Tuesday, July 8, 2014

Does BMI Underestimate Adiposity in Kids?

sharma-obesity-kids-scale2Regular readers are well aware of my reservations regarding the use of BMI as a diagnostic parameter in clinical practice. After all, while BMI may tell us how big someone is, it certainly is not a good measure of how sick someone is.

But to be honest, BMI was never intended as a measure of disease – it was (at best) introduced as a surrogate measure of adiposity (fatness).

Nevertheless, supporters of BMI continue to argue that it is still a good measure of fatness and as such should remain part of standard assessment – even in kids.

Now, a paper by Javed and colleagues, published in Pediatric Obesity, examines how well BMI performs as a means to identify obesity as defined by body fatness in children and adolescents.

The authors conducted a systematic review and meta-analysis of 37 studies in over 53,000 participants assessing the diagnostic performance of BMI to detect adiposity in children up to 18 years.

While the commonly used BMI cut-offs for obesity showed showed a high specificity (0.93) to detect high adiposity, the sensitivity was much lower (0.73) – particularly in boys.

This means that kids who exceed the current BMI cut-offs are indeed very likely to have fatter bodies (for what it’s worth).

On the other hand, relying on BMI cut-offs alone will miss as many as 25% of kids whose body fat percentage exceeds current definitions of adiposity.

Thus, assuming that bod fatness or adiposity is indeed a clinically useful measure of health, the use of BMI alone will ‘underdiagnose’ adiposity in a significant proportion of kids (especially boys) who may well be at risk from excess fat.

A word of caution about fatness is certainly in order – as in adults, much depends on exactly where the fat is located (abdominal or ectopic vs. subcutaneous) and other factors (e.g. cell size, inflammation, insulin sensitivity, etc.).

Thus, even if BMI was a perfect measure of body fat, it would probably still require further examinations and tests to determine exactly whether or not this “extra” fat poses a health risk.

As in adults, a clinical staging system similar to the Edmonton Obesity Staging System may be a fat better indicator of determining which kids may need to worry about their body fat and which don’t.

@DrSharma
Edmonton, AB

Hat tip to Kristi Adamo for pointing me to this study

ResearchBlogging.orgJaved A, Jumean M, Murad MH, Okorodudu D, Kumar S, Somers VK, Sochor O, & Lopez-Jimenez F (2014). Diagnostic performance of body mass index to identify obesity as defined by body adiposity in children and adolescents: a systematic review and meta-analysis. Pediatric obesity PMID: 24961794

.

VN:F [1.9.22_1171]
Rating: 0.0/10 (0 votes cast)
VN:F [1.9.22_1171]
Rating: 0 (from 0 votes)


Tuesday, June 24, 2014

Time To Go Nuts About Nuts?

sharma-obesity-nutsNuts are reportedly chock full of all kinds of nutrients and are probably among the healthiest of snacks. However, they are also among the most calorie-dense foods – a small handful of nuts (~30 g) can easily add up to 150-200 cals.

So, do high consumers of nuts run the risk of weight gain?

This issue is discussed in depth by Sze Yen Tan and colleagues in a paper published in the American Journal of Clinical Nutrition, in which they review the effects of nuts on appetite, food intake, metabolism, and body weight.

While eating nuts may not exactly lead to weight loss, most studies find that consumption of “extra” calories as nuts leads to substantially less weight gain than may be expected based on their caloric content.

Their review reflect a number of ways in which nuts may have this effect:

Effect on hunger and appetite:

“…nut ingestion suppresses hunger and desire to eat and promotes fullness. These sensations may aid dietary compensation that offsets much of the energy contributed by nuts. However, strong compensation can also occur independently of reported appetitive effects. This may reflect imprecision in appetite measurement or a truly independent uncharacterized mechanism.”

Mastication (chewing):

“Nuts require considerable oral processing effort and this may, in part, account for the often-noted less-than-predicted effect of their consumption on body weight. The mechanical act of chewing reportedly generates satiation signals through cognitive, neural, endocrine, and physical (eg, gastric emptying) mechanisms; augments cephalic phase responses linked to appetite; influences digestion efficiency; modestly increases energy expenditure; and elicits dietary compensation.”

Nutrient absorption:

“A number of studies have evaluated the efficiency of energy absorption from ground and tree nuts through feeding trials. All showed substantive increases in fecal fat loss with nut consumption, although the values ranged widely from ∼5% to >20%”

Energy expenditure:

“Collectively, there is some evidence that nut consumption increases thermogenesis, but the data are not robust and there is no clear mechanism. One possibility is that the lipid from nuts is absorbed over a prolonged period of time, leading to a small but sustained source of substrate that fuels thermogenesis and could appear as an increase in REE.”

Fat metabolism:

“It has been proposed that nut consumption elevates fat oxidation and preferentially reduces body fat mass, especially in the viscera. These actions are attributed to their high unsaturated fat content….Human studies incorporating different nuts into the diet at realistic doses are needed to determine the effect of nut consumption on body composition.”

With regard to impact on body weight, the authors reach the following conclusions:

Adding nuts to habitual diets:

“Although there are reports of small, but significant increases in body weight with nut consumption, the preponderance of evidence indicates that under controlled or free-living situations, nut consumption does not promote weight gain.”

Eating nuts in calorie-restricted diets:

“The inclusion of nuts in energy-restriction regimens does not impede weight loss. In several trials in which nuts did not augment weight loss, there was a reduction in cardiovascular disease risk indexes in the nut-consuming groups, suggesting that such benefits derive from properties of the nuts rather than just weight change.”

Eating nuts in weight maintenance:

“Several studies assessing the role of nut consumption in weight-maintenance programs have noted a decrease in body weight from baseline. Whether this is due to a greater thermic effect of food or REE effect of the nuts compared with the foods they displaced in the diet has not been established. Nevertheless, current data indicate that the inclusion of nuts in a weight-maintenance program will not lead to weight gain and may aid weight loss.”

Thus, in summary, the authors conclude that,

“…evidence indicates that they pose little challenge to and may even aid weight management. This is attributable to the strong dietary compensation effects they elicit, inefficiency in the absorption of the energy they provide, and possibly an elevation of energy expenditure and fat oxidation.”

As a general caveat to all of these data, it needs to be noted that results varied widely depending on the types of nuts and how exactly these nuts were consumed (e.g. as snacks or added to meals – the former often being more favourable than the latter).

Also, many of the studies had relatively small number of participants and were of rather short duration.

Nevertheless, it does appear that going nuts about nuts may not be quite as detrimental to your weight as their energy content would suggest.

@DrSharma
Toronto, ON

ResearchBlogging.orgTan SY, Dhillon J, & Mattes RD (2014). A review of the effects of nuts on appetite, food intake, metabolism, and body weight. The American journal of clinical nutrition, 100 (Supplement 1) PMID: 24920033

 

.

VN:F [1.9.22_1171]
Rating: 10.0/10 (3 votes cast)
VN:F [1.9.22_1171]
Rating: +1 (from 1 vote)


Wednesday, June 18, 2014

4th Canadian Obesity student Meeting (COSM 2014)

Uwaterloo_sealOver the next three days, I will be in Waterloo, Ontario, attending the 4th biennial Canadian Obesity Student Meeting (COSM 2014), a rather unique capacity building event organised by the Canadian Obesity Network’s Students and New Professionals (CON-SNP).

CON-SNP consist of an extensive network within CON, comprising of over 1000 trainees organised in about 30 chapters at universities and colleges across Canada.

Students and trainees in this network come from a wide range of backgrounds and span faculties and research interests as diverse as molecular genetics and public health, kinesiology and bariatric surgery, education and marketing, or energy metabolism and ingestive behaviour.

Over the past eight years, since the 1st COSM was hosted by laval university in Quebec, these meetings have been attended by over 600 students, most presenting their original research work, often for the first time to an audience of peers.

Indeed, it is the peer-led nature of this meeting that makes it so unique. COSM is entirely organised by CON-SNP – the students select the site, book the venues, review the abstracts, design the program, chair the sessions, and lead the discussions.

Although a few senior faculty are invited, they are largely observers, at best participating in discussions and giving the odd plenary lecture. But 85% of the program is delivered by the trainees themselves.

Apart from the sheer pleasure of sharing in the excitement of the participants, it has been particularly rewarding to follow the careers of many of the trainees who attended the first COSMs – many now themselves hold faculty positions and have trainees of their own.

As my readers are well aware, I regularly attend professional meetings around the world – none match the excitement and intensity of COSM.

I look forward to another succesful meeting as we continue to build the next generation of Canadian obesity researchers, health professionals and policy makers.

You can follow live tweets from this meeting at #COSM2014

@DrSharma
Waterloo, Ontario

VN:F [1.9.22_1171]
Rating: 10.0/10 (1 vote cast)
VN:F [1.9.22_1171]
Rating: +1 (from 1 vote)


Thursday, June 12, 2014

Lack of Oxygen Can Trigger Adipose Tissue Inflammation

sharma-obesity-adipocytes3Lack of oxygen is a well known stressor for any living cell – this is of course also true for fat cells (adipocytes).

But lack of oxygen does not just occur when there is a problem with breathing or blood flow. Lack of oxygen (hypoxia) can also occur a the cellular level, when the cellular oxygen demand exceeds supply.

According to what may well be considered  a “landmark” paper by Lee and colleagues, published in CELL, it appears that increased adipocyte oxygen consumption may be the key trigger of molecular changes that cause local inflammation and systemic insulin resistance commonly associated with obesity.

The paper reports on a series of animal studies with diet-induced obesity (through a high-fat diet), demonstrating that with increasing weight gain, adipocyte respiration in the mitochondria becomes “uncoupled” leading to a significant increase in oxygen consumption with relative hypoxia.

This uncoupling appears to be mediated through activation of adenine nucleotide translocase 2 (ANT2), an inner mitochondrial membrane protein, by saturated fatty acids.

The resulting hypoxia, in turn, activates the transcription factor HIF-1α, setting off a pro-inflammatory response which in turn leads to insulin resistance with an increased risk of diabetes.

The researcher also show that blocking either ANT2 or HIF-1α can prevent these events, thereby suggesting new pharmacological targets for alleviating the pro-inflammatory and metabolic consequences of obesity.

Obviously, there is always room for caution in extrapolating animal findings to humans, but this paper is likely to spawn a flurry of similar work in human fat cells.

As cellular hypoxia is more likely to occur the larger the fat cell, these studies also tie in the previous observations of a positive association between adipocyte cell size and metabolic abnormalities.

Certainly a topic we can expect to hear more of in the not too distant future.

@DrSharma
Edmonton, AB

ResearchBlogging.orgLee YS, Kim JW, Osborne O, Oh da Y, Sasik R, Schenk S, Chen A, Chung H, Murphy A, Watkins SM, Quehenberger O, Johnson RS, & Olefsky JM (2014). Increased Adipocyte O2 Consumption Triggers HIF-1α, Causing Inflammation and Insulin Resistance in Obesity. Cell, 157 (6), 1339-52 PMID: 24906151

VN:F [1.9.22_1171]
Rating: 9.5/10 (2 votes cast)
VN:F [1.9.22_1171]
Rating: 0 (from 0 votes)


Wednesday, May 7, 2014

The Colour Of Fat

Brown Fat Cells in White Fat Tissue

Brown Fat Cells in White Fat Tissue

As a regular reader you will be well aware that body fat is not body fat. Much depends on its exact location, but also on the cellular structure and biological function of the different types of fat depots.

This is the subject of a paper by Brian Owens, a science editor from New Brunswick, Canada, published in the recent Nature Outlook supplement on Obesity.

Although, the predominant form of fat tissue in humans is white fat (which, is in fact yellow), we also have other types of fat cells that are either brown or beige.

While the primary function of white fat cells is to store fat, brown(ish) fat cells specialize in burning it.

This may lead us to believe that brown fat cells are the “good guys” whereas white fat cells are the “bad guys” but this could not be further from the truth.

As Owens explains (quoting Patrick Seale), the white fat cells actually play a key role in keeping us safe from the ill-effects of excess fat by safely sequestering it away:

“Healthy white fat protects the body by providing a ‘safe home’ for lipids, which can be toxic to other tissues such as muscle or the liver. So these fat cells hold on to the lipids until the energy they are storing is needed, when they release them into the blood.”

Thus, white fat actually plays an important role in protecting us from metabolic disease. This is most evident in people who genetically (or in the case of anti-retroviral treatment) lack sufficient white fat cells. These folks end up depositing their excess fat in those other tissues (e.g. liver, pancreas, muscle, etc), thereby causing exactly the same metabolic problems that are commonly associated with obesity.

So why do some people with excess white fat develop these problems?

Here Owens quotes Philipp Scherer, who explains that cell size may have something to do with this:

“Problems arise when white fat cells store too much lipid. They begin expanding and proliferating rapidly in a process that resembles the growth of a solid tumour….The blood supply cannot keep up with this expansion, and the cells begin to suffer from lack of oxygen. This hypoxia attracts the protein HIF-1α, which in fat tissue stimulates the extracellular matrix surrounding the cells, leading to fibrosis. The huge, oxygen-starved fat cells do not have enough room to expand and get squeezed to death, releasing their lipid cargo. As the cells start to die, macrophages swarm to the fat depots to try and clean up the mess by carrying away the lipid droplets. The problem is that the macrophages cannot clear up the lipids fast enough, and so they begin to spill over into other tissues, such as the liver and pancreas.”

As for brown fat – it has a completely different function, namely to help regulate body temperature by burning off calories to generate heat.

But researchers have discovered yet an additional type of fat cell – one that lies some where between typical white and brown fat. In fact, it seems that most the brown fat in humans is actually beige – these seem to be cells recruited from white fat depots that transform themselves into “brownish” cells with certain stimuli (e.g. cold exposure, physical exercise).

These beige cells may also be important protectors against metabolic disease. The article quotes work by Bruce Spiegelman showing that selectively disabling beige fat in mice by targeting the protein PRDM16, which is found only in these cells, leaving the white and brown fat intact leads to animals with severe metabolic dysfunction — obesity, insulin resistance and fatty livers.

Thus it appears that the loss of the beige fat destroys the protective abilities of subcutaneous white fat – at least in mice.

If nothing else, these studies show that we have yet much to learn about fat cells. In fact, there may be other subtypes of fat cells specific to the different fat depots in the body (of which there are many), that may each have their unique importance and functions.

Whether or not we can harness this new knowledge to find better treatments for obesity remains to be seen – simply destroying fat cells willy-nilly can certainly do more harm than good.

@DrSharma
New York, NY

VN:F [1.9.22_1171]
Rating: 10.0/10 (5 votes cast)
VN:F [1.9.22_1171]
Rating: +4 (from 4 votes)

In The News

Diabetics in most need of bariatric surgery, university study finds

Oct. 18, 2013 – Ottawa Citizen: "Encouraging more men to consider bariatric surgery is also important, since it's the best treatment and can stop diabetic patients from needing insulin, said Dr. Arya Sharma, chair in obesity research and management at the University of Alberta." Read article

» More news articles...

Publications

  • Subscribe via Email

    Enter your email address:

    Delivered by FeedBurner




  • Arya Mitra Sharma
  • Disclaimer

    Postings on this blog represent the personal views of Dr. Arya M. Sharma. They are not representative of or endorsed by Alberta Health Services or the Weight Wise Program.
  • Archives

     

  • RSS Weighty Matters

  • Click for related posts

  • Disclaimer

    Medical information and privacy
    Any medical discussion on this page is intended to be of a general nature only. This page is not designed to give specific medical advice. If you have a medical problem you should consult your own physician for advice specific to your own situation.


  • Meta

  • Obesity Links

  • If you have benefitted from the information on this site, please take a minute to donate to its maintenance.

  • Home | News | KOL | Media | Publications | Trainees | About
    Copyright 2008–2014 Dr. Arya Sharma, All rights reserved.
    Blog Widget by LinkWithin