Michał Holecki

The Influence of Weight Loss on Serum Osteoprotegerin Concentration in Obese Perimenopausal Women

Objective: To assess the influence of weight reduction therapy on serum osteoprotegerin (OPG) concentration in obese patients and compare these results with normal‐weight controls.

The indexes of arterial structure and function in women with simple obesity: a preliminary study

Obesity is associated with an increased risk of cardiovascular disorders. The aim of the present study was to compare the indexes of arterial structure and function in women with simple obesity and healthy individuals. Twenty-two women with simple obesity (body mass index [BMI]: 33.6 ± 2.9 kg/m2, age: 29.7 ± 6.2 years), and 34 healthy women were included in the study. Healthy subjects were divided into two subgroups according to their age (<35 and >45 years): Control A-16 young women (age <35 years, BMI: 24.0 ± 3.0 kg/m2), and Control B-18 older women (age >45 years, BMI: 25.8 ± 2.9 kg/m2). Noninvasive, high-resolution, vascular ultrasound was used to evaluate the endothelial-dependent vasodilatation: flow-mediated dilatation of brachial artery (FMD); the arterial structure: intima-media thickness (IMT) of common carotid artery (CCA); and the compliance parameters corresponding to structural changes in large arteries (PWV: pulse wave velocity; PP: pulse pressure; TAC: total arterial compliance; Ao C: aorta compliance, CCA C: CCA compliance, stiffness indexes). Endothelial-dependent vasodilatation as represented by FMD was comparable in the obese group (16.8% ± 7.9%; median: 15.5%) and healthy subjects (Control A: 14.1% ± 4.7%; median: 13.6%; Control B: 13.9% ± 6.5%; median: 13.0%). The mean value of IMT was significantly increased (P < 0.05) in Control B group (0.67 ± 0.07 mm) in comparison to both obese patients (0.58 ± 0.09 mm) and Control A group (0.53 ± 0.05 mm). The compliance parameters (PWV, AoC, CCA C, stiffness indexes) were impaired in obese patients and Control B patients as compared to Control A individuals. PWV and stiffness indexes were significantly increased, and the AoC, CCA C-diameter, CCA C-area were significantly decreased. Simple obesity constitutes an important risk factor accelerating arterial stiffness in women.

Influence of Calcium and Vitamin D Supplementation on Weight and Fat Loss in Obese Women

Background: Dairy products not only reduce the risk of hypertension and cardiovascular diseases but may play a role in the treatment of obesity. As there is some evidence that calcium (Ca) and vitamin D may play a role in effective weight management, we decided to evaluate the influence of Ca and vitamin D supplementation on weight and fat loss in obese women. Material and Methods: Forty obese women were enrolled in this study. Subjects were divided into 2 groups comparable with body mass index (BMI) and age. Group 1 was provided with calcium carbonate and 1-(OH)-vitamin D supplementation. Group 2 was provided with only a diet. Subjects participated in a 3-month weight reduction therapy (balanced diet, modification of life style, and regular physical exercise). Blood samples (serum concentration of Ca, phosphorus (P), parathormone (PTH), 25-(OH)-D3) and clinical characteristics (weight, height, BMI, body composition) were taken at baseline and after the 3-month program. Results: No significant differences of body weight, body fat content, serum parathormone, 25-(OH)-D3 concentration, and plasma total Ca and P concentration were observed between analyzed groups both before and after the treatment. Additionally, we did not observe any significant influence of Ca and vitamin D supplementation on weight and fat loss. Conclusion: Ca plus vitamin D supplementation during a 3-month low caloric diet has no additional effect on weight and fat loss in obese women.

Inflammation but not obesity or insulin resistance is associated with increased plasma fibroblast growth factor 23 concentration in the elderly

Fibroblast growth factor 23 (FGF23) is a hormone involved in calcium–phosphate homoeostasis. The data of recently published studies suggest that FGF‐23 may also play a role in some metabolic processes beyond mineral metabolism, such as insulin resistance or energy homoeostasis. The aim of the study was to attempt the relationships between plasma cFGF‐23 (C‐terminal) and iFGF‐23 (intact) concentrations and the occurrence of obesity, insulin resistance and inflammation in elderly population.

Flow-Mediated Dilation and Gender in Patients with Coronary Artery Disease: Arterial Size Influences Gender Differences in Flow-Mediated Dilation

Background: The risk of atherosclerosis and its complications differs between male and female subjects. This is probably associated with gender differences in endothelial function as reflected by endothelium‐dependent vasodilation. The aim of the study was to compare flow‐mediated dilatation (FMD) in males and females with coronary artery disease (CAD), and to determine factors that might potentially influence FMD. Methods: Ninety‐six patients with stable CAD (CCS II–III): 76 males (mean age: 57.7 ± 10 years) and 20 postmenopausal females (mean age: 60.1 ± 10 years) were included into the study. Clinical data, pharmacotherapy, concomitant diseases, and FMD were all assessed. FMD was measured with high‐resolution ultrasound as the percent change of brachial artery diameter (BAd) after a 3‐minute occlusion (%FMD), and following the administration of 0.4 mg sublingual nitroglycerin (%NTG‐MD). Results: The percentage of FMD was significantly decreased (P < 0.05), and BAd was significantly larger (P < 0.001) in males as compared to females. Clinical data, pharmacotherapy, and concomitant diseases were comparable in the study groups. In all subjects examined, %FMD was related to BAd (r =−0.415, P < 0.001) and the percentage of ejection fraction (EF%) (r = 0.325, P < 0.01) in the univariate analysis, and to BAd only (r =−0.343, P < 0.01) in the multivariate analysis. The percentage of nitroglycerine‐mediated vasodilatation (NTG‐MD) correlated negatively with BAd (r =−0.430, P < 0.001), and positively with EF% (r = 0.334, P < 0.01) in the univariate analysis, and with BAd (r =−0.288, P < 0.05) in the multivariate analysis. Index %FMD × BAd was comparable for male and female subjects. Conclusions: Males and postmenopausal females with CAD show differences in endothelium‐dependent vasodilatation that seem to secondarily result from differences in the BAd. Objective comparison of %FMD is only possible between patients with the same brachial artery size.

Osteoporosis in liver disease: pathogenesis and management

Osteoporosis affects a substantial proportion of patients with chronic liver disease. Pathologic fracture in osteoporosis significantly affects quality of life and life expectancy. By some estimates, 40% of patients with chronic liver disease may experience osteoporotic fracture. In this study we review the pathogenesis, diagnosis and treatment of specific liver disease entities and their relation to osteoporosis.

Nutrition Management of the Post–Bariatric Surgery Patient

Bariatric surgery is considered one of the most effective methods of achieving long-term weight loss when all other medical treatments have failed. The number of bariatric procedures increases each year. Nevertheless, bariatric procedures are associated with a number of complications that require careful multidisciplinary management. Nutrition supervision is of substantial value, as malnutrition, vitamin, and micro- and macronutrient deficiencies may lead to deleterious consequences. In this review, we provide essential information on nutrition management, both before and after bariatric surgical procedures.

Is plasma urotensin II concentration an indicator of myocardial damage in patients with acute coronary syndrome

Introduction Urotensin II (UII) is a vasoactive peptide secreted by endothelial cells. Increased plasma UII concentration was observed in patients with heart failure, liver cirrhosis, diabetic nephropathy and renal insufficiency. In patients with myocardial infarction both increased and decreased plasma UII concentrations were demonstrated. The aim of this study was to analyze whether plasma UII concentration reflects the severity of acute coronary syndrome (ACS). Material and methods One hundred and forty-nine consecutive patients with ACS, without age limit, were enrolled in the study. In all patients plasma concentration of creatinine, creatine kinase isoenzyme MB (CK-MB), troponin C, N-terminal prohormone of brain natriuretic peptide (NT-pro BNP), and UII were assessed, and echocardiography was performed in order to assess the degree of left ventricular hypertrophy, ejection fraction (EF) and mass (LVM). Results In patients with the highest risk (TIMI 5-7) plasma UII concentration was significantly lower than in those with low risk (TIMI 1-2): 2.61±1.47 ng/ml vs. 3.60±2.20 ng/ml. Significantly lower plasma UII concentration was found in patients with increased concentration of troponin C (2.60±1.52 ng/ml vs. 3.41±2.09 ng/ml). There was a significant negative correlation between plasma UII concentration and TIMI score or concentration of troponin C, but not CK-MB. Borderline correlation between plasma UII and ejection fraction (R = 0.157; p=0.063) or NT-proBNP (R = − 0.156; p=0.058) was found. Conclusions Decreased plasma urotensin II concentration in patients with ACS could be associated with more severe injury of myocardium.

Long-term effects of lipase inhibition by orlistat on gastric emptying and orocecal transit time of a solid meal

BackgroundWe assessed the impact of a prolonged lipase inhibition upon gastric emptying (GE) and orocecal transit time (OCTT) of a 355-kcal low-fat solid meal.MethodsIn double-blind manner, 40 obese women BMI > 30 kg/m2, randomly allocated into two equal groups, took orally t.i.d. 120 mg orlistat or placebo during 8 weeks of a weight-reducing management. At randomization and after 2 months, GE was measured simultaneously with OCTT by means of a 13C-octanoic acid and a hydrogen breath test, respectively. Lipolytic activity was evaluated with a 13C-mixed triglyceride breath test (13C-MTGBT).ResultsA profound lipase inhibition by orlistat was confirmed by a 79.5% ± 16.9% reduction of the cumulative 6-h 13C recovery with 13CMTGBT. GE remained unchanged either in the orlistat (T1/2, 188 ± 35 min start versus 198 ± 36 min end) or the placebo (T1/2, 191 ± 35 min start versus 180 ± 39 min end) group. OCTT increased from 208 ± 54 min to 271 ± 64 min (P < 0.01) after orlistat treatment and did not change significantly (216 ± 76 vs. 234 ± 72 min) in the placebo group.ConclusionsNo adverse effect on the GE and a moderate prolongation of the OCTT of a low-fat solid meal is to be expected under a prolonged treatment with orlistat at a typical dosage regimen.

Alexithymia, depression, anxiety and binge eating in obese women

Background and Objectives: Alexithymia is a personality trait that may affect the development and course of obesity and effectiveness of treatment. The aim of the study is to assess the prevalence of alexithymia in obese women beginning a weight reduction program and determine the relationships between alexithymia and anxiety, depression, and binge eating. Methods: Obese women (n = 100; age 45 ± 13 yr) completed the following self-report inventories: Toronto Alexithymia Scale (TAS 26), Hospital Anxiety and Depression Scale (HADS), and Binge Eating Scale (BES). Results: Alexithymia was found in 46 patients and was more frequent among women who had attained only primary and vocational education than in those with a higher education level (39.1% vs. 10.9%; p = 0.002) and in those >45 years old than in younger women (30.4% vs. 69.6%; p = 0.03). The frequency of severe depression symptoms was higher in alexithymic women than in non-alexithymic women (19.6% vs. 5.6%; p = 0.03); however, the anxiety state was equally prevalent in both subgroups. The prevalence of alexithymia (52.6% vs. 44.4%) and its level (73.2 ± 8.9 vs. 71.2 ± 11.3 points) were similar in women with and without binge eating disorder. Multivariate mixed linear regression analysis revealed that higher body mass index was associated with primary and vocational education (odds ratio [OR] = 16.69) and severe depression symptoms (OR = 52.45), but not alexithymia.