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The 1st Asia Pacific Congress on
Controversies to Consensus in Diabetes, Obesity and Hypertension (CODHy)
Shanghai, China, June 2-5, 2011
  Obesity/ Lipids Print


M. Boaz (1,2), J. Kislov (3), J. Wainstein (3)

1 Epidemiology and Research Unit, E. Wolfson Medical Center, Holon, Israel

2 Nutrition Department, School of Health Sciences, Ariel University Center, Ariel, Israel

3 Diabetes Unit, E. Wolfson Medical Center, Holon, Israel


Background: Associated with neuropathy, symptoms of gastroparesis are common in patients with type 2 diabetes mellitus (T2DM) and include nausea, vomiting, bloating, and early satiety associated with delayed gastric emptying. Gastric motor abnormalities have been reported in obese patients, and obesity is associated with T2DM. An association between obesity and gastroparesis symptoms in diabetic patients with neuropathy has not been investigated.

Methods: In a cross-sectional survey of gastroparesis prevalence in 380 T2DM patients, 161 were identified as having neuropathy. Gastroparesis symptom prevalence was compared by obesity (BMI≥30kg/m2). A general linear model of number of symptoms was developed.

Results: Subjects were 66.6±10.years of age, 51% female, diabetes duration 15.6±8.2 years, fasting blood glucose 159±69 mg/dl, HbA1c 8±1.6% and 56.5% obese. Obese subjects reported significantly more early satiety (61.5% vs. 35.2%, p=0.001); fullness (63.7% vs. 40.8%, p=0.004); bloating 70.3% vs. 49.3%, p=0.006) and abdominal distention (71.4 vs. 50.7%, p=0.007) than non-obese subjects. Obese subjects were more likely to have any gastroparesis symptom (RR 2.4, 95% CI 1.01-5.9, p=0.04); moreover, obese subjects reported more gastroparesis symptoms: 4 (0-10) vs. 3 (0-8), p=0.005. In the model of number of gastroparesis symptoms, obesity persisted as a significant, independent predictor even after controlling for age, sex and HbA1c (p=0.03).

Conclusions: Obesity emerged as a significant, independent predictor of gastroparesis symptoms in patients with T2DM and neuropathy.  This finding suggests that mechanisms in addition to neuropathy - perhaps hormones such as ghrelin - play a role in the pathogenesis of gastroparesis in this patient population.



M. Boz (1), E. Ulgen (1), C. Muderrisoglu (1), F. Aktas (1), E. Altunoglu (1), F. Erdenen (1), M. Erguney (1)

1 Istanbul Training and Research Hospital, Clinics of Internal Medicine


Introduction and objectives: The relation between body weight and arterial blood pressure is reported since many years in obese population. However, a causal link between insulin resistance and Type 2 diabetes or hypertriglyceridemia and metabolic syndrome is not well demonstrated. The aim of this study is to examine the relationships between insulin levels and arterial blood pressures, glycemia, triglyceridemia and some others parameters linked to metabolic syndrome in obese population.

Methods: 195 obese patients were pooled out followed in our out-patient clinics. We accepted only between 40-60 years old and non-diabetic patients. Some characteristics of this population: age(years). 48.6±5.2, Waist circumference(cm):112.2±15.1, WHR (Waist Hip Ratio): 0.87±0.7, SBP (Systolic Blood Pressure: mmHg):132.3±18.7, DBP (Diastolic Blood Pressure mmHg): 80.7±10.FBG (Fasting Blood Glucose mg/dl):103.5±27.7, triglyceridemia(mg/dl):156.8±78.5 and BMI(Body Mass Index:Weight (kg)/Height(m2 ):38.9±7.6.

Results: When we divided the study group into two groups according to insulin levels (10 mU/l) < or >): increased BMI, waist circumference but not WHR and C-peptide, FBG, triglyceridemia significantly(p<0.0001) are in the high insulin level group. Elevated SBP (p<0.03) but not DBP, decreased HDL(p<0.07) and HbA1C(p<0.01) also in the same group. Inversely when we divided into two groups according to SBP levels(120 mg  < or  >):increased BMI, DBP(p<0.0001), waist circumference(p<0.001) but not WHR, and increased FBG(p<0.01), triglyceridemia(p<0.01), insulinemia(p<0.007) and C-peptide(p<0.003) are in the elevated SBP group.

Conclusion: Hyperinsulinemia and elevated SBP are associated variables in obese patients. These parameters are the main components of metabolic syndrome.



L. Jamshidi (1), A. Seif (1)

1 Islamic Azad University, Hamedan Branch, Hamedan, Iran


Obesity is a significant health crisis around the world. Of great concern are the data pointing to the recent increase in the prevalence of obesity irregardless of age group and country. A lipid disorder increases risk for atherosclerosis, and thus for heart disease, stroke, high blood pressure (hypertension), and other problems. Abnormal cholesterol and triglyceride levels may also be caused by being overweight or obese.

Objective: The objective of this study was to quantify the prevalence of overweight and obesity and Comparison of serum lipid levels in adult.

Materials and methods: During in this study 1327 (721 male and 584 females) aged 24-60 years were studied. A questionnaire was filled, and weight and height and WHR were measured. Plasma cholesterol and triglyceride levels were measured after an overnight fast.

Discussions and conclusions: The body mass index (BMI) was calculated and adjusted for age and sex. Prevalence of overweight and obesity were 41.8%. BMI increased with age, and it was higher in those who had lower levels of physical activity. Increase of the serum cholesterol, LDL, TG level was strongly associated with the abdominal obesity. This study highlights the high prevalence of overweight and obesity in adult in Hamedan.



L. Jamshidi (1), A. Seif (1)

1 Islamic Azad University, Hamedan Branch, Iran


Objective: The prevalence of obesity is increasing at an alarming rate in many parts of the world. Obesity is a significant health crisis around the world. Individual and environmental factors that have an influence on energy balance are not fully understood. Current treatments for obesity have been largely unsuccessful in maintaining long-term weight loss, suggesting the need for new insight into the mechanisms that result in altered metabolism and behavior and may lead to obesity. Parallel to an increase in body weight, one has also observed a reduction in sleep times. The aim of this study was to examine the Sleep problems and anthropometric factors (weight gain) in Iranian adults, hamedan.

Materials and methods: A questionnaire was filled and weight, baseline waist circumference measured. We examined association between BMI and quality of sleep. Body composition measurements and self-reported sleep duration were determined. Changes in adiposity indices were compared between short- (5-6 hours), average- (7-8 hours), and long- (9-10 hours) duration sleeper groups. After adjustment for age, sex, and baseline body mass index, short-duration sleepers gained 2.24 kg more and long-duration sleepers gained 1.37 .Short- and long-duration sleepers were 34.2% and 11.7% more likely to experience a 5-kg weight gain. The risk of developing obesity was elevated for short- and long-duration sleepers as compared with average-duration sleepers.



J.K. Kim (1), H.T. Kang (1,2), J.Y. Kim (3), J. Limton (4), J.H. Yoon (5,6), S.B. Koh (5,6,7)

1 Department of Family Medicine, Wonju College of Medicine, Yonsei University, Wonju-city, Gangwon-do, South Korea

2 Department of Medicine, Graduate school of Yonsei University, Seoul, South Korea

3 Division of Cardiology, Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Wonju-city, Gangwon-do, South Korea

4 International Health Care Center, Severance Hospital, College of Medicine, Yonsei University, Seoul, South Korea

5 Department of Preventive Medicine, Wonju College of Medicine, Yonsei University, Wonju-city, Gangwon-do, South Korea

6 Department of Environmental and Occupational Medicine, Wonju College of Medicine, Yonsei University, Wonju-city, Gangwon-do, South Korea

7 Institute of Genomic Cohort, Wonju College of Medicine, Yonsei University, Wonju-city, Gangwon-do, South Korea


Background and Aims: Dyslipidemia is associated with renal dysfunction and cardiovascular diseases. The ratio of triglycerides (TG, mg/dL) to high-density lipoprotein cholesterol (HDL-C, mg/dL) is a reliable indicator of insulin resistance and atherosclerotic diseases. The purpose of this study was to examine the association between TG/HDL-C and albuminuria in rural Korean adults.

Methods and Results: This cross-sectional study included 9,094 adult subjects (4,091 men, 5,003 women) who were enrolled in the Korean Genomic Rural Cohort (KGRC) and aged 40 years or more. Albuminuria was defined as a urine albumin/creatinine ratio (UACR) ¡30 mg/g. Participants were categorized into quartile groups by TG/HDL-C for comparison. Median UACR and albuminuria prevalence increased in a linear fashion in both genders according to TG/HDL-C quartile. Compared to the lowest quartile of TG/HDL-C (<1.94 in men, <1.71 in women), the odds ratios (ORs) for albuminuria in participants who were categorized in the highest quartile of TG/HDL-C (¡4.98 in men, ¡4.20 in women) were 1.30 (95% confidence interval (CI), 0.97¨C1.75) and 1.36 (1.03¨C1.79) in men and women, respectively, when adjusted for age, systolic blood pressure, and other covariates. In normotensive men and women, the ORs for albuminuria in the highest TG/HDL-C quartile were 1.58 (1.04-2.39) and 1.68 (1.15-2.45), respectively, even after full adjustment. In contrast, TG/HDL-C was not associated with albuminuria in hypertensive subjects.

Conclusions: TG/HDL-C was independently associated with increased prevalence of albuminuria in normotensive rural Korean subjects aged 40 years or more in KGRC.



A.R. Marshall (1), N. Hboubi (2), S. Jones (3)

1 Cardiff University, Cardiff, UK

2 Neville Hall, Abergavenny, UK

3 Blaenau Gwent Weight Management, Blaenau Gwent, UK


Objectives: 1) To investigate whether waist, mid-arm and neck circumference, and the Epworth sleepiness scale can be used to accurately estimate BMI, 2) To determine whether patients have a preference between anthropometric measuring or weighing.

Method: Data was collected from 74 obese patients, recruited via Blaenau Gwent weight management clinic and 28 participants of a control group (BMI 18-30). Data collected included waist and height measurement, weight, mid-upper arm (MUAC) and neck circumference (NC), Epworth sleepiness score and any preference indicated when asked, between anthropometric measurement and traditional weighing to estimate BMI.

Both groups were separated into sex. Using formulaic rearrangement and trend analysis an equation (the H-M formula) was devised to estimate BMI for both groups of participants using the data collected minus weight. This estimation was then compared against BMI calculated in the traditional method.

Results: BMI can be accurately estimated from waist, MUAC and NC collectively using the sex adjusted H-M formula. BMI did not correlate with Epworth sleepiness scores. Most patients have no preference as to whether they are weighed or body measurements taken.

Conclusions: The H-M formula is a cost-effective, quick, portable, non-invasive method to estimate BMI that can be used in patients who are unable or unwilling to be measured in the traditional way.



N.H. Naran (1), N.J. Crowther (1)

1 National Health Laboratory Services and the School of Pathology of the University of the Witwatersrand, Johannesburg, South Africa


Introduction: The principal anthropometric determinant of insulin resistance is thought to be visceral adipose tissue mass. When matched for BMI, this fat depot is known to be larger in subjects of Indian ancestry compared to those of European ancestry. The size of the visceral adipose tissue depot increases in parallel with rising BMI. The aim of this study was therefore to determine whether a proxy measure of visceral adipose mass, waist circumference, has a stronger influence on insulin resistance in overweight and obese than lean Indian subjects. Methods: A convenience sample of 243 non-diabetic Indian subjects resident in Johannesburg were recruited into the study. Anthropometric and biochemical parameters were recorded. Insulin resistance was calculated using the HOMA model and the relationship between insulin resistance and anthropometric variables was determined. Results: In the total cohort, HOMA correlated with BMI (beta=0.41, p<0.0001) independently of waist circumference (beta=0.28, p<0.003). In lean subjects BMI (beta=0.31, p=0.0001) was the principal determinant of HOMA whilst in overweight/obese subjects, waist circumference (beta=0.30, p=0.003) was the strongest correlate of insulin resistance. Conclusion: This study demonstrates that in lean Indian subjects BMI is the major determinant of insulin resistance whilst in overweight and obese subjects waist circumference predominates. Thus, when examining the relationship between anthropometric variables and insulin resistance lean, overweight and obese subject groups should be examined separately. In studies where such groups are combined, the relationship between simple anthropometric measurements and insulin resistance will be influenced by the ratio of lean: overweight: obese individuals.



J.H. Schneider (1), W.V. Petersen (1), M. Kueper (1), T. Meile (1), A. Koenigsrainer (1)

1 Department of General, Visceral, and Transplant Surgery, Germany


Background: Obesity is characterized by excess body fat. In the northern hemisphere the prevalence of overweight increased up to 34 % and carries substantial co morbidities as diabetes mellitus (DM). Esophageal dysmotility (ED) is well known in morbid obese patients as well as in patients with DM. There are only a few studies which addressed the prevalence of ED in this patient.  

Methods: In prospective study data of 10 healthy volunteers (group I) were compared with 30 morbid obese patients (BMI >40) without DM in group II. In group III: 23 patients with short duration of DM (<3 years) and in group VI: 31 patients with long extended time of DM (7<years) were collected. In group V we measured 10 morbid obese DM patients with severe comorbidities. Al participants underwent a standardized esophageal manometry, ambulatory 24h pH-Metry and a Multichannel Intraluminal Impedance (MII) investigation.

Results: In group II we measured significant more pathological sequences of the esophagus compared to all other groups (p<0.03). The DeMeester Score showed in group II the highest pathological value of acid reflux (p<0.03). Obese patients in group IV und V showed significant more acid and non-acid refluxepisodes compared to patients of group III (p<0.02). In contradiction the amount of refluxepisodes were significantly higher in the control group (p<0.0001).

Conclusion: Our study confirmed different esophageal and gastric motility aberrations. Diminution masks some pathological findings of the esophagus. In morbid obese patients with DM the DeMeester Score is significantly increased in our series.



J.H. Schneider (1), W.V. Petersen (1), M. Kueper (1), T. Meile (1), A. Koenigsrainer (1)

1 Department of General, Visceral, and Transplant Surgery, Germany


Background: Obesity became one of the leading chronic diseases throughout the world. The relationship of obesity and gastroesophageal reflux disease (GERD) is incomplete understood. The purpose of the study was to evaluate gastroesophageal reflux in patients of different stages of obesity.

Methods: 51 obese patients were enrolled in this study. Additional 16 healthy volunteers were as controls in group I collected. All obese patients were divided into three subgroups according to their BMI. All the participants underwent esophageal manometry, gastroscopy and 24h combined MII and 24h pH-metry. The arrangement of several segments of neighboured impedance electrodes allows detecting a bolus presence at various levels and the direction of the bolus movement. Statistics were performed with the conventional computer assistant JMP program.   

Results: The prevalence of GERD in morbidly obese patients was 47%. Compared to the control group I the mean of esophageal contraction amplitudes differed significantly in all patient groups (p<0.005). The median LESP was significantly decreased in all subgroups (II-IV) (p<0.001). The DeMeester score of obese patients with GERD showed considerably significant higher values than the normal weighted control group (p<0.05). The ratio between the frequencies of acid compared to non-acid reflux episodes were approximately 2:1 in the groups II-IV. The proximal migration level (15cm) of the acid reflux was in obese patients significantly higher than in the control group (p<0.05).

Conclusion: Patients with morbid obesity to developed GERD. But GERD does not correlate directly with the degree of obesity.



K.Y. Son (1), S.J. Kim (1), H.C. Choi (1), B.L. Cho (1)

1 Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea


BACKGROUND: The distribution of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) is known to be related with age and body mass index (BMI). However, whether the changes in VAT and SAT distribution with BMI vary with age has not been studied.

METHODS: We analyzed 6472 Korean men aged between 30 and 79 who underwent abdominal fat computed tomography (CT). We examined the distribution of VAT and SAT across BMI within the same age group using regression models, and compared the degrees of change in distribution patterns according to age groups using t-test.

RESULTS: The VAT was positively associated with BMI increase in all age groups (all p<0.05), and a greater degree of VAT change was observed with increasing age (30s, 10.9±0.5; 40s, 12.4±0.3; 50s, 13.4±0.3; 60s, 14.2±0.5; 70s, 16.1±1.1; all p<0.05). The SAT was positively associated with BMI increase in all age groups (all p<0.05). The degree of increase in SAT decreased with age in age groups of 30s, 40s and 50s (30s, 18.5±0.4; 40s, 15.3±0.3; 50s, 13.3±0.3; all p<0.05), but remained the same afterwards (60s, 13.1±0.4; 70s, 13.9±0.8; p>0.05).

CONCLUSIONS: The VAT and SAT are both positively associated with BMI, and the degrees of changes in the distribution of VAT and SAT vary with age. The VAT increment with BMI consistently increases with age. The SAT increment decreases until the 50s and remains relatively constant afterwards.



Q. Su (1), C. Baker (1), M. Dekker (1), K. Adeli (1)

1 University of Toronto


Perturbations in lipid metabolism are intricately involved in the pathogenesis of obesity and type II diabetes. The gut-brain-liver neuronal axis via the vagus nerve is a two-way highway of communication between the central nervous system and peripheral tissues/organs that regulates many aspects of food intake and energy metabolism. Clinically, complete disruption of abdominal vagus nerve fibers has consistently abrogated weight gain or caused weight loss in the treated subjects. The present investigation sought to understand the molecular mechanisms underlying prevention of metabolic syndrome by vagotomy. Sub-diaphragmatic vagotomy of mice, in which both hepatic and gastric divisions of the vagal nerve were disrupted, led to significant decreases in both hepatic and plasma levels of triglyceride and apolipoprotein B compared to sham-surgery controls. In addition, the population of very low density lipoprotein particles was greatly reduced by vagotomy. By subjecting both vagotomized and sham mice to a high fat, high cholesterol (HFC) diet, we found that vagotomy protected mice against weight gain and hepatic insulin resistance induced by the HFC diet. Mechanistic studies revealed that mRNA levels of hepatic stearoyl CoA desaturase-1, which catalyzes the synthesis of oleyl CoA from stearolyl CoA, were dramatically decreased in the vagal-nerve-disrupted mice. Furthermore, increased secretion of the gut hormone, glucagon-like peptide-1, may contribute to maintenance of insulin sensitivity in vagotomized mice fed the HFC diet. These findings reveal a strong link between the vagal nervous system and gut hormones in maintaining metabolic homeostasis and preventing chronic disease induced by high-fat and/or high-carbohydrate diets.



A. Weiss (1), Y. Beloosesky (1), M.M. Boaz (1,2)

1 Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel

2 Department of Nutrition, School of Health Sciences, Ariel University Center, Ariel, Israel


Background: In a previous report, we showed that BMI was significantly, inversely associated with risk of death.  This inverse association between BMI and mortality may represent a protective metabolic "reserve" during periods of stress.  Total cholesterol has been identified as a measure of nutriture and is inversely associated with mortality in hemodialysis subjects.  We therefore examined whether increased total cholesterol reduced mortality risk in very old hospitalized patients.

Methods: A total of 477 inpatients (226 males), mean age of 81.5±7 years, hospitalized in an acute geriatric ward between 1999 and 2000 were included in the study. Serum total cholesterol was measured on admission day in the framework of usual care.  Patients were followed until August 31, 2004. Mortality data were extracted from death certificates.

Results: During a follow-up of 3.47 ± 1.87 years, 248 patients died. Those who died had significantly lower baseline serum total cholesterol than those who survived (182.5 ± 45.8 vs. 201.9 ± 39.6 mg/dl, p =0.005).  Serum total cholesterol was significantly, inversely associated with all cause mortality even after controlling for age, sex, diabetes, renal failure and BMI (HR 0.996, 95% CI 0.993-0.999, p=0.009), indicating that each 1 mg/dl increase in serum total cholesterol was associated with a 0.04% decrease in risk of death.  HR estimates for serum total cholesterol were unchanged when the analysis was restricted to the subset of patients (n=435) who survived for at least six months. 

Conclusions: In very elderly subjects, increased serum total cholesterol was associated with reduced mortality risk.

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