Role of Full-spectrum Endoscopy in Colorectal Cancer Screening: Randomized Trial.

GOALS: The aim of this study was to compare a new, full-spectrum endoscope (Fuse; EndoChoice, Alpharetta, GA) to standard forward-viewing colonoscopy in the detection of colorectal neoplasms. BACKGROUND: Colonoscopy, the gold standard for the detection of colorectal cancer, fails to detect 22% to 28% of polyps, increasing the risk of interval cancer. Endoscopic improvement of the adenoma detection rate decrease interval carcinomas. Full-spectrum endoscopy (FUSE) (330-degree field of view), in a tandem study, has been shown to reduce the adenoma miss rate. STUDY: Prospective, randomized study of 249 patients in patients referred from the colorectal screening program with a positive fecal occult blood test (FOBT). Patients were randomized to standard forward-viewing colonoscopy (170 degrees) or to full-spectrum colonoscopy with the Fuse system (330 degrees). Study variables were the adenoma detection rate, the polyp detection rate, the mean number of adenomas per procedure, the lesions detected according to the location, morphology and size, cecal intubation rate, total procedure time, insertion time to the cecum, therapeutic success, and adverse events. RESULTS: The Fuse system did not produce a significantly higher adenoma detection rate than standard forward-viewing colonoscopy (FUSE 73.1% vs. standard colonoscopy 68.1%; P=0.47) but did have a significantly longer insertion time (FUSE 6.2 min vs. standard colonoscopy 4.2 min; P< 0.001). Further analysis failed to reveal any significant difference in polyp/adenoma detection rates by lesion size or colonic section. CONCLUSIONS: FUSE did not detect significantly more colorectal neoplasia than forward viewing colonoscopy in a medium-risk CRC screening population with positive FOBT.

Relation of the rs6923761 gene variant in glucagon-like peptide 1 receptor with weight, cardiovascular risk factor, and serum adipokine levels in obese female subjects.

BACKGROUND: Studies of the glucagon-like peptide 1 (GLP-1) receptor have been directed at identifying polymorphisms in the GLP-1 receptor gene that may be a contributing factor in the pathogenesis of diabetes mellitus and cardiovascular risk factors. Nevertheless, the role of GLP-1 variants on body weight, cardiovascular risk factors, and adipokines remains unclear in obese patients. OBJECTIVE: Our aim was to analyze the effects of rs6923761 GLP-1 receptor polymorphism on body weight, cardiovascular risk factors, and serum adipokine levels in nondiabetic obese females. DESIGN: A sample of 645 obese nondiabetic Caucasian females was enrolled in a prospective way. Basal fasting glucose, c-reactive protein (CRP), insulin, insulin resistance (homeostasis model assessment (HOMA)), total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides concentration, and adipokines were measured. Weights, body mass index (BMI), waist circumference, fat mass by bioimpedance, and blood pressure measures were measured. RESULTS: Three hundred and twenty-seven participants (50.7%) had the genotype GG and 318 (49.3%) study subjects had the next genotypes; GA (270 study subjects, 41.9%) or AA (48 study subjects, 7.4%) (second group). In wild group (GG genotype), BMI (1.8 ± 2.3 kg/m(2) ; P < 0.05), weight (3.1 ± 1.3 kg; P < 0.05), fat mass (2.4 ± 1.1 kg; P < 0.05), waist circumference (2.7 ± 1.9 cm; P < 0.05), triglyceride levels (10.4 ± 5.3 mg/dl; P < 0.05), interleukin 6 (IL-6) (1.5 ± 0.9 ng/dl; P < 0.05), resistin (1.1 ± 0.3 ng/dl; P < 0.05), and leptin (30.1 ± 10.3 ng/dl; P < 0.05) levels were higher than mutant group (GA + AA). CONCLUSION: Data from our study revealed an association with decreased metabolic and cardiovascular markers in obese females. BMI weight, fat mass, waist circumference, triglycerides, leptin, resistin, and IL-6 serum levels were lower in subjects with A allele than non-A allele subjects.

Evaluation of weight loss and adipocytokine levels after two hypocaloric diets with different macronutrient distribution in obese subjects with the rs6923761 gene variant of glucagon-like peptide 1 receptor.

BACKGROUND: The role of glucagon-like peptide-1 receptor (GLP-1R) variants on body weight response after dietary intervention has not been evaluated so far. OBJECTIVE: Our aim was to evaluate weight loss and adipocytokine levels after two hypocaloric diets with different macronutrient distribution in obese subjects with rs6923761. DESIGN: A sample of 280 obese subjects was randomized to two hypocaloric diets. RESULTS: 124 patients (44.3%) had the genotype GG (wild-type) and 156 (55.7%) had another genotype (mutant), i.e. GA (n = 132, 47.1%) or AA (n = 24, 8.6%). With the type I diet (low in carbohydrates) in the wild-type and mutant groups, BMI, weight, fat mass, waist circumference, insulin levels, insulin resistance and triglycerides decreased. Anthropometric parameters were higher in non-A-allele carriers than A-allele carriers. With the type II diet (low in fats) in all genotypes, BMI, weight, fat mass, waist circumference, insulin levels, total cholesterol and LDL cholesterol decreased. CONCLUSION: Our data showed better anthropometric parameters in obese subjects with the mutant allele (A) of the rs6923761 GLP-1R polymorphism. A lack of association of this polymorphism with weight loss or biochemical parameters after two different hypocaloric diets was observed.

Evaluation of weight loss and adipocytokines levels after two hypocaloric diets with different macronutrient distribution in obese subjects with rs9939609 gene variant.

BACKGROUND: Common polymorphisms of the fat mass and obesity associated gene (FTO) have been linked to obesity in some populations. One of these genetic variants (rs9939609) has been related to an increased risk of obesity. OBJECTIVE: Our aim was to evaluate weight loss and adipocytokine levels after two hypocaloric diets with different macronutrient distribution in obese subjects with RS9939609 gene variant. DESIGN: 305 obese patients were enrolled in a prospective way. In the basal visit, patients were randomly allocated during 3 months to low carbohydrates and low fat. RESULTS: After treatment with both diets and in both genotypes, weight, fat mass, waist circumference and systolic blood pressures decreased. With the diet type I and in TT genotype, insulin (-6.6 ± 9.8 IU/L) and homeostasis model assessment (-2.9 ± 6.1 units) decreased. With the diet type II and in both genotypes (wild and mutant type), insulin (-5.2 ± 6.1 vs. -3.8 ± 6.1 IU/L; p < 0.05) and homeostasis model assessment (-2.4 ± 4.8 vs. -1.1 ± 3.8 kg; p < 0.05) decreased. In the A allele group, a significant decrease was detected in total cholesterol levels (-11.5 ± 20.1 mg/dL), low density lipoprotein cholesterol levels (-13.2 ± 20.9 mg/dL) and c-reactive protein levels (-1.3 ± 3.8 mg/dL) secondary to weight loss after treatment with diet II. The decrease of leptin levels was higher in mutant type group than wild type group with low fat diet (-10.3 ± 36.1 vs. -28.6 ± 53.7 ng/mL; p < 0.05). CONCLUSION: Metabolic improvement secondary to weight loss was better in A carriers with a low fat hypocaloric diet.

Basal GLP-1 levels in morbidly obese patients following biliopancreatic diversion surgery.

BACKGROUND: Previous studies addressing the changes of glucagon-like peptide-1 (GLP-1) concentrations in morbidly obese patients after bariatric surgery have demonstrated conflicting results. The aim of the present study was to investigate the changes in serum GLP-1 levels 9 months after biliopancreatic diversion in morbidly obese patients without diabetes mellitus. METHODS: A sample of 40 morbidly obese patients without diabetes mellitus was enrolled. Biochemical and anthropometrical evaluations were conducted at basal and 9 months after surgery. RESULTS: The mean patient age was 46.6 ± 13.1 years, and the mean preoperative body mass index (BMI) was 47.1 ± 18.1. A significant decrease in BMI, weight, waist circumference, fat mass, glucose, LDL cholesterol, total cholesterol, and triglyceride levels was observed after 9 months. Serum basal GLP-1 levels did not change after surgery (0.65 ± 0.18 ng/ml vs. 0.66 ± 0.17 ng/ml; n.s.). Postsurgical correlation analysis showed a negative association between basal GLP-1 and HDL cholesterol (r = -0.57; p < 0.01). CONCLUSIONS: Fasting GLP-1 concentrations did not change after massive weight loss with biliopancreatic diversion in morbidly obese patients without diabetes mellitus.

Relation of leptin and adiponectin with cardiovascular risk factors, intact parathormone, and vitamin D levels in patients with primary hyperparathyroidism.

BACKGROUND: Primary hyperparathyroidism (PHPT) is associated with high cardiovascular morbidity. The aim of the present study was to explore the relationship of leptin and adiponectin levels with cardiovascular risk factors and anthropometric parameters in patients with PHTP with and without metabolic syndrome (MS). METHODS: A total of 62 patients with PHPT were enrolled. Weight, blood pressure, basal glucose, insulin, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, insulin, HOMA-R, intact parathormone, vitamin D, calcium, leptin, and adiponectin levels were measured in fasting condition. RESULTS: Prevalence of MS with ATP III definition was 32.3% (20 patients; 15 females (75%) and 5 males (25%)) and 67.7% patients without MS (n = 42 patients; 35 females (83.3%) and 7 males (16.7%)). In the analysis with leptin as dependent variable, the weight and HOMA-R levels remained in the model (F = 9.2; P < 0.05), with an increase of 1.31 (CI 95%: 0.24-2.31) ng/ml with each one unit of HOMA-R and an increase of 0.4 (CI 95%: 0.01-0.84) ng/ml with each 1 kg of weight. In a second model with adiponectin as dependent variable, the HOMA-R and HDL-cholesterol levels remained in the model (F = 7.37; P < 0.05), with a decrease of -0.62 (CI 95%: 0.01-1.1) ng/ml with each one point of HOMA-R and an increase of 0.18 (CI 95%: 0.04-0.38) ng/ml with each 1 mg/dl of HDL-cholesterol. In the multivariate, PTH I was not associated with other variables. CONCLUSION: There was a high prevalence of MS-32.3% of patients with PHPT presented an MS. Serum levels of leptin and adiponectin are not related with PTH I, vitamin D, and calcium levels in patients with PHPT.

Relationship of fat distribution with adipokines in patients with acquired immunodeficiency virus infection.

BACKGROUND: The aim was to examine the relationship of fat distributions with adipokines concentrations in HIV-infected patients. METHODS: This was a cross-sectional analysis of 36 HIV (free of lipodystrophy) infected patients. Dual-energy X-ray absorptiometry was used. RESULTS: In the multivariate analysis, basal adiponectin concentration was a dependent variable, whereas waist to hip ratio and abdominal fat mass were independent predictors in the model (F = 5.1; P < 0.05). Adiponectin concentration decreases by 5.541.2 µg/ml (CI 95%: 8,071.9-3,029.1) for each unit of waist to hip ratio and 561.9 ng/ml (CI 95%: 918.2-213.4) for each kilogram of fat mass of abdominal area. In the multivariate analysis, basal leptin concentration was a dependent variable, whereas waist circumference remained an independent predictor in the model (F = 6.3; P < 0.05), with a direct correlation. Leptin concentration increases by 0.067 ng/ml (CI 95%: 0.001-0.12) for each centimeter of waist circumference. CONCLUSIONS: Leptin and adiponectin are related with adiposity in HIV-infected patients.

Relationship of -55C/T polymorphism of uncoupling protein 3 (UCP3) gene with metabolic syndrome by ATP III classification.

BACKGROUND AND AIMS: The relation of -55C/T polymorphism of uncoupling protein 3 (UCP3) with metabolic syndrome (MS) has been evaluated only in one previous study with contradictory results. The aim of our study was to investigate the association of -55C/T polymorphism of UCP3 gene with MS. DESIGN: A population of 817 obese Caucasian patients was analyzed in a cross-sectional survey. Genotype of UCP3 gene -55C/T was studied. To estimate the prevalence of MS , the definitions of the ATPIII were considered. RESULTS: Five hundred and ninety-four patients (72.7%) had the genotype -55CC (wild group), whereas 223 patients (27.3%) had the genotype -55C/T. Genotype -5TT was not detected. Prevalence of mutant UCP genotypes was similar in patients with MS (75.7% wild genotype and 24.3% mutant genotype) and without MS (69.7% wild genotype and 30.3% mutant genotype). Odds ratio of MS wild vs. mutant genotype was 1.17 CI 95%: 0.99-1.38). Total cholesterol and low density lipoprotein (LDL) cholesterol concentrations were lower in mutant-type group than wild-type group in patients with MS. No differences in other parameters were detected between genotypes in the same group of MS. CONCLUSION: -55C/T UCP polymorphism is not major risk factor for the MS. However, in mutant group of -55CC UCP3 gene in patients with MS, total cholesterol and LDL cholesterol were lower than wild-type patients.

The ratio of adiponectin to HOMA as an index of metabolic syndrome in obese women.

OBJECTIVE: The aim of our study was to investigate the role of the ratio of adiponectin concentration to homeostasis model assessment insulin resistance (HOMA-IR) as a predictor of metabolic syndrome (MS) in obese subjects. METHODS: We studied a population-based cross-sectional sample of 217 obese women. To estimate the prevalence of MS, the definitions of the Adult Treatment Panel III (ATP III) were considered. RESULTS: The area under the curve (AUC) of the receiver-operating characteristic (ROC) curve for the detection of each MS component on the basis of the ratio of the serum adiponectin concentration to HOMA-IR (A/H ratio) was higher than that for the detection based on serum adiponectin concentration (for central obesity: 0.722 vs. 0.316, for increased triglycerides: 0.579 vs. 0.500, for increased blood pressure: 0.573 vs. 0.493, and for elevated fasting plasma glucose: 0.718 vs. 0.465). The AUC of the ROC curve for the detection of MS on the basis of the A/H ratio was higher than that for the detection based on serum adiponectin concentration (0.700 vs. 0.481). CONCLUSION: The A/H ratio appears to provide a discriminatory marker for MS risk and some components of MS (central obesity, increased blood pressure and elevated fasting plasma glucose) in obese women.

G308A polymorphism of TNF-alpha gene is associated with insulin resistance and histological changes in non alcoholic fatty liver disease patients.

Some studies have pointed to a role of TNF-alpha in pathogenesis of non alcoholic fatty liver disease (NAFLD). The aim of our study was to investigate the influence of G308A polymorphism TNF alpha gene on the histological changes, insulin resistance and TNF-alpha levels in overweight patients. A population of 66 patients with NAFLD was recruited in a cross sectional study. A biochemical analysis of serum was measured. Genotype of TNF alpha gene G308A was studied. Fifteen patients (22.7%) had the genotype G308A (mutant type group) and 51 patients (77.3%) G308G (wild type group). Patients with mutant type group presented more moderate-severe portal inflammation (86.7%) in liver biopsy compared to patient with wild genotype (19.7%). Mutant type group had more moderate-severe fibrosis (73.3%) than wild type group (51.3%). The multivariate analysis adjusted by age, sex, BMI and genotype with the dependent variable (fibrosis) showed that HOMA remained in the model, with an increase of the probability to develop fibrosis of 1.78 (CI95%:1.06-3.2) and develop moderate-severe inflammation of 1.45 (CI95%:1.02-2.1) with each increase of one unit on HOMA levels. In conclusion, Patients with mutant genotype have more frequently moderate-severe portal inflammation and fibrosis than wild type genotype.

Candidemia distribution, associated risk factors, and attributed mortality at a university-based medical center.

Candida is the fourth most common cause of nosocomial bloodstream infections (BSI), being Candida albicans the most common species. This study evaluated the distribution of Candida spp isolates at a tertiary care medical center. The associated factors and outcome of patients with candidemia at the Puerto Rico Medical Center (PRMC) were evaluated. Laboratory data from May 2005 to April 2006 was reviewed. Blood cultures reported as positive for Candida spp were identified and records were reviewed. Two hundred and four blood cultures were reported with Candida spp, corresponding to 85 different episodes of candidemia in 82 patients: 3 patients presented more than one candidemia episode with two different Candida spp. In seventy-two percent (61/85) of candidemia episodes, the organism isolated was a non-albicans Candida, being C. parapsilosis the most common species isolated with 49% (42/85). Sixty five records were evaluated; of which 45 cases were reviewed (20 cases were excluded from the study due to incomplete information). The predominant factors identified were being on broad spectrum antibiotics 95.6% (43/45), central catheter placement 97.8% (44/45), mechanical ventilation 64.4% (29/45), and urinary catheter placement 73.3% (33/45). The mortality among the reviewed cases was 48.9% (22/45).

[C358A polymorphism of the endocannabinoid degrading enzyme fatty acid amide hydrolase (FAAH) and adipocytokine levels in the morbidly obese]. / Polimorfismo C358A de la enzima "amida hidrolasa de ácidos grasos" y los niveles de adipocitoquinas en obesos mórbidos.

INTRODUCTION: The 385 C/A polymorphism of fatty acid amide hydrolase (FAAH) has recently been demonstrated to be associated with overweight and obesity. The aim of our study was to investigate the association between missense polymorphism (cDNA 385 C->A) of the FAAH gene and anthropometric parameters, cardiovascular risk factors and adipocytokines in morbidly obese patients. MATERIAL AND METHODS: A sample of 66 morbidly obese patients was analyzed. In all patients, weight, blood pressure, fasting glycemia, lipoprotein(a), C-reactive protein, insulin, total cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, triglyceride and adipocytokine levels, as well as the genotype of the C358A polymorphism of FAAH, were determined. RESULTS: The mean age was 48.0(16.1) years and the mean body mass index was 44.4 (4.1). There were 17 males (25.8%) and 49 females (74.2%). Forty-five patients (8 males/37 females) (68.2%) were G358G (wild genotype) and 21 patients (4 males/17 females) were G358A (31.8%) (mutant group). Biochemical, anthropometrical and adipocytokine levels showed no statistically significant differences between the two genotypes. CONCLUSION: In patients with morbid obesity, the C358A polymorphism of FAAH was not associated with anthropometric parameters, biochemical markers or adipocytokine levels.

[The effects of a low-fat versus a low carbohydrate diet in obese adults]. / Efectos de una dieta baja en grasas frente a una dieta rica en proteínas y grasa en pacientes obesos.

BACKGROUND AND OBJECTIVE: The aim of our study was to compare the effect of a high fat and a high protein diet vs a fat restricted diet on weight loss in obese patients. SUBJECTS AND METHODS: A population of 74 obesity non diabetic outpatients was analyzed in a prospective way. Patients were randomly allocated to two groups: a) diet I (low fat diet: 1500kcal/day, 52% carbohydrates, 20% proteins, 27% fats) with a distribution of fats and b) diet II (high fat and high protein diet: 1507kcal/day, 38% carbohydrates, 26% proteins, 36% fats). After three months with diet, weight, blood pressure, glucose, C reactive protein, insulin, insulin resistance, total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides were evaluated. RESULTS: There were randomized 35 patients (4 males and 31 females) in the group I and 39 patients (6 males and 33 females) in diet group II. In group I, systolic pressure, BMI, weight, fat free mass, fat mass total body water, intracellular body water and waist circumference decreased significantly. In group II, glucose, total cholesterol, LDL cholesterol, systolic blood, BMI, weight, fat mass, total body water and waist circumference decreased significantly. Differences among averages of parameters before treatment with both diets were not detected. CONCLUSIONS: No differences were detected on weight loss between a fat-restricted diet and a high fat and high protein enhanced diet.

[Arginine enhanced enteral nutrition, effect on blood inflammatory markers in head and neck cancer patients]. / Efecto de una fórmula enteral enriquecida en arginina sobre los marcadores inflamatorios en pacientes con tumores de cabeza y cuello.

BACKGROUND AND OBJECTIVE: Although immune dysfunction in cancer patients could be multifactorial, the immune system may be modulated by specific nutritional substrates, such as arginine. The aim of our study was to evaluate the effect of enteral nutrition supplemented with a high dose of arginine on c-reactive protein (CRP), interleukin 6 (IL6) and tumoral necrosis factor (TNF alpha) in surgical head and neck cancer patients. SUBJECTS AND METHODS: At surgery, patients were randomly allocated to two groups: (a) enteral diet supplements with arginine (group I, n=18); (b) isocaloric, isonitrogenous enteral formula (group II, n=23). Perioperatively and on the postoperative day 6 the following parameters were evaluated: serum values of prealbumin, transferrin, lymphocytes, IL6, TNF alpha and CRP. RESULTS: The mean age (standard deviation) was 60.9 (10.6) years. Prealbumin and transferrin improved in both groups, CRP decreased in both groups, (group I: 105.1 (62.8)mg/dl vs 53.2 (51)mg/dl: p<0.05 and group II: 103.3 (62)mg/dl vs 61.9 (57.4)mg/dl: p<0.05). IL6 improved in both groups (group I: 38.35 (14.2)pg/ml vs 15.6 (9.1)pg/ml: p<0.05 and group II: 32.8 (35)pg/ml vs 6.8 (4.9)pg/ml: p<0.05) TNF alpha and lymphocytes did not change. CONCLUSIONS: Both formulas improved IL6 and CRP levels. A high dose of enteral arginine in these patients did not add biochemical advantages as compared to a standard enteral formula.

[Randomized clinical trial between nutritional counselling and commercial hypocaloric diet in weight loss in obese patients with chronic arthropathy]. / Ensayo clínico aleatorizado entre consejo dietético una dieta hipocalórica comercial para la pérdida de peso de pacientes obesos con artropatía crónica.

BACKGROUND AND OBJECTIVE: The aim of our work was to evaluate in obese patients with an indication of replacement surgery for degenerative osteoarthritis, the utility of a hypocaloric diet with Optisource vs nutritional counseling. MATERIAL AND METHOD: Thirty six patients were randomized in both branches: diet I with lunch and dinner substituted by two Optisource (1109,3 kcal/day, 166,4g of carbohydrates (60%), 63g of proteins (23%), 21,3g of lipids 17%) and diet II with nutritional counselling with a decrease of 500 cal/day from the previous dietary intake. Before and 3 months after treatment, a nutritional and biochemical study was performed. RESULTS: Nineteen patients were randomized in group I and 17 patients in group II. 19 patients finished the study in group I and 14 in group II. Weight loss was higher in group I than II (7,7 [4,7] vs 3,92 [3,32] kg; P=.05), with a significant decrease of HOMA and diastolic blood pressure in group I. Decreases of body mass index (-2,9 [1,8] vs -1,4 [0,9]; P=.05), fat mass (-3,8 [3,4] vs -2,3 [1,7] kg; P=.0,05) and HOMA (-2,0 [2,2] vs -0,4 [1,82]; P=.05) were higher in group I than II. CONCLUSIONS: Obese patients with chronic osteoarthritis treated with a mixed diet supplemented with a commercial hypocaloric formula improved weight, fat mass and HOMA in a better way than patients treated with a dietary counselling alone.

Influence of insulin resistance and adipocytokines on elevated serum alanine aminotransferase in obese patients.

BACKGROUND: Insulin resistance and adipocytokines have been associated with fatty liver and nonalcoholic fatty liver disease. The aim of our study was to study the influence of insulin resistance and adipocytokines in obese patients on elevated serum alanine aminotransferase (ALT). METHODS: A population of 214 female obese patients was studied cross-sectionally. HOMA-IR was calculated as indicator of insulin resistance. Adipocytokines (leptin, resistin, adiponectin, interleukin-6, and TNF-alpha) blood levels were measured. RESULTS: The mean age and body mass index of our study group was 38.2+/-14.7 years and 35.27+/-6.5, respectively. HOMA and leptin levels were higher in the third ALT tertile than in the first ALT tertile. Adiponectin level was higher in the first tertile than in the second and third tertiles. These parameters show statistical differences between the second and third ALT tertiles. In the multiple regresion analysis with a dependent variable (ALT) and the statistical univariant variables as independent variables, the HOMA-IR remained in the model with an increase of 0.27 U/L of ALT (CI 95%, 0.6-3.4) (F=8.1; p<0.05) with each 1 unit of HOMA-IR adjusted by age, weight, and dietary intake. CONCLUSIONS: Some metabolic parameters are associated with elevated ALT in obese female patients. However, adjusted by other variables, only insulin resistance remained associated.

Influence of Lys656Asn polymorphism of the leptin receptor gene on insulin resistance in nondiabetic obese patients.

BACKGROUND: Alterations of the normal leptin receptor (LEPR) gene may be involved in the development of obesity. Leptin has been shown to be able to modulate insulin secretion. Different polymorphisms in the LEPR gene have been studied, albeit with unclear results. The polymorphism on codon 656 produces a change in charge, making this change possibly functional. OBJECTIVE: The objective of this study was to investigate the influence of Lys656Asn polymorphism in the LEPR gene on serum insulin, glucose values, and insulin resistance in the fasted state among obese men and women without diabetes mellitus. DESIGN: Two hundred thirty-three (body mass index, >30 kg/m(2)) nondiabetic obese patients were analyzed. Indirect calorimetry, tetrapolar electrical bioimpedance, blood pressure determination, serial assessment of nutritional intake with 3-day written food records, and biochemical analysis were performed. Statistical analysis was performed for Lys656/Asn656 and Asn656/Asn656 jointly as a mutant allelic group and for Lys656/Lys656 as a wild allelic group. RESULTS: The subjects' (67 males and 166 females) mean age and mean body mass index were 43.6+/-16.6 years and 35.3+/-5.6 kg/m(2), respectively. One hundred forty-three patients (61.9%) had the genotype Lys656/Lys656 (wild group), whereas 88 (38.1%) had either the genotype Lys656/Asn656 (n=81; 30.7%) or the genotype Asn656/Asn656 (n=7; 7.4%) (mutant group). Age and sex distribution were similar in both groups. No difference was detected between the mutant and wild allelic groups in anthropometric parameters and dietary intakes. Homeostasis model assessment (HOMA; 2.8+/-1.7 vs. 5.6+/-4.8; P<.05) and insulin (18.1+/-10.7 vs. 32.1+/-25 mUI/ml; P<.05) levels were higher in males with the genotypes Lys656/Asn656 and Asn656/Asn656 than in males with the genotype Lys656/Lys656. Leptin levels were higher in males with a mutant genotype than in males with a wild genotype (39.3+/-23 vs. 63.5+/-28 ng/ml; P<.05). CONCLUSION: The novel findings of our study are those of the association of the Lys656/Asn656 and Asn656/Asn656 genotypes with higher levels of insulin, HOMA, and leptin in males and the lack of such an association in females.

Changes of ghrelin and leptin in response to hypocaloric diet in obese patients.

OBJECTIVE: Hypocaloric diet-induced weight loss produces a coordinated decrease in plasma leptin levels and an increase in plasma ghrelin levels. The aim of the present study was to determine whether subjects who lose significant weight experience changes in circulating ghrelin and leptin levels. METHODS: A population of 66 obese patients was analyzed. Leptin, active ghrelin blood levels, and other cardiovascular risk factors were measured before and after 3 mo of a hypocaloric diet. RESULTS: Sixty-six patients (17 male, 49 female) gave informed consent and were enrolled in the study. Forty-six patients did not lose 5% of initial weight (group I, weight loss 1.4 +/- 2.5 kg) and 20 patients lost weight (>5% of initial weight; group II, weight loss 7.1 +/- 2.6 kg). In group I, active ghrelin levels increased (7.40 +/- 8 versus 19.40 +/- 32 pg/mL, P < 0.05) and leptin levels decreased (102.6 +/- 86 versus 89.30 +/- 76 ng/mL, P < 0.05). In group II, leptin levels also decreased significantly (69.80 +/- 67 versus 53.50 +/- 59 ng/mL, P < 0.05). Active ghrelin in this group did not show differences (24.20 +/- 41 versus 10.30 +/- 12 pg/mL, NS). In the multivariate analysis with a dependent variable (change in active ghrelin levels, pg/ml) in group II adjusted by age and sex, only basal fat mass and basal intake of protein remained in the model. In the multivariate analysis with a dependent variable (change in leptin levels, pg/ml) in group II adjusted by age and sex, only basal fat mass and BMI remained in the model. CONCLUSION: Patients with weight loss secondary to a hypocaloric diet did not change active ghrelin levels and decreased leptin levels after treatment.

Effect of a hypocaloric diet on serum visfatin in obese non-diabetic patients.

OBJECTIVE: Obesity and insulin resistance are associated with classic and new cardiovascular risk factors, such as inflammatory markers and adipocytokines. The aim of this study was to examine whether weight reduction could change visfatin serum concentrations in obese patients. METHODS: This was an interventional longitudinal study analyzing a population of 80 obese non-diabetic outpatients. Weight, blood pressure, fasting serum glucose, C-reactive protein, plasma insulin, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triacylglycerols, and insulin resistance (homeostatic model assessment) were measured before and after 3 mo on a hypocaloric diet. RESULTS: Eighty patients were enrolled. The mean age was 46.7 +/- 16.7 y, the mean body mass index was 34.1 +/- 4.8 kg/m(2), with 20 men (25%) and 60 women (75%). After 3 mo on a hypocaloric diet, body mass index, fat mass, waist circumference, systolic blood pressure, fasting serum glucose, total cholesterol, and low-density lipoprotein cholesterol decreased. The serum concentration of visfatin decreased with weight loss (112.14 +/- 70.2 versus 99.4 +/- 58.1 ng/mL, P < 0.05). In the multivariate analysis of visfatin concentration before and after treatment, as a dependent variable, only age remained an independent predictor in the model (F = 12.5, P < 0.02), with an inverse correlation: visfatin decreased 4.1 g/mL (F = 12.5, P < 0.05) and 3.7 g/mL (95% confidence interval 1.2-6.1), respectively, for each year of age. CONCLUSION: Weight reduction after a 3-mo period of a hypocaloric diet is associated with a significant decrease in circulating serum concentrations of the novel adipokine visfatin in obese subjects. Visfatin is inversely correlated with age.

Influence of Ala54Thr polymorphism of fatty acid-binding protein-2 on clinical results of biliopancreatic diversion.

OBJECTIVE: Bariatric surgery is the most effective long-term treatment for morbid obesity, reducing obesity-associated comorbidities. The purpose of the present study was to evaluate the fatty acid-binding protein-2 Ala54Thr polymorphism outcomes 1 y after biliopancreatic diversion in morbidly obese patients. METHODS: A sample of 41 morbidly obese patients (body mass index >40 kg/m(2)) were operated upon from December 2004 to December 2006. Weight, fat mass, blood pressure, basal glucose, triacylglycerides, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were measured at the basal visit and at each visit. The frequency of patients with diabetes mellitus, hypertension, and hyperlipidemia was recorded at each visit. RESULTS: Twenty-three patients (56.1%) had genotype Ala54/Ala54 (wild group) and 18 patients had genotype Ala54/Thr54 (15 patients, 36.5%) or Thr54/Thr54 (3 patients, 7.4%; mutant group). In the wild group, body mass index, weight, fat mass, systolic blood pressure, glucose, total cholesterol, low-density lipoprotein cholesterol, and triacylglycerol concentrations decreased. Diastolic blood pressure remained unchanged. In the mutant group, the same parameters improved, without statistical differences from the wild group. Initial excess weight percent loss at 1 y of follow-up was similar in both genotype groups (61.8% versus 61.9%, NS). CONCLUSION: Polymorphism Ala54Thr of fatty acid-binding protein did not have an effect on weight loss or clinical outcomes after bariatric surgery.