*SBW+423,6 (r=0,77) VAT=14,7*SBW+350,9 (r = 0,59); that DXA appears to be reliable method to measure subcutaneous and O2pulsmax=0,23*SBW+1,9 (r = 0,76); visceral fat in the abdominal region. (females) Wmax=2,2*SBW+9,9 (r = 0,69) VO2max=29,6*SBW+741,2 (r = 0,56) VAT=12,4*SBW+331,6 (r = 0,44) O2pulsmax=0,18*SBW+3,6 (r = 0,57) Discussion: Physical fitness in obese children is highly correlated to standardised body weight. The cardiorespiratory fitness of obese children is generally as good as that of normal weight children.

International Journal of Obesity Abstracts S151 T3:PO.185 T3:PO.186 Children dietary beliefs and behaviours are associated with their Body Mass The influence of abdominal fat distribution measured by DEXA on the Index, in Cyprus- A multivariate analysis severity of sleep apnea in postmenopausal women Lazarou Chrystalleni1, Panagiotakos Demosthenes1, Matalas Antonia-Leda1 Gyorfi Maria1 , Sandra Sandor1, Szakacs Zoltan2 1Harokopio University 1Department Of Rheumatology; Central Hospital Of The Hungarian Home Defence Force, Budapest, Hungary; 2Sleep Disorder Center, Central Hospital Objective: To investigate the relationship between children’s Body Mass of the Hungarian Home Defence Force, Budapest, Hungary Index (BMI) and their dietary beliefs and behaviour. Methods: Pan-Cyprian cross -sectional study with multistage sampling of Introduction: Body fat distribution may influence the severity of sleep 1140 children (11±0.98years, range 9–13years) from 24 p rimary schools. apnea. The authors compared abdominal fat distribution seen in Children’s BMI(n=823, n=454 girls) was calculated from parents’ reference. postmenopausal women with parameters recorded by cardiorespiratory Logistic regression (n=611) was applied with dependent variable the BMI polygraphy. The objective of this study was to characterize the relationship class(NW=Normal Weight vs. OW/OB=Overweight/Obese), taking into between the quantity as well as the distribution of abdominal fat and the consideration possible confounders (residence, age, gender, parental BMI and severity of sleep apnea, in postmenopausal women. parental dietary behaviour). Factor analysis was employed to extract the main Methods: Total and regional fat mass was determined by DEXA. Protocols behavioral factors (n=991);the extracted factors were then used as for measuring total and abdominal fat were used. The quantity of abdominal independent variables in a new confirmatory logistic regression analy sis fat was assessed in the region between the second and fourth lumbar vertebra. (n=740). The severity of obstructive sleep apnea was evaluated by cardiorespiratory Results: The final logistic regression model which included 11 statistically polygraphy. significant variables, explained 31% of the variance in children’s BMI. The Results: Sixty-two postmenopausal women suffering from sleep apnea were results indicate that compared to NW, OW/OB children are: A. two times studied. Mean age of the study population was 57.54±7.48 years. The severity more likely to consider themselves overweight [OR 2.23(95%CI 1.20 -4.18)], of apnea was categorized as mild-tomoderate if Apnea-Hypopnoe Index B. five times more likely to be or to have been on a diet [OR 5.12(95%CI (AHI) was in the range of 5 to 30, whereas an AHI above 30 signified severe 2.91-9.03)] C. more than 1.5 times more likely to eat outside home 2 apnea. Total and abdominal fat content were 44.89±5.86% and 50.15±5.24% times/week [OR 1.17(95%CI 1.02 -2.56)], and D. more than 50% less likely in patients with severe Obstuctive Sleep Apnea Syndrome (OSAS) (n=38), to eat while not being hungry [OR 0.44(95%CI 0.25 -0.75)]. Three factors whereas these indices were 42.70±7.99% and 46.20±8.42% in the subset with emerged as important in explaining the variance in children’s BMI: “guilty mild-tomoderate sleep apnea. According to a Student’s two-tailed t-test, the about eating”,“ concerning about body weight” and “eating all my food”. The difference between group means was significant for percentage body fat in first two seem to increase the likelihood of a child being OW, whereas the the abdominal region (P=0.023), but not for total body fat (P=0.13). third seems to be protective [OR for F1:1.29 95%CI (1.09 -1.52), OR for Conclusion: Excess abdominal fat content aggravates sleep apnea in F2:1.72 95% CI(1.46 -2.04), OR for F3:0.69 95%CI (0.56-0.84)]. postmenopausal women. Conclusion: Children’s dietary beliefs and behaviour are important predictors of Cypriot children’s BMI.

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Vertical oscillation of the body in obese women while walking uphill and downhill as A double-blind, placebo-controlled crossover study to quantify the effects of measured by high accuracy GPS sibutramine on energy intake and energy expenditure in obese subjects during a test meal using a Universal Eating Monitor (UEM) method Nguyen Dac Minh Tuan1, Lecoultre Virgile1, Terrier Philippe1, Schutz Yves1 1 1 2 3 1 Halford Jason , Boyland Emma , Dovey Terence , Huda Mohammed , Dourish Departement Of Physiology, University Of Lausanne, Switzerland Colin4, Dawson Gerry4, Wilding John3

Introduction: During walking, rhythmic vertical oscillation of the body at each step 1 2 contributes to the energy expenditure, which is also influenced by numerous other factors, School Of Psychology, University Of Liverpool, UK; Department of Psychology, Staffordshire University; 3Clinical Sciences Centre, University Hospital Aintree, including speed of displacement and slope of terrain. In obese people, minimizing the 4 vertical oscillations may be an effective way to diminish energy expenditure. The Liverpool, UK; P1Vital, Department of Psychiatry, University of Oxford, UK variations of vertical oscillation in different slopes during walking remain unknown. Aims: To explore -during outdoor free walking- the 3 axis body oscillations in relation to In a double-blind, placebo-controlled crossover study the effects of seven day body weight from which an estimate of the energy cost at different slopes can be made. dosing with sibutramine (10mg and 15mg daily) on appetite and energy balance Methods: 19 control (C) (weight = 60±9 kg, BMI=22±2 kg/m2) & 19 obese (Ob) (weight was determined in 32 obese women (BMI 34.9± 3.4 kg/m2, age 46.3±12.8 years) 2 = 88±15 kg, BMI=32±6 kg/m ) women walked at their spontaneous speed along a 2.5km using a Universal Eating Monitor (UEM – a computerised monitor of food intake outdoor circuit with variable positive and negative slopes. Body oscillation assessment and feeding behaviour) and indirect calorimetry. Doses of 10mg and 15mg was performed by differential GPS’s (measurement at 20Hz). sibutramine reduced food intake by 16.6 and 22.3% respectively (P<0.001). Results: A residual positive & negative displacement during downhill & during uphill Analysis of meal microstructure demonstrated that sibutramine reduced eating rate walking respectively was observed in both C and Ob subjects (see table). Vertical rather than meal length (10mg P=0.011; 15mg P<0.001). In addition, 10mg oscillation varied significantly (p<0.001) between slopes in both Ob and C. However, Ob sibutramine significantly reduced hunger later in the meal (P=0.043) and 15mg did not exhibit significantly different vertical oscillation compared to C. increased fullness early in the meal (P=0.004) both of which are consistent with enhanced within-meal satiation. Prior to the test meal there were significant Direction of Average vertical body displacement, Slopes (%) displacement cm (SD) increases in fullness suggesting that 10 and 15 mg sibutramine had extended the satiating effects of the fixed-load breakfast (10mg P=0.021; 15mg P=0.004). C Ob Despite significant reductions in food intake, there was no evidence of a up 3.4 (0.9) 3.5 (0.5) -10 compensatory increase in post-lunch appetite, further demonstrating the potent down -10.5 (1.2) -10.3 (1.0) appetite suppressant effect of sibutramine. Sibutramine had little effect on resting 0 up = down 6.2 / -6.2 (1.1) 6.3 / -6.3 (0.8) metabolic rate though 15mg slightly reduced respiratory quotient (P=0.002 at up 10.9 (1.3) 10.9 (1.3) +10 4pm). These results provide novel evidence that decreased consumption of a test down -3.8 (1.1) -4.0 (0.9) meal induced by sibutramine is primarily due to reduced eating rate. Our findings demonstrate that the UEM method provides a sensitive measure of drug effects on Conclusion: The theoretical absolute energy expenditure (potential + kinetic energy) the microstructure of eating and has the potential to detect efficacy of novel anti- during walking is known to be greater in Ob than in C subjects. This difference is not due obesity agents at an early stage of drug development. to differences in vertical oscillation, but primarily to a greater body mass. Conflict of Interest: None Disclosed. Funding: This project was supported by the University of Liverpool through MerseyBio and the School of Psychology and the Faculty of Medicine, in association with the Liverpool Obesity Research Network (LORN).

International Journal of Obesity Abstracts S152 T3:PO.189 T3:PO.190

Early weight loss response with orlistat in hypertensive obese patients predicts improvements in blood Orlistat treatment significantly improves blood pressure, glycaemic control and lipid profile in pressure and lipid profile obese/overweight patients with type 2 diabetes and hypertension

1 2 2 Jacob Stephen , Boldrin Mark , Hauptman Jonathan Broom Iain1, Guy-Grand Bernard2, Hill Julie3 1Adipositas Zentrum Südwest, Villingen, Germany; 2Hoffmann La Roche Inc, Nutley, USA 1Aberdeen Royal Infirmary, UK; 2Service de Nutrition, France; 3Roche Products Pty Limited, Introduction: Hypertension affects >40% of people with BMI ≥30 kg/m2, a. We retrospectively analysed Sydney, Australia the XENDOS study to assess the effects of orlistat in patients with hypertension. Patients and Methods: XENDOS randomised 3,305 obese patients with normal or IGT to lifestyle Introduction: Hypertension and type 2 diabetes (T2D) are independent cardiovascular risk changes plus orlistat (ORL) 120mg or placebo (PLA) TID. This analysis investigated 1 year outcomes in factors that are often associated with excess body weight. Previous studies have shown that patients with baseline hypertension (JNC-VII classification: SBP≥140mmHg and DBP≥90) who achieved orlistat is efficacious in obese/overweight patients with hypertension or T2D so we examined the an early response defined as ≥5% weight loss at 3 months. effect of orlistat-induced weight loss on BP, glycaemia and other metabolic parameters in Results: obese/overweight patients with both T2D and hypertension. • Patients: 630 patients (ORL=301, PLA=329) with baseline hypertension, 313 early response Patients and Methods: Data were pooled from five double-blind studies that involved 2692 patients overweight/obese patients (BMI 28-50 kg/m2) with high cardiovascular risk (T2D, hypertension • Early weight loss response was seen in nearly twice as many ORL-recipients (65.1%) as placebo or hyperlipidaemia) treated for 24 or 52 weeks with placebo (PLA) or orlistat (ORL) 120mg TID. recipients (35.6%) This analysis investigated outcomes in patients with T2D and hypertension only (JNC-VII • After 1 year: diabetes classification: DBP180 and SBP1130 mmHg) - early response patients showed greater reductions in bodyweight, waist circumference and lipid Results: levels with ORL versus PLA . Patients: 500 with baseline hypertension and T2D - mean changes from baseline in SBP/DBP were −15.1/−10.2mmHg with ORL and −12.4/−8.6mmHg At study endpoint, patients showed substantial improvements in BP, glycaemic control lipid with PLA. profile and weight (table) - 48.0% of ORL patients and 40.2% of PLA patients no longer fulfilled the JNC7 criteria for In patients who achieved •5% weight loss at 3 months (European label) ORL produced even hypertension. greater changes in SBP/DBP (-13.16/-7.83mmHg), HbA1c (-0.84%), insulin (-38.72 pmol/l) and - plasminogen activator inhibitor-1 (PAI-1), a CVD-associated factor, also decreased more with ORL than PLA. fasting glucose (-1.92 mmol/l) and weight -9.61kg than PLA patients Conclusion: Early response to ORL treatment (as per SmPC) in obese patients with baseline hypertension BP normalisation in ORL-patients (24.2%) was more than 2-fold higher than PLA patients may be a useful predictive tool to identify patients who will achieve clinically significant reductions in (10.5%) weight and BP. The proportion of patients that normalised with respect to BP was greater with ORL than Conclusion: In obese/overweight patients with hypertension and T2D, ORL produced significant PLA at 1 year. improvements in various cardiovascular risk factors. These improvements were even greater in 1 year early response patients, and more than twice as many patients normalised their BP on ORL vs Mean change: Orlistat n=196 Placebo PLA according to JNC7 guidelines. n=117 ORL (n=257) PLA (n=243) Bodyweight (kg) −15.9* −12.3 Mean change from baseline: SBP (mmHg) −6.45** −3.47 Waist circumference (cm) −12.7† −10.3 DBP(mmHg) −4.31‡ −3.11 Total cholesterol (%) −11.5* −3.1 HbA1c (%) −0.41* −0.03 LDL cholesterol (%) −13.7* −3.5 Insulin (pmol/l) −25.02** −14.17 Triglycerides (%) −15.4‡ −12.7 Fasting glucose (mmol/l) −1.23* −0.38 − Insulin (pmol/l) −43.2‡ −34.3 Total-Cholesterol (%) 4.19* 0.77 LDL- Cholesterol (%) − 1.98 FPG (mmol/l) − 0.02 7.32* 0.06‡ Bodyweight (kg) −4.83* −1.49 PAI-1 (U/ml) −10.3* −5.7 Waist circumference (cm) −5.20* −1.98 versus placebo: * P<0.0001; † P<0.01; ‡ not significant. BP normalized (% patients) 15.3† 8.7 a. Brown et al. Obes Res 2000;8:605–19. versus placebo: *p<0.0001; **P<0.01; †P<0.05; ‡not significant

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Diastolic function and calculated pulmonary artery pressure in obese patients Effect of a short term Tai Chi mind-body intervention on obese women Sido Zoltan1, Bachmann Bela1, Honig Tibor1, Bernat Ivan1, Pavlik Gabor2 Gatta Blandine1, Deschamp Arnaud2, Lafont Lucille2, Roger Patrick1 1Central Hospital Of Hungarian Army, Dept. Of Cardiology; 2Semmelweis University, Faculty of Physical Education and Sports Sciences 1Endocrinology, Hopital Du Haut Leveque; 2EA 498, Department of Introduction: The authors pointed out in earlier works, that the obesity has significant Sport Sciences and Physical Education, University Victor Segalen effect as well to the heart’s geometry as to the systolic and diastolic function of left Bordeaux 2, Bordeaux, France ventricle. Patients and methods: Present study investigated how the left ventricular diastolic Although obesity, a major health problem is a chronic disorder of multi- function and pulmonary artery pressure changes in obesity. 73 male (46.3 ±6.0 y, BMI: 2 2 factorial etiology, is assumed to be a key determinant 40.9 ± 7.4 kg/m ) and 85 female (41.3 ± 5.8 y, BMI: 37.8 ± 6.1 kg/m ) suffering from obesity were examined from 2003.01.01. to 2006.08.31. 41 male (46,1 ± 7.0 y, BMI: 21.9 in its development and maintenance. This study was conducted to ± 2.1 kg/m2) and 57 female (41.5 ± 5.4 y, BMI: 21.1 ± 2.1 kg/m2) of normal weight explore the benefit of a Tai Chi mind-body intervention versus a served as healthy control group. During echocardiographic examination the ratio (E/A) of stretching group on obese women. 21 obese women (BMI 37.1 ±3.1 early diastolic peak filling velocity (E) and late diastolic peak filling velocity (A), kg/m², mean age 43.6 ±11.5 years) were included to a 10-weeks weight isovolumetric relaxation time (IVRT), as well as the ratio (E/Ea), with the help of tissue Doppler imaging (TDI) early diastolic velocity (Ea) and the transmitral early flow reduction program including a hypocaloric balance diet, a weekly velocity (E) were determined. Pulmonary artery pressure (PASP) was calculated from psychologist consultation and physical exercise program which was tricuspidal flow. All measurements were performed conforming to the recommendations randomly determined to either a Tai Chi mind-body (TC) or a stretching of the American Society of Echocardiography. (S) 2 hours intervention. Weight, height, heart rate, blood pressure, body Results: IVRT in case of males suffering from obesity was 115.1 ± 13.4 msec, contrary to control group where it resulted in 91.2 ± 24.6 msec. In case of females the IVRT was composition, mobility score, mood and perceived efficacy were 107.3 ± 15.5 msec, while in control group 74.5 ± 15.7 msec. E/A in males with obesity determined at baseline and at the end of the 10 weeks. There was no outcame 0.97 ± 0.2, meanwhile in control group this was 1.72 ± 0.4. Females E/A yielded significant difference in the 2 groups at baseline. After 10 weeks, fat 1.1 ± 0.4, in contrast in control group was 1.87 ± 0.4. Value of E/Ea in case of males was mass (42.1 ± 9.6 versus 50.1 ± 10.9, kg, TC vs S, P<0.05) and resting 9.5 ± 2.5, in contrast in control group 5.5 ± 0.9. E/Ea in females resulted in 9.3 ± 1.7 the heart rate (72.8 ± 8.7 versus 94.8 ± 5.4, BPM, TC vs S, P<0.05) differ same time in control group 5.6 ± 0.8. Calculated systolic pulmonary pressure in males yielded to 33.5 ± 5.2 mm of mercury, contrary in control group 14.5 ± 3.2 mm of significantly between groups. The timed up and go test was significantly mercury. This parameter resulted in 36.6 ± 7.0 mm of mercury in females, in contrast to improved in the TC group (5.8 ± 0.9 versus 6.9 ±1.1 second, TC vs S, control group 15.2 ± 3.4 mm of mercury. All of these differences in each parameters P<0.05). The TC group increased their perceived general efficacy resulted in strong significance (P<0.0001). compared with the stretching group (35.5± 2.7 vs 32.6 ± 5.1, TC vs S, Summary: The obesity significantly deteriorates the left ventricular diastolic function and the calculated pulmonary artery pressure remarkably increased in both gender, P<0.05). The observed benefits of a mind-body intervention indicated especially in women. These parameters may explain the deterioration of obese patient’s the utility of Tai Chi as an adjunct treatment for obese women. cardiac function.

International Journal of Obesity Abstracts S153 T3:PO.194 T3:PO.195

Antagonizing glutamate-gated Ca2+ ion channels with memantine Prevalence of obesity and its clinical correlations in patients suffered from acute normalises binge-eating disorders coronary syndrome

1 1 2 3 1 2 Mytas Dimitrios , Stougiannos Pavlos , Kyriazis Ioannis , Zervas Eleftherios , Hermanussen Michael , Tresguerres Jesus Lalousis Athanasios3, Alonistioti Anastasia1, Damoulianou Margarita1, Pyrgakis Vlassios1 1University Of Kiel, Germany; 2Universidad Complutense, Madrid, Spain 1Cardiology Dpt., Korinthos General Hospital, Greece; 2Obesity Outpatient Clinic, Korinthos General Hospital, Greece; 3Internal Medicine Dpt., Korinthos General The regulation of appetite relies on complex hypothalamic neurocircuitry Hospital, Greece within which the excitatory neurotransmitter glutamate (GLU) plays an Aim: To investigate the prevalence of obesity and its clinical correlations in important role. Administering large doses of this amino acid directly patients suffered from acute coronary syndrome stimulates neurons of the lateral hypothalamus, but may also stimulate Methods: 261 consecutive patients(mean age 64+12years, 189 male/72 female) food intake by intoxicating arcuate nucleus neurons. Both the hospitalized due to an ACS, divided into two groups (GroupA: BMI>30, GroupB: stimulatory and the neurotoxic effects of GLU are mediated by the N- BMI<30). A detailed medical history was record and the metabolic profile was methyl-D-aspartate receptor (NMDA-R). The NMDA-R is a GLU-gated evaluated. The patients were evaluated concerning the existence of cardiovascular Ca2+ ion channel that can be blocked, e.g., by the noncompetitive risk factors, while the presence of metabolic syndrome was also determined. We NMDA-R antagonist memantine. Memantine has been shown to display subsequently compare them with regards to in-hospital complications, cardiac mortality and readmissions in 6 month follow-up. neuroprotective properties. We previously hypothesized that human Results: Group A consisted of 57 obese patients (21.8%), while the rest 204 obesity results from chronic over-consumption of GLU, and performed a comprised the non-obese group B with no age or sex difference among them. MS therapeutic trial in nine obese, but otherwise healthy subjects. was recorded in 86% in group A and 40% in group B( P=0.0001). Medical history Memantine treatment markedly decreased appetite within few hours and of the two groups, revealed that the only statistically significant difference in favor completely suppressed the binge-eating disorder within 24 hours. Body of group A regarded diabetes mellitus(DM):(56% vs. 26%, P=0.0001). Also, the weight decreased significantly during the following 8 weeks by 5 to 10 obese group exhibited higher levels of triglycerides (149±76 vs. 123±66 mg/dl, percent. The findings strongly support the hypothesis that elevated levels P=0.00001), fasting glucose(151±51 vs. 124±40 mg/dl, P=0.001) and waist circumference(112±7 vs. 93.7cm, P=0.0001). Additionally, a trend in the high of nutritional GLU are involved in the pathomechanism of human density lipoproteins difference levels was observed, yet, it was statistically obesity. insignificant. Finally, obese patients with MS exhibited a higher frequency of in hospital events (by 46.9%) and higher number of read missions (18%) during the following 6-month period. Conclusions: Prevalence of obesity was particularly increased among patients that suffered an ACS. Obese patients had more frequently DM and distorted lipidemic profile, while the additional presence of MS was combined with an increased risk of in hospital events and readmissions.

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Relationship of homocysteine and tumor necrosis factor alpha in obese Effects of various drugs with hypolipidemic activity on total serum homocysteine patients with metabolic syndrome levels in obese patients with hyperlipidemia

1 1 1 Filippatos Theodosios1, Kostapanos Michalis1, Gazi Irene1, Nakou Eleni1, Bogdanski Pawel , Pupek-Musialik Danuta , Dytfeld Joanna , Luczak 2 1 3 1 Magdalena1, Musialik Katarzyna1, Szulinska Monika1 Derdemezis Christos , Georgoula Mary , Bairaktari Eleni , Elisaf Moses , Kiortsis Dimitrios2 1 Department Of Internal Medicine, Metabolic Disorders And Hypertension, 1Department Of Internal Medicine, Medical School, University Of Ioannina, University Of Medical Sciences Ioannina, Greece; 2Laboratory of Physiology, School of Medicine, University of Ioannina, Ioannina, Greece; 3Laboratory of Biochemistry, University Hospital of Metabolic syndrome (MS) is a cluster of several obesity-associated disorders Ioannina, Ioannina, Greece and risk factors over-represented in populations with coronary heart disease. Hyperhomocysteine is a proatherogenic factor. The major mechanism for Introduction: Homocysteine is an intermediate amino acid resulting from the homocysteine-mediated atherogensis is still unclear. metabolism of methionine. Hyperhomocysteinemia is considered as an independent Aim: The aim of the study was evaluation of homocysteine in patients with risk factor for cardiovascular disease. clinical features of MS and assessment of the potential association between Purpose: To assess the effects of various drug s with hypolipidemic activity on homocysteine and tumor necrosis factor alpha (TNF-α). total serum homocysteine (THCY) levels in obese patients with hyperlipidemia. Method: 32 obese patients with MS according to ATP III (F/M – 18/14, aged Method: Metabolic parameters and THCY levels were assessed in 30 patients on 46.3±13.9; BMI=37.1±7.3kg/m2) were analysed. As a control 40 healthy lean orlistat (360 mg 3 times a day, O group) , in 26 patients on fenofibrate (200 mg/day, F group) as well as in 30 patients on rosuvastatin (10 mg/day, R group) volunteers (F/M 29/11, aged 44.0±8.7) were used. Serum total homocysteine therapy, at baseline and after 16 weeks of treatment. α was determined by immunoassay using Axym Analyzer. TNF- Results: Total cholesterol, low density lipoprotein cholesterol and triglycerides concentration by IRMA method. levels were significantly improved during the treatment in all treatmen ts. High Results: 1. Serum levels of homocysteine in obese patients with metabolic density lipoprotein cholesterol levels were significantly increased in F group, while syndrome group significantly exceeded those observed in the normal subjects in all other groups remained unchanged. At baseline, THCY levels were (P<0.01). 2. Significantly higher values of TNF-α in this group were significantly correlated with serum creatinine, uric acid and folic acid levels. observed (P<0.001). 3. Positive correlation between homocysteine and TNF- THCY levels did not significantly altered with R and O administration ( from α (r=0.49; P<0.05) was found. 10.8±3.2 to 10.3±2.4 •U/L, p=NS in R group and from 9.9±7.2 to 9.0±3.6 •U/L, Conclusions: p=NS in O group), while they were elevated with F administration (from 10.1±5.3 to 12.5±6.8 •U/L, p<0.01). The observed THCY changes did not significantly 1. Patients with metabolic syndrome have increased level of homocysteine. correlated with any change in serum lipid or metabolic parameters. 2. Metabolic syndrome is characterised by low-grade inflammatory process. Conclusions: Rosuvastatin and orlistat treatment had no significant effect on 3. Positive correlation between homocysteine and TNF should be considered THCY levels, while fenofibrate administration resulted in a significant increase of as a potential mechanism of atherogenic action of homocysteine. this variable.

International Journal of Obesity Abstracts S154 T3:PO.199 T3:PO.200

Adiposity and eating behaviours under atypical antipsychotics Hypertension and metabolic profile in patients with familial obesity

1,2 3 1 1 Blouin Mélissa , Tremblay Angelo , Jalbert Marie-Eve , Venables Hélène , 1 1 4 4 1 Malczewska-Malec Malgorzata , Leszczynska-Golabek Iwona , Partyka Bouchard Roch-Hugo , Roy Marc-André , Alméras Natalie Lukasz1, Zdzienicka Anna1, Hartwich Jadwiga1, Dembinska-Kiec Aldona1 1Laval Hospital Research Center; 2Department of Food Sciences and 3 Nutrition, Laval University; Division of Kinesiology, Laval University; 1 4 Department of Clinical Biochemistry, Jagiellonian University Medical Centre de recherche Université Laval Robert-Giffard College The use of atypical antipsychotics is associated with substantial weight gain but the mechanisms responsible for this phenomenon remain speculative. Background: Obesity is linked to the development of type 2 diabetes and From a clinical standpoint, some patients report an alteration of their food hypertension. Hyperleptinemia and hyperinsulinemia (insulin resistance) are considered as the pathogenic factors in the development of hypertension in patients intake since the initiation of their therapy, a factor which may lead to a with visceral adiposity. positive energy balance. Therefore, this study explores eating behaviours Aim: Aim of the study was the assessment of metabolic status parameters in among atypical antipsychotic-treated patients and compares them to non- patients with familial obesity with and without hypertension. schizophrenic healthy individuals (controls). After an overnight fast, appetite Method: 243 patients from obese families from Southern Poland underwent sensations were recorded before and after a standardized breakfast with visual detailed clinical and laboratory metabolic assessment. Blood lipids (incl. analogue scales. Three hours after breakfast, an ad libitum buffet-type meal triglycerides and free fatty acids), insulin, glucose, leptin (ELISA) were determined was offered to participants in order to document spontaneous food intake and during the oral lipid (OLTT) and glucose (OGTT) tolerance tests. Insulin resistance food preferences. Moreover, satiety quotients were calculated in order to was calculated by HOMA score. determine the physiological satiation of both meals. The Three-Factor Eating Results: There were 98 subjects with hypertension in the investigated group of 243 Questionnaire was used to document eating behaviours. Body composition patients with familial obesity. Hypertensive subjects demonstrated higher weight, and abdominal fat distribution were also assessed. Compared to controls (n = BMI, WHR, higher per cent of the body fat mass, waist circumference - 20), atypical antipsychotic-treated patients (n = 22) showed greater adiposity particularly in men and higher total and LDL cholesterol level. They also µ indices (BMI, waist girth, visceral adipose tissue; P ≤ 0.05) and had demonstrated the higher mean leptin concentration (29.68 ± 14.7 g/ml vs. 21.88 significantly higher cognitive dietary restraint, disinhibition and susceptibility ±16.8 µg/ml, P < 0.001), the higher glucose and insulin concentration (in 90 and to hunger scores (P ≤ 0.05). Moreover, patients’ degree of hunger was higher 120 min of the OGTT), the higher insulin output during OLTT (measured as the 120min insulin concentration). HOMA index was 4,49 + 3,4 in hypertensive, obese following the standardized breakfast (P = 0.02). As opposed to controls, and 2,31 + 1,6 in hypertensive but non obese patients (P<0,001). enhanced strategic restraint behaviours were associated with decreased Conclusion: Hypertension in obese patients was associated with hyperleptinemia satiation during the buffet type meal in patients (slope: P = 0.09). In and insulin resistance. conclusion, altered eating behaviours, possibly restraint dieting observed among patients under atypical antipsychotics, predict increased hunger and could influence the extent of body weight gain triggered by these drugs.

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Bulk density of ready-to-eat cereals affects satiety and subsequent Aspirin resistance in metabolic syndrome and diabetes intakes in young women Bernát Sándor Iván1, Pongrácz Endre2, Schweitzer Katalin3, Sidó Zoltán1 Irvine Paul1, Livingstone Barbara1, Welch Robert1 1Dr. Radó György Central Hospital of Ministry of Defense, Department of 2 3 1University Of Ulster Cardiology, Budapest; Central Hospital of Ministry of Interior; Institute of Defence of Health Previous work suggests that increasing the volume of food consumed 1 Prehistory: It is a well-known fact, that there is a higher rate of thrombo- may increase satiety leading to decreased intakes . The aim of this study embolic events in patients suffering from metabolic syndrome and diabetes. was to compare two ready- to-eat (RTE) cereals, that differed in bulk There were two aims of our study: 1. whether is there higher aggregability of density, and hence volume, for their effects on satiety and subsequent platelets in metabolic syndrome; 2. what is the rate of the aspirin resistance in intakes. The RTE cereals were puffed wheat (PW) and shredded wheat diabetes, which is mainly connected to the elevated platelet activity. (SW) which are both whole-grain cereals with similar nutritional Patients: We recruited four groups of patients: A) 150 healthy control profiles, but which differ greatly in bulk density (BD; weight per unit persons; B) 100 patients suffering from metabolic syndrome C) 398 patients volume) and hence the proportion of air in their structures. The study suffering from ischemic heart disease without diabetes; D) 96 patients was conducted using a repeated-measures, randomised, within-subjects, suffering from ischemic heart disease with diabetes. We measured the platelet crossover design. Healthy female subjects (n 33; age 22.7 (SD 4.2) aggregation without anti-platelet therapy in healthy control persons and in years; BMI 23.0 (SD 2.6) kg/m2) participated on two occasions, one patients suffering from metabolic syndrome. In the second study we week apart. Subjects consumed a breakfast consisting of 40 g portions of examined the rate of aspirin resistance in patients suffering from ischemic PW (BD, 60 g /L; volume, 667mL) or SW (BD, 171 g/mL; volume, 234 heart disease with and without diabetes. mL) with milk, sugar and juice (~1750kJ total). Compared to the Method: We measured the platelet aggregation (Born method) by Carat TX-4 breakfast with SW, the PW breakfast resulted in significantly (P < 0.05) type platelet aggregometer with the use of 5 and 10 uM ADP, 2 ug/ml collagen and 10 uM epinephrine as aggregation inducers. greater post-breakfast satiety and led to significantly (P <0.05) lower Results: The level of platelet aggregation in the 100 non-treated patients intakes of energy (-8%) and weight of food (-6%) at an ad libitum lunch suffering from metabolic syndrome was significantly elevated compared to 180mins later. These results support the concept that foodstuffs with the control patients (ADP-5 P=0.00029; ADP-10 P=0.000042; collagen greater air contents, and hence increased volumes, may lead to enhanced P=0.0094 epinephrine P=0.034). Either the partial (39% versus 21%) or the satiety and decreased energy intakes. complete (36.4 versus 18.8 %) rate of aspirin resistance were significantly 1. Rolls B, Barnett RA. The Volumetrics Weight-Control Plan. New higher in the patients suffering from ischemic heart disease with diabetes than York: Harper Collins, 2000. in the non diabetic ischemic heart disease patients. Conflict of Interest: None. Conclusion: Our results verified enhanced platelet aggregabilty in metabolic Funding: Research relating to this abstract was funded by the Northern syndrome and diabetes as well. We suggest monitoring the efficacy of anti Ireland Centre for Food and Health. plate let therapy, and to make a really effective anti platelet therapy.

International Journal of Obesity Abstracts S155 T3:PO.203 T3:PO.204

Measure of the waist circumference: agreement of diagnostic criterions of Abdominal obesity and proteinuria in Korean men metabolic syndrome in Primary Care Suh Heuysun1, Zang Tschunhwa1, Lee Kyurae Sánchez De Enciso Miguel1, Rodríguez Concepción1, López Mª Carmen1, Vázquez Enrique1, Novo Mercedes1 1Department Of Family Medicine, Gachon Medical School,Gil Medical Center 1Sergas Background: Metabolic syndrome is associated with some risk factors for Objectives: 1. Level of agreement between two diagnostic criterions of kidney disease. abdominal obesity is one of the risk factor in Metabolic metabolic syndrome (MS). Syndrome, so it can be expected that there are some association between 2. To know the components of the metabolic syndrome (MS) with more abdominal obesity and kidney disease. we examined the epidemiologic prevalence. association between proteinuria as the kidney disease and abdominal obesity Patients and Methods: They were included in this study all the patients who as a risk factor of Metabolic syndrome in a large representative data in Korea. visited their doctor for any reason (4 primary care consultations) during the Methods: 3,572men (20~79 years) were analysed from the Korean National month of June of 2006. To all they were determined the waist circumference , Health and Nutrition Examination Survey 1998. The Metabolic Syndrome the size, the weight, the blood pressure (BP) and they were carried out an was assessed as defined by NCEP ATP III, while abdominal obesity was complete sanguine analytic. The diagnosis o f MS was carried out in each assessed according to the Asia-Pacific guidelines. The age-adjusted case according to the diagnostic criterions of the IDF as well as those of the prevalence of proteinuria with WC and BMI was analysed by chi-square test AHA/NHLBI. for trend. The Odd Ratios of proteinuria with associated factors were Results: The sample is composed of 854 individuals. Applying the diagnostic analysed by multiple logistic regression. criterions of the IDF, 391 cases presented MS, while applying those of the Results: The age-adjusted prevalence of proteinuria related abdominal AHA/NHLBI 363 cases presented it. The Kappa index when comparing both obesity was 4%(P=0.033)and the prevalence of proteinuria related to BMI diagnostic criterions was of 86%. were 3.0% (BMI<18.5, P=0.02), 2.6% (BMI 18.5-22.9, P=0.40), 1.8% (BMI Results were unchanged after adjustment for age and sex. The prevalence of 23.0-24.9, P=0.03), 4.3% (BMI 25.0-29.9, P=0.00), 5.0% (BMI>30.0, each one of the components of the MS were: 78.2 % (high waist P=0.31). The multivariative-adjusted odd ratios of factors associated with circumference, according to the IDF), 53.6 % (high waist circumference, proteinuria demonstrated 2.31 ( 95% CI, 1.34-3.96, 1 30 packyear) for current according to the AHA/NHLBI), 55.6 % (high BP), 50.7 % (high glucose), Smoking, 1.66 ( 95% CI, 1.06-2.59, 1 130/85mmHg) for Blood pressure, 16.9 % (low HDL cholesterol) and 21.1 % (high triglycerides). 1.896(95% CI, 1.22-2.96, 1110mg/dL) for Fast Blood Glucose. Conclusions: 1. A very good agreement exists between the diagnostic Conclusion: This result suggests abdominal obesity has no independent criterions for MS of the IDF and those of the AHA/NHLBI. relationship with proteinuria in Korean men. More research for the changes of 2. The component of the MS with more prevalence is the high waist kidney in early stage to the abdominal obesity is needed. circumference (IDF), followed by high blood pressure.

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The association of hair tissue magnesium level with obesity related variables Normal Weight Obese Syndrome: an early inflammation? In Healthy Postmenopausal women Di Renzo Laura1,3, Di Lorenzo Nicola2, Orlandi Carmine2, Rosaria Napola Maria1, 1 1 1,2,3 Suh Heuysun1, Chang Soyoung1, Lee Kyurae1 Stazi Ilaria , Domino Emidio , De Lorenzo Antonino

1 2 1 Division Of Human Nutrition, University Of Tor Vergata, Rome, Italy; Nova Department Of Family Medicine, Gachon Medical School, Gil Medical 3 Salus Foundation, Trasacco (Aq), Italy; I.N.Di.M., National Istitute for Center Mediterranean Diet and Nutrigenomic, Reggio Calabria, Italy

Background: The obesity was recognized the one of chronic inflammatory Background: In obese subjects, the adipose mass represents an important source diseases and known as relating to the serum hypomagnesemia. But the above of proinflammatory cytokines. De Lorenzo et al. have identified a new syndrome, 99% of total magnesium exist in intracellular area, serum extracellular defined Normal Weight Obese (NWO), in women with normal weight and body magnesium is not a accurate method. In healthy Postmenopausal women, we mass index (BMI), but Fat Mass > 30 % and potentially increased risks of studied the association the magnesium with obesity related variables using developing obesity related diseases. hair tissue mineral analysis which has collecting convinience and ability to Objective: Aim of the present study is to verify the hypothesis that NWO women evaluate status of magnesium in intracellular area. are characterized by an early inflammation, due to body composition and that their Methods: The subject of this study included 175 postmenopausal women plasma pro-inflammatory cytokine concentration values are larger than in non aged 45~65y and cross-sectional study was applied. Women were excluded if obese women. they had hypertension, type 2 diabetes mellitus, cardiovascular disease or Design: Twenty NWO, twenty preobese-obese and twenty normal healthy(non acute inflammatory disease. Our study group classified three ones, according obese), age-matched Caucasian Italian women were analysed. Anthropometric to the BMI: normal(BMI<23kg/m2), overweight (23kg/m2

International Journal of Obesity Abstracts S156 T3:PO.207 T3:PO.208

Plasma obestatin levels in normal weight, obese and anorectic women Synergistic acting of mixture of herbs extracts as an adjunct in the dietary treatment of obesity. Results from a randomized, double blind, placebo Sedlackova Dana1, Hainer Vojtech1, Zamrazilova Hana1, Papezova Hana2, controlled study Nedvidkova Jara1 Krotkiewski Marcin1. Linke K.2, Krela-Kazmierczak Iona2 1Endokrinologicky Ustav (Institute of Endocrinology); 2Charles University, 1st Faculty of Medicine. Psychiatric Clinic 1Department of Clinical Neuroscience, The Sahlgrenska Academy At Göteborg University; 2Department of Gastroenterology, Academy of Obestatin is a recently discovered peptide produced in stomach which Medicine, Poznan, Poland suppresses food intake and decreases body weight in experimental animals. The aim of the study was: 1) to compare fasting obestatin levels in normal Introduction: The aim of the study was to evaluate the influence of natural weight women, obese women and patients with (AN), 2) to product (Cuur®– Bringwell, Stockholm Sweden: epigallocatechin gallate, reveal associations of obestatin levels with selected anthropometric and coleus forskohlii, yerba matte, betula alba) synergistically influencing both hormonal indexes. metabolic rate and fat absorption. Subjects and methods: Normal weight (n 15), obese (n= 15) and anorectic (n Patients and methods: Obese women premenopausal (BMI > 30) were 10) women were examined after a 14-br overnight fast. Hormonal assays randomly divided into active (A) and placebo (Pl) group. Only patients who (obestatin, ghrelin, leptin, GH), anthropometric and body composition completed the study (30 in each group) were taken to statistical calculation. assessments were conducted. Patients received low calorie diet 1100 kcal/day, during three months. Results: Fasting obestatin levels in obese women were significantly lower Results: Body weight, body fat decreased by 7.75 kg, 6.24 kg and 5.25 kg, than in normal weight and AN women. In contrast to AN, a significant 3.9 kg in the active and placebo group respectively. Waist and neck relationship between obestatin and ghrelin level was observed in obese circumference decreased by 10.15 cm, 1.42 cm and 7.62 cm, 0.82 cm subjects (r = 0.744, P = 0.001). Borderline correlation between obestatin and respectively. Neck and waist circumference correlated to each other and to ghrelin was found in normal weight subjects (r = 0.500, P = 0.057). In normal body weight, plasma lipids and blood pressure. The decrease of neck weight women, obestatin levels were inversely related to adiposity and to circumference similarly to the decrease of waist circumference correlated serum leptin levels, whereas a positive association of obestatin with lean body with the decrease of body weight and, the decrease of blood pressure and mass was revealed. No significant relationship between the fasting levels of metabolic variables. obestatin and GH was demonstrated. Total cholesterol decreased by 17.2 mg/dl in the Cuur and by 4.3 mg/dl in the Conclusion: Obese women exhibited significantly lower obestatin levels than placebo group, systolic blood pressure 8.5 mm Hg and 3.83 mm Hg normal weight and anorectic subjects. Obestatin negatively correlated with respectively. Fat excretion in stools decreased by 52% in the active group. adiposity measures in normal weight women. No relationship between Conclusion: Synergistically acting herb extract can accelerate body weight obestatin and GH levels was demonstrated in all groups of studied women. and body fat loss during low calorie diet. Neck circumference can be treated Supported by Grant Agentury IGA No. NR/7800-4. as anthropometric measure related to body weight and metabolic factors associated with obesity.

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Do obese women and men experience similar difficulties in changing their Microalbuminuria and diminished insulin secretion are linked with the metabolic dietary habits? syndrome in nondiabetic Taiwanese

1 1 1 1 1 Hakala Paula1, Hämäläinen Helena1, Rastas Merja2, Uusitupa Matti3, Yang Yi-Ching , Wu Jin-Shang , Lu Feng-Hwa , Wu Shih-Hsing , Chang Chih-Jen Tuomilehto Jakko2 1Department Of Family Medicine, College Of Medicine, National Cheng Kung 1 2 University, Tainan, Taiwan Social Insurance Institution, Turku; National Public Health Institute, 3 Helsinki; University of Kuopio, Kuopio Although insulin resistance and obesity are currently considered primary factors underlying development of the metabolic syndrome, microalbuminuria and Aims: To identify difficulties in changing eating habits among obese women inadequate insulin secretion may also be involved. The present study is the first to and men with impaired glucose tolerance (IGT). examine intercorrelations among these factors in a community-based Taiwanese 2 Method: 61 women and 49 men (mean BMI 32 kg/m , mean age 53.6 years) population. An epidemiological survey of chronic diseases conducted in 1996 was were randomly allocated to two groups. The intervention group participated utilized to evaluate 1340 community-dwelling, nondiabetic adults. Principal in an individualized counselling programme which aimed at reducing weight. component factor analyses involving varimax orthogonal rotation of transformed The control group was given general information about diet and exercise. continuously distributed variables were performed. Sex-specific factor analyses Difficulties in changing the dietary habits were assessed by means of a yielded four separate factors in women (obesity/insulin resistance, lipid, blood questionnaire over the 5-year follow-up period. pressure and insulin resistance/secretion factors) and three in men (obesity/insulin Results: Mean weight loss at 5 years was 5.0 kg in women and 3.0 kg in men resistance/secretion, lipid and blood pressure factors). For men the corrected insulin in the intervention group (2.2 kg and 0 kg in the control group). Of the response clustered with obesity, and insulin resistance loaded on the same factor, explaining 31% of variance; however, microalbuminuria was closely linked with subjects, 40 % were able to describe 1-3 types of difficulties. For both blood pressure variables, and the corrected insulin response loaded on the same genders, the commonly reported difficulties were lack of self-discipline to factor , explaining 13.2% of variance. Obesity and insulin resistance were resist the temptation of delicacies (women 36%, men 32%) and inability to confirmed as central anomalies of all features of the metabolic syndrome. The diminish the size of servings (women 20%, men 10%). Among men, observed linkage of impaired ß -cell function and microalbuminuria with the difficulties were also caused by deep-rooted dietary habits (16%), by irregular metabolic syndrome should facilitate prediction of the onset of working hours (11%), and by diseases (10%). Women reported difficulties in cardiovasculometabolic disorders. Inadequate ß-cell function and microalbuminuria restricting their eating in the evenings (13%) and experienced family are plausible components of the metabolic syndrome in Taiwanese subjects. members’ dietary habits as a barrier to changing their own eating habits (9%). Conflict of Interest: None Disclosed. Conclusions: Women and men reported both similar and gender-specific Funding: Research was supported by the grants from the National Science reasons behind the difficulties in changing their eating habits. In dietary Council, Taipei, Taiwan (NSC-87-2314-B-006-083) and National Cheng Kung counselling, it is essential to identify individually the barriers to changing University Hospital (NCKUH-86-042). dietary habits and, together with the patient, look for feasible ways to overcome them.

International Journal of Obesity Abstracts S157 T3:PO.211 T3:PO.212

World Health Organization versus National Cholesterol Education Long term effect of the addition of a summer camp to a behavioural Program defined Metabolic Syndrome in prediction of All-Cause treatment programme for obese adolescents Mortality in Taiwanese Elderly Forssell Erika1, Svensson Viktoria1, Nordenfelt Anja1, Lindberg Sari1, Chang Chih-Jen1, Yang Yi-Ching1, Wu Jin-Shang1, Lu Feng-Hwa1, Wu Hölcke Mats1, Marcus Claude1 Chih-Hsing1 1Karolinska Institutet 1Department Of Familiy Medicine, College Of Medicine, National Cheng Kung University, Tainan, Taiwan Background: Long term effect of behavioural treatment of adolescent obesity is known to be limited. The aim of the present study was to The Aim of this study was to investigate the prevalence of the metabolic evaluate if obesity treatment in summer camps may improve the long syndrome in community-dwelling elderly in Taiwan and to compare the term effectiveness. predictive role of different definition of the metabolic syndrome by Methods: 2001-2004, 44 boys and 57 girls 10-19 years attended our World Health Organization (WHO) and the National Cholesterol obesity camp. All were enrolled at the Obesity Centre and the summer Education Program Adult Treatment Pane l III (NCEP ATPIII) in a five- camp is an additional two weeks treatment programme, where the year survival follow -up of this elderly cohort. We applied a stratified participants follow a schedule of physical activities and a strict meal systemic clustered sampling scheme to select subjects aged 65 years or order. The camp programme also includes seminars regarding the over from Tainan, t he oldest city in Taiwan. From 2000 -2001, 1438 out consequences of obesity, the importance of physical activity and food of 2146 (67.0%) eligible non - institutionalized subjects participated in knowledge as well as activities aimed to improve self esteem. To the baseline survey. The prevalence of metabolic syndrome was 54.2% evaluate the effect of the camps the difference in body mass index in men and 58.1% in women by WHO criteria and 33.5% in men and standard deviation score (BMI SDS) before the camp and 2 years after 51.8% in women by modified NCEP ATPIII ( using Chinese-specific was used. A BMI reduction of 0.5 BMI SDS units was considered as waist circumference cut -point). Multivariate Cox proportional hazard clinically significant (Reinehr T Pediatrics 2004). models showed that the metabolic syndrome defined with the WHO Results: The participants lost in average 4.3 kg (0.7 to 8.4 kg) during the criteria, but not with the modified NCEP ATPIII, was an independent camp (mean BMI SDS from 5.0±1.2 to 4.6±1.2). After one year mean predictor of total mortality after adjustment for age, education level, BMI SDS was 4.7±1.3 and after two years to 4.8±1.5. Two years after physical activity, smoking, serum cholesterol level, history of the camp 35% had remaining BMI SDS reduction of 10.5 units. cardiovascular disease and diabetes. Conclusions: A two week summer camp in combination with follow up Conflict of Interest: None Disclosed. visits at an obesity clinic had a clinically significant long term effect for Funding: Research was supported by the grants from the National at least one third of the severely obese adolescents. Science Council,Taipei, Taiwan (NSC-87-2314-B-006-083).

T3:PO.213 T3:PO.214

Results of treatment of pituitary somatotroph adenomas A randomized double-blind placebo-controlled clinical trial of Green Mate Extract EFLA-920 for treatment of overweight and obesity 1 1 1 Grigoriev Andrey , Molitvoslovova Natalya , Kuzmin Anatolij Kang Jae Heon1, Song Hong Ji2, Kim Hwa Jung3

1 Endocrinology Scientific Centre 1Inje University Seoul-Paik Hospital; 2Hallym University Sacred Heart Hospital; 3Seoul National University College of Medicine Results of treatment of pituitary somatotroph adenomas. In ESC for the period since October 2004 till October 2006 were Objectives: To evaluate the efficacy and safety of the Green Mate Extract EFLA - operated 69 patients with acromegaly. Men were 22 (32%), women – 47 920 on weight loss. (68%). Age of patients changed from 24 till 68 (middle – 47).All patients Design: 6-week prospective double-blind, placebo -controlled, randomized parallel design. Subjects were randomized to receive either the Maté extract product or a were separated into 2 groups: surgery (group 1) and combination placebo supplement for 6 weeks with 1:1 allocation ratio. All subjects also received treatment (group 2), which consist of surgery and somatostatin analogues diet and exercise education . therapy before and after surgery. In most cases were macroadenomas, Subjects: The study included 60 subjects aged 20–39 y with a body mass index only 5 patients (7%) had microadenomas. Suprasellar invasion had 21 (BMI) over 25 kg/m2 without any comorbidity, and who had not received any other patients (30%), infrasellar – 28 (41%) and 32% patients had invasion to weight control maneuver within the last 3 months. one or both cavernous sinuses. 50 patients operated by transnasal Measurements: Percent body fat, fat mass and lean body mass were measured by approach and 19 with endoscopic techniques. DEXA (Dual-Energy X-ray Absorptiometry) at the baseline and 6 weeks. Body weight, waist circumference, BM I, blood pressure, serum lipid, glucose and liver Results: Significant clinical improvement is seen in most patients – 66 function were measured at the baseline, 3 weeks and 6 weeks. Efficacy and safety (97%). Reduce diabetes mellitus we observed at 43% patients (6 from results were based on intent-to-treat analysis. 14), visual improvement had 78% patients (14 from 18). Nobody had Results: After 6 weeks, subjects in the active treatment group experienced a CSF leak after operation. Diabetes insipidus had 6 patients (9%). significantly greater reduction o f the percent of body fat (active group 0.3% Pulmonary embolus had 3 patients (1 patient died). After 6-12 months reduction vs. placebo group 0.6% increase, P=0.04) and fat mass (active group were examination 14 patients from group 1 and group 2. GR was 500g reduction vs. placebo group 200g increase, P=0.04). The difference in normalized in 79% of patients of each group. IGF-1 was normalized in reduction of body fat percentage was significant after adjustment for baseline measurement and daily energy intake (P=0.03). No significant difference was 75% of each group. And postglucose GH level was normalized in 46% observed between groups in body weight, BMI or waist circumference. In terms of into group 1 and 58% into group 2. safety, renal function, liver function test s and blood pressure of the subjects were Conclusion: Transsphenoidal surgery for acromegaly is safe and within normal ranges at the baseline, 3weeks and at 6 weeks in both groups. No effective treatment with minimal mortality and morbidity. Obvious differences were observed with respect to diastolic or systolic blood pressure or the distinctions in postoperative dynamics IGF-1 and postglucose GH in occurrence of any adverse event. both groups it is not revealed. There is a tendency in greater efficiency of Conclusion: Over the 6-week trial, subjects on the active treatment arm the combined treatment. experienced a significantlygreater percent of body fat reduction and fat mass than placebo group subjects, without an increase in the rate of adverse events. Funding: Research relating to this abstract was funded by Samjung Flavor Co.

International Journal of Obesity Abstracts S158 T3:PO.215 T3:PO.216

Leptin and Alveaolar Hypoventilation in Obese Children Effects of metformin treatment in obese children and adolescents

1 1 1 2 Trang Ha , Hammoudi Lyna , Bouregdha Souham , Yen Frances T , Bihain Galcheva Sonya1, Iotova Violeta1, Georgieva Miglena1 Bernard2, Frelut Marie-laure3 1Univerity Hospital 'St. Marina' 1Hopital Robert Debré; 2Institut National Polytechnique de Lorraine, JE2482 Lipidomix; 3Hôpital Saint Vincent de Paul The epidemic of childhood and adolescent obesity is a serious health problem Until now, obesity-hypoventilation syndrome has been reported in obese adults that tracks into adulthood, with a high risk for increased morbidity/mortality only. Leptin has been shown to increase ventilation in obese mutant mice. This in later life. Drug treatment is not a typical option in children. Although study aimed to investigate the spectrum of breathing disorders in obese children, Metformin decreases insulin resistance and the degree of adiposity in adults, with particular attention to alveolar hypoventilation, and potential relationships its role in children is unclear. with leptin. Aim: To assess the effect of Metformin combined with dietetic advice on Methods: Seventy obese children (31 males, 14 ± 2 years, body mass index 38 ± 7 weight, BMI and metabolic indexes in 1 4 obese children/adolescents (8f, kg/m2) were prospectively assessed using arterial blood gases, lung function tests, 6m), aged 12.5±3.0 years, 11 into puberty. polysomnography and measurement of fasting plasma leptin. Methods: We used family and medical history, measurements of weight, Results: Obese children presented with various combinations of sleep apneas and height, BMI, pubertal stage, blood pressure (BP), blood glucose levels (BGL) alveolar hypoventilation: 65 patients (93%) had obstructive sleep apneas- during OGTT, lipids, insulin levels, liver and kidney function tests and hypopneas, among whom 28 (40%) hypoventilated, 21 during sleep only and 7 ultrasound examination. Metformin was administered for 3 -6 months with a during sleep/daytime. Plasma leptin levels were higher in patients with sleep daily dose of 850 -1700 mg. Statistical analysis was made with SPSS 11.05. apneas than in those without (53.3 ± 30.6 vs 31.9 ± 14.6 ng/l, P=0.025), higher in Results: The patients’ follow-up was 11.3±5.3 months. All participants those with hypoventilation than in those without (62.1 ± 33.3 vs 44.8 ± 26.6 ng/l, P=0.025), and higher in those with sleep hypoventilation than in those with tolerated Metformin well and had normal fasting and 2-hour BGL. Mean sleep/daytime hypoventilation (68.3 ± 41.9 vs 35.2 ± 13.3 ng/l, P=0.007). Among weight loss was 0.63±10.7 kg, BMI reduction was by 1.35±3.5 kg/m2. BP patients with hypoventilation, leptin negatively correlated with sleep time spent decreased insignificantly, HDL-cholesterol in creased from 1.0±0.25 to with hypercapnia (N=28, R=-0.478, P=0.018), but not with apnea-hypopnea index. 1.2±0.3 mmol/l, 2-h insulin levels reduced from 108.3±97 to 83.5±87.1 Logistic regression analysis with sleep hypoventilation as dependent variable µU/ml. Aminotransferase levels (ALT, AST) also decreased but more than showed that leptin was a significant predictor for its presence (P=0.013, odd ratio half of the chi ldren had hepatic steatosis on ultrasound examination. All 1.030, 95% confidence interval 1.006-1.055). these changes di d not reach statistical significance. Conclusions: Obese children are at risk, not only for obstructive sleep apneas, but Conclusion: Our pilot study shows that Metformin combined with diet may also for alveolar hypoventilation. Leptin may play a key role in CO2 homeostasis be useful for stopping weight gain and for the improvement of the metabolic maintenance in obese children. abnormalities in obese children and adolescents. Funding: Grant CRC02021 (DRCD Ile de France, France). Key words: obesity, metabolic abnormalities, children/adolescents, No financial or other potential conflicts of interest exist for any of the authors. Metformin

T3:PO.217 T3:PO.218

Anthropometric measures, parental body mass index and insulin resistance in children The impact of obesity status and television viewing on food choice criteria in Greek adolescents with and without obesity Hassapidou Maria1

1 2 1 3 4 Mårild Staffan , Toivonen Henri , Fors Hans , Forsell Christer , Friberg Peter 1Technological Educational Institution Of Thessaloniki, Greece

1The Queen Silvia Children's University Hospital, Sahlgrenska Academy; 2Department of Background: The prevalence of obesity in childhood and adolescence is increasing worldwide. The Paediatrics, Kärnsjukhuset, Skövde. Sweden; 3Department of Paediatrics, Alingsås, purpose of this study was to examine the impact of obesity and television viewing on the food choice 4 criteria of adolescents. Sweden; Deptrtment of Clinical Physiology, Sahlgrenska Academy, Göteborg, Sweden Methods: The participants were 1003 pupils (495 boys and 508 girls) of mean age 14.6±1.5 years. The sample was submitted to anthropometric measurements. Body fat was estimated with the skinfold method. Aim: To assess the relation between parental body mass index (BMI) and the children’s The subjects were categorized according to their % of body fat. Dietary data was collected using a waist, neck and arm circumferences to presence of obesity or insulin resistance in questionnaire regarding the motives that lead to a selection of a food. children. Results: An important percentage of adolescents in Thessaloniki (20.5%) was overweight and obese. The significant differences in food choice criteria according to obesity status and to TV viewing are presented Method: The study population was 126 (75 female) 8.5 -13.5 year old subjects, with an in table 1 and 2, respectively. obese (n=66), an overweight (n=30) and a normal weight (n=30) subgroup. Homa –index was calculated as p -glucose*p-insulin/22.5. BMI of the children was transformed to z - Table 1: Significant differences in dietary criteria according to obesity status scores of a reference population. Obesity and overweight were defined according to the International Obesity Task Force. Overweight adolescents Non- overweight Results: The 95% confidence limits did not overlap between the three subgroups for Dietary criteria adolescents parental BMI, or the children’s waist, arm and neck circumferences. The means for obese Caloric value (%yes) 44.6* 38.3* vs. control children for maternal BMI was 30(SD 6.3) vs. 23.7(SD 3.7) kg/m², for waist circumference 98(SD12.2) vs. 65(SD 6.3) cm, and for arm circumference 33.2(SD 3.33) 89.0* 94.5* vs. 22.4(SD 2.96) cm. Homa -index were 3.56(SD1.99) and 3.04(SD1.88) for children Healthfulness (%yes) with obesity and overweight (ns), while mean of normal weights was significantly lower Vitamin/mineral content 84.5* 89.4* 1.75(SD 0.92). In a stepwise multiple regression analysis, maternal BMI (P<0.0001) and (%yes) homa (P=0.04) were independent predictors of the child’s BMI z -score (R²=0.30). while waist circumference (P<0.0001) and arm circumference (P=0.003) were independent Table 2: Significant differences in dietary criteria according to television viewing predictors of homa (R²=0.41). Dietary criteria Television Viewing (hours a day) Conclusion: Parental BMI and children’s body circumferences differ in children with normal weight, overweight and obesity. Homa index does not differ between obese and 0 ≤2 2-4 ≥4 overweight children , but between these and those of normal weight. Maternal BMI and children’s homa -index predict the children’s’ BMI z -score, while waist and arm New foods 74.2* 76.4* 77.2* 86.7* circumferences predict insulin resistance. (%yes) Labeled foods 29.2* 28.4* 33.5* 45.5* Conflict of Interest: None Disclosed. (%yes) Funding: Research relating to this abstract was funded by Västra Götalandsregionen health authority. Significant difference between groups, *P<0.05 Conclusions: Adolescents with high body fat levels had far more improper dietary criteria in comparison with non-overweight adolescents. Overweight adolescents were less interested in healthfulness and vitamin and mineral content of foods compared to non-overweight ones. TV viewing increased the desire for new and labeled foods.

International Journal of Obesity Abstracts S159 T3:PO.219 T3:PO.220

Study on the effect of nutritional fibers in the treatment of obesity and A New Randomized Controlled Trial for Obesity Treatment Based on Self-Determination Theory and Motivational Interviewing: Intervention Description dislipidaemia in women

Handjiev Svetoslav1, Handjieva-Darlenska Theodora2 Teixeira Pedro J.1, Silva Marlene N.1, Vieira Paulo N.1, Minderico Cláudia S.1, Castro Margarida M.1, Carraça Eliana1, Marcelino Miguel1, Adam Susana1, Santos Teresa1, 1 1National Transport Hospital; 2Medical Faculty, Medical University- Sardinha Luis B. Sofia, Bulgaria 1Faculty of Human Movement - Technical University of Lisbon, Lisbon, Portugal

Aim: To investigate the effect of nutritional product rich in fibers in the Introduction: Given the current low rates of success, new theory-based approaches and treatment of obesity and dislipidaemia in women. successful intervention strategies are needed to counter obesity. While tested before for other health behaviors, with promising results, Self-Determination Theory(SDT) and Materials and methods: 46 obese women were examined (mean age - Motivational Interviewing(MI) have not been experimentally evaluated for weight 46.3, mean body mass index – 33.1). They were randomised in to two management. This study describes a novel treatment for obesity, centered on physical groups: 15 subjects on control hypocaloric diet and 31 subjects on activity (PA) and based on SDT and MI, part an ongoing 3-year trial. hypocaloric diet, combined with margarine rich in fibers, vitamin A, E Method: A total of 257 overweight/obese females were randomized into intervention/control groups and started treatment. The main intervention consists of 30 and B6. Both groups were on a diet for a period of two months. group meetings covering PA, eating/nutrition, body image, and other cognitive-behavioral Results: At the end of the two-month nutritional period the group on a contents. Central intervention targets are autonomy, intrinsic motivation, and self- hypocaloric diet, combined with margarine rich in fibers had a regulation of behavior change. Autonomy-supportive treatment climate and internal significant reduction in body weight, body mass index (BMI), fat mass causality orientations are hypothesized to enhance autonomous regulation, perceived competence, and intrinsic motivation for lasting behavioral changes. Controls receive a and an increase in lean body mass/fat mass ratio in comparison with the general health and nutrition curricula. Assessments for this study include SDT-relevant control group. A significant improvement in the lipidological psychological moderators and mediators, body weight and body composition (DXA), (cholesterolaemia and triglyceraemia) parameters was discovered. physical activity (accelerometry and 7-day PAR) and diet (3-day food records). Conclusion: The importance of nutritional fibers in the treatment of Results: In the first two of three cohorts (n=169, age=37.2 ± 7.5 yrs, BMI= 31.8 ± 4.1 kg/m2), the intervention was successfully implemented, with a low (12%) attrition rate in obesity and metabolic syndrome is emphasized in the study. the intervention group (22% in controls). Conclusions: Understanding and promoting PA and wei ght normalization among the overweight/obese are urgent needs, but lack solid empirical evidence. Most existing findings are post-hoc and/or have limited theoretical support. Main theoretical tenets of SDT and related intervention strategies (based on MI) will be described. Conflict of Interest: None Disclosed. Funding: Research relating to this abstract was funded by Science and Technology Foundation (FCT), Oeiras City Council, Calouste Gulbenkian Foundation, Nestlé Portugal, and IBESA Portugal.

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Hyperandrogenism and metabolic syndrome in overweight/obese premenopausal Prevalence of the metabolic syndrome in the daily consultation of Primary women Care

Silva-Nunes Jose1, Duarte Leone1, Godinho Conceição2, Rodrigues Isaura2, 1 1 1 Vazquez Seijas Enrique Jose , Lopez Silva Maria del Carmen , Rodríguez Gardete-Correia Luis Fernández Concepcion1, Sánchez de Enciso Ruiz Miguel1, Novo López 1 1 2 Mercedes Endocrinology Department - Curry Cabral Hospital; Clinical Pathology Department - Curry Cabral Hospital 1Sergas.Primary Care. Lugo. Spain Background and Aims: Hyperandrogenism is often depicted in patients with the metabolic syndrome (MetS). The aim of our work was to confirm that Objectives: hyperandrogenism associates with MetS and to look for factors that most directly To know the prevalence of the metabolic syndrome (MS) in Primary Care correlate with androgen levels in premenopausal women. (PC). Methods: Blood pressure (BP) was determined in 210 obese/overweight To see if differences exist in this prevalence according to demographic premenopausal women; venous blood was collected in the early follicular phase, variates to study. after 10 hours fasting, for glucose, insulin, triglycerides, HDL-c, LH, FSH, SHBG, Patient and Methods: They were included in this study all the patients who estradiol, total (t-Test) and free testosterone (f-Test). Insulin resistance (IR) was visited their doctor for any reason (4 PC consultations) during the month of determined by the homeostatic model assessment (HOMA-IR). Patients were June of 2006. To all they were determined the waist circumference, the size, classified as having MetS according to the IDF definition. We compared sexual the weight, the blood pressure and they were carried out a complete sanguine hormones between those with and without MetS and looked for parameters that analytic. The diagnosis of MS was carried out according to the approaches greatly correlate with androgen levels. ATP III (upgrade of 2005). Results: Women were characterized by mean age=35±9 yrs, BMI=36.8±6.7 Kg/m2, waist perimeter (Wp)=103.1±13.7 cm, systolic BP(SBP)=116.6±10.6 Results: The sample is composed of 854 individuals that present a half age of mmHg, diastolic BP(DBP)=71.1±6.7 mmHg, glucose=86.8±20.2 mg/dl, 62.02 years (+ / - 16.2), being 38.76% males and the rest (61.24 %) females. insulin=15.3±10.8 µU/l, triglycerides=116.1±75.5 mg/dl, HDL-c=53.3±15.7 mg/dl, Overall of cases 363 presented MS what represents a prevalence of the LH=4.7±4.5 mU/ml, FSH=6.7±4.7 mU/ml, SHBG=53.3±43.7 nmol/l, 42.5%. The subgroups prevalences according to the demographic variates estradiol=55.9±43.3 pg/ml, t-Test=0.63±0.43 ng/ml, f-Test=1.86±1.41 pg/ml and was: 49.2 % (males) and 38.2 % (females); 49.2 % (age > 65 years) and 35.6 HOMA-IR=3.41±2.78. MetS was present in 23.3% of patients. Comparing those % (age <65 years). These differences turned out to be statistically significants with and without MetS, we found a significant difference for f-Test (P=0.011) and (P = 0,0067 y P = 0,0001 respectively). a trend for t-Test (P=0.08) and SHBG (P=0.079). f-Test was directly and Conclusion: independently associated with HOMA-IR (P=0.000; r=0.394) and inversely • Four of each 10 patients that go to PC consultation presents MS. associated with age (P=0.000; r=-0.315) and SHBG (P=0.000; r=-0.363). • The men present bigger prevalence of MS that the women. Conclusion: Overweight/obese premenopausal women with the MetS have higher • active androgen circulating levels than those without. IR is the best single predictor People aged > 65 years present bigger prevalence of MS that of hyperandrogenism, accounting for approximately 15% of androgen levels those of inferior age. variability.

International Journal of Obesity Abstracts S160 T3:PO.223 T3:PO.224

Role of VLCD diet in weight reduction in obese with diabetes and without The diet with food suplements for treatment of obesity diabetes Pogozheva Alla1, Baturin Alexander1 Matoulek Martin1, Sucharda Petr1, Kunešová Marie2, Housová Jitka1, 1 1 1 1 Svobodová Šárka , Strásnká Zuzana , Haluzík Martin , Owen Klára , Svaèina 1The Institute of Nutrition Štìpán1

13rd Internal Clinic, 1st Medical Faculty, Charles University; 2Institute of Objectives: The effectiveness of dietary treatment for patients with Endocrinology, Prague obesity based with to study the body composition dynamics. Material & Methods: There have been examined 186 patients with Aim of study: The main aim is an assessment of obese patient during obesity. All the patients were given diet with 1400 kcal energy (20% hospitalization with VLCD diet or two weeks in obesitology unit in protein, 30% fat) with supplement of fibres or extracts of cafe and tea, or IIIrd internal Clinic. We compare group of patients with diabetes and without complex vitamins with Cr, during three weeks. We estimated of diabetes. anthropometric data and body composition by bioimpedansmetria, Methods: We observed 154 obese in-patients from 1996 – 2006. The physical activity fixed by an accelerometer “Caltrac”. hospitalizations in obesitology unit include a) VLCD (600 Kcal per day) b) Results: The fat free mass and total body water were higher, and the fat two weeks starvation, which is used 2000 very rarely in patient with huge mass was lesser in the old people. The fat free mass and total body water decrease of basal metabolism (BEE) and unable to increase of physical were lesser, and the fat mass was higher in the obese people. The level of activity (total endoprothesis, arthritis etc.) physical activity was lesser in the old men. Before treatment an average Results: We observed 154 obese in-patients - 92 without diabetes mellitus diet energy value was 3206±172,5 kcal for men, energy requirement - type 2 ( DM-) end 62 with diabetes type 2 (DM+) with age average56, 2 ± 2 ± 13,1 yo; (53, 0 ± 12,2 yo DM- vs. 60,9 ± 13,2 yo DM+) with BMI 43,3 kg/m 2644 153,3 kcal. ± 8,8 kg/m2 (42,3 ± 8,3 DM- vs. 44,8 ± 9,4). Weight reduction was 8,45 kg ± In 21 days body weight has reduction under the influence of diet therapy 2,9 kg in all group (8,3 ± 2,8 kg DM- vs. 8,6 ± 3,0 DM+). When weight comprised from 4,7% to 6,5%. Waist measurement of obesity patients reduction was re-count to % of body weight, it was reduction of 6,9 % body reduced 3,1-4,5% correspondingly. Hips reduced 2,1-4,1%. The weight, (7,0 % DM- vs. 6,8 % DM+) at the start. waist/hips ratio reduced not significantly. Fat mass reduction: 5,7-8,7%; Discussion: We analyze only about 35 % in-patient from this period from fat free mass reduction – 1,2-3,7%. Fat free mass quote relative increase: our obesitology unit at last ten years. But it seems that patient with diabetes 0,8-1,4%. Water component reduction: correspondingly 1,4-6,1%. mellitus type 2 reduce less then obese without diabetes although weight Conclusion: The most effectiveness demonstrated of diet with a reduction is grater during three or four days at the start. We should analyze supplement of fibres. body composition at the start and at the end. It will be more interesting weight progress a few years after hospitalization. We want to define patients, who will from this will profits from these hospitalizations mostly. Supported by grant IGA MH 8384-3.

T3:PO.225 T3:PO.226

Different adipokine levels and paraoxonase activity in childhood obesity Influence of body fat distribution, cardiometabolic profile and diabetes on adiponectin in obese women Koncsos Peter1, Seres Ildiko1, Józsa Lajos2, Ilyés István2, Gönczi Ferenc3, Varga Eva1, Paragh György1 Ballaux Dominique1, Mertens Ilse1, Funahashi Tohru2, Matsuzawa Yuji2, Van Gaal Luc1 1First Department Of Medicine, Medical And Health Science Centre, University Of Debrecen; 2Department for Family Doctors, Medical and Health Science Centre, 1Antwerp University Hospital, Belgium; 2Osaka University, Japan University of Debrecen; 3Kenézy Gyula Hospital, Debrecen Introduction: Obesity and T2DM both have an increased amount of visceral fat, Background: Obesity during childhood and particularly adolescence is related to known as a determinant of insulin resistance. Adiponectin contributes to the increased morbidity and mortality in later life. Recent studies suggest that development of insulin resistance and T2DM. adipokines play an important role in complications associated with obesity. Our Aim of the present study: To analyze the relationship between metabolic profile, present study examined the relationship between two adipokines - leptin, body fat distribution and adiponectin in obese non-diabetic and diabetic patients adiponectin - and paraoxonase (PON1) activity in childhood obesity, as influencing Methods: Fasting adiponectin, lipids and metabolic variables were measured from factors in the development of atherosclerosis. 166 overweight and obese women (diabetic n=65; non-diabetic n=101), matched Materials and methods: Overweight and normal-weight children aged 8-14 years for age (58±9y), BMI, %fat mass and total amount of abdominal fat. Insulin were enrolled. We measured anthropometric, lipid-, carbohydrate-metabolism resistance was estimated by HOMA. Anthropometric measures were performed by parameters, adipokine levels and their correlations with PON1 activity. standard techniques and visceral fat by CT-scan. Results: The plasma leptin concentration of overweight children was significantly Results: BMI, total fat, %FM and lipids were similar in both groups. Diabetic higher (P<0.0001); the adiponectin concentration (P<0.05) and PON1 arylesterase women had significantly (P<0,001) more visceral fat(206±130 vs 149±81cm²), activity (P<0.05) was significantly lower in the group of overweight children higher waist and Visceral/Subcutaneous fat ratio(0,49±0,18 vs. 0,35±0,12). HDL-C compared to the normal-weight children. We measured higher leptin levels at girls was lower(47±13 vs. 61±14mg/dl) and triglycerides higher(206±130 both in the overweight group and the control group. The PON1 arylesterase activity vs.149±81mg/dl), but total cholesterol did not differ. Adiponectin was correlated negatively with the concentration of leptin (r=-0,629; P=0,0004), as well significantly(P<0,001) lower in the diabetic population (8,3±3,9 as with the body fat percentage (r=-0,4815; P=0,043). The body fat percentage vs.14,0±6,0µg/ml), who was more insulin resistant(P<0.001). Regression analysis showed positive correlation with the concentration of leptin (r=0,4918; P=0,0382). showed HDL-C and HOMA-IR to be independent determinants of adiponectin in Conclusion: Our results suggest that the pathological metabolic status in childhood non-diabetic women, whereas in the diabetic group HDL-C was the main obesity creates favorable conditions for the initiation of the premature determinant. atherosclerosis. Different levels of adipokines and decreased paraoxonase activity Conclusion: Diabetic obese patients are more insulin resistant and have a higher may be useful markers beside the conventional risk factors in the observation of the amount of visceral fat as non-diabetic subjects, while adiponectin-levels are lower. metabolic status. However, HDL-C and insulin resistance seem to be more important in the Funding: Research relating to this abstract was funded by OTKA Hungary determination of adiponectin-levels as compared to the amount of visceral fat in (K63025). this group of patients.

International Journal of Obesity Abstracts S161 T3:PO.227 T3:PO.228

The effect of weight loss on the paraoxonase activity and adipokine levels in Glycemic and insulinemic responses as determinants of appetite in humans patients with metabolic syndrome Sloth Birgitte1, Flint Anne1, Møller Bente Kramer1, Raben Anne1, Pedersen Dorthe1, Sztanek Ferenc2, Seres Ildiko2, Audikovszky Maria1, Debreczeni Lorand1, Kovácsay Tetens Inge1, Holst Jens Juul2, Astrup Arne1 Anna1, Pados Gyula1, Paragh György2 1Department of Human Nutrition, The Royal Veterinary And Agricultural 1St. Imre Hospital, Budapest, 2First Department of Medicine, Medical and Health University; 2Second Department of Medical Physiology, the Panum Institute, Science Centre, University of Debrecen University of Copenhagen

Background: Previous studies have demonstrated that oxidative stress is increased Background: The importance of the postprandial glycemic and insulinemic in obese patients. The high-density lipoprotein (HDL) associated human response for appetite and energy intake (EI) is controversial. paraoxonase 1 (PON1) can inhibit low-density lipoprotein oxidation and has an Objective: The aim of the study was to test the hypothesis that postprandial antiatherogenic effect. Numerous studies have shown that modest weight loss is appetite sensations and subsequent EI are determined by postprandial glycemic and associated with reduced blood pressure, improved insulin sensitivity and glycaemic insulinemic responses after intake of a range of breakfast meals. control, and a less atherogenic serum lipid profile. The aim was to examine the Design: The study was a randomized, cross-over meal test including 28 healthy effect of low-carbohydrate diet induced weight loss on the antioxidant PON1 young men, each testing 10 of 14 breakfast meals. Each meal contained 50 g of activity and leptin and adiponectin levels. carbohydrate with varyingglycemic index and energy and macronutrient contents. Methods: 91 female patients with metabolic syndrome were involved in the study. Blood samples were taken, and appetite sensations measured (by Visual Analogue Patients were kept on low-carbohydrate diet (45%carbohydrate, 35% fat, 20% Scales), 3 h postprandially. Subsequently, EI at lunch (EIlunch) was recorded. protein) for 3.5 months. Results: The glycemic response was unrelated to appetite sensations, whereas the Results: It was observed, that after a 3.5 month diet the BMI (P<0.001) reduced insulinemic response was positively associated with postprandial fullness (R2=0.33, significantly, the mean weight loss was 8.5 kg. Serum triglyceride, cholesterol and P<0.05). In contrast, the insulinemic response was unrelated to the subsequent glucose levels decreased (-29.41%, -5.3%, -9.44% respectively). HDL-C, LDL-C, EIlunch, whereas the glycemic response was positively associated with EIlunch apoB-100 and apoA1 levels were unchanged. hsCRP (P<0.01), anti-oxLDL (R2=0.33, P<0.05). Although no significant difference in EIlunch was observed (P<0.05) and leptin (P<0.05) levels decreased, while serum PON1 activity between different breakfast conditions, a low breakfast EI was associated with a (P<0.05) and adiponectin level increased (P<0.05) after weight loss. These changes high EI at lunch (R2=0.60, P<0.01). resulted in a significant negative correlation between PON1 and leptin (r= -0.39, Conclusions: The present study does not support the contention that postprandial P<0.001) and a positive correlation between PON1 and adiponectin (r=0.41, glycemic response is important for short-term appetite sensations, but a low P<0.001). glycemic index meal may reduce subsequent energy intake. Contrastingly, Conclusion: Hyperleptinemia and hypoadiponectinemia have a strong correlation postprandial insulin seems to affect short-term appetite sensations. with the decrease of PON1 activity and contribute to the accelerated atherosclerosis Conflict of interest: None of the authors had any conflict of interest. Arne Astrup in obesity. Low-carbohydrate diet induced weight loss could normalize the lipid is medical advisor for Weight Watchers. The Department receives study funding profile, adipokine levels and improves the antioxidant status by increasing serum from more than 50 different food companies. paraoxonase activity in patients with metabolic syndrome. Funding: The study was supported by the Danish Research Agency(grant no. Research relating to this abstract was funded by Hungarian Health Science Council 42870) and Kellogg’s Europe. (ETT 243/2006).

T3:PO.229 T3:PO.230

Nutrition obesity immunology Abnormal eating behaviors among Turkish late adolescents

1 Krotkiewski Marcin Kiziltan Gul1, Karabudak Efsun1

1 The Sahlgrenska Academy At Göteborg University. Institute Of Clinical 1Baskent University Neuroscience The aim of this study was to determine the abnormal eating behaviors Two main factors decided during centuries about survival of human kind- energy supply and immunological defense system. Undernutrition and famine [binge-eating (BE) and night eating (NE)] and relationships with body was associated with total inhibition of immunological activity and mass index (BMI) and dietary intakes in late adolescents. The study was with exaggerated immunological reactivity. For young societies conducted between May and June 2004, in Ankara. The study population and young persons the most important is to fight infections, for developed included 281 (142 females and 139 males) late adolescents with a mean countries and older generation the most important is a protection against age of 20.9± 1.7 years. To detect the binge eating and night eating exaggerated production and damaging effects of inflammatory cytokines. problems, the screening questions were used. The dietary intakes were This is best reflected by the ratio between proinflammatory cytokines TNFα, assessed by Food Frequency Questionnaire. Fifty-nine students (21.0 %) IL-1, IL-6, IL-12 and the anti-inflammatory IL-10, TGF-β, IL-4. The ratio is met the criteria for BE, forty students (14.2 %) met the criteria for NE, increasing with age and is close correlated to degree of coronary heart the rest were control groups. Males had higher abnormal behaviors than disease, stroke, hypertension, diabetes. Over consumption, particularly females. In groups 32.2 % of the bingers, 12.5 % of the night eaters were chronic one causes infiltration by macrophages of adipose tissue (visceral, classified as at risk of overweight and obese. Compared the groups, subcutaneous and perivascular). Excessive food intake leads to overload and bingers skipped main meals especially breakfast and lunch more than the stress of cytoplasmic reticulum and stimulation of transcription factors NFκB others. Significant differences were observed in daily total energy intake and AP1 responsible for the generation of proinflammatory cytokines and among BE (2396±1134kcal/day), NE (1948±765 kcal/day) and control free radicals leading to development of metabolic syndrome. Decreased food (1663±738 kcal/day) groups. There were also significant differences intake is associated with the activation of transcriptions factor PPARγ, α, δ, among groups in consuming of breads/cereals, dairy products and LXR and RXR leading to decreased production of inflammatory cytokines vegetable servings (P<0.05). Night eaters consumed more fruits and and increased production of adiponectin and IL-10. Single nucleotide dairy products than BE and control groups. Bingers consumed more polymorphism (SNPs) of the level of transcriptions factors and/or interleukins breads/cereals, vegetables, meats, sweets and fat than the others. In all can precipitate or protect against obesity. Increased production of groups fat consumption and the percentage of fat from total energy was proinflammatory cytokines accelerates transmethylation of DNA and histones higher than AHA recommendations. These findings suggest that BE and deacetylation leading to genes silencing – epigenetic processes responsible NE should be a significant health problem especially for the males for development of cancer and arteriosclerosis. Dietary prevention of aberrant DNA methylation can in animal model prevent development of obesity. associated with obesity.

International Journal of Obesity Abstracts S162 T3:PO.231 T3:PO.232

Can DXA Accurately Measure Abdominal Fat? Comparison with MRI Apolipoprotein E Polymorphism Has No Cross Sectional Association with C- and Anthropometric Assessment reactive Protein Levels Women

1 2 3 4 5 1 1 2 1 1 1 Lowndes Joshua , Zoeller Robert , Moyna Niall , Gordon Paul , Visich Paul , Di Gregorio S , Del Rio L , Ibañez L , Sole C , Bonel E , Garcia M Pescatello Linda6, Miles Mary7, Seip Richard8, Thompson Paul8, Angelopoulos Theodore1 1CETIR, Centre Mèdic, Barcelona, Spain; 2Hospital Sant Joan de Déu, Barcelona, Spain 1University Of Central Florida; 2Florida Atlantic University; 3Dublin City University; 4West Virginia University; 5Central Michigan University; 6University of 7 8 Abdominal fat (AF) is associated with an increased risk for metabolic Connecticut; Montana State University; Hartford Hospital and cardiovascular disorders. Direct measurement of fat mass by Introduction: There are 3 common alleles of the ApoE gene that differentially magnetic resonance imaging (MRI) is accurate but expensive, complex, affect its function and as such confer different risks for cardiovascular disease and and relatively inaccessible. MRI pixel values for given tissues may vary mortality. As Apo has also been shown to have anti-inflammatory properties, and from slice to slice or between individuals as a result of heterogeneity in atherosclerosis is in part an inflammatory disease, it is possible that that the the magnetic field. We evaluated the assessment of AF with Dual- differential cardiovascular risk associated with this polymorphism is in part related Energy X-ray Absorptiometry (DXA) and compared the results with to differing degrees of protection against systemic inflammation. Therefore the those obtained by MRI. A total of 29 subjects (age 19.9±2.0 years; BMI purpose of this study was to compare the level of high sensitive C-Reactive protein range: 16.9–29.7) had DXA total body assessment, MRI total fat (CRP) among the 3 common ApoE genotypes. Methods: Sixty-sixty females were assessed for ApoE genotype and CRP levels measurement, and anthropometric measurements [waist circumference (mean age 38.2 ± 11.6 years). CRP was assessed using a two-site (WC), weight, height]. DXA AF (g) in the android region (between the chemiluminescent enzyme immunometric assay with one monoclonal and one ribs and pelvis) was measured with a Lunar Prodigy (GE Healthcare) polyclonal anti-CRP antibody. equipment. MRI Excite11 (GE Healthcare) total fat measurement in the Results: ApoE had no effect on CRP levels (E2/E3: 3.26 ± 2.27, n=21; E3/E3: 3.50 L3 slice was converted from volume to mass using the density of 0.92 ± 2.46, n=18; E3/E4: 2.02 ± 2.13 mg/L, n=27; P=0.064). To minimize the variation kg/l for adipose tissue. Results were analyzed by Pearson´s correlation. within the cohort the normal weight individuals were removed from the analysis DXA AF showed a significant correlation with MRI AF in the L3 slice (n=20) and the effect of Apo E polymorphism was reexamined in the remaining 45 overweight and obese women. Again there was no significant effect of ApoE (R=0.965, P<0.001; R=0.953 in subjects with BMI<25; R=0.916 in (E2/E3: 3.58±2.41, n=15; E3/E3: 4.54±2.31, n=12; E3/E4: 2.63±2.38 mg/L, n=18; subjects with BMI>25). There was also a positive correlation between P=0.108). WC and DXA AF (R=0.836, P<0.001), and between WC and MRI total Discussion: No association was found between systemic CRP and ApoE genotype fat mass in L3 slice (R=0.825; P<0.001). DXA AF showed a positive in this cohort. While CRP is a stable measure of chronic systemic inflammation, it correlation with MRI visceral fat mass in L3 slice (R=0.676; P<0.001). is possible that a more comprehensive examination of inflammation would be DXA regional body composition analysis is a reliable method for needed for a relationship to be unmasked. measurement of abdominal fat in a rapid and comfortable manner. Funding Support: NIH 1R15AG#13767-01A1.

T3:PO.233 T3:PO.234

Normal Weight Obese (NWO) Women: an evaluation of candidate new Cytokine profile in a morbidly obese population after weight loss induced by syndrome Roux-en-Y gastric bypass (RYGB)

Orlandi Carmine1, Di Renzo Laura2,3, Di Lorenzo Nicola1, Stazi Ilaria2, Moulin Cristiane1, Marguti Ivo2, Peron Jean2, Rizzo Luiz2, Halpern Alfredo1 Napola Maria Rosaria2, Domino Emidio2, De Lorenzo Antonino1,2,3 1Obesity and Metabolic Syndrome Unit, Endocrinology Service, University 1Nova Salus Foundation, 67059 Trasacco (Aq), Italy; 2Division of Human Of São Paulo, Brazil; 2Department of Immunology, Biomedical Sciences Nutrition, University of Tor Vergata, I-00133 Rome, Italy; 3I.N.Di.M., Institute, University of São Paulo, Brazil National Istitute for Mediterranean Diet and Nutrigenomic, Reggio Calabria, Italy Introduction: The balance between proinflammatory and anti-inflammatory cytokines is relevant in development of infectious and allergic diseases and it Background and aims: Obesity, an independent risk factor for appears to be involved in the pathogenesis of cardiovascular diseases and cardiovascular disease (CVD), has been associated with the early cancer. Obesity is related to a higher rate of infections, asthma, development of coronary atherosclerosis in adolescents and young men. A cardiovascular diseases and certain tumors. Our aim was evaluate the effect subset of metabolically obese but normal weight individuals was identified, of weight loss induced by RYGB on cytokines profile. with potentially increased risks for development of the metabolic syndrome Patients and methods: Production of interleukin(IL)-2, interferon- despite their normal body mass index. We determined the relationship among gama(INF-), IL-4, IL-6, IL-10, IL-12 and tumor necrosis factor-alfa(TNF- ) body fat distribution and selected CVD risk factors to distinguish normal from peripheral blood mononuclear cells were analyzed in 10 non-diabetic, weight obese from controls with a normal metabolic profiles. non-smoker and sedentary patients with grade III obesity (6F/4M, BMI Methods and results: We analysed anthropometric variables, body 50.6±7.3 kg/m2, 42.7±6.2 years) before, 1 month and 6 months after RYGBP. composition by DXA, RMR by indirect calorimetry and bioumoral variables PBMCs were stimulated with phytohemmagglutinin and cytokines were of 74 clinically healthy Caucasian Italian women. Significant differences measure by ELISA. were observed in the biochemical HDL-chol values between NWO and Results: The weight loss was 13.7±3.1 kg and 33.7±4.2 kg at 1 month and 6 controls and pre obese-obese. Significant correlations were found among months following surgery, respectively. There was a significant post-surgical cardiovascular risk indexes, lean mass (kg) (LEAN) of the right part of the decrease in BMI at 6 months (-12.1±1.7 kg/m2, P<.001). Production of IL-10 trunk and TC/HDL (R=-0.69, P<0.001) and LDL/HDL (R=-0.72, P<0.001), decreased 6 months postoperatively (672.8±305.7 vs 210.9±198.6 pg/mL; P and LEAN mass and RMR (R=0.44, P=0.022) of NWO women. <0.01). There was no difference in production of other cytokines 1 month and Conclusions: In NWO women the cardiovascular risk indexes are related to 6 months after RYGBP. metabolic variables and to body fat mass distribution. NWO individuals Conclusion: Weight loss induced by RYGB resulted in a decrease of IL-10 showed a relationship between the decrease in LEAN of the left leg and an production. IL-10 is a cytokine with a well known regulatory role. The drop increase in CVD risk factors. We suggest that LEAN mass distribution seems on IL-10 levels may signal that, at 6 months after surgery, patients have the to be a potential predictor of CVD. potential to mount a more efficient proinflammatory response.

International Journal of Obesity Abstracts S163 T3:PO.235 T3:PO.236

Orofacial motricity, mastication pattern and swallowing are altered in obese subjects Impact of milk consumption on BMI and height in children

1 1 1 1 de Figueiredo Adriane , Moulin Cristiane , Cercato Cintia , Mancini Marcio , Villares 1 1 2 1 1 1 Albala Cecilia , Cifuentes Mariana , Ebbeling Cara , Bustos Nelly , Lera Sandra , Halpern Alfredo 1 1 2 Lydia , Olivares Sonia , Ludwig David 1 Obesity and Metabolic Syndrome Unit, Endocrinology Service, University Of São Paulo, 1 2 Brazil Institute of Nutrition & Food Technology, University Of Chile; Children's Hospital, Harvard University Introduction: Several studies have investigated the implications of mastication in saciety. To test if obese subjects have more alterations in masticatory system than normal Objective: To evaluate the effects of replacing habitual consumption of weight individuals, we investigated the orofacial motricity and the function of sugar-sweetened soft drinks with milk over 16 weeks stomatognathic system of both groups. Patients and methods: Twenty obese patients (7M/13F, mean age 34.9±10.3, mean BMI Methods: Randomised controlled trial of the effect of a 16-wk intervention 41.5±8.9 kg/m2) and twenty lean volunteer (3M/17F, mean age 30.7±6.7, mean BMI consisting of replacing habitual consumption of sugar-sweetened soft drinks 22.3±1.9 kg/m2) were evaluated by a speech therapist. with milk on the change in body mass index among 96 children aged 8-10 Results: Major numbers of obese subjects had alterations in orofacial motricity, years at baseline, recruited at elementary schools in Santiago-Chile. mastication pattern and swallowing (table 1). There was no difference between the two Measurements prior to randomization and at the end of the study included groups in jaw movement and the number of bites. body weight and height and body composition (DEXA scanning). Table 1: Aspects evaluated Obese (n) Lean (n) p value Results: 52 boys and 46 girls were randomized to either 3 servings of Alteration in mastication 13 8 NS milk/day or control group. 23 boys and 20 girls in the intervened group and Mastication with open lips 1 0 NS 26 boys and 21 girls in the control group completed the study. Baseline Alteration in swallowing 17 7 0. 01 measurements were similar for intervened and control groups. After 16 Alteration in mobility of lips 3 0 NS weeks, the analysis by intention to treat showed no differences in BMI nor fat Alteration in mobility of tongue 3 6 NS mass between intervened and control groups. In boys but not in girls, there Alteration in position of lips 4 4 NS ± ± Alteration in position of tongue 0 2 NS was a greater increase in height (2.5 0.88 cm vs 1.77 1.04, P<0.02) and a Oral breathing 2 2 NS higher lean mass (1169.4 ± 140.3 vs 753.6 ± 125.9, P<0.04) in the intervened Elevated muscular tonus of lips 2 2 NS group in comparison with the controls. Self-reported adherence to the Diminished muscular tonus of lips 11 1 0. 001 intervention was very high for the whole group (98%). Diminished muscular tonus of tongue 15 6 0.004 Conclusion: In boys, but not in girls a high consumption of milk could be a Diminished muscular tonus of cheeks 10 3 0.018 Diminished contraction of masseter 15 3 < 0.001 factor for increasing height and lean body mass. Diminished contraction of temporal 8 2 0.028 Conflict of Interest: None Disclosed. Jaw movements exclusively verticals 2 3 NS Funding: Research relating to this abstract was funded by National Institutes Jaw movements mainly verticals 7 5 NS of Health, Fogarty International Center. Unilateral mastication 6 0 0.01 Conclusion: Obese subjects have more alterations in masticatory system than lean individuals.

T3:PO.237 After 1 year After 2 years Orlistat treatment in non-elderly patients with metabolic syndrome (MS) Mean change: Orlistat Placebo Orlistat Placebo – meta-analysis shows early response patients have significant Weight (kg) -12.3* -4.3 -9.0* -2.4 improvements in MS criteria Waist -10.9* -5.2 -11.4* -6.4 circumference 1 2 3 Ziegler Olivier , Laville Martine , Basdevant Arnaud , Montestruc (cm) 4 4 Francois , Moisan Christine SBP -6.9* -2.5 -4.8‡ -3.8 (mmHg) 1C.H.U De Nancy, Toul, France; 2Hopital Edouard Henriot, Lyon, 3 4 DBP -5.9* -2.2 -4.7† -1.7 France; Hotel Dieu, Paris, France; Roche, Neuilly, France (mmHg) LDL- -7.5* 5.3 -2.0* 7.3 Introduction: Twenty randomised double-blind studies were cholesterol (%) retrospectively analyzed to assess orlistat’s efficacy in non-elderly MS HDL- 12.1‡ 13.9 11.0‡ 12.0 patients showing >5% weight loss at 12 weeks. cholesterol (%) Patients and Methods: Patients with MS (NCEP ATPIII criteria) Total- -7.7* 2.0 -4.8* 2.1 received orlistat (120mg tid) or placebo for 0.5–4years. Patients were cholesterol (%) excluded if at baseline they were >60years, had diabetes Triglycerides -12.5* -4.2 -0.3† -0.2 (FPG >7mmol/L), hypertension (SBP >160/DBP >90mmHg) or were (%) being treated for diabetes, hypertension or dyslipidaemia. Results Glucose -0.1* 0.2 0.1* 0.3 (mmol/l) • Patients: orlistat (early weight loss)=714, placebo=1573. • Insulin (pmol/l) -3.1* -0.4 -3.1† -1.1 Compared with placebo, orlistat reduced weight and waist Proportion of circumference, and significantly improved glycaemic status, BP and patients with: lipid profile (table). • •5% weight loss 88 42 74 43 50–55% of orlistat recipients had no MS at 6, 12 and 24 months (%) compared with approximately 40% of placebo recipients. •10% weight 57 18 47 22 Conclusion: Orlistat significantly improved MS criteria. Of particular loss (%) note was the large improvement with orlistat compared with placebo in versus placebo: * P<0.0001, † P<0.05, ‡=not significant the concentrations of LDL-cholesterol, an established CVD risk factor. Early response to orlistat in MS patients is a useful predictor for overall success.

International Journal of Obesity Abstracts S164 T3:PO.238 T3:PO.239

Efficacy of 5% caffeine gel application in women with localized gynoid Children obesity, insulin resistance and effect on weight-loss lipodystrophy Deram Sophie Marie1, Villares Sandra1,2, Nicolau Christiane1, Frazzatto Vlasak Rene1, Meunier Claire2, Stich Vladimir1, Sarrazin Rouland Brigitte2, Eliane1,2, Guazzelli Isabel1,2, Halpern Alfredo2 Garrigue Eric2 1Faculdade De Medicina Da Universidade De São Paulo, Brazil - LIM25; 1Center of preventive medicine; 2Institut De Recherche Pierre Fabre 2Hospital das Clínicas - São Paulo, Brazil

Introduction: The role of 5% caffeine gel in the treatment of localized Objectives: Prevalence of childhood obesity affecting their future adult’s gynoid lipodystrophy has been evaluated in a randomized efficacy study. health is increasing dramatically and an efficient treatment concept must be Methods: Subjects: 101 women (age range 18-45 years, BMI range 20-29 developed. A multi-disciplinary weight-loss program has been recommended. kg.m-2) with localized thigh gynoid lipodystrophy were involved in the study. We examined the effect of varying degrees of obesity on the prevalence of the Treatment: 5% caffeine gel, Percutafeine®, was applied for 6 weeks on the metabolic syndrome (MS) and its relation to insulin resistance (IR) and lateral side of one thigh, randomly assigned. weight-loss in our obese children ambulatory five months program. Protocol: Subjects maintained their habitual diet and physical activity. Material & Methods: A total of 232 obese children (age 10.8±1.3 years) Efficacy of treatment was assessed by the measurement of hypoderm (BMI 30.4±4.5 kg/m2; BMIzscore 2.29±0.3) were evaluated. They were thickness using sonography (10 MHz) and the measurement of the largest divided into 3 groups according to BMI Zscore (SDS-BMI)(Z) : Group I= thigh circumference at baseline, after 4 and 6 weeks of treatment. 1.272.46. They were Results: Body weight was maintained during the study. A higher reduction of followed for 20 weeks in a multi-disciplinary weight-loss and balanced diet hypoderm thickness was found after 4 weeks on the treated thigh compared educational program. with the control one (mean -0.90 ± 2.45mm vs -0.24 ± 2.15mm, respectively, Results: Significant values were: waist circumference (88.4±6.9; 104.8±10.1 P=0.008; max -17.8 vs -10.0mm). This was associated with a reduction of the cm), insulin level (14.9±7.5; 20.7±12.4 µU/mL), HOMA (3.19±1.6; 4.4±2.8), thigh circumference after 4 weeks (mean -0.72 ± 1.14 vs -0.54 ± 0.96cm, leptin level (31.5±18; 59±37.8 ng/mL), HDL (44.6±10.8; 39.7±8.3 mg/dL), P=0.035; -4.0 vs -2.9cm) and, more markedly, after 6 weeks of treatment and MS (22.1%; 48.1%) respectively for Group I and III. Glucose and (mean -0.98 ± 1.26 vs -0.68 ± 1.07cm, p=0.002; max -5.5 vs -3.8cm). No triglycerides levels were not significant. After five months program, 95% of rolling was performed during the application to measure the product the children lost Z (degree of obesity) with an average loss of Z of 0.24±0.18 effectiveness only, rather than the mechanical benefice of the massage. No for Group I and II and a significant lower loss of Z for Group III (0.13±0.1). adverse events were reported. Conclusion: The more obese (Group III) are significantly more resistant to Conclusion: Local application of 5% caffeine base gel displays a beneficial insulin and weight-loss and have a significant higher prevalence of MS, effect in the therapeutic approach of localized gynoid lipodystrophy in non- consequently there is still a great need for research into the treatment of these overweight as well as overweight women. very obese children where nutritional reeducation isn't enough.

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Long term Weight Management: Using genetics to personalize calorie-controlled The relationship between obestatin and ghrelin in abdominal obesity diets 1 1 1 1 2 3 4 4 Vicennati Valentina , Pagotto Uberto , Genghini Silvia , de Iasio Grimaldi Keith , Valdes Ana , Marinos Stathis , Florou Anna , Arkadianos Ioannis , 1 1 1 Gill-Garrison Rosalynn1 Rosaria , Palladoro Federica , Pasquali Renato

1Sciona Inc, Boulder, CO, USA; 2Twin Research Unit, King’s College London, 1UO Endocrinologia-Ospedale S.Orsola-Malpighi UK; 3NTUA, Athens, Greece; 4RAS Health, Athens, Greece Obestatin is a derivation product from preproghrelin. It has opposite An obstacle to successful long term weight management is adherence to calorie- effect than ghrelin on food intake. The relationship between ghrelin and controlled diets. Gene-environment studies have demonstrated individual variability in nutrient requirements. We have included nutrigenetic diet obestatin in obesity is still not clearly understood. Our aim is to address personalisation combined with traditional weight management programs. Patients plasma obestatin levels in a homogenous group of abdominally obese attending a weight management clinic were offered the Sciona nutrigenetic test women (AO, 20) vs. normal weight controls (CT, 12). In basal condition which screens for 24 variants in 19 genes involved in nutrient metabolism. each subject underwent an OGTT and biochemical and hormonal Seventy-three patients have enrolled in the test group and seventy in the non-tested determinations. Obestatin concentrations were significantly higher group. The latter were selected by computer software that created a comparison (P<0.05) in AO than CT, while ghrelin levels were significantly higher group matched for age, sex, starting BMI and clinic visits. Weight management (P<0.05) in CT. As expected, AO had significantly lower adiponectin programs were identical except that diet in the nutrigenetic group was modified according to genetic variation. During six months of follow up there was a (P<0.05) concentrations and higher cholesterol and triglycerides tendency for the tested group to have greater BMI reduction but no significant (P<0.05) than CT. In AO, obestatin levels were positively and differences. In the patients followed up for more than 300 days (26 in nutrigenetic significantly correlated to ghrelin (r=2.762, P<0.05), cholesterol group, 22 in comparison group) results were significantly better in the nutrigenetic (r=2.675, P<0.05) and triglycerides (r=3.00, P<0.01). On the contrary group (P<0.005). Individuals in the nutrigenetic test group were more likely to there was no correlation between obestatin and the main anthropometric have maintained some weight loss 19/26 (73%) than those in the comparison group variables. Moreover, obestatin was not correlated to age. AO had higher 7/22 (32%) resulting in an age and gender adjusted odds ratio of 6.26 (95% CI obestatin levels and lower ghrelin concentrations. These interesting 1.74-22.52). Average BMI reduction in the nutrigenetic group was 1.93 kg/m2(5.6% loss) vs. an average BMI gain of 0.51 kg/m2 (2.2% gain) (P<0.004). findings might be somehow implicated in the pathophysiology of Among patients whose starting blood glucose was >100 mg/dL, 57% (17/30) of the obesity. nutrigenetic group but only 25% (4/16) of the non-tested comparison group had levels reduced to <100 mg/dL after >3 months weight management therapy (odds ratio for lowering glucose to <100 mg/dL due to diet=1.98 95%CI 1.01, 3.87, P<0.046). In conclusion the addition of nutrigenetically tailored diets resulted in better compliance, longer-term BMI reduction and improvements in blood glucose.

International Journal of Obesity Abstracts S165 T3:PO.242 T3:PO.243

Dual Energy X-ray Absorptiometry Abdominal Fat and Sagittal Change of visceral fat area and risk factors in complex weight reduction treatment Diameter Measurements in Children Halmy Eszter1, Halmy Laszlo2

1 2 1 1 1 1 1 Hung Ass For Overweight And Obese; Centre of Hypertension and Lipid Metabolism, Central Di Gregorio S , Del Rio L , Garcia M , Bonel E , Sole C Hospital 1CETIR, Centre Mèdic, Barcelona, Spain Objectives: Well-known data from literature show that diet or exercise alone is not as effective as complex treatment. Our aim was to determine the effect of complex treatment on the change of body fat, visceral fat area (VFA) and risk factors. There is a strong relationship between abdominal fat distribution and the Subjects: 139 overweight and obese inpatients (male:68, female:71) BMI: 41.59 kg/m² risk of metabolic and cardiovascular disease. Sagittal abdominal (SD:8.28), age: 44.9y (SD:10.64)(17y-72y), time of treatment 0:22.66 (SD: 12.55) median:19.0 diameter(SAD) measured by a simple caliper is used to estimate days. Method: After clinical examination daily underwater exercise +gymnastic +brisk walking +diet abdominal fat and visceral fat in particular. Dual-energy X-ray (800-1500 kcal/day), every day control. Bio-impedance by InBody720 for VFA, anthropometric absorptiometry(DXA) directly measures fat mass in the total body as parameters and risk factors were measured.Walking distance was measured by Omron HJ-113-E. well as sub-regions including the abdominal or “android” region. DXA Results: Body weight (kg) BMI (kg/m²) waist circ (cm) hip circ (cm) has very low radiation and is easily performed. We evaluated the 121.76 (SD:27.33) 41.59 (SD:8.28) 123.5 (SD:18.11) 128.7 (SD:17.24) relationship between abdominal fat mass assessed by DXA and SAD. A 115.82 (SD:26.91) 39.36 (SD:7.83) 117.6 (SD:17.57) 124.66 (SD:16.59) total of 35 subjects participated in this study(BMI range 14.3–34.8). Thirteen subjects had normal weight(age 6.9 to 20.4 years) and 22 were FB% Fat mass (kg) VFA (cm²) RRsyst (mmHg) 42.06 (SD:8.06) 52.61 (SD:18.28) 179.6 (SD:57.8) 149.66 (SD:19.51) overweight (age 8.1-19.4 years). The DXA fat in the android region 41.19 (SD:8.58) 48.31 (SD:17.76), 168.35 (SD:50.6) 125.0 (SD:12.32) (between the ribs and pelvis) was measured with a Lunar Prodigy(GE Healthcare Lunar), software version 8.1, which calculates abdominal fat RRdiast (mmHg) glucose (mmol/l) cholesterol LDL-chol (AF) mass (g) as well as fat and lean tissue in other regions. (mmol/l) (mmol/l) 91.7 (SD:12.67) 6.23 (SD:2.29) 5.26 (SD:1,13) 3.15 (SD:0.95) Results were analyzed by Pearson´s correlation. DXA AF showed a 77.87 (SD:7.67) 4.93 (SD:1.05) 4.54 (SD:1.03) 2.70 (SD:0.89) significant correlation in the total group with SAD(R=0.912, P<0.001). There was also a significant correlation for both overweight and normal HDL-chol triglyceride hCRP (mmol/l) walking distance/day subjects(R=0.925, P<0.001 and R=0.865, P<0.001 respectively). We (mmol/l) (mmol/l) 1.31 (SD:0.32) 2.34 (SD:1.64) 8.87 (SD:8.73) 4.4 km/day (SD:2.9) also observed a significant correlation between DXA AF and waist 1.67 (SD:0.25) 1.65 (SD:0.79) 5.33 (SD:4.87) 10.1 km/day(SD:5.4) circumference(R=0.901, P<0.001). We conclude that DXA fat All results have math. significance P<0,001. measurement may be useful in identifying children with high Conclusions: Our complex treatment resulted in significant changes in VFA and risk factors. abdominal/visceral fat mass.

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Anthropometric predictors of total body fat mass, trunk, and abdominal fat Aerobic exercise programe and cardiovascular risk in obese type 2 diabetic mass changes in overweight and obese women in a short-term weight loss patients program Lazarevic Gordana1, Antic Slobodan2, Milojkovic Maja2, Tasic Ivan1, Branco Teresa1, Minderico Claudia1, Martins Sandra1, Silva Analisa1, Rocha Stefanovic Vladisav3 Paulo1, Baptista Fátima1, Palmeira António1, Teixiera Pedro1, Sardinha Luis1 1Clinic of Cardiology Clinical Center Nis, Serbia; 2Clinic of Endocrinology 1Faculty Of Human Movement Clinical Center Nis, Serbia; 3Institut of Nephrology Clinical Center Nis, Serbia Background: The purpose of this study was to analyze pre -treatment anthropometric predictors of total fat mass (TFM), trunk fat mass (TRFM), Aim: The aim of the present study was to investigate the effects of supervised and abdominal fat mass (AFM) changes in a short-term weight loss program aerobic exercise programme on overall cardiovascular risk and oxidative in overweight and obese women. stress-defense parameters in obese type 2 diabetic patients, without any Methods: Subjects were 126 overweight and obese women (age, 38.3±5.8 changes in previously prescribed therapy or usual diet habits. yrs; BMI, 30.3±3.8 kg/m2) who participated in a 4-month lifestyle weight loss Methods: Changes from baseline to 6 months of aerobic exercise were program. At baseline, sagital diameter (SD), body weight (BW), BMI, waist assessed for average daily physical activities, several major cardiovascular circumference (WC) and hip circumference (HC) were the anthropometric risk factors and oxidative stress-defense parameters in total of 38 male, type 2 variables evaluated. Using DXA, changes in body composition variables diabetic patients, aged 53.9 ± 7.4 years, with a mean BMI 31.6 ± 2.6 kg/m2. (TFM, TRFM, and AFM) were estimated. The International Physical Activity Results: Significant (P<0.001) alteration in average daily physical activities Questionnaire was used to evaluate physical activity (PA) and a 3-day recall during the 6 months of the study period and expressed as physical activity was used to estimate caloric intake (CI). Multiple regression analysis was index (33.8 ± 4.6 vs. 37.7 ± 5.9), was followed with significant (P<0.001) performed to assess the relationships between the predictor variables (SD, improvement in BMI (31.6 ± 2.6 vs. 30.3 ± 2.7 kg/m2), waist circumference BW, BMI, WC, and HC) and the outcome variables, TBFM, TRFM, and (108.8 ± 8.1 vs. 102.9 ± 8.2 cm), systolic (140.1 ± 13.7 vs. 122.5 ± 11.3 AFM changes, controlling for PA and CI changes and age. mmHg) and diastolic blood pressure (88.7 ± 8.3 vs. 75.6 ± 6.9 mmHg), Results: After the intervention program, TFM and BW changes were - fasting glycemia (11.4 ± 3.1 vs. 7.3 ± 1.7 mmol/l), glycated hemoglobin (8.6 2.78±3.5 kg and - 3.04±3.1 kg, respectively. Controlling for PA, CI, and age, ± 1.9 vs. 7.3 ± 1.6 %) and median blood glucose (10.6 ± 3.04 vs. 8.2 ± 2.0 TFM changes was inversely related (P<0.05) with initial BW (β=-0.069), mmol/l), as well as glutathione (9.1 ± 0.9 vs. 15.7 ± 5.3 µmol/g Hb) and BMI (β=-0.194), HC (β=-0.100), and SD (β=-0.243). TRFM and AFM plasma malondialdehyde (16.2 ± 4.8 vs. 10.7 ± 2.5 µmol/l). changes were not associated with any independent variable (P>0.05). Conclusion: Regularly prescribed aerobic exercise, performed under Conclusion: These results suggest that baseline values of BW, BMI, SD, and supervision, has beneficial effects on overall cardiovascular risk and HC are good predictors of TFM changes. No association was present with oxidative stress-defense parameters in obese type 2 diabetic patients. initial WC values. Baseline anthropometric measures could not predict changes in specific areas of body fat estimated by DXA.

International Journal of Obesity Abstracts S166 T3:PO.246 T3:PO.247

The effect of a VLCD programme using INSUmed on fat mass in patients with Changes in glucose metabolism and insulin resistance in non-diabetic morbidly BMI above 29 – a comparison of type 2 diabetic and non diabetic patients obese patients after Roux-en-Y Gastric Bypass

1 1 1 1 Görzer Evelyn , Wamser Kerstin , Tscherner Daniela , Toplak Hermann Kalinowski Piotr1, Paluszkiewicz Rafal1, Remiszewski Piotr1, Bialobrzeska- Paluszkiewicz Janina2, Klosiewicz-Latoszek Longina2, Zborowska Hanna3, 1 Dept.Of Internal Medicine, Medical University Graz Krawczyk Marek1

Weight reduction is the most important aim to prevent concomitant diseases in 1Chair And Department Of General, Transplant And Liver Surgery; 2Metabolic patients with overweight and obesity. Conventional weight loss is rarely successful, Outpatient Clinic, Food and Nutrition Institute, Warsaw; 3Central Laboratory, especially when performed in diabetic patients. Primary aim of this trial was to Medical University of Warsaw Central Hospital pursue weight reduction and reduction of fat mass in obese type 2 diabetic patients using a meal replacement programme using a VLCD and to compare the results to Background: Roux-en-Y Gastric Bypass (RYGB) improves glucose metabolism a group of non-diabetic patients. 40 weight stable patients were enrolled (11 obese in morbidly obese diabetic patients but its influence on glucose metabolism in non- diabetic patients and 29 obesity patients) in this outpatient study. At baseline and diabetic patients is not well described. thereafter weekly body composition (body fat mass, body water, lean body mass) Aim: The purpose of the study was to assess changes in glycemia and insulin was collected using bioelectrical impedance measurement (BIA 101, AKERN, resistance in non-diabetic morbidly obese patients following RYGB. Italy). Furthermore dietary and exercise advices were performed weekly. After 2 Methods: Twenty non-diabetic morbidly obese patients (13 females and 7 males) days with 4 INSUmed® products, 2 meals were substituted with INSUmed® underwent RYGB. Patients’ average age was 34.1±7.3 years, average body weight products with one normal meal left (about 600 kcal). In all type 2 diabetic patients 140.9±27.2kg and average Body Mass Index (BMI) 48.1±6.5. Fastingglycemia, the anti-diabetic agents were adjusted carefully. After 12 weeks a weight reduction fasting insulin and HbA1c were measured before the operation and 6 and 12 of 7.5±3.1 kg (P<0.0001) in obese diabetic patients vs. 11.7±4.8 kg (P<0.001) in months after the operation. HOMA model was used to assess insulin resistance. the non-diabetic population could be observed. The reduction in fat mass was Results: All patients had normal fastingglucose levels at baseline that decreased 6 6.9±3.1 kg (P<0.001) in the diabetic group vs. 11.8±4.8 kg (P<0.001) in obese and 12 months after the operation (4.9±0.7 vs 4.4±0.4 vs 4.3±0.3 mmol/l; P<0.05). patients which is 92% and 101% in both groups, respectively. There were no Fasting insulin levels also decreased during the follow up (93.1±55.2 vs 55.6±16.2 hypoglycemic events in our type 2 diabetes population, not even in insulin vs 39.0±9.6 pmol/l; P<0.05). as well as insulin resistance measured with HOMA depending patients, due to the dose adjustment performed. After 12 weeks the (3.1±2.3 vs 1.6±0.5 vs 1.1±0.3; P<0.05). HbA1c level decreased after 6 months insulin need had been gradually reduced to 49% of the start dose, despite that the (5.6±0.4% vs 5.2±0.2%; P<0.05) but increased between 6 month and 12 month mean HbA1c decreased by 0.5%. In conclusion using a VLCD like INSUmed® (5.2±0.2% vs 5.3±0.4%; P>0.05). Six months after the operation average body and concomitant dietary advice in conjunction with exercise and reduction of weight was 103.5±22.5kg, BMI 35.3±5.2 and 12 months after the operation hypoglycaemic therapy led to a significant weight reduction – almost completely 93.3±19.8kg and 31.9±4.7 respectively. through reduction of body fat mass. This programme was completely safe even in Conclusions: In morbidly obese patients RYGB leads to decrease in fasting diabetic patients, though the observed weight loss was by one third lower than in glycemia, fasting insulin and reduction in insulin resistance 6 and 12 months after nondiabetics. The use of VLCD is useful in everyday life and should be established the operation. However HbA1c levels decrease only after 6 months and increase as standard treatment in obese patients, even in those with diabetes type 2. thereafter suggesting an increase in mean glucose levels.

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Metabolic syndrome and related risk factors in primary schoolchildren in Self-efficacy and restraint in relation to weight loss among obese men Greece: the CHILDREN Study and women in Turkey

1 1 1 1 Grammatikaki Evangelia , Tzavara Chara , Bouloubasi Zoi , Konsta Orsalia , Bas Murat1, Donmez Selahattin2 Spyridaki Aspasia2, Fragkiadakis George A.2 Manios Yannis1 1 2 1 Baskent University, Department Of Nutrition And Dietetics; Unnoticed Department of Nutrition and Dietetics, Harokopio University of Athens, 2 Diet Private Nutrition Counselors Greece; Department of Nutrition and Dietetic, Technological Educational Institute of Crete, Greece Objective: To investigate the characteristics of MetS in a sample of Objective: To investigate the characteristics of MetS in a sample of Greek Greek schoolchildren. schoolchildren. Subjects and Methods: 373 selected children, 169 boys and 204 girls Subjects and Methods: 373 selected children, 169 boys and 204 girls (aged (aged 10-12 years) were examined. MetS was defined according to the 10-12 years) were examined. MetS was defined according to the NCEP’s NCEP’s ATP III criteria for metabolic syndrome adapted for ATP III criteria for metabolic syndrome adapted for adolescents. adolescents. Results: The proportion of children with MetS in the total sample was 5,4% Results: The proportion of children with MetS in the total sample was (95% CI: 3.1-7.7), 3.0% in boys and 7.4% in girls (95% CI: 0.4-5.5 and 3.7– 5,4% (95% CI: 3.1-7.7), 3.0% in boys and 7.4% in girls (95% CI: 0.4-5.5 11.0, respectively, P=0.061). Among the individuals with MetS, the and 3.7-11.0, respectively, P=0.061). Among the individuals with MetS, prevalence of its components was: Abdominal obesity 95%, hypertension the prevalence of its components was: Abdominal obesity 95%, 90%, fasting glucose >110mg/dl 10%, low HDL-C 55% and hypertension 90%, fasting glucose >110mg/dl 10%, low HDL-C 55% hypertrigliceridaemia 60%. Individual risk factors were similar for boys and and hypertrigliceridaemia 60%. Individual risk factors were similar for girls (P>0.1 for all risk factors). One or more components of MetS were boys and girls (P>0.1 for all risk factors). One or more components of found in 65.1% of the individuals, two or more in 29.8%, three or more in MetS were found in 65.1% of the individuals, two or more in 29.8%, 5.4% and four or more in 0,5%. The proportion of children with the MetS was greater in those with parental history of diabetes (33.3% vs. 4.4%, P=0,009). three or more in 5.4% and four or more in 0,5%. The proportion of The syndrome was more common in children with one or two obese parents children with the MetS was greater in those with parental history of compared to those with normal weight parents (10.8% vs. 3.8%, P=0,024). diabetes (33.3% vs. 4.4%, P=0,009). The syndrome was more common Conclusions: Abdominal obesity seems to be the most frequent component in children with one or two obese parents compared to those with normal of the MetS in schoolchildren in Greece. Parental obesity or history of weight parents (10.8% vs. 3.8%, P=0,024). diabetes were found to be positively associated with occurrence of MetS in Conclusions: Abdominal obesity seems to be the most frequent schoolchildren. component of the MetS in schoolchildren in Greece. Parental obesity or history of diabetes were found to be positively associated with occurrence of MetS in schoolchildren.

International Journal of Obesity Abstracts S167 T3:PO.250 T3:PO.251

Adiposity indices and dementia Minor effects of green tea catechins and caffeine on energy metabolism in normal weight males 1 1 1 1 Gustafson Deborah , Blennow Kaj , Steen Bertil , Bengtsson Calle , Skoog 1 1,2 1 1 1 Gregersen Nikolaj Ture , Bitz Christian , Krog-Mikkelsen Inger , Hels Ole , Kovacs Ingmar Eva3, Rycroft Jane4, Mela David3, Astrup Arne1

1Gothenburg University 1Department Of Human Nutrition, The Royal Veterinary And Agricultural University (RVAU); 2Novo Nordisk, Copenhagen, Denmark; 3Unilever Food & Health Institute, 4 High body mass index (BMI) is related to dementia and age-related brain Unilever R&D, Vlaardingen, The Netherlands; Unilever R&D Colworth, Sharnbrook, changes in the Gerontological and Geriatric Population Studies and the UK Prospective Population Study of Women in Sweden. We have observed a Background: Green tea may substantially affect energy metabolism; however, it is 36% higher risk of Alzheimer’s disease (AD) and a 2-fold higher odds of unclear if its effects are caused by specific catechins, caffeine or the combination of these. 2 white matter lesions (WML) per one kg/m increase in BMI at age 70. Objective: Examine the separate and combined effects of different catechins and caffeine Compared to women without temporal lobe atrophy, women with atrophy had on energy metabolism and fat oxidation. 2 1.1-1.5 kg/m2 higher BMI over 24 years prior to measurement of temporal Design: Fifteen healthy normal weight (BMI: 22.3 ± 0.4 kg/m ) subjects, mean age 23.6 ± atrophy (P<0.05, 13-16% higher risk). In a subsample of PPSW women 0.7 years, were studied in a 5-way randomized crossover double-blinded placebo- controlled design. The five treatments (given as 6 capsules/test day) were: placebo, donating cerebrospinal fluid (CSF), a lower level of sex hormone binding caffeine, caffeine + epigallocatechin gallate (EGCG), caffeine + epigallocatechin (EGC) globulin (SHBG) measured 24 tears prior, was related to blood-brain barrier or caffeine + mixture of catechins. On each test day energy expenditure (EE), respiratory disturbance, and leptin was not. Finally, in a genetic subsample, cross- quotient (RQ) and substrate oxidation were measured in respiratory chamber for 13.5h. sectional genotype-phenotype associations of the ACE I/D polymorphism and Results: We found no significant treatment effect on EE (P=0.20) or RQ (P=0.68), but adiposity indices showed that ACE II was related to dementia only among clear trends. EGCG/Caffeine resulted in insignificantly higher levels of EE compared to those with a BMI < 25 kg/m2 (P=0.020), waist circumference < 88 cm Caffeine-only and Placebo (5712 ± 119 vs. 5678 ± 137 vs. 5585 ± 127 kJ/12.5h), but (P<0.016) and hip circumference < 101 cm (P=0.049). This emphasizes the lower levels of RQ (0.839 ± 0.009 vs. 0.846 ± 0.007 vs. 0.851 ± 0.007). Fat oxidation was non-significantly higher (84.8 ± 5.2 vs. 80.1 ± 4.6 vs. 76.9 ± 4.0 g oxidized fat/12.5h) on renin-angiotensin system (RAS) linking obesity, hypertension, and EGCG/Caffeine compared to Caffeine-only and Placebo (NS). maintenance of vascular homeostasis in AD pathogenesis. These Swedish Conclusions: Our results suggest that the tested catechins/caffeine combinations at these data illustrate that high BMI increases dementia risk and related pathologies, levels and with this mode of application exert relatively weak effects on EE and fat is influenced by genetic susceptibility, and exhibits temporal patterns related oxidation. Positive trends observed were not significant and indicate that further studies to the natural history of the disease and related pathology. Supported by are required to clarify the role of catechins in energy metabolism. National Institutes of Health/National Institutes on Aging 1R03AG026098 - Conflict of interest: None Disclosed 01A1, the Alzheimer's Association (IIRG-03-6168 and ZEN-01-3151), and Funding: This study was supported by Unilever Food & Health Institute, Unilever R&D, Vlaardingen, The Netherlands. the Swedish Brain Power Project; Gustafson D. Lancet Neurology, 2006;5:713-20.

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Safety profile of Sibutramine during a 6-week treatment period in high-risk patients with Sibutramine is Efficacious for Weight Loss Regardless of Gender - An Analysis of the Sibutramine Cardiovascular cardiovascular disease and/or diabetes - an analysis of the Sibutramine Cardiovascular Outcomes Outcomes (SCOUT) Trial (SCOUT) Trial Coutinho Walmir1, Caterson Ian2, Finer Nick3, Van Gaal Luc4, Maggioni Aldo5, Sharma Arya6, Torp-Pedersen Christian7, James W Philip T8 Maggioni Aldo1, Caterson Ian2, Coutinho Walmir3, Finer Nick4, Van Gaal Luc5, Sharma Arya6, 1 2 3 Torp-Pedersen Christian7, James W Philip T8 Catholic University Of Rio De Janeiro, Brazil; University of Sydney, Australia; Wellcome Trust Clinical Research Facility, Cambridge University, Cambridge, UK; 4University Hospital of Antwerp, Belgium; 5ANMCO Research 6 7 1 2 3 Center, Florence, Italy; McMaster University Hospital, Hamilton, Ontario, Canada; Bispebjerg University Hospital ANMCO Research Center, Florence, Italy; University of Sydney, Australia; Catholic Copenhagen, Denmark; 8London School of Hygiene and Tropical Medicine, London, UK University of Rio de Janeiro, Brazil; 4Wellcome Trust Clinical Research Facility, Cambridge University, Cambridge, UK; 5University Hospital of Antwerp, Belgium; 6McMaster University Introduction: Obesity and overweight are associated with multiple cardiovascular (CV) risk factors but the relative Hospital, Hamilton, Ontario, Canada; 7Bispebjerg University Hospital Copenhagen, Denmark; importance of body weight change in predicting morbidity and mortality in the two sexes at older ages is 8 controversial. Weight may be more responsive to management in men for biological and other reasons. Data from London School of Hygiene and Tropical Medicine, London, UK SCOUT are utilized to better understand gender-related aspects of pharmacologically-induced weight loss. Patients and Methods: Men and women >=55 years with a BMI >=27 kg/m2 and <=45 kg/m2 or <=25 kg/m2 and Introduction: This double blind, randomized, placebo-controlled trial is assessing cardiovascular <27 kg/m2 with waist circumference (WC) >=102 cm (men) or >=88 cm (women) were eligible. Patients must have (CV) outcomes in overweight or obese patients, aged >=55 years at high risk of a CV event. A 6- also experienced a CV event or have type 2 diabetes (T2DM) and another CV risk factor. Before randomization, all week lead-in period when all patients received single-blind sibutramine (SIB) 10 mg plus weight patients received single-blind sibutramine (SIB) 10 mg and weight management for 6 weeks to ensure safety in this high-risk population. management was included to allow an assessment of initial safety in these high-risk, Results: 10,742 patients (58% men vs. 42% women) received SIB 10 mg for 6 weeks. Median age of both groups cardiovascularly compromised patients for whom SIB is normally contraindicated. was 63 years; men presented with more CV disease alone or combined with T2DM (19% vs. 13% and 66% vs. Patients and Methods: Overall 10,742 patients enrolled and were treated. Over 97% presented 51%). Women had more T2DM plus another risk factor (16% vs. 35%). with a medical history of CV disease that included angina (45%), coronary artery disease (64%) Median (5%, 95%) Body Weight, BMI and WC Changes by Gender During 6-week Treatment Period (LOCF and myocardial infarction (41%). The majority was receiving treatment for dyslipidemia (81%) analysis) or hypertension (88%), and 84% had type 2 diabetes mellitus (T2DM). Serious adverse events Men Women Overall (SAE) that met pre-defined regulatory criteria, and those adverse events (AE) that led to study Initial weight (kg) 98.3 89.0 94.8 drug discontinuation were recorded as part of the safety assessment. [79.4, 128.0] [69.0, 116.0] [72.9, 124.0] Results: During the 6-week lead-in period, only 3% of patients discontinued due to an AE. No Weight change (kg) -2.1 -2.3 -2.2*** individual AE led to the discontinuation of more than 0.2% of patients; ranked highest lowest for [-6.3, 0.7] [-6.0, 0.2] [-6.2, 0.5] the 10 most common: drug intolerance, headache, constipation, nausea, insomnia, hypertension, % weight change -2.2 -2.6 -2.4*** [-6.1, 0.7] [-6.6, 0.3] [-6.4, 0.5] dry mouth, tachycardia, atrial fibrillation, and blood pressure increase. SAEs occurred in 2.7% of 2 patients. No single SAE occurred in more than 0.2% of patients; ranked highest-lowest for the 5 Initial BMI (kg/m ) 32.9 35.1 33.8 [28.0, 41.6] [28.2, 44.2] [28.1, 43.1] most common: atrial fibrillation, unstable angina, angina pectoris, coronary artery disease, and BMI change (kg/m2) -0.7 -0.9 -0.8*** myocardial infarction. During this 6-week period, 15 patients died (0.1%) including 10 attributed [-2.1, 0.2] [-2.4, 0.1] [-2.2, 0.2] to a CV cause, equivalent to rates of 1.2% and 0.8% per year, respectively. Initial WC 113.0 109.0 Conclusion: The SAEs and discontinuations for AEs were lower than might be anticipated for [99.5, 134.0] [92.0, 129.0] these high-risk patients. SIB was well tolerated. No new safety signals were identified in this WC change (cm) -2.0 -2.0 large group of high-risk patients during the 6-week treatment period. Patients are continuing in [-8.5,2.9] [-9.0, 3.0] the first double-blind study of weight loss in patients with a high risk of CV morbidity. *** P<0.001 (per Wilcoxon Signed Rank Test) Conflict of Interest and Funding Disclosure: Payment received from Abbott Laboratories for Conclusion: Despite being lighter, with lower predicted lean body mass, women lost at least as much weight as men. participation in the Executive Steering Committee of the SCOUT study. Research relating to this The overall changes from week –6 to baseline/ endpoint for body weight, BMI and WC were statistically significant abstract was funded by Abbott. (P<0.001). Conflict of Interest and Funding Disclosure: Payment received from Abbott Laboratories for participation in the Executive Steering Committee of the SCOUT study. Research relating to this abstract was funded by Abbott.

International Journal of Obesity Abstracts S168 T3:PO.254 T3:PO.255

Impact of Type 2 Diabetes and Cardiovascular Disease on Initial Response (6-weeks) to Sibutramine Six-week Treatment Period with Sibutramine Reduces Blood Pressure in High-risk Hypertensive Patients – An Treatment - An Analysis of the Sibutramine Cardiovascular Outcomes (SCOUT) Trial Analysis of the Sibutramine Cardiovascular Outcomes (SCOUT) Trial

1 2 3 4 5 6 1 2 3 4 5 6 Sharma Arya , Caterson Ian , Coutinho Walmir , Finer Nick , Van Gaal Luc . Maggioni Aldo , Torp-Pedersen Van Gaal Luc , Caterson Ian , Coutinho Walmir , Finer Nick , Maggioni Aldo , Sharma Arya , Torp- 7 8 7 8 Christian , James W Philip T Pedersen Christian , James W Philip T 1 2 3 1 2 3 McMaster University Hospital, Hamilton, Ontario, Canada; University of Sydney, Australia; Catholic University University Hospital Of Antwerp, Belgium; University of Sydney, Australia; Catholic University of Rio 4 4 of Rio de Janeiro, Brazil; Wellcome Trust Clinical Research Facility, Cambridge University, Cambridge, UK; de Janeiro, Brazil; Wellcome Trust Clinical Research Facility, Cambridge University, Cambridge, UK; 5University Hospital of Antwerp, Belgium; 6ANMCO Research Center, Florence, Italy; 7Bispebjerg University 5 6 ANMCO Research Center, Florence, Italy; McMaster University Hospital, Hamilton, Ontario, Canada; Hospital Copenhagen, Denmark; 8London School of Hygiene and Tropical Medicine, London, UK 7Bispebjerg University Hospital Copenhagen, Denmark; 8London School of Hygiene and Tropical Medicine, London, UK Introduction: In obese patients with an increased risk for cardiovascular (CV) mortality and morbidity such as those enrolled in the ongoing SCOUT trial, blood pressure (BP) control is of vital importance. This analysis addresses BP Introduction: While moderate weight loss improves metabolic and cardiovascular (CV) risk factors, there effects and tolerance of sibutramine (SIB) over a 6-week period in this high-risk population. is evidence that patients with Type 2 diabetes mellitus (T2DM) fail to achieve even this goal. The SCOUT Patients and Methods: SCOUT is a double blind, randomized, placebo-controlled outcome trial in overweight or obese subjects at high risk of a CV event. All patients enter an initial single blind, 6-week lead-in period and receive trial was used to assess patients with different risk factors and their ability to lose weight with SIB 10 mg. Patients with uncontrolled hypertension (i.e., Systolic (S) BP >160 mmHg and Diastolic (D) BP >100 sibutramine. mmHg were not eligible. No change in BP medication was permitted during the single blind period. Patients were Patients and Methods: During a 6-week lead-in period before randomization into a placebo-controlled considered to be normotensive if their values for SBP/DBP were <140/90 mmHg or <130/80 mmHg for patients phase, all patients received a weight management program and single blind sibutramine (SIB) 10 mg with diabetes before the 6-week treatment period. daily. Enrolled patients were classified into CV risk categories prior to treatment: Results:10,742 patients entered the study. In the 25% of patients who were normotensive, antihypertensive class use a) Pre-existing CV disease but not T2DM with another risk factor (CV only) comprising ß-blocker, diuretic, angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker, calcium b) T2DM and no pre-existing CV disease but at least one CV risk factor (T2DM only). channel blocker or other was reported in 20% (1 class) and in 59% (>=2 classes), respectively. Of the 75% who c) Pre-existing CV disease and T2DM with another risk factor (CV+T2DM) entered with hypertension, 9% reported no use of antihypertensive medication; 21% and 71%, respectively were Weight loss during the 6-week period was assessed by risk category. receiving 1 or >=2 classes. Results: 10,742 patients received SIB 10 mg. Over 16% were classified as CV only, 24% T2DM only, Median BP by Initial BP Classification and Concomitant BP Medication (LOCF analysis) and 60% CV+T2DM. In total, 84% of the patients presented with pre-existing T2DM; 72% of subjects Initial SBP/DPB SBP/DPB at 6 Change in were receiving treatment for T2DM with a biguanide (45%), sulfonylurea (30%), insulin (26%) or other (mmHg) weeks or final SBP/DPB classes of drugs. th th visit (mmHg) (mmHg) Median Weight Change [5 , 95 percentiles] by Initial Risk Category During 6-week Treatment Normotensivea No BP medication 123.5/71.0 123.5/72.5 1.0/1.0 Period (LOCF analysis) 1 BP medication 124.0/71.0 124.5/72.0 1.0/1.0 class CV Only T2DM Only CV+T2DM Overall 2 or more BP 124.0/70.5 124.5/72.5 1.5/1.5 medication classes

Hypertensiveb No BP medication 142.0/80.0 136.0/79.0 -4.5/-1.5 Initial weight 93.5 95.7 94.8 94.8 1 BP medication 143.0/80.5 138.3/79.5 -4.0/-1.0 (kg) [73.0, 122.0] [74.0, 126.7] [72.5, 123.5] [72.9, 124.0] class Weight -2.5 -2.2 -2.0 -2.2 2 or more BP 143.0/81.0 137.5/79.0 -5.0/-2.0 change (kg) [-6.8, 0.5] [-6.2, 0.5] [-6.0, 0.5] [-6.2, 0.5] medication classes % weight -2.6 -2.4 -2.3 -2.4 change [-6.9, 0.5] [-6.2, 0.5] [-6.3, 0.6] [-6.4, 0.5] a: Normotensive: <140/90 mmHg (non diabetic); <130/80 mmHg (diabetic) b: Hypertensive: 1140/190 mmHg (non-diabetic); 1130/180 mmHg (diabetic) Conclusion: 6-week treatment with SIB 10 mg was similarly effective in weight reduction in Conclusion obese/overweight patients with pre-existing CV disease and/or T2DM at high risk of having new CV Treatment with SIB for up to 6 weeks in normotensive high-risk patients resulted in small median increases in BP events. consistent with changes previously observed. In patients classified as hypertensive, BP was reduced even in those patients already receiving 12 classes of medication for BP control.

T3:PO.256 T3:PO.257

Significance of Cognitive-Behaviroal Therapy in the Treatment of Obesity Weight loss results for 4881 females who started the LighterLife Pejicic Snjezana1, Burgic-Radmanovic Marija2 Programme in 2005 and who completed at least 12 weeks

1Clinical Center Banja Luka, Clinic For Endocrinology, Diabetes And Metabolic Disease; Horsnell Tina1, Holt Joanna1, du Plessis Juliette1, Cox Jackie1, Hewlett 2 Clinic for Psychiatric Disease, Clinical Center Banja Luka, BiH Bar1

Dietary therapy, increased physical activity and behavioral therapy are basic measures in 1 the treatment of obesity. Behavioral therapy offers methods which change eating habits of LighterLife, UK obese persons, aiming to remove barriers relating dietary therapy and increased physical activity. The goal is to try efficiency of applying cognitive-behavioral therapy in the LighterLife is a medically monitored, commercial Weight-loss and program for the reduction of body mass of obese persons, versus the application of Weight-Management Programme, specialising in the treatment of dietary therapy and physical activity alone. The study included 60 obese persons, who 2 were divided into two groups (A and B), with 30 patients in each group, 20 to 58 years of patients with BMI >29kg/m . The Programme uses a nutritionally- age with the body mass index (BMI) >= 30 kg/m2 and hyperlipidemia (LDL cholesterol complete Very Low Calorie Diet (VLCD), (average values 530 Cals, 50g >= 4.2 mmol/l serum), who have not been previously treated for obesity and were prot, 50g Carbs) complemented by Transactional Analysis and Cognitive unhappy with their weight. Patients from both groups were on hypocalorie diet, Behavioural Therapy (TCBT) as the cornerstone to change. During the individually designed and had physical activity every day. Patients in group B underwent group cognitive - behavioral therapy under the supervision of psychiatrist once a week initial weight loss stage, female patients abstain from conventional food with the duration of 120 min (total 12 sessions). Both groups also went to see an for 14 weeks. Abstinence from conventional foods enables individuals to endocrinologist 6 times, on which occasions their body weight, blood pressure, reflect and evaluate food habits and choices. Once patients have parameters of lipid status serum and level of glucose in serum were measured. The study successfully reached the target weight using the VLCD, an ongoing lasted for 12 weeks. Results showed that in group B the medium value of body mass reduction after twelve weeks of treatment was 9.5kg (8.9%), which corresponded the weight-maintenance programme provides ongoing support and help to expected reduction (5-15%) and in group A 4.4 kg (4.1%), In group B, LDL cholesterol patients to help them to implement and sustain further healthy lifestyle decreased for 34.5% and in group A for 5.0%; HDL cholesterol increased for 2.7% while changes whilst returning to conventional food. Of 4881 female patients in group A it decreased for 2.5%; total triglycerides decreased for 15.3%, and in group A that started the LighterLife Programme in 2005, 70% (3417) remained for 5.4%; values of glicaemia decreased for 14.8% while in group A they remained on the Programme until at least week 12. The mean average weight loss unchanged. Behavioral therapy primarily affected the improvement of motivation and readiness of patients to stick to the dietary regime and physical activity (in 100% of the at 12 weeks on the weight loss stage was 19.2kg and mean weight loss patients).In designing the program for the reduction of obesity it is necessary to include per week was 1.55 Kg. In January 2006 LighterLife developed new cognitive – behavioral therapy, which brings significantly better therapy outcomes. programme materials and product formulations, which may improve Obesity treatment requires multidisciplinary approach as well as individual therapeutic attrition and compliance. Weight loss and completion results for 2006 approach to every patient. Cognitive – behavioral therapy is recommended as initial therapy in slight and moderate forms of obesity, as well as an addition to pharmacological will be reported. therapy in severe and very severe forms of obesity.

International Journal of Obesity Abstracts S169 T3:PO.258 T3:PO.259

Obese men are at higher risk than obese women. Following a small trial, What motivates men to lose weight? a long term observational study will report over the next 10 years on Holt Joanna1, Horsnell Tina1, Mullins Gill1, du Plessis Juliette1, Cox Jackie1, weight loss and weight maintenance on a group of self referred obese Hewlett Bar1 men 1LighterLife Holt Joanna1, Horsnell Tina1, Cox Jackie1, du Plessis Juliette1, Mullins Gill1, Hewlett Bar1 Obesity is an ever increasing problem in both men and women, and carries increased health risks for men associated with central obesity 1LighterLife Motivating factors for losing weight may differ for men. It is important that such factors be clearly understood to enable the development of approaches that are attractive to men. It is recognised that uptake onto commercial slimming Programmes is LighterLife is a commercial medically monitored, Weight-loss and Weight- much lower for men than for women. maintenance Programme which specialises in the treatment of patients with BMI LighterLife is a medically monitored, commercial Weight-loss and >29kg/m2. Currently 8.6% of the LighterLife patient base is male. Weight-Maintenance Programme which specialises in the treatment of 250 men were asked about their own motivation for losing weight and startinga patients with BMI > 29kg/m2. Currently, men and women use the same diet and their requirements if they did decide to diet. Programme; Very Low Calorie Diet (VLCD), (average 530 Cals, 50g prot, 50g Carbs) complemented by Transactional Analysis and Cognitive Responses – Motivating factors for weight loss Behavioural Therapy (TCBT) as the cornerstone to change, During the Impact of health on family 30% initial weight loss phase male clients abstain from conventional food for Impact of health on relationships 30% an initial period of at least 8 weeks, with further weight loss modules if Effect on work 10% required. Vanity 30% In 2005 approximately 8.6% in of LighterLife’s patient base was male. Previously reported data shows that male patients achieve average Responses – Attractive features of the LighterLife Programme weight loss of 18.9Kg (3 stone) in 8 weeks. In 2007 LighterLife is Simplicity/easy to understand 40% launching a male specific programme; levels of uptake, weight loss and Fast/effective results 35% completion results will be collated for new starting male patients from Support/counselling 25% January 2007 onwards and weight loss and long term weight maintenance results will be reported. Weight loss programmes should focus toward the main factors that motivate men in order to attract patients. Results from this survey indicate that the men’s motivations are associated with the impact of their health/weight on personal relationships and family life. Results also suggest that a straightforward approach and method, rapid, attainable results and support provided by the group and counsellors are important to male patients.

T3:PO.260 T3:PO.261

Orlistat reduces anthropometric parameters in a different way according to sex Orlistat reduces obesitygrade. Differences in the classification of obesity according to the gender Bellido Guerrero Diego1 Bellido Guerrero Diego1 1Hospital Arquitecto Marcide, El Ferrol (A Coruña), Spain 1Hospital Arquitecto Marcide, El Ferrol (A Coruña), Spain Introduction: The therapy against obesity has considerably improved thanks to the discovery of new drugs, like orlistat, a reversible inhibitor of the intestinal lipase. This Introduction: Orlistat works by inhibits gastrointestinal lipase. As a result of this article analyzes the different reduction of the anthropometric and analytic parameters mechanism of action, 30% of ingested dietary fat is not absorbed. between men and women. Primary objectives: Methods: All 6770 patients were obese or had overweight Grade II. Patients were treated 1. Analysis of obesity grade. with hypocaloric diet and orlistat for a minimum period of 3 months. Orlistat 120-mg was 2. Analysis stratified by gender. given t.d.s. with meals or up to 1 hour after a meal. Methodology: Patients included in the study had type II overweight or were obese. Results: Significant decreases in mean body weight (7.3%), means VAT (11.62%, which Patients were treated with orlistat and hypocaloric diet for a minimum period of 3 months was 1.38 times higher in men than in women), mean BMI (7.88%), and mean abdominal at dose of 120-mg with meals or up to 1 hour after a meal perimeter (greater decrease in men as well, 1.56) was seen after three months of Results: Weight (7.3%), BMI (7.88%), waist perimeter (5.52%) and VAT (11.62%) were treatment. More outstanding changes in the analytic results were seen in men (glucose, reduced significantly by orlistat. At visit VT, the number of patients with Type II Systolic BP, total and LDL cholesterol, triglycerides and HbA1c), with the exception of overweight or Obesity Type I increased at the expense of patients with higher grade of

HDL cholesterol that was the same for both sexes, but women had a greater reduction in obesity, whose number decreased (from 90 patients with Obesity Type IV at VB to 2

Diastolic BP and LDL. patients at visit VT). In the analysis bygender the same trend was observed. The

percentage of obese women at VB was 84.29%, and 56.78% at VT. Men were 90.30% at Evolutions Men Women P-value VB and 77.84% at VT. (%) (n = 2895) (n = 3873) Mann-Whitney CLASSIFICATION MEN WOMEN Glucose (mg/dl) (15.3-16.7) (7-8.1) 0.000 (%) BASAL FINAL BASAL FINAL Systolic BP (mmHg) (8.0-9.0) (6.7-7.5) 0.006 Normal 0.00 0.04 0.00 0.27 Diastolic BP (mmHg) (1.9-2.7) (3.3-3.7) 0.000 Overweight I 0.00 3.25 0.00 8.52 Total Cholesterol (mg/dl) (14-15.8) (12.2-13.4) 0.004 Overweight II 9.70 18.86 15.70 34.70 HDL Cholesterol (mg/dl) (-0.5-0.2) (0.1-0.7) 0.080 Obesity I 47.17 63.08 43.58 38.98 LDL Cholesterol (mg/dl) (3.8-5.3) (7.5-8.5) 0.000 Obesity II 29.97 6.73 28.71 12.79 Triglycerides (mg/dl) (39.5-44.0) (21.2-22.9) 0.000 Obesity III 11.43 8.03 10.97 4.94 HbA1c (%) (0.56-0.6) (0.4-0.45) 0.000 Obesity IV 1.73 0.00 1.03 0.07

Conclusions: Orlistat demonstrated a reduction in the analytical and anthropometric Conclusions: Orlistat has proved efficacy in the reduction of obesitygrade in both men parameters with a greater efficacy in abdominal perimeter and VAT in men. and women, showing a bigger difference in women. In some cases ideal body weight was achieved.

International Journal of Obesity Abstracts S170 T3:PO.262 T3:PO.263

Orlistat reduces the anthropometric parameters depending on the obesity grade Orlistat reduces the visceral adipose tissue according to the central obesity grade

Bellido Guerrero Diego1 Bellido Guerrero Diego1

1Hospital Arquitecto Marcide, El Ferrol (A Coruña), Spain 1Hospital Arquitecto Marcide, El Ferrol (A Coruña), Spain

Introduction: Obesity is a condition in which the fatty tissue is increased to be a risk Introduction: Obesity is characterized by an excess body fat, which usually involves an factor for certain health conditions. Orlistat blocks the absorption of approximately 30% increase in the weigh and the co-morbidity risk. Orlistat is a lipase inhibitor, which blocks of fat. This action helps patients decrease weight and keep it off, and to improve obesity- the absorption of 30% of ingested dietary. related conditions. The study’s objectives were to calculate the anthropometrics Methods: The included patients were treated with low-caloric diet and Orlistat during 3 parameters reductions, and its relation with the obesity grade. months at the least, at doses of 120 mg 3 times a day. Data was evaluated at the beginning Methods: The included patients were grade II overweigh or obese treated with low- of the study (VB) and after 3 months (VT). caloric diet and orlistat during 3 months at doses of 120 mg 3 times a day. Results: At VB the values were: 91.4 kg weigh, 106.3 cm abdominal perimeter (AP), Results: At basal visit the values were: 91.4 kg weigh, 106.3 cm abdominal perimeter 34.4 kg/m2 BMI and 172.0 cm2 VAT. At VT, reductions were observed: 6.8 kg in weigh, (AP), 34.4 kg/m2 BMI and 172.0 cm2 VAT. After 3 months reductions were observed: 2.7 kg/m2 in BMI, 6.0 cm in AP and 20.8 cm2 in VAT. The VAT reduction was function 6.8 kg in weigh, 2.7 kg/m2 in BMI, 6.0 cm in AP and 20.8 cm2 in VAT. All reductions of gender, 14.16% in men and 10.27% in women. The VAT reduction was greater in were statistically significant. The anthropometric parameters and the obesity grade were central obese patients at high risk (men > 102 cm, women > 90cm) than in central obese higher in men than in women on basal and final visit. The relation between the patients (men 95-102 cm, women 82-90 cm). The reduction was greater in the central anthropometric parameters reductions and the obesity grade was linear. It was distorted obese patients than in non-obese patients too. The VAP reduction was correlated with the for grade IV obese patients for VAT and AP. The weigh and BMI reductions increased AP reduction (Spearman's coefficient: 0.987) and it was different depending on the sex. (grades I-II) and decreased (grades III-IV) with the obesity. N % Mean P-value Weight AP BMI Reduction Kruscall- Reductions N VAT (%) (%) (%) (%) Wallis (%) Normal 98 1.74 7.44 Overweight II 841 5.9 10 4.3 6.4 Low Risk 619 10.92 8.28 0.000 Obesity I 6.0 2910 7.0 12.1 9.4 High Risk 4954 87.35 12.06 Obesity II 6.0 1907 8.7 12.1 9.4 Total 5671 100.00 11.62 Obesity III 7.1 714 6.9 13.8 7.9 Conclusion: Orlistat reduces the VAT surface according to the central obesitygrade. The VAP reduction was correlated with the AP reduction. Conclusions: The relation between the anthropometric parameters reductions and the obesity grade is linear.

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Orlistat reduces the weigh according to the basal measurement of triglycerides Orlistat Reduces The Metabolic Syndrome And Its Associated Factors

Bellido Guerrero Diego1 Muñoz Torres M1, Alonso G1

1Hospital Arquitecto Marcide, El Ferrol (A Coruña), Spain 1Hospital Universitario San Cecilio, Granada, Spain

Introduction: Obesity is a risk factor for the cardiovascular disease. Medication commonly The therapy against obesity has considerably improved thanks to new drugs, like orlistat, an prescribed for obese patients is orlistat, which reduces intestinal fat absorption by inhibiting intestinal lipase inhibitor. This article analyzes the prevalence of Metabolic Syndrome (MS). pancreatic lipase. Methods: All 6770 patients were obese or had overweight Grade II. Patients were treated with The study objective was to analyze the weigh and triglycerides reductions. orlistat and hypocaloric diet for a minimum period of 3 months. Orlistat 120-mg was given t.d.s. Methods: The included patients were overweigh or obese. They were treated with a reduced with meals or up to 1 hour after a meal. calorie diet and orlistat during three months. Orlistat was administered at doses of 120 mg 3 Results: After treatment, significant reductions in VAT, weight, abdominal perimeter and BMI times a day with the food or 1 hour after meals. were founded. MS was defined as the conjunction of 3 or more risk factors in a patient. After Results: At basal visit, the patient’s values were: 91.4 kg of weigh, abdominal perimeter (AP) of follow up all risk factors were reduced significantly. At baseline, 66.15% of patients presented 106.3 cm, BMI of 34.4 kg/m2 and VAT of 172.0 cm2. After three months, reductions in these MS, and only 34.07% three months after. Patients with MS at baseline reduced its VAT 3.95 measurements were observed: 6.8 kg in weigh, 2.7 kg/m2 in BMI, 6.0 cm in AP and 20.8 cm2 in times more than the ones without MS. Men had greater VAT reductions than women in all risk VAT. Regarding the basal values, all reductions were statistically significant. factors. The mean weigh reduction in men was 7.40 kg, while in women was 6.31 kg. These Risk Factor Mean p-value Men Women p- differences had statistical significance. Reduction Reduction Mann- (%) (%) value The weigh reduction was greater in patients with high concentration of triglycerides Whitney than in patients with low concentration. Central No 9.98 12.67 8.50 0.000 Obesity 0.000 Yes 23.92 28.70 22.11 0.000 N % Mean p-value Reduction Triglycerides No 9.63 10.46 9.24 0.000 (% Weight) 0.000 Hypertriglyceridemia No 5350 99.25 7.76 Yes 15.39 20.87 11.74 0.000 1 Yes 40 0.75 7.42 0.352 Triglycerides >200 HDL- No 11.16 13.49 9.96 0.000 mg/dl Cholesterol 0.001 Cholesterol >200 mg/dl Yes 13.42 19.00 10.15 0.000 Hypertriglyceridemia No 3848 81.83 7.50 2 Yes 854 18.17 8.62 0.000 BP No 11.63 14.25 10.29 0.000 Triglycerides >200 0.514 mg/dl Yes 11.55 13.90 10.17 0.000 Hypertriglyceridemia No 2787 59.28 6.86 0.000 3 Yes 1915 40.72 8.92 Glucose No 11.11 12.82 10.31 0.000 Triglycerides > 170 0.000 mg/dl Yes 17.80 24.23 9.08 0.000 Conclusions: Orlistat is an effective medicine for reducing weigh. To higher basal concentration of triglycerides, greater reduction of weigh. Conclusions: Orlistat reduces the number of patients with MS and its associated problems. These reductions are related to a greater decrease of the VAT, being more appreciable in men.

International Journal of Obesity Abstracts S171 T3:PO.266 T3:PO.267

Orlistat Reduces Both Anthropometric And Analytic Parameters In Obese Patients Or Patients Effect of Orlistat on adiposity and lipidic metabolism in women with excess With Overweight Type Ii of weight after being surgically treated with : prospective Lobón Hernández Ja1 longitudinal study

1 Universidad De Granada, Granada, Spain Marti-Giménez I1, Sánchez-Hernández J2, Palacin Jm1

Introduction: Obesity is a chronic metabolic pathology characterized by an excess of body fat 1 2 commonly associated with overweight. It is a risk factor for other chronic diseases like diabetes, Servicio Cirugía Plástica. C.M.Teknon, Barcelona, Spain; Departamento De hart disease, and hypertension. Improvements in obesity have been achieved by orlistat, which Medicina. Universidad De Barcelona, Barcelona, Spain avoids 30% of ingested dietary fat to be absorbed. Primary objectives: 1. To analyze the evolution of the anthropometric parameters. 2. To analyze the evolution of the analytic parameters. Introduction: Obesity is an abnormal accumulation of body fat which is Methods: All patients included in the study had overweight Type II or were obese. Patients were associated with an increased risk of cardiovascular diseases. Liposuction treated with orlistat and hypocaloric diet for a minimum period of 3 months. Orlistat 120-mg was surgery can help reduce this risk. Orlistat is a drug to treat obesity because given t.d.s. with meals or up to 1 hour after a meal. Visceral adipose tissue (VAT) was calculated limits the absorption of monoglycerides and free fatty acids. with Simone Lemieux et al. evaluation. Data was collected from VB to VT during three months. Results: The average VAT (20.8 cm2), body weight (6.8 Kg) and BMI (2.7 Kg/m2) reductions Methods:An observational study was realized in women with excess of were statistically significant. Average abdominal perimeter reduction was 6.0 cm, greater y men weight after being surgically treated with liposuction. After surgery, the than in woman. There was a significant drop in all mean values of all analytic parameters after patients received low-caloric diet or low-caloric diet and orlistat to control the treatment: weigh excess during 6 months. The study objective was: REDUCTION P-value (units) Mann-Whitney To confirm the orlistat efficacy in the reductions of weight, body mass index Glucose (mg/dl) 10.4 (14.97) 0.000 (BMI), abdominal perimeter (AP), visceral adipose tissue (VAT), conicity index (CI) and metabolic profile. Systolic AP (mmHg) 7.7 (12.66) 0.000 Results: Reductions in the weight (3.7%/8.9%), BMI (3.9%/9.9%), AP (4.02%/7.3%), VAT (11.8%/19.1%) and CI (2.1/2.8) were observed in the Diastolic AP (mmHg) 3.0 (8.70) 0.000 two treatment arms. These reductions were greater in the orlistat arm (second Total Cholesterol (mg/dl) 13.5 (16.36) 0.000 values). The cholesterol mean value was the same in the beginning that at the end of the study. The triglycerides mean value was lower at the end of the HDL Cholesterol (mg/dl) 0.2 (7.12) 0.044 study (76 mg/dl) that in the beginning (81.38 mg/dl). The HDL-cholesterol was greater at the end of the study (58.66 mg/dl) that in the beginning (54.94 LDL Cholesterol (mg/dl) 6.9 (13.17) 0.000 mg/dl). As a result, the triglycerides/HDLcholesterol ratio decreased. Triglycerides (mg/dl) 28.7 (30.63) 0.000 Conclusions: Regarding the non orlistat arm, orlistat make easier the anthropometric parameters reductions. Orlistat could act directly or indirectly HbA1c (%) 0.5 (0.41) 0.000 on the fatty redistribution produced by the liposuction surgery because the VAT and CI reductions are grater in this treatment arm. Conclusions: Orlistat demonstrated a reduction in the anthropometrical and analytical parameters in both genders with a greater influence in men.

T3:PO.268 T3:PO.269

Effect of orlistat on the insulinemia and insulin resistence index (homa) in patients after being Effect of orlistat on the systemic inflammation parameters in obese patients surgically treated with liposuction: prospective longitudinal study

1 1 Sánchez-Hernández J1, Marti-Giménez I2, Ballesta-Alcaraz J3, Juan Gil B4 Formiguera Xavier , Sierra Ángel

1Departament De Medicina. Universitat De Barcelona, Barcelona, Spain; 2Servicio Cirugía 1 3 Servei De Medicina Interna. Unitat D'Obesitat Mòrbida. Hospital Plastica. C.M.Teknon, Barcelona, Spain; Servicio Cirucía Plástica. Sagrat Cor., Barcelona, Spain; 4Unidad Diagnóstico Por Imagen. Hospital Sant Joan Martorell, Barcelona, Spain Universitari Germans Tries I Pujol, Badalona, Spain Introduction: Obesity is a condition in which the fatty tissue is increased to be a risk factor for Introduction: The obesity is a pathology associated with an increased risk of certain health conditions. Orlistat is a gastrointestinal lipase inhibitor which blocks the absorption cardiovascular diseases, hypertension, dyslipemia, insulin resistance and type of 30% of ingested dietary fat. Methods: This is a study of women who underwent liposuction and received low caloric diet II diabetes. In the last years increased values of the inflammation markers (C- after, and women that had low caloric diet and orlistat (120 mg t.d.s) after surgery. The reactive protein – CRP) have also been reported in obese patients. objectives of this study were: - To confirm the efficacy and safety of orlistat in the Methods: A study with two treatment arms was performed: one arm was anthropometric parameters reductions after liposuction. treated with low-caloric diet and the other one with low-caloric diet and - To assess the effect of these reductions. Results: Reductions in the VAT, weight, BMI and conicity index (CI) were observed in the two Orlistat at doses of 120 mg t.d.s. Data from 49 patients was evaluated at the treatment arms. These reductions were greater in the orlistat arm. Reduction in insulin was beginning of the study and 1 week and 3 months after. observed exclusively in the women treated with orlistat being statistically significant. The Objectives: mentioned reductions in the VAT, weight, BMI and CI did not have any influence on the • To evaluate the impact of the reductions in the anthropometric parameters reduction of insulin. The HOMA model showed that the resistance to insulin decreased in the orlistat arm. on the cytokines levels (tumour necrosis factor alpha (TNF ), interleukin-6 and adiponectine) and on the systemic inflammation markers (CPR). TREATMENT PARAMETERS EVOLUTION- (Mean ± SD) Results: The anthropometric parameters decreased significantly in both Insulin* VAT Weight** BMI** CI HOMA* treatment arms. In the orlistat arm a greater weight reduction (5.4% vs. 2.5%) and a greater decrease in obesity grade were observed comparing to the No Orlistat 19.6% 11.5% -3.7% -3.9% -2.3% 20.3% control arm. The evolution of the cytokine levels was not found to be (±0.196) (±0.132) (±0.043) (±0.039) (±0.045) (±0.567) statistically significant. Occasionally, increased cytokine levels were Orlistat 24.2% 19.3% -8.9% -9.8% -3.1% -25.9% observed in all the cytokine types. The CRP mean value had an increase of ±0.113) (±0.128) (±0.067) (±0.067) (±0.035) (± 14.5% in the control arm and a drop of 10.95% in the Orlistat arm comparing 0.119) to baseline. Conclusions: The evolution of the CRP values in the patients treated with * U Mann-Whitney, P-value < 0.05 ** T-Student, P-value < 0.05 Orlistat was positive while in the other group the opposite tendency was observed. The cytokines did not have any significant evolution during the Conclusions: Orlistat is effective in the reductions of weight and BMI after liposuction, and has study. an effect on the resistance to the insulin and its reduction.

International Journal of Obesity Abstracts S172 T3:PO.270 T3:PO.271

Effect of orlistat on visceral fat in patients treated with liposuction Liver involvement in obese children and adolescents Monereo Megias S1, Montoya Álvarez T1, Olivar Roldán J1, Mato Ansorena J2 Muller Regina1 1Servicio Endocrinología Y Nutrición. Hospital De Getafe, Getafe, Spain; 2Cirujano Plástico. Clínica Mato-Ansorena, Madrid, Spain 1Pediatrics Society Of São Paulo, Sao Paulo, Brasil Introduction: The visceral fat (VF) plays a key role in obesity etiopathogenia. Recent studies show that neither VF nor the insulin resistance were modified by the subcutaneous Objective: The aim of this study is to assess hepatic dysfunction in fat removal through lipectomy and/or liposuction unless they were accompanied by a obese patients. negative energy balance. The study objective is to analyze the orlistat effect on VF in Methods: 30 patients, between 7 and 18 years old (median 13 years and patients treated with liposuction. Methods: 31 women with a mean BMI 26.17 ± 3.9 and normal metabolism of 3 months) were clinical and laboratorial studied and followed up at carbohydrates and lipids underwent wide liposuction (2445.3 ± 1420 cc). After General and Adolescent out patient clinic. It was used NCHS weight/ randomization: 12 patients took balanced diet and orlistat at doses of 120 mg t.d.s. during height curves and body mass index (BMI=W/H2) to diagnose obesity, 6 months, and 19 patients only took balanced diet. The anthropometric and analytical considering obese patients the ones who were above the 95th NCHS and parameters were studied and an image study was performed (transverse section at BMI percentile. Laboratory tests: serum levels of ALT- alanine intervertebral space L4/L5) to assess the VF in the beginning of the study and after 6 months. aminotransferase, AST – aspartate aminotransferase, AP- Alkaline Results: There were not any significant differences in the studied variables between the phosphatase, GGT – gamma-glutamyl transferase, cholesterol, HDL- two groups. However, the orlistat group reduced VF and lipidic profile. cholesterol, LDL-cholesterol.and tryglicerides. Abdominal ultrasonography was performed and it was analyzed the following sites: Reductions Control Orlistat P liver (size, surface, parenchyma, echogenecity, edges, vessels, biliary Weight (kg) 4,58+6,47 4,73+4,89 0.9 BMI (kg/m2) 1,67+2,33 1,73 +1,78 0.9 ducts) and the gallbladder. AP (cm) 8,97+13,35 5,75 +4,45 0.6 Results: Physical examination: acantosis nigrans in five adolescents and Visceral fat (cm2) 10,77+36.02 17,51+25,81 0.6 two of them with hepatomegaly. Cholesterol level and serum Visceral fat (%) 8,68+10,87 3,32+22,59 0.49 triglycerides was increased in 5 patients (16, 60%) with decreased HDL Cholesterol (%) 7,72+2.09 8,27+12.58 0.2 and increased LDL. The ALT values were increased in 8 patients (26, Triglycerides (%) 5,65+51,91 16.6+34,03 0.55 6%) and AST increased in 3 patients (10%) (74-138 IU/L and 42%¨-142 cHDL (%) 4,39+10,37 % +3,12+8,5% 0.1 IU/l). Abdominal ultrasonography revealed bright, diffusely echogenic cLDL (%) +4,01+26.76% 17,29+18,95% 0.07 liver consistent with liver steatosis in 9 patients. Litiasis were found in 3 Conclusions: The weigh loss observed after liposuction is not associated with the VF patients and decreased gallbladder contractility in 5 patients. reduction. Orlistat after liposuction is better than liposuction only, because patients Conclusion: The high frequency of steatohepatitis, litiasis and hipo- reduce VF and improve lipid profile. contractility of gallbladder show us that ultrasonograph is very important for early cholelithiasis diagnosis.

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Associations between alcohol consumption measured by carbohydrate- Reporting on the mean weight loss and reduction in BMI for 11511 females deficient transferrin and anthropometric indices who completed 14 weeks on the LighterLife Programme between 1998 and 2005 Kim Sung-Soo1, Kim Jung-Seong1, Jeong Jin-Kyu1 Holt Joanna1, Horsnell Tina1, du plessis Juliette1, Hewlett Bar1 1Chungnam Natl. Univ. Hosp 1LighterLife Objective: There are many studies that suggest absent or weak associations between alcohol consumption and obesity. Alcohol biomarkers may be Around two-thirds of the UK population are overweight or obese and this helpful to explain to the effects of alcohol on obesity. The aim of this study figure is rising every day. Action is required to tackle this increasing problem, was to investigate associations between alcohol biomarkers and however, NHS resources alone are unlikely to meet the increasing demand. anthropometric indices. Weight loss of 5-10% can improve co-morbidities and reduce costs for the Methods: This study involved 97 male drinkers with regular meals. Subjects NHS. The UK Government has marked a shift towards the concept of were classified into 57 moderate drinkers with <=standard 14 drinks per week Primary Care Trusts (PCTs) working in partnership with reputable (S-MD) vs. 40 heavy drinkers with >standard 14 drinks per week (S-HD) and commercial sector companies in tackling obesity. LighterLife is a medically 51 moderate drinkers with %CDT<2.6% (C-MD) vs. 46 heavy drinkers with monitored, commercial Weight-loss and Weight-Maintenance Programme for %CDT>=2.6% (C-HD). The optimized cutoff point of %CDT for detecting S- patients with BMI > 29kg/m2. During the initial weight loss stage, patients HD was calculated at 2.62 with these data. Associations between alcohol take a nutritionally complete very low calorie diet (VLCD) and abstain from biomarkers and anthropometric indices were analyzed in each group. Alcohol conventional food for 14 weeks, with further weight loss modules if required. biomarkers included carbohydrate-deficient transferrin (%CDT), AST, ALT Data was collected for females starting the LighterLife Programme from 1998 and GGT. to 2005 (11511 total). Results: %CDT was associated with BMI (r=0.447; P=0.002) and WC Results (r=0.486; P=0.001) in C-HD. After adjusting for age, smoking and activity, Mean start BMI 37.79kg/m2 Mean start weight 101.59kg Mean End BMI 30.38kg/m2 Mean end weight 81.69kg %CDT was associated with BMI (r=0.346; P=0.039) and WC (r=0.384; 2 P=0.021) in C-HD. Other alcohol biomarkers such as AST, ALT and GGT Mean drop in BMI 7.40kg/m Mean weight loss 19.90kg were not associated with BMI and WC in S-MD, S-HD, and C-MD, after adjusting for age, smoking, and activity. %CDT explained 24.3% of BMI These results show that female patients achieve an average weight loss of (P=0.002) and 26.6% of WC (P=0.01) in C-HD. 19.6% in 14 weeks. Conclusions: %CDT is positively associated with BMI and WC in C-HD. LighterLife are currently developing a protocol to provide joined-up This result suggest that %CDT may be helpful to adjust a large individual approach to provision of obesity services and assist PCTs in reducing costs variability according to the amount of alcohol consumed and genetic factors. and improving incidence of the metabolic syndrome by tackling obesity.

International Journal of Obesity Abstracts S173 T3:PO.274 T3:PO.275

One year follow up of 100 post obese patients following the maintenance element of the Body Composition Measurements with the Lunar iDXA and Prodigy LighterLife Programme Densitometers Holt Joanna1, Horsnell Tina1, Cox Jackie1, du Plessis Juliette1, Hewlett Bar1 Wacker Wynn1, Deman Peter2, Barden Howard1, Ergun David1 1LighterLife, UK 1 2 LighterLife is a medically monitored, commercial Weight-loss and Weight- GE Healthcare Lunar, Madison, WI, USA, GE Healthcare Lunar, Maintenance Programme for patients with BMI> 29kg/m2. The programme uses a Very Diegem, Belgium Low Calorie Diet (VLCD), complemented by Transactional Analysis and Cognitive Behavioural Therapy (TCBT). Precision error provides a quantitative measure of the ability of For patients at target weight, there is a weight-maintenance programme to help sustain densitometry systems to detect changes in body composition over time, lifestyle changes. Patients are encouraged to attend for at least one year. Foodpacks can be purchased to assist in weight maintenance; attendance at maintenance meetings is free. and is thus an important component of clinical decision-making. Maintenance data for 100 post obese female patients who had attended the LighterLife Minimizing precision error reduces the “least significant change” and maintenance programme for >52 weeks in 2005. time required to detect a significant biological change. Recently, GE Healthcare introduced a new imaging densitometer, the Lunar iDXA. In Weight loss details: Mean start weight 95.9kg Mean start BMI 36.6kg/m2 this study we report precision for the total body measurement sites (%fat, Mean end weight 78.8kg Mean end BMI 29.6kg/m2 fat and lean mass in grams).We scanned 29 women and 10 men for a Mean weight loss 18.7kg Mean change in BMI 7.0kg/m2 total of 39 subjects (mean age 56.7 yrs, SD 13.7; mean BMI 25.3, range 15.9 - 37.0) in triplicate at the total body on the Lunar Prodigy (GE One year’s weight maintenance: 0 – 20% ABOVE START WEIGHT 1% Healthcare) and Lunar iDXA systems, with repositioning between each 0 – 10% BELOW START WEIGHT 15% scan. Precision (%CV) was calculated as the root-mean-square standard 10.1 – 20% “ “ “ 39% deviation for bone mineral density (BMD), bone mineral content (BMC), 20.1 – 30% “ “ “ 39% and body composition variables.Precision for Lunar iDXA and Prodigy 30.1 – 40% “ “ “ 5% total body BMD was 0.5% and 0.8%, respectively. Total body BMC (g) 40.1 – 50% “ “ “ 1% precision was 0.5% and 1.7% for iDXA and Prodigy, respectively. Body We will continue to follow this cohort and report on their weight maintenance. In order composition precision for iDXA vs. Prodigy was 0.8% vs. 1.7% for to evaluate the effectiveness of the current management programme, further data will be %fat, 0.8% vs. 1.7% for fat mass (g), and 0.5% vs. 1.2% for lean mass collected to compare weight maintenance statistics for patients completing management (g), respectively. against those that leave the programme at target weight. We conclude that Lunar iDXA provides significantly better precision for total body BMD, BMC and body composition measurements, allowing earlier detection of small changes in both research and clinical situations.

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Can physical activity be one of the methods in the prevention of obesity Relationship between some food factors with nutritional status in high school among adolescents? adolescents girls in Semnan, Iran Doost Mohammadian A1, MSc; Keshavarz A.2, PhD; Dorosty A.R.2, PhD; Maksimovic M.¹, Maksimovic J.², Risti G.¹ Mahmoodi M.3, PhD; Sadrzadeh H.2, MSc

¹Institute for hygiene and medical ecology, School of Medicine, 1Department Of Nutrition Research, National Nutrition And Food Technology Belgrade, Serbia Research Institute, Shaheed Beheshtee University Of Medical Science 2 ²Institute of epidemiology, School of Medicine, Belgrade, Serbia Department of Nutrition and Biochemistry, School of Public Health and Institute of public Health Research, Tehran University of Medical Science 3 Department of Epidemiology and Biostatistices, School of Public Health and The aim of the investigation was to estimate the difference in the Institute of public Health Research, Tehran University of Medical Science nutritional state between physically active adolescents and adolescents who were not regularly involved in sports activities. Also, our goal was Background and aims: Malnutrition especially obesity and overweight among to study whether physical activity could be an independent method for adolescents as an important health problem is highly associated with diabetes, the prevention of obesity. Group of sportiest consisted of 123 boys, coronary artery disease, osteoporosis and other chronic disease in adults. The average age 14.23±0.9 years, who, beside sport activities during school objective of this article was to determine the relationship between some food classes were involved in physical activities 4 times a week for 90 factors with nutritional status in secondary school adolescent girls in Semnan, Iran. Methods: In a cross- sectional study, using two stage random sampling, 256 girl minutes (basketball). Control group consisted of 76 boys, average age students aged 14-18 year old were randomly selected from 8 Semnan high schools. 14.78±1.82 years, whose physical activity was limited to sport classes, Weight and height were measured and BMI was calculated. Nutritional status was only. The nutritional state in both groups was estimated using Body defined by index of BMI-for-age from CDC 2000 reference. Data on 24 hours Mass Index (BMI). recall, food record and food frequency were collected by questionnaires. In the group of sportiest were 16.45% of malnourished adolescents, Results: Data analyzed indicated that daily fat intake (P=0.04, r=+0.01), energy compared to 3.75% in the control group (P<0.05). We found 79.0% in percent of fat (P=0.003, r=+0.18) and fast food frequency (P= 0.026, r=+0.139) had significant relationship with BMI percentile. There was significant relationship the group of sportiest with normal nutritional state and in the control between snack frequency and nutritional status in high school adolescents girl group 67% (P>0.05). Obesity was found among 4.55% adolescents from (P=0.023). Daily energy, carbohydrate, protein intake, energy percent of group of sportiest, and among 29.25% in the control group (P<0.01). macronutrient except fat, frequency of meal food, fruit and vegetable, red meat, These results suggest that the physical activity can not be an independent dairy products except cheese, coca had no significant relationship with nutritional method of the prevention of obesity, but regular physical activity as a status. part of training along with controlled dietary intake can prevent Conclusion: Therefore, nutritional education and improvement food habit among excessive weight gain. Sometimes it may be combined with changes in adolescents are necessary to induct. behaviour and in some cases with restricted dietary program.

International Journal of Obesity Abstracts S174 T3:PO.278

Taking care of extremely obese patients in the medical department: are we prepared?

Sucharda P1, Matoulek M1, Kalvach Z1, Svacina S1

1Obesitology Unit, 3rd Medical Dept., General University Hospital & Charles University - 1st School of Medicine, Prague, Czech Republic

Aim: To draw attention to problems associated with hospitalization of extremely obese persons. Methods: Our experience with treatment of extremely obese patients, referred from most regions of the Czech Republic. Results: Six extremely obese (also called “super-super obese”, BMI 60 – 95, maximum body weight 247 kg), non-ambulant patients were treated in our Obesity ward in the past two years. During repeated hospitalizations they lost 60 – 96 kg. Some of them were very seriously ill at admission and bed confined. In all cases the moving ability has been restored. Discussion: The care of the seriously ill, extremely obese persons (BMI > 60, weight >170 kg) needs non-standard procedures and exceptional effort of medical staff. The offer of accessible equipment and tools for these patients is limited, even reputable manufacturers have no special products in their programs. Conclusion: The care of such heavy disabled patients, however improvised, is possible and able to restore at least basic locomotion and self-care; sometimes can be life-saving, e.g. in cases of progressive respiratory insufficiency. Supported by Health+

International Journal of Obesity