Search

The objective was to investigate the effects of a 3-week weight-management program including moderate energy restriction and exercise training at two intensities (LI:40% and HI:70% V'O2max) on body composition, energy expenditure and fat oxidation rate in severely obese adolescents. Twenty obese adolescents, aged 15-17 years (BMI: 37.5 kg/m2 ; 38.2 % fat mass) participated in this study. Before starting (week 0, W0) and at the end of the weight-management period (week 3, W3), body composition was assessed by a multifrequency tetrapolar impedancemeter (BIA); basal metabolic rate (BMR), energy expenditure and substrate oxidation rate during exercise and post exercise recovery by indirect calorimetry. At W3, body mass and fat mass decreased significantly (p

Background & aims: Visceral adiposity distribution also appears to influence metabolic complication. The purpose of this study was to determine a visceral adiposity cut-off points to indicate risk factor to develop NAFLD in Brazilian and Italian obese adolescents. Methods: 151 Brazilian and 87 Italian obese adolescents were enrolled. Visceral adiposity was distributed in cut-off values using a ROC curve analysis. Results: We verified that Brazilian obese adolescents showed a worse metabolic profile and liver function compared to Italian population. The risk factor to develop NAFLD was two fold higher in Brazilian compared with Italian obese adolescents. The corresponding OR (95%CI) was 6.66 (2.85e15.60) and 2.97 (0.61e14.47), for Brazilian and Italian population, respectively. The optimal visceral adiposity cut-off point to indicate risk factor of NAFLD development was 3.78 cm in Brazilian obese adolescents and 2.83 cm in Italian obese adolescents. Conclusions: Brazilian obese adolescents have a higher risk to develop NAFLD compared with Italian obese adolescents, confirmed by upper odds ratio values and a higher visceral adiposity cut-off value.

The objective of the present study was to explore the relationship between basal metabolic rate (BMR), gender, age, anthropometric characteristics, and body composition in severely obese white subjects. In total, 1,412 obese white children and adolescents (BMI > 97° percentile for gender and age) and 7,368 obese adults (BMI > 30 kg/m2) from 7 to 74 years were enrolled in this study. BMR was measured using an indirect calorimeter equipped with a canopy and fat free mass (FFM) were obtained using tetrapolar bioelectrical impedance analysis (BIA). Using analysis of covariance, we tested the effect of gender on the relationship between BMR, age, anthropometry, and body composition. In children and adolescents, the predictor gender interaction was significant in all cases except for FFM gender. In adults, all predictor gender interactions were significant. A prediction equation based on body weight (BW), age, and gender had virtually the same accuracy of the one based on FFM, age, and gender to predict BMR in both children and adults (R2adj = 0.59 and 0.60, respectively). In conclusion, gender was a significant determinant of BMR in children and adolescents but not in adults. Our results support the hypothesis that the age-related decline in BMR is due to a reduction in FFM. Finally, anthropometric predictors of BMR are as accurate as body composition estimated by BIA.

BACKGROUND: Pharmacological or exercise stimuli repeated at a short interval (but not electrical muscle stimulation) are associated with a blunting of GH responsiveness. AIM: To compare GH responses to repeated bout of three different GH-releasing stimuli. METHODS: The effects of two consecutive bouts (with a 2-h interval) of whole body vibrations (WBV), maximal voluntary contractions alone (MVC), or alternated with WBV (MVC-WBV) on blood GH and lactate (LA) were assessed in nine young males. RESULTS: Baseline levels of both GH and LA increased significantly after the first bout of all the tested stimuli, and were significantly lower after WBV than after MVC or MVC alternated with WBV, no difference being detected between these last. The administration of a second bout resulted in significantly lower GH increases than those elicited in the first bout in the three different tests; significantly lower LA responses were recorded after the second bout of MVC and MVC-WBV when compared with those obtained after the first bout, while no significant differences were observed after the two WBV bouts for LA. All responses after the second bout of MVC and MVC-WBV were significantly higher than those observed after WBV alone. GH concentrations were significantly correlated with LA after all stimuli, although LA concentrations after the second bout were associated with markedly lower GH levels. CONCLUSIONS: A significant blunting of GH responsiveness ensues after a second bout of different GH-releasing stimuli, independent from the amount of GH released after the first bout. This is a pattern also observed for other pharmacological stimuli and exercise modalities, and suggests a common mechanism underlying different GH-releasing stimuli.

The objective is to study the effects of low-intensity (LI) or high-intensity (HI) equicaloric exercises on energy expenditure (EE) and substrate oxidation rate during and after the exercises in severely obese Caucasian adolescents. Twenty obese boys (BMI-SDS 3.04 +/- 0.52, %Fat Mass 38.2 +/- 2.1%) aged 14-16 years (pubertal stage >3) participated in this study. Maximal oxygen uptake (V'O(2max)) and maximal fat oxidation rate were determined with indirect calorimetry using a graded exercise test on a treadmill. EE and substrate oxidation rate during equicaloric low-intensity (LI, 42% V'O(2max) for 45 min) and high-intensity (HI, 67% V'O(2max) for 30 min) exercises on a treadmill and during post-exercise recovery period (60 min) were determined with indirect calorimetry. Maximal fat oxidation rate was observed at 42 +/- 6% V'O(2max) (62 +/- 5% HR(max)) and fat oxidation rate was 0.45 +/- 0.07 g/min. The total amounts of EE, during the LI and HI exercises, and the post-exercise recovery periods were not significantly different (1,884 +/- 250 vs. 1,973 +/- 201 kJ, p = 0.453), but the total amount of fat oxidised was significantly higher (+9.9 g, +55.7%, p < 0.001) during the LI exercise than during the HI exercise. However, fat oxidation rates during the post-exercise recovery periods were not significantly different following LI and HI exercises. Total fat oxidised was significantly higher during the LI than during the HI exercise in obese adolescents. However, the equicaloric exercise intensity did not influence EE, fat and carbohydrate oxidation rate during the recovery period.

Juvenile metabolic syndrome (MetS) is a growing major medical problem in industrialised countries. We estimated its prevalence among two similar clinic-based sequentially recruited cohorts of extremely obese adolescents (age: 12-18 years) from Italy (N=665, males=271, females=394) and Germany (N=661, males=261, females=400) using the recent IDF paediatric criteria. The prevalence of the MetS was 23.3% among the Italians and 40.4% among the Germans. A multivariate logistic regression revealed an increased risk related to age (adjusted odd ratio (AOR): 2.24; 95% confidence interval (CI): 1.59-3.16; p

The physical activity ratio (PAR) values are commonly used to convert subjects' physical activity recalls into estimates of daily energy expenditure (DEE). A PAR is defined as the ratio between energy expenditure corresponding to a sedentary or a physical activity (kJ/min) and basal metabolic rate [(BMR) kJ/min]. The objective of the present study was to determine the PAR for different sedentary and physical activities in obese adolescents. Thirty-three obese adolescents [mean body mass index: 35.1 kg/m2; 40.3 % fat mass] aged 11 to 17 yr participated in this study. BMR was assessed by indirect calorimetry after an overnight fast by means of an open-circuit, indirect computerised calorimetry with a rigid, transparent, ventilated canopy. Energy expenditures corresponding to various sedentary and physical activities in free-living conditions were determined using a portable metabolic unit, and body composition by bioelectrical impedance analysis (BIA). The PAR of each activity was obtained by dividing the assessed energy expenditure by BMR. In this study, the PAR of various sedentary and physical activities did not vary significantly with sex, age, and body mass. Thus, the data for boys and girls were combined and the PAR for 27 sedentary and physical activities were determined. The PAR values can be applied to determine the mean DEE (kJ) using the specific equation considering BMR (kJ/min), PAR, and duration (min) of each activity performed by the subject during the 24 h. This information will be useful to health-care professionals because estimation of DEE in obese adolescents is necessary in order to prescribe an adequate dietary therapy to induce a desired level of energy deficit.

Physical activity is essential in obesity management because of the impact of exercise-related energy expenditure (EE) and fat oxidation (Fox) rate on a daily balance, but the specific physiological effects of different exercise modalities are scarcely known in obese individuals. The objective of the study was to compare the metabolic responses to treadmill (TM) and cycle ergometer (CE) exercise in obese adolescents. Gas exchange, heart rate (HR), blood lactate (LA) concentration, EE and Fox were determined at different intensity levels (up to about 85% of maximal oxygen uptake) during TM and CE in 14 pubertal (Tanner stage: >3) obese (BMI SDS: 2.15-3.86) male adolescents (age: 13-18 years). At comparable HR, oxygen uptake, EE and Fox were higher, and LA lower, during TM than CE (P

In order to assess the energy cost of cycling and aerobic capacity in juvenile obesity, responses to cycle ergometer exercise were studied in 10 pubertal obese (OB, BMI SDS: 3.40 +/- 0.58 SD) adolescent girls (age: 16.0 +/- 1.2 yrs.) and in 10 normal weight (NW, BMI SDS: -0.30 +/- 0.54) girls of the same age (15.1 +/- 1.9). To this aim, gas exchange, heart rate (HR) and energy expenditure (EE) were studied during graded cycle ergometer test at 40, 60, 80, 100 and 120 W. The energy cost of cycling was higher in OB, being oxygen uptake (VO2) higher (about 20%) in OB than in NW girls at all workloads (p < 0.01 - 0.001)). Estimated maximal VO2 and VO2 at anaerobic threshold were significantly (p < 0.05) higher in OB girls (although lower per unit body mass (p < 0.01) and similar for unit fat-free mass), and explained the higher oxygen pulse and lower HR for any EE observed during submaximal exercise in OB. While net mechanical efficiency (ME) was significantly lower in OB (p < 0.01), delta ME was similar in both groups, indicating no substantial derangement of muscle intrinsic efficiency. It is concluded that, despite a higher cost of cycling, OB girls can rely on a larger aerobic capacity which makes them able to sustain this kind of exercise within a wide range of work loads, with relevant implications when planning protocols of physical activity in the context of interventions for the reduction of juvenile obesity

BACKGROUND: Growth hormone (GH) replacement in adult GH-deficient (GHD) patients is reported to have a long-term beneficial effect on muscle mass and function, these effects being greater in young males and in adult-onset compared with those with childhood-onset GHD. To date, more discordant data are reported on the degree of muscle impairment in untreated GHD patients, due to the large heterogeneity of this syndrome. METHODS: Muscle maximum total isotonic strength (ST), lower limb maximum power output (W), maximum aerobic capacity (VO(2)max) and body composition (by tetrapolar bio-impedentiometry) were evaluated in seven short-stature adults with childhood-onset GHD and in seven age-matched normal-stature controls with comparable lifestyle and daily physical activity. RESULTS: Significant differences were found in body composition between control subjects and GHD patients, who presented higher adiposity (mean BMI+/-SD: GHD, 27.8+/-5.8 kg/m(2); controls, 22.1+/-0.8 kg/m(2); p=0.047), larger fat mass (GHD, 21.8+/-10.7 kg; controls, 8.8+/-3.5 kg; p=0.008), and lower fat-free mass (GHD, 65.8+/-11.4 %; controls, 87.0+/-6.5 %; p=0.002). In absolute terms, GHD patients attained significantly lower values in ST (GHD, 2479+/-493 N; controls, 4578+/-1476 N; p=0.008), W (GHD, 1092+/-452 W; controls, 1910+/-781 W; p=0.035) and VO(2)max (GHD, 1.68+/-0.40 l/min; controls, 2.67+/-0.84 l/min; p=0.035) than those attained by controls. The differences were still evident when the results were normalized by unit body mass, whereas they disappeared when the parameters were expressed per unit fat-free mass, suggesting for these patients the presence of an intrinsic muscle function in the same range as that of control subjects. CONCLUSIONS: Middle-aged and short-stature adults with childhood-onset GHD, who received discontinuous pit-GH substitution therapy only during childhood and have uncorrected long-lasting GHD, still retain a normal intrinsic muscle capability in attaining isotonic strength, generating anaerobic power as well as accomplishing oxidative processes. Nonetheless, it is not known which age-dependent evolution in motor dysfunction could be expected in this subgroup of GHD patients, when ageing processes add up to hormonal deficiencies.

Background: It is well established that repeated GHRH administration or repeated voluntary exercise bouts are associated with a complete blunting of GH responsiveness when the administration of the second stimulus follows the first one after a 2-h interval. Aim: To evaluate GH responses to neuromuscular electrical stimulation (NMES) in healthy adults. Methods: Six volunteers (mean age+/-s.d. 31.7+/-5.5 years) were studied before and after two consecutive bouts of NMES exercise (a series of 20 contractions at the maximum of individual tolerance, frequency: 75 Hz, pulse duration: 400 mus, on-off ratio: 6.25-20 s) administered at a 2-h interval. Results Baseline GH levels (mean: 0.3+/-0.2 ng/ml) significantly increased after the first NMES (peak: 4.2+/-3.7 ng/ml), with a complete normalization after 120 min (0.3+/-0.3 ng/ml). The administration of the second bout of NMES of comparable characteristics also resulted in a significant GH increase (peak: 5.2+/-3.2 ng/ml), which was comparable with that observed after the previous one. GH net incremental area under the curve after the first and second bouts of NMES were not significantly different (155.1+/-148.5 and 176.9+/-123.3 ng/ml per h, P=0.785). Conclusions: Unlike repeated pharmacological stimuli and voluntary exercise bouts, subsequent sessions of NMES administered at a 2-h interval appear to circumvent feedback mechanisms and to re-induce the GH responses, thus indicating a possible different underlying mechanism elicited by different GH-releasing stimuli.

The classification system based on five factors with cut-offs defined by the recent International Diabetes Federation consensus was used to estimate the prevalence of the metabolic syndrome in a cohort of 570 obese Italian women (age: 18-83 years; body mass index (BMI): 30.2-66.7kg/m(2)). A binary logistic regression analysis model assessed the combined impact of age, BMI, waist circumference (WC) and waist-to-hip ratio (WHR) on such prevalence. The overall prevalence of the syndrome among these obese women was 58.6%. The multivariate binary logistic regression analysis revealed that the prevalence progressively increased with age (p

The present study aimed to compare quadriceps femoris muscle strength and fatigue between obese (grade II and III) and nonobese adults. Ten obese (mean age: 25 years; mean BMI: 41 kg/m(2)) and ten lean (mean age: 27 years; mean BMI: 23 kg/m(2)) men were tested. Quadriceps muscle fatigue was quantified as the (percent) torque loss during a voluntary isokinetic (50 maximal contractions at 180 degrees /s) and an electrostimulated (40 Hz) isometric protocol (5 min, 10% of the maximal torque). Maximal voluntary isometric and isokinetic torque and power were also measured. Voluntary torque loss was significantly higher (P < 0.05) in obese (-63.5%) than in lean subjects (-50.6%). Stimulated torque decreased significantly (P < 0.05) but equally in the two subject groups. Obese subjects displayed higher absolute (+20%; P < 0.01) but lower relative (i.e., normalized to body mass) (-32%; P < 0.001) muscle torque and power than their lean counterparts. Obese individuals demonstrated lower fatigue resistance during voluntary but not during stimulated knee extensions compared to their nonobese counterparts. Peripheral mechanisms of muscle fatigue-at least those associated to the present stimulated test-were not influenced by obesity. The observed quadriceps muscle function impairments (voluntary fatigue and relative strength) probably contribute to the reduced functional capacity of obese subjects during daily living activities.

OBJECTIVE: To investigate the short- and medium-term (ie, at 1-y follow-up) effects of a hospital-based body weight reduction (BWR) program lasting 3 weeks in severely obese individuals. DESIGN: Longitudinal, clinical intervention study entailing energy-restricted diet, tailored aerobic-strength exercise, psychological counselling and nutritional education during a 3-week period followed by 49 weeks of indirect supervision at home. SUBJECTS: In all, 45 women and 19 men aged 30.2 +/- 7.2 y (mean +/- s.d.) with severe obesity (BMI: 41.3 +/- 4.3 kg/m(2)), classified as weight losers (final < initial weight) and regainers (final> or =initial weight). INTERVENTIONS: Body composition, physical performance and cardiovascular risk factors before and after the BWR program and at follow-up. RESULTS: The large majority of the experimental subjects obtained a clinical success after the 1-y period, and the rate was higher in females (n = 37/45, ie, 82.2%) than in males (n = 11/19, ie, 57.9%). At follow-up, weight losers had higher percent fat-free mass, muscle strength, HDL-cholesterol and self-reported physical activity level and lower total cholesterol and glucose levels than weight regainers (P < 0.05-0.01). Males displayed significantly larger fat-free mass losses than females at post-BWR and at follow-up. CONCLUSIONS A 3-week hospital-based integrated BWR program resulted in a high rate of clinical success in severely obese individuals at 1-y follow-up (particularly in females), that was associated with increased levels of self-reported physical activity and improved muscle strength and lipid profile. Further research is needed to establish the long-term effects (ie, at 2-5 y) associated to this treatment.

The purposes of this study were to compare postural stability between obese and lean subjects and to investigate the effect of a 3-week body weight reduction (BWR) program entailing specific balance training on postural stability of extremely obese patients. Time of balance maintenance and mean error on the medial-lateral direction at the trunk and lower limb level were assessed during a single limb stance on a movable platform in 19 non-obese and in 20 extremely obese individuals (age range: 20-40 yr). Time of balance maintenance was shorter (obese: 21.1+/-7.7 vs lean: 27.3+/-3.1 sec) and medial-lateral sway of the trunk was larger in obese (5.4+/-3.2 degrees) than in lean (3.2+/-1.1 degrees) subjects (p

Obese men and women have notably different body composition, which contributes to a different functional motor impairment, but it is unknown whether they respond differently to the same intervention for body weight (BW) reduction and motor capability improvement. The aim of this investigation was to compare changes in body composition, strength production and power output observed in severely obese men and women after a BW reduction intervention, and to test the hypothesis that changes in body composition may be related to changes in motor functionality. Ninety-five obese men and women of the same age (29.3 +/- 7.0 SD yr) and body mass index (41.2 +/- 4.4 kg/m2) participated in a short-term (3 week) mass reduction program (5 days/week) entailing exercise (aerobic and strength training) and energy-restricted diet. BW and body composition, maximum voluntary total isotonic strength (ST), and maximum leg power output (W) were evaluated before and after the program. After the intervention, BW decreased significantly in both men and women, but males lost a significantly higher amount of their initial BW than females (5.12 +/- 0.91 vs 4.27 +/- 1.42%, p

Ninety-nine Italian elite athletes (61 M, 38 F, mean age +/- SE: 24.1 +/- 0.6 yr, age range: 17-47 yr) of different disciplines volunteered to participate in this investigation. Basal GH concentrations were significantly higher (p

OBJECTIVE: To investigate the effectiveness of a body mass reduction programme entailing diet caloric restriction and moderate physical activity with or without supplementary treatment with recombinant (r) GH or steroids to improve body composition and muscle performance in severely obese women aged 61-75 years. METHODS: Twenty women were randomly assigned to one of three groups: body mass reduction alone; body mass reduction plus rGH; body mass reduction plus nandrolone undecanoate. Body composition, isotonic muscle strength and anaerobic power output during jumping were determined before and after the 3-week period. RESULTS: Whatever the experimental group considered, body mass (P

In order to investigate the effect of gender, age and level of obesity on body composition and anaerobic power output, and to test the hypothesis that variation in body composition affects muscle power output in obesity, a cohort of 377 subjects (112 males and 265 females, aged 18-75 yr) with different levels of obesity [class IIII, body mass index (BMI) range: 30.6-60.3 kg m(-2)] was cross-sectionally investigated. Body composition was assessed with bioelectric impedance analysis (BIA), in standardized conditions and using obesity-specific prediction formulas. Lower limb anaerobic power output (W) was measured with a modification of the Margaria stair climbing test. In males, a similar increase in fat-free mass (FFM) and fat mass (FM) was observed as a function of BMI, while in females, FM increased more than FFM. In both genders, FFM significantly decreased as a function of age (p or =50 yr) with extreme obesity (class III) suffered from the most serious motor dysfunction within this obese cohort. This result may have important clinical relevance in the care of obesity.

Background Non-alcoholic fatty liver disease (NAFLD) is an independent predictor of type 2 diabetes mellitus (T2DM). Insulin resistance and beta-cell dysfunction are involved in the pathogenesis of T2DM. Insulin resistance is associated with NAFLD but little is known about beta-cell dysfunction and NAFLD. Aim We tested whether NAFLD severity is associated with insulin sensitivity and beta-cell function in morbidly obese women. Subjects and methods We studied 61 Caucasian women aged 18–60 years without T2DM and with a body mass index ranging from 35.3 to 48.8 kg/m2. The insulin sensitivity index (ISI) and the disposition index (DI) from oral glucose tolerance testing were used as measures of insulin sensitivity and beta-cell function, respectively. Fat was measured by dual-energy X-ray absorptiometry. Fatty liver was diagnosed by ultrasonography and ordinally coded as 0 = none, 1 = light, 2 = moderate, 3 = severe. Proportional-odds logistic regression was used to evaluate the association of NAFLD severity with logeISI and logeDI with and without correction for total and truncal fat. Results The odds of more severe vs. less severe NAFLD decreased for increasing logeISI [odds ratio (OR) 0.40, 95 % CI 0.19–0.84, p < 0.05] and logeDI (OR 0.80, 95 % CI 0.69–0.92, p < 0.01). Neither total nor truncal fat had any effect on these associations. Conclusion In morbidly obese women, NAFLD severity is inversely associated with insulin sensitivity and beta-cell function. The association of NAFLD severity with beta-cell dysfunction is stronger than that with insulin resistance.