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Exciting Science Presented at ENDO 2005 Provides New Insight Into the Development of Childhood Obesity: Large Population Study Reveals Simple, Effective Test to Indicate Obesity and Cardiovascular Risk Although it is commonly believed that obesity is associated with increased cardiovascular risk, there is no standard measure, or indicator, for determining the exact relationship between obesity and this elevated risk. For many years, physicians regarded body mass index (BMI) as the standard measure of obesity, however more recently, some physicians have begun using waist circumference (WC). In the study "Waist-to-Tallness Ratio is the Best Anthropometric Indicator of Cardiovascular Risk - Findings from the DETECT Study," researchers at the Max Planck Institute of Psychiatry in Munich and the University of Dresden attempted to standardize for physicians the most appropriate indicator for determining the effect of obesity on cardiovascular risk. In order to do so, the researchers analyzed findings from the DETECT study, which took a look at a trial population of 48,353 primary care patients. The analysis examined the efficacy of using waist-to-tallness ratio (WTR), BMI, WC, hip circumference and waist-to-hip ratio. WTR was found to be the simplest and most accurate indicator for determining obesity and its related cardiovascular risks in both males and females. Translating Research Into Practice:
What's New in Obesity Research? Coming this month in the The Journal of Clinical Endocrinology & Metabolism (JCE&M): 
Research Reveals Potential New Treatment for the Regulation of Menstruation, Ovulation in Women With PCOS
Somatostatin, a hormone released by the hypothalamus, reduces levels of growth hormone (GH), luteinizing hormone (LH) and insulin within the body. Octreotide-LAR is a pharmacologic somatostatin analog that mimics natural somatostatin found in the body. Octreotide-LAR has been FDA-approved for the treatment of acromegaly - an overactive pituitary condition marked by the enlargement of bones on a person's extremities, face and jaw - and the treatment of diarrhea neuroendocrine tumors. However, since GH, LH and insulin are involved in the pathogenesis of polycystic ovary syndrome (PCOS) and somatostatin receptors and insulin are present within the ovaries, researchers in the study "Efficacy of Octreotide-LAR in Dieting Women with Abdominal Obesity and Polycystic Ovary Syndrome" attempted to evaluate the effect of octreotide-LAR on PCOS, a common hormonal disorder in reproductive-age women that causes irregular menstrual cycles, infertility, ovarian cysts, increased risk for diabetes and obesity, and excessive hair growth (hirsutism), among other health problems. The study, which was single-blind and placebo controlled, examined eighteen obese women with PCOS who were all put on a low-calorie diet during the first month of study, then randomized to either a low-calorie diet plus 10 mg octreotide-LAR or placebo one im injection every 28 days for the remaining six months of the study. Researchers took computerized tomography measurements of fat distribution; measured levels of androgens, GH, insulin-like growth factor-1 (IGF-1), IGF binding proteins (IGFBPs), and fasting and glucose-stimulated insulin; and monitored the ovulation patterns of the study subjects. The study revealed that although treatment with octreotide-LAR had no better effect in reducing body fat and in improving fat distribution than placebo, it effectively decreased fasting and glucose-stimulated insulin levels, increased IGFBP-2 and IGFBP-3, and improved hirsutism. Moreover, levels of the male hormones testosterone and androstenedione were reduced in the women randomized to treatment with octreotide-LAR versus placebo. Remarkably, all women treated with octreotide-LAR ovulated at the end of the study, compared with only one of those receiving placebo. Regulation of the women's menstrual cycles was a major advantage of treatment with this therapy. Study investigators encourage additional research into the efficacy of treating PCOS with somatostatin analogs. Translating Research Into Practice:
"This research examining a new potential treatment option provides additional insight into the complex condition known as polycystic ovary syndrome, or PCOS. Although we know that insulin sensitizing drugs, such as metformin, are proven and effective treatments for women with PCOS, this most recent study suggests that somatostatin analogs, like octreotide-LAR, may also be effective for women with this disorder. Further research is warranted to determine where this class of medications will fit into the treatment arsenal for PCOS." In the study "Treatment of Anovulatory PCOS Women", leading researchers evaluated the efficacy of clomiphene citrate (CC) and metformin for the treatment of the most common hormonal disorder in reproductive-age women, the polycystic ovary syndrome (PCOS). Although metformin has been shown to be an effective option in the treatment of anovulation in women with PCOS, CC is still considered to be the first-line drug to induce ovulation. This study - a prospective, parallel, randomized double-blind double-dummy controlled clinical trial - evaluated one hundred non-obese infertile women with PCOS. After a six-month treatment period, the study revealed that treatment with metformin was significantly more effective in improving fertility in the study subjects than treatment with CC. According to experts, while more research is needed, the clinical implication of metformin as an effective ovulatory regulator for the millions of infertile women with PCOS is promising. It is common for women with gestational diabetes mellitus (GDM) to later demonstrate diabetes and obesity - both components of the metabolic syndrome, or a cluster of metabolic risk factors that increase the risk of developing heart disease, stroke and other chronic conditions. Researchers in the study "The Prevalence of the Metabolic Syndrome in a Danish Population of Women with Previous GDM is 3-Fold Higher than in the General Population" aimed to estimate the prevalence of the metabolic syndrome among women with previous GDM by three different criteria - those established by the World Health Organization (WHO), the third Adult Treatment Panel (ATP III) and the European Group for the Study of Insulin Resistance (EGIR). Researchers conducted a follow-up analysis on a Danish cohort of women admitted to the Diabetes and Pregnancy Center at Rigshospitalet, Copenhagen University Hospital, with diet-treated GDM from 1978-1996. The follow-up took place in 2000-2002 at median 9.8 years following the women's pregnancy and findings were compared with a control group of 1,000 age-matched women from a population-based sample. The researchers report that, independent of the definition of the metabolic syndrome, the prevalence of the condition was three times as high in women with prior diet-treated GDM compared with age-matched control subjects. Prevalence of the metabolic syndrome increases to seven times as high in obese women with prior diet-treated GDM compared with age-matched control subjects. Researchers say that these findings support the need for women with prior GDM to have regular evaluations with their physicians, be monitored for vascular disease, get educated about their personal risk factors and institute healthy lifestyles. If you have any questions about this issue of The Endocrine Edge or The Endocrine Society, please contact media@endo-society.org |
