Obesity in Early Adulthood as a Risk Factor for Psoriatic Arthritis

Obesitas merupakan faktor risiko psoriasis, demikian juga untuk artritis psoriasis.

Kelebihan lemak berhubungan dengan peningkatan kadar sitokin inflamasi. Peningkatan sitokin inflamasi berhubungan dengan psoriasis.

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Obesity in Early Adulthood as a Risk Factor for Psoriatic Arthritis
Razieh Soltani-Arabshahi, MD; Bob Wong, PhD; Bing-Jian Feng, PhD; David E. Goldgar, PhD; Kristina Callis Duffin, MD;Gerald G. Krueger, MD

Arch Dermatol. 2010;146(7):721-726. doi:10.1001/archdermatol.2010.141
Objective  To study whether obesity increases the risk of psoriatic arthritis (PsA), given that obesity is a risk factor for psoriasis and is associated with more severe disease.
Design  Case series. We used Cox regression analysis to study the relationship between obesity and PsA while controlling for age at psoriasis onset, current body mass index (BMI), sex, family history of psoriasis, worst-ever body surface area (BSA) involvement, Koebner phenomenon, and nail involvement.
Setting  Dermatology clinics at the University of Utah School of Medicine.
Patients  Volunteer sample of patients with dermatologist-diagnosed psoriasis enrolled in the Utah Psoriasis Initiative from November 2002 to October 2008 (943 subjects; 50.2% women, 49.8% men).
Main Outcome Measures  Physician diagnosis of PsA from self-report questionnaire.
Results  In our subjects, we found that BMI at age 18 years was predictive of PsA (odds ratio [OR], 1.06) (P < .01)over and above control variables. Other variables that were predictors of PsA included younger age at psoriasis onset (odds ratio [OR], 0.98) (P < .01), female sex (OR, 1.45) (P = .01), higher worst-ever BSA involvement with psoriasis (OR, 1.01) (P = .04), Koebner phenomenon (OR, 1.59) (P < .01), and nail involvement (OR, 1.76) (P < .01). Current BMI and family history of psoriasis were not significant predictors of PsA.
Conclusions  This study suggests that obesity at age 18 years increases the risk of developing PsA. Adiposity is associated with higher levels of inflammatory cytokines known to be associated with psoriasis. This inflammatory milieu could increase the risk of PsA in predisposed subjects. Prevention and early treatment of obesity may decrease the risk of PsA.

Lingkar pinggang membesar = risiko kematian meningkat

Pada pria, lingkar pinggang (LP) >=120cm menghadapi risiko kematian dua kali lebih besar dibanding LP <90.

Pada wanita LP >=110cm menghadapi risiko kematian dua kali lebih besar dibanding LP <75cm.

LP semakin besar akan meningkatkan risiko kematian.

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Waist Circumference and All-Cause Mortality in a Large US Cohort

Eric J. Jacobs, PhD; Christina C. Newton, MSPH; Yiting Wang, PhD; Alpa V. Patel, PhD; Marjorie L. McCullough, ScD;Peter T. Campbell, PhD; Michael J. Thun, MD; Susan M. Gapstur, PhD

Arch Intern Med. 2010;170(15):1293-1301. doi:10.1001/archinternmed.2010.201

Background  Waist circumference (WC), a measure of abdominal obesity, is associated with higher mortality independent of body mass index (BMI). Less is known about the association between WC and mortality within categories of BMI or for the very high levels of WC that are now common.
Methods  We examined the association between WC and mortality among 48 500 men and 56 343 women, 50 years or older, in the Cancer Prevention Study II Nutrition Cohort. A total of 9315 men and 5332 women died between 1997 and the end of follow-up in 2006.
Results  After adjustment for BMI and other risk factors, very high levels of WC were associated with an approximately2-fold higher risk of mortality in men and women (among men, relative risk [RR] = 2.02; 95% confidence interval [CI], 1.71-2.39 for WC >=120 cm compared with <90 cm; among women, RR = 2.36; 95% CI, 1.98-2.82 for WC >=110 cmcompared with <75 cm). The WC was positively associated with mortality within all categories of BMI. In men, a 10-cm increase in WC was associated with RRs of 1.16 (95% CI, 1.09-1.23), 1.18 (95% CI, 1.12-1.24), and 1.21 (95% CI, 1.13-1.30) within normal (18.5 to <25), overweight (25 to <30), and obese (>=30) BMI categories, respectively. In women, corresponding RRs were 1.25 (95% CI, 1.18-1.32), 1.15 (95% CI, 1.08-1.22), and 1.13 (95% CI, 1.06-1.20).
Conclusion  These results emphasize the importance of WC as a risk factor for mortality in older adults, regardless ofBMI.

Lorcaserin untuk obesitas

Locarserin, obat baru untuk obesitas, terbukti efektif menurunkan berat badan

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Multicenter, Placebo-Controlled Trial of Lorcaserin for Weight Management
Steven R. Smith, M.D., Neil J. Weissman, M.D., Christen M. Anderson, M.D., Ph.D., Matilde Sanchez, Ph.D., Emil Chuang, M.D., Scott Stubbe, M.B.A., Harold Bays, M.D. and William R. Shanahan, M.D. and the Behavioral Modification and Lorcaserin for Overweight and Obesity Management (BLOOM) Study Group
N Engl J Med 2010; 363:245-256July 15, 2010

BACKGROUND
Lorcaserin is a selective serotonin 2C receptor agonist that could be useful in reducing body weight.

METHODS
In this double-blind clinical trial, we randomly assigned 3182 obese or overweight adults (mean body-mass index [the weight in kilograms divided by the square of the height in meters] of 36.2) to receive lorcaserin at a dose of 10 mg, or placebo, twice daily for 52 weeks. All patients also underwent diet and exercise counseling. At week 52, patients in the placebo group continued to receive placebo but patients in the lorcaserin group were randomly reassigned to receive either placebo or lorcaserin. Primary outcomes were weight loss at 1 year and maintenance of weight loss at 2 years. Serial echocardiography was used to identify patients in whom valvulopathy (as defined by the Food and Drug Administration) developed.

RESULTS
At 1 year, 55.4% of patients (883 of 1595) receiving lorcaserin and 45.1% of patients (716 of 1587) receiving placebo remained in the trial; 1553 patients continued into year 2. At 1 year, 47.5% of patients in the lorcaserin group and 20.3% in the placebo group had lost 5% or more of their body weight (P<0.001), corresponding to an average loss of 5.8±0.2 kg with lorcaserin and 2.2±0.1 kg with placebo during year 1 (P<0.001). Among the patients who received lorcaserin during year 1 and who had lost 5% or more of their baseline weight at 1 year, the loss was maintained in more patients who continued to receive lorcaserin during year 2 (67.9%) than in patients who received placebo during year 2 (50.3%, P<0.001). Among 2472 patients evaluated at 1 year and 1127 evaluated at 2 years, the rate of cardiac valvulopathy was not increased with the use of lorcaserin. Among the most frequent adverse events reported with lorcaserin were headache, dizziness, and nausea. The rates of serious adverse events in the two groups were similar.

CONCLUSIONS
In conjunction with behavioral modification, lorcaserin was associated with significant weight loss and improved maintenance of weight loss, as compared with placebo.

Low carb or low fat diet ?

Diet manakah yang lebih baik, apakah rendah karbohidrat atau rendah lemak ? 

Setelah 2 tahun kedua diet menghasilkan penurunan berat badan, tidak ada perbedaan bermakna pada komposisi tubuh, bone mineral density. Keunggulan diet rendah karbohidrat adalah peningkatan kolesterol-HDL yang signifikan, sehingga lebih menurunkan risiko kardiovaskuler.

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Annals of Internal Medicine vol. 153 no. 3 147-157
August 3, 2010

Weight and Metabolic Outcomes After 2 Years on a Low-Carbohydrate Versus Low-Fat Diet

A Randomized Trial

Gary D. Foster, PhD; Holly R. Wyatt, MD; James O. Hill, PhD;Angela P. Makris, PhD, RD; Diane L. Rosenbaum, BA; Carrie Brill, BS;Richard I. Stein, PhD; B. Selma Mohammed, MD, PhD; Bernard Miller, MD; Daniel J. Rader, MD; Babette Zemel, PhD; Thomas A. Wadden, PhD;Thomas Tenhave, PhD; Craig W. Newcomb, MS; and Samuel Klein, MD

Background: Previous studies comparing low-carbohydrate and low-fat diets have not included a comprehensive behavioral treatment, resulting in suboptimal weight loss.
Objective: To evaluate the effects of 2-year treatment with a low-carbohydrate or low-fat diet, each of which was combined with a comprehensive lifestyle modification program.
Design: Randomized parallel-group trial. (ClinicalTrials.gov registration number:NCT00143936)
Setting: 3 academic medical centers.
Patients: 307 participants with a mean age of 45.5 years (SD, 9.7 years) and mean body mass index of 36.1 kg/m2 (SD, 3.5 kg/m2).
Intervention: A low-carbohydrate diet, which consisted of limited carbohydrate intake (20 g/d for 3 months) in the form of low–glycemic index vegetables with unrestricted consumption of fat and protein. After 3 months, participants in the low-carbohydrate diet group increased their carbohydrate intake (5 g/d per wk) until a stable and desired weight was achieved. A low-fat diet consisted of limited energy intake (1200 to 1800 kcal/d; ≤30% calories from fat). Both diets were combined with comprehensive behavioral treatment.
Measurements: Weight at 2 years was the primary outcome. Secondary measures included weight at 3, 6, and 12 months and serum lipid concentrations, blood pressure, urinary ketones, symptoms, bone mineral density, and body composition throughout the study.
Results: Weight loss was approximately 11 kg (11%) at 1 year and 7 kg (7%) at 2 years. There were no differences in weight, body composition, or bone mineral density between the groups at any time point. During the first 6 months, the low-carbohydrate diet group had greater reductions in diastolic blood pressure, triglyceride levels, and very-low-density lipoprotein cholesterol levels, lesser reductions in low-density lipoprotein cholesterol levels, and more adverse symptoms than did the low-fat diet group. The low-carbohydrate diet group had greater increases in high-density lipoprotein cholesterol levels at all time points, approximating a 23% increase at 2 years.
Limitation: Intensive behavioral treatment was provided, patients with dyslipidemia and diabetes were excluded, and attrition at 2 years was high.
Conclusion: Successful weight loss can be achieved with either a low-fat or low-carbohydrate diet when coupled with behavioral treatment. A low-carbohydrate diet is associated with favorable changes in cardiovascular disease risk factors at 2 years.