Does impedance measure a functional state of the body fat?

The aim was to compare methods of body fat measurement in different BMI groups. An additional aim was to discuss differences reflecting the structural and functional changes of fat tissue. The study group included 130 adult Caucasian women stratified by body mass index (BMI): 18-24.99 (n=30), 25-29.99 (n=26), 30-34.99 (n=33), 35-39.99 (n=30), and BMI>/=40 (n=11). Bioelectrical impedance was performed using Tanita TBF 410 GS, Bodystat 1500, and Omron BF 300. A caliper type Best was also applied. Correspondence of four methods with DEXA was assessed using the Bland-Altman and ANOVA analyses. Measurements by BIA were not significantly different from DEXA up to BMI of 30, but DEXA significantly overestimated in the higher BMI subgroup by all three methods. Caliper measurement significantly underestimated DEXA in all BMI subgroups. BIA methods overestimated DEXA for the obese subjects. Tanita did statistically the best. The Caliper test appeared less preferable than the BIA methods, especially in the higher BMI subgroup. DEXA and Caliper measurements seem to be the best estimate of structural (anatomical) fat quantity. We hypothesize that BIA methods could also measure some other physiopathological conditions like inflammation, hydration or cell infiltration of fat.

Post-exercise changes of beta hydroxybutyrate as a predictor of weight changes.

The aim was to find the differences in ketogenesis initiation in the early period after the exercise in obese patients and to find if these changes may predict the weight loss during the physical activity program. 96 females were enrolled. A clamped heart rate test (CHR) was performed to establish comparable exercise intensity. Blood samples for beta hydroxybutyrate (BOHB) assessment were collected prior, immediately after and 60 min after the test. Patients underwent a three month fitness program. Anthropometric measurements (fat mass and biochemical parameters) were measured. An energy intake was monitored and comparable in all subjects. A significant increase of BOHB was found in 60(th) minute after the test, when compared with initiation levels (BOHB1 vs. BOHB3; p=0.03). This increase correlates with % fat mass (R=0.196; p=0.02) and negatively with age (R= -0.147; p=0.05) and with weight reduction during the three-month program (R= -0.299; p=0.03). Serum BOHB increase after the single exercise may detect individuals with an ability to induce lipolysis in three-month program of physical activity for obese patients.

Cardiac surgery increases serum concentrations of adipocyte fatty acid-binding protein and its mRNA expression in circulating monocytes but not in adipose tissue.

Adipocyte fatty acid binding protein (A-FABP) is a novel adipokine involved in the regulation of lipid and glucose metabolism and inflammation. To evaluate its potential role in the development of postoperative hyperglycemia and insulin resistance we assessed A-FABP serum concentrations and mRNA expression in skeletal and myocardial muscle, subcutaneous and epicardial adipose tissue and peripheral monocytes in 11 diabetic and 20 age- and sex-matched non-diabetic patients undergoing elective cardiac surgery. Baseline serum A-FABP did not differ between the groups (31.1+/-5.1 vs. 25.9+/-4.6 ng/ml, p=0.175). Cardiac surgery markedly increased serum A-FABP in both groups with a rapid peak at the end of surgery followed by a gradual decrease to baseline values during the next 48 h with no significant difference between the groups at any timepoint. These trends were analogous to postoperative excursions of plasma glucose, insulin and selected proinflammatory markers. Cardiac surgery increased A-FABP mRNA expression in peripheral monocytes, while no effect was observed in adipose tissue or muscle. Our data suggest that circulating A-FABP might be involved in the development of acute perioperative stress response, insulin resistance and hyperglycemia of critically ill irrespectively of the presence of diabetes mellitus.

[Prospective, multicentric, non-interventional study to assess the existing treatment of type 2 diabetes mellitus patients inadequately controlled with metformin monotherapy - KOMETA CZ]. / Prospektivní, multicentrická, neintervencní studie na zhodnocení soucasné lécby pacientu s diabetes mellitus 2. typu, nedostatecne kompenzovaných monoterapií metforminem - KOMETA CZ.

After several years of diabetes, the first line anti-diabetic therapy of metformin usually starts failing. The KOMETA study was a prospective, multicentric, non-interventional epidemiological study in patients with type 2 diabetes mellitus inadequately controlled with metformin therapy. The study was conducted between 2010 and 2011. The study demonstrated a significant improvement in diabetes control, reduction of waist circumference, reduction in blood pressure and adjustment of dyslipidemia compared to baseline. Based on this study, our doctors select anti-diabetic drugs responsibly and they often use medicines without the hypoglycaemia risk. Nevertheless, more than two thirds of patients achieve the HbA1c control of under 6% according to IFCC. The main conclusion of this study is that under standard conditions it is possible to achieve full metabolic control of type

[Hypoglycaemia--a phenomenon over which modern diabetology manages to prevail]. / Hypoglykemie - fenomén, nad kterým moderní diabetologie pomalu vítezí

Hypoglycaemia is considered to be the most significant complication when treating diabetes. The most important is its association with cardiovascular risk. Rigorous self-monitoring, lifestyle changes and the use of insulin analogues reduce the risk significantly in type 1 diabetes patients. Combined insulin and incretin therapy appears to be useful. Individualized therapy and incretin treatment in particular represent considerable risk reduction in type 2 diabetes patients. It is crucial to change therapy in a patient who underwent hypoglycaemia. Modern antidiabetic therapy helps to surmount the risk of hypoglacaemia and it is possible at any stage of type 2 diabetes treatment to select therapy with lover risk of hypoglacaemia: incretin therapy is the most suitable following metformin treatment failure, incretin analogues are the most suitable when oral antidiabetic agents fail, and insulin analogues are the most appropriate when insulin therapy is to be initiated. Key words: cardiovascular risk - insulin therapy - incretin therapy - oral antidiabetic medication - insulin analogues.

[Management of obesity--options, effectiveness and perspectives]. / Terapie obezity--postupy, úcinnost a perspektivy.

Weight reduction is an obvious aim of the obesity treatment. However, modern obesitology emphasises prevention of complications associated with obesity and improving the quality of life of obese patients. Consequently, obesity is a difficult to treat disease with respect to permanent weight reduction and easier to treat condition with respect to the quality of life. Life style changes usually fail as a treatment option, unless they are accompanied with personally demanding psychotherapy and motivational support. Compliance with the requirements for diabetes prevention is effective even without weight reduction. Treatment with anti-obesity medication and bariatric surgery are also associated with long-term effectiveness. However, orlistat is the only anti-obesity agent currently available. New antiobesity medication with central effect that would replace no longer used sibutramin, are expected to reach clinical practice in a few years. The effect of incretin analogues on weight reduction also provides hope. Physical activity has the best effect on obese patients' prognosis. Nonetheless, the future of obesity treatment is mainly associated with pharmacotherapy and new technologies, e.g., gastric stimulation.

[Is there any relation between diabetes therapy and cancer risk?]. / Existuje vztah mezi lécbou diabetu a vznikem nádoru?

Type 2 diabetes is associated with increased risk of cancer. This risk is related to HbA1 increase and this influence is present also in prediabetes and in nondiabetics with HbA1c in upper normal range. In last 2 years, it was concluded that that the specific antidiabetic therapy could influence the cancer risk. In this review we show that reduction of HbA1c does not change cancer risk. Most important is the risk reduction of cancer risk by metformin. Insulin therapy and the use ofsulphonylurea related drugs, increases the risk of cancer. This risk can be eliminated in the combination with metformin. Other published results including the suspected effect related to the use of glargine, pioglitazone, sitagliptine and exenatide are inconsistent and analysis of long term effects of these drugs is necessary. The large discussion in many publications shows the important role of FDA and EMA. This agencies do not suspend drugs without consistent evaluation of results.

Increased circulating and epicardial adipose tissue mRNA expression of fibroblast growth factor-21 after cardiac surgery: possible role in postoperative inflammatory response and insulin resistance.

We studied the changes in serum fibroblast growth factor-21 (FGF-21) concentrations, its mRNA, and protein expression in skeletal muscle and adipose tissue of 15 patients undergoing cardiac surgery. Blood samples were obtained: prior to initiation of anesthesia, prior to the start of extracorporeal circulation, upon completion of the surgery, and 6, 24, 48, and 96 hours after the end of the surgery. Tissue sampling was performed at the start and end of surgery. The mean baseline serum FGF-21 concentration was 63.1 (43.03-113.95) pg/ml and it increased during surgery with peak 6 hours after its end [385.5 (274.55-761.65) pg/ml, p < 0.001], and returned to baseline value [41.4 (29.15-142.83) pg/ml] 96 hours after the end of the surgery. Serum glucose, insulin, CRP, IL-6, IL-8, MCP-1, and TNF-alpha concentrations significantly increased during the surgery. Baseline FGF-21 mRNA expression in skeletal muscle was higher than in both adipose tissue depots and it was not affected by the surgery. Epicardial fat FGF-21 mRNA increased after surgery. Muscle FGF-21 mRNA positively correlated with blood glucose levels at the end of the surgery. Our data suggest a possible role of FGF-21 in the regulation of glucose metabolism and insulin sensitivity in surgery-related stress.

[Colorectal cancer and diabetes]. / Kolorektální karcinom a diabetes.

Colorectal carcinoma is a tumour with higher incidence in patients with type 2 diabetes and obesity. Recently, a slightly higher risk has also been shown in prediabetic states. The most important latest finding is that of a reduced risk in patients treated with metformin; there is a trend now to also prescribe metformin in patients with disturbed glucose tolerance or increased fasting glycaemia. Regular physical activity and reduced animal fat intake with increased intake of fruits and vegetables may help to prevent the disease. Pathogenesis may include changes to intestinal flora. The most important current preventive clinical measure is colonoscopy. Type 2 diabetes patients should be considered as a risk group and thus prevention should be targeted at these patients.

[Incretin therapy and the metabolic syndrome]. / Inkretinová lécba a metabolický syndrom.

Incretin therapy includes treatment with incretin analogues (exenatid and liraglutid) and so called incretin enhancers (gliptins and DPP-4 inhibitors respectively--sitagliptin, vildagliptin, saxagliptin, linagliptin). In patients with type 2 diabetes, this novel antidiabetic treatment usually leads to successful reduction in fasting as well as postprandial glycaemia and glycosylated haemoglobin. At the same time, it importantly improves all components of metabolic syndrome (dyslipidemia, hypertension, systemic inflammation). Incretin analogues also reduce body weight while DPP-4 inhibitors are weight-neutral. Both groups of drugs are expected to have positive cardiovascular effects, although it is not clear whether these are likely to be direct or indirect, i.e. facilitated by improved compensation of metabolic syndrome components.

The effect of very-low-calorie diet on mRNA expression of inflammation-related genes in subcutaneous adipose tissue and peripheral monocytes of obese patients with type 2 diabetes mellitus.

CONTEXT: Low-grade inflammation links obesity, type 2 diabetes mellitus (T2DM), and cardiovascular diseases. OBJECTIVE: To explore the expression profile of genes involved in inflammatory pathways in adipose tissue and peripheral monocytes (PM) of obese patients with and without T2DM at baseline and after dietary intervention. DESIGN: Two-week intervention study with very-low-calorie diet (VLCD). SETTING: University hospital. PATIENTS: Twelve obese females with T2DM, 8 obese nondiabetic females (OB) and 15 healthy age-matched females. INTERVENTION: Two weeks of VLCD (2500 kJ/d). MAIN OUTCOME MEASURES: Metabolic parameters, circulating cytokines, hormones, and mRNA expression of 39 genes in sc adipose tissue (SCAT) and PM. RESULTS: Both T2DM and OB group had significantly increased serum concentrations of circulating proinflammatory factors (C-reactive protein, TNFα, IL-6, IL-8), mRNA expression of macrophage antigen CD68 and proinflammatory chemokines (CCL-2, -3, -7, -8, -17, -22) in SCAT and complementary chemokine receptors (CCR-1, -2, -3, -5) and other proinflammatory receptors (toll-like receptor 2 and 4, TNF receptor superfamily 1A and 1B, IL-6R) in PM, with OB group showing less pronounced chemoattracting and proinflammatory profile compared to T2DM group. In T2DM patients VLCD decreased body weight, improved metabolic profile, and decreased mRNA expression of up-regulated CCRs in PM and chemokines [CCL 8, chemokine (C-X-C motif) ligand 10] in SCAT. VLCD markedly increased mRNA expression of T-lymphocyte attracting chemokine CCL-17 in SCAT. CONCLUSION: Obese patients with and without T2DM have increased mRNA expression of chemotactic and proinflammatory factors in SCAT and expression of corresponding receptors in PM. Two weeks of VLCD significantly improved this profile in T2DM patients.

[The incidence of obesity and its complications in the Czech Republic]. / Výskyt obezity a jejích komplikací v Ceské republice.

Over the recent years, the incidence of obesity is continuously rising. A research conducted in 2008-2009 on a representative sample of Czech population (n = 2,058) suggests that 23% of adult population of the Czech Republic are obese and 34% are overweight. This represents an increase of 5% in the number of obese people (17% vs. 22%), while the number of overweight remains practically the same (35% vs. 34%). A more significant shift in female waist circumference compared to male has also been shown. The incidence of hypertension in the evaluated sample was more than a two-fold higher in obese participants (48% vs. 21%) and as much as 3-fold higher in type 2 diabetes mellitus (7% vs. 20%). The risk of body weight increase is the highest between 50th and 59th year of age, where hypertension and diabetes are the most frequently diagnosed. The risk of obesity in adulthood is mostly carried over from childhood and more than 3/4 (77%) of those, who were overweight or obese as children, are in these categories as adults. Quality of life and satisfaction with own health is more related to BMI than age. Even though body weigh is increasing with the same amplitude in sportsman and physically active people, they are reaching lower final BMI due to their lower starting body weight. It is clear that physically active lifestyle in younger age is the best predictor of lower BMI in adult life. Consumption of secondary processed meat and lower consumption of fruit and vegetables are important factors in adulthood.

[Eating disorders in obese individuals--a psychiatric or internal medicine issue?]. / Poruchy príjmu potravy u obézních--problematika psychiatrická, nebo interní?

Many relations are connecting obesity and eating disorders--one disease is often modifying the other. Anorexia Nervosa and Bulimia Nervosa are mostly treated by psychiatrists. Internal medicine specialists are mostly involved only in complications (e.g. malnutrition, ion disorders). Obesity is mostly treated only by internists. Psychiatrists are only involved in some depressive patients. Obese patients with eating disorders are mostly not sent to psychiatric diagnostics. In this article an overview of eating disorder symptoms and classification is given--binge eating disorder, night eating syndrome and grazing. These symptoms are defined and possibilities of diagnosis and treatment are described.

[Diabetic osteopathy: previously disputed but most likely important ailment]. / Diabetická osteopatie: onemocneni kdysi sporné a pravdepodobne významné.

Diabetic osteopathy is usually not mentioned in the list of diabetic complications. This osteopathy is very important in clinical medicine. In the pathogenesis many factors are involved--bone formation, hyperglycaemia, glycosuria, glycation of collagene etc. Clinically important is the high risk of fractures present in diabetic patients. This risk can be positively and negatively modified by antidiabetic drugs. It is important to find some markers for fracture risk in diabetes. Nowadays only bone densitometry can be used with some limitations to quantify this risk.

[Antihyperglycaemic treatment and vascular diseases]. / Antihyperglykemická lécba a cévní onemocnení.

Hyperglycaemia is being linked to the development of vascular complications of diabetes--diabetic micro- as well as macro-angiopathies. It is, therefore, logical to assume that a reduction of glycaemia will result in a reduction of diabetic complications. However, recent clinical studies in type 2 diabetes described a range of observations that make this general statement less unambiguous: possibly increased incidence of coronary events following rosiglitazone use, discontinuation of some studies due to significantly decreased HbA1c in long-term diabetes, metabolic memory phenomenon, where early diabetes treatment exerts it effect for more than 10 years, and resulting differences in treatment approach to type 2 diabetes patients with respect to the duration of the disease. It can be concluded with respect to the issue of antihypeglycaemia treatment and its cardiovascular effect: 1. Early compensation of diabetes in newly diagnosed diabetic patients exerts its effect as long as 15 years and more. 2. Longer duration of diabetes implicates probably higher target value for diabetes compensation than the current 5.3% HbA1c according to IFCC. 3. No link has been proven between a specific anti-diabetic agent and worsened cardiovascular prognosis; the RECORD study provided conclusive evidence that rosiglitazone has no negative effect on the vascular system. 4. On contrary, it is very likely that some of the new anti-diabetic agents, for example from among the incretin analogues, will impact positively on the vascular system. 5. There is no doubt about the importance of hyperglycaemia correction in prevention of cardiovascular diseases in type 1 diabetes patients.

Metabolic surgery for the treatment of type 2 diabetes in patients with BMI <35 kg/m2: an integrative review of early studies.

Type 2 diabetes mellitus (T2DM) resolution in morbidly obese patients following metabolic surgery suggests the efficacy of T2DM surgery in non-morbidly obese patients (body mass index [BMI] <35 kg/m(2)). This literature review examined research articles in English over the last 30 years (1979-2009) that addressed surgical resolution of T2DM in patients with a mean BMI <35. Weighted and simple means (95% CI) were calculated to analyze study outcomes. Sixteen studies met inclusion criteria; 343 patients underwent one of eight procedures with 6-216 months follow-up. Patients lost a clinically meaningful, not excessive, amount of weight (from BMI 29.4 to 24.2; -5.1), moving from the overweight into the normal weight category. There were 85.3% patients who were off T2DM medications with fasting plasma glucose approaching normal (105.2 mg/dL, -93.3), and normal glycated hemoglobin, 6% (-2.7). In subgroup comparison, BMI reduction and T2DM resolution were greatest following malabsorptive/restrictive procedures, and in the preoperatively mildly obese (30.0-35.0) vs overweight (25.0-25.9) BMI ranges. Complications were few with low operative mortality (0.29%). Novel and/or known mechanisms of T2DM resolution may be engaged by surgery at a BMI threshold

[The influence of 6-months treatment with exenatide on type 2 diabetes mellitus compensation, anthropometric and biochemical parameters]. / Vliv 6mesícního podávání exenatidu na kompenzaci diabetes mellitus 2. typu, antropometrické a biochemické parametry.

OBJECTIVES: Exenatide, a synthetic GLP-1 analogue, is a new antidiabetic agent from the group ofincretine mimetics coming into the daily clinical practice. In our study we evaluated the effect of 6-months treatment with exenatide on diabetes compensation, anthropometric and biochemical parameters in the patients with poorly controlled type 2 diabetes mellitus and obesity. METHOD: We included 18 patients with poorly controlled diabetes (mean HbA1c 8.5 +/- 0.3%) treated with diet and peroral antidiabetic agents (4 patients were treated with insulin in the past). Exenatide was administered via subcutaneous injection twice daily for 6 months. Patients were examined after 1 month, when the dose ofexenatide was increased from 5 microg twice daily to 10 microg twice daily and after 3 and 6 months. We evaluated the diabetes compensation, biochemical parameters, body weight changes and side effects ofexenatide. RESULTS: 6-months exenatide treatment significant decreased body weight (baseline vs 6 month treatment 107.3 +/- 4.4 kg vs 103.7 +/- 4.6 kg, p = 0.02), BMI (36.7 +/- 1.2 kg/m2 vs 35.3 +/- 1.3 kg/m2, p = 0.01) a HbA1c (8.5 +/- 0.3% vs 7.4 +/- 0.4%, p = 0.04) and increased HDL-cholesterol (0.92 +/- 0.1 mmol/l vs 0.98 +/- 0.1 mmol/l, p = 0.02). Fasting glycemia tended to decline at the end of the study, but the difference did not reach the statistical significance. The area under the curve of glycemia levels after the standardized breakfast in the subgroup of 8 patients after the 6-months exenatide treatment was significantly lower when compared to baseline values (2,908 +/- 148 vs 2,093 +/- 194, p = 0.03). Concentrations of total and LDL-cholesterol and triglycerides did not change significantly. The most frequent side effects of exenatide treatments were transient anorexia and nausea (38.5%), dyspepsia and functional gastrointestinal discomfort (38.5%) and various neuropsychical symptoms (nervosity and insomnia - 30.8%). Most of the side effects disappeared during the treatment, none of these side effects was a reason for discontinuation of a treatment. 3 minor hypoglycemic episodes occured in patients simultaneously treated with derivates of sulfonylurea, but no serious hypoglycemia occured during the entire study. CONCLUSION: Exenatide treatment in obese patients with poor diabetes control was accompanied by statistically significant decrease of body weight, improvement of diabetes control and increase in HDL-cholesterol.

[Metformin as the first line antidiabetic agent]. / Postavení metforminu jako antidiabetika první volby.

Metformin is considered to be the only drug suitable in patients with prediabetes and is the drug of choice in patients with type 2 diabetes. Apart from important antidiabetic effect, it also has some important additional effects: reduced incidence of tumours, positive effects on cardiovascular system, stimulation of immunity, positive effects on the bone, effect on ovulation, influence over body weight reduction, pancreas-protective effects (reduced incidence of carcinoma and possible effect on reduction in incidence of pancreatitis during incretin treatment), positive effects on liver steatosis. Since diabetes patients live with increased cardiovascular risk, it is important to continuously remind ourselves of the positive cardiovascular effects of metformin.

[Obesity treatment in metabolic syndrome patients]. / Lécba obezity u metabolického syndromu.

Fat accumulation is an important pathogenetic factor in metabolic syndrome. Weight reduction, at the same time, has a positive effect on metabolic syndrome components. Lifestyle changes are important in the treatment of obesity although they are usually unlikely to provide permanent effect. At present, bariatric surgery and pharmacotherapy represent easily accessible and effective treatment options. In addition, bariatric surgery often results in full remission of type 2 diabetes. Unlike older anti-obesity agents, currently available anti-obesitics sibutramine and orlistat might be taken long-term for years, allowing avoidance of the typical weight increase following treatment completion phenomenon. Furthermore, both agents provide broad therapeutic effect as they affect all components ofmetabolic syndrome. The weigh of obese patients with impaired glucose tolerance and increased fasting glycaemia might be reduced with metformin. A range of other substances is in development, of which incretin analogues, expected to be used in obese non-diabetic patients, appear the most promising. Bariatric surgery decreases significantly mortality of obese patients with metabolic syndrome. It is likely that mortality reduction following the use of anti-obesity agents will soon be proven as well.