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Fourteen pairs of obese female monozygotic twins were recruited for a study of genetic influences on serum and adipose fatty acid (FA) composition. Following 1 wk of inpatient stabilization, fasting serum and adipose tissue obtained by surgical excision were analyzed by thin-layer and gas chromatography. Intrapair resemblances (IPR) for individual FA were assessed by Spearman rank correlation and by analysis of variance and were found in serum cholesteryl esters (CF), triglycerides (TG), and adipose TG. With two exceptions (CE linoleate and adipose eicosapentaenoate), these IPR were limited to the nonessential FA. Palmitate had significant IPR in four lipid fractions; in serum CE and adipose TG palmitate was strongly correlated with multiple measures of adiposity. In contrast to other lipid fractions, serum phosphatidylcholine (PC) FA had 12 [PR, of which 6 were essential FA including arachidonate (r = 0.76, P < 0.0005), eicosapentaenoate (r = 0.78, P < 0.0005), and docosahexaenoate (r = 0.86, P< 0.0001). The PC [PR could not be explained by analysis of preadmission 7-d food records. After dividing the pairs into two groups differing and nondiffering according to fat intake of individuals in the pair, there was no evidence of a gene-environment interaction between fat intake and FA composition. The IPR for nonessential FA indicate that there is active genetic control of either food choices or postabsorptive metabolic processing. The high level of IPR in the PC fraction in contrast to the other lipid fractions suggests strong genetic influence over selection of specific FA for this membrane fraction independent of diet.

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.

Uncoupling proteins are located in the inner mitochondria membrane. Their name is derived from their function: they uncouple oxidative procesess of the respiratory chain from ATP synthesis. Hitherto several members of the family have been described, the best known being UCP1. UCP1 can be expressed exclusively in brown adipose tissue and it is responsible for the heat production. In humans the brown fat disappears during the early childhood. In adults another members of the UCP family can be found--UCP2 and UCP3. It is widely accepted that these proteins affect lipid metabolism and energy expenditure. They are intensively studied owing to their possible use in the therapy of obesity. However, their physiological function has not been yet fully established.

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.

A high fasting respiratory quotient (RQ) was observed during the treatment by very low calorie diet (VLCD) in obese patients who regained weight at two-year follow-up (weight regainers) or in those who exhibited repeated cycles of weight loss with a subsequent weight regain (weight cyclers). In contrast obese patients who succeeded to retain the weight loss achieved initially by the VLCD at 2-yr follow-up (weight losers) or those who did not exhibit weight fluctuations (weight noncyclers) were characterized by a significantly lower RQ. Therefore a high fasting RQ during the VLCD treatment should be considered predictive of body weight gain. Resting metabolic rate (RMR) expressed per kg fat free mass (FFM) did not influence body weight changes. A high RQ revealed in obese subjects reporting parental obesity and a low fasting RQ observed in those obese without family history of obesity suggest a role of hereditary factors in the ability to oxidize fat in severely obese subjects. In contrast, parental history of obesity did not affect RMR in severely obese individuals.

Background: The important role of hereditary factors in the etiology of obesity has been demonstrated by various authors in last few years. The possible influence of some genetic factors on weight reduction or maintenance following conservative and/or surgical treatment was studied in 14 pairs of obese female monozygotic twins., Methods: 12 pairs of twins underwent a weight reduction regimen initiated by short-term inpatient treatment; two pairs were treated by nonadjustable gastric banding. Some factors that may be genetically influenced and that can predict, to some extent, success or failure in long-term weight loss were followed up in obese pairs., Results: The most valuable predictors of long-term outcome in this group of patients were initial weight loss, fat mass, respiratory quotient, waist circumference, and sagittal abdominal diameter., Conclusion: Hereditary factors cause significantly higher risk of treatment failure in some obese subjects. There is a need to pay special attention to these factors in order to achieve successful long-term weight loss.

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.

A group of 318 obese patients followed-up at the Obesity Unit in Prague in 1995-1997 was included into a study. Their treatment was based on the standard combination of a weight reduction diet, physical activity and behavioural intervention. In patients with more severe degrees of óbesity VLCD in one daily portion, pharmacotherapy, in-patient regimen lasting 24 days, including VLCD (1,500 kJ/day), exercise and group psychotherapy; or bariatric surgery (mostly laparoscopic gastric banding) were used, if necessary. Patients were divided into two groups according to their compliance to the weight reducing regimen. Group A dropped out before 2 years of follow-up, group B was followed-up 2 years or more. The groups did not differ significantly in their mean age, initial body weight, initial BMI and fat content and in percentage of males and females. Weight, BMI, fat content, essential anthropometric indices (waist circumference, WHR, subscapular and triceps skinfolds) and blood pressure are presented in this study. The maximum weight loss was significantly higher in group B. We did not find any other significant differences between group A and group B. The most significant predictor of compliance expressed as duration of follow-up (evaluated by multiple regression with stepwise variable selection) was the maximum BMI decrease (p < 0.005). The most significant predictors of the weight loss at the end of the follow-up were maximum weight loss and maximum decrease of BMI (p < 0.001). Family history of obesity (obese one or both parents) was significantly more often in group B (p < 0.05). This trend was expressed predominantly in females (p < 0.01), where also family history of obesity in mother was significantly more often in group B (p < 0.05). The frequency of methods used in individual patients was estimated. Standard combination of diet, enhanced physical activity and behavioural intervention was used in all patients. All other methods were used significantly more frequently in group B. In group A in-patient treatment was significantly more often used in men. The in-patient treatment promotes the compliance with the therapeutic regimen in women significantly more effectively than in men.

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.

Guidelines for the management of obesity include recommendation about diet, exercise, behavioral modification, drug therapy and bariatric surgery in the comprehensive management of an obese patient. It is emphasized that the treatment of obesity should be individually tailored according to the age of the patient, degree and phase of obesity, body fat distribution and an expression of risk factors and comorbidities. The new realistic goals in obesity management do not focus on the weight loss per se but mainly on the risk factors reduction which accompanies even modest weight loss. The system of obesity management introduced in the Czech Republic includes obesity management centres attached to major teaching hospitals, obesity out-patient clinics (led by an obesity specialist), primary care physicians and weight reduction clubs. Postgraduate training in obesity management should be recognized by health authorities as a function specialty. A time demanding therapeutic strategy in obesity management should be taken into account by both health policy makers and health insurance companies.

An increasing prevalence of obesity all over the world reflects a lack of effective measures in both prevention and treatment of obesity. Obesity as a disease has been underestimated by the lay-public as well as health care providers. However, obesity represents a substantial health problem associated with a decreased quality of life. Obesity is linked to numerous chronic diseases (cardiovascular diseases, diabetes, hyperlipidemia, gout, osteoarthritis, gall-stones, and bowel, breast and genitourinary cancers) that lead to premature disability and mortality. Health risks increase with a body mass index (BMI) over 25 in individuals 19-35 years of age and with a BMI over 27 in those 35 years of age and older. Health risks also increase with an excess accumulation of visceral fat manifested as an increase in waist circumference (> 100 cm) or in waist to hip ratio (> 0.85 for females and > 1.00 for males). According to studies carried out in different countries current economic costs of obesity represent 5-8% of all direct health costs. In contrast, effective treatment of obesity results in a substantial decrease in expenditures associated with pharmacotherapy of hypertension, diabetes, hyperlipidemia and osteoarthritis. Both scientists and clinicians involved in obesity research and treatment recommend to introduce the long-term weight management programs focussing more on the overall health of the participants than the weight loss per se. Therefore, it will be necessary to establish new realistic goals in the obesity management that reflect reasonable weights and recently experienced beneficial health effects of modest (5-10%) weight loss. Comprehensive obesity treatment consisting of low fat diet, exercise, behavioral modification, drug therapy and surgical procedures requires differentiated weight management programs modified according to the degree and type of obesity as well as to current health complications present. The Czech Society for the Study of Obesity defined a comprehensive weight reduction program carried out in weight reduction clubs, out-patient obesity clinics and in specialized departments attached to the university hospitals. In order to provide an integrated knowledge from many different disciplines connected with obesity three week postgraduate course has been organized for physicians involved in obesity management. Even the most spread weight reduction clubs in our country (STOB) are supervised by the trained counselors. The main goal of different weight management programs is to find out optimal approaches leading to long-term beneficial outcome and ameliorating the variety of disorders associated with obesity.

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.

Background: Treatment of obesity with strict reducing diets is as a rule associated with the development of energetic efficiency manifested among others also by a decline of energy expenditure. The objective of the trial was to test whether addition of oils containing triacylglycerols with medium-chain fatty acid can prevent this decline and whether their administration can affect the lipid spectrum., Methods and Results: Sixty obese patients were served for a four-week period of hospitalization at the obesitology unit a low-energy diet REDITA (Promil Co., N. Bydzov) providing 1596 kJ, 37 g protein, 50 g carbohydrate and 3 g fat. Part of the treatment was regular aerobic exercise, behavioural therapy to teach correct dietary habits and physical activity; physical activity was monitored by means of pedometers. From this group during the 3rd and 4th week 11 patients with similar characteristics were separated (age, body weight, BMI and energy expenditure at rest) as in the basic group. These patients were given daily 15 ml oil containing triacylglycerols with medium-chain fatty acids, MCT OIL (Mead Johnson, Evansville), providing 545 kJ. The resting energy expenditure was assessed in all patients every morning on fasting, immediately after awakening, using indirect calorimetry and it was corrected with regard to the respiratory quotient and excretion of catabolic nitrogen. The body composition was assessed at the beginning and at the end of the trial by hydrostatic weighing. Administration of oil containing triacylglycerols with medium-chain fatty acids (MCT OIL) prevented the decline of the resting energy expenditure (130.0 +/- 9.2 kJ/kg lean body mass/day, as compared with 126.5 +/- 7.2 kJ/kg lean body mass/day in the basic group: the difference is statistically not significant). Although addition of oil increased the energy intake by 545 kJ/day, the drop of body weight and BMI was comparable with that in the group of obese patients who did not receive the oil (10.3 +/- 1.1 kg vs. 10.6 +/- 0.5 kg). While during administration of the oil the resting energy expenditure did not change (5.97 +/- 0.30 kJ/min. vs. 5.24 +/- 0.58 kJ/min.), in obese patients who were only on the strict reducing diet it declined from 5.45 +/- 0.18 kJ/min. to 4.44 +/- 0.22 kJ/min. (p < 0.01). The significant drop of total cholesterol achieved by dietotherapy alone (5.41 +/- 0.21 mmol/l vs. 6.26 0.20 mmol/l before treatment) was not affected by administration of oil (4.86 +/- 0.28 mmol/l vs. 5.69 +/- 0.35 mmol/l before treatment). HDL-cholesterol, on the other hand, declined only in obese patients with dietotherapy (1.40 +/- 0.04 mmol/vs. 1.22 +/- 0.04 mmol/l after treatment, p < 0.01). The triacylglycerol values declined significantly in both groups (p < 0.01)., Conclusions: It appears that administration of thermogenetically acting triacylglycerols with medium-chain fatty acids can prevent diet-induced energetic efficiency and can improve the long-term success of dietotherapy of obese patients.

Background: Hitherto published experimental and clinical studies provide controversial findings as regards the relations of risk factors of atherogenesis and ischaemic heart disease and variations of body weight. The objective of the present study was to find out whether variations of body weight in women with severe obesity influence the incidence of some other risk factors of atherogenesis., Methods and Results: Two groups of obese women were examined. The group described as "weight cyclers" comprised 29 women where repeated variations of body weight were recorded, whereby at least two cycles of weight loss and subsequent gain were higher than 10 kg. The mean age of the group was 40.6 +/- 1.6 years, the body weight 113.0 +/- 4.2 kg, the body mass index (BMI) 39.88 +/- 1.48, the mean number of weight cycles (< 10 kg) was 2.38 +/- 0.11. The second group described as "non-weight cyclers" comprised 55 women whose body weight change, with the exception of pregnancy, at the age above 20 years did not exceed 5 kg. The mean age of this group of women was 38.5 +/- 2.1 years, the body weight 110.4 +/- 2.9 kg and BMI 39.31 +/- 0.98. The anthropometric indicators--ratio of lean body mass, the waist/hip ratio, the waist/thigh ratio, the sagittal diameter at the L4/L5 level did not differ in the two groups: an exception was only the centralization index which differed at the borderline of statistical significance (p < 0.05). The values of other risk factors are as follows: (the first figure refers to the "weight cyclers"). Systolic blood pressure 135.0 +/- 2.5 mmHg and 135.9 +/- 2.4 mmHg resp., diastolic blood pressure 86.1 +/- 1.7 mmHg and 86.2 +/- 1.5 mmHg resp., fasting serum insulin (IRI) 22.2 +/- 3.5 mU/l and 26.2 +/- 2.4 mU/l resp., the fasting blood sugar level 5.30 +/- 0.17 mmol/l and 5.48 +/- 0.16 mmol/l, total cholesterol 5.29 +/- 0.17 mmol/l and 5.53 +/- 0.13 mmol/l, HDL-cholesterol 1.40 +/- 0.05 mmol/l and 1.30 +/- 0.04 mmol/l, triacylglycerols 1.92 +/- 0.22 mmol/l and 2.10 +/- 0.22 mmol/l. The serum concentrations of free fatty acids (at 7.00 a.m., 1.00 p.m., 9 p.m.) did not differ in the two groups: 0.790 +/- 0.058 mmol/l and 0.772 +/- 0.060 mmol/l at 7.00 a.m., 0.621 +/- 0.066 mmol/l and 0.641 +/- 0.051 mmol/l resp. at 1.00 p.m., 0.730 +/- 0.066 mmol/l and 0.810 +/- 0.061 mmol/l resp. at 9.00 p.m., Conclusions: The increased flow of free fatty acids from intraabdominal fat depots is considered to be one of the factors mediating metabolic complications in the android type of obesity. Therefore the absence of any difference in fasting free fatty acid levels in both groups of investigated obese women suggests that variations in body weight do not participate in the increased risk of development of metabolic complications in women with severe obesity. Marked variations in body weight in women with severe obesity do not influence the incidence of the risk factors of atherogenesis.

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.

The authors give an account of anthropometric examinations in obese patients. These methods are used not only for quantitative assessment of the degree of obesity but also to define the body fat distribution. The predominant body fat distribution in the upper body half on the chest and abdomen is typical for android obesity and is, contrary to gynoid obesity, a serious health risk as regards cardiovascular diseases and metabolic complications. The authors describe methods of assessment of body circumference and skinfolds. The degree of obesity is assessed from the body mass index (BMI) and the percentage of total body fat calculated from skinfolds measured by means of a caliper. The type of body fat distributions is usually expressed by the waist/hip ratio or by the ratio between the subscapular skinfold thickness and the skinfold above the tricept ("index of centralization"). Recently some authors advise to calculate by anthropometry also the amount of visceral fat which is a significant risk factor of cardiovascular and metabolic complications of obesity.

The energy economy induced by a reducing diet and manifested by a reduced energy output at rest threatens greatly the long-term success of reducing regimes. The authors investigated the effect of a four-week therapy of obese patients by a low energy protein diet with an energy value of 1560 kJ on the resting metabolic rate (RMR), the serum concentration of thyroid hormones and TSH and on the Achilles tendon reflex time. Four weeks' treatment with a low energy protein diet caused a significant drop of the energy output at rest in the control group of obese men (by 17.5%), as well as in the control group of obese women (by 16.9 per cent). In the group of obese women who were given during the last two weeks of treatment depot methyl xanthine derivative, Euphilline (Byk Gulden), the energy output at rest did not decline as a result of dietetic treatment and the decline of the BMI was significantly higher than in the control group of obese women, although the two groups did not differ in the initial BMI, mean age and the degree of physical activity during treatment. With the exception of the control group of men where the serum triiodothyronine level declined, in the investigated obese subjects no significant changes of the investigated thyroid function parameters were recorded. The syndrome of low T3 thus does not participate in a substantial way in the drop of the metabolism at rest during treatment with a low energy protein diet, obviously due to the intake of 50 g carbohydrate per day.(ABSTRACT TRUNCATED AT 250 WORDS)

Assessment of the skinfold thickness in obese patients by means of a caliper makes it possible to determine the percentage of total body fat and provides information on the distribution of subcutaneous body fat and thus to characterize the type of obesity. In more severe obesity it is not possible to differentiate reliably by means of classical calipers larger skinfolds, in particular the subscapular and abdominal skinfold which thus makes these anthropometric examinations useless. A newly developed modification of the Best caliper makes it possible to measure reliably the majority of skinfolds in obese subjects as the arm of the caliper can be shifted to a range as high as 90 mm. Best's caliper provides, in contrary to others, the possibility to set a constant pressure when measuring the skinfold. In the discussion the authors draw attention to some methodological problems and the clinical importance of examining obese subjects by means of a caliper.

The Czechoslovak low-energy protein diet contains 1559 kj per day, incl. 33.0 g protein, 50 g carbohydrate, 4.0 g fat, 6.0 g fibre and recommended vitamin and mineral allowances. The diet was administered to 75 subjects with a mean age of 39.88 +/- 1.21 years and a body weight of 112.57 +/- 2.89 kg, and a body weight index (BMI) of 39.44 +/- 0.94, for 28 days. During treatment the body weight declined by 9.67 +/- 0.41 kg and the BMI by 3.74 +/- 0.20. At the same time there was a significant decline of the total cholesterol (p less than 0.001), LDL cholesterol (p less than 0.001), HDL cholesterol (p less than 0.01) and triacylglycerols (p less than 0.05). In 20 subjects with hyperlipidaemia similar changes of the total cholesterol and LDL cholesterol were recorded, while the decrease of HDL cholesterol (p less than 0.001) and triacylglycerols (p less than 0.001) was more marked. The nitrogen balance became during the fourth week on the diet positive (+0.64 g), there was a transitory decline of the total protein concentration. The serum amino acid concentration did not change significantly with the exception of isoleucine, the level of which increased. The serum immunoglobulin concentration did not change significantly. It may be concluded that the low-energy protein diet has a favourable impact on the lipid metabolism, without a marked negative effect on the protein metabolism.

The low-energy protein diet providing 1559 kJ is the first accurately defined diet for the treatment of obesity in the CSSR. The daily amount contains 4.0 g fat, 33.0 g protein, 50.0 g carbohydrate, 5.6 g fibre and daily recommended allowances of vitamins. The diet is enriched with potassium, magnesium and iron. The low-energy protein diet was used for a period of 28 days in the treatment of 49 obese patients aged 40.49 +/- 1.39 years whose initial weight was 110.14 +/- 3.41 kg and the BMI 39.44 +/- 1.13. The therapeutic regime comprised in addition to the diet adequate physical exercise of aerobic character and training of correct eating behaviour. Four weeks treatment led to a significant decline of body weight (by 10.60 +/- 0.46 kg) and a significant drop of the BMI (by 3.65 +/- 0.16). Men lost more weight than women. In women a substantial drop of the body weight (90.5%) was due to reduction of body fat, while in men adipose tissue participated by 60.0% in the loss. During the fourth week of treatment a positive nitrogen balance was achieved, obviously due to adequate physical exercise. The waist/hip ratio was not affected by treatment in either group. The therapeutic regime influenced favourably some risk factors of ischaemic heart disease. In addition to a significant drop of the systolic and diastolic blood pressure a significant decline of total cholesterol, triacylglycerols and serum insulin occurred. There was a concurrent decline of the urinary C-peptide excretion. The therapeutic regime involving the low-energy protein diet was well tolerated by the patients. The incidence of side effects during treatment was less frequent than in treatment by intermittent fasts. No disorders of the cardiac rhythm were recorded during treatment.

A new very low energy formula diet containing 1560 kJ (373 kcal) per day was employed in the treatment of 49 obese patients. The treatment, of 4 weeks duration, included aerobic physical exercise and behavioural intervention. This kind of therapy resulted in a significant decrease (P less than 0.001) of both weight (-10.60 +/- 0.46 kg) and body mass index (-3.36 +/- 0.16). The fat stores represented 90.5 per cent of weight loss in women and 60.0 per cent of weight loss in men. The first very low energy formula diet produced in Czechoslovakia proved to be an efficient and safe tool for the treatment of obesity, positively affecting high blood pressure, lipid and carbohydrate metabolism in the absence of serious side-effects.

A twelve-day reducing regime involving exercise and a reducing diet (2.5 MJ/day), led in 23 obese women to an average loss of body weight of 4.52 +/- 0.35 kg. The loss of adipose tissue during the reducing regime was greater than the total loss of body weight, obviously due to proliferation of lean body mass as a result of exercise. Concurrently a significant decline of the mean morning concentration of thyroxine, triiodothyronine, C-peptide and STH in serum was recorded, while the concentration of TSH, cortisol, prolactin, LH and FSH increased insignificantly and the concentration of insulin and testosterone declined insignificantly. Exercise thus did not prevent a decline of triiodothyronine induced by the low energy diet. The exercise in the morning did not cause a stress conditioned increase of the secretion of cortisol, prolactin and STH at the onset and at the end of the reducing regime. From the metabolic aspect the favourable absence of the stimulating action of exercise on cortisol secretion is due to the character of motor activity (40-50% VO2max). The absence of a stress conditioned rise of prolactin during exercise prevents the inhibiting action of prolactin on gonadal functions. The reducing regime has also a favourable effect on insulin secretion, as on the 12th day of the reducing regime there was a significant decline of the serum level of immunoreactive insulin in the course of exercise.