Metabolic syndrome after pregnancies complicated by pre-eclampsia or small-for-gestational-age: a retrospective cohort.

OBJECTIVE: To study the prevalence of metabolic syndrome in women after a pregnancy complicated by pre-eclampsia or small-for-gestational-age (SGA), both epitomes of placental syndrome. DESIGN: A retrospective cohort study. SETTING: Single tertiary centre for maternal medicine in the Netherlands. POPULATION: Women with a history of pre-eclampsia in absence of SGA (n = 742) or pregnancy complicated by normotensive SGA (n = 147) between 1996 and 2010. METHODS: Women were routinely screened for underlying cardiometabolic and cardiovascular risk factors at least 6 months postpartum. Logistic regression analysis was used to calculate the odds ratio and adjusted odds ratio for each group. Adjustments were made for age, maternal height, smoking, parity, and interval between delivery and measurement. MAIN OUTCOME MEASURES: Prevalence of the metabolic syndrome. RESULTS: The prevalence of the metabolic syndrome in our population was two-fold higher for women with a history of pre-eclampsia (13.9%) compared with women with a history of SGA (7.6%). Calculated odds ratios for metabolic syndrome, fasting insulin, HOMA, and microalbuminuria were all higher for women with a history of pre-eclampsia compared with women with SGA. This difference persisted after adjustment for confounding factors: metabolic syndrome (adjusted odds ratio, aOR 2.11; 95% confidence interval, 95% CI 1.00-4.47) and hyperinsulinaemia (aOR 1.78; 95% CI 1.13-2.81) insulin resistance (HOMAIR ; aOR 1.80; 95% CI 1.14-2.86). Microalbuminuria (aOR 1.58; 95% CI 0.85-2.93) did not reach the level of significance after adjustment for confounding factors. CONCLUSIONS: A history of pre-eclampsia, rather than SGA, was associated with metabolic syndrome, suggesting that it relates to maternal rather than fetal etiology of placental syndrome.

Distinct associations between energy balance and the sleep characteristics slow wave sleep and rapid eye movement sleep.

CONTEXT: Epidemiologically, an inverse relationship between body mass index (BMI) and sleep duration is observed. Intra-individual variance in the amount of slow wave sleep (SWS) or rapid eye movement (REM) sleep has been related to variance of metabolic and endocrine parameters, which are risk factors for the disturbance of energy balance (EB). OBJECTIVE: To investigate inter-individual relationships between EB (EB= energy intake-energy expenditure∣, MJ/24 h), SWS or REM sleep, and relevant parameters in normal-weight men during two 48 h stays in the controlled environment of a respiration chamber. SUBJECTS AND METHODS: A total of 16 men (age 23±3.7 years, BMI 23.9±1.9 kg m(-2)) stayed in the respiration chamber twice for 48 h to assure EB. Electroencephalography was used to monitor sleep (2330-0730 hrs). Hunger and fullness were scored by visual analog scales; mood was determined by State Trait Anxiety Index-state and food reward by liking and wanting. Baseline blood and salivary samples were collected before breakfast. Subjects were fed in EB, except for the last dinner, when energy intake was ad libitum. RESULTS: The subjects slept on average 441.8±49 min per night, and showed high within-subject reliability for the amount of SWS and REM sleep. Linear regression analyses showed that EB was inversely related to the amount of SWS (r=-0.43, P<0.03), and positively related to the amount of REM sleep (r=0.40, P<0.05). Relevant parameters such as hunger, reward, stress and orexigenic hormone concentrations were related to overeating, as well as to the amount of SWS and REM sleep, however, after inclusion of these parameters in a multiple regression, the amount of SWS and REM sleep did not add to the explained variance of EB, which suggests that due to their individual associations, these EB parameters are mediator variables. CONCLUSION: A positive EB due to overeating, was explained by a smaller amount of SWS and higher amount of REM sleep, mediated by hunger, fullness, State Trait Anxiety Index-state scores, glucose/insulin ratio, and ghrelin and cortisol concentrations.

Acute stress and food-related reward activation in the brain during food choice during eating in the absence of hunger.

BACKGROUND: Stress results in eating in the absence of hunger, possibly related to food reward perception. HYPOTHESIS: Stress decreases food reward perception. AIM: Determine the effect of acute stress on food choice and food choice reward-related brain activity. SUBJECTS: Nine females (BMI = 21.5 + or - 2.2 kg/m(2), age = 24.3 + or - 3.5 years). PROCEDURE: Fasted subjects came twice to randomly complete either a rest or stress condition. Per session, two functional MRI scans were made, wherein the subjects chose the subsequent meal (food images). The rewarding value of the food was measured as liking and wanting. Food characteristics (for example, crispiness, fullness of taste and so on), energy intake, amount of each macronutrient chosen, plasma cortisol and Visual Analog Scale (VAS) hunger and satiety were measured. RESULTS: Fasted state was confirmed by high hunger (80 + or - 5 mm VAS). Breakfast energy intake (3 + or - 1 MJ) and liking were similar in all conditions. Wanting was lower postprandially (Delta = -0.3 items/category, P<0.01). Breakfast decreased hunger (-42 mm VAS, P<0.01). Postprandially, energy intake (-1.1 MJ), protein intake (-14.7 g) and carbohydrate intake (-32.7 g all P<0.05) were lower. Fat intake was not different (-7.3, P = 0.4). Putamen activity was not lower postprandially. Cortisol levels were increased in the stress condition (Area under the curve of cortisol: DeltaAUC = +2.2 x 10(4) nmol min(-1) l(-1), P<0.05). Satiety was lower after breakfast (-8 mm VAS, P<0.01). Postprandial energy intake, protein intake and carbohydrate intake were relatively higher compared with the rest condition, resulting from more choice for crispiness and fullness of taste (P<0.05). Brain activation was reduced in reward areas: amygdala, hippocampus and cingulate cortex (AUC = -13.33, -1.34, -2.56% blood oxygen level dependent (BOLD) s for choosing breakfast and AUC = -9.31, -1.25, -2.34%BOLD s<0.05 for choosing the second meal). Putamen activation was decreased postprandially (AUC = -1.2%BOLD s, P<0.05). CONCLUSION: Reward signaling and reward sensitivity were significantly lower under stress, coinciding with increased energy intake from food choice for more crispiness and fullness of taste. The changes in putamen activation may reflect specifically decreased reward prediction sensitivity.

The relationship between leptin, gonadotropic hormones, and body composition during puberty in a Dutch children cohort.

OBJECTIVE: To investigate the relationship between leptin concentrations, gonadotropic hormone concentrations, and body composition during puberty in a Dutch children cohort. DESIGN: In a cohort of 98 children, we determined anthropometric measurements, body composition, and concentrations of leptin, FSH, and LH. RESULTS: Sex differences were observed from Tanner stage 1 onwards in weight, body fat percentage, and leptin/fat mass ratio. In boys and girls, the relationship between leptin concentrations and FM was weaker at Tanner stage 2 (R(2)=0.33 and R(2)=0.39; P<0.001), 3 (R(2)=0.27 and R(2)=0.36; P<0.002), and 4 (R(2)=0.21 and R(2)=0.28; P<0.03) than at Tanner stage 1 (R(2)=0.51 and R(2)=0.67; P<0.001) and 5 (R(2)=0.46 and R(2)=0.78; P<0.01). In girls, a peak in leptin concentrations (8.5+/-6.0 ng/ml) preceded a peak in LH and FSH concentrations (15.1+/-3.5 and 5.0+/-4.5 IU/l). A lead/lag relationship was observed of leptin at Tanner stage 1 to LH and FSH at Tanner stage 2 (R(2)=0.12, P<0.05 and R(2)=0.18, P<0.05). In boys, there was no peak in leptin, LH, and FSH; additionally, leptin at Tanner stage 3 was related FSH at Tanner stage 4 (R(2)=0.17, P<0.04). CONCLUSION: In boys and girls during puberty, factors independent of fat mass become (transiently) more important in the regulation of plasma leptin concentrations. Moreover, in girls, leptin is suggested to act as a permissive factor for the onset of puberty, while, in boys, leptin has a different timing and possibly different function.

Periphyton collectors as a tool to measure environmental performance of ocean outlets.

Brown and Root has participated in extensive investigations of the effects of the discharges from Perth's Ocean Outlets, as part of the Perth Long-Term Ocean Outlet Monitoring (PLOOM) Programme (1995 to 2001). The major environmental concern with these discharges is the potential for nutrients in the wastewater to stimulate excess primary production in the sea. PLOOM, and its predecessor, the Perth Coastal Waters Study, have been instrumental in developing parameters for the measurement of the performance of Perth's ocean outlets. These parameters are currently being integrated in the development of Environmental Quality Criteria (EQC) for the Perth region. EQC play an important role in the management framework by providing the quantitative benchmarks for measuring success in achieving the environmental quality objectives. PLOOM has monitored a range of environmental parameters in the Perth Metropolitan area, including water quality, nutrient levels, water circulation and plume dilution, levels of metals and pesticides present in the marine environment, and the environmental health of benthic communities, in particular of temperate reef systems. During the PLOOM studies, a valuable tool was being developed to monitor outlet performance. Artificial reef structures ("periphyton collectors") were placed in the plume trajectory. Here, periphyton is defined as: the microalgae (diatoms and microscopic filamentous forms), algal propagules, bacteria, microfauna and particulate material that are found in a mucous-like layer commonly coating seagrass leaves, and that initially colonise artificial surfaces. The advantage of periphyton collectors is that these largely remove the effects of natural variability, can be placed at any depth and distance from a potential nutrient source, provide an easy, cost effective measure of environmental impact, integrated over an extended period (one month), and produce tangible results which can be interpreted by the wider community, as well as legislative authorities and by outlet managers. In addition, outlet performance can be measured by means of these tools, and tested against accepted environmental criteria. Between 1995-2001, periphyton collectors, consisting of 15 x 15 cm PVC plates attached to moorings at fixed depths (2, 4 and 8 m), were deployed for one month during spring, summer and autumn, at increasing distance from the source (250 and 500 m distance to the north, east, west, and south, and at 1,000, 2,000, 4,000 m to the north and south only). After retrieval, the collectors were analysed for total biomass (g AFDW m(-2)), calcium carbonate content (% AFDW) and chlorophyll levels (chlorophyll a m(-2)). The results confirmed the predictions made by hydrodynamic modelling (e.g. Zic and Gondinoudis, 2002) and are in accordance with measured nutrient and chlorophyll a levels around the outlets, and demonstrated that the zone of influence was strongly determined by the prevailing currents (to the north), and largely restricted to surface layers (2-4 m depth). Both biomass and chlorophyll content proved reliable parameters, which have the potential to be used as Environmental Quality Criteria (EQC's) for the management of Perth's coastal waters. These EQC's were developed in collaboration with legislative authorities, as part of draft criteria, in accordance with national guidelines: ANZECC/ARMCANZ (2000) Australian and New Zealand Guidelines for Fresh and Marine Water Quality.

Gut decontamination by oral ofloxacin and ciprofloxacin in healthy volunteers.

The selectivity of enterobacterial decontamination during oral ofloxacin and ciprofloxacin was studied in 15 volunteers. Dilution studies of 294 faecal samples were made to monitor concentrations of enterobacteria, yeasts and enterococci. Detection of beta-aspartylglycine content was used for evaluation of interaction with the indigenous (mostly anaerobic) flora. Inactivation of ofloxacin and ciprofloxacin by faeces was studied to explain the effects of gut decontamination. Escherichia coli was successfully eliminated from the gut in all volunteers during treatment. Decontamination was found to be more or less selective with both quinolones, although yeast overgrowth and decrease of enterococci was significantly higher with ciprofloxacin. This may be explained by the higher intrinsic activity of ciprofloxacin against anaerobic flora, the inactivation by faeces being low for both agents. Ofloxacin and ciprofloxacin are two new quinolones of value in the therapy of infections between 'waist and knee' (e.g. cystitis, enteritis, prostatitis) because of the elimination of the infection focus combined with the eradication of the source.