Nicoletta Marazzi

Relationship between basal metabolic rate, gender, age, and body composition in 8,780 white obese subjects.

The objective of the present study was to explore the relationship between basal metabolic rate (BMR), gender, age, anthropometric characteristics, and body composition in severely obese white subjects. In total, 1,412 obese white children and adolescents (BMI > 97° percentile for gender and age) and 7,368 obese adults (BMI > 30 kg/m2) from 7 to 74 years were enrolled in this study. BMR was measured using an indirect calorimeter equipped with a canopy and fat free mass (FFM) were obtained using tetrapolar bioelectrical impedance analysis (BIA). Using analysis of covariance, we tested the effect of gender on the relationship between BMR, age, anthropometry, and body composition. In children and adolescents, the predictor × gender interaction was significant in all cases except for FFM × gender. In adults, all predictor × gender interactions were significant. A prediction equation based on body weight (BW), age, and gender had virtually the same accuracy of the one based on FFM, age, and gender to predict BMR in both children and adults (R2adj = 0.59 and 0.60, respectively). In conclusion, gender was a significant determinant of BMR in children and adolescents but not in adults. Our results support the hypothesis that the age‐related decline in BMR is due to a reduction in FFM. Finally, anthropometric predictors of BMR are as accurate as body composition estimated by BIA.

Prediction of resting energy expenditure in severely obese Italian women

The aims of the present study were to develop and cross-validate new equations for predicting resting energy expenditure (PREE) in severely obese Italian women, and to compare their accuracy with those of the Harris-Benedict, Bernstein, WHO/FAO/UNU, Owen, Mifflin, Nelson, Siervo, Huang and Livingston equations to predict REE, using the Bland-Altman method. One hundred and eighty two women [mean body mass index (BMI) 45.6 kg/m2; 56.7% fat mass (FM)], aged 19 to 60 yr participated in this study. REE was measured by indirect calorimetry and body composition by bioelectrical analysis. Equations were derived by stepwise multiple regression analysis, using a calibration group and tested against the validation group. Two new specific equations based on anthropometric REE=Weigh tx0.042+Heightx3.619-2.678 (R2=0.66, SE=0.56 MJ) or body composition parameters REE=FF Mx0.067+FMx0.046+1.568 (R2=0.63, SE=0.58 MJ) were generated. Mean PREE were no different from the mean measured resting energy expenditure (MREE) (<1%, p>0.800) and REE was predicted accurately (95–105% of MREE) in 60% of subjects. The WHO/FAO/UNU, Harris-Benedict and Siervo equations showed mean differences <2% and PREE was accurate in <44% of subjects. The Huang, Mifflin and Livingston equations showed a mean PREE underestimation (>5.0%, p<0.001) and PREE was accurate in <38% of subjects. The Owen, Bernstein and Nelson equations showed a greater PREE underestimation (>14%, p<0.001 ) in >90% of subjects. The new prediction equations allow an accurate estimation of REE in groups of severely obese women and result in lower mean differences and lower limits of agreement between PREE and MREE than commonly used equations.

The relationship between body composition and muscle power output in men and women with obesity

In order to investigate the effect of gender, age and level of obesity on body composition and anaerobic power output, and to test the hypothesis that variation in body composition affects muscle power output in obesity, a cohort of 377 subjects (112 males and 265 females, aged 18–75 yr) with different levels of obesity [class IIII, body mass index (BMI) range: 30.6–60.3 kg mp−2] was cross-sectionally investigated. Body composition was assessed with bioelectric impedance analysis (BIA), in standardized conditions and using obesity-specific prediction formulas. Lower limb anaerobic power output (W ? ) was measured with a modification of the Margaria stair climbing test. In males, a similar increase in fat-free mass (FFM) and fat mass (FM) was observed as a function of BMI, while in females, FM increased more than FFM. In both genders, FFM significantly decreased as a function of age (p<0.001), but was higher in men of all ages. Similar patterns of variation were observed in W. A differently significant correlation between BMI and W was observed between men and women, and it was found by multivariate analysis of variance (MANOVA) that W ? was affected negatively by age (p<0.001) and positively by BMI (p<0.001) in males, while in females only age had a significant effect (p<0.001) but not BMI. A positive correlation (p<0.001) was detected between FFM and .W, in both genders. .W per unit body mass, the actual muscle power for rapid external work, was higher in men than in women of all groups, and decreased with age in both genders, but only in older women decreased significantly (p<0.01) depending on BMI. It is concluded that the gender-dependent pattern of variation in body composition may be an important determinant of the different motor limitations observed in men and women. Older women (≥50 yr) with extreme obesity (class III) suffered from the most serious motor dysfunction within this obese cohort. This result may have important clinical relevance in the care of obesity.

Growth hormone abuse: methods of detection

In the past two decades, growth hormone (GH) has been considered as a performance-enhancing drug in the sport world, certainly favoured by the awareness that there is not yet an approved method for detecting its abuse. Because resting or random measurements of plasma GH concentrations per se are meaningless, new methods have been devised to evaluate plasma levels of GH-sensitive substances that are more stable, and hence detectable, than the hormone itself. This review discusses some of the most recently proposed approaches, including a diagnostic algorithm, based on the timed application of different tests, which, collectively, would have a high diagnostic capability.

Combined evaluation of resting IGF‐I, N‐terminal propeptide of type III procollagen (PIIINP) and C‐terminal cross‐linked telopeptide of type I collagen (ICTP) levels might be useful for detecting inappropriate GH administration in athletes: a preliminary report

objective  To verify whether combined measurements of GH‐dependent parameters might be useful in detecting exogenous recombinant GH (rGH) administration in male athletes from different disciplines.

Comparison of dual-energy X-ray absorptiometry, air displacement plethysmography and bioelectrical impedance analysis for the assessment of body composition in morbidly obese women

Background/Objectives:We evaluated the agreement of air displacement plethysmography (ADP) and bioelectrical impedance analysis (BIA) with dual-energy X-ray absorptiometry (DXA) for the assessment of percent fat mass (%FM) in morbidly obese women.Subjects/Methods:Fifty-seven women aged 19–55 years and with a body mass index (BMI) ranging from 37.3 to 55.2 kg/m2 were studied. Values of %FM were obtained directly from ADP and DXA, whereas for BIA we estimated fat-free mass (FFM) from an equation for morbidly obese subjects and calculated %FM as (weight−FFM)/weight.Results:The mean (s.d.) difference between ADP and DXA for the assessment of %FM was −2.4% (3.3%) with limits of agreement (LOA) from −8.8% to 4.1%. The mean (s.d.) difference between BIA and DXA for the assessment of %FM was 1.7% (3.3%) with LOA from −4.9% to 8.2%.Conclusion:ADP–DXA and BIA–DXA are not interchangeable methods for the assessment of body composition in morbidly obese women.

Anorexigenic postprandial responses of PYY and GLP1 to slow ice cream consumption: preservation in obese adolescents, but not in obese adults.

OBJECTIVE Eating slowly increases the postprandial responses of some anorexigenic gut hormones in healthy lean subjects. As the rate of food intake is positively associated with obesity, the aim of the study was to determine whether eating the same meal at different rates evokes different postprandial anorexigenic responses in obese adolescent and adult subjects. DESIGN AND METHODS Eighteen obese adolescents and adults were enrolled. A test meal was consumed on two different sessions by each subject, meal duration taking either 5  min (fast feeding) or 30  min (slow feeding). Circulating levels of glucagon-like peptide 1 (GLP1), peptide YY (PYY), glucose, insulin, and triglycerides were measured over 210  min. Visual analog scales were used to evaluate the subjective feelings of hunger and satiety. RESULTS fast feeding did not stimulate GLP1 release in obese adolescent and adults, whereas slow feeding increased circulating levels of GLP1 only in obese adolescents. Plasma PYY concentrations increased both in obese adolescents and in adults, irrespective of the eating rate, but slow feeding was more effective in stimulating PYY release in obese adolescents than in adults. simultaneously, slow feeding evoked a higher satiety only in obese adolescents compared with fast feeding but not in obese adults. in obese adolescents, slow feeding decreased hunger (only at 210 min). irrespective of the eating rate, postprandial responses of insulin and triglycerides were higher in obese adults than in obese adolescents. CONCLUSION Slow feeding leads to higher concentrations of anorexigenic gut peptides and favors satiety in obese adolescents, but this physiological control of food intake is lost in obese adults.

A follow-up of GH-dependent biomarkers during a 6-month period of the sporting season of male and female athletes.

In order to verify the effects of the sporting season (entailing periods of training, competition, recovery, resting) on GH-dependent parameters in male and female athletes from different sporting disciplines, 47 male and female athletes (3 rowers, 5 swimmers, 7 alpine skiers, 3 soccer players, 7 middle distance runners, 14 sprinters, 4 triathletes, 1 road walker, 3 cyclists) were followed-up for a period of 6 months. Blood samples were taken every two months for the evaluation of IGF-I, N-terminal propeptide of type III procollagen (PIIINP) and C-terminal cross-linked telopeptide of type I collagen (ICTP). Abnormal IGF-I, PIIINP and ICTP levels were observed during the follow-up period in 7/100 (7%), 9/100 (9.0%) and 8/100 (8%) samples of the male group, respectively, and in 9/88 (10.2%), 1/88 (1.1%) and 0/88 (0%) samples of the female group, respectively. Abnormal levels appeared to be randomly distributed over the different periods of the sporting season and within male and female subjects, with the large majority of abnormal values being found in the younger athletes. Taking into account all the tests done during the 6-month period (no. 564), individual markers falling outside the normal range (for age) were observed in a small number of instances (34/564 tests done, 24/300 for males and 10/264 for females). When our method for the detection of exogenous recombinant GH (rhGH) administration, based on the concomitant determination of these three peripheral GH-dependent markers and on the attribution of specific scores, was applied in the same athlete at a given time point of the 6-month period, the prevalence of a positive score was extremely low (ie, 3/188 samples or 1.6%). Total positive scores were actually recorded in only three male athletes (2 swimmers and 1 skier, aged <21 yr) at one occasion during the 6-month period considered. In contrast, no total positive scores were found in female athletes (ie, 0/88 samples). In conclusion, the concentrations of IGF-I, PIIINP and ICTP were stable and not significantly modified during 6 months of a sporting season (entailing periods of training, competition, recovery, resting) in athletes from different sporting disciplines. Therefore our method, based on the concomitant determination of three peripheral GH-dependent biomarkers appears safe, acceptable, relatively inexpensive and repeatable (in case of positive or suspected values) immediately or at different intervals of the sporting season. Further additional studies are requestedto precise the cut-off values for narrower age-class subdivisions in both genders in order to improve the proposed method. (J. Endocrinol. Invest. 29: 237–243, 2006)

Growth hormone and lactate responses induced by maximal isometric voluntary contractions and whole-body vibrations in healthy subjects

Background: In contrast with maximal voluntary resistance exercise, which is allegedly considered a potent GH stimulus in young subjects, evaluation of GH response to whole-body vibrations (WBV) has yielded conflicting results. Methods: The acute effects of WBV alone (test A), maximal voluntary isometric contractions (MVC) (test B), and combination of WBV and MVC (test C) on serum GH and blood lactate (LA) levels were studied in 9 healthy adult males. Muscle soreness was assessed 24 and 48 h after exercise by a visual analogue scale. Results: GH responses were significantly higher after tests B and C than after test A (GH peaks: 18.8±9.5 ng/ml or 20.8±13.7 ng/ml, respectively, vs 4.3±3.5 ng/ml; p<0.05), with no difference between tests B and C. LA concentrations significantly increased after tests A, B, and C, being significantly higher after tests B and C than after test A (LA peaks: 2.0±0.5 mmol/l or 6.7±2.3 mmol/l, respectively, vs 7.6±0.9 mmol/l; p<0.05). Peak LA values were significantly correlated to GH peaks in the 3 tests (r=0.48; p<0.05). Muscle soreness was significantly higher 24–48 h after tests B and C than after test A, no significant differences being present between tests B and C. Conclusions: WBV stimulates GH secretion and LA production, with no additive effect when combined with repeated isometric voluntary contractions. Optimization of protocols based on WBV seems important to maximize the positive effects of this intervention on the somatotropic function. tis

Changes in plasma levels of ghrelin, leptin, and other hormonal and metabolic parameters following standardized breakfast, lunch, and physical exercise before and after a multidisciplinary weight-reduction intervention in obese adolescents

Objective: To investigate in severely obese adolescents the effects of a 3-week multidisciplinary weight-reduction intervention involving moderate energy restriction, individualised physical activity and behavior therapy on the response of some hormonal and metabolic parameters to meals and exercise. Design: Clinical longitudinal study on inpatients in a specialised institution. Subjects: A total of 20 obese adolescents (10 boys and 10 girls) aged 12–17 yr [body mass index (BMI): 37.7±6.1 kg/m2; fat mass (FM): 44.8±13.2 kg]. Measurements: The changes in plasma concentration of leptin, ghrelin, GH, IGF-I, insulin, glucose, and non-esterified fatty acids (NEFA) in response to standardised meals and exercise bouts were measured before and after the weight-reduction intervention. At the same times, body composition was assessed by bioelectrical impedance as well as appetite sensations using a visual analog scale. Results: At the end of the intervention, the adolescents had lost body weight and FM (expressed both in kg and %) (p<0.05), without any significant fat-free mass loss (in % terms). In response to both meals and exercise, after the 3-week intervention, plasma leptin concentration decreased significantly (p<0.05), whereas the other hormones (insulin, ghrelin, GH, and IGF-I) and metabolic parameters (glucose and NEFA) did not change. Interestingly, appetite was not affected by the intervention. Conclusion: This 3-week multidisciplinary intervention in obese adolescents induced a significant body weight loss with beneficial changes in body composition. However, despite there being no change in metabolic parameters and ghrelin in response to meals and exercise after the intervention, plasma concentrations of leptin were decreased. The failure of ghrelin levels to increase by this approach might explain the good control of appetite observed at the end of the study.