Impacts of Types and Degree of Obesity on Non-Alcoholic Fatty Liver Disease and Related Dyslipidemia in Chinese School-Age Children?

Objective To explore the impacts of types and degree of obesity on non‐alcoholic fatty liver disease （NAFLD） and related lipids disturbance in Chinese school‐age children. Methods A total of 1 452 school‐age Children of 7 to 17 years were recruited in Beijing with representative cluster sampling method. Data of anthropometric measurements including weight, height and waist circumference were collected from March to May of 2007. Body mass index（BMI）was calculated. Blood samples were obtained and lipid profiles including triglyceride （TG）, total cholesterol （TC）, high‐density lipoprotein cholesterol （HDL‐C） and low‐density lipoprotein cholesterol （LDL‐C） were measured, while glutamate‐pyruvate transaminase （ALT） and glutamic‐oxalacetic transaminase （AST） were determined to evaluate liver function. The liver was also scanned by sonography, and abnormal hepatic sonograms were documented. NAFLD was diagnosed according to the criteria recommended by the Fatty Liver and Alcoholic Liver Disease Study Group under the Chinese Liver Disease Association. Analysis of covariance （ANOVA）, Chi‐square test for trend and binary logistic regression analysis were performed. Results The dyslipidemia and ultrasonographic fatty liver deteriorated with the degree of obesity defined either by BMI or waist circumference. Compared with BMI, waist circumference contributed more to the development of dyslipidemia, fatty liver and NAFLD. The highest levels of TG, TC, LDL‐C, and lowest level of HDL‐C were seen in the mixed obese group followed by abdominal obese, peripheral obese and non‐obese ones. Adjusted for gender and age, the odds ratios （ORs） and their 95% confidence intervals of peripheral obesity, abdominal obesity and mixed obesity were 0, 10.93 （0.98‐121.96） and 79.16 （10.95‐572.44） for predicting NAFLD; 12.61 （1.24‐127.78）, 19.39 （5.23‐71.85）, and 93.21 （29.56‐293.90） for predicting ultrasonographic fatty liver; 1.78 （0.59‐5.44）, 3.01 （1.91‐4.77）, and 4.64 （3.52‐6.12） for predicting dyslipidemia, respectively compared with the non‐obese control group. The trend of hazards over groups was statistically significant （P0.01）. Conclusion The levels of lipid profile and the prevalence of NAFLD and dyslipidemia increased in parallel with the degree of obesity; As compared with the non‐obese control, the mixed obesity had the strongest association with NAFLD and dyslipidemia, followed by abdominal obesity and peripheral obesity in Chinese school‐age Children.

Abnormal Adipokines Associated with Various Types of Obesity in Chinese Children and Adolescents

Objective To explore the role of adipokines including insulin, resistin, leptin, adiponectin, acylation stimulating protein （ASP） and complement C3 （C3） in various types of obesity （peripheral obesity, abdominal obesity and mixed obesity） in Chinese children and adolescents, and their relationships with body size and pubertal development. Methods Children and adolescents （n=3 508） aged 6 to 18 years, with 1 788 boys and 1 720 girls were assessed for body mass index, waist circumference, pubertal development, blood insulin, resistin, leptin, adiponectin, ASP and C3 levels. Three types of obesity [peripheral obesity （n=43）, abdominal obesity （n=473）, mixed obesity （n=1 187）] and non‐obese control （n=1 805） were defined with combined use of Chinese body mass index and waist circumference criteria. Results Serum resistin, leptin and adiponectin levels were higher in girls than those in boys （all P0.01）. Insulin and leptin increased and adiponectin decreased across five Tanner stages in both girls and boys （all P0.001）, while ASP changed only in girls （P0.001） and C3 only in boys （P0.001）. Insulin, leptin and ASP were higher, but adiponectin was lower in all three types of obesity vs. the non‐obese control （all P0.05）. The greatest abnormalities of all six adipokines were found in the mixed obesity group. With inclusion of body mass index and waist circumference in simultaneous regression analyses, both body size indices were independently and significantly correlated with insulin, leptin and adiponectin after age and gender adjustment. Compared with waist circumference, the body mass index was stronger in interpreting insulin, leptin, adiponectin and ASP levels, whereas it was weaker in explaining variance of plasma C3. Conclusions Obese children have a worse metabolic profile with high insulin, resistin, leptin, ASP and C3, and low adiponectin levels. The adipokine profile in mixed obesity is worse than that in peripheral or abdominal obesity. Identification of obese subjects with a malignant adipokine profile using a combination of body mass index and waist circumference is important for the prevention of obesity‐related disease.

Advances in Acupuncture and its Associated Therapies for the Prevention and Treatment of Obesity Type 2 Diabetes Mellitus

Obesity type 2 diabetes mellitus is a common metabolic disease in clinical practice,and its prevalence is increasing rapidly with the aging of the population and changes in lifestyle.Acupuncture,as a distinctive therapy,has its unique advantages in the treatment of obesity type 2 diabetes and has an irreplaceable role in a variety of treatment methods.The author organized the literature on acupuncture and its related therapies to prevent and treat obesity type 2 diabetes in recent years and found that acupuncture and its associated therapies to prevent and treat obesity type 2 diabetes mainly include:simple acupuncture,electroacupuncture,acupoint catgut embedding therapy,auricular-plaster therapy and other treatments,all of which can safely and effectively improve clinical symptoms,acupuncture and its related therapies to treat obesity type 2 diabetes has a broad prospect,worthy of further clinical promotion.

Morbid Obesity in Diabetes Mellitus Type 2 and Exenatide

Worldwide, the prevalence of diabetes and obesity is increasing in recent years in developed countries. The first step of treatment is changes in lifestyle and in case of failure to initiate drug treatment. In our case, the patient with morbid obesity and glucose intolerance to metformin therapy was initiated without achieving weight loss and loss of glycemic control after 6 months of treatment. It was decided to add exenatide as an alternative to bariatric surgery. At the end of the study (12 months), it showed a weight reduction of 20.8% (Table 1), 20.83% BMI, glycosylated hemoglobin decrease of 2 points, and improved the lipid profile. So exenatide may be an acceptable option in the use of patient profile. It would be necessary to seek a new alternative treatment with minimal side effects and less healthcare costs.

Increased BMR in Overweight and Obese Patients with Type 2 Diabetes may Result from an Increased Fat-free Mass

The study aimed to determine the relationships between the basal metabolic rate（BMR） and body composition of overweight and obese Chinese adults with type 2 diabetes mellitus（DM）. This cross-sectional clinical study enrolled 193 Chinese adults with type 2 DM who were overweight（24 kg/m2≤BMI〈28 kg/m2, n=99）, or obese（BMI ≥28 kg/m2, n=94）. Ninety-seven adults with normal BMIs, including 50 DM patients and 47 healthy adults, were recruited as a control group. BMR was measured by indirect calorimetry; predicted BMR was calculated according to the Schofield equation; and the relationships between BMR, body composition, and biochemical results were determined by the Pearson correlation. The results showed that obese DM patients had significantly higher BMRs than both overweight patients（P〈0.05） and patients with normal BMI did（P〈0.05）. The measured BMR was significantly lower than the predicted BMR（P〈0.05） in all groups. Obese and overweight DM patients had significantly greater weight, waist circumference, hip circumference, BMI, body surface area, body fat percentage, fat mass, and fat-free mass than patients with normal BMI. Except for waist circumference, these body composition measurements were significantly increased in obese DM patients when compared with those in overweight DM patients（P〈0.05）. Fat-free mass was closely correlated with BMR in both DM patients（r=0.874, P〈0.01） and in healthy controls（r=0.902, P〈0.01）. It was concluded that overweight and obese Chinese adults with type 2 DM had increased BMRs compared with normal-weight controls, which may result from the difference in fat-free mass.

Waist Circumference-dependent Peripheral Monocytes Change after Gliclazide Treatment for Chinese Type 2 Diabetic Patients

Gliclazide used for the treatment of type 2 diabetes mellitus（T2DM） stimulates insulin secretion and influences peripheral blood monocytes.The roles of gliclazide in peripheral monocytes of newly diagnosed T2 DM patients were investigated in this study.A total of 105 newly diagnosed T2 DM patients with no history of antihyperglycemic medication were treated with gliclazide-modified release for 16 weeks.The total and differential leukocyte profiles of peripheral blood were measured at baseline and week 16.The peripheral blood monocyte count at week 16 was significantly lower than that at baseline（P=0.019）.Peripheral monocytes level at baseline was positively correlated with waist circumference.After gliclazide treatment,the peripheral monocytes were decreased [（320.09±15.13）×10~6/L vs.（294.19±14.22）×10~6/L] in non-abdominal obesity group,but increased in abdominal obesity group [（344.36±17.24）×10~6/L vs.（351.87±16.93）×10~6/L].Compared with non-abdominal obese patients,abdominal obese patients showed higher Δmonocytes（P=0.046） and Δacute insulin secretion（P=0.049）,but lower ΔHb A1c（P=0.047）.There was significantly positive correlation between Δmonocytes and Δacute insulin secretion（P=0.015）,which disappeared after adjusting for age,waist circumference and dosage at baseline.In conclusion,waist circumference is correlated with peripheral monocyte change after gliclazide treatment in Chinese newly diagnosed T2 DM patients.Peripheral monocytes are decreased in non-abdominal obesity group and increased in abdominal obesity group after gliclazide treatment.

Good Regulation of Acupunctore in Simple Obesity Patients with Stomach－Intestine Excessive Heat Type

In order to investigate the regulatory effect of acupuncture on obesity patients with the Stom-ach-Intestine Excessive Heat Type, the pre-acupunctureal and post-acupunctural obesity index and biochemi-cal indices of 718 simple obesity patients with Stomach-Intestine Excessive Heat Type were observed. It wasshowed that the marked weight loss effect was achieved in the cases by acupunctore, and the biochemical in-dices improved. It suggests that acupuncture had a optimal regulatory effect on the function of nerve, en-docrine, digestion and energy metabolism.

Therapy to Obese Type 2 Diabetes Mellitus:How Far Will We Go Down the Wrong Road?

Traditional glucose-lowering chemical agents, including various types of insulin and insulin secretagogues, insulin sensitizers, gliptins, etc., are based on diabetic pathogenesis of insulin resistance(IR) and islet insufficiency. Numerous evidence-based medical studies have shown that these traditional hypoglycemic chemical agents do not provide cardiovascular benefit to patients with type 2 diabetes mellitus(T2 DM) and may even increase the risk of all-cause mortality. Based on research evidence published to date, these studies show that overload of energy could increase the incidence and prevalence of T2 DM, and reduction in the heat load can significantly reduce the incidence of T2 DM. Therefore, the essence of T2 DM is heat overload, meaning heat overload is the etiology of obese T2 DM. At the same time, results of numerous studies show that heat overloading is the cause of IR. IR and islet dysfunction are protective factors in intervening with heat overload.These drugs, which are based on the mechanisms of IR and islet insufficiency, increase caloric reserve and cause or worsen obesity, which is equivalent to exacerbating the basic etiology and the cardiovascular risk factor of T2 DM. Thus, a reasonable strategy for prevention and treatment of obese T2 DM appears to promote the negative balance of calories and the elimination of caloric reserves. Chinese herbal medicines can promote negative balance of heat in many aspects, which can bring new hope for prevention and treatment of T2 DM.