Bo Larsson

Abdominal adipose tissue distribution, obesity, and risk of cardiovascular disease and death: 13 year follow up of participants in the study of men born in 1913.

In a prospective study of risk factors for ischaemic heart disease 792 54 year old men selected by year of birth (1913) and residence in Gothenburg agreed to attend for questioning and a battery of anthropometric and other measurements in 1967. Thirteen years later these baseline findings were reviewed in relation to the numbers of men who had subsequently suffered a stroke, ischaemic heart disease, or death from all causes. Neither quintiles nor deciles of initial indices of obesity (body mass index, sum of three skinfold thickness measurements, waist or hip circumference) showed a significant correlation with any of the three end points studied. Statistically significant associations were, however, found between the waist to hip circumference ratio and the occurrence of stroke (p = 0.002) and ischaemic heart disease (p = 0.04). When the confounding effect of body mass index or the sum of three skinfold thicknesses was accounted for the waist to hip circumference ratio was significantly associated with all three end points. This ratio, however, was not an independent long term predictor of these end points when smoking, systolic blood pressure, and serum cholesterol concentration were taken into account. These results indicate that in middle aged men the distribution of fat deposits may be a better predictor of cardiovascular disease and death than the degree of adiposity.

Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish Obese Subjects Study): a prospective, controlled intervention trial

BACKGROUND Obesity is a risk factor for cancer. Intentional weight loss in the obese might protect against malignancy, but evidence is limited. To our knowledge, the Swedish Obese Subjects (SOS) study is the first intervention trial in the obese population to provide prospective, controlled cancer-incidence data. METHODS The SOS study started in 1987 and involved 2010 obese patients (body-mass index [BMI] >or=34 kg/m(2) in men, and >or=38 kg/m(2) in women) who underwent bariatric surgery and 2037 contemporaneously matched obese controls, who received conventional treatment. While the main endpoint of SOS was overall mortality, the main outcome of this exploratory report was cancer incidence until Dec 31, 2005. Cancer follow-up rate was 99.9% and the median follow-up time was 10.9 years (range 0-18.1 years). FINDINGS Bariatric surgery resulted in a sustained mean weight reduction of 19.9 kg (SD 15.6 kg) over 10 years, whereas the mean weight change in controls was a gain of 1.3 kg (SD 13.7 kg). The number of first-time cancers after inclusion was lower in the surgery group (n=117) than in the control group (n=169; HR 0.67, 95% CI 0.53-0.85, p=0.0009). The sex-treatment interaction p value was 0.054. In women, the number of first-time cancers after inclusion was lower in the surgery group (n=79) than in the control group (n=130; HR 0.58, 0.44-0.77; p=0.0001), whereas there was no effect of surgery in men (38 in the surgery group vs 39 in the control group; HR 0.97, 0.62-1.52; p=0.90). Similar results were obtained after exclusion of all cancer cases during the first 3 years of the intervention. INTERPRETATION Bariatric surgery was associated with reduced cancer incidence in obese women but not in obese men. FUNDING Swedish Research Council, Swedish Foundation for Strategic Research, Swedish Federal Government under the LUA/ALF agreement, Hoffmann La Roche, Cederoths, AstraZeneca, Sanofi-Aventis, Ethicon Endosurgery.

Risk factors for Type 2 (non-insulin-dependent) diabetes mellitus. Thirteen and one-half years of follow-up of the participants in a study of Swedish men born in 1913

SummaryThis report presents data on antecedents of Type 2 (non-insulin-dependent) diabetes mellitus in a homogeneous sample of randomly selected 54-year-old men from an urban Swedish population with a diabetes incidence of 6.1% during 13.5 years of follow-up. The increased risk leading to diabetes for those in the top quintile compared to the lowest quintile of the distribution of statistically significant risk factors were: body mass index = 21.7, triglycerides = 13.5, waist-to-hip circumference ratio = 9.6, diastolic blood pressure = 6.7, uric acid = 5.8, glutamic pyruvic transaminase = 3.9, bilirubin = 3.2, blood glucose = 2.7, lactate = 2.4 and glutamic oxaloacetic transaminase = 2.0. Those with a positive family history of diabetes had 2.4-fold higher risk for developing diabetes than those without such a history. In a multivariate analysis glutamic pyruvic transaminase, blood glucose, body mass index, bilirubin, systolic blood pressure, uric acid and a family history of diabetes were all significantly associated with the development of diabetes. Our study demonstrates the great importance of adiposity and body fat distribution for the risk of diabetes. A number of established risk factors for coronary heart disease are risk factors for diabetes as well. Disturbed liver function and increased levels of lactate are early risk factors for diabetes — presumably indicators of the presence of impaired glucose tolerance and/or hyperinsulinaemia.

Effects of obesity and weight loss on left ventricular mass and relative wall thickness: survey and intervention study.

Abstract Objectives: To investigate the consequences of longstanding obesity on left ventricular mass and structure and to examine the effects of weight loss on these variables. Design: Cross sectional survey and controlled intervention study. Setting: City of Gothenburg and surrounding areas, Sweden. Subjects: 41 obese patients treated with weight reducing gastric surgery, 31 obese patients treated conventionally, and 43 non-obese subjects. Main outcome measures: Changes in left ventricular mass and relative wall thickness. Results: Obese patients had higher blood pressure, greater left ventricular mass, and increased relative wall thickness than did matched non-obese control subjects. Obese subjects treated with gastric surgery had a substantial weight loss and a significant reduction in all variables when compared with conventionally treated obese subjects. Univariate and multivariate analysis of pooled data from the two groups of obese subjects showed that changes in relative wall thickness and left ventricular mass were more closely related to the change in weight than to the concomitant change in blood pressure. Conclusions: Structural heart abnormalities occurring in conjunction with obesity diminish after weight loss. The regression in these structural aberrations is better predicted by the weight loss than by the accompanying reduction in blood pressure. To prevent or improve abnormalities of heart structure in obese people, weight control should be the primary goal; it should be regarded as at least as important as regulating blood pressure. Key messages Obesity and hypertension often coexist, leading to various degrees of eccentric and concentric left ventricular hypertrophy These structural heart changes are in turn powerful risk factors for cardiovascular morbidity and mortality Weight loss is followed by a reduction in left ventricular mass and relative wall thickness Changes in left ventricular structure are better predicted by the weight loss than by the accompanying reduction in blood pressure To prevent or improve abnormal heart structure in obese people, weight control should be the primary goal and should be regarded as at least as important as regulating blood pressure

Diabetes mellitus in Swedish middle-aged men

SummaryAs part of a study of the epidemiology of diabetes mellitus in middle-aged Swedish men, the present paper reports the prevalence and incidence of diabetes and the prevalence of impaired glucose tolerance. Two cohorts of 50-year-old men, representative of the corresponding male population of Gothenburg, Sweden, were examined in 1963 and 1973, respectively, and then followed until 1980. In the cohort of men born in 1913 (n=855) the diabetes prevalence (WHO criteria), based on a questionnaire and fasting blood glucose, increased from 1.5% at age 50 to 7.6% at age 67. In the cohort of men born in 1923 (n=226) the prevalence was 3.7% at age 50 and 4.0% at age 57. The overall prevalence of diabetes and impaired glucose tolerance was 25% among men born in 1913 (age 67) and 18% among men born in 1923 (age 57). The cumulative risk of developing diabetes from age 50 to 67 was 7.8%. Variables associated with impaired glucose tolerance and newly found diabetes, when degree of obesity was considered, were systolic blood pressure and triglycerides, well known risk factors for both coronary heart disease and diabetes. Uric acid, fasting insulin and glutamic puruvic transaminase, recently discussed as possible risk factors, were also associated with impaired glucose tolerance and newly found diabetes. Thus, both impaired glucose tolerance and newly found diabetes were associated with a clustering of risk factors, not only for diabetes but also for coronary heart disease.

Hyperinsulinaemia is not a major coronary risk factor in elderly men

SummaryInsulin and insulin resistance have attracted considerable interest as possible risk factors for coronary heart disease during the last decade. We therefore examined the 8 year incidence of coronary heart disease in 595 67-year-old men in relation to baseline insulin and other risk factors. The incidence of coronary heart disease increased from 9% among non-diabetic men to 13.5% among those with impaired glucose tolerance, 12.9% among newly-detected diabetic men and up to 31.3% among men with known diabetes. The incidence of coronary heart disease was related to fasting blood glucose and 1 h and 2 h blood glucose during the oral glucose tolerance test and to serum cholesterol and serum triglycerides. Fasting serum insulin was of borderline significance for the risk of coronary heart disease. When known diabetic subjects were excluded only serum cholesterol and serum triglycerides remained as statistically significant risk factors. Among diabetic subjects (known and newly-detected) only blood glucose was related to the risk of coronary heart disease. In multivariate analyses the different degrees of glucose intolerance or fasting blood glucose were independently related to the risk of coronary heart disease (p=0.008–0.010). Serum triglycerides were also an independent risk factor in three out of four multivariate models (p=0.02–0.09). Fasting serum insulin was not an independent risk factor. These findings do not support the hypothesis that hyperinsulinaemia is a major risk factor for coronary heart disease in elderly men. Hyperglycaemia (or diabetes mellitus) seems to be the most important risk factor.

Quality of Life in Early Heart Failure: The Study of Men Born in 1913

To see whether well-being and quality-of-life are affected in congestive heart failure (CHF), a number of health variables, self-assessed and objectively measured, were estimated among 67-year-old men sampled from the general population of Gothenburg, Sweden. Based on history, physical examination and drug treatment, 407 men were studied and grouped into 4 stages of CHF, ranging from no signs or symptoms of CHF to advanced CHF. Men with CHF had more of other cardiovascular disease manifestations, utilized more health care, and reported less well-being and a higher rate of self-assessed disability than men with no CHF. These quality-of-life changes were found not only in the overt cases but also in early CHF. Regardless of CHF stage, quality-of-life seemed more affected in men on drug treatment, compared with those not treated.

A Cross‐sectional Analysis of Glucose Tolerance and Cardiovascular Disease in 67–year‐old Men

The relationship between degree of glucose tolerance and cardiovascular disease has been studied in a cross‐sectional population survey of 644 men born in 1913, randomly sampled and examined at the age of 67. The cohort was divided into different groups according to current diagnostic criteria for diabetes and impaired glucose tolerance. An almost 2‐fold higher prevalence of hypertension, myocardial infarction, angina pectoris, and congestive heart failure was found in the group with impaired glucose tolerance compared to the group with a normal glucose tolerance. Fifty per cent of the men with impaired glucose tolerance were being treated with some drug for cardiovascular disease, usually diuretics for hypertension. Intermittent claudication showed a 2.5‐fold higher prevalence among the diabetic patients. A computerized 12‐lead exercise‐ECG test, with a unique accuracy in measuring ST‐segment changes, was performed in a subset of 135 men. This showed no association between ST‐segment depression and different degrees of glucose tolerance, even when accounting for confounding factors such as treatment withβ‐blocker agents or digoxin, pathological Q‐waves, and differences in maximal heart rate.

Thermogenic effect of food in physically well-trained elderly men

SummaryBasal metabolic rate (BMR) and the thermogenic effect of food (TEF) after a liquid mixed meal of 2092 kJ (500 kcal) were examined in physically well-trained, elderly men in comparison with sedentary weight- and age-matched controls. BMR tended to be higher and TEF was significantly higher in the physically well-trained men than in the controls. No certain differences were found in plasma thyroid hormones or catecholamines. BMR correlated with whole body potassium while TEF did not. The tendency to elevated BMR in the well-trained men might therefore be due to their greater muscle mass. The elevated TEF, however, probably has other causes and might be associated with the elevated catecholamine sensitivity associated with the physically trained condition.

Adipocyte metabolism in endogenous hypertriglyceridemia

In order to define specific metabolic abnormalities of adipose tissue metabolism in endogenous hypertriglyceridemia (EH) patients with this condition were compared with normolipidemic controls matched for body fat and fat cell size. In vitro the enlarged fat cells of EH were found to have an increased basal and noradrenaline-stimulated lipolysis in comparison with cells of the same size from normolipidemic controls. The insulin inhibition of noradrenaline-stimulated lipolysis was blunted. Lipoprotein lipase activity in these cells was clearly depressed. Basal triglyceride synthesis from labeled glucose was low in relation to plasma insulin. The reduction of insulin tolerance in vivo suggested that the depression of plasma glycerol and free fatty acid concentration was small in EH, suggesting that the more detailed findings in vitro were of relevance for in vivo conditions. It was suggested that the hyperinsulinemia and decreased glucose tolerance of EH may well be responsible for some of the aberrations of adipocyte metabolism in EH. The decreased responsiveness of lipolysis to insulin and the low lipoprotein lipase activity are, however, findings not typical for enlarged fat cells exposed chronically to insulin and might be characteristic for the fat cells of EH. It seems of importance to further define the factor(s) responsible for these metabolic aberrations, because the abnormalities of the acipocyte metabolism in EH may well offer a possible explanation to the pathogenesis of that condition.