European Guidelines for Obesity Management in Adults

Obesity is a chronic metabolic disease characterised by an increase of body fat stores. It is a gateway to ill health, and it has become one of the leading causes of disability and death, affecting not only adults but also children and adolescents worldwide. In clinical practice, the body fatness is estimated by BMI, and the accumulation of intra-abdominal fat (marker for higher metabolic and cardiovascular disease risk) can be assessed by waist circumference. Complex interactions between biological, behavioural, social and environmental factors are involved in regulation of energy balance and fat stores. A comprehensive history, physical examination and laboratory assessment relevant to the patient's obesity should be obtained. Appropriate goals of weight management emphasise realistic weight loss to achieve a reduction in health risks and should include promotion of weight loss, maintenance and prevention of weight regain. Management of co-morbidities and improving quality of life of obese patients are also included in treatment aims. Balanced hypocaloric diets result in clinically meaningful weight loss regardless of which macronutrients they emphasise. Aerobic training is the optimal mode of exercise for reducing fat mass while a programme including resistance training is needed for increasing lean mass in middle-aged and overweight/obese individuals. Cognitive behavioural therapy directly addresses behaviours that require change for successful weight loss and weight loss maintenance. Pharmacotherapy can help patients to maintain compliance and ameliorate obesity-related health risks. Surgery is the most effective treatment for morbid obesity in terms of long-term weight loss. A comprehensive obesity management can only be accomplished by a multidisciplinary obesity management team. We conclude that physicians have a responsibility to recognise obesity as a disease and help obese patients with appropriate prevention and treatment. Treatment should be based on good clinical care, and evidence-based interventions; should focus on realistic goals and lifelong multidisciplinary management. (C) 2015 S. Karger GmbH, Freibur

A new gilded age : wealth accumulation in the modern world

Issues of wealth inequality have been the subject of considerable public interest and inquiry in recent years. The Great Recession of 2008 in the United States (US) made many question the extent to which the global economic system not only caused economic hardship but also managed to create a class of ultra-rich in the US and across the globe. Much focus in popular discourse has centred on the degree to which a group of individuals is able to wield enormous economic influence with a concomitant concentration of wealth holdings. In general, mainstream economics has largely played down this aspect of the capitalist system; instead, the poverty aspect of wealth distribution has garnered the attention of most economists. This thesis seeks to establish the ultra-rich as an area worthy of study by focusing on various dimensions that have affected wealth accumulation and brought about an era of unprecedented concentration of wealth at a global level. As a project largely bereft of contemporary prior work, the thesis seeks to explore and establish three key elements of modern wealth accumulation, particularly in its extreme form. Firstly, what are the general trends that signify the emergence of an economic elite across the globe, how has this elite evolved, and how are they distributed across countries and sectors of the economy? Here, the analytical approach adopted is one often utilised in historical economic studies of, for example, the US Gilded Age of the late 1800s. Major findings include that the US continues to lead the world in the generation of individuals with extreme wealth holdings, followed by Western Europe. Developing countries, however, provide a substantial portion of the increases observed. Inheritance continues to play a major role in the existence of billionaires in many regions of the globe, but its role has diminished at a global level, mainly driven by the influx of nouveau riche from China and Russia, as well as from the US. The majority of new wealth is concentrated in finance and real estate, followed by the consumer discretionary sector. These trends observed both before and after the Global Financial Crisis (GFC) of 2008. Further, the data reveal a high degree of survival among the great fortunes, and especially of fortunes based on finance. Secondly, the determinants of wealth accumulation are explored. Utilising an accounting identity of household wealth, issues of savings and consumption, financialisation, the structure of top incomes, particularly the relative importance between capital and earned income are considered. Across all facets, the wealthy increasingly exhibit and exploit behaviours and actions that ensure persistence of their wealth stock while the poorest are being further disadvantaged. Thirdly, the empirical research in this thesis also considers the role of risk aversion and whether it varies with the level of wealth observed. Applying a mean-variance-based measure of relative risk aversion (RRA) to an Australian household micro panel derived from the Household, Income and Labour Dynamics in Australia1 (HILDA) survey, the level of risk aversion of Australia’s household financial portfolios is estimated. Controlling for various socio-economic characteristics, the present study explores whether risk aversion heterogeneity is a function of wealth heterogeneity. In contrast to most studies, it finds evidence of very high risk aversion among the majority of poor households but vastly lower risk aversion among the high percentiles in the wealth distribution. After applying a first differences model across three survey waves spanning 2002 to 2010, risk tolerance is found to increase significantly with wealth. Risk tolerance is positively associated with mortgage payments, but rental payments have no relationship. In addition, there is no evidence that holding a university education has any discernible impact on risk aversion. The study also elicited some preliminary findings on the impact of financial advice on observed risk aversion. Financial advice is found to accentuate risk aversion, particularly among the wealthiest households. These findings have potential implications for the distribution of wealth in Australia, which has received renewed interest. Finally, the sources of wealth across seven advanced economies are explored, with particular emphasis on the role of new and inherited wealth. Despite the consistent increases in the ultra-rich across these countries, there is a significant element of heterogeneity in the degree to which inheritance or new wealth dominates in a given country or region. Further, there is an element of variation in terms of the extent of the role of certain sectors in the rise of the ultra-rich. Across North America, financial services have played the dominant role in bolstering the population of billionaires, with much of the growth in diversified financials followed by property. This thesis seeks to situate the trends within the context of the sweeping historical macroeconomic, social and institutional changes that have been wrought particularly since the end of the Second World War

Nonclassic lipoid congenital adrenal hyperplasia masquerading as familial glucocorticoid deficiency

Context: Familial glucocorticoid deficiency (FGD) is an autosomal recessive disorder resulting from resistance to the action of ACTH on the adrenal cortex. Affected individuals are deficient in cortisol and, if untreated, are likely to succumb to hypoglycemia and/or overwhelming infection. Mutations of the ACTH receptor (MC2R) and the melanocortin 2 receptor accessory protein (MRAP), FGD types 1 and 2 respectively, account for approximately 45% of cases. Objective: A locus on chromosome 8 has previously been linked to the disease in three families, but no underlying gene defect has to date been identified. Design: The study design comprised single-nucleotide polymorphism genotyping and mutation detection. Setting: The study was conducted at secondary and tertiary referral centers. Patients: Eighty probands from families referred for investigation of the genetic cause of FGD participated in the study. Interventions: There were no interventions. Results: Analysis by single-nucleotide polymorphism array of the genotype of one individual with FGD previously linked to chromosome 8 revealed a large region of homozygosity encompassing the steroidogenic acute regulatory protein gene, STAR. We identified homozygous STAR mutations in this patient and his affected siblings. Screening of our total FGD patient cohort revealed homozygous STAR mutations in a further nine individuals from four other families. Conclusions: Mutations in STAR usually cause lipoid congenital adrenal hyperplasia, a disorder characterized by both gonadal and adrenal steroid deficiency. Our results demonstrate that certain mutations in STAR (R192C and the previously reported R188C) can present with a phenotype indistinguishable from that seen in FGD

Bidirectional Psychoneuroimmune Interactions in the Early Postpartum Period Influence Risk of Postpartum Depression

More than 500,000 U.S. women develop postpartum depression (PPD) annually. Although psychosocial risks are known, the underlying biology remains unclear. Dysregulation of the immune inflammatory response and the hypothalamic–pituitary–adrenal (HPA) axis are associated with depression in other populations. While significant research on the contribution of these systems to the development of PPD has been conducted, results have been inconclusive. This is partly because few studies have focused on whether disruption in the bidirectional and dynamic interaction between the inflammatory response and the HPA axis together influence PPD. In this study, we tested the hypothesis that disruption in the inflammatory-HPA axis bidirectional relationship would increase the risk of PPD. Plasma pro- and anti-inflammatory cytokines were measured in women during the 3rd trimester of pregnancy and on Days 7 and 14, and Months 1, 2, 3, and 6 after childbirth. Saliva was collected 5 times the day preceding blood draws for determination of cortisol area under the curve (AUC) and depressive symptoms were measured using the Edinburgh Postpartum Depression Survey (EPDS). Of the 152 women who completed the EPDS, 18% were depressed according to EDPS criteria within the 6 months postpartum. Cortisol AUC was higher in symptomatic women on Day 14 (p = .017). To consider the combined effects of cytokines and cortisol on predicting symptoms of PPD, a multiple logistic regression model was developed that included predictors identified in bivariate analyses to have an effect on depressive symptoms. Results indicated that family history of depression, day 14 cortisol AUC, and the day 14 IL8/IL10 ratio were significant predictors of PPD symptoms. One unit increase each in the IL8/IL10 ratio and cortisol AUC resulted in 1.50 (p = 0.06) and 2.16 (p = 0.02) fold increases respectively in the development of PPD. Overall, this model correctly classified 84.2% of individuals in their respective groups. Findings suggest that variability in the complex interaction between the inflammatory response and the HPA axis influence the risk of PPD

Structure and function of a broad-specificity chitin deacetylase from <i>Aspergillus nidulans </i>FGSC A4

publishedVersio

Effects of intrauterine exposure to synthetic glucocorticoids on fetal, newborn, and infant hypothalamic-pituitary-adrenal axis function in humans : a systematic review

BACKGROUND: Synthetic glucocorticoids are commonly used in reproductive medicine. Fetal organ systems are highly sensitive to changes in the intrauterine environment, including overexposure to glucocorticoids. Structural and functional alterations resulting from such changes may persist throughout life and have been associated with diverse diseases. One system that could be particularly sensitive to fetal glucocorticoid overexposure is the hypothalamic-pituitary-adrenal (hpa) axis. Many human studies have investigated this possibility, but a systematic review to identify consistent, emergent findings is lacking. METHODS: We systematically review 49 human studies, assessing the effects of intrauterine exposure to synthetic glucocorticoids on fetal, neonate, and infant hpa function. RESULTS: Study quality varied considerably, but the main findings held true after restricting the analyses to higher-quality studies: intrauterine exposure to synthetic glucocorticoids reduces offspring hpa activity under unstimulated conditions after pain but not pharmacological challenge. Although reduced unstimulated hpa function appears to recover within the first 2 wk postpartum, blunted hpa reactivity to pain is likely to persist throughout the first 4 months of life. There is some evidence that the magnitude of the effects is correlated with the total amount of glucocorticoids administered and varies with the time interval between glucocorticoid exposure and hpa assessment. CONCLUSIONS: This systematic review has allowed the demonstration of the way in which intrauterine exposure to various regimens of synthetic glucocorticoids affects various forms of hpa function. As such, it guides future studies in terms of which variables need to be focused on in order to further strengthen the understanding of such therapy, whilst continuing to profit from its clinical benefits

An Integrated Framework for Multi-Granular Explanation of Video Summarization

In this paper, we propose an integrated framework for multi-granular explanation of video summarization. This framework integrates methods for producing explanations both at the fragment level (indicating which video fragments influenced the most the decisions of the summarizer) and the more fine-grained visual object level (highlighting which visual objects were the most influential for the summarizer). To build this framework, we extend our previous work on this field, by investigating the use of a model-agnostic, perturbation-based approach for fragment-level explanation of the video summarization results, and introducing a new method that combines the results of video panoptic segmentation with an adaptation of a perturbation-based explanation approach to produce object-level explanations. The performance of the developed framework is evaluated using a state-of-the-art summarization method and two datasets for benchmarking video summarization. The findings of the conducted quantitative and qualitative evaluations demonstrate the ability of our framework to spot the most and least influential fragments and visual objects of the video for the summarizer, and to provide a comprehensive set of visual-based explanations about the output of the summarization process.Comment: Under revie

Emotions and self-esteem as indicators of somatic complaints in children

The literature on somatic complaints in children without a clear physical medical cause often demonstrates connections with various psychological factors, such as negative emotions and problems handling them, poor self-image, and coping potential. We entered these elements into a structural model to elucidate the relationships among them and tested it on 330 children (mean age 10 years and 9 months). The results showed that mood balance contributed most to the prediction of self-reported somatic complaints. Moreover, mood (in combination with anxiety and depression problems) had an indirect impact on children's somatic complaints by influencing self-esteem. The influence and position of coping was less clear. The results are discussed in terms of the 'symptom perception theory'. Copyright © 2006 John Wiley & Sons, Ltd

The individual and combined effects of obesity- and ageing-induced systemic inflammation on human skeletal muscle properties.

BACKGROUND/OBJECTIVES: The purpose of this study was to determine whether circulating pro-inflammatory cytokines, elevated with increased fat mass and ageing, were associated with muscle properties in young and older people with variable adiposity. SUBJECTS/METHODS: Seventy-five young (18-49 yrs) and 67 older (50-80 yrs) healthy, untrained men and women (BMI: 17-49 kg/m(2)) performed isometric and isokinetic plantar flexor maximum voluntary contractions (MVCs). Volume (Vm), fascicle pennation angle (FPA), and physiological cross-sectional area (PCSA) of the gastrocnemius medialis (GM) muscle were measured using ultrasonography. Voluntary muscle activation (VA) was assessed using electrical stimulation. GM specific force was calculated as GM fascicle force/PCSA. Percentage body fat (BF%), body fat mass (BFM), and lean mass (BLM) were assessed using dual-energy X-ray absorptiometry. Serum concentration of 12 cytokines was measured using multiplex luminometry. RESULTS: Despite greater Vm, FPA, and PCSA (P0.05), while IL-8 correlated with VA in older but not young adults (r⩾0.378, P⩽0.027). TNF-alpha correlated with MVC, lean mass, GM FPA and maximum force in older adults (r⩾0.458; P⩽0.048). CONCLUSIONS: The age- and adiposity-dependent relationships found here provide evidence that circulating pro-inflammatory cytokines may play different roles in muscle remodelling according to the age and adiposity of the individual.International Journal of Obesity accepted article preview online, 29 August 2016. doi:10.1038/ijo.2016.151

Factors affecting milk cortisol in mid lactating dairy cows

Background: Whether the measurement of cortisol in dairy cows can be used as a biomarker of adverse environmental or pathophysiological conditions is still under of scientific debate. In these situations, several systems mainly the hypothalamic-pituitary-adrenal axis, the autonomic nervous system, and the immune system are recruited to reestablish homeostasis. A first aim of the present study was to compare milk and blood cortisol concentrations and to consider its variability in milk in relation to farm, milk yield and days in milk. A second study investigates the effects of breed, class of somatic cell count (SCC) and farm on milk cortisol levels in a larger number of cows and farms, with the aim to validate the results obtained in the pilot study. Methods: For study 1, 135 cows were sampled from 2 Italian Simmental and 2 Italian Holstein commercial farms, whilst in the second study, 542 cows were sampled from 6 commercial farms of Italian Simmental and 499 cows from 4 commercial farms of Italian Holstein. Results: In study 1, the values of cortisol content in milk were significantly higher in Holstein than Simmental cows. Significant differences between farms were observed for milk and plasma cortisol concentrations. Cortisol content in milk was not correlated to plasma content in study 1 and the mean milk to plasma cortisol ratio was about 1:30. In study 2, for Holstein cows, significantly higher values of milk cortisol in comparison to Simmental cows was reported. A significant effect of class of SCC was observed, cows belonging to class 3 (SCC higher than 400.000/ml) showed the highest mean values of milk cortisol. The farm effect was significant also in the study 2, confirming the results obtained in the first study. Conclusions: Milk can be considered a preferential site of sampling in dairy cows to point out short term stimulation of the hypothalamic-pituitary-adrenal axis. Further studies are needed to investigate the physiological basis of the relationship between milk cortisol content and bree