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Background It is well established that body composition influences metabolic health, but emerging data are conflicting with the largely purported idea that a large fat‐free mass (FFM) has a protective effect on health. A potential explanation for these discrepancies is the way FFM is represented. The first objective is to determine the association between the metabolic syndrome (MetS) and FFM when the latter was represented in three different ways: 1—absolute FFM; 2—relative to squared height (FFMi); and 3—relative to body weight (FFM%). The second objective is to assess the impact of FFM on the relative risk of having the MetS after taking fat mass, physical activity, and sociodemographic variables into account. Methods A total of 5274 individuals from the National Health and Nutrition Examination Survey database were studied. Age‐specific and sex‐specific quartiles of the three representations of FFM were defined, and the prevalence of MetS was determined in each of them. Quartiles of FFMi (kg/m2) were used to calculate the odds ratios of having the MetS independently of FM, physical activity levels, and sociodemographic variables. Results The prevalence of MetS decreased with increasing quartiles of whole‐body FFM% (Q1: 40%; Q4: 10%) but grew with increasing quartiles of absolute FFM (Q1: 13%; Q4: 40%) and FFMi (Q1: 10%; Q4: 44%). Similar results were observed for appendicular and truncal FFM. The odds ratios of having the MetS, independently of fat mass, physical activity, and sociodemographic variables, were significantly greater in the fourth quartile of FFMi when compared with the first quartiles of each specific subgroup [Q4 vs. Q1: younger men: 4.16 (1.99–8.68); younger women: 5.74 (2.46–13.39); older men: 1.98 (1.22–3.22); older women: 2.88 (1.69–4.90); all P ≤ 0.01]. Conclusions These results support the notion that the representation of FFM significantly influences its association with MetS and that a larger FFM, whether absolute or relative to height, is associated with alterations in cardiometabolic health.

Objective: To compare the acute and chronic effects of low-volume high-intensity interval training (HIIT) to moderate-intensity continuous training (MICT) on glycemic control, body composition and continuous glucose monitoring (CGM) in older women with type 2 diabetes (T2D). Methods: Thirty older women (68 ± 5 years) with T2D were randomized in two groups—HIIT (75 min/week) or MICT (150 min/week). Glucose homeostasis (A1c, glucose, insulin, HOMA-IR2) and body composition (iDXA) were measured before and after the 12-week exercise intervention. During the first and last week of training (24-h before and 48-h after exercise), the following CGM-derived data were measured: 24-h and peak glucose levels, glucose variability and time spent in hypoglycemia as well as severe and mild hyperglycemia. Results: While lean body mass increased (p = 0.035), total and trunk fat mass decreased (p ≤ 0.007), without any difference between groups (p ≥ 0.81). Fasting glucose levels (p = 0.001) and A1c (p = 0.014) significantly improved in MICT only, with a significant difference between groups for fasting glucose (p = 0.02). Neither HIIT nor MICT impacted CGM-derived data at week 1 (p ≥ 0.25). However, 24-h and peak glucose levels, as well as time spent in mild hyperglycemia, decreased in HIIT at week 12 (p ≤ 0.03). Conclusion: These results suggest that 12 weeks of low-volume HIIT is enough to provide similar benefit to MICT for body composition and improve the acute effect of exercise when measured with CGM.

A greater fat-free mass (FFM) is purported to be associated with protective effects on insulin resistance (IR). However, recent studies suggested negative associations between FFM and IR. (1) To explore the direction of the association between FFM and IR in a large heterogeneous sample after controlling for confounding factors. (2) To determine cut off values of FFM associated with an increased risk of IR. Outcome variables were measured in 7044 individuals (48.6% women, 20–79 years; NHANES, 1999–2006): body composition [fat mass (FM), FFM and appendicular FFM (aFFM); DXA], FFM index [FFMI: FFM/height (kg/m2)], appendicular FFMI [aFFM/height (kg/m2)] and insulin resistance (HOMA-IR). Multivariate regression analyses were performed to determine the independent predictors of HOMA-IR in younger (20–49 years) and older (50–79 years) men and women. ROC analyses were used to determine FFM cut-offs to identify a higher risk of insulin resistance (HOMA-IR > 75th percentile). aFFMI was an independent predictor of IR in younger (men: β = 0.21; women: β = 0.31; all p ≤ 0.001) and older (men: β = 0.11; women: β = 0.37; all p ≤ 0.001) individuals. Thresholds for aFFMI at which the risk of IR was significantly increased were 8.96 and 8.39 kg/m2 in younger and older men, and 7.22 and 6.64 kg/m2 in younger and older women, respectively. Independently of age, a greater aFFMI was an independent predictor of IR. These results suggest revisiting how we envision the link between FFM and IR and explore potential mechanisms.

Background: The aim of this study was to identify modifiable risk factors associated with isolated impaired fasting glucose (IFG), isolate impaired glucose tolerance (IGT), or combined IFG-IGT in men and women aged 50 years and older. Methods: Cross-sectional analyses were performed in 703 men and women aged between 50 and 80 years old from NHANES (2007–2008). Outcome variables: IFG and IGT (ADA 2003), estimated body composition, cardiometabolic profile, and socio-demographic, dietary, and lifestyle factors. Results: First, 235 had normal glucose tolerance (men = 38.3%, women = 61.7%), 243 had IFG (men = 61.7%, women = 38.3%), 67 had IGT (men = 40.3%, women = 59.7%) and 158 had both conditions (men = 57.0%, women = 43.0%). The only common determinant of both IFG and IGT was triglyceride levels. High total fat mass index (FMI) and high total fat-free mass index (FFMI) were independently associated with IFG; while high C-reactive protein (CRP) levels were independently associated with IGT. Finally, combined IFG-IGT was associated with inadequate fiber intake, high FMI, FFMI, and CRP levels. Conclusions: Middle-age and older individuals presented different modifiable risk factors depending on whether they had IFG or IGT. IFG was associated with deteriorated body composition and lipids, whereas IGT was associated with deteriorated lipids and inflammatory factors. IFG-IGT, on the other hand, was associated with a larger number of risk factors, including worsen body composition, cardiometabolic and dietary factors. To prevent the transition to type 2 diabetes, specific clinical interventions targeting these risk factors should be considered.

To determine the influence of cardiorespiratory fitness (hereafter “fitness”) and physical activity levels on cardiometabolic risk factors in premenopausal women going through the menopause transition. An ancillary study including 66 premenopausal women who participated to a 5-year observational, longitudinal study (2004 to 2009 in Ottawa) on the effects of menopause transition on body composition and cardiometabolic risk factors. Women underwent a graded exercise test on treadmill to measure peak oxygen uptake (VO2 peak) at year 1 and 5 and physical activity levels were measured using accelerometers. Cardiometabolic risk factors included: waist circumference, fasting plasma lipids, glucose and insulin levels, HOMA-IR score, c-reactive protein, apolipoprotein B (apoB) and resting systolic and diastolic blood pressure. Change in fitness was not associated with changes in cardiometabolic risk factors. The changes in total physical activity levels on the other hand showed a significant negative association with apoB levels. Three-way linear mixed model repeated measures, showed lower values of waist circumference, fasting triglycerides, insulin levels, HOMA-IR score, apoB and diastolic blood pressure in women with a fitness ≥ 30.0 mlO2 kg− 1 min− 1 compared to women with a fitness, Highlights • Fitness and physical activity levels are independent predictors of CVD. • Change in total physical activity levels was negatively association with apoB. • Fitness was associated with more favorable values of cardiometabolic risk factors.

Adequate protein intake and resistance training are effective strategies to maintain muscle mass, but the effect of their combination on metabolic profile during weight loss remains to be determined in older adults. The main objective of this study was to determine the effect of a 16-week high-protein caloric restriction combined with resistance training on chronic disease risk factors in obese older individuals with metabolic impairments. A total of 26 overweight adults aged between 60 and 75 years (BMI 32.4 ± 3.9 kg/m2) with at least 2 factors of the metabolic syndrome participated in this study and were randomized into two groups: 1) high-protein caloric restriction (HP; n= 12) and 2) high-protein caloric restriction combined with dynamic-resistance training (HP+RT; n=14). Caloric intake was reduced by 500 kcal/d in all participants and protein intake equated 25-30% of total calories (~1.4 g/kg/d). Exercise training consisted of 3 session/week of resistance training on pulley machines. Outcome measures included total and trunk fat mass (FM), total and appendicular lean body mass (LBM), fasting glucose level, lipid profile and blood pressure. Our results showed that total and trunk FM (all p

Objective: To investigate if an exaggerated peak exercise systolic blood pressure (peak ESBP) is associated with alteration of cardiometabolic risk factors and predict future resting hypertension in middle aged women. Methods: Data analysis was performed in 95 healthy normotensive premeno-pausal women at baseline and 84 after 5-year follow-up (age, 49.9 ± 1.9 years; BMI, 23.3 ± 2.2 kg/m2; resting BP, 117/73 ± 11.8/7.6 mmHg). Blood pressure was measured at rest and during a progressive exercise test on treadmill. Women were divided into two groups according to their peak ESBP

It is unknown whether leptin and peptide YY (PYY) influence changes in resting energy expenditure (REE), independently of fat mass (FM) and fat-free mass (FFM) in addition to changes in other energy expenditure (EE) components during weight loss.The objective of the study was to examine the relationships between leptin, PYY, and body composition with different EE components before and after weight loss and whether changes in leptin and PYY were associated with differences in predicted vs measured REE after the intervention.This was a randomized controlled design.The study was conducted in a laboratory.Participants were ninety-three overweight/obese postmenopausal women (aged 58.1 ± 4.8 y; body mass index 32.1 ± 4.3 kg/m(2)).Interventions included a 6-month caloric restriction diet alone or caloric restriction diet+resistance training.Body composition (dual energy x-ray absorptiometry), REE (indirect calorimetry), total EE (TEE; doubly labeled water), and fasting leptin and total PYY before and after weight loss were measured.Both interventions yielded significant decreases in weight, FFM, REE, and leptin, whereas a significant time × group interaction was noted for FM (greater decrease in FM in the diet+resistance training group) (P.05 for all outcomes). No significant differences in TEE, physical activity EE, and PYY were noted between baseline and after the intervention. Age, FFM, leptin, and PYY were the best predictors of baseline REE (R(2) = 0.77; P = .0001), whereas age, FFM, and FM were associated with REE after the intervention (R(2) = 0.88; P = .0001). The same predictors, except for leptin, were significantly related to TEE at baseline (R(2) = 0.70; P = .0001) and after the intervention (R(2) = 0.29; P = .0001), whereas only PYY was a significant predictor of physical activity EE at baseline and after the intervention. Changes in FM and leptin accounted for 27% of the variance in ΔREE (P = .0001). Greater predicted vs measured REE was noted after the intervention (P = .02). However, Δ leptin and ΔPYY were not significant predictors of the differences between postintervention measurement and predicted REE.Δ Leptin and ΔFM were strong contributors to changes in REE. However, Δ leptin and ΔPYY were not significant predictors of the differences between predicted and measured REE after the intervention.

It is unknown whether the satiety quotient (SQ) differs across the menopausal transition, and whether changes in SQ are related to changes in anthropometric/body composition variables. The objective of this study was to evaluate the changes in SQ and its association with energy intake and changes in anthropometric/body composition variables across the menopausal transition.At baseline, 102 premenopausal women (aged 49.9 ± 1.9 years, body mass index 23.3 ± 2.2 kg/m(2)) took part in a 5-year observational, longitudinal study. Body composition (DXA), appetite (visual analog scales), energy and macronutrient intakes (ad libitum lunch and 7-day food diary) were assessed annually. The SQ (mm/100 kcal) was calculated at 60 and 180 min post-breakfast consumption.Overall, the SQ increased at years 3 and 4 (p = 0.01-0.0001), despite no significant differences between menopausal status groups. Lower fullness, prospective food consumption and mean SQ values predicted overall increases in lunch energy and macronutrient intakes (p = 0.04-0.01), whereas only prospective food consumption and fullness SQ predicted energy intake and carbohydrate intake, respectively, when assessed with food diaries (p = 0.01). Delta SQs were negatively correlated with changes in waist circumference (p = 0.03-0.02), whereas delta SQs were positively (p = 0.04) and negatively (p = 0.02) associated with delta fat mass between years 1 and 5, and years 4 and 5, respectively.These results suggest that variations in SQ across the menopausal transition are related to energy and macronutrient intakes and coincide with changes in body composition and waist circumference.

Objective The purpose of this study was to investigate changes in dietary intake and appetite across the menopausal transition. Methods This was a 5-year observational, longitudinal study on the menopausal transition. The study included 94 premenopausal women at baseline (age: 49.9 ± 1.9 yrs; BMI: 23.3 ± 2.3 kg/m2). Body composition (DXA), appetite (visual analogue scale), eating frequency, energy intake (EI) and macronutrient composition (7-day food diary and buffet-type meal) were measured annually. Results Repeated-measures analyses revealed that total EI and carbohydrate intake from food diary decreased significantly over time in women who became postmenopausal by year 5 (P > 0.05) compared to women in the menopausal transition. In women who became postmenopausal by year 5, fat and protein intakes decreased across the menopausal transition (0.05 > P < 0.01). Although a decrease in % fat intake was observed during the menopausal transition (P < 0.05), this variable was significantly increased in the postmenopausal years (P < 0.05). Spontaneous EI and protein intake also declined over time and were higher in the years preceding menopause onset (P < 0.05). Desire to eat, hunger and prospective food consumption increased during the menopausal transition and remained at this higher level in the postmenopausal years (0.05 > P< 0.001). Fasting fullness decreased across the menopausal transition (P < 0.05). Conclusion These results suggest that menopausal transition is accompanied with a decrease in food intake and an increase in appetite.

Objectives Factors that influence weight gain during the menopausal transition are not fully understood. The purpose of this study was to investigate changes in energy expenditure (EE) across the menopausal transition. Methods One hundred and two premenopausal women (age: 49.9 ± 1.9 yrs; BMI: 23.3 ± 2.2 kg/m2) were followed for 5 years. Body composition (DXA), physical activity EE (accelerometer), resting EE and thermic effect of food (indirect calorimetry) were measured annually. Results Total EE decreased significantly over time in postmenopausal women (P < 0.05), which was mostly due to a decrease in physical activity EE (P < 0.05). Although average resting EE remained stable over time in postmenopausal women, a significant increase, over the 5-year period, was noted in women who were in the menopausal transition by year 5 (P < 0.05). Finally, the time spent in moderate physical activity decreased and the time spent in sedentary physical activity increased during the menopausal transition (P < 0.05). Conclusion These results suggest that menopausal transition is accompanied with a decline in EE mainly characterized by a decrease in physical activity EE and a shift to a more sedentary lifestyle.

Healthy diet and physical activity are associated with a lower cardiometabolic risk (CMR). Little is known about whether they interact to improve CMR. The purpose of the present study was to determine the synergistic associations of diet quality and physical activity energy expenditure (PAEE) on CMR factors. The present study was ana posteriorianalysis of two cross-sectional studies on 124 inactive non-diabetic postmenopausal women with a BMI ≥ 27 kg/m2. The following factors were measured: diet quality (assessed by the Canadian Healthy Eating Index (C-HEI) from a 3 d food record); PAEE (doubly labelled water); body composition (dual-energy X-ray absorptiometry, computed tomography scan); lipoprotein profile (total, HDL- and LDL-cholesterol (HDL-C and LDL-C), non-HDL-C, total cholesterol:HDL-C, TAG, apoA1, apoB, apoA1:apoB and LDL-C:apoB); insulin sensitivity (homeostasis model assessment of insulin resistance and hyperinsulinaemic–euglycaemic clamp); inflammatory markers (high-sensitivity C-reactive protein (hs-CRP), haptoglobin, orosomucoid, IL-6 and leucocyte count). The association of the interaction PAEE × C-HEI and CMR factors was evaluated by hierarchical regressions. Fat mass-adjusted ANCOVA determined the interaction between PAEE and the C-HEI. In hierarchical regressions, the interaction PAEE × C-HEI was a correlate of more favourable values of HDL-C, apoB, apoA1:apoB and LDL-C:apoB ratios, and hs-CRP, while only PAEE was a negative correlate of haptoglobin. Compared with those in the low-PAEE/low-C-HEI group, women in the high-PAEE/high-C-HEI group had 10 % higher HDL-C, 13 % lower apoB, 11 % larger LDL particles and 28 % lower hs-CRP concentrations (P

The purpose of this study was to investigate the relationship between visceral adipose tissue (VAT), estimated with the Bertin index obtained from dual-energy X-ray absorptiometry (DXA), with cardiometabolic risk factors before and after a weight loss program and compare it with VAT measured with computed tomography (CT) scan. The study population for this analysis included 92 nondiabetic overweight and obese sedentary postmenopausal women (age: 58.1 ± 4.7 years, BMI: 31.8 ± 4.2 kg/m(2)) participating in a weight loss intervention that consisted of a caloric restricted diet with and without resistance training (RT). We measured (i) VAT using CT scan, (ii) body composition (using DXA) from which the Bertin index was calculated, (iii) cardiometabolic risk factors such as insulin sensitivity (using the hyperinsulinenic-euglycemic clamp technique), peak oxygen consumption, blood pressure, plasma lipids, C-reactive protein as well as fasting glucose and insulin. VAT levels for both methods significantly decreased after the weight loss intervention. Furthermore, no differences in VAT levels between both methods were observed before (88.0 ± 25.5 vs. 83.8 ± 22.0 cm(2)) and after (76.8 ± 27.8 vs. 73.6 ± 23.2 cm(2)) the weight loss intervention. In addition, the percent change in VAT levels after the weight loss intervention was similar between both methods (-13.0 ± 16.5 vs. -12.5 ± 12.6%). Moreover, similar relationships were observed between both measures of VAT with cardiometabolic risk factors before and after the weight loss intervention. Finally, results from the logistic regression analysis consistently showed that fat mass and lean body mass were independent predictors of pre- and post-VAT levels for both methods in our cohort. In conclusion, estimated visceral fat levels using the Bertin index may be able to trace variations of VAT after weight loss. This index also shows comparable relationships with cardiometabolic risk factors when compared to VAT measured using CT scan.

M Sénéchal1,2, H Arguin6, DR Bouchard4,5, AC Carpentier3, JL Ardilouze3, IJ Dionne1,2, M Brochu1,21Research Centre on Aging, Health and Social Services Centre, University Institute of Geriatrics of Sherbrooke, 2Faculty of Physical Education and Sports, University of Sherbrooke, 3Clinical Research Centre, Sherbrooke University Hospital Centre, Sherbrooke, QC; 4Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB; 5Health, Leisure & Human Performance Research Institute, Winnipeg, MB; 6Division of Kinesiology, Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, QC, CanadaObjective: To examine the association between weight gain since menopause and weight regain after a weight loss program.Methods: Participants were 19 obese women who participated in a 15-week weight loss program and a 12-month follow-up. Main outcomes were: body composition, resting metabolic rate, energy intake, energy expenditure, and weight regain at follow-up.Results: All body composition measures significantly decreased after intervention (all P ≤ 0.01) while all measures of fatness increased significantly after the 12-month follow-up (P ≤ 0.01). Body weight gain since menopause was associated with body weight regain (r = 0.65; P = 0.003) after follow-up even after adjustment for confounders.Conclusion: Weight gain since menopause is associated with body weight regain following the weight loss program. Therefore, weight gain since menopause should be considered as a factor influencing weight loss maintenance in older women.Keywords: obesity, body weight, weight regain, postmenopausal women, aging

Background: Obesity in older adults results from several interacting factors. Consequently, interventions have shown mitigated effects. Objectives: We determined 1) the different subgroups of obese elderly based on clusters of associated comorbidities and 2) the trajectory of these clusters to assess their stability over 3 years and factors contributing to transitions. Methods: Obese men (n=193; BMI= 33.15 ± 2.69 kg/m2) and women (n=220; BMI= 33.71 ± 3.71 kg/m2) aged between 68 and 82 years were studied. Outcome variables were: body composition, strength, physical capacity, nutrition, psychological and physical health and social participation. Cluster analyses, stratified by sex, were used to identify obesity profiles at baseline and follow-up. Results: Three profiles were identified, based on general health (GH), psychological health (PH) and physical capacity (PC). Cluster 1: healthy obese (GH+, PH+, PC+); Custer 2: obese with low physical capacity (GH+/-, PH+/-, PC-); Cluster 3: unhealthy obese (GH-, PH-, PC-). After 3-years, 61% and 62% of men and women remained in their initial cluster, compared to 20.4% and 12.0% who transitioned toward a worse health Cluster and 18.3% and 14.2% who transitioned toward a more favorable cluster, partly explained by changes in physical health for men and physical and psychological health for women. Conclusion: The results of this study show that targeting physical capacity in men and physical and psychological health status in women could prevent further health decline in obese elderly. Further studies are needed to investigate the role of these clusters in the prediction of cardiometabolic complications and mortality.

The purpose of this study was to compare different methods to identify metabolically healthy but obese (MHO) individuals in a cohort of obese postmenopausal women. We examined the anthropometric and metabolic characteristics of 113 obese (age: 57.3 +/- 4.8 years; BMI: 34.2 +/- 2.7 kg/m(2)), sedentary postmenopausal women. The following methods were used to identify MHO subjects: the hyperinsulinemic-euglycemic clamp (MHO: upper quartile of glucose disposal rates); the Matsuda index (MHO: upper quartile of the Matsuda index); the homeostasis model assessment (HOMA) index (MHO: lower quartile of the HOMA index); having 0-1 cardiometabolic abnormalities (systolic/diastolic blood pressureor =130/85 mm Hg, triglycerides (TG)or =1.7 mmol/l, glucoseor =5.6 mmol/l, HOMA5.13, high-sensitive C-reactive protein (hsCRP)0.1 mg/l, high-density lipoprotein-cholesterol (HDL-C)1.3 mmol/l); and meeting four out of five metabolic factors (HOMAor =2.7, TGor =1.7 mmol/l, HDL-Cor =1.3 mmol/l, low-density lipoprotein-cholesterolor =2.6 mmol/l, hsCRPor =3.0 mg/l). Thereafter, we measured insulin sensitivity, body composition (dual-energy X-ray absorptiometry), body fat distribution (computed tomography scan), energy expenditure, plasma lipids, inflammation markers, resting blood pressure, and cardiorespiratory fitness. We found significant differences in body composition (i.e., peripheral fat mass, central lean body mass (LBM)) and metabolic risk factors (i.e., HDL-C, hsCRP) between MHO and at risk individuals using the different methods to identify both groups. In addition, significant differences between MHO subjects using the different methods to identify MHO individuals were observed such as age, TG/HDL, hsCRP, and fasting insulin. However, independently of the methods used, we noted some recurrent characteristics that identify MHO subjects such as TG, apolipoprotein B, and ferritin. In conclusion, the present study shows variations in body composition and metabolic profile based on the methods studied to define the MHO phenotype. Therefore, an expert consensus may be needed to standardize the identification of MHO individuals.

This cross-sectional study proposes two relative strength indexes in order to evaluate the risks of lower mobility in healthy older adults: 1) handgrip strength on body mass index and 2) quadriceps strength on body weight. Nine hundred and four men and women aged between 67-84 years old were tested for body composition, muscle strength and mobility function. Individuals in the lowest and middle tertiles of relative handgrip strength were respectively 2.2 (1.3-3.7) and 4.4 (2.6-7.6) more likely to have a lower mobility score. As for relative quadriceps strength, odd ratios for lowest and middle tertiles were respectively 2.8 (1.6-4.9) and 6.9 (3.9-12.1). Relative strength indexes, either using handgrip strength or quadriceps strength, are convenient to use in large scale studies and clinical practice.

Sarcopenia and obesity have been independently associated with physical capacity impairments. However, few studies have investigated the impact of sarcopenic/obesity on physical capacity in older individuals using objective measures of physical capacity and body composition. This study included 904 older individuals aged between 68 and 82 years old. Body composition (fat mass (FM) and lean body mass (LBM) by dual-energy X-ray absorptiometry (DXA)), physical capacity (timed up and go, chair stands, walking speed at normal and fastest pace, and one leg stand), sum of reported chronic conditions and physical activity level were measured. A global physical capacity score was then calculated giving a maximal score of 20. Finally, four groups were created within genders based on sarcopenia and obesity ((i) nonsarcopenic/nonobese; (ii) sarcopenic/nonobese; (iii) nonsarcopenic/obese; (iv) sarcopenic/obese). The four groups were significantly different for the sit-to-stand test and the one leg stand test (P < 0.05) and only for the one leg stand test in women (P < 0.05). In both genders results for the global physical capacity score revealed that both obese groups (sarcopenic and nonsarcopenic) were similar (P = 0.14 in men and P = 0.19 in women) and had a lower global physical capacity score compared to nonsarcopenic/nonobese individuals (P < 0.05). In addition, sarcopenic women displayed a higher score than both obese nonsarcopenic and obese sarcopenic groups (P < 0.01). Sarcopenic/obese men and women do not display lower physical capacity compared to nonsarcopenic/obese individuals in this cohort of well-functioning older men and women. Obesity per se appears to contribute more to lower physical capacity than sarcopenia.

Objective: Identify a body mass index (BMI) threshold above which physical capacity would be significantly affected. Methods: This study included 904 physically independent older individuals aged between 67 and 84 years old. Measures were: BMI, physical capacity score (PCS) computed according to five lower extremity physical tests, sum of reported chronic conditions and physical activity level. Results: When subjects were divided in 10 BMI groups, no clear threshold was identified in men since the PCS was only significantly decreased in the heaviest group, which correspond to a BMI of >34.5 kg/m 2 . In women, a BMI of 30.5 kg/m 2 was identified as the threshold above which the PCS was significantly decreased compared with the reference group. Discussion: Although no clear BMI threshold was identify in older men, a BMI of 30.5 kg/m 2 in women was associated with a significantly lower physical capacity.

Background. Aging is associated with increases in fat mass (FM) and decreases in fat-free mass (FFM) that may affect physical capacity. However, it is not clear whether high FM or low FFM contribute more to a reduction in physical capacity. Methods. A structural equation modeling strategy was used to test an explanatory model of the association between body composition and physical capacity. The concept of physical capacity was assessed by walking speed at a normal pace and the one leg stand test. To test the model, 904 men and women between 67 and 84 years old were studied. Body composition was measured by dual-energy x-ray absorptiometry (DXA). Confounding factors related to body composition and physical capacities were included in the explanatory model (physical activity level, age, gender, and number of reported diseases). Results. The final model showed that physical capacity can be represented by a factorial first-order model including generic measures of walking speed and balance. Moreover, our results showed that percentage of FM was significantly associated with physical capacity ( p , .01), whereas no such association was observed with FFM. Other variables such as physical activity level, number of self-reported diseases, and age were associated with physical capacity (all p , .01). Overall, the proposed model explained 48% and 57% of the variance observed in men and women when using the one leg stand and the walking speed at normal pace tests as measures of physical capacity. Conclusion. FM was significantly and inversely correlated with physical capacity, whereas FFM was not associated when controlled for other potential confounding variables. More studies are needed to investigate the effect of different levels of obesity on physical capacity in older individuals.

Women transitioning to menopause are at risk for central fat mass gain and associated health problems caused by hormone-related changes in appetite, energy expenditure, and body fat distribution.1-3 Health problems associated with central fat mass, especially abdominal fat, in obese postmenopausal women include chronic diseases such as heart disease, hypertension, type 2 diabetes, cancers, and osteoarthritis.4,5 Women can minimize weight gain and body fat distribution changes, especially gains in abdominal fat, by ensuring healthy nutrition and/or increasing physical activity.6-9 Greater weight loss often occurs when exercise and dietary approaches are combined.10 In addition to daily cardiovascular activities, early postmenopausal women also seem to benefit from resistance training twice a week.11 Other benefits of resistance training include minimizing potential decreases in lean body mass and bone density during weight loss.1 However, only 52% of Canadian women aged 45 to 54 years are physically active during their leisure time,12 and only 48% meet daily dietary recommendations of five or more servings of fruits and vegetables.13 Little is known about how much women consider the influence of menopausal changes on body composition and body fat distribution when making decisions about body weight management. Women want to be involved in decisions relevant to their health.14 Compared with men, women are involved in making more health decisions and decisions of greater complexity.15,16 Those who were younger and had higher education were more likely to take an active role in decision-making. Decisions are of higher quality when they are informed by evidence on options and aligned with the relative priority women place on outcomes of options.17 To date, studies assessing middle-aged women’s decision-making indicate that they experience uncertainty about choosing the best course of action18 and are limited to examining decisions about the use of natural health products for menopausal symptoms.19,20 Factors interfering with women’s decision-making included difficulty in finding reliable information, reluctance of physicians to discuss natural health products, and conflicting opinions of others. Knowledge translation (KT) tools present evidence in user-friendly ways to enhance understanding and use of the evidence for making decisions.21 Systematic reviews of KT tools, such as decision aids, have demonstrated enhanced knowledge, more realistic expectations, higher consumer participation in decisions, and reduced factors contributing to decisional conflict.22 However, little is known about the effects of KT tools on middle-aged women facing lifestyle decisions about body weight management during the menopausal transition. The objective of this study was to assess middle-aged women’s needs when making body weight management decisions and to evaluate a new KT tool for addressing their needs.

NANTEL, JULIE, MARTIN BROCHU, AND FRANCOIS PRINCE. Locomotor strategies in obese and non-obese children. Obesity. 2006;14:1789-1794. Objective: The constant strain in obese children may in- crease the risks of articular problems in adulthood. In the short term, obesity in children could lead to modifications of the gait pattern. The purpose of this study was to compare biomechanical parameters between obese and non-obese children during self-paced walking. Research Methods and Procedures: Gait analysis was per- formed on 10 non-obese and 10 obese (body weight 95th percentile) children between 8 and 13 years of age. Subjects were asked to walk at their own pace on a 10-m walkway with two embedded AMTI force plates (Advanced Mechan- ical Technology, Watertown, MA) sampling at 960 Hz. Kinematics were captured with eight VICON optoelectronic cameras (Oxford Metrics Limited, Oxford, United King- dom) recording at 60 Hz. Results: Obese children modified their hip motor pattern by shifting from extensor to flexor moment earlier in the gait cycle. This led obese children to significantly de- crease the mechanical work done by the hip extensors during weight acceptance and significantly increase the mechanical work done by the hip flexors compared with non-obese children. The ratio of power-absorption-by-hip- flexors to power-generation-by-hip-flexors was also signif- icantly increased in the obese group compared with non- obese children. Finally, there was a significant decrease in the single support duration in the obese group compared with non-obese. Discussion: The kinetics analyzed showed that obese chil- dren could take advantage of a passive hip strategy to achieve forward progression during walking. However, con- sidering that they are mechanically less efficient to transfer energy, walking at a natural cadence should be an appro- priate exercise to reduce weight in obese children.

The purpose of this study was to investigate the inflammatory state in obese women displaying the "metabolically healthy but obese" (MHO) phenotype.We examined the metabolic characteristics of 88 obese, sedentary postmenopausal women. Subjects were classified as MHO or as "at risk" based on the upper and lower quartiles of insulin sensitivity as measured by the hyperinsulinemic-euglycemic clamp technique. Thereafter, we determined 1) body composition, 2) body fat distribution, 3) plasma lipid and lipoprotein levels, 4) glucose homeostasis, 5) resting blood pressure, 6) peak oxygen consumption, and 7) inflammation markers as potential modulators of differences in the coronary risk profile.Twenty-two MHO women displayed high insulin sensitivity (15.35 +/- 2.3 mg/min.kg fat-free mass), and 22 at risk subjects with low insulin sensitivity (7.98 +/- 1.4 mg/min.kg fat-free mass) were identified. Despite comparable total body fatness between groups (47.7 +/- 4.8 vs. 45.5 +/- 4.4%; not significant), MHO individuals had significantly lower levels of visceral fat, fasting insulin, plasma triglycerides, high-sensitivity C-reactive protein (CRP), and alpha-1 antitrypsin levels and higher levels of high-density lipoprotein cholesterol than at risk individuals (P0.05). Stepwise regression analysis showed that CRP, fasting triglycerides, and the lean body mass index explained 19.5, 8.5, and 4.0%, respectively, of the variance observed in glucose disposal (total r(2) = 0.320; P0.001).Results of the present study indicate that postmenopausal women displaying the MHO phenotype also have a favorable inflammation profile as shown by lower CRP and alpha-1 antitrypsin levels compared with insulin-resistant women. This suggests that a lower inflammation state, as attested by low CRP levels, could play a role in the protective profile of the MHO individual, and this may be associated metabolically to a lower risk for cardiovascular disease.

Physical activity energy expenditure (PAEE) is a determinant of prognosis and fitness in older patients with coronary heart disease (CHD). PAEE and total energy expenditure (TEE) are closely related to fatness, physical function, and metabolic risk in older individuals. The goal of this study was to assess effects of resistance training on PAEE, TEE, and fitness in older women with chronic CHD and physical activity limitations ( N = 51, mean age: 72 + 5 yr). The study intervention consisted of a progressive, 6-mo program of resistance training vs. a control group condition of low-intensity yoga and deep breathing. The study interventions were completed by 42 of the 51 participants. The intervention group manifested a 177 ± 213 kcal/day (+9%) increase in TEE, pre- to posttraining, measured by the doubly labeled water technique during a nonexercise 10-day period ( P < 0.03 vs. controls). This was due to a 50 ± 74 kcal/day (4%) increase in resting metabolic rate measured by indirect calorimetry ( P < 0.01, P < 0.05 vs. controls) and a 123 ± 214 kcal/day (9%) increase in PAEE ( P < 0.03, P = 0.12 vs. controls). Resistance training was associated with significant increases in upper and lower body strength, but no change in fat-free mass, measured by dual X-ray absorptiometry, or left ventricular function, measured by echocardiography and Doppler. Women in the control group showed no alterations in TEE or its determinants. There were no changes between groups in body composition, aerobic capacity, or measures of mental depression. These results demonstrate that resistance training of 6-mo duration leads to an increase in TEE and PAEE in older women with chronic CHD.

We evaluated the value of resistance training on measures of physical performance in disabled older women with coronary heart disease (CHD).The study intervention consisted of a 6-month program of resistance training in a randomized controlled trial format. Training intensity was at 80% of the single-repetition maximal lift. Control patients performed light yoga and breathing exercises. Study participants included 42 women with CHD, allor= 65 yr of age and community dwelling. Subjects were screened by questionnaire to have low self-reported physical function. The primary study measurements related to the performance of 16 household activities of the Continuous Scale Physical Functional Performance test (CSPFP). These ranged from dressing, to kitchen and cleaning activities, to carrying groceries and walking onto a bus with luggage, and a 6-min walk. Activities were measured in time to complete a task, weight carried during a task, or distance walked. Other measures included body composition, measures of aerobic fitness and strength, and questionnaire-based measures of physical function and depression score.Study groups were similar at baseline by age, aerobic capacity, strength, body composition, and in performing the CSPFP. After conditioning, 13 of 16 measured activities were performed more rapidly, or with increased weight carried, compared with the control group (all P0.05). Maximal power for activities that involved weight-bearing over a distance, increased by 40% (P0.05).Disabled older women with CHD who participate in an intense resistance-training program improve physical capacity over a wide range of household physical activities. Benefits extend beyond strength-related activities, as endurance, balance, coordination, and flexibility all improved. Strength training should be considered an important component in the rehabilitation of older women with CHD.

Purpose: The effect of gemfibrozil is mediated by the activation of peroxisome proliferator-activated receptor alpha (PPARα). The objective of this study was to determine whether the lipid response to gemfibrozil therapy is influenced by the PPARα-L162V polymorphism. Methods: Sixty-three abdominally obese men were randomly assigned to a 6-month-intervention program with either receiving a placebo (N = 31) or gemfibrozil (N = 32). Results: In response to gemfibrozil therapy, L162-homozygotes exhibited a 5.5% increase in high-density lipoprotein 2 cholesterol (HDL2-C) levels compared with a 50.0% increase among carriers of the V162 allele (P = 0.03). Conclusion: These results suggest that the HDL2-C response to gemfibrozil is modulated by the PPARα-L162V polymorphism.

Evidence suggests that fibrate therapy reduces the risk of recurrent coronary heart disease among men with low levels of high density lipoprotein cholesterol (HDL-C). Indirect observations and new possible biological pathways suggest that the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism might modulate the lipoprotein/lipid profile and its response to fibrate therapy. To assess the possible interaction between fibrate therapy and such variants on plasma lipid and lipoprotein levels, 65 dyslipidemic abdominally obese men were treated for 6 months with or without gemfibrozil (600 mg twice daily). No differences in baseline plasma lipid and lipoprotein levels were found between genotype groups except for the HDL(3)-C subfraction, which was higher in the DD group (p = 0.02). A two-way factorial ANOVA was used to evaluate the effect of the genotype (DD homozygotes vs I allele carriers), the treatment (placebo vs gemfibrozil), and the interaction between these two independent variables on changes observed in lipid and lipoprotein concentrations. A significant genotype-by-treatment interaction (p = 0.02) was found for the plasma HDL-C response to the intervention program. In fact, having the DD genotype and being treated with gemfibrozil had a synergical effect on HDL-C levels. The results of this study suggest that the ACE I/D polymorphism influences the effect of gemfibrozil on plasma HDL-C levels.

The impact of high-intensity interval training (HIIT) compared to the current exercise recommendations (moderate intensity continuous aerobic exercise; CONT) has to be verified in obese older women before being used by health professionals. Objective: The purpose of this study is to compare the effect of HIIT to CONT on body composition, metabolic profile and affective responses in obese elderly. Methods: A total of 20 older and sedentary women (60–75 years) with abdominal obesity (waist circumference ≥ 88 cm) are currently recruited and randomized to one of the following group: 1) HIIT (n=10); 2) CONT (n=10). All variables are measured before and after 8 weeks of intervention: Anthropometry (weight, height, body mass index), body composition (fat mass [FM], lean body mass [LBM], visceral adipose tissue [VAT]; DXA), metabolic profile (fasting lipid profile, glucose and insulin) and physical capacity (senior fitness test). Affective responses are measured before and after each training session. Preliminary Results: VAT tend to decrease in HIIT group only (p=0.07) while total FM remained unchanged. Moreover, HDL-C tend to increase in HIIT only (p=0.09) while LDL-C decreased (p=0.01) in both groups. Finally, while HbA1c tend to increase, total cholesterol tend to decrease in HIIT and CONT (both, p=0.08). Finally, affective response before and after each training were similar between HIIT and CONT (both p>0.48) and remained unchanged. Conclusion: Our preliminary results suggest that HIIT could provide better improvements (VAT and HDL-C) compared to the current exercise recommendations in physically inactive older women.

Although obesity is often associated with insulin resistance and a cluster of metabolic disturbances, the existence of a subgroup of healthy but obese individuals has been postulated. It is unclear why some obese individuals fail to show traditional risk factors associated with the insulin resistance syndrome despite having a very high accumulation of body fat. To address this issue, we identified and studied a subgroup of metabolically normal but obese (MNO) postmenopausal women to gain insight into potential physiological factors that may protect them against the development of obesity-related comorbidities. We carefully examined the metabolic characteristics of 43 obese, sedentary postmenopausal women (mean ± sd, 58.0± 6.0 yr). Subjects were classified as MNO or as metabolically abnormal obese (MAO) based on an accepted cut-point for insulin sensitivity (measured by the hyperinsulinemic/euglycemic clamp technique). Thereafter, we determined 1) body composition (fat mass and lean body mass), 2) body fat distribution (abdominal visceral and sc adipose tissue areas, midthigh sc adipose tissue and muscle attenuation), 3) plasma lipid-lipoprotein levels, 4) plasma glucose and insulin concentrations, 5) resting blood pressure, 6) peak oxygen consumption, 7) physical activity energy expenditure, and 8) age-related onset of obesity with a questionnaire as potential modulators of differences in the risk profile. We identified 17 MNO subjects who displayed high insulin sensitivity (11.2 ± 2.6 mg/min·kg lean body mass) and 26 MAO subjects with lower insulin sensitivity (5.7 ± 1.1 mg/min·kg lean body mass). Despite comparable total body fatness between groups (45.2 ± 5.3% vs. 44.8 ± 6.6%; P = NS), MNO individuals had 49% less visceral adipose tissue than MAO subjects (141 ± 53 vs. 211 ± 85 cm2; P < 0.01). No difference was noted between groups for abdominal sc adipose tissue (453 ± 126 vs. 442 ± 144 cm2; P = NS), total fat mass (38.1 ± 10.6 vs. 40.0 ± 11.8 kg), muscle attenuation (42.2± 2.6 vs. 43.6 ± 4.8 Houndsfield units), and physical activity energy expenditure (1060 ± 323 vs. 1045 ± 331 Cal/day). MNO subjects had lower fasting plasma glucose and insulin concentrations and lower insulin levels during the oral glucose tolerance test (P values ranging between 0.01–0.001). No difference was observed between groups for 2-h glucose levels and glucose area during the oral glucose tolerance test. MNO subjects showed lower plasma triglycerides and higher high density lipoprotein cholesterol concentrations than MAO individuals (P < 0.01 in both cases). Results from the questionnaire indicated that 48% of the MNO women presented an early onset of obesity ( Our results support the existence of a subgroup of obese but metabolically normal postmenopausal women who display high levels of insulin sensitivity despite having a high accumulation of body fat. This metabolically normal profile is associated with a lower accumulation of visceral adipose tissue and an earlier age-related onset of obesity.

We examined the effects of a 6-month randomized program of endurance training (n = 14), resistance training (n = 17), or control conditions (n = 20) on insulin sensitivity in nonobese, younger women (18–35 yr). To examine the possible mechanism(s) related to alterations in insulin sensitivity, we measured body composition, regional adiposity, and skeletal muscle characteristics with computed tomography. We observed no changes in total body fat, sc abdominal adipose tissue, or visceral adipose tissue with endurance or resistance training. Insulin sensitivity, however, increased with endurance training (pre, 421 ± 107; post, 490 ± 133 mg/min; P < 0.05) and resistance training (pre, 382± 87; post, 417 ± 89 mg/min; P = 0.06). When the glucose disposal rate was expressed per kg fat-free mass (FFM), the improved insulin sensitivity persisted in endurance-trained (pre, 10.5 ± 2.7; post, 12.1 ± 3.3 mg/min·kg FFM; P < 0.05), but not in resistance-trained (pre, 9.7 ± 1.9; post, 10.2 ± 1.8 mg/min·kg FFM; P = NS) women. Muscle attenuation ratios increased (P < 0.05) in both endurance- and resistance-trained individuals, but this was not related to changes in insulin sensitivity. Moreover, the change in insulin sensitivity was not related to the increased maximum aerobic capacity in endurance-trained women (r = 0.24; P = NS). We suggest that both endurance and resistance training improve glucose disposal, although by different mechanisms, in young women. An increase in the amount of FFM from resistance training contributes to increased glucose disposal probably from a mass effect, without altering the intrinsic capacity of the muscle to respond to insulin. On the other hand, endurance training enhances glucose disposal independent of changes in FFM or maximum aerobic capacity, suggestive of an intrinsic change in the muscle to metabolize glucose. We conclude that enhanced glucose uptake after physical training in young women occurs with and without changes in FFM and body composition.

Objective: To examine the relation between insulin sensitivity and total and regional body fat in nonobese postmenopausal women. Design: Cross-sectional study. Setting: A clinical research center. Patient(s): Twenty-seven women in the early postmenopausal period, with a mean (±SD) age of 50.8 ± 4.1 years, who had had their last menstrual period 6 months to 3 years before the study. None were taking hormone replacement therapy, and all had an FSH level of >35 mIU/mL, a body mass index of 2 , and a waist circumference of Intervention(s): Computed tomography scans at the L4–5 vertebral disk space, dual-photon x-ray absorptiometry scans, and euglycemic hyperinsulinemic clamps were performed. Main Outcome Measure(s): Intraabdominal fat, subcutaneous abdominal fat, sagittal diameter, total body fat, percent body fat, and insulin sensitivity. Result(s): The natural log of insulin sensitivity correlated significantly with intraabdominal fat ( r = −.39), subcutaneous fat ( r = −.43), and sagittal diameter ( r = −.48). After adjusting for total fat, sagittal diameter remained significantly related to insulin sensitivity. Conclusion(s): Central abdominal fat is inversely and independently related to insulin sensitivity after adjusting for total fat in women in the early postmenopausal period. Efforts to reduce either subcutaneous abdominal fat or intraabdominal fat should be helpful in reducing the risk of noninsulin-dependent diabetes mellitus in postmenopausal women.

There is considerable controversy regarding factors regulating free-living physical activity energy expenditure (PAEE) in older individuals. This component is highly variable, is difficult to accurately assess, and reflects both volitional and nonvolitional activities. We examined the association between maximal aerobic fitness (peak VO2) and free-living PAEE in older individuals. One hundred and eighty healthy older patients (96 females and 84 males) between 45–90 yr of age were studied. Total energy expenditure was measured from doubly labeled water. PAEE was calculated as the difference between total energy expenditure, resting metabolic rate, and estimated thermic effect of a meal. Peak VO2 was assessed from an exercise test to volitional fatigue. Fat mass and fat-free mass were assessed from dual energy x-ray absorptiometry. After correction for age, fat mass, and fat-free mass, significant correlations were observed between peak VO2 and PAEE for older males (r = 0.42; P < 0.0001) and females (r = 0....

The aim of the present study was to examine whether site differences in sc adipose tissue (AT) lipolysis may be considered a contributing factor to the altered metabolic risk profile of visceral compared to peripheral obese men once the concomitant variation in adipose cell size is taken into account. For this purpose, sc abdominal and femoral fat cell lipolytic responses were investigated in two groups of men (body mass index, 28 ± 2 kg/m2), aged 36 ± 3 yr, who were matched for both sc abdominal AT area (256 ± 64 cm2) and sc abdominal adipose cell weight (0.55 ± 0.08 μg lipid/cell) but were characterized by either a high (162 ± 29 cm2; n = 18) or a low (101 ± 21 cm2; n = 18) visceral AT deposition. The maximal lipolytic response to epinephrine or to isoproterenol (β-adrenergic agonist) as well as the maximal antilipolytic effect of either epinephrine or clonidine (α2-adrenergic agonist) assessed in sc adipocytes were similar among men with low vs. high levels of visceral AT. However, theβ -adrenoceptor s...

To the Editor: A unique subset of obese individuals has been identified that appears to be protected against obesityrelated metabolic disturbances [1, 2]. These individuals, now known as ‘metabolically healthy but obese’ (MHO) individuals, display a favourable metabolic profile, characterised by high levels of insulin sensitivity, normal lipid and inflammation profiles and no sign of hypertension, despite having excessive body fatness. In fact, the metabolic profiles of MHO postmenopausal women are virtually indistinguishable from those of young lean women [3]. Interestingly, a recent longitudinal study reported that the protective metabolic profile observed in MHO individuals was associated with lower incidences of type 2 diabetes and cardiovascular diseases [4]. Moreover, evidence suggests that MHO individuals may account for as much as 20–30% of the obese population [5]. An important question that seems to be unresolved is whether MHO individuals would gain any metabolic benefit from weight loss. Indeed, several studies have shown that weight loss improves insulin sensitivity and metabolic abnormalities and reduces the risk for type 2 diabetes in obese individuals [6, 7]. However, attempts to achieve weight loss in MHO individuals, by way of diet, may be actually counterproductive and potentially harmful. One may even question the need to aggressively treat MHO individuals given their favourable metabolic profile. Therefore, the aim of the present study was to investigate the effect of a 6 month energy-restricted diet on insulin sensitivity using the euglycaemic–hyperinsulinaemic clamp technique in a sample of MHO postmenopausal women. This study was approved by the ethics committee of the University of Montreal. After reading and signing the consent form, each participant was invited to the Metabolic Unit for testing. The women then entered a medically supervised 6 month weight loss programme, which aimed to reduce body weight by 10%. To achieve a level of energy restriction, the baseline resting metabolic rate was extrapolated over a 24 h period (kcal/min×1,440 min) and multiplied by an activity factor of 1.4, which corresponds to a sedentary state. Thereafter, instructions on how to follow a hypoenergetic diet Diabetologia (2008) 51:1752–1754 DOI 10.1007/s00125-008-1038-4

Introduction: Polymorphisms of the dopamine receptor D2 (DRD2) gene have been associated with obesity phenotypes. Our aim was to examine if the genotype of TaqIA Restriction Fragment Length Polymorphism (RFPL) was related to an attenuated weight loss response or to changes in energy expenditure (EE) and food preference before and after weight loss. Methods: Obese post-menopausal women (age = 57.1 ± 4.6 yr, weight = 85.4 ± 15.4 kg and BMI = 32.8 ± 4.5 kg/m2) were genotyped for TaqIA (n = 127) by using PCR–RFLP analysis and categorized as possessing at least one copy of the A1 allele (A1+) or no copy (A1−). Women were randomized into two groups, caloric restriction (CR) and caloric restriction + resistance training (CRRT) and in this study were further classified as follows: A1+CR, A1+CRRT, A1-−CR and −A1−CRRT. Body composition, total daily EE, physical activity EE, Resting EE (REE), and energy intake were obtained at baseline and post-intervention using DXA, doubly-labeled water, indirect calorimetry, and 3-day dietary records, respectively. Results: Overall, all of the anthropometric variables and REE significantly decreased post-intervention (p < 0.001). Women in the CRRT group lost significantly more fat mass (FM) than the CR women (p < 0.05). There were significant time by group by allele interactions for attenuated body weight (BW), BMI, and FM loss for A1+ (vs. A1−) in CRRT (p < 0.05) and for increased % carbohydrate intake (p < 0.01). Conclusion: TaqIA genotype was associated with body weight loss post-intervention; more specifically, carriers of the A1 allele lost significantly less BW and FM than the A1− and had increased carbohydrate intake in the CRRT group.

The presence of obesity-related metabolic disturbances varies widely among obese individuals. Accordingly, a unique subset of obese individuals has been described in the medical literature, which seems to be protected or more resistant to the development of metabolic abnormalities associated with obesity. These individuals, now known as 'metabolically healthy but obese' (MHO), despite having excessive body fatness, display a favorable metabolic profile characterized by high levels of insulin sensitivity, no hypertension as well as a favorable lipid, inflammation, hormonal, liver enzyme and immune profile. However, recent studies have indicated that this healthier metabolic profile may not translate into a lower risk for mortality. Mechanisms that could explain the favorable metabolic profile of MHO individuals are poorly understood. However, preliminary evidence suggests that differences in visceral fat accumulation, birth weight, adipose cell size and gene expression-encoding markers of adipose cell differentiation may favor the development of the MHO phenotype. Despite the uncertainty regarding the exact degree of protection related to the MHO status, identification of underlying factors and mechanisms associated with this phenotype will eventually be invaluable in helping us understand factors that predispose, delay or protect obese individuals from metabolic disturbances. Collectively, a greater understanding of the MHO individual has important implications for therapeutic decision making, the characterization of subjects in research protocols and medical education.

Introduction: Measuring free-living energy expenditure in aging human is a considerable challenge. The objective of this study was to predict total energy expenditure (TEE) in elders by combining the metabolic cost of activities and accelerometer outputs. Methods: Seventeen elders (7 women, 10 men) aged 60 to 78 yr were recruited. Body composition was measured by dual x-ray absorptiometry. Doubly labeled water was used as the criterion standard to measure TEE on a 7-d time frame. During the same period, participants wore a uniaxial accelerometer (Caltrac) to estimate TEE. Resting metabolic rate and metabolic costs of sitting, standing, and walking (1, 3, and 5 km[middle dot]h-1) were measured by indirect calorimetry. Results: There was no correlation between Caltrac's outputs and doubly labeled water measurement of TEE. The best predictors of TEE were fat-free mass, the metabolic cost of standing, and the metabolic cost of walking at 3 km[middle dot]h-1 (r2 = 0.78, P < 0.01). Conclusions: Our results suggest that TEE may be estimated with good accuracy using fat-free mass, the cost of standing still, and the cost of walking at 3 km[middle dot]h-1. These predictors are easy to measure in older adults. Further work is needed to confirm our findings and develop prediction equation with these parameters

Limited data are available regarding the impact of caloric restriction (CR) in combination with resistance training (RT) on the metabolic profile of postmenopausal women.The objective of the study was to determine whether RT adds to CR in improving body composition and the metabolic profile.This was a 6-month, randomized, clinical trial.Patients included 107 postmenopausal women (body mass index27 kg/m(2)).The intervention was a 6-month CR alone or in combination with a RT program.Fat mass (FM), lean body mass (LBM), abdominal sc fat and visceral fat, fasting lipids, insulin sensitivity, resting blood pressure, and inflammation markers were measured.Both groups were similar at baseline and significantly decreased body weight, body mass index, FM, percent FM, abdominal sc fat, and visceral fat after the study (P0.001), with greater losses of percent FM and trunk FM in the CR + RT group (P0.05). LMB significantly decreased in the CR (-0.9 +/- 2.4 kg) and the CR+RT (-0.4 +/- 2.2 kg) groups (P0.005), with no difference between them. Both groups significantly improved plasma triglycerides, fasting insulin level, glucose disposal, and markers of the inflammation profile after weight loss (P0.05), with no difference between groups. No improvements were observed for the other variables of interest in both groups.CR+RT was associated with greater losses in percent FM and trunk FM compared with CR alone. However, CR+RT was not associated with additional improvements in the metabolic profile compared with CR alone.

Central fat mass (CFM) correlates with insulin resistance and increases the risk of type 2 diabetes and cardiovascular complications. On the other hand, increased peripheral fat mass (PFM) is associated with higher insulin sensitivity. Thus, we examined the contribution of adipose tissue distribution, as assessed by the PFM/CFM ratio, to insulin sensitivity in overweight and obese postmenopausal women.A total of 124 nondiabetic overweight and obese postmenopausal women underwent an oral glucose tolerance test (OGTT) and a hyperinsulinemic/euglycemic (HI) clamp. Body composition was determined using computed tomography for visceral adipose tissue (VAT) and dual X-ray absorptiometry for fat mass, lean body mass and their respective proportions. Participants were divided by tertiles of the PFM/CFM ratio.Participants with preferential CFM (group 1) had higher fasting insulin levels and insulin area under the curve (AUC) during OGTT, as well as lower glucose infusion rates during the HI clamp, whether it was expressed per kg of body weight (M) or per kg of fat-free mass (Mm), compared with the other two groups. The PFM/CFM ratio also correlated significantly with fasting insulin (r=-0.32, P0.001), the insulin AUC (r=-0.42 P0.001), M (r=0.39 P0.001) and Mm (r=0.37 P0.001). Using hierarchical regression, we demonstrated that the PFM/CFM ratio was an independent predictor of insulin AUC, M and Mm and that its sequential addition to CFM and VAT improved significantly the predictive value of the model for insulin sensitivity for all variables except fasting insulin.The PFM/CFM ratio, which integrates the antagonistic effects of both central and peripheral depots on insulin sensitivity, added substantially to the prediction of insulin sensitivity over VAT and CFM alone.

Some insulin-resistant obese postmenopausal (PM) women are characterized by an android body fat distribution type and higher levels of lean body mass (LBM) compared to insulin-sensitive obese PM women. This study investigates the independent contribution of LBM to the detrimental effect of visceral fat (VF) levels on the metabolic profile. One hundred and three PM women (age: 58.0+/-4.9 years) were studied and categorized in four groups on the basis of their VF (higher vs. lower) and lean BMI (LBMI=LBM (kg)/height (m2); higher vs. lower). Measures included: fasting lipids, glucose homeostasis (by euglycemic/hyperinsulinemic clamp technique and 2-h oral glucose tolerance test (OGTT)), C-reactive protein (CRP) levels, fat distribution (by computed tomography (CT) scan), and body composition (by dual-energy X-ray absorptiometry). Women in the higher VF/higher LBMI group had lower glucose disposal and higher plasma insulin levels compared to the other groups. They also had higher plasma CRP levels than the women in the lower VF/lower LBMI group. VF was independently associated with insulin levels, measures of glucose disposal, and CRP levels (P

Objective: Recent reports have suggested that the existence of associations between hormonal dysregulation and chronic upregulation of inflammatory markers, which may cause obesity-related disturbances. Thus, we examined whether acylated ghrelin (AcylG) and total ghrelin (TotG) levels could be associated with the following inflammatory markers: C-reactive protein (CRP), tumor necrosis factor α (TNF-α), and soluble TNF receptor 1 (sTNF-R1). Design: Cross-sectional study consisting of 50 overweight and obese postmenopausal women. Methods: AcylG and TotG levels were assessed at 0, 60, 160, 170, and 180 min of the euglycemic/hyperinsulinemic clamp (EHC). We evaluated insulin sensitivity, body composition, and blood lipid profiles as well as fasting concentrations of CRP, TNF-α, and sTNF-R1. Results: In fasting conditions, sTNF-R1 was negatively correlated with AcylG (r = −0.48, P < 0.001) levels. In addition, AcylG/TotG was associated negatively with sTNF-R1 (r = −0.44, P = 0.002) and positively with TNF-α (r = 0.38, P = 0.009) values. During the EHC, TotG (at all time points) and AcylG (at 60 and 160 min) values were significantly decreased from fasting concentrations. AcylG maximal reduction and area under the curve (AUC) values were correlated to sTNF-R1 (r = −0.35, P = 0.02 and r = −0.34, P = 0.02, respectively). Meanwhile, the AcylG/TotG AUC ratio was associated negatively with sTNF-R1 (r = −0.29, P < 0.05) and positively with TNF-α (r = 0.36, P = 0.02). Following adjustments for total adiposity, sTNF-R1 remained correlated with fasting and maximal reduction AcylG values. Similarly, AcylG/TotG ratios remained significantly correlated with sTNF-R1 and TNF-α. Importantly, 23% of the variation in sTNF-R1 was independently predicted by fasting AcylG. Conclusion: These results are the first to suggest that both fasting and EHC-induced AcylG profiles are correlated with fasting values of sTNF-R1, a component of the TNF-α system. Thus, AcylG may act, at least in part, as one mediator of chronic inflammatory activity in human obesity.

The number of postmenopausal women is expected to rise markedly in coming years. The increased risk of cardiovascular disease associated with menopause may in part reflect changes in body composition and body fat distribution as well as lowered sensitivity to insulin. This randomized, placebo-controlled trial was aimed at showing whether combined estrogen/progestin replacement (hormone therapy [HT]) can lessen the accumulation of central body fat and thereby improve insulin sensitivity. Seventy-six perimenopausal and early postmenopausal women with a mean age of 52 years were randomized to receive either 0.625 mg conjugated estrogens plus 2.5 mg medroxyprogesterone acetate orally or a placebo. Fifty-one women completed the 2-year trial. The euglycemic hyperinsulinemic clamp technique was used to assess insulin-stimulated glucose disposal. Fat mass, percent fat, and fat-free mass were estimated by dual-photon x-ray absorptiom-etry, and intraabdominal fat and subcutaneous abdominal fat by computed tomography scanning. The treated and control women were similar demographically at baseline. Fasting glucose levels were higher in placebo recipients. No significant group differences in intraabdominal fat, subcutaneous abdominal fat, total fat, fat-free mass, or percent fat were observed during the study. The same was the case for waist circumference and body weight. Insulin sensitivity decreased 17% in women given HT but the group difference was not significant. Insulin sensitivity per fat-free mass also declined during HT. Among 28 women who reported their food consumption during the study, those on HT had a 12% drop in caloric intake; there was no change in the placebo group. Self-reported carbohydrate intake decreased 16% in women given HT but increased by 2% in placebo recipients. There was no substantial group difference in leisure-time physical activity. No HT-related decrease in insulin sensitivity was noted in 17 women who returned 1 year after discontinuing HT or placebo. Combination HT lowers insulin sensitivity without significantly altering body composition or the distribution of body fat in nonobese women early in menopause. The insulin resistance is attributed to decreased peripheral insulin sensitivity rather than altered endogenous glucose production. The effect is reversible by discontinuing HT.

We studied whether disabled older women with coronary heart disease can perform resistance training at an intensity sufficient to improve measured and self-reported physical function [ n = 30, 70.6 ± 4.5 (SD) yr]. Compared with the controls, the resistance-training group showed significant improvements in overall measured physical function score using the Continuous-Scale Physical Functional Performance Test (+24 vs. +3%). The Continuous-Scale Physical Functional Performance Test measures physical function for 15 practical activities, such as carrying groceries or climbing stairs. Resistance training led to improved measures for domains of upper body strength (+18 vs. +6%), lower body strength (+23 vs. +6%), endurance (+26 vs. +1%), balance and coordination (+29 vs. −2%), and 6-min walk (+15 vs. +7%). Women involved in the flexibility-control group showed essentially no improvement for physical function measures. No changes were observed for body composition, aerobic capacity, or self-reported physical function in either group. In conclusion, disabled older women with coronary heart disease who participate in strength training are able to train at an intensity sufficient to result in improvements in multiple domains of measured physical functional performance, despite no change in lean body mass.