Underreporting in obese inpatients undergoing a psycho-nutritional rehabilitative program.

OBJECTIVE: To evaluate the possible correlation between underreporting and anthropometric, psychological and socio-anagraphic characteristics in obese inpatients. DESIGN: Perspective longitudinal study. SUBJECTS: Forty-two obese inpatients enrolled to a multidisciplinary 3-week weight loss program in a psycho-nutritional rehabilitative structure located in Salice Terme, Northern Italy. They underwent anthropometric, dietary, clinical, and psycho diagnostic evaluation. RESULTS: Forty-two subjects were included in the study of which 29 (70 %) were females and 13 were males. Mean BMI and mean waist circumference were 42.7 ± 9.5 kg/m(2) and 125 ± 18 cm, respectively. The mean weight loss of 4.2 ± 2.2 kg in the whole sample was significantly greater in males compared to females. The waist circumference fell in equal measure in both of the sexes. Thirty patients were classified as underreporters according to Goldberg, two-thirds of which were females. In the course of the three recovery weeks, a third of the 30 subjects identified as underreporters at the beginning continued to underreport energy intake. CONCLUSION: In our study, the prevalence of underreporting was equal to over 70 % of the original sample. There was no significant difference between the weight losses achieved by the underreporter and non-underreporter groups. All the underreporters initially became partly non-underreporters during treatment. Those who gave up the practice of underreporting were patients who had a more elevated BMI, who were more susceptible to binge eating behavior and who experienced a strong uneasiness both physically and psychologically. They also had a strongly impaired quality of life.

Weight loss after Swedish Adjustable Gastric Banding: relationships to insulin resistance and metabolic syndrome.

BACKGROUND: The metabolic syndrome is a cluster of cardiovascular risk factors (central obesity, hypertension, dyslipidemia, disturbance in glucose metabolism) associated with insulin-resistance. The cluster of risk factors defining the metabolic syndrome increases cardiovascular risk more than each single component. The aim of the present longitudinal study was to evaluate the relationship between weight loss and changes in insulin-resistance and in the prevalence of the metabolic syndrome 1-year after SAGB implantation. METHODS: 51 premenopausal severely obese women (mean age 35.2 +/- 8.8 years, BMI 43.3 +/- 6.9) were enrolled. As a control group, 51 premenopausal non-obese women (BMI < 30) were enrolled. All obese subjects underwent successful implantation of the SAGB via videolaparoscopy. In all subjects insulin-resistance was estimated by HOMA index and metabolic syndrome was defined according to the criteria of the European Group for the Study of Insulin Resistance. RESULTS: HOMA (4.2 +/- 2.0 vs 1.9 +/- 0.8, P < 0.001) and the prevalence of the metabolic syndrome (58.8% vs 7.8%, P < 0.001) were significantly higher in obese than non-obese women. 1 year after SAGB, BMI significantly decreased from 43.3 +/- 6.9 to 34.5 +/- 7.4 (P < 0.001). HOMA index showed a significant dramatic breakdown (4.2 +/- 2.0 vs 2.4 +/- 1.0, P < 0.001). The prevalence of the metabolic syndrome declined significantly (58.8% vs 21.6%, P < 0.001). CONCLUSION: Our study shows that in severely obese women, insulin-resistance and the prevalence of the metabolic syndrome significantly decrease 1 year after SAGB. Our findings indicate that SAGB could be a useful tool to reduce the global cardiovascular risk in severely obese people and to improve their long-term prognosis.

Restenosis after intracoronary stent placement: can apolipoprotein(a) polymorphism play a role?

BACKGROUND: The relationship between lipoprotein(a) and restenosis after intracoronary stent implantation has been analysed by two specific studies, but the role of apoliprotein(a) polymorphism was not considered. The aim of the present prospective study was to evaluate whether lipoprotein(a) levels and apolipoprotein(a) phenotypes are predictors of restenosis after elective stent implantation in patients with de novo lesions of coronary arteries. METHODS: We recruited 182 patients with a new lesion successfully treated with elective placement of one or two Palmaz-Schatz stents. Follow-up angiography was scheduled at 6 months or earlier if clinically indicated. Nine patients were lost to the follow up. Among 173 patients enrolled, restenosis was present in 52 (30.0%) and absent in 121 (70.0%). RESULTS: Lipoprotein(a) levels were higher in the restenosis than in the nonrestenosis group (29.5+/-17.2 versus 27.4+/-20.2 mg/dl), even if the difference did not attain statistical significance (P=0.067). The restenosis group had a percentage of subjects with at least one apolipoprotein(a) isoform of low molecular weight significantly greater than the nonrestenosis group (82.7 versus 66.9%; P=0.035). A multiple logistic regression analysis showed that multiple stenting (RR: 4.01; CI 95%: 1.65-13.91; P=0.004), presence of diabetes (RR: 3.96; CI 95%: 1.67-9.37; P=0.002) and presence of multivessel disease (RR: 2.71; CI 95%: 1.19-6.16; P=0.017) were predictors of restenosis after stent placement. Lipoprotein(a) and apolipoprotein(a) polymorphism did not enter the model as predictive variables. CONCLUSIONS: Our study confirms that multiple stenting, diabetes and multivessel disease are powerful predictors of restenosis after intracoronary stent implantation. On the contrary, lipoprotein(a) and apolipoprotein(a) polymorphism do not appear to be reliable markers of restenosis in patients with stent implantation.