[Metabolic and hormonal links in obese individuals with and without symptoms of syndrome X]. / Metabolické a hormonální vazby u obézních se znaky syndromu X a bez nich.

We carried out statistical analysis of biochemical, anthropometric and anamnestic values at the first contact with 114 patients in the specialized obesity unit. We evaluated metabolic state of different groups varying in the presence of risk factors of atherosclerosis. We disclosed statistically significant differences between those groups, enabling evaluation of the severity of state and early decision on suitability and urgency of treatment.

[Case reports of morbid obesity]. / Nekteré kazuistiky morbidne obézních.

Morbid obesity (BMI over 40 kg/m2) is typically complicated by many serious diseases including early death. Using 7 case studies of morbid obese patients we are documenting severe polymorbidity of these persons including severe manifestation of metabolic syndrome. Using adequate therapy, e.g. gastric banding, risk of these patients can be reduced. Some parts of metabolic syndrome can be documented in adolescent children of these patients. The aim of this study is to show the importance of early intervention in patients with morbid obesity.

Dexfenfluramine in psychotic patients.

Dexfenfluramine (DF) is contraindicated in severe psychiatric disorders and in depression. We used DF in 3 patients with chronic psychosis and severe overeating without changes in psychiatric pharmacotherapy. Two patients had paranoid schizophrenic psychosis with hallucinations, one patient mixed psychosis, beginning with lactation psychosis, and several attacks of hallucinations and depression later. Overeating was removed in all 3 patients without any negative effect on the psychotic state. All patients were able to maintain their body weight. Two patients with poorly controlled diabetes improved markedly their metabolic status. Doses up to 75 mg per day of DF were necessary during binge eating episodes in one patient. We conclude that DF can be used with care under close psychiatric supervision in psychotic patients with severe overeating.

Long-term results of aggressive weight reduction treatment.

We have checked weight changes in 11 patients eight years after 2-weeks in-patient weight reduction treatment and weight changes of another group of 11 patients three years after gastric banding. Using multiple linear regression we've looked for factors which could influence the aforementioned weight changes. For weight reduction regimens we confirmed only the following connection: BMI reduction in 8 years = 12.256 - 2.827 x BMI reduction in 2 weeks. For gastric banding it was: BMI reduction in 3 years = -7.880 + 2.383 x BMI reduction in 6 months. We therefore conclude that the long term effects of reduction regimens is not influenced by any hormonal or metabolic characteristics of the patient, but can be predicted by the early weight loss of the patient. Patients who lose too much during the reduction regimen will find it more difficult to keep the weight down, whereas patients who lose weight rapidly after gastric banding have the best long term prognosis.

[Insulin, steroids and steroidogenesis]. / Inzulin, steroidy a steroidogeneza.

Presented survey summarises insulin-steroid interactions. Beside the well known resistance to insulin induced by steroid hormones, also the central effect of insulin, its influence on the system hypophysis-adrenals, and its stimulatory effect on the generation of steroids in adrenals and ovaries are reviewed. Insulin-steroid interactions are further illustrated by pathogenesis of the polycystic ovary syndrome and by our study on dehydroepiandrosterone regulation. Insulin induced changes in the dehydroepiandrosterone level during the intravenous glucose tolerance test were described.

Dehydroepiandrosterone and insulinaemia.

Low dehydroepiandrosterone (DHEA) and hyperinsulinaemia are assumed to be risk factors of atherosclerosis. Exogenous hyperinsulinaemia during hyperinsulinaemic clamp decreases DHEA. We have evaluated interaction of these hormones during 2 weeks of therapeutic starvation in 11 obese patients (mean BMI 41.2 kg/m2), 5 nondiabetics and 6 diabetics with diet only therapy. Comparing diabetics with normals we have found no differences in BMI and blood DHEA, DHEAS and insulin levels. We have found a light implication of negative correlation of insulin to DHEA and DHEAS level in diabetics (r = -0.71, -0.73, p = 0.16, 0.18). During starvation insulinaemia is declining, DHEA initial increase is followed by a decrease (r = 0.93, p = 0.01). We conclude that insulin decrease during starvation could be a cause of DHEA decrease. This finding is unexpected according to the potential of exogenous insulin to suppress DHEA. Further investigation of endogenous DHEA and insulin relation is necessary.

Somatometric and hormonal effects of dexfenfluramine.

The effect of dexfenfluramine, the new serotoninergic appetite suppressor, was tested in 20 women. The drug was administered 3 months, 15 mg twice a day. A selected reduction of carbohydrate and of fat intake was observed. The body weight decreased mainly due to fat loss in the abdominal region. An important decrease of blood lipids was recorded, while insulinemia and OGTT remained unchanged. Serum alkaline phosphatase increased and ALT decreased. Other liver tests did not change. During the treatment the level of cortisol, TSH, T3 and 17-ketosteroids were not affected. T4 decreased and GH increased. These metabolic and hormonal effects were discussed. The treatment with dexfenfluramine was well tolerated and was found to have several favourable effects.

Risk calculation of type 2 diabetes.

The paper presents an analysis of the risk of developing Type 2 diabetes according to family history and anthropometric variables. The age of diabetes onset was analysed in 2024 diabetics. We obtained several groups according to family history. In each group taken separately, the data describing the cumulative percentage of diabetes onset was fitted by logistic curve F(x) = p1/(1 + p2*p3((x/10)-p4)). Comparing these curves we see that cumulative age-dependent risk increases from the group of randomly chosen persons through the group of first degree relatives to the children of diabetics. The highest risk of diabetes onset is determined by the curve representing the group of known diabetics. Another analysis was performed in a different group of 390 obese subjects (34 diabetics among them). Male diabetics had significantly higher body mass index (BMI) and weight than male non-diabetics. Female diabetics showed significantly higher weight, body mass index, waist to hip ratio (WHR) and age than female non-diabetics. Elimination of factors with randomization and matching showed a complicated relationship between diabetes, age and anthropometric variables. Using stepwise logistic regression we obtained the model for prediction of diabetes risk based on age, BMI, WHR: probability of diabetes = exp(u)/(1 + exp(u)), where u = -13.9 + 0.05431*age + 6.789*WHR + 0.07881*BMI for obese women, u = -11.84 + 10.01*WHR for obese men. In conclusion, genetic factors are the most important and can be exactly quantified in Type 2 diabetes. The importance of anthropometric variables for prediction of diabetes risk is also presented.

Hormonal and metabolic adaptation to a reducing regimen in children.

The effect of a combined slimming regimen (5.2 MJ diet and a low to medium intensity motor activity) were studied in 20 moderately obese children. Blood samples were obtained on days 0, 10 and 52 of the regimen. Insulin and triacylglycerols decreased after 10 days of treatment and the reached levels were maintained up to day 52. Cortisol, T4 and T3 decreased throughout the whole regimen. Glucose and lactate first decreased, and then increased to reach initial levels. NEFA and beta-hydroxybutyrate moved opposite to glucose. The initial decrease and the terminal very high increase of growth hormone were, however, statistically not significant. The serum proteins remained unaffected. In addition to a mean loss of 9 kg, the favourable effect of the slimming regimen consisted in the decrease of insulinemia, cortisolemia and triacylglycerolemia. The unfavourable effect was seen in the decrease of T3, responsible for the decreasing weight loss in the course of slimming regimens.

Prolonged oral glucose tolerance test combined with indirect calorimetry and estimation of several substrates and hormones in obese subjects.

OGTT prolonged to 4 hours was performed in untreated 50 obese outpatients (mean age 37.9 years and BMI 37.2). Parallel to glucose, insulin, growth hormone (GH), cortisol, beta-hydroxybutyrate (BOHB), nonesterified fatty acids (NEFA) and indirect calorimetry (RQ) were estimated at hourly intervals. Basal values of thyroxine (T4), triiodothyronine (T3), total cholesterol and triacylglycerols were also obtained. Mean glycemia after overnight fasting as well as after 75 g glucose reached upper limits of the normal range. The subsequent decrease was slower. Insulinemia followed a similar trend. The initial drop of GH after the glucose load reverted to an increase above the basal value. A similar pattern was observed with cortisolemia, but the decrease and increase were less important. The basal value of RQ was rather low and glucose ingestion produced only a small increase, followed by a greater decrease. Serum levels of NEFA and BOHB sharply decreased one hour after glucose intake and afterwards regained the initial values. The mean basal values of T4 and T3 were within the normal range--the low T3 syndrome was not involved in the large majority of cases. Cholesterol and triacylglycerols approached the upper normal limit. The correlations brought additional information. Insulinemia increased parallel with the amount of body fat. The basal level was decisive for most hormones and substrates--the high or low set level could be followed in the course of the whole test. Increased insulinemia and increased glycemia suggested the presence of a mild insulin resistance with the participation of GH and cortisol. Increased levels of fasting insulinemia and glycemia were present also in obese subjects with a normal OGTT. The correlations permitted to disclose insulin-like effects of GH on basal conditions. Increased BOHB was responsible for a high cholesterol. It is suggested that even small fluctuations of glycemia related to food intake may produce a substantial modification of the hormonal status in obese subjects and initiate or support the metabolic disorders in obesity. In this respect a greater role is ascribed to the phase of decreasing glycemia in comparison to the increasing phase. Lipids are the prevailing source of energy in insulin resistant subjects. The rather stable values of indirect calorimetry indicate that energy metabolism of obese subject works on a low, pre-set level-independently on the supply of some relevant hormones and substrates.

[Energy metabolism in obesity]. / Energetický metabolismus u obezity.

The regulation of energy metabolism in obesity may differ from normal condition in several respects. The synthesis of lipids may be enhanced due to a greater production of insulin, estrogens and cortisol and to a lack of dehydroepiandrosterone. Lipolysis is reduced in obese subjects by a decreased secretion of catecholamines, growth hormone, adipsin and cachectin. Inadequate intake of food and stress modify the T3/rT3 ratio. Oxidative phosphorylation and the production of ATP is modified, thermogenesis decreases due to a reduced synthesis of thermogenin. A decreased activity of substrate cycles and of the Na-K ATPase, is expected. Most of these disorders are normalized in post-obese patients. Many common drugs interfere with energy metabolism, namely those used in psychiatry and all hormones and their antagonists mentioned above and used for a long time. Obesity should not be considered as a simple result of overeating and lack of physical activity.

[Pregnancy and obesity. II. Hormonal and metabolic changes]. / Tehotenství a obezita. II. Hormonální a metabolické zmeny.

28 obese women were investigated in the course of the 21st (A) and 30th (B) week of pregnancy. Increased serum levels of GH, T4 and T3 were found in both samples of blood (A and B), while serum insulin, cholesterol and triacylglycerols were increased only at time B. It was suggested that the similar increase of GH, T4 and T3 at time A and B was due to pregnancy because the level of these hormones is usually not increased in non-pregnant obese women, while hyperinsulinemia and often increased values of cholesterol and triacylglycerols are a common finding in non-pregnant obesity. This presumption was confirmed only partially--body weight and the skin folds correlated only with insulin and T3, while GH, cortisol, T4, cholesterol and triacylglycerols correlated only exceptionally. High levels of insulin and T3 may be due to overeating.

Hormonal, metabolic and cardiovascular response to the duration of a combined slimming regimen.

The rapid weight decrease at the beginning of strict slimming regimens leads often to an inconsiderate shortening of these cures. Our long-term experience with a slimming regimen lasting 13 days based on diet (3.7 MJ) and 4 hours of supervised exercise of low to moderate intensity was omitted by the organizers. They shortened the cure to 8 days. We checked therefore a group of obese women on the first, eight and twelfth day in the course of this regimen. A statistically significant decrease of serum insulin, growth hormone, triiodothyronine and cholesterol was observed on the twelfth day. These trends were not significant on the eighth day. On the other hand, the step-test revealed on the eighth day a reduction of the heart rate during recovery. Nevertheless, a higher level of significance was obtained after 12 days. No significant response to the regimen was obtained in the case of blood glucose, thyroxine, cortisol, uric acid, AST and ALT. The advantages of the 12-day regimen are discussed--especially the decrease of insulinemia, because hyperinsulinemia is responsible for several complications of obesity. The importance of the decrease of cholesterolaemia and the modification of heart rate after a load was also stressed. These favourable effects are not depreciated by a smaller weight loss in the second week due to an enhanced protein synthesis, stimulated by exercise and supported by a decrease of T3 which protects the organism against energy deficit.

[Hormones in bone metabolism. II. Other systemic hormones]. / Hormony v kostním metabolismu. II. Dalsí systémové hormony.

The authors present a review on a number of systemic hormones involved in bone metabolism. At the same time they demonstrate mechanisms of their action on the cellular, tissue and skeletal level. Attention is drawn to the participation of these hormones in the pathology of bone and other organs and the necessity to protect the skeleton during their therapeutic use in other than osteologic indications.

[Sexual development in obese women]. / Sexuální vývoj obézních zen.

By means of an interview and the questionnaire "Heterosexual Development of Women" [HDW] the authors subjected to sexuological examination 129 obese women aged 20-50 years with a body mass index above 25. As regards the time when overweight developed 29 women developed obesity during the prepubertal period and in 100 of the women obesity developed during adolescence and later. It was revealed that the sexual development of obese women was normal. The mean values in the HDW questionnaire in both subgroups with a different period of development of overweight were all within the normal range.

[The effect of the duration of a weight reduction regimen on the hormonal, metabolic and cardiovascular response]. / Vliv délky kombinovaného redukcního rezimu na hormonální, metabolickou a kardiovaskulární odezvu.

The rapid weight decrease at the beginning of strict slimming regimens leads often to an inconsiderate shortening of these cures. Our long-termed experience with a slimming regimen lasting 13 days and based on diet (3.7 MJ) and 4 hours of supervised exercise of low to moderate intensity was omitted by the organizers. They shortened the cure to 8 days. We checked therefore a group of obese women on the first, eighth and twelfth day in the course of this regimen. A statistically significant decrease of serum insulin, growth hormone, triiodothyronine and cholesterol was observed on the twelfth day. These trends were not significant on the eighth day. On the other hand, the step-test has shown on the eighth day a reduction of the heart rate during recovery. Nevertheless, a higher level of significance was obtained after a cure of 12 days. No significant response to the regimen was obtained in the case of blood glucose, thyroxine, cortisol, uric acid, AST and ALT. The advantages of the 12 day regimen were discussed--especially the decrease of insulinemia, because hyperinsulinemia is responsible for several complications of obesity. The importance of the decrease of cholesterolemia and the modification of heart rate after a load was also stressed. These favourable effects should not be depreciated by a smaller weight decrease on the second week due to an enhanced synthesis of proteins, stimulated by exercise and supported by a decrease of T3 which brings a protection against energy defficiency.

[Factors affecting normal levels of insulin, cortisol, STH, thyroxine and triiodothyronine]. / Nekteré faktory ovlivnující normální hodnoty inzulínu, kortizolu, STH, tyroxínu a trijódtyroninu.

Published "normal" values of some hormones have an excessively wide range and unequal mean values because the material on which these values are based is from subjects suffering from different diseases which only apparently are not associated with the investigated hormone, or else the specimens are obtained under non-standard conditions (malnutrition, stress, alcohol etc.). This wide range of normal values may hide incipient pathological processes and is not suitable even as control group. The investigation is based on the assessment of insulin, growth hormone (GH), cortisol, thyroxine (T4) and triiodothyronine (T3) in a group of blood donors. The assembled results were compared with two other groups of blood donors and a group of obese subjects. The following findings were assembled: We recommend to lower the upper borderline of "normal" insulinaemia from the recommended value of 26 to 20 i.u./l, as the original range may comprise milder forms of hyperinsulinism which is recently assumed to participate in the genesis of type 2 diabetes, hypertension, coronary ischemia and polycystic ovaries. Elevated normal values of serum insulin may be obtained also from blood donors who usually have breakfast before the blood is collected. The wide range of cortisolaemia is due to the diurnal rhythm. The basal value is raised by a declining blood sugar level, alcohol, obesity and of course, varying forms of stress. The upper range of cortisolaemia at 8 a.m. should not be beyond the range of 140-690 nmol/l. GH secretion is governed by an individual 3.5-hour cycle as well as changes of the blood sugar level, e. g. during the OGTT: the declining blood sugar level raises the GH level.(ABSTRACT TRUNCATED AT 250 WORDS)

[Neurotic symptoms in obese women]. / Neurotické príznaky u obézních zen.

In a group of 129 obese women with a body mass index (BMI) above 25 by means of questionnaire N5 the frequency and intensity of neurotic symptoms was examined. It was revealed that in the sub-group of 61 probands with pathological obesity (BMI above 30) both values were highly significantly higher (p less than 0.01) than in 68 women with simple obesity (BMI 25-30). Among ten most frequent neurotic symptoms in obese women above all depressive and vegetative symptoms predominated.