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Background: In the literature there are several body impedance analysis (BIA) prediction equations generally determined in younger populations and their accuracy in the elderly has not been adequately confirmed. Objective: We verified the reliability of the BIA method in a body composition study in the elderly. Methods: To assess the accuracy of bioelectrical impedance analysis we compared this method with dual photon absorptiometry (DPA), assumed as a gold standard; body composition was predicted by seven BIA prediction equations in 24 healthy elderly individuals. Results: The best equation in fat-free mass (FFM) estimation is the RJL System formula (published by Segal in 1988); nevertheless, the wide range of the error in FFM estimating may limit its clinical application. The FFM hydration variability seems to be the principal variable which explains the error in FFM estimation by BIA prediction equations. Conclusion: These findings indicate that the use of BIA equations is not interchangeable, when FFM is calculated in an elderly population, and more validation studies are necessary in this age group to evaluate the clinical application of this method.

Objective: To determine the weight-reducing efficacy of orlistat, a novel gastrointestinal lipase inhibitor, and to define the optimal dosage regimen and establish the tolerability of the drug when used for a 6-month treatment period. Methods: The study was a multicentre randomised, double-blind, parallel group in design and involved 676 obese male and female subjects aged at least 18 years with a body mass index between 28 and 43 kg · m−2. Following a 5-week placebo run-in period, subjects were randomised to receive orlistat 30 mg, 60 mg, 120 mg, 240 mg or matching placebo three times a day (tid) for 24 weeks during meals. Patients were maintained on a mildly hypocaloric diet throughout the study period. The primary efficacy parameter was body weight change over time. Results: Orlistat resulted in a significantly greater mean loss of body weight than observed in the placebo group. In absolute terms, mean weight loss was greatest in the 120 mg group (9.8%). More orlistat- than placebo-treated patients lost >10% of initial body weight (37% of the 120 mg group vs 19% of the placebo group). Orlistat was well tolerated. Predictably, in view of its known pharmacological effects, more orlistat-treated patients experienced gastrointestinal events. Mean levels of vitamins A, D and E, and β-carotene remained within the clinical reference ranges in all treatment groups and rarely required supplementation. After 24 weeks, plasma concentrations of orlistat were either non-measurable or detected at the assay's limit of quantitation. Conclusion: Orlistat treatment results in a dose-dependent reduction in body weight in obese subjects and is well tolerated. Orlistat 120 mg tid represents the optimal dosage regimen.

The purpose of this study was to confirm the safety and efficacy of dexfenfluramine in association with a weight-stabilising diet in obese patients. A total of 415 obese subjects received dexfenfluramine 15mg twice daily for 3 months. These subjects were suffering from obesity with either no concomitant complications (n = 210) or the following concomitant complications: hypertension (n = 59), non-insulin-dependent diabetes mellitus (NIDDM) [n = 86], eating disorders (n = 60). The demographic parameters and the parameters related to bodyweight in the various subgroups were similar at the time of inclusion. After 3 months of dexfenfluramine treatment, the mean weight loss in the patients who had completed the study was as follows: simple obesity 5.7 ± 0.3kg (n = 183); obesity with hypertension: 6.0 ± 0.3kg (n = 57); obesity with NIDDM: 4.2 ± 0.3kg (n = 78); obesity with eating disorders: 6.1 ± 0.4kg (n = 58). In the patients with obesity and hypertension, the mean systolic and diastolic pressures showed highly significant reductions (p < 0.001). In the patients with obesity and NIDDM, the fasting and postprandial blood glucose and glycosylated haemoglobin were also highly significantly reduced (p < 0.001). In the obese patients with eating disorders, the mean total caloric intake was reduced by 36%, which was highly significant (p < 0.001). The mean carbohydrate and fat intake was reduced by 35.4 and 37.9%, respectively (p < 0.001), whereas protein intake was only marginally reduced. Adverse events were usually moderate and transient, occurring at the beginning of treatment. The most common were drowsiness (6.3%), dry mouth (5.3%) and headaches (5.3%). This incidence was similar to that found in previous clinical trials. In conclusion, dexfenfluramine induced significant weight loss in this group of obese patients, both with and without concomitant complications. A concomitant improvement in diabetes and hypertension was observed in patients initially presenting with these complications. In addition, dexfenfluramine improved the eating disorders that are frequently responsible for overweight and had a selective effect on diet, essentially reducing carbohydrate and fat intake and not that of protein.

To assess six-year changes in medicine use and supplementation practice of elderly Europeans.Longitudinal assessment including two rounds of the SENECA STUDY: 1993 (first follow-up) and 1999 (final follow-up). Random sample of elderly born between 1913-1918, 284 men and 337 women in 1999. Data were collected in 10 small towns in 9 European countries by personal interview using standardized questionnaire.In the six-year period the percentage of subjects taking medicines increased significantly (81.3 vs. 87.6%), while supplement usage did not change (23.2 vs. 23.5%). In 1999 a greater percentage of participants took in long-term order (or= 2 years) antihypertensive drugs (33% vs. 21%), diuretics (18% vs.12%), anticoagulants (17% vs. 5%)and nitroglycerine (13% vs. 6%). In 1999 the supplements more frequently taken were calcium (12% of all the subjects, 7% of men and 17% of women), vitamin D (10% of all the subjects, 6% of men and 14% of women) and ascorbic acid (10% of all the subjects, 8% of men and 13% of women). In the finale survey calcium supplements were taken by more respondents than in 1993 (12% vs. 8%). Medicine and food supplement use was more frequent by women than by man in both 1993 and 1999.The higher prevalence of using medicines with cardiovascular effects suggests an increase of cardiovascular problems with age. The higher frequency of calcium and vitamin D usage among women suggests that these nutrients are taken for preventing senile osteoporotic fractures.

Dietary intake and nutritional status was assessed in a random sample of 190 Italians (70-75 years of age) participating in the Survey in Europe on Nutrition and the Elderly (EURONUT-SENECA). The daily energy intake as assessed by a Modified Dietary History, was 2208+/-562 Kcalories in men and 1742+/-527 Kcalories in women. The alcohol intake was significantly higher in men than in women (35. 9+/-32.5 g/day vs 14.7+/-15.4 g/day; p0.0001). As for calcium, there was a high percentage of men (77%) and women (86%) with a lower intake than the recommended values. The subjects underweight (BMI20) were only 4.1% men and 9.7% women, while the great part was normal (BMI= 20-24.9) and overweight (BMI=25-29.9). The body composition parameters showed a significant difference between two genders. Men had a Total Body Water (56.5+/-4.5% vs 51.3+/-5.4%; p0. 001) and Fat-Free Mass (80.4+/-5.2% vs 70.9+/-6.8%; p0.001) higher than women. Few subjects were at high risk of deficiency with regard to plasma levels of vitamins, haemoglobin and albumin. If we analyse the composition of the diet consumed, we can remark the characteristics of a typical Mediterranean diet. We conclude that the general nutritional status of our sample was fairly good.

To determine the weight-reducing efficacy of orlistat, a novel gastrointestinal lipase inhibitor, and to define the optimal dosage regimen and establish the tolerability of the drug when used for a 6-month treatment period.The study was a multicentre randomised, double-blind, parallel group in design and involved 676 obese male and female subjects aged at least 18 years with a body mass index between 28 and 43 kg x m(-2) Following a 5-week placebo run-in period, subjects were randomised to receive orlistat 30 mg, 60 mg, 120 mg, 240 mg or matching placebo three times a day (tid) for 24 weeks during meals. Patients were maintained on a mildly hypocaloric diet throughout the study period. The primary efficacy parameter was body weight change over time.Orlistat resulted in a significantly greater mean loss of body weight than observed in the placebo group. In absolute terms, mean weight loss was greatest in the 120 mg group (9.8%). More orlistat- than placebo-treated patients lost10% of initial body weight (37% of the 120 mg group vs 19% of the placebo group). Orlistat was well tolerated. Predictably, in view of its known pharmacological effects, more orlistat-treated patients experienced gastrointestinal events. Mean levels of vitamins A, D and E, and beta-carotene remained within the clinical reference ranges in all treatment groups and rarely required supplementation. After 24 weeks, plasma concentrations of orlistat were either non-measurable or detected at the assay's limit of quantitation.Orlistat treatment results in a dose-dependent reduction in body weight in obese subjects and is well tolerated. Orlistat 120 mg tid represents the optimal dosage regimen.

415 obese subjects received dexfenfluramine 15 mg twice daily for 3 months. These subjects were suffering from obesity with either no concomitant complications (n = 210) or the following concomitant complications: hypertension (n = 59), non-insulin-dependent diabetes mellitus (NIDDM)[n = 86], eating disorders (n = 60). After 3 months of dexfenfluramine treatment, the mean weight loss in the patients who had completed the study was as follows: simple obesity 5.7(+)-0.3 kg (n = 183); obesity with hypertension: 6.0(+)-0.3 kg (n = 57); obesity with NIDDM: 4.2(+)-0.3 kg (n = 78); obesity with eating disorders: 6.1(+)-0.4 kg (n = 58). In the patients with obesity and hypertension, the mean systolic and diastolic pressures showed highly significant reductions. In the patients with obesity and NIDDM, the fasting and postprandial blood glucose and glycosylated haemoglobin were also highly significantly reduced. In the obese patients with eating disorders, the mean total caloric intake was reduced by 36%, which was highly significant. The mean carbohydrate and fat intake was reduced by 35.4 and 37.9%, respectively, whereas protein intake was only marginally reduced. Adverse events were usually moderate and transient, occurring at the beginning of treatment. In conclusion, dexfenfluramine induced significant weight loss in this group of obese patients, both with and without concomitant complications. A concomitant improvement in diabetes and hypertension was observed in patients initially presenting with these complications.

To analyse the relationships between eating pattern, vomiting frequency, weight loss and the rate of band related complications in morbidly obese patients undergoing Adjustable Silicone Gastric Banding (ASGB).80 morbidly obese patients (57 females and 23 males) consecutively operated by ASGB were evaluated both before and 3, 6 and 12 months after ASGB. Ten patients (12.5%) had binge eating disorder and were analysed separately.(1) weight loss expressed as percentage of overweight, (2) total daily energy intake, (3) percentage of energy as lipids, carbohydrates and proteins, (4) percent as liquid, soft or solid foods and (5) vomiting frequency.ASGB induced a highly significant reduction of total daily energy intake and percent as solid foods, without significant changes in macronutrient distribution. There was an inverse relationship between vomiting frequency and the intake of solid foods. Non-binge eaters with more vomiting ate less solid food and lost more weight than patients without vomiting. The frequency of neostoma stenosis was higher in patients with high vomiting frequency than in patients with no vomiting. Patients with binge eating disorder had a significantly higher vomiting frequency and a five-fold higher frequency of neostoma stenosis than patients without binge eating disorder. However, the percentage of overweight lost did not differ between patients with and without binge eating.Vomiting is a major determinant of global outcome after ASGB. The vomiting frequency in the first months after ASGB was associated with eating pattern, the frequency of neostoma stenosis and possibly the rate of weight loss during the first year of follow-up.

Six lipomas from patients affected by Multiple Symmetric Lipomatosis (MSL) and by Multiple Endocrine Neoplasia Type 1 (MEN 1) were analyzed for loss of heterozygosity on chromosome 11 region q12-13 using four RFLPs. Allelic loss for the D11S146 locus was found only in one visceral MEN 1-associated lipoma. Lipomas that exhibited a lack of allelic lesions were analyzed for an eventual abnormal amount or a defective function of the Gs protein by studying the Gs alpha subunit gene, codons 201 and 207, by PCR and TGGE techniques. All the samples were negative for activating mutations.

To analyze the relationship between visceral fat accumulation and resting energy expenditure in obese women and to evaluate the effects of a severe weight loss both on energy expenditure and on fat distribution.Twelve premenopausal women, aged 19-50 years, undergoing adjustable silicone gastric banding (ASGB) for morbid obesity participated at the study. The patients were evaluated twice. The baseline evaluation was performed immediately before surgery. After surgery, a diet specifically developed for patients submitted to gastric restriction (2.5 MJ/day) was given to the patients. The second evaluation was performed 6 months after surgery.Resting metabolic rate (RMR) was determined by indirect calorimetry. Total fat area (TFA), visceral fat area (VFA) and subcutaneous fat area (SFA) were measured by abdominal computed tomography. Fat mass (FM) and fat free mass (FFM) were derived by bioelectrical impedance analysis.At baseline, RMR was positively related to VFA (r = 0.60, P0.05). ASGB induced a highly significant weight loss of 24.4 +/- 9.0 kg. This weight reduction was mainly due to a loss of FM (68.5 +/- 10.8 vs 48.5 +/- 9.2 kg, P0.001), whereas FFM was only slightly reduced (52.6 +/- 4.0 vs 47.9 +/- 4.6 kg, P0.05). The BMI reduction was positively related to the baseline BMI and FM values (r = 0.61, P0.05 and r = 0.55, P0.05, respectively). There was no significant correlation between the BMI reduction and the baseline variables of fat distribution, nor between the BMI reduction and the basal RMR. Weight loss was accompanied by modifications of fat distribution. In particular, the reduction of VFA after surgery was strictly related to the VFA values at baseline (r = 0.91, P0.001). Weight loss induced a significant reduction of RMR (7.96 +/- 1.77 vs 6.57 +/- 6.90 MJ/day; P0.01). The reduction of the RMR observed with weight loss was significantly related to the FFM loss (r = 0.63, P0.05), whereas no correlations were found between the changes of RMR and the FM loss. Regarding to fat distribution, the reduction of the RMR was significantly related to the visceral fat loss (r = 0.57, P0.05), but not to the modifications of total or subcutaneous fat area. The independent contribution of the modifications of FFM, FM, and visceral fat to the changes of RMR was analyzed by multiple regression analysis. In this model, both FFM and visceral fat changes resulted independently related to the RMR.(1) visceral fat accumulation was a significant predictor of RMR in the very obese woman; (2) visceral obese women lost more visceral fat than subcutaneous ones; (3) the reduction of the RMR observed during weight loss could partly be explained by a reduction of visceral fat mass.

Functional disability was evaluated in a cross- section sample of 671 persons, aged ⩾60 years attending the Local Health Care Unit of Borgo San Dalmazzo, Cuneo, Italy, by the OECD (Organization for Economic Co- operation and Development) questionnaire. The unidimensionality of the item set and grading order of severity were studied by Multiple Correspondence Analysis; cumulativeness was examined by Guttman scale- analysis.The OECD set measured two dimensions of disability, physical and sensorial. By excluding the six items that caused the greatest loss of homogeneity, a reduced set of ten items was obtained that was cumulative (Reproducibility coefficient=0.934 and Scalability coefficient=0.778) and also produced a simpler score (0–10 points scale). Based on this score, 40% of the subjects presented no disability in running 100 metres (the most difficult task), and males were less disabled than females (p=0.001). The level of functional disability was slightly decreased in males, and nearly uniform in females up to 70–74 years, after which a clear decrease appeared (p=0.001). The more disabled aged state a need for a higher number of health services (injection and physical therapy, nursing hospital, nursing home, physician), but knowledge and use of these services are not clearly related to physical function. Based on our results, the choice of scaling appears irrelevant if the homogeneity of the item set is checked; if the cumulative criterion is identified, the use of a simplified cumulative score can be proposed as a sensitive measure of disability, and indirectly, the amount of personal assistance needed. (Aging Clin. Exp. Res. 5: 95- 103, 1993)

In 19 towns and cities across Europe, physical activity and activities of daily living were studied in 2586 elderly people born between 1913 and 1918. Data were obtained as part of a standardized questionnaire. Large variations in both levels of physical activity and activities of daily living existed among research towns and cities. Altogether, women spent more hours per day on physically active tasks than men, including more time on housework (2.6-3.9 h/day versus 0.7-2.3 h/day for men) and on leisuretime activities (2.0-4.2 h/day versus 0.9-2.3 h/day for men). According to 16 items of functioning, including both items of personal functioning and more complex tasks, functioning was rated as good in most of the elderly. In all centres good functioning was most prevalent in men, and in the younger elderly born in 1917 or 1918. In further cross-sectional analyses the relationship between physical activity, nutrition and other life-style factors, on the one hand, and anthropometry, health and performance, on the other hand, will be examined.

In 17 towns in 11 countries across Europe, 10 questions on health were asked as part of a general standardized interview regarding self-perceived global and relative health, quality of life, chronic diseases, use of medicine and specific ailments. 2544 men and women born between 1913 and 1918 participated in the survey. No age-related health differences were found within this 5-year age group. Self-perceived global health was better in men than in women, and more men than women judged their health to be better than that of other persons of their age. The gender difference in prevalence of chronic diseases and use of medicine was less pronounced. Most people judged their health to be good (20-82%) despite a high prevalence of chronic disease (59-92%) and symptoms from different organ systems (leg problems: 16-60%). There were large variations in all measures of health between towns, even between towns within the same country. The trend was in the direction of better health in northern industrial towns than in southern rural towns. The differences were still significant after correction for differences in non-participation rate. The findings are consistent with findings in other health surveys. The findings about self-rated health, chronic diseases and specific ailments will be used in further cross-sectional analyses of the role of differences in diet habits and nutrition for health in Europeans, controlled for living conditions and life-style.

On 5 and 6 April 1991, at the National Research Council (CNR) in Rome, a Consensus Conference on the relationship between overweight, obesity and health was held. The conference was sponsored by FATMA (Applied Project on Disease Factors of the CNR) and UICO (Italian Society for the Study of Obesity) with the purpose of establishing guidelines for health employees. The development of the conference followed the methodology set down by OMAR to obtain a rational and significant consensus on the answers to six basic questions prepared by the planning committee. The questions were the pivotal point of the conference and were brought to the attention of all the attendees and widely diffused among the medical community; they were proposed with the aim of giving an exhaustive definition of obesity, to investigate its relationship with mortality and morbidity, to highlight its social characterization, to indicate methods of evaluation and recommendations for weight loss, to select groups at risk, and to focus general guidelines for research. After the presentation of the state of the art on 18 topics by experts in the field, the 22 members of the consensus panel, impartial experts from a vast area of the scientific community, discussed a draft document representing the answers to the questions, which was subsequently submitted to the 307 attendees, discussed and then approved. This paper is the definitive document of the Consensus Conference. The introduction explains the reasons which led to the decision to promote the conference six years after the one held in the United States. The methodology is then set out. The questions are answered in the form of recommendations and backed up by data and scientific evidence from the literature.

On April 5th and 6th 1991, at the National Research Council (CNR) in Rome, a Consensus Conference on the relationship between Overweight, Obesity and Health was held. The Conference was sponsored by FATMA (Applied Project on Disease Factors of the CNR) and UICO (Italian Society for the Study of Obesity) with the purpose of establishing guidelines for health employees. The development of the Conference followed the methodology set down by OMAR to obtain a rational and significant consensus on the answers to 6 basic questions prepared by the Planning Committee. The questions were the pivotal point of the Conference and were brought to the attention of all the attendees and widely diffused among the medical community; they were proposed with the aim of giving an exhaustive definition of obesity, to investigate its relationship with mortality and morbidity, to highlight its social characterization, to indicate methods of evaluation and recommendations for weight loss, to select groups at risk, and to focus general guidelines for research. After the presentation of the state of the art on 18 topics by experts in the field, the 22 members of the Consensus Panel, impartial experts from a vast area of the scientific community, discussed a draft document representing the answers to the questions, which was subsequently illustrated to the 307 attendees, discussed and then approved. This paper is the definitive document of the Consensus Conference. The introduction explains the reasons which led to the decision to promote the Conference six years after the one held in the United States. The methodology is then set out. The questions are answered in the form of recommendations and backed up by data and scientific demonstrations from the literature.

The paper evaluates the results of vertical gastroplasty in the treatment of morbid obesity. A series of 34 patients (24 F and 10 M) with the following characteristics was included in the study: mean age 41 years, preoperative weight 141 kg, % of ideal weight 204%, BMI 49; mean follow-up was 35 months. Postoperative mortality was zero and there were reduced early and long-term complications. Mean weight loss, expressed as a percentage of overweight, at 6 months was 48.5%, 56.8% at 12 months, 63.4% at 24 months and 67.2% at 36 months. The authors conclude that, given the low incidence of complications and the satisfactory weight loss which was maintained long after the operation, vertical gastroplasty appears to be the preferred operation, since it represents a safe and effective method of treating pathological obesity.

The aim of the study was to assess the relation between the waist to hips ratio (WHR) and the distribution of adipose tissue in visceral or subcutaneous site through the use of CAT. Results are expressed as the ratio of visceral to subcutaneous adipose tissue area (VSR). A total of 61 patients were randomly selected for inclusion in the study. Contrary to normal weight subjects, obese patients did not reveal significant correlations between the two ratios. Following multi-variant analysis in normal weight subjects, WHR appeared to be influenced by sex, BMI and VSR. In patients with prevalently visceral adiposity WHR was determined by sex and VSR, whereas in patients with prevalently subcutaneous adiposity it was influenced by BMI alone. In conclusion, the significant correlations between WHR and tomographic indices of adipose tissue distribution reported in the literature are not present in all types of patient, and in particular are not found in obese patients and normal weight subjects with prevalently subcutaneous adiposity.

This study includes anthropometric measurements (Body Mass Index, triceps and subscapular skinfolds, % Body Fat and Mid Arm Muscle circumference) of a cross-sectional sample of 1247 elderly representative of the Italian population between 65–95 yr (522 males and 725 females). BMI at the 50th percentile is 26 for males and 27.7 for females, at the 90th it is 31.1 and 34.7 for males and females, respectively. Compared with the data of Master et al. (1960), 13% (males) and 28% (females) of the elderly Italian subjects were overweight in 1985.

Some parameters of adipose tissue development have been studied in normal, full-term infants of gestational-diabetic mothers (GDM) and insulin-dependent diabetic mothers (IDDM). Values of skinfold thickness, body fat mass, and fat cell weight in full-term newborns of GDM and IDDM are greater than in infants of nondiabetic mothers. Fat mass enlargement in newborns of diabetic mothers seems to be caused almost exclusively by an increase in the triglyceride content of the single adipocytes. Results of determinations of fat cell weight are in fact significantly higher in newborns of GDM and IDDM and correlate closely with skinfold thickness and body fat mass: No differences resulted in the approximate estimate of fat cell number. Neither maternal weight gain during pregnancy nor pregravidic overweight seem to be directly related to the expansion of adipose tissue observed in newborns of diabetic mothers. Maternal blood glucose levels and neonatal IRI levels in cord blood significantly correlated with fat cell weight. Maternal FFA levels are not related to parameters of adipose tissue development in newborns of normal, GD, and IDD mothers. In conclusion, enlargement of body fat mass in full-term infants of GDM and IDDM is dependent on glucose availability and, thus, on the insulin-induced enhancement of triglyceride synthesis and storage in single adipocytes. Free fatty acids do not seem to play an important role in regulating the triglyceride content of fat cells in newborns of gestational-diabetic or insulin-dependent diabetic mothers.

Nuclear techniques are very useful in the simultaneous determination of many trace elements in biological samples; the sensitivity depends on the method and on the elements in study and in many cases is better than 0;1 ppm. Proton-induced X-ray fluorescence and alpha-particle elastic diffusion techniques are described; the methods of sample preparation, the sensitivity obtained and some experimental results are included.

A clinical and metabolic study of 61 patients with myoocardial infarct before the age of 40 yr showed a high frequency of familial involvement, particularly in subjects with type IIA and IIB hyperbetalipoproteinaemia. Excess weight and arterial hypertension were rare, while premonitory angina was absent in 59%. Four subjects were diabetic. Oral glucose tolerance was normal in 14 and of diabetic type in 26 of 40 patients examined; the insulin response pointed to insulin-resistance. Dyslipidaemia was noted in 45%, including type IIA and IIB hyperbetalipoproteinaemia in 27%. Distribution of the frequency of infarct in function of cholesterolaemia classes gave a bimodal curve indicative of distinct normo- and hypercholesterolaemic groups within the series. Reduced glucose tolerance was more frequent in patients with low blood cholesterol. This suggests that reduced tolerance and high blood cholesterol are independent risk factors in coronary disease. No relation between the clinical and metabolic data could be ascertained.

The effect of carnitine administration on neonatal lipid metabolism was studied during endovenous loading with Intralipid (1 g/kg body weight over a 4-hour period). During a 6-hour period the plasma level of triglycerides, glycerol, free fatty acids (FFA), beta-hydroxybutyrate (beta-OHB), and acetoacetate were monitored in a group of newborns infused with carnitine and compared with a control group infused only with Intralipid. Carnitine administration caused an increased plasma concentration of ketone bodies, probably consequent to an increased rate of FFA mitochondrial beta-oxidation. An increased plasma level of glycerol and FFA was also observed, whereas the triglyceride plasma levels were not different between the two groups. Carnitine administration in the neonatal period seems to act by increasing ketogenesis and lipolysis.

It is well recognised that the newborn of diabetic mothers may be overweight and obese, presumably due to excessive glucose and insulin levels in the fetus. Since recent evidence indicates that the number of fat cells is established early in life, we studied the effect of intrauterine hyperglycaemia and hyperinsulinaemia on adipose tissue cellularity. Six men (age range 21–26 years) and six women (age range 18–24 years) were investigated. Their weights at birth generally exceeded the average value by 2 S.D. As a group they were not obese at the time of the investigation and neither total number of fat cells, average cell size nor body fat differed significantly from controls of the same age. There was no correlation between the number of fat cells and the weight at birth. The adipose tissue cellularity in the offspring of alloxan-diabetic rats (AX) and in controls (C) of equal weight was also studied. When sacrificed (after 40 days) body weights and the weights of the epididymal and retroperitoneal fat pads were similar in the AX and C groups. However, the number of fat cells of the retroperitoneal fat pad was significantly increased in the AX group, while the cell size was slightly diminished. Cell data of the epididymal fat pads were not significantly different. The results indicate that excessive glucose and insulin levels in utero may influence the number of fat cells, but, in man, they do not seem to lead to a permanent hyperplasia of the adipose tissue.

We have evaluated the relationships between adipose tissue lipoprotein-lipase activity (AT-LPL) or post-heparin plasma lipolytic activity (PHLA) and the composition of circulating lipoproteins in 7 patients with multiple symmetric lipomatosis (MSL). In addition we have investigated the behaviour of serum triglycerides after an oral fat load (1 g triglycerides/kg body weight) in 5 MSL patients and in 5 age and sex matched controls. We found significantly higher values of HDL, HDL2 and HDL3 cholesterol in MSL patients than in controls. Moreover, HDL2/HDL3 cholesterol ratio was higher in MSL patients than in controls, which indicate a predominant increase in HDL2 subfraction. The mean values of AT-LPL in lipomatous tissue was significantly higher than in control tissue. A positive statistically significant correlation was found between AT-LPL activity and HDL, HDL2 and HDL3 cholesterol values. After the fat load the maximal increments of serum triglyceride levels and the triglyceride areas over 8 and 12 h are lower in MSL patients than in controls; there was an inverse, statistically significant correlation between the total PHLA or the extrahepatic PHLA values and the triglyceride areas after lipid load. We conclude that MSL represents a useful naturally occurring model for the study of the role of AT-LPL in the metabolism of triglyceride-rich lipoproteins and in the clearance of lipoproteins in the post-prandial phase.

A crossover study was carried out in 22 obese patients to evaluate the effect of a hydrophilic mucilage associated with a 800 calorie hypoglucidic diet, as compared to diet alone, on body weight and on plasma lipid levels. The administration of mucilage resulted in a weight loss greater than that obtained with diet alone. Moreover, plasma cholesterol and triglyceride level reduction was more pronounced in the patients on mucilage treatment. While reduction in plasma triglyceride levels was correlated to variations in body weight, reduction in cholesterol levels was not. This fact may be explained by reduced intestinal absorption of bile acids, as suggested by the significant reduction in plasma bilirubin levels observed in patients on mucilage treatment. During the first period of treatment with mucilage, a slight reduction in plasma levels of iron and calcium was observed, without modifications in red blood cell counts, haematocrit values and haemoglobin concentration. In 6 patients on protracted treatment (6 months), no further modifications in serum iron and calcium levels were observed.

The echocardiographic features of the left ventricle of 37 obese women (body mass index above 30) and 37 lean controls, matched for sex, age, height and blood pressure levels, were studied. Twenty-six patients in each group were hypertensive. The normotensive obese patients did not show any differences, comparing to the normotensive controls; on the contrary, the hypertensive obese patients had higher left ventricular mass (LVM), stroke volume and cardiac output (CO), and lower total peripheral resistance (TPR) than the hypertensive controls. A positive correlation was found between the LVM and the CO (r = 0.57, P less than 0.01) in hypertensive obese patients, and between the relative wall thickenss (h/r, that is the ratio between the left ventricular wall thickness and the left ventricular radius) and TPR (r = 0.64, P less than 0.01) in the hypertensive controls. It is concluded that obesity per se does not determine left ventricular hypertrophy in women; however, when obesity is associated with arterial hypertension, a distinct pattern of hypertrophy, characterized by high CO and low TPR, develops.

Carbon monoxide diffusion (DLCO), blood gas analysis at rest and after exercise, distribution of ventilation and perfusion by Xenon 133 were carried out in 43 hyperlipidemic patients, Fredrickson's types I, IIA, IIB, and IV. DLCO was significantly reduced in hypertriglyceridemic and to a lesser degree in hypercholesterolemic patients. A significant negative correlation was found between DLCO and triglyceride values. Significantly lower basal PaO2 values, which improved after exercise, were observed in both type IIA and type IV hyperlipemic patients. The ventilation/perfusion ratio distribution (V/Q) did not increase from the basal to the apical segments of the lungs in hyperlipidemic patients as it did in normals. The hypothesis of an alteration in pulmonary surface-active lipoprotein, directly related to hyperlipoproteinemia or indirectly caused by fat microembolism, may explain the reduced DLCO, the loss of V/Q gradient, and the decrease in PaO2 (which improves after exercise) observed in hyperlipemic patients. Disturbances in pulmonary gas exchange and PaO2 reduction could play an important role in the pathogenesis of both angina pain due to ischaemic heart disease, which is frequently observed in hyperlipemic patients, and the postprandial angina syndrome.

Glucose metabolism in fat cells from fasted-refed rats and ad-libitum-fed controls were studied in the postabsorptive state. Two types of experiments were performed. First, each rat donated one epididymal fat pad and the metabolic results were expressed in relation to the number and size of fat cells of these tissues. Second, the other epididymal fat pad in the rats in each experimental group was pooled for experiments in duplicate where liberated fat cells were separated in fat-cell size classes, which enabled comparisons of metabolic activities at the same fat-cell size. Glucose incorporation into carbon dioxide and triglyceride glycerol and fatty acids were about equally elevated in absolute terms in the refed rats. In relative terms the increase was much more pronounced in carbon dioxide and fatty acids because these activities were very low in control rats. These results confirm previous results showing elevated metabolism after fasting-refeeding, and also demonstrate that this is an adaptation of fat-cell metabolism rather than a consequence of a higher cellular density of adipose tissue after fasting-refeeding with smaller fat cells. Adaptations of metabolism after fasting-refeeding might be of potential importance for elucidation of the cause of the rapid relapse after weight decrease of obese subjects with diminished fat-cell size.

The above study was carried out in a population sample of 1250 elderly subjects living at home, from five Italian regions (Budrio in Emilia-Romagna, Ponte S. Nicolò in Veneto, Bernareggio in Lombardy, Sezze in Latiumm, Melito in Campania). The results obtained lead to the following conclusions: 1. The condition of loneliness appears to have a detrimental influence on health in both sexes. Among other consequences, loneliness leads to progressive spontaneous reduction of daily milieu and social requirements, as well as to an impression of dependence that cannot be easily overcome. 2. The study of the relationship between the presence or absence of chronic pathologies and legal title of domicile has shown that if the home is their own by legal property or usufruct this has a favorable influence, especially in males. Property also satisfies emotional needs, through the profound ties between personal history and certain places. 3. Positive changes in life style may have beneficial effects on the interaction between socio-economic variables and the onset of chronic pathologies, especially in old age.

Summary We report on two patients with an asymmetrical expansion of fat tissue. At computed tomography, lipomatous tissue proved to be superficially located in one patient and both subcutaneously and deeply located in the second. Signs and symptoms of a peripheral neuropathy were observed in both patients, who were otherwise asymptomatic. The lipolytic activity in post-heparin plasma was normal in both patients. The fat cell size of lipomatous tissue, obtained in one patient by percutaneous needle biopsy, was higher than that of contralateral, uninvolved adipose tissue. The adipose tissue lipoprotein lipase activity in lipomatous tissue was higher than that in normal tissue. High density lipoprotein (HDL), HDL2 and HDL3 cholesterol values were elevated in both patients but not exceeding 1 standard deviation the values of age and sex matched controls. Isoprenaline-stimulated lipid mobilization was similar in lipomatous and in control tissue.

Lipoprotein lipase activity in lipomatous tissue, post-heparin lipoprotein lipase activity in plasma, and the composition and concentration of serum lipoproteins were studied in 15 patients with Multiple Symmetric Lipomatosis (MSL). Extremely elevated lipoprotein lipase activity in adipose tissue was found in MSL patients. Total and hepatic post-heparin plasma lipolytic activity was normal, while a moderate but statistically significant increase of extrahepatic lipolytic activity was present. An abnormal composition of serum lipoproteins, characterized by a significant increase in high density lipoproteins, namely HDL2 subfraction, and apoprotein A-I, was demonstrated. A concomitant decrease in and abnormal composition of low density lipoproteins were found. This lipoprotein pattern is consistent with a newly recognized type of hyperalphalipoproteinemia. Significant correlations were found between serum HDL2 cholesterol values and lipoprotein lipase activity in adipose tissue (as well as between serum VLDL-triglyceride and HDL2 cholesterol values). These observations confirm the role of adipose tissue lipoprotein lipase in triglyceride-rich lipoprotein catabolism. The elevated levels of lipoprotein lipase activity in adipose tissue, in addition to a previously demonstrated decrease in adrenergic-stimulated lipid mobilization, could account for both the abnormal fat accumulation in lipomatous fat cell and for hyperalphalipoproteinemia in MSL patients. The occurrence of MSL in two brothers suggests an inherited enzymatic defect, indicating MSL as a ''triglyceride storage disease in adipose tissue''.

We have evaluated the effects of dextrofenfluramine treatment on body weight control during a 90 day period, in obese patients on a calorie-restricted diet. The weight loss in dextrofenfluramine-treated patients was significantly higher than in placebo group. The rate of weight loss was linear up to the end of the trial in d-fenfluramine patients. Neural disturbances (vertigo, headache, depression) were the most frequent side effects observed in both the d-fenfluramine and in the placebo-treated groups, without significant differences between the groups. A total number of 23 patients in the dextrofenfluramine group and 20 patients in the placebo group complained side effects. Six patients (five in the d-fenfluramine group and one in the placebo group) discontinued the treatment, due to the side effects. No modifications of the biochemical parameters considered (fasting blood glucose, bilirubin, alkaline phosphatase, creatinine, blood cell counts, asparate-amino transferase (AST), alanine-amino transferase (ALT), total plasma and HDL cholesterol, and triglycerides) were observed at the end of the trial. A significant reduction of total serum cholesterol was observed in both groups at the end of the period of treatment. In conclusion, dextrafenfluramine was proved to be in short term trials an effective and safe tool in overweight control in obese patients.