Effects of winter housing system on hygiene, udder health, frostbite, and rumination of dairy cows.

The objective of this study was to evaluate the effects of 2 winter (December to April) housing systems on dairy cow hygiene scores, frostbite, teat condition, clinical mastitis, and activity and rumination across 3 winter seasons (2013, 2014, and 2015). Certified-organic cows (n = 268) were randomly assigned to 2 treatments (2 replicates per system): (1) outdoor straw pack (outdoor) or (2) 3-sided compost-bedded pack barn (indoor). Cows calved during 2 seasons (spring or fall) at the University of Minnesota West Central Research and Outreach Center, Morris, Minnesota, organic dairy. Organic wheat straw was used as bedding for the 2 outdoor straw packs, and bedding was maintained by farm management to keep cows dry and absorb manure throughout the winter. The compost-bedded pack barn (2 pens in the barn) was bedded with organic-approved sawdust, and the bedding material was stirred twice per day with a small chisel plow. Hygiene scores were recorded biweekly as cows exited the milking parlor. Incidence of clinical mastitis was recorded in a binary manner as treated (1) or not treated (0) at least once during a lactation. Frostbite incidence was collected monthly. Activity and rumination times (daily and 2-h periods) were monitored electronically using a neck collar sensor (HR-LD Tags, SCR Dairy, Netanya, Israel). Indoor cows had greater udder hygiene scores (1.75 vs. 1.46) and greater abdomen hygiene scores (1.79 vs. 1.43) compared with outdoor cows. Additionally, the indoor cows had greater upper and lower leg hygiene scores compared with outdoor cows. Incidence of clinical mastitis was greater for indoor cows compared with outdoor cows (27.1% vs. 15.1%, respectively). Frostbite incidence was not different between indoor (30.1%) and outdoor (17.5%) cows. Daily rumination was 509 min/d for indoor cows and 530 min/d for the outdoor cows. In summary, lactating cows housed outdoors on straw-bedded packs had cleaner udders and improved udder health compared with cows housed in a compost-bedded pack barn.

Effects of winter housing systems on production, economics, body weight, body condition score, and bedding cultures for organic dairy cows.

Certified-organic dairy cows (n = 268) were used to evaluate the effect of 2 winter (December to April) housing systems on milk production, somatic cell score (SCS), body weight, body condition score (BCS), and economics across 3 winter seasons (2013, 2014, and 2015). Bedding cultures from the housing systems were also evaluated. Cows were randomly assigned to 2 treatments (2 replicates per group): (1) outdoor (straw pack, n = 140) or (2) indoor (3-sided compost bedded pack barn, n = 128). Cows calved during 2 seasons (spring or fall) at the University of Minnesota West Central Research and Outreach Center, Morris, Minnesota, organic dairy. Milk, fat, and protein production and SCS were recorded from monthly milk recording. Body weight and BCS were recorded biweekly as cows exited the milking parlor. Bedding cultures from the housing systems were collected biweekly. Costs for key inputs and the price received for milk production were recorded for the study period and averaged for use in the profitability analysis. Energy-corrected milk and SCS were not different for the outdoor (15.1 kg/d, 2.64) and indoor (15.7 kg/d, 2.57) housing systems, respectively. In addition, cows in the outdoor and indoor housing systems were not different for body weight (528 vs. 534 kg) and BCS (3.22 vs. 3.23), respectively. Daily dry matter intake was 19.1 kg/d for the outdoor cows and 19.6 kg/d for indoor cows. The total bacteria count from bedding samples tended to be lower in the outdoor (13.0 log10 cfu/mL) compared with the indoor (14.9 log10 cfu/mL) system. Milk revenue and feed cost were not different for the 2 housing systems. Labor and bedding costs were lower and net return was higher for the outdoor housing system. The outdoor straw pack system had a $1.42/cow per day net return advantage over the indoor compost bedded pack barn. In summary, lactating cows housed outdoors on straw-bedded packs did not differ for production or SCS, or for body weight, BCS, or dry matter intake, but had greater profitability than cows housed in an indoor compost bedded pack barn.

Short communication: Relationship of activity and rumination to abundance of pest flies among organically certified cows fed 3 levels of concentrate.

The objectives of this study were to evaluate activity, rumination time, and their association with 3 kinds of pasture flies for organic dairy cows (n=57) fed 3 grain supplementation strategies during the grazing season from May to September 2013. Cows were assigned to 1 of 3 replicate supplementation groups: (1) no corn-grain supplementation (100% pasture, PAS, n=19); (2) low corn-grain (2.72kg/cow per day, LG, n=19); and (3) high corn-grain (5.44kg/cow per day, HG, n=19). Cows calved during 2 seasons (fall and spring) at the University of Minnesota West Central Research and Outreach Center, Morris, from October to December 2012 and March to May 2013. Supplement (corn-grain and minerals) was fed in a total mixed ration of corn silage and alfalfa silage, and at least 30% of diet dry matter intake for LG and HG cows consisted of pasture. Activity and rumination time (daily and 2-h blocks of time) were monitored electronically using HR-LD tags (SCR Engineers Ltd., Netanya, Israel) for 125d. Activity (cow body movement and head movement) was reported in activity units from SCR DataFlow II software, and rumination times were reported in minutes per day. PROC HPMIXED in SAS (SAS Institute Inc., Cary, NC) was used for statistical analysis, and independent variables were season of calving (fall or spring), month of grazing (June to September), supplementation group, and interactions of month of grazing and supplementation group. Replicate was a random effect with repeated measures. Daily activity was higher for PAS cows (1,138 activity units) than for HG cows (1,001 activity units), and LG cows (1,019 activity units). Daily activity was highest in July (1,258 activity units) and lowest in September (819 activity units). Rumination was not different for PAS (397min/d), LG (384min/d), or HG (370min/d) cows. Daily rumination was greater in September (402min/d) than in July (361min/d). Daily activity increased rapidly between 0600-0800h and 1600-1800h. From 1800 to 2000h, cows had a rapid decline in activity until 0600h the next day. All supplementation groups had the greatest rumination activity from 0200 to 0400h and the least between 1000 and 1200h. Greater activity of cows on a herd basis was moderately correlated with increased fly populations. Monthly activity patterns of grazing cows were associated with fly populations on cows.

The incidence of albuminuria after bariatric surgery and usual care in Swedish Obese Subjects (SOS): a prospective controlled intervention trial.

BACKGROUND: Obesity is associated with increased risk of chronic kidney disease and albuminuria is a predictor of renal impairment. Bariatric surgery reduces body weight in obese subjects, but it is not known whether surgery can prevent development of albuminuria. This study aims to determine the long-term effect of bariatric surgery on the incidence of albuminuria. SUBJECTS: The Swedish Obese Subjects study is a non-randomized, prospective, controlled study conducted at 25 public surgical departments and 480 primary health care centers in Sweden. Between 1 September 1987 and 31 January 2001, 2010 participants who underwent bariatric surgery and 2037 controls were recruited. Inclusion criteria were age 37-60 years and BMI ⩾ 34 in men and BMI ⩾ 38 in women. In this analysis, we included 1498 patients in the surgery group and 1610 controls without albuminuria at baseline. Patients in the bariatric surgery group underwent banding (18%), vertical banded gastroplasty (69%) or gastric bypass (13%); controls received usual obesity care. Date of analysis was 1 January 2011. Median follow-up was 10 years, and the rates of follow-up were 87%, 74 and 52% at 2, 10 and 15 years, respectively. The main outcome of this report is incidence of albuminuria (defined as urinary albumin excretion >30 mg per 24 h) over up to 15 years. RESULTS: During the follow-up, albuminuria developed in 246 participants in the control group and in 126 in the bariatric surgery group, corresponding to incidence rates of 20.4 and 9.4 per 1000 person years, respectively (adjusted hazard ratio, 0.37; 95% confidence interval, 0.30-0.47; P < 0.001). The expected number of surgeries needed to prevent the development of albuminuria in one patient at 10 years was nine. CONCLUSIONS: Bariatric surgery is associated with reduced incidence of albuminuria compared with usual obesity care.

Body composition through adult life: Swedish reference data on body composition.

BACKGROUND/OBJECTIVES: The prevalence of obesity, defined as body mass index (BMI) ⩾30 kg/m(2), differs between populations; however, there is a need for data on description on body composition in reference populations of different ages and from different countries. The objective of this study was to pool dual-energy X-ray absorptiometry (DXA) body composition reference data from population-based Swedish cohorts. SUBJECTS/METHODS: Four population-based cross-sectional cohort studies including 1424 adult Swedes were divided into five age groups (20-29, 30-39, 40-49, 50-61 and 75 years of age); BMI 24.6±3.9 kg/m(2) were pooled. Body composition was measured with DXA. RESULTS: The difference in BMI from the youngest to the oldest age group was 3.2 and 4.3 kg/m(2) in men and women, respectively (P<0.001, both sexes), and fat mass (FM) was 9.9 and 9.1% higher in the oldest compared with the youngest men and women (P<0.001, both sexes). Fat-free mass (FFM) remained stable up to 60 years of age in men (P=0.83) and was lower at 75 years of age compared with the younger ages. In women, FFM was lower from age 60. From youngest to oldest age groups, height-adjusted FM differed from 4.6 to 7.8 kg/m(2) in men and from 6.8 to 10.8 kg/m(2) in women (P<0.001, both sexes). CONCLUSIONS: Our results provide reference data on body composition in Swedish populations. BMI and FM were higher among older age groups compared with the younger ones. FFM remained stable up to 60 years of age and was lower first among the 75 years of age.

Carotid artery remodelling in relation to body fat distribution, inflammation and sustained weight loss in obesity.

BACKGROUND: Obesity is known to be associated with carotid artery remodelling, but less is known about how body fat distribution, inflammation and weight loss may affect this relation. METHODS: Ultrasonography, dual-energy X-ray absorptiometry and computed tomography were performed to evaluate carotid artery intima-media thickness (IMT), body composition and fat distribution, respectively. Participants were divided into three matched study groups (n = 44 per group): obese patients with sustained weight loss 10 years after bariatric surgery [surgery group, body mass index (BMI) 31.5 kg m(-2)]; obese patients who maintained stable weight during the same time period (obese group, BMI 42.5 kg m(-2)); and normal weight subjects (lean group, BMI 24.4 kg m(-2)). RESULTS: Patients in the surgery group, compared with those in the obese group, had slightly lower common carotid artery (CCA) IMT (0.75 ± 0.18 vs. 0.78 ± 0.17 mm) and common carotid bulb (CCB) IMT (0.92 ± 0.32 vs. 0.97 ± 0.32 mm); however, these differences were not statistically significant. Lean individuals, compared with those in the surgery group, had significantly lower CCA and CCB IMT values (P < 0.001). In forward stepwise multiple regression analyses including all subjects (n = 132), CCA IMT was predicted mainly by visceral adipose tissue, but was also related to blood pressure and levels of triglycerides and high-sensitivity C-reactive protein. Carotid lumen diameter was primarily influenced by lean body mass. CONCLUSION: Visceral adiposity was the main determinant of premature carotid artery atherosclerosis, possibly through elevated blood pressure, dyslipidaemia and inflammation. Lean body mass predicted carotid artery lumen diameter. Obese patients with long-term sustained weight loss did not have thinner carotid artery walls compared with their weight-stable obese counterparts.

Macrophage gene expression in adipose tissue is associated with insulin sensitivity and serum lipid levels independent of obesity.

OBJECTIVE: Obesity is linked to both increased metabolic disturbances and increased adipose tissue macrophage infiltration. However, whether macrophage infiltration directly influences human metabolism is unclear. The aim of this study was to investigate if there are obesity-independent links between adipose tissue macrophages and metabolic disturbances. DESIGN AND METHODS: Expression of macrophage markers in adipose tissue was analyzed by DNA microarrays in the SOS Sib Pair study and in patients with type 2 diabetes and a BMI-matched healthy control group. RESULTS: The expression of macrophage markers in adipose tissue was increased in obesity and associated with several metabolic and anthropometric measurements. After adjustment for BMI, the expression remained associated with insulin sensitivity, serum levels of insulin, C-peptide, high density lipoprotein cholesterol (HDL-cholesterol) and triglycerides. In addition, the expression of most macrophage markers was significantly increased in patients with type 2 diabetes compared to the control group. CONCLUSION: Our study shows that infiltration of macrophages in human adipose tissue, estimated by the expression of macrophage markers, is increased in subjects with obesity and diabetes and associated with insulin sensitivity and serum lipid levels independent of BMI. This indicates that adipose tissue macrophages may contribute to the development of insulin resistance and dyslipidemia.

Review of the key results from the Swedish Obese Subjects (SOS) trial - a prospective controlled intervention study of bariatric surgery.

Obesity is a risk factor for diabetes, cardiovascular disease events, cancer and overall mortality. Weight loss may protect against these conditions, but robust evidence for this has been lacking. The Swedish Obese Subjects (SOS) study is the first long-term, prospective, controlled trial to provide information on the effects of bariatric surgery on the incidence of these objective endpoints. The SOS study involved 2010 obese subjects who underwent bariatric surgery [gastric bypass (13%), banding (19%) and vertical banded gastroplasty (68%)] and 2037 contemporaneously matched obese control subjects receiving usual care. The age of participants was 37-60 years and body mass index (BMI) was ≥34 kg m(-2) in men and ≥38 kg m(-2) in women. Here, we review the key SOS study results published between 2004 and 2012. Follow-up periods varied from 10 to 20 years in different reports. The mean changes in body weight after 2, 10, 15 and 20 years were -23%, -17%, -16% and -18% in the surgery group and 0%, 1%, -1% and -1% in the control group respectively. Compared with usual care, bariatric surgery was associated with a long-term reduction in overall mortality (primary endpoint) [adjusted hazard ratio (HR) = 0.71, 95% confidence interval (CI) 0.54-0.92; P = 0.01] and decreased incidences of diabetes (adjusted HR=0.17; P < 0.001), myocardial infarction (adjusted HR = 0.71; P = 0.02), stroke (adjusted HR=0.66; P = 0.008) and cancer (women: adjusted HR = 0.58; P = 0.0008; men: n.s.]. The diabetes remission rate was increased severalfold at 2 years [adjusted odds ratio (OR) = 8.42; P < 0.001] and 10 years (adjusted OR = 3.45; P < 0.001). Whereas high insulin and/or high glucose at baseline predicted favourable treatment effects, high baseline BMI did not, indicating that current selection criteria for bariatric surgery need to be revised.

Two-year outcome of laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity: results from a Swedish Nationwide Study (AMOS).

CONTEXT: The prevalence of obesity among adolescents has increased and we lack effective treatments. OBJECTIVE: To determine if gastric bypass is safe and effective for an unselected cohort of adolescents with morbid obesity in specialized health care. DESIGN, SETTING AND PATIENTS: Intervention study for 81 adolescents (13-18 years) with a body mass index (BMI) range 36-69 kg m(-2) undergoing laparoscopic gastric bypass surgery in a university hospital setting in Sweden between April 2006 and May 2009. For weight change comparisons, we identified an adult group undergoing gastric bypass surgery (n=81) and an adolescent group (n=81) receiving conventional care. MAIN OUTCOME MEASUREMENTS: Two-year outcome regarding BMI in all groups, and metabolic risk factors and quality of life in the adolescent surgery group. RESULTS: Two-year follow-up rate was 100% in both surgery groups and 73% in the adolescent comparison group. In adolescents undergoing surgery, BMI was 45.5 ± 6.1 (mean ± s.d.) at baseline and 30.2 (confidence interval 29.1-31.3) after 2 years (P<0.001) corresponding to a 32% weight loss and a 76% loss of excess BMI. The 2-year weight loss was 31% in adult surgery patients, whereas 3% weight gain was seen in conventionally treated adolescents. At baseline, hyperinsulinemia (>20 mU l(-1)) was present in 70% of the adolescent surgery patients, which was reduced to 0% at 1 year and 3% at 2 years. Other cardiovascular risk factors were also improved. Two-thirds of adolescents undergoing surgery had a history of psychopathology. Nevertheless, the treatment was generally well tolerated and, overall, quality of life increased significantly. Adverse events were seen in 33% of patients. CONCLUSIONS: Adolescents with severe obesity demonstrated similar weight loss as adults following gastric bypass surgery yet demonstrating high prevalence of psychopathology at baseline. There were associated benefits for health and quality of life. Surgical and psychological challenges during follow-up require careful attention.

Alcohol and macronutrient intake patterns are related to general and central adiposity.

BACKGROUND/OBJECTIVES: Alcohol and dietary fat have high energy densities and may therefore be related to body weight and fat deposition. We studied associations between alcohol and macronutrient intake patterns and general and central adiposity. SUBJECTS/METHODS: A population-based cross-sectional study of 524 men and 611 women. The participants answered a dietary questionnaire describing habitual food consumption including intake of alcoholic beverages. Macronutrient intake was analysed in relation to anthropometric measures and dual energy X-ray absorptiometry determined body fat. RESULTS: In women, total alcohol intake was negatively associated with body fat percentage (ß:-0.67, P<0.01). In men, total alcohol intake was positively associated with sagittal abdominal diameter (SAD) (ß: 0.28, P=0.01). In addition, positive associations were found between intake of alcohol from spirits and body fat percentage (ß: 1.17, P<0.05), SAD (ß: 0.52, P<0.05) and waist circumference (ß: 2.29, P=0.01). In men, protein intake was positively associated with body mass index (BMI) (ß: 0.03, P=0.001), body fat percentage (ß: 0.04, P<0.05), SAD (ß: 0.02, P=0.01) and waist circumference (ß: 0.09, P<0.01). Also in men only, negative associations between fat intake and BMI (ß: -0.03, P<0.01), SAD (ß: -0.02, P<0.05) and waist circumference (ß: -0.05, P<0.05) were found. CONCLUSIONS: Alcohol intake was inversely associated to relative body fat in women whereas spirits consumption was positively related to central and general obesity in men. Macronutrient intakes, particularly protein and fat, were differently associated with obesity indicators in men versus women. This may reflect a differential effect by gender, or differential obesity related reporting errors in men and women.

Effects of bariatric surgery on disability pension in Swedish obese subjects.

BACKGROUND: Prospective controlled data on the long-term effects of bariatric surgery on disability pension are not available. This study prospectively compare disability pension in surgically and conventionally treated obese men and women. METHODS: The Swedish obese subjects study started in 1987 and involved 2010 obese patients who had bariatric surgery and 2037 contemporaneously matched obese controls, who received conventional treatment. Outcomes of this report were: (i) incidence of disability pension from study inclusion to 31 December 2006 in all subjects, and, (ii) number of disability pension days over 10 years in a subgroup of individuals (N=2901) followed for at least 10 years where partial pensions were recalculated to full number of days per year. Objective information on granted disability pension was obtained from the Swedish Social Insurance Agency and disability pension follow-up rate was 99.9%. RESULTS: In men, the unadjusted incidence of disability pension did not differ between the surgery and control groups (N=156 in both groups). When adjusting for baseline confounders in men, a reduced risk of disability pension was suggested in the surgery group (hazard ratio 0.79, 95% confidence interval 0.62-1.00; P=0.05). Furthermore, the adjusted average number of disability pension days was lower in the surgery group, 609 versus 734 days (P=0.01). In women, bariatric surgery was not associated with significant effects on incidence or number of days of disability pension. CONCLUSION: Bariatric surgery may be associated with favourable effects on disability pension for up to 19 years in men whereas neither favourable nor unfavourable effects could be detected in women.

Association of adipose tissue blood flow with fat depot sizes and adipokines in women.

OBJECTIVE: To explore possible associations between adipose tissue (AT) blood flow (ATBF), AT depot sizes and adipocyte-derived hormones (adipokines) in women. SUBJECTS: In all, 43 healthy women were divided into four groups: normal-weight (n=11) and obese (n=11) pre-menopausal women and normal-weight (n=10) and obese (n=11) post-menopausal women. METHODS: Fasting levels of adipokines were obtained, and a single-slice computed tomography scan at the level of L4-L5 was used to estimate fat depot sizes. ATBF was assessed by xenon washout while in a fasting state and after oral glucose load. We also measured glucose, insulin and non-esterified fatty acids. RESULTS: Total, subcutaneous and visceral AT areas strongly correlated with ATBF (all P<0.001). Circulating leptin levels strongly and inversely correlated with ATBF (P=0.001), but this association did not remain after adjustment for body mass index. Adiponectin was not associated with blood flow. CONCLUSION: ATBF is closely linked to subcutaneous and visceral AT size. Further analyses are needed to determine possible mediators of this association, including mechanistic studies to assess a putative role for leptin as a significant modulator of blood flow.

Differential coexpression analysis of obesity-associated networks in human subcutaneous adipose tissue.

OBJECTIVE: To use a unique obesity-discordant sib-pair study design to combine differential expression analysis, expression quantitative trait loci (eQTLs) mapping and a coexpression regulatory network approach in subcutaneous human adipose tissue to identify genes relevant to the obese state. STUDY DESIGN: Genome-wide transcript expression in subcutaneous human adipose tissue was measured using Affymetrix U133 Plus 2.0 microarrays (Affymetrix, Santa Clara, CA, USA), and genome-wide genotyping data was obtained using an Applied Biosystems (Applied Biosystems; Life Technologies, Carlsbad, CA, USA) SNPlex linkage panel. SUBJECTS: A total of 154 Swedish families ascertained through an obese proband (body mass index (BMI) >30 kg m(-2)) with a discordant sibling (BMI>10 kg m(-2) less than proband). RESULTS: Approximately one-third of the transcripts were differentially expressed between lean and obese siblings. The cellular adhesion molecules (CAMs) KEGG grouping contained the largest number of differentially expressed genes under cis-acting genetic control. By using a novel approach to contrast CAMs coexpression networks between lean and obese siblings, a subset of differentially regulated genes was identified, with the previously GWAS obesity-associated neuronal growth regulator 1 (NEGR1) as a central hub. Independent analysis using mouse data demonstrated that this finding of NEGR1 is conserved across species. CONCLUSION: Our data suggest that in addition to its reported role in the brain, NEGR1 is also expressed in subcutaneous adipose tissue and acts as a central 'hub' in an obesity-related transcript network.

Self-reported sleep apnoea and mortality in patients from the Swedish Obese Subjects study.

Sleep apnoea is associated with increased mortality in sleep clinic and community population groups. It is unclear whether a clinical report of sleep apnoea results in additional mortality risk in patients with severe obesity. The Swedish Obese Subjects (SOS) study is a nonrandomised controlled trial of bariatric surgery versus conventional treatment for the treatment of severe obesity and its complications (mean ± SD body mass index 41 ± 5 kg · m(-2)). The presence or absence of sleep apnoea (witnessed pauses in breathing) was determined by self-reporting at baseline in 3,953 patients who were observed for 54,236 person-yrs (mean 13.5 maximum 21.0 yrs). Sleep apnoea was reported by 934 (23.6%) patients at baseline and was a significant univariate predictor of mortality (hazard ratio (95% CI) 1.74 (1.40-2.18)). In a range of multivariate models of mortality risk, controlling for ≤ 16 other potential confounders and established mortality risk factors, sleep apnoea remained a significant prognostic factor (fully adjusted model 1.29 (1.01-1.65)). Self-reported sleep apnoea is an independent prognostic marker of all-cause mortality in obese patients.

Associations of markers in 11 obesity candidate genes with maximal weight loss and weight regain in the SOS bariatric surgery cases.

PURPOSE: To test whether DNA sequence variation in 11 obesity genes is associated with maximum weight loss and weight regain over 6 years of follow-up in bariatric surgery patients of the Swedish obese subjects (SOS) intervention study. METHODS: A total of 1443 subjects were available for analysis (vertical banded gastroplasty: n = 966, banding: n = 293 and gastric bypass: n = 184). Single-nucleotide polymorphisms (SNPs) from the following 11 genes were included: ADIPOQ, BDNF, FTO, GNB3, LEP, LEPR, MC4R, NR3C1, PPARG, PPARGC1A and TNF. General linear models were used to analyze associations between the SNPs and maximum weight loss and weight regain. RESULTS: The average maximum weight loss was 33.7 kg (s.d. 13.3; min -95.5 kg, max +2.0 kg), which was reached 2.2 (s.d. 1.6) years after the surgery. Subjects regained approximately 12 kg (range 0.0-51.4 kg) by year 6. After correcting for multiple testing, the FTO SNP rs16945088 remained significantly associated with maximum weight loss (P = 0.0002), as minor allele carriers lost approximately 3 kg less compared with common allele homozygotes. This association was particularly evident in the banding surgery patients (P < 0.0001), whereas no significant association was found in the gastric bypass subjects. No other SNPs were associated with maximum weight loss. Furthermore, no SNPs were significantly associated with weight regain. CONCLUSION: The FTO SNP rs16945088 was associated with maximum weight loss after banding surgery. We found no evidence that obesity-risk SNPs in FTO or other obesity candidate genes derived from genome-wide association studies are associated with maximum weight loss or weight regain over 6 years of follow-up in bariatric surgery patients. The potential role of other obesity genes remains to be investigated.

Appendicular fracture repair in dogs using the locking compression plate system: 47 cases.

The locking compression plate (LCP) has combination screw holes, making it possible to use the implant in three different ways; as a pure internal fixator using locking head screws, as a conventional compression plate using compression screws, or as a hybrid of the two. The experience with the LCP system in veterinary fracture repair is limited. The objective of this study was to evaluate the outcome of appendicular fractures in dogs, which were repaired with the LCP system combined with less invasive surgical techniques. Medical records and radiographs from 47 dogs were studied retrospectively. Thirty-four percent of the fractures were simple, six percent wedge and 60% comminuted fractures of the humerus (11 %), radius and ulna (30 %), femur (34 %) and of the tibia and fibula (25 %). The fractures were treated using the LCP as an internal fixator; in some cases as a plate and rod construct. Forty-six of 47 fractures reached radiographic union. Mean healing time of the fractures was seven weeks (95% confidence interval from 5.8 to 8.3 weeks). There were statistically significant differences in healing time between juvenile (age under one year) and adults. Complications in the form of implant failures and infections were encountered in approximately 11% of the cases. All implant failures were due to surgical errors. The LCP system in combination with a less invasive surgical approach was found advantageous in comminuted fractures where the LCP was used as a bridging plate, in situations when exact plate contouring was difficult, and when other implants prevented the use of bi-cortical screws.

Body composition in a cohort of Swedish adolescents aged 15, 17 and 20.5 years.

OBJECTIVE: To assess variables of body composition and identify their correlates in a group of individuals studied from adolescence to early adulthood. METHODS: Cross-sectional results were obtained from 203, 149 and 106 subjects at the respective ages. Sixty-two subjects examined at all three ages constituted the longitudinal study group. A cohort of randomly selected 15-year-old adolescents from an industrial town in Sweden was studied by dual energy X-ray absorptiometry (DXA) and followed up at 17 and 20.5 years. Lean body mass (LBM), fat mass (FM) and total body bone mineral content (TBMC) were measured by DXA. Total bone mineral density (TBMD) was calculated. Information of parental educational level, energy intake and food habits, energy expenditure (TEE) and physical activity level (PAL) was obtained by questionnaires and diaries. RESULTS: LBM, TBMC and TBMD increased significantly more in males and FM more in females, from 15 to 20.5 years of age. Body weight, height, TEE, PAL and the fathers' educational level and, at age 15, also gender were identified as significant correlates of the body composition variables. CONCLUSION: New reference values for body composition at ages 15, 17 and 20.5 years are presented and also a finding about an association between the father's educational level and the adolescent's body composition.

Accurate tissue area measurements with considerably reduced radiation dose achieved by patient-specific CT scan parameters.

A low-dose technique was compared with a standard diagnostic technique for measuring areas of adipose and muscle tissue and CT numbers for muscles in a body composition application. The low-dose technique was intended to keep the expected deviation in the measured area of adipose and muscle tissue to <1% of the total tissue area. The largest diameter of the patient determined the parameters for the low-dose technique. 17 patients - chosen to cover a wide range of diameters (31-47 cm) for both abdomen and thighs - were examined using both techniques. Tissue areas were compared, as were CT numbers for muscle tissue. Image noise was quantified by standard deviation measurements. The area deviation was <1%, except in the smallest subjects, in whom it was <2%. The integral radiation dose of the low-dose technique was reduced to 2-3% for diameters of 31-35 cm and to 7.5-50% for diameters of 36-47 cm as compared with the integral dose by the standard diagnostic technique. The CT numbers of muscle tissue remained unchanged with reduced radiation dose. Image noise was on average 20.9 HU (Hounsfield units) for subjects with diameters of 31-35 cm and 11.2 HU for subjects with diameters in the range of 36-47 cm. In conclusion, for body composition studies with CT, scan protocols can be adjusted so that the integral dose is lowered to 2-60% of the standard diagnostic technique at our centre without adversely altering area measurements of adipose and muscle tissue and without altering CT numbers of muscle tissue.

Bariatric surgery and reduction in morbidity and mortality: experiences from the SOS study.

Obesity is associated with increased morbidity and mortality. Intentional weight loss results in improvement of cardiovascular risk factors, but most observational studies suggest that weight reduction is associated with increased overall and cardiovascular mortality. No prospective intervention studies on mortality have earlier been reported in obese subjects. The prospective, controlled Swedish Obese Subjects Study enrolled obese subjects who either underwent bariatric surgery (n=2010) or were allocated to a contemporaneously matched, conventionally treated obese control group (n=2037). This review sums up effects on morbidity and mortality over an average of 10 years. The mean weight change of the control group was less than +/-2% over up to 15 years of weight recording. Maximum weight losses in the surgical subgroups were observed after 1-2 years. After 10 years, the weight losses from baseline were stabilized at 25, 16 and 14%, respectively. Bariatric surgery improved all traditional cardiovascular risk states except hypercholesterolemia over 10 years. There were 129 deaths in the control group compared with 101 in the surgery group. The unadjusted overall mortality was reduced by 23.7% (P=0.0419) in the surgery group (relative to controls), whereas the gender-, age- and risk factor-adjusted mortality reduction was 30.7% (P=0.0102). The most common causes of death were myocardial infarction (controls n=25, surgery n=13) and cancer (47/29). Bariatric surgery for severe obesity is associated with long-term weight loss, improved risk factors and decreased overall mortality.

Critical assessment of the current guidelines for the management and treatment of morbidly obese patients.

An interdisciplinary panel of specialists met in Mallorca in the first European Symposium on Morbid Obesity entitled; "Morbid Obesity, an Interdisciplinary Approach". During the two and half days of the meeting, the participants discussed several aspects related to pathogenesis, evaluation, and treatment of morbid obesity. The expert panel included basic research scientists, dietitians and nutritionists, exercise physiologists, endocrinologists, psychiatrists, cardiologists, pneumonologists, anesthesiologists, and bariatric surgeons with expertise in the different weight loss surgeries. The symposium was sponsored by the Balearic Islands Health Department; however, this statement is an independent report of the panel and is not a policy statement of any of the sponsors or endorsers of the Symposium. The prevalence of morbid obesity, the most severe state of the disease, has become epidemic. The current recommendations for the therapy of the morbidly obese comes as a result of a National Institutes of Health (NIH) Consensus Conference held in 1991 and subsequently reviewed in 2004 by the American Society for Bariatric Surgery. This document reviews the work-up evaluation of the morbidly obese patient, the current status of the indications for bariatric surgery and which type of procedure should be recommended; it also brings up for discussion some important real-life clinical practice issues, which should be taken into consideration when evaluating and treating morbidly obese patients. Finally, it also goes through current scientific evidence supporting the potential effectiveness of medical therapy as treatment of patients with morbid obesity.