Are BMI and other anthropometric measures appropriate as indices for obesity? A study in an Asian population.

We have examined the relationships between percentage of body fat (PBF) and risk factors for cardiovascular disease and insulin resistance and how good body mass index (BMI) and other anthropometric measures are as indices of obesity. High PBF levels were associated with increased risk of cardiovascular disease and insulin resistance. The World Health Organization BMI of 30 kg/m(2) for obesity has low sensitivity, 6.7% and 13.4% for men and women, respectively. For every obese man and woman identified, 6.7 and 1.76 times nonobese men and women, respectively, will be misclassified as obese. With the locally established BMI cutoff point for obesity of 27 kg/m(2) for men and 25 kg/m(2) for women, the sensitivity was improved to 46.7% and 60.8%, respectively. For every obese man and woman identified, 3.76 and 1.64 times nonobese men and women, respectively, will be misclassified as obese. None of the other anthropometric indices was better than the locally established BMIs. We showed that the BMIs for obesity for our local men and women are different. These BMIs were most precise among all indices studied. However, they still lead to high false-positive rates. For more effective management of the problem of obesity, we need to develop more precise, simple, and cost-effective methods for the measurement of PBF.

Managing aging men in Asia: a strategic approach.

We have established a comprehensive diagnostic paradigm for the management of aging men which seeks to evaluate the various determinants of the aging process in five major health areas: cardio-health, bone health, sex health, general health and endocrine state. This paradigm appears to be useful for the management of the problem of aging in our local population. It could be used for the management of individuals as well as for population research. When combined with the establishment of evidence-based management modalities, it will provide a useful tool for the holistic management of aging in Asia.

Sex and aging in the city: Singapore.

A survey was carried out on 307 healthy men and 774 women, aged between 30 and 70 years to evaluate the determinants of sex life in the highly urbanized Singapore population. The results showed that significantly more women (28.8%) as compared to men (16.3%) were currently sexually inactive. The main reason for sexual inactivity for women was being divorced or widowed (37.9%) and for men, the loss of interest in sex (42.8%). Relationship problems and being stressed out in life were the next two most common reasons for both men and women. Coital frequency for men and women between the ages of 30 and 55 years averaged about five to six times monthly and was significantly reduced to about three times monthly in those above 55 years old. More men (25.7%) wanted to have more frequent sex than women (5.4%), but were unable to fulfill their desire and the primary reason was that they were too stressed out in life. Results from this study revealed that sex life is determined not only by physiological, but also cultural, social and lifestyle factors. In Singapore, life style factors accounted largely for sexual inactivity, and the inability to fulfill the desire for more frequent sex. The term 'lifestyle impotency' was coined to describe the group of men and women who were too stressed out in life to have sex. Therefore, there is a need to evolve a paradigm for the management of sexual dysfunctions by taking into account the underlying etiological factors which, as we have shown, may not be resolved by pharmaceutical interventions.

Dose-response effects of equine chorionic gonadotrophin (eCG) and human chorionic gonadotrophin (hCG) on early embryonic development and viable pregnancy rate in rats.

The present study examined the dose-response effects of eCG treatment alone and in combination with various doses of hCG on early embryonic development in vivo and viable pregnancy rate in rats. Mated female Wistar rats were treated with eCG alone (0, 10, 20 or 40 iu), or with 20 iu eCG in combination with various doses of hCG (10, 20, 40 or 80 iu) administered 48 h later. The animals were killed on days 2, 3, 4, 5 or 14 of pregnancy and the numbers of embryos and fetuses recovered were scored. All rats treated with 0 or 10 iu eCG were pregnant. The pregnancy rate was reduced from 62.5% on day 2 to 25% on day 14 and from 31% on day 2 to 10% on day 14 in the groups treated with 20 and 40 iu eCG, respectively. The reduction in pregnancy rate induced by 20 iu eCG was negated by the increasing doses of hCG used. A 100% pregnancy rate was noted on days 2 and 3 in the groups treated with doses of hCG between 10 and 80 iu and from day 2 to day 4 in the groups treated with doses of hCG between 20 and 80 iu. However, a higher viable pregnancy rate was observed only in the group treated with 10 iu hCG compared with the group treated with 20 iu eCG and 0 iu hCG. These results imply that hyperstimulation of rats with high doses of eCG compromises pregnancy rate and markedly reduces litter size and that the addition of hCG is required for complete ovulation, which results in higher embryo yield and a delay in early embryo demise.

Direct effects of varying doses of oestradiol on early embryonic development in in vitro culture of rat's two-cell embryos.

Hyperstimulation in the rat using pregnant mares' serum gonadotrophin (PMSG) has been known to cause death in pre-implantation embryos, as well as enhancement of oestradiol production. This study examines the effect of oestradiol, in levels that are found in hyperstimulated pregnant rats, on pre-implantation embryonic development. Using a simplified in vitro system, 2-cell embryos retrieved from rats on the 2nd day of pregnancy were cultured in rat two-cell embryo culture medium (R2ECM) containing pharmacological doses of oestradiol for 96 h and scored daily in the morning. Three ngxmL(-1) oestradiol reduced the incidence of >8-cell embryos to morulae on the 5th day and blastocysts on the 6th day of development. Most embryos were retarded at the lower cell stages on the 5th day and degenerated by the 6th day. None of the blastocysts expanded on the last day of culture. Fifteen ngxmL(-1) oestradiol accelerated embryo development on the 3rd day but retarded development on the 4th day, and increased the incidence of degenerated embryos by the 5th and 6th day of development. These results suggest that the elevated oestradiol may constitute a mechanism by which PMSG induces death in pre-implantation rat embryos, possibly via a direct action on the embryos.

Successful in vitro growth of rat two-cell embryos to blastocysts using a simple chemically defined medium.

The aim of the present study was to formulate a simple chemically defined medium for the in vitro growth of rat two-cell embryos to blastocysts. Embryos from day 2 pregnant rats were retrieved and placed in paraffin oil-covered droplets of "rat two-cell embryo culture medium" (R2ECM) containing combinations of various serum supplements, glucose, L-glutamine, and cultured up to 96 h in a CO(2) incubator. Embryos cultured in the basic medium (R2ECM), as well as those supplemented either with fetal bovine serum (FBS) or male rat serum (MRS) did not develop beyond the two- to four-cell stage. In R2ECM with 0.3% bovine serum albumin (BSA) and 7.5 mM glucose, 44% of embryos reached the blastocyst stage by 96 h in culture, and the blastulation rate increased to about 83% when 1 mM of L-glutamine was added. To evaluate the effects of varying doses of glucose, two-cell embryos were cultured in R2ECM supplemented with 0.3% BSA, 1 mM L-glutamine, and 2.5, 5.0, or 7.5 mM of glucose. The percentage of embryos reaching the blastocyst stage for 2.5, 5.0, and 7.5 mM glucose was 64.6%, 65.3%, and 82.9%, respectively. The present study showed that the modified medium (R2ECM) is a simple chemically defined medium that is capable of supporting in vitro growth of rat two-cell embryos to blastocysts in high proportion (greater than 80%) without the need for change of medium within 96 h of culture.

Effects of hyperstimulation with gonadotrophins and age of females on oocytes and their metaphase II status in rats.

The present study was undertaken to evaluate the effects of hyperstimulation and aging on the number and proportion of oocytes in the metaphase II stage in female Wistar rats. It explored the validity of the hypothesis that a combination of hyperstimulation with pregnant mare serum gonadotrophins (PMSG) and age could compromise, to a greater extent, the oocyte quality as indicated by the proportion of ovulated oocytes in the metaphase II stage. Female Wistar rats were stimulated with varying doses of PMSG and human chorionic gonadotrophins (hCG) and the number and proportion of ovulated oocytes in the metaphase II stage were examined and compared between different groups of young adult (8-10 weeks old) and aging (30-32 weeks old) female rats. While spontaneous ovulation occurred in all young adult rats, only 50% of the aging rats did. The ovulation rate in aging rats was increased from 50 to 93% when non-PMSG-stimulated rats were given a dose of 10 IU of hCG at proestrus. The lower number of ovulated oocytes noted, even in those hyperstimulated with high doses of PMSG/hCG, also indicated a reduction in fertility in aging rats. Under the influence of high doses of PMSG, all aging rats ovulated, but as with the young adult rats, a higher dose of hCG was needed to achieve the maximum number of ovulated oocytes from the PMSG-induced expanded pool of preovulatory follicles. However, the average number of ovulated oocytes in aging rats was, nevertheless, still significantly lower than in young adult rats even when approximation of weight was considered. No consistent significant difference in proportion of normal oocytes was noted within groups and between young adult and aging rats. A lower proportion of ovulated oocytes was arrested at the metaphase II stages when rats, whether they were young adult or aging, were hyperstimulated with 40 IU of PMSG. However, this proportion was restored to normal (about 100%) when a higher dose of hCG, which is a signal responsible for initiating oocyte maturation, was used. Results of the present study showed that there appears to be an age-related reduction of sensitivity of the preovulatory follicles to the ovulation induction signal of hCG and thus higher doses of hCG were needed to ovulate the PMSG-induced expanded pool of dominant follicles. In older rats, apart from the obvious depletion of the pool of follicles, the evidence from the present study suggests that some of these older rats do have follicles, but that these were unable to develop to preovulatory follicles, probably because of the absence of sufficiently high levels of gonadotrophins essential for the initiation of folliculogenesis. PMSG-hyperstimulation can affect nuclear maturation; the proportion of ovulated oocytes not arrested at the metaphase II stage was higher. However, the proportion of ovulated oocytes at the metaphase II was restored to normal by increasing the dose of hCG use. Hence, meiotic aberration in rats is not age-dependent but rather dependent on the amplitude of the luteinizing hormone (LH)/hCG surge present. The results from this study nullified the hypothesis that hyperstimulation in combination with aging would lead to a higher proportion of abnormality in ovulated oocytes with respect to their being at inappropriate meiotic stages.

The sensitivity of the trivariate analysis using maternal serum alpha-feto protein, human chorionic gonadotrophin and maternal age in screening for fetal aneuploidy in mothers above the age of 35.

This study was undertaken to assess the usefulness of maternal serum human chorionic gonadotrophin, alpha-fetoprotein and maternal age in screening for fetuses with abnormal chromosomes in pregnant women aged 35 years and over. From 1989 to 1991, 1208 women seen at the National University Hospital had karyotyping procedures performed for maternal age > 35 years as well as second trimester serum samples taken for alpha-fetoprotein and human chorionic gonadotrophin. Sixteen (1.3%) chromosomal abnormalities were present. Using cut off risk levels of 1:250 and 1:384, the sensitivity of the analysis in screening for Down's syndrome pregnancies was 71.5% and 86% respectively. For the non Down's chromosomal abnormalities, using cut off risk levels of 1:250 and 1:384, the sensitivity of the analysis was only 22.3% and 33.4% respectively. Thus risk calculations based on the two serum markers and maternal age failed to identify all fetuses with abnormal chromosomes.

Oogenesis, fertilisation and early embryonic development in rats. I: Dose-dependent effects of pregnant mare serum gonadotrophins.

Five hundred and eight mature female Wistar rats divided into 35 different groups were stimulated with pregnant mare serum gonadotrophins (PMSG) (0, 5, 10, 20 & 40 IU) at the late diestrus stage to induce multiple follicular development. No chorionic gonadotrophin (CG) was used for ovulation induction. The quality of oocytes and their in vitro fertilisability, quality of Day 2-embryos, viability of pregnancy and status of fetuses on Day 14 of gestation and status of embryos retrieved on Day 2, 3, 4 and 5 of pregnancy in different subgroups of rats were examined. Results showed that more oocytes and embryos fertilised in in vivo were retrieved from rats supraphysiologically stimulated with 20 IU of PMSG. However, concurrent with the larger number, higher proportions of abnormal oocytes and embryos were found. High doses of PMSG caused lower in vitro fertilisability of oocytes and greater degrees of embryonic degeneration. Although, the number of oocytes and Day 2-embryos were higher in the 20PMGS dose group, the pregnancy rate was significantly reduced to 27%. In the 40PMSG group no viable pregnancy was noted. Most embryo demise occurred by day 3-5 of pregnancy, probably within the oviducts and before the implantation stage. In rats supraphysiologically stimulated with 20 and 40 IU of PMSG, the number of morphologically normal looking embryos was greatly reduced by Day 3-5 of pregnancy. In the 40PMSG group, there were no embryos retrieved by Day 4 and 5.(ABSTRACT TRUNCATED AT 250 WORDS)

Oogenesis, fertilisation and early embryonic development in rats. II: Dose-dependent effects of human chorionic gonadotrophin.

A total of 950 female Wistar rats in 81 groups were involved in this study. Different groups of rats were stimulated with PMSG (0, 10 & 20 IU) at diestrus followed, 48-52 hr later, by different doses of HCG (0, 10, 20, 30 & 40) for ovulation induction. The dose-dependent effects of HCG, either with or without the use of PMSG for stimulation of multiple follicular development, on the quality of oocytes and their in vitro fertilisability, quality of Day 2-embryos, viability of pregnancy and status of embryos retrieved on Day 2, 3, 4 or 5 of pregnancy in different subgroups of rats were examined. Results showed that more oocytes and embryos fertilised in vivo were retrieved from rats supraphysiologically stimulated with 20 IU of PMSG. The addition of HCG did not increase the number of ovulated oocytes or Day-2 embryos. In other words, the number of oocytes or embryos produced is dependent on the dose of PMSG administered during diestrus rather than on the dose of HCG given for ovulation induction. Hence, no increase in the amount of HCG is required to effectively ovulate bigger cohort of preovulatory follicles in supraphysiologically stimulated rats. As was shown earlier, in vitro and in vivo fertilisation rates were reduced when higher doses of PMSG were used. Similarly, these rates were reduced when increasing doses of HCG were used in rats not previously stimulated with PMSG. When higher doses of HCG were used in rats stimulated earlier with PMSG (10 and 20 IU), the in vitro but not the in vivo fertilisation rates were further reduced.(ABSTRACT TRUNCATED AT 250 WORDS)