[Prognosis in obesity, what has changed?]. / Prognose der Adipositas, was hat sich geändert?

Since the publication of the Build Study 1979 further analyses have refined our concepts concerning the prognosis of obesity. We have recognized that intraabdominal fat depots especially favor the development of complications and shorten life. Smoking diminishes body weight slightly, but leads to a detrimental replenishment of this intra-abdominal fat accumulation. Body-Mass-Index (BMI)--especially if combined with waist-hip-ratio (WHR)--allows a better appreciation of the degree of obesity than the conventional Broca-Index. It also facilitates decisions on the necessity and the choice of suitable therapeutic measures (diet, combination with exercise and psychotherapy, surgical intervention). A slight overweight appears protective in senior citizens, but we shouldn't recommend a deliberate weight gain for this purpose. Paradoxically, there is still no definite proof yet that measures for weight reduction really improve mortality prognosis. First hints in this direction are coming from super-obese patients (BMI above 40) who have been operated by gastroplasty.

[Cardiac effects of a reducing diet]. / Kardiale Auswirkungen einer Reduktionskur.

40 in-patients have been treated by modified fasting during 4 weeks. Routine ECG's and radiological controls of heart size did not show signs of myocardial lesions or of an impairment of the generation, propagation or dissipation of cardiac impulse. Slightly elevated serum levels of CK, CK-MB, alpha-HBDH, SGOT, and SGPT could indicate a reduction of fat-free body-mass including some elements of myocardium. Potassium and magnesium levels should be controlled and sometimes corrected by ingestion of electrolyte preparations. Under the conditions described and with the methods we used, we could not demonstrate an increased cardiac risk during a weight reduction cure by modified fasting of moderate duration. This should also apply to low-calorie diets with a deficit of about 1000 cal./day, whilst total fasting and the substitution with protein preparations of poor nutritional value must be considered as risky procedures.

Oral antidiabetic combination therapy with sulphonylureas and metformin.

In a multicentre trial in general practice, a total of 1823 type 2 diabetics, not adequately controlled by diet and maximal sulphonylurea therapy, were treated with additional metformin 850--2 550 mg/d for 12 weeks. The average postprandial blood sugar decreased from 15.48 mmol/l to 10.43 mmol/l, HbA1 fell from 11.0% to 9.1%. Serum triglycerides decreased from an initial level of 2.87 mmol/l to 2.41 mmol/l an mean total cholesterol from 6.76 mmol/l to 6.16 mmol/l. In addition, body weight and blood pressure declined steadily. All the described changes were statistically significant. The metformin-sulphonylurea combination therapy was generally well tolerated. Gastrointestinal side effects occurred in about 7% of patients, but mainly in the first week of treatment, generally disappearing spontaneous as therapy was continued. Side effects led to a discontinuation of the treatment in 4.2% of patients.

[Problems of the elderly, insulin injecting diabetic patients in ambulatory care]. / Probleme älterer, insulinspritzender Diabetiker bei der ambulanten Behandlung.

Not announced visits with interviews and practical demonstrations in the homes of 106 insulin-treated diabetics above 60 years of age produced rather sad results. Less than half of these patients were able to inject themselves. With increasing age insulin dosage was less and less correct; two thirds of the patients older than 75 years injected wrong doses. If the injections were performed by medical staff of the "Sozialstation", every second patient received his morning dosage only after breakfast or without any perceivable time-schedule. Only 7.5% of the patients seen followed their prescribed diet strictly, but 51+?% of them applied one or more "alternative" cures. It is true that in these older diabetic patients metabolic control does not play the same decisive role quoad vitam and concerning late complications as in younger ones, but the results we obtained should motivate us to improve, simplify and intensify patient education in the hospital and perform more controls of the lessons taught (and learned?) in the doctor's office.

Absence of detrimental changes of cognitive parameters during fasting.

During the first 10 d of a total fast the changes in a series of cognitive parameters: short-term memory, long-term memory, speed of information processing, vigilance, and mental control were tested in 14 obese inpatients and compared with a control group. Ten days of fasting induced no detrimental changes. An improvement in the subtest 'Repetition of digits' was interpreted as improved motivation as a consequence of successful weight reduction. In contrast to the experience of normal weight people during famine periods, obese patients seem to tolerate short-term fasting periods without negative intellectual effects.

[Weight changes under thyroxine substitution for euthyroid goitre (author's transl)]. / Gewichtsverhalten bei Thyroxinsubstitution wegen euthyreoter Struma.

Total thyroxine levels and body weight were measured over nine months in 213 out-patients with euthyroid goitre who were taking 50--150 micrograms thyroxine daily; 40 persons receiving merely iodine-containing salt served as controls. Weight gain among the thyroxine group averaged 0.34 +/- 0.19 kg, compared with 0.44 +/- 0.38 kg in the control group. In both groups those under 50 years tended to gain weight, while older ones lost it. The results indicate that thyroxine given in usual doses in the treatment of goitre does not affect body weight when thyroid metabolism is normal.

[Lowering of cholesterol levels through adding pectins and soybean proteins to a reducing diet (author's transl)]. / Senkung des Cholesterinspiegels durch Zusatz von Pektinen und Sojaprotein zur Reduktionsdiät.

A mixture of soybean proteins and pectins (EMD 35327) was given to 10 obese people with and without diabetes for a period of 3 weeks in a dosage of a total of 1000 kcal/d. The control group consisted of 10 obese who were given a conventional 1000 kcal mixed diet. In comparison to the control group the test group showed a highly significant decrease of serum cholesterol, a significantly better loss of weight and somewhat lower post-prandial blood sugar and triglyceride levels. The latter two could not be statistically proven due to the small number of probands. There were no side effects worth noticing.

[Differences in taste assessment of sweeteners by normal and overweight persons]. / Unterschiedliche Geschmacksbewertung von Süssungsmitteln durch norm- und übergewichtige Probanden

Taste assessment was tested in 20 obese and 20 normal-weight in-patients using watery solutions of saccharose and three synthetic sweeteners. Each patient was asked to assess ten different taste qualities of each solution on a point scale. There were highly significant differences between the two groups of subjects. The difference was especially marked for the categories "synthetic - natural", "unpleasant - very tasty", and "changeable - stable in times". These findings suggest changes in physical or central taste sensation in obese persons. This view is supported by their decreased ability to differentiate between saccharose and any sweetener. The results further support substituting sweetening agents for sugar in reducing diets.