Romero‐Corral, Abel

Background Decreases in estrogen are shown to increase body fat in men. However, obese men have high levels of estrogen and the effects of weight gain on estrogen have not been previously investigated. The objective of this study was to investigate the relationship between regional fat depots and estrogen during modest weight in healthy men. Methods We investigated the effects of overfeeding in 25 healthy men (30 ± 7 years, 24.7 ± 3.1 kg/m 2 ). Changes in regional fat depot during weight gain were assessed using dual‐energy X‐ray absorptiometry and abdominal computed tomography scans. Participants gained approximately 5% body weight in 8 weeks. Estrone (E1), 17β‐estradiol (E2) and sex hormone binding globulin (SHBG) were measured at baseline and after weight gain. Results Overfeeding was accompanied by 3.9 ± 1.3 kg weight gain. These increases in weight resulted from increases in total body fat mass (18.3 ± 8.5 vs. 21.7 ± 8.8 kg, p<0.001) while the fat free mass did not change (58.4 ± 8.6 vs. 58.9 ± 8.7 kg, p=0.15). E1 (32.28 ± 14.25 vs. 33.44 ± 12.29 pg/mL, p=0.56) and E2 (25.04 ± 8.3 vs. 26.52 ± 7.8 pg/mL, p=0.28) did not change after weight gain. However, weight gain resulted in decreased SHBG (22.8 ± 10.5 vs. 20.8 ± 11.1 nmol/l, p=0.036) and increased E2/SHBG ratio (1.4 ± 1.0 vs 1.63 ± 1.0, p=0.027). The changes in E2/SHBG ratio, a surrogate marker of bioavailable E2, was positively associated with increases in abdominal fat mass (p=0.048, rho=0.39) and increases in visceral fat mass (p=0.049, rho=0.39). Conclusion Modest weight gain in healthy men does not alter circulating E1 and E2 levels. However weight gain results in decreased SHBG and increased free E2 (E2/SHBG ratio). The increased E2/SHBG ratio suggesting a pro‐estrogen effect is associated with increases in visceral fat mass during weight gain. Our study therefore suggests a complex relationship between abdominal fat gain and free E2 in men which may conceivably predispose to feminizing characteristics in obese men. Support or Funding Information PS is supported by AHA Grant 11SDG7260046 and NIH grant DK81014. NC is supported by AHA grant AHA 13POST16420009. MDJ is supported by NIH grants DK45343 and DK40484. VKS is supported by NIH Grants HL73211, and DK81014. This study was made possible by a grant from NCRR (1UL1 RR024150).

Background: Normal weight adults gain leg fat gain via adipocyte hyperplasia and upper body subcutaneous (UBSQ) fat gain via adipocyte hypertrophy. Objective: To understand whether regional fat loss mirrors fat gain and whether leg fat loss results in decreased adipocyte number vs. size. Design: We assessed UBSQ, leg and visceral fat gain and loss in response to over- and underfeeding in 23 young, healthy normal weight adults (15 men). Participants gained ∼5% weight over 8 weeks and lost ∼80% of gained fat over the following 8 weeks. We measured abdominal subcutaneous and femoral adipocyte size and number after weight gain and loss. Results: Volunteers gained 3.1 ± 2.1 kg of body fat with overfeeding and lost 2.4 ± 1.7 kg with calorie restriction. Although upper body subcutaneous (UBSQ) fat and visceral fat gains were completely reversed with weight loss, leg fat had not yet returned to baseline values by 8 weeks. Abdominal and femoral adipocyte size decreased significantly with weight loss, but the number of adipocytes did not decrease. Abdominal adipocyte size decreases correlated (rho= 0.76, p = 0.001) with UBSQ fat mass decreases and femoral adipocyte size decreases correlated (rho= 0.49, p=0.05) with leg fat mass decreases. Conclusion: UBSQ and visceral fat depots increase and decrease proportionately with short term weight gain and loss, whereas gain and loss of leg fat are less well linked. Loss of lower body fat is due to reduced fat cell size, not number, which may result in long-term increases in leg fat cell number. This may have implications for long-term weight control.

Introduction: Obesity is linked with heightened vulnerability to cardiovascular diseases including hypertension. Nonetheless, mechanistic studies addressing the effects of experimental weight gain on blood pressure are lacking. We sought to examine whether experimental weight gain raises ambulatory blood pressure in healthy individuals and identify any relationship between changes in blood pressure and changes in regional fat distribution. Methods: Twenty-six normal weight subjects were randomized to a 8-week period of weight gain through overfeeding (N=16; age 30.4±6.6 years, BMI 23.5±3.5 kg/m 2 ) or weight maintenance (N=10; age 27.1±7.7 years, BMI 23.6±2.7 kg/m 2 ). Measurements of body composition by dual-energy X-ray absorptiometry and abdominal computed tomographic scans and 24-h ambulatory blood pressure monitoring were obtained at baseline and at follow-up. Results: Overfeeding resulted in an increase in body weight of 3.7±1.5 kg ( p <0.001) in weight gainers, with increments seen in total (21994±8247.4 to 25180.7±8563.1 gr, p <0.001), visceral (61.6±32.7 to 75.5±30.9 cm 2 , p =0.002) and subcutaneous fat (135.5±77.4 to 167.9±82.9 cm 2 , p <0.001). No changes occurred in the maintenance group. Weight gainers exhibited an increase in 24-h systolic blood pressure at follow-up (113.7±8 to 117.7±7.9 mmHg, p =0.009) and mean blood pressure (MAP) (85.1±4.9 to 86.8±5.1 mmHg, p =0.02), while blood pressure was unchanged in controls. Changes in MAP were positively correlated only with changes in visceral fat (rho=0.452, p =0.02) but not with changes in weight or any other body composition measure. Conclusion: Modest weight gain leads to marked elevation in 24-h blood pressure in lean healthy subjects. The association between increased MAP and abdominal visceral fat accumulation suggests that visceral deposition of adipose tissue may contribute specifically and mechanistically to the enhanced risk of hypertension associated with weight gain.

Background Expression of adiponectin, an anti‐atherogenic and insulin‐sensitizing adipokine, is decreased in obesity. Mechanisms underlying this reduction are not well understood. Increased adiponectin in obesity may protect against development of cardiac and metabolic disorders. Objective To investigate the role of leptin in regulating adiponectin expression in humans. Design 1) determining the relationship between leptin and adiponectin in healthy humans during modest weight gain; 2) in‐vitro validation of the role of leptin in adiponectin expression. Results Modest weight gain of 3.8 ± 1.2 kg over 8 weeks of overfeeding in normal weight healthy subjects (n=33, 22 men, 30±7 years) increased both leptin and adiponectin. Changes in leptin during weight gain correlated with changes in adiponectin (rho=0.35, p=0.045), suggesting that leptin may regulate adiponectin expression. In cultured differentiated human white preadipocytes, leptin increased adiponectin mRNA and protein expression. Conclusions Leptin induces adiponectin expression. In obesity, adipose tissue may be resistant to leptin signaling thus preventing increases in adiponectin. Therefore, impaired leptin signaling may contribute to low adiponectin in obesity. Targeting leptin resistance may be beneficial in preventing obesity‐associated cardiac and metabolic disorders. Support : AHA 11SDG7260046, R21 DK81014

Background: Decreased testosterone (TTST) and sex hormone binding globin (SHBG) contribute to development of cardiometabolic disorders in obese men. We aimed to determine the effect of weight gain and weight loss on TTST and SHBG in healthy men and to examine their relationship with endothelial function. Method: 25 normal weight healthy men underwent an overfeeding protocol to gain 5% body weight over 8 weeks. Following weight gain, they underwent 8 weeks of weight loss. TTST, SHBG and endothelial function (brachial artery flow‐mediated dilation, FMD) were measured at baseline (T1), after weight gain (T2) and after weight loss (T3). Results: Volunteers gained 4 ± 1.3 kg and subsequently lost 3.2 ± 1.5 kg of body weight. TTST levels did not change (T1: 18.85 ± 6.2 nmol/L, T2: 19.3 ± 6.9 nmol/L, T3: 20.3 ± 7.6 nmol/L). However, SHBG decreased during weight gain (p=0.04) and increased during weight loss (p=0.0005) (T1: 22.8 ± 10.5 nmol/L, T2: 20.8 ± 11.1 nmol/L, T3: 25.58 ± 11.5 nmol/L). Furthermore, SHBG reduction during weight gain tended to correlate with decreases in FMD (p=0.06; R 2 =0.15). During weight loss, increases in SHBG correlate negatively with changes in FMD (p=0.008; R 2 =0.32). Conclusion : In normal weight healthy men, SHBG decreases with modest weight gain and increases with weight loss. TTST does not change. Changes in SHBG partly predict improvements in endothelial function with weight loss. Grant Funding Source : Supported by AHA 11SDG7260046, R21 DK81014, AHA 13POST16420009

Abstract Background: Differences in body fat (BF) distribution in patients with normal body mass index (BMI) with elevated alanine aminotransferase (ALT) remains poorly described. Objective: To determine the relationship between total BF, waist circumference (WC), insulin resistance (IR), and cardiometabolic risk profile in subjects with elevated ALT and normal BMI. Methods: We analyzed cross-sectional data from 4,914 US participants in the third National Health and Nutrition Examination Survey database, who were ≥20 years of age, had normal BMI, and had body composition assessed by bioimpedance. Results: Mean ± SD age was 41.4 ± 0.3 years, and 58% participants were women. BF was 20 ± 0.1% in men and 29.9 ± 0.1% in women. As total BF increased by tertiles, there was a tendency towards a higher prevalence of nonalcoholic fatty liver disease in men (6.1%, 6.5%, 9.5%, P = 0.13), but not in women (8.7%, 8.2%, 10.7%, P = 0.71). As WC increased by tertiles, there was a higher prevalence of elevated ALT in men (2.6%, 8.6%, 6.6%, P < 0.0001), but not in women. As ALT increased, men had significantly higher levels of nonhigh density lipoprotein cholesterol (HDL-C), increased apolipoprotein B, increased IR, and lower levels of C-reactive protein, whereas, women had higher levels of non-HDL-C and increased IR. Conclusion: In subjects with normal BMI, increased WC is associated with a higher prevalence of elevated ALT in men, but not in women. Higher levels of ALT correlated with a poor cardiometabolic risk profile.

BackgroundTransient left ventricular dysfunction can occur under conditions of extreme emotional or physiological stress. There is little data on right ventricular function in such situations.MethodsOne hundred twenty patients admitted to an ICU with a noncardiac illness were studied. Those with documented coronary disease, ejection fraction <40%, sepsis, or intracranial hemorrhage were excluded. Echocardiograms were performed within 24 hours of admission. Tricuspid annular plane systolic excursion (TAPSE) was measured to assess right ventricular systolic function. Plasma catecholamines (norepinephrine, epinephrine, dopamine) were measured on admission. Clinical and demographic data were collected, along with data on ICU length of stay (LOS), hospital LOS, and in‐hospital and long‐term mortality. TAPSE was tested for correlation with adverse outcomes and length of stay.ResultsMean TAPSE for the group was 2.05 ± 0.66 cm. Based on area under the ROC curve analysis, TAPSE <2.4 cm was the best cutoff for predicting in‐hospital and long‐term mortality. There were 13 in‐hospital deaths, 12 in the group with TAPSE <2.4 cm and one among those with TAPSE ≥2.4 cm. On multivariate analysis, TAPSE <2.4 cm was a significant predictor of in‐hospital mortality (χ2 = 4.6, P = 0.03). When tested against hospital LOS, an inverse correlation was found (P = 0.04). No association was found between TAPSE and catecholamine levels.ConclusionsRight ventricular systolic function, as assessed by TAPSE, has important prognostic value in critically ill patients. Mean values were lower in patients who died in‐hospital versus those who survived to discharge. In addition, patients with TAPSE <2.4 cm had a longer hospital length of stay.