Increased activity of interleukin-23/interleukin-17 proinflammatory axis in obese women.

OBJECTIVE: To compare the concentrations of cytokines belonging to Th17 axis (interleukin (IL)-17 and IL-23) and Th1 axis (IL-12 and interferon (IFN)-gamma) in obese and lean women, and to investigate their relationships with the proinflammatory adipokine leptin, proinflammatory cytokine macrophage migration inhibitory factor (MIF) and anthropometric and metabolic parameters of obesity. DESIGN: Cross-sectional study. SUBJECTS: Twenty-six obese women (age 20-52 years, body mass index (BMI): 30-48 kg/m(2)) and 20 healthy lean women (age 23-46 years, BMI: 18-25 kg/m(2)). MEASUREMENTS: Plasma levels of cytokines and leptin, BMI, waist circumference (WC) and insulin resistance index HOMA (homeostatic model assessment). RESULTS: Blood concentrations of IL-17, IL-23, MIF and leptin, but not IL-12 or IFN-gamma, were higher in obese compared with lean women (P=0.002, 0.046, 0.006 and 0.002, respectively). There was a positive correlation between IL-17 and IL-23 (r(s)=0.530), which was at the border of statistical significance (P=0.065). Neither IL-17 nor IL-23 correlated with leptin or MIF, and there was no association between IL-17 and IL-23 levels with BMI, WC or HOMA index. CONCLUSION: Interleukin-23/IL-17 axis is stimulated in obese women independently of the increase in abdominal fat, insulin resistance, leptin and MIF levels.

Evaluation of the nutritional status and tumor characteristics in premenopausal and postmenopausal breast cancer patients.

Evaluation of the nutritional status, fat tissue distribution, and tumor characteristics was carried out in patients with primary breast cancer. The patients were classified into two groups according to their menopause: premenopausal and postmenopausal. Breast cancer prevalence was considerably higher in postmenopausal patients (61%). The patients' nutritional status was shown through the body mass index. Based on this indicator, the patients were characterized as nonobese and obese. In the premenopausal group, there was no significant difference between these categories, whereas the number of obese patients was significantly higher (80%) in the postmenopausal group. The analysis of tumor parameters as related to menopause and body size did not yield any significant differences. However, the estrogen receptor content was significantly higher in postmenopausal patients (p < 0.0001). Distribution of fat tissue of the android type was higher in obese postmenopausal women than in premenopausal ones (77%). The investigation showed that the breast cancer incidence odds are 3.5 times higher in obese postmenopausal than in premenopausal patients.

Environmental factors, health-related habits, and serum selenium levels in cancer patients and healthy controls.

Previous studies conducted in Yugoslavia indicated that the concentration of selenium in soil, food items, and serum of the population is very low. The aim of the study was to investigate the possible relationship among environmental, health-related habits, nutrition, and selenium serum levels in cancer patients and the healthy population. The case-control study included a group of cancer patients and a matched group of healthy controls: 57 cancer patients and 41 healthy controls living in Stari Grad (an urban area of Belgrade), as well as 17 cancer patients and 13 healthy controls living in Barajevo (a rural community in the vicinity of Belgrade). The healthy controls were matched to cancer patients in sex and age; they were not blood related. The selenium serum levels were measured by atomic absorption spectrophotometry. Health-related habits and relevant dietary factors ("food frequency" method) that may influence the selenium serum levels were assessed by questionnaires. The differences in average values of selenium serum levels between the cancer patients and healthy controls were not significantly different, but both were below the lowest recorded in referential studies. A significant difference between the values obtained from urban and rural subgroups was noted. The most important factors that influenced the level of selenium included the residence place in the region with selenium deficiency (Barajevo), age, associated chronic diseases, and some dietary factors potentially related to the intake of selenium. The results obtained in this investigation pointed out that use of selenium supplementation in this area should be seriously considered.

Relationship between education and atherosclerotic disease risk factors in patients with peripheral arterial disease.

AIM: The aim of the present study was to investigate whether different levels of education are associated with different atherosclerotic disease risk factors. METHODS: The cross-sectional study, involving 388 consecutive patients with verified peripheral arterial disease, was performed in Belgrade. Formal education level was used as a proxy for socioeconomic status. Anthropometric parameters and data on cardiovascular risk factors were analyzed in participants with different levels of education. In the analysis, univariate and multivariate logistic regressions were used. RESULTS: Multivariate analysis showed that low education was significantly positively related to alcohol consumption (Odds Ratio - OR, 4.67; 95% confidence interval - CI, 1.80-12.12), increased triglycerides (OR, 2.73; 95% CI, 1.13-6.61), and physical activity during work (OR, 43.10; 95% CI 14.37-129.28), and negatively related to former smoking (OR, 0.11; 95% CI, 0.03-0.46) and sports and leisure - time physical activity (OR, 0.13; 95% CI, 0.04-0.41 and OR, 0.25; 95% CI, 0.11-0.57). Medium education was significantly positively related to increased triglycerides (OR, 1.74; 95% CI 1.01-2.98) and increased LDL-cholesterol (OR 2.37; 95% CI, 1.35-4.18), and to physical activity during work (OR, 2.22; 95% CI, 1.34-3.67), and negatively related to age (OR, 0.95; 95% CI, 0.92-0.98) and leisure - time physical activity (OR, 0.47; 95% CI, 0.30-0.74). CONCLUSION: It can be concluded that if there are differences in the risk of the occurrence of peripheral arterial disease by education status, they could be only partly explained by differences in the observed atherosclerotic disease risk factors.

[Criteria for the classification of obesity]. / Merila za procenu stepena gojaznosti.

Obesity is defined as a condition of increased adipose tissue mass. Although it is quite clear that many health complications are associated with severe obesity, it is very difficult to measure adipose tissue and precise quantification of the amount needed to increase risk to health. The cutoff between normality and obesity is still the subject of debate. For now, the body mass index (BMI) is used as index of obesity, but the curves describing the relationship with morbidity and mortality are U or J-shapes. As the definition of obesity for medical purpose should take into account the risk for associated diseases, it is very difficult to establish the bordelines for obesity with BMI as basis. In this paper the authors also pointed out the recent recognition that the distribution of fat may be a more important risk factor than the total adipose tissue mass. The waist-to-hip-ratio (WHR) is recommended as an index of fat distribution, especially abdominally located. The relationship between disease risk and WHR is linear or exponential, what means that it is easier to establish borderlines of medical significance with WHR as baseline. It can be concluded that definition of obesity for medical purposes should take into account the risk for NIDDM, CVD and some carcinomas. Therefore, WHR should be included in the combination with BMI as it has higher discriminative power for diseases and mortality rate.

[Blood selenium in healthy persons and individuals with malignant diseases]. / Selen u serumu zdravih ljudi i osoba obolelih od malignih bolesti.

INTRODUCTION: Preliminary researches taken part in Yugoslavia showed the risky low concentration of selenium in soil, food items and in serum of the examined population [10]. This research was carried out to discover the some factors which could influence the relationship of serum selenium concentration and the appearance of malignant diseases. METHODS: The investigation was carried out in two Belgrade communities, one rural (Barajevo), and the other central (Stari Grad), in two groups: cancer patients (57 + 17) and healthy controls (41 + 13). These groups were similar in median age and gender. Samples of human serum were obtained by venepunction, and after wet digestion selenium concentration was determined by hydride generated AAS (Perkin-Elmer 5000). Anamnestic data concerning family history of malignancy and comorbidity, especially chronic noncommunicable diseases, were collected by questionnaire. All the participants were asked about their health related habits like: cigarette smoking and alcohol consumption. Dietary habits were assessed by food frequency method. Body mass index (BMI) was calculated as the parameter of nutritional status. RESULTS: The mean serum selenium level in cancer patients and healthy control (Table 1) were not significantly different. But, both cancer patients and healthy controls from Barajevo have significantly lower values comparing to those living in Stari Grad. Table 2 shows the relationship between serum selenium level and various environmental factors. The factors identified as the most important are: living in community Barajevo, age, history of chronic disease and some dietary factors. The univariate analysis (Table 3) revealed that factors like cigarette smoking, alcohol consumption, family history of malignancy and comorbid states were not important predictive factors for patient malignant disease. The multivariate analysis revealed that consumption of sugar, fat and fruit were of the highest predictive value in assessing cancer relative risk. DISCUSSION: The results of selenium serum level in investigated population are in agreement with those published by Maksimovic [10]. They are among the lowest concentrations in Europe, especially in participants living in Barajevo. Thought the number of investigators found generally lower serum selenium levels in cancer patients, the finding is not entirely consistent [14, 15], and so are the results obtained here. Consumption frequency calculated for 44 food items which may be most important source of dietary selenium intake (like: meat, fish, diary products and cereals), didn't show important relationship with serum selenium levels. People living in Barajevo consume food grown in their own soils (proofed deficient with selenium), and this might the reason for the striking differences in serum selenium levels between people living in Barajevo and Stari Grad. CONCLUSION: The results obtained in this investigation indicated that serum selenium level is low both groups cancer patients and healthy controls too. Food items identified as sources of selenium in diet are not connected with this low selenium level.

[Dietetic-hygienic measures in the control of arterial hypertension in obese females]. / Dijetetsko-higijenske mere u suzbijanju arterijske hipertenzije gojaznih osoba zenskog pola.

Since the evidence to data suggest that some obese person respond well to non-pharmacological measures, the aim of this study was to examine the extent of body weight reduction necessary to reduce blood pressure to normal values. A group of 250 obese women with hypertension (blood pressure measurements over 160/95) and an overweight of at least 20 per cent excess of ideal weight was included in the study. The patients were advised to take well balanced low-calorie (about 1000 kcal/day) diet containing 66 g proteins, 140 g carbohydrates, 13 g fat and 0.5 g salt. They were advised to increase daily physical activities. Low-calorie diets were used to decrease body weight in groups of patients with changed of unchanged antihypertensive drug therapy, also. Decrease in body weight resulted in significant decrease in blood pressure; over two-thirds of complaint patients achieve normal blood pressure with a loss of only 5-10 per cent of their weight excess even if at this point they were still overweight. In the group receiving no drug therapy 78 per cent reached normal blood pressure, 76 per cent in the patients whose antihypertensive treatment had to be modified during the study and 63 per cent in the group receiving unchanged drug therapy. It was concluded that weight reduction program (diet and physical activity) can be a possible approach to treat hypertension without drugs and patients can attain normotension long before achieving the ideal weight.

Orlistat, a gastrointestinal lipase inhibitor, in therapy of obesity with concomitant hyperlipidemia.

Orlistat, a gastrointestinal lipase inhibitor, decreases fat absorption and thus it reduces caloric intake. The objectives of this placebo-controlled, double-blind, multicentre trial were to evaluate the efficacy of orlistat in terms of weight reduction, the effects on serum lipid levels and its tolerability profile. 119 obese patients (body mass index, BMI > or = 30 kg/m2) with hyperlipidemia (LDL-cholesterol > or = 4, 2 mmol/l) were randomized to receive either orlistat capsules 120 mg (n = 60) or placebo capsules (n = 59), three times daily, during 24 weeks. All patients were also on a mild hypocaloric diet. Mean weight reduction was 10.75 kg (10.7%) in orlistat group and 7.34 kg (7.5%) in placebo group. All serum lipid parameters improved in the orlistat group. The only adverse event more frequently noted with orlistat was stool fat. Orlistat in combination with diet provides increased weight loss than diet alone, improvements of serum lipids in subjects with hyperlipidemia and it has a good tolerability profile without systemic effects.

Effects of reducing diet and increased leisure time physical activity on hypertension associated with obesity.

The study examined the effects of energy restriction and increased leisure time physical activity on the body mass, body fat, and blood pressure. A group of moderately obese women (120-160% of ideal body mass) referred to the Dietetic Unit as out-patients, were assigned to a reducing diet and increased activities. The diet provided an average of 4.18 MJ (bout 1000 kcalories), with a reduced salt intake of 0.5 g per day, enriched with cellulose and supplemented by trace elements and vitamins. Increased leisure time activities consisted in one-hour walking a day at the least and ten-minute light gymnastics. The average reduction in the blood pressure obtained in the study was 19 mmHg systolic and 10 mmHg diastolic in the non-exercising group. The exercised subjects had a greater reduction in the systolic (23 mmHg) and diastolic (11 mmHg) blood pressures. The significant correlation was not found between the body mass loss and the blood pressure decrease. It was observed that the normal blood pressure was achieved in about two thirds of the patients when they had lost 9 to 132 percent of their body mass, indicating that the achievement of a desirable body mass is not essential for the sizeable reduction in the blood pressure. Although this study demonstrates that a combined nutritional-physical activity intervention program may be effective in reducing a high blood pressure, it does not show a distinction between the body mass loss and physical activity as mediating factors.

[Android and gynecoid types of obesity as factors in the onset of certain related diseases]. / Androidni i ginoidni tip gojaznosti kao faktor u nastajanju nekih relevantnih bolesti.

The prevalence of some diseases was studied in 238 android and 720 gynoid obese women and 180 android obese men with the aim to establish the relationship between the type of obesity and relevant diseases. In the selected group of obese patients (25 android and 90 gynoid obese women and 26 android obese men) fed on a reducing diet (1000 kcal--4.2 M.J.) 67 women were engaged in intensified physical activity during the 90 days of dieting. The relationship between the weight loss and the type of obesity as well as the relationship between the weight loss in women engaged in intensified physical activity and those abstaining from it was investigated. The investigation has shown that the prevalence of hypertension, coronary heart disease and diabetes was much higher in men and women affected by the android type of obesity than in women affected by the gynoid type of obesity. The prevalence of gallbladder's as well as venous system diseases and spondylosis in women affected by both types of obesity was much higher than in android obese men, but the prevalence of constipation was higher in gynoid obese women. From data relating to response to reducing diet it is concluded that the weight loss was equal among the women affected by the android and gynoid types of obesity, but the weight loss in android and gynoid obese women engaged in intensified physical activity was significantly higher than in those abstaining from it.2+herefore, for the prevention and