Blood Glucose Levels And BMI In Very Obese Children Improved By Metformin

Main Category: Obesity / Weight Loss / Fitness
Also Included In: Diabetes;  Pediatrics / Children's Health
Article Date: 13 Dec 2012 - 0:00 PST Current ratings for:
Blood Glucose Levels And BMI In Very Obese Children Improved By Metformin

Metformin therapy has a beneficial treatment effect over placebo in improving body mass index (BMI) and fasting glucose levels in obese children, according to a recent study accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM). The study showed reduction in BMI was sustained for six months.

Childhood obesity has increased globally over the last two decades and it is linked to an increase in the diagnosis of type 2 diabetes in childhood, previously a condition that was only diagnosed in adults. Metformin is a first line drug for type 2 diabetes, and has been used for many decades. In adults metformin delays the onset of type 2 diabetes, but there is no evidence that the drug has a similar effect on children.

"Our findings provide evidence that a treatment course of metformin is clinically useful, safe and well-tolerated in obese children who are at risk for type 2 diabetes," said Deborah Kendall, MD, of Royal Manchester Children's Hospital in the United Kingdom and lead author of the study. "Metformin may also provide stimulus for lifestyle changes and potentially reduce long-term risk for type 2 diabetes and its associated health problems."

This prospective, randomized, double-blind, placebo-controlled trial was conducted at six pediatric endocrine centers in the United Kingdom and involved 151 obese children and young people with hyperinsulinemia and/or impaired fasting glucose or impaired glucose tolerance. Study participants received either metformin or placebo daily for six months. This trial is the largest of its kind to focus on metformin in obese non-diabetic children and young people.

"Our results show that metformin can improve BMI and blood glucose levels in obese children, but longer term effects such as reduction in the incidence of type 2 diabetes need further study," noted Kendall.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our obesity / weight loss / fitness section for the latest news on this subject.
Other researchers working on the study include: R. Amin, F. Ivison, A. McGovern, L. Tetlow, P. Clayton and C. Hall of Royal Manchester Children's Hospital; T. Barrett of Birmingham Children's Hospital, UK; P. Dimitri, J. Wales and N. Wright of the University of Sheffield, UK; M. Kibirige of The James Cook University Hospital, UK; V. Mathew of Hull Royal Infirmary, UK; K. Matyka and H. Stirling of University Hospital Coventry and Warwickshire National Health Service Trust, UK; and A. Vail of the Centre of Biostatistics, UK.

The article, "Metformin in Obese Children and Adolescents: The MOCA Trial," appears in the January 2013 issue of JCEM.

The Endocrine Society

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Newborns Delivered To Obese Mothers May Have Lower Levels Of Iron

Main Category: Pregnancy / Obstetrics
Also Included In: Obesity / Weight Loss / Fitness;  Pediatrics / Children's Health
Article Date: 11 Jul 2012 - 0:00 PDT Current ratings for:
Newborns Delivered To Obese Mothers May Have Lower Levels Of Iron

A growing number of studies imply that children born to obese mothers face health problems stemming from the womb.

New research from the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University and The Mother Infant Research Institute at Tufts Medical Center suggests that low iron status is among these health problems, according to an analysis of maternal hepcidin, a hormone that is key in keeping iron levels balanced.

The study enrolled 15 obese pregnant women with body mass index (BMI) greater than 30 and 15 healthy weight pregnant women with BMIs between 20 and 25 as a control group. Maternal blood draws took place during the second trimester of pregnancy and newborn iron status was measured in cord blood.

The researchers found that being born to an obese mother with elevated hepcidin levels was associated with lower iron status at birth. Obese adults are known to produce higher levels of hepcidin compared to healthy weight adults and the researchers suggest that overproduction of the hormone interferes with the transfer of iron from mother to infant. The results were recently published online by the Journal of Perinatology.

During pregnancy, hepcidin levels are kept at low levels to optimize iron transfer from mother to fetus. "When there is excess hepcidin in a cell, it binds to and inhibits the function of ferroportin, the protein that allows iron to pass through the cell membrane and into the bloodstream," explained senior author Simin Nikbin Meydani, DVM, PhD, director of the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (USDA HNRCA).

"The chronic low-grade inflammation that can result from being obese triggers an abnormal immune response, increasing production of proteins that increase hepcidin levels," added Maria Carlota Dao, first author and a doctoral student in the Nutritional Immunology Laboratory at the USDA HNRCA. Because iron plays a crucial role in the formation of the central nervous system, children born with iron deficiency are at a greater risk for delays in motor and cognitive development.

"The data on the impact of low maternal iron levels on the fetus comes from undernourished populations," said first author Sarbattama Sen, MD, a neonatologist at Tufts Medical Center and an assistant professor of pediatrics at Tufts University School of Medicine (TUSM). "To the best of our knowledge, ours is the first study to demonstrate that obesity might hamper iron transfer from mother to child and offers some insight into the mechanism of how it occurs. Future studies, however, are needed to confirm the role of obesity associated with inflammation during pregnancy on hepcidin and iron status of the newborn."

The authors further stress that more research is needed before any changes to dietary guidelines or recommendations to obese pregnant women should be considered. Most prenatal vitamin supplements contain 27 milligrams of iron, the daily amount currently recommended by The American Congress of Obstetricians and Gynecologists.

"During pregnancy, women should try to eat a varied, healthy diet while taking the standard prenatal vitamins recommended by their doctors," Sen adds. "Weight gain goals should be based on a woman's BMI prior to becoming pregnant. In 2009, the Institute of Medicine issued new guidelines on weight gain during pregnancy."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our pregnancy / obstetrics section for the latest news on this subject. Simin Nikbin Meydani is also a professor at the Friedman School of Nutrition Science and Policy at Tufts University and is a member of the immunology program faculty at the Sackler School of Graduate Biomedical Sciences at Tufts University. Additional authors of this study are Chitra Iyer, MD, a former maternal fetal medicine fellow at Tufts Medical Center and David Klebenov, a TUSM student. .
The authors received funding for this study from the USDA, a Tufts Medical Center Research Grant, the Natalie V. Zucker Foundation for Women Scholars, the Stanley N. Gershoff Scholarship and the National Heart Lung and Blood Institute (NHLBI) T32 training program.
Dao MC, Sen S, Iyer C, Klebenov D, and Meydani SN. "Obesity During Pregnancy and Fetal Iron Status: Is Hepcidin the Link?" Journal of Perinatology advance online publication. June 21, 2012; doi: 10.1038/jp.2012.81.
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Obese Patients Face Increased Risk Of Kidney Damage After Heart Surgery

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our cardiovascular / cardiology section for the latest news on this subject. Study co-authors include Mias Pretorius, MD, Jonathan Schildcrout, PhD, Nathaniel Mercaldo, John Byrne, MD, T. Alp Ikizler, MD, Nancy J. Brown, MD (Vanderbilt University School of Medicine).

Disclosures: The authors reported no financial disclosures.

The article, entitled "Obesity and Oxidative Stress Predict Acute Kidney Injury Following Cardiac Surgery," will appear online at http://jasn.asnjournals.org/ on May 24, 2012, doi: 10.1681/ASN.2011090940.

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

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Lipoprotein Levels In Obese Patients With NAFLD Do Not Improve With Exercise

Editor's Choice
Main Category: Liver Disease / Hepatitis
Also Included In: Obesity / Weight Loss / Fitness;  Sports Medicine / Fitness
Article Date: 29 May 2012 - 10:00 PDT Current ratings for:
'Lipoprotein Levels In Obese Patients With NAFLD Do Not Improve With Exercise'

Moderate physical activity does not improve lipoprotein concentrations in obese patients with non-alcoholic fatty liver disease (NAFLD), say researchers. The team found that in these patients, exercise only decreases triglyceride and alanine transaminase (ALT) levels by a small amount.

The study is published in Hepatology, a journal of the American Association for the Study of Liver Diseases.

According to the World Health Organization (WHO), in 2008, 1.5 billion individuals aged 20+ were overweight, and of these, 500 million were considered obese.

NAFLD is a common complication of obesity and can cause inflammation and scarring in the liver as well as liver failure. Earlier studies revealed that regular exercise and weight loss improved metabolic disturbances linked with NALFD.

In this study, Dr. Samuel Klein and his team from the Washington University School of Medicine in St. Louis, Mo., set out to determine how physical activity programs recommended by the Department of Health and Human Services impacted cholesterol, ALT, and triglyceride levels in obese patients with NALFD.

The researchers enrolled 18 obese patients with NAFLD to participate in the study. 12 participants were randomly assigned to the physical activity group and 6 were assigned to the control group. Those in the physical activity group engaged in 30-60 minutes of moderate exercise 5 days per week for 16 weeks.

The team evaluated how much physical exercise affected very low density lipoproteins (VLDL), intrahepatic triglyceride (IHTG), and apolipoprotein B-100 (apoB-100).

The researchers found that physical activity reduced IHTG content by 10%, but did not change body fat percentage or total body weight. Before the exercise program began, total body weight was 103.1 kg vs. 102.9 kg after, and total body fat was 38.9 vs. 39.2 after the exercise program.

No change in liver lipoprotein levels (VLDL or apoB-100) was found among participants in the physical activity group.

Dr. Klein concludes:

"Our data demonstrate that a moderate intensity exercise program followed by obese patients with NALFD causes a small decrease in IHTG content, even when body weight and total body fat mass are maintained.

Current exercise recommendations seem to have only a modest effect on triglycerides and ALT levels, suggesting that improvement in lipoprotein metabolism and fatty liver (steatosis) may be due to weight loss and not increased physical activity."

The researchers note that further research is required in order to assess the impact of moderate physical activity on IHTF content in individuals with NAFLD.

Written By Grace Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

'Lipoprotein Levels In Obese Patients With NAFLD Do Not Improve With Exercise'

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Better Outcomes In Obese Heart Failure Patients

Main Category: Heart Disease
Also Included In: Obesity / Weight Loss / Fitness
Article Date: 05 Jul 2012 - 1:00 PDT Current ratings for:
Better Outcomes In Obese Heart Failure Patients

A slim waist and normal weight are usually associated with better health outcomes, but that's not always the case with heart failure patients, according to a new UCLA study.

Researchers found that in both men and women with advanced heart failure, obesity - as indicated by a high body mass index (BMI) - and a higher waist circumference were factors that put them at significantly less risk for adverse outcomes.

The study findings are published in the July 1 online issue of the American Journal of Cardiology.

Heart failure affects 5.8 million people, including 2.5 million women. Approximately one-half to two-thirds of heart failure patients are overweight or obese.

Women and men are known to have differences in body composition and body-fat distribution, and this study is one of the first to specifically assess the impact of BMI and waist circumference on women and compare it with men.

The findings also offer further insight into an observed phenomenon in chronic heart failure known as the "obesity paradox": Obesity is a known risk factor for developing heart disease and heart failure, but once heart failure has manifested, being overweight may provide some protective benefits.

"The study provides us with more insight about how both genders of heart failure patients may be impacted by the obesity paradox," said senior author Dr. Tamara Horwich, an assistant professor of cardiology at the David Geffen School of Medicine at UCLA. "Heart failure may prove to be one of the few health conditions where extra weight may prove to be protective."

For the study, researchers analyzed data on advanced heart failure patients treated at UCLA Medical Center from 1983 to 2011. The team assessed 2,718 patients who had their BMI measured at the beginning of heart failure treatment and 469 patients who had their waist circumference measured at the beginning of treatment.

Using standardized measures, the researchers identified men or women as having a high BMI if they were greater or equal to 25 kg/m² - this included both overweight patients (25 to 29.9 kg/m²) and obese patients (30 kg/m² or greater).

For men, a high waist circumference was considered 40 inches (102 cm) or greater, and for women, 37 inches (88 cm) or greater. This assessment also included patients who were either overweight or obese.

At the two-year follow-up, researchers used statistical analysis and found that in men, a high waist circumference and high BMI were associated with event-free survival from adverse outcomes like death, the need for a heart transplant, or the need for ventricular assist device placement.

Women with a higher BMI also had better outcomes than their normal-weight counterparts, and women with a high waist circumference also trended toward improved outcomes.

Both men and women with a normal BMI and waist circumference were at a substantially higher risk for these adverse outcomes. In fact, a normal BMI was associated with significantly worse outcomes - a 34 percent higher risk in men and a 38 percent higher risk in women - than a high BMI.

Normal waist circumference was also associated with an increased risk of adverse outcomes in both genders, with men's risk doubling and women's risk tripling.

"We knew that obesity might provide a protective benefit for heart failure patients, but we didn't know whether this obesity paradox applied specifically to women with heart failure, as well as men - and it does," Horwich said.

BMI measurement has been used for years as a surrogate measure of body fat. Since it measures all mass - including lean muscle, which weighs more than fat - the measurement may not be specific for total body fat. Waist circumference is a newer addition that may provide a more direct connection to body fat, since it measures the fat accumulated around the belly.

"The study also demonstrates how BMI and waist circumference can be used together to provide a more accurate measure of fat in the body to help determine obesity and assess risk," said the study's first author, Adrienne L. Clark, a resident in the department of medicine at the Geffen School of Medicine.

According to Horwich, no one knows exactly why the obesity paradox exists for heart failure patients, but there are several possible explanations.

Being underweight is traditionally associated with a poorer prognosis in heart failure patients. Obesity may be at the other end of the spectrum, and patients may thereby benefit from increased muscle mass, as well as metabolic reserves in the form of fatty tissue. In addition, increased levels of serum lipoproteins that are associated with increased body fat may play an anti-inflammatory role, neutralizing circulating toxins and inflammation-related proteins.

Obese patients also present at an earlier stage of heart failure due to increased symptoms and functional impairment caused by excess body weight, so they may be getting help sooner, which also could improve outcomes, the researchers said.

The next steps in research will include larger studies with longer follow-up times, as well as a closer look at the physiology behind the obesity paradox.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our heart disease section for the latest news on this subject. The study was funded by the National Heart, Lung and Blood Institute, part of the National Institutes of Health (grant 1K23HL085097).
Jennifer Chyu of the UCLA Department of Molecular, Cell and Developmental Biology, was also a study author.
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Minimally Invasive Operations Lead To Fewer Complications For Obese Appendectomy Patients

Main Category: GastroIntestinal / Gastroenterology
Also Included In: Obesity / Weight Loss / Fitness
Article Date: 28 Jun 2012 - 1:00 PDT Current ratings for:
Minimally Invasive Operations Lead To Fewer Complications For Obese Appendectomy Patients

Obese patients who need to have their appendixes removed fare better after a minimally invasive surgical procedure rather than an open operation, according to a new study published in the July issue of the Journal of the American College of Surgeons.

While the traditional open operation (appendectomy) and minimally invasive procedure (laparoscopic appendectomy) are known to have similar outcomes for people of normal weight, surgeons at the University of Southern California's Keck School of Medicine found that obese patients had fewer complications 30 days after a minimally invasive laparoscopic operation, in which surgeons make one to three small incisions in the abdomen and remove the appendix through one of the small openings. The obese patients had longer hospital stays and higher rates of infectious complications if they underwent the open procedure, whereby a surgeon removes the appendix through a 2-to-4-inch incision in the right side of the abdomen.

"There are early studies that suggest the laparoscopic approach may be less risky in obese patients, but there's not much recent information available to strongly prove it," said lead study author Rodney J. Mason, MBBCh, FACS, associate professor of surgery at Keck School of Medicine. Appendectomies are among the most common types of operations in the United States.1 Meanwhile, more than 35 percent of U.S. adults and 17 percent of youth are obese, according to the U.S. Centers for Disease Control and Prevention.2 "We expect to see more and more obese people with medical conditions that require general surgical intervention" Dr. Mason said. "We need to know what approach works best for these patients."

Dr. Mason and colleagues did two analyses in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) database of patients who had appendectomy procedures between 2005 and 2009. Approximately 13,330 patients in the database were considered obese, based on a body mass index (BMI) of 30 or higher.

In the first analysis, Mason and his team of surgeons compared how all the obese patients in the database fared after having either an open or laparoscopic appendectomy. Results showed that patients who had the open procedure were significantly more likely to have complications, including wound infections, pneumonia, heart attacks, and septic shock. For example, 8 percent of the open appendectomy patients had non-wound related complications like heart attacks, compared with 4 percent of laparoscopy patients. Additionally, open appendectomy patients stayed in the hospital a mean of 2.3 days longer than patients who had the laparoscopic appendectomy. Overall, the laparoscopic procedure was associated with a 57 percent reduction in morbidity compared with the open procedure in obese patients.

The second analysis matched 1,114 of the laparoscopic appendectomy patients with an open operation patient group who had the same demographics and comorbid conditions. Results again showed that complications were more likely for patients who had open appendectomies. They spent more than a day longer in the hospital, and their procedures took longer than the time required for patients who had the laparoscopic procedure, which was associated with a 53 percent reduction in the risk of morbidity. Also, the more patients weighed, the worse their outcomes were with open procedures. In contrast, all the patients who underwent the laparoscopic procedure had similar outcomes, regardless of how obese they were.

Despite the noted improved outcomes for the laparoscopic surgical approach in patients with complicated appendicitis, over 40 percent of these patients in the database had undergone an open operation. With national expenditures already estimated at about $147 billion for obesity-related conditions,3 the study's results have implications for health care costs, particularly at hospitals that say open procedures cost less because they do not require the expensive equipment needed for laparoscopy.

"We've shown a shorter length of stay. There's the cost savings right there," Dr. Mason said. "Also if you can prevent a patient's wound infection, which stops him or her from having to come see the doctor four times after a procedure, reducing that complication will reduce costs. And if someone doesn't get pneumonia after an operation, that result will be cost-effective as well."

Dr. Mason noted that because laparoscopic appendectomy is still relatively new, especially for obese patients, some surgeons and hospitals default to the tried-and-true open procedure. But that approach is changing. "It depends on the surgeons' training and whether they were trained to perform laparoscopy or not," he explained. "Many surgeons are more inclined to perform laparoscopic procedures because that's how they were trained."

Moreover, the move toward laparoscopic appendectomy is to some extent patient driven, Dr. Mason pointed out. "Most of my patients seem to prefer laparoscopic operations nowadays" he concluded.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our gastrointestinal / gastroenterology section for the latest news on this subject. 1 Owings MF, Kozak LJ. "Ambulatory and in-patient procedures in the United States, 1996." In: Vital and Health Statistics, Series 13, No. 139 [DHHS publication no. (PHS) 99-1710.] Hyattsville, MD: National Center for Health Statistics, 1998:26
2 Ogden, CL, et al. "Prevalence of Obesity in the United States, 2009-2010." NCHS Data Brief 82: Jan. 2012: http://www.cdc.gov/nchs/data/databriefs/db82.pdf
3 Finkelstein, EA, et al. "Annual medical spending attributable to obesity: Payer- and service-specific estimates." Health Affairs 28(5): w822-w831; Sept-Oct. 2009.
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