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Bariatric surgery is the most effective method in the treatment of obesity and type 2 diabetes (T2DM). The aim of this study was to evaluate the effects of different types of bariatric procedures on remission of T2DM and on the fatty acid composition in subcutaneous adipose tissue. Patients included obese diabetic women who underwent bariatric surgery: biliopancreatic diversion (BPD), n=8, laparoscopic gastric banding (LAGB), n=9 or laparoscopic greater curvature plication (LGCP), n=12. Anthropometric characteristics and fatty acid composition of adipose tissue (FA AT) were analyzed before surgery, then 6 months and 2 years after surgery. FA AT was analyzed by gas chromatography. Diabetes remission was estimated. BPD was most efficient in inducing a remission of diabetes (p=0.004). Significantly higher increases in lauric (12:0), myristoleic (14:1n-5) and palmitoleic (16:1n-7) acids and delta-9 desaturase were found two years after BPD, suggesting higher lipogenesis in adipose tissue. Docosatetraenoic acid (22:4n-6) increased significantly after BPD, while docosapentaenoic acid (22:5n-3) decreased 6 months after BPD and increased after 2 years. No changes were found after LAGB and LGCP after 2 years. Bariatric surgery led to significant changes in the fatty acid composition of subcutaneous adipose tissue in severely obese diabetic women after six months and two years, and was partly influenced by the type of surgery used.

Background: Measurements of anthropometric parameters are widely used in clinical practice as a convenient index of intraabdominal fat. The paper is aimed to reveal correlations between ultrasound measurement of intraabdominal depth (IAAT) and selected anthropometric and biochemical parameters in childhood., Methods and Results: In 69 obese children (38 boys, BMI28.3+/-3.2, aged 12.8+/-0,52 and 31 girls with BMI27.4+/-5.02, 12.4+/-0.51), anthropometry, IAAT and laboratory tests were evaluated. Height, weight, BMI, waist and hip circumferences, 10 skinfolds and blood pressure were measured. Blood glucose, uric acid, lipids, inzulín and C-peptide levels were determined. Pearson's partial correlation coefficients after adjusting for age were calculated. In boys, the following significant correlations of IAAT were revealed: with BMI (r=0.44, p<0.06), chest (r=0.45, p<0.005) and hip (r=0.65, p<0.0001) circumferences, waist/hip ratio (WHR, r=0.61, p< or =0.0001), subscapular (r=0.45, p< or =0.005), axillary (r=0.55, p<0.0004), suprailiac (r=0.51, p< or =0.001) and abdominal (r=0.54, p=0.0004) skinfolds. However, among biochemical indexes only triglyceride level was associated with IAAT (r=0.41, p< or =0.01). In girls, the following significant correlations of IAAT were observed: with BMI (r=0.42, p< or =0.01), chest (r=0.42, p< or =0.01) and waist (r=0.46, p<0.009) circumferences, subscapular (r=0.46, p<0.009) and abdominal (r=0.52, p<0.003) skinfolds. In girls, no significant correlation of IAAT with WHR and metabolic parameters was found., Conclusions: IAAT in children is associated with anthropometric indexes of body fat distribution and in boys also with serum triglyceride level.

We have reported strong intrapair resemblances (IPRs) in serum phosphatidylcholine (PC) fatty acid composition within adult monozygotic twins living apart. This study assessed the contribution of genetic factors to changes in serum and adipose tissue fatty acids resulting from weight loss and followed by a subsequent year of weight maintenance. Eleven pairs of female obese monozygotic twins (age: 38.9 +/- 1.8; BMI: 32.5 +/- 0.9) were recruited for the study. Fasting serum and adipose tissue were obtained after 1 week of inpatient stabilization, after 1 month of inpatient very-low-calorie diet (VLCD), and again after 1 year of outpatient weight maintenance. Fatty acids in serum lipid fractions and adipose tissue were quantitated by gas chromatography. Using multiple regression adjusted for age and initial value, IPRs were determined for the changes induced by VLCD and by the year of weight maintenance. There were few IPRs in nonessential fatty acids. By contrast, there were numerous IPRs for essential fatty acids (EFA), especially in the n-3 family across the VLCD. Following the maintenance year, however, frequent IPRs for nonessential fatty acids were seen, particularly in serum PC, and strong IPRs were seen for 18:3 n-3 and 20:5 n-3 across multiple fractions. These results infer the existence of strong genetic factors determining both the nonessential and EFA compositions of tissue lipids in humans independent of diet. Of particular note were the consistent IPRs for n-3 fatty acids despite dietary stress, indicating that the conservation and distribution of this EFA family are subject to considerable genetic variance in humans.

Fasting plasma levels of both cortisol and sex hormone binding globulin (SHBG) in obese women were significantly inversely related to anthropometric characteristics of body fat distribution. It means that a central accumulation of body fat might be partly mediated by cortisol and SHBG levels. Significant within-pair resemblance observed in plasma cortisol level in obese female monozygotic twins suggests an important role of genetic factors in determination of cortisol secretion. However, no within-pair similarities revealed in plasma SHBG concentrations favour a major role of environmental factors in the regulation of plasma SHBG level. On the other hand the twin study supported the role of genetic determinants in changes of both cortisol and SHBG levels in response to energy deficit induced by very low calorie diet (VLCD). The mechanisms controlling baseline levels of cortisol and SHBG apparently differ from those controlling their responses to energy restriction.

Adipose tissue distribution predicts development of obesity complications better than total adipose tissue content. The aim of the study was to evaluate the role of the hormonal factors contributing to the adipose tissue distribution in obese females. The cohort examined consisted of 94 women in the range of overweight to obesity, aged 44.2 +/- 11.2 years (21-67), weight 100.1 +/- 17.5 kg (65.8-148), BMI 37.13 +/- 5.72 kg/m2 (26.4-50.7). Adipose tissue (AT) distribution was examined by CT at level L4/5 and intraabdominal adipose tissue and the subcutaneous abdominal adipose tissue area (IAAT and SAAT, respectively) were determined. Growth hormone (GH), dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulphate (DHEAS), cortisol, testosterone, androstene-dione, SHBG, total thyroxine, total triiodothyronine (T3), TSH and leptin were assessed by routine methods by RIA and CLIA. GH, DHEA and DHEA-S correlated significantly negatively with IAAT (r = -0.24, p < 0.05, r = -0.30, p < 0.01, r = -0.34, p < 0.005, respectively). A borderline significant negative correlation of T3 with IAAT was shown (r = -0.20, p = 0.054). A significant positive correlation of SAAT with total testosterone and serum leptin was found (r = 0.27, p < 0.01, r = 0.64, p < 0.001, respectively). When comparing the difference of individual hormone levels between the 1st and 5th quintile of IAAT, no significant difference between the groups was found after adjustment for weight and age. In contrast, when comparing the 1st and 5th quintile according to the SAAT a significantly lower total testosterone and leptin in the 1st quintile of SAAT was found. Only in leptin the difference remained significant after adjustment for adipose tissue content. In conclusion, the results suggest that the relationship of individual hormones examined in this study to the central adipose tissue distribution are mostly mediated by age and adipose tissue content; they do not seem to be in a causal connection with the intraabdominal adipose tissue content. The only exception concerns leptin, which is significantly related to the subcutaneous abdominal adipose tissue area.

Lipolysis in adipose tissue and balance between energy intake and expenditure are involved in the regulation of adipose tissue mass. Several recent findings suggest that alterations in the regulation of lipolysis and/or energy balance might contribute to the development of obesity. Hormone-sensitive lipase and uncoupling proteins play important role in regulation of lipolysis in adipose tissue as well as in the regulation of energy balance of various tissues. Mechanisms of the control of expression of genes coding synthesis of these proteins are poorly known. A brief overview of the present knowledge of the effects of nutritional intervention on the regulation of lipolysis in adipose tissue and on the expression of genes of hormone-sensitive lipase and that of uncoupling proteins is given in this article. Results of the authors' studies on the effect of calorie restriction on gene expression in adipose tissue are presented.

Unlabelled: A missence mutation Trp64Arg in the beta3-adrenergic receptor gene is associated with obesity, insulin resistance, a lower metabolic rate and the earlier onset of NIDDM but the published results are controversial. We investigated the effect of this mutation on insulin resistance (euglycemic hyperinsulinemic clamp), on fat mass and fat distribution (anthropometry, bioimpedance, CT) and resting metabolic rate (indirect calorimetry), lipid spectrum and other metabolic disturbances in Czech juveniles recruited from juvenile hypertensives (H, n = 68) and controls (C, n = 81). The frequency of this mutation (determined by digestion of 210 bp PCR product with MvaI) was double in H than in C (14.7%, vs. 7.4%) and the carriers of Arg64 allele had sig. higher fasting glucose (H: p = 0.002. C: p = 0.025). Four Trp64/Arg64 and six Trp64/Trp64 men (age 23 +/- 4.2, vs. 22.5 +/- 1.9 y, BMI 26 +/- 5.5, vs. 22.9 +/- 5.1 kg/m2) took part in a detailed pilot study. But no signif. differences (Horn's method) in fasting glucose (4.6 +/- 0.6, vs. 4.9 +/- 0.4 mmol/l), in parameters of insulin resistance (M-value150-180 min. 9.1 +/- 1.1, vs. 8.9 +/- 1.5 mg glucose/kg.min(-1)), resting metabolic rate/lean body mass (RMR/kg LBM: 78.6 +/- 4.6, vs. 85.6 +/- 23.2 kJ/kg), lipid spectrum and other screened parameters were found. The lowest resting metabolic rate (RMR/kg LBM 55.4; 62.6 kJ/kg) was found in brothers (both C, Trp64/Trp64) who highly differ in body constitution (BMI 19.0 resp. 32.4 kg/m2). We suppose that in this case the energy metabolism is probably determined by other genetic loci and does not correlate with body fat mass., Conclusion: Our pilot study does not confirm the influence of Trp64Arg mutation in heterozygous carriers on insulin resistance, energy metabolism and lipid spectrum.

Microdialysis--a technique available since more than two decades--has been recently applied in investigation of metabolism of adipose tissue in humans. The technique enables a continuous sampling of metabolites and other small molecules in the extracellular space of subcutaneous adipose tissue and it enables a local exposure of adipose tissue to metabolically active agents. The method has been used to determine the interstitial concentrations of metabolites (glycerol, glucose, lactate etc.) in adipose tissue and to investigate the regulation of lipolysis and of carbohydrate metabolism in situ in subcutaneous adipose tissue. The method has been widely used in clinical research of adipose tissue and it is supposed to be used for continuous monitoring of metabolites in clinical practice.

Eight pairs of obese female monozygotic twins were subjected to a 4-week, very-low-calorie diet (VLCD) that induced a decrease in mean body mass index from 32.9 +/- 1.1 to 29.7 +/- 1.1 kg/m2. Infusion of the beta-adrenergic agonist, isoproterenol, induced an increase in plasma levels of nonesterified fatty acids and glycerol that was more pronounced during than before VLCD. sc fat biopsies were obtained before and during VLCD to study adipocyte lipolysis. beta-adrenergic sensitivity was moderately improved during VLCD. Basal and stimulated lipolyses, and hormone-sensitive lipase activity and protein levels were increased during VLCD. Before VLCD, intrapair resemblance was found for basal and stimulated lipolysis rates. In response to the treatment, intrapair resemblance was observed for basal lipolysis and for lipolysis stimulated with agents acting on plasma membrane receptors. These results suggest that the increase of basal lipolysis during VLCD is caused by an increase of hormone-sensitive lipase expression. They support the notion that the genotype may play a role in regulating the changes of adipose tissue lipolysis rates observed during VLCD.

The effects of 28 days of a very low calorie diet (382 Cal/day)) on the beta-adrenergic lipolytic response and nutritive blood flow in sc adipose tissue were investigated in vivo using the microdialysis technique in 24 obese subjects. The diet did not modify the extracellular glycerol concentrations, but increased the local nutritive blood flow (measured by the ethanol escape method). The lipolytic response and the vasodilating effect of increasing concentrations of isoprenaline (from 0.001-10 mumol/L) added to the perfusate were enhanced after 28 days of diet. Before the diet, equimolar concentrations (100 mumol/L) of dobutamine [selective beta 1-adrenoceptor (beta 1-AR) agonist], terbutaline (selective beta 2-AR agonist), and CGP 12,177 (selective beta 3-AR agonist) increased glycerol concentration in adipose tissue. The lipolytic effect of terbutaline was the greatest, and the effect of CGP 12,177 was the least marked. After 28 days of the diet, the effects of terbutaline and CGP 12,177 were not modified, whereas the effect of dobutamine was increased and reached the effect of terbutaline. The three agonists increased nutritive blood flow; this effect was not modified during the diet. In summary, this study demonstrates an increase in the in vivo lipolytic responses to isoprenaline and dobutamine during the hypocaloric diet. Furthermore, functional beta 3-AR are present in the sc adipose tissue of obese patients; however, their activation is only weakly involved in the lipolytic process in this population and is not modified by the hypocaloric diet.

Abdominal type of obesity is linked to risk factors of atherosclerosis and to metabolic diseases. 216 women, aged 17 to 67 years, mean age 43.1 +/- 0.76, mean weight 108.7 +/- 1.6 kg and mean BMI 39.57 kg/m2, were examined. Body composition was assessed by hydrodensitometry, fat distribution was determined by simple anthropometric measurements (waist circumference, sagittal abdominal diameter at the level L4,5, waist to hip ratio-WHR and waist to thigh ratio-WTR), by computed tomography estimating of visceral fat area and by the ultrasound assessment of visceral fat. Close correlation of visceral fat area determined by CT with the ultrasound assessment of visceral fat was found (r = 0.71). In contrast to WHR, a strong correlation of the waist circumference and sagittal abdominal diameter to total body fat content (r = 0.89, r = 0.84, respectively). Close relation of the waist circumference, sagittal abdominal diameter and WTR to visceral fat examined by ultrasound was discovered (r = 0.61, r = 0.66 and r = 0.58, respectively). The sample was divided into quintiles according to waist circumference, abdominal sagittal diameter and WHR. After adjustment for weight and age, waist circumference and sagittal abdominal diameter tend to be more closely related to the metabolic variables (total cholesterol, HDL-cholesterol, triglycerides, fasting blood glucose, fasting insulin, uric acid) and to the arterial blood pressure than WHR. In the group followed only weak relation was found between anthropometric measures of fat distribution and occurrence of diseases complicating obesity, probably as a result of a high overall fatness connected with a high content of visceral fat.

The aim of the study was to evaluate a new bioimpedance method for assessment of body fat employing bipedal electrodes instead of those attached to both upper and lower extremities. The new analyzer (TBF-105, Tanita Corp., Tokyo, Japan) enables simultaneous measurements of body weight and total body resistance in a subject standing on the stainless steel electrodes. The instrument was tested in both normal weight and obese women. Fat mass estimated by bipedal bioimpedance was highly correlated with that determined by hydrodensitometry (n = 145, r = 0.945, p < 0.001). Fat mass estimated by bipedal bioimpedance significantly correlated not only with subcutaneous fat measured as a sum of 10 skinfolds (r = 0.758, p < 0.001) but also with visceral fat determined as an area on CT scan (r = 0.780, p < 0.001). Anthropometric variables did not substantially influence the differences revealed in fat mass determined by bipedal bioimpedance and by densitometry. An overestimation of total fat mass by bipedal bioimpedance has not been revealed in severely obese individuals, even in those with higher fat accumulation in the limb region. In conclusion, our data have demonstrated that the new bioimpedance instrument employing bipedal electrodes represents a reliable tool for rapid body fat assessment in both normal weight and obese women.

To evaluate a long-term efficacy of very-low-calorie-diet (VLCD) treatment, 42 obese patients were reexamined 1 y after the initiation of the weight reduction by VLCD treatment for 1 mo. All the subjects participating in the long-term outpatient weight-reduction regime were divided into weight losers and regainers according to the weight change achieved at the end of 1-y follow-up. A final body weight decrease in weight losers was followed by a significant decline of total cholesterol-high-density-lipoprotein (HDL) cholesterol ratio together with significant rise of serum HDL cholesterol whereas almost all skinfold thicknesses declined. In weight regainers the sum of 10 skinfold thicknesses was the same at the end of follow-up as at the beginning of VLCD treatment, but body fat distribution was shifted towards the gynoid type when individual skinfold thicknesses were assessed. However, among the generally employed indexes of body fat distribution only waist-thigh ratio significantly decreased in weight losers. Nonsignificant differences in serum concentrations of total cholesterol, HDL cholesterol, and triglycerides between weight regainers and weight losers at the end of long-term follow-up suggest that some kind of adherence to weight reduction regime including physical exercise may favorably affect the lipid profile as well as body fat distribution independently on the body weight regained.

One-month treatment of obese patients (body mass index, 39.44 +/- 0.94, measured in kg/m2) with a very-low-calorie diet (VLCD) resulted in a significant weight loss, which was higher in men than in women. In contrast, the decrease of percent fat content was higher in gynoid obese women than in men or women with android fat distribution. In females fat mobilization was depressed at the thigh region where a substantially lower percent decrement of thigh skinfold thickness was demonstrated in comparison with males. VLCD treatment positively affected blood pressure and concentrations of total cholesterol, triglyceride, insulin, and cortisol. Total cholesterol-high-density-lipoprotein (HDL) cholesterol ratio remained unchanged and HDL cholesterol in serum significantly declined. Indexes of body fat distribution were not significantly influenced by the short-term treatment by VLCD except waist-hip ratio, which declined in android obese females. VLCD does not decrease a tolerance of physical exercise, as the metabolic response to submaximal workload on a cycle ergometer as well as the responses of cortisol, growth hormone, and prolactin remained unchanged after the treatment.

Abstract Background Neuropeptide Y (NPY) is an important central orexigenic hormone predominantly produced by the hypothalamus, and recently found to be secreted in adipose tissue (AT). Acipimox (Aci) inhibits lipolysis in AT and reduces plasma glycerol and free fatty acid (FFA) levels. Exercise and Aci are enhancers of growth hormone (GH) and NPY secretion and exercise may alter leptin levels. We expect to find abnormal neuropeptidergic response in plasma and AT in patients with bulimia nervosa (BN). We hypothesize that Aci influences these peptides via a FFA-independent mechanism and that Aci inhibits lipolysis through a cyclic adenosine monophosphate (cAMP)-dependent pathway. Dysregulations of the AT-brain axis peptides might be involved in binge eating as is the case in BN. Methods The objective of this study was to determine the responses of plasma NPY, GH, leptin, FFA and glycerol levels to exercise in BN patients and healthy women (C) given the anti-lipolytic drug Aci or placebo. The secondary objective of this study was to compare the responses of extracellular glycerol levels and plasma glycerol levels to exercise alone or together with Aci administration in BN patients and C women. Extracellular glycerol was measured in vivo in subcutaneous (sc) abdominal AT using microdialysis. Eight BN and eight C women were recruited for this single-blind, randomized study. Aci or placebo was given 1 hour before the exercise (45 min, 2 W/kg of lean body mass [LBM]). NPY, GH, leptin, FFA, glycerol plasma and AT glycerol levels were measured using commercial kits. Results The primary outcome of this study was that the exercise with Aci administration resulted in plasma NPY and GH increase (after a 45-minute exercise) and leptin (after a 90-minute post-exercise recovering phase) increased more in BN patients. The secondary outcomes of this study were that the exercise with Aci administration induced a higher decrease of extracellular glycerol in BN patients compared to the C group, while the exercise induced a higher increase of glycerol concentrations in sc abdominal AT of BN patients. Plasma glycerol levels decreased more in BN patients and plasma FFA levels were depressed in both groups after the exercise with Aci administration. The exercise induced similar increases in plasma NPY, GH, FFA and glycerol levels, and a similar decrease in the plasma leptin level in both groups. Conclusions We confirm the results of a single-blind, randomized, microdialysis study, i.e. that the Aci-induced elevation in plasma NPY and GH levels during the exercise is higher in BN patients and that Aci increased plasma leptin levels in the post-exercise recovering phase (90-minute) more in BN patients. The post-exercise rise (45-minute) in AT glycerol is much more attenuated by acute Aci treatment in BN patients. Simultaneously, we found facilitated turnover of plasma glycerol after the exercise together with Aci administration in BN. Our results support the hypotheses that Aci exerts an effect on the FFA-independent and cAMP-dependent mechanism. Trial Registration Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12611000955910