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Background: Body mass index (BMI) is the dominating weight-for-height index, but its validity as a body fat (BF) index has not been properly examined. Objectives: Our aims were to establish and validate optimal weight-for-height indexes for predicting absolute and relative (percentage) amounts of BF, to examine whether other commonly available anthropometric variables or age could add to the predictive power, and to explore the upper limit for percentage BF. Design: One thousand one hundred twelve randomly selected subjects, and an additional 149 obese subjects, were included in the study. The subjects were randomly allocated to either a primary study group or a validation group. BF was measured with dualenergy X-ray absorptiometry. The relations between weight/height (W/[H.sup.x]) and BF (absolute or percentage) were examined for values of the exponent x that ranged from 0.0 to 3.0. The predictive power of equations that were based on optimal weight-for-height indexes was compared with equations based on weight, height, other anthropometric variables, and age. Results: Absolute BF was optimally and linearly predicted by W/[H.sup.1], whereas the percentage BF was optimally and nonlinearly predicted by W/[H.sup.2]. The percentage BF asymptotically approached 52% in women and 56% in men. The percentage BF increased only marginally from BMI (in kg/[m.sup.2]) values of >35 in women and >60 in men. Predictions of absolute BF were associated with smaller errors (8.5% for men and 5.7% for women) than were predictions of percentage BF (8.7% for men and 7.9% for women). The addition of other anthropometric measurements for both men and women, and the addition of age for women only, in the regression analyses moderately reduced these errors. Conclusion: Our data suggest that W/H may be a more optimal weight-for-height index than is BMI, particularly at high body weights. Am J Clin Nutr 2006;83:252-9. KEY WORDS Body fat indexes, maximum relative fatness, prediction of body fat, weight-for-height

Obesity is over-represented in patients with psoriatic arthritis (PsA) and associated with higher disease activity, poorer effect of treatment and increased cardiovascular morbidity. Studies on the effects of weight loss are however needed. This study aimed to prospectively study the effects of weight loss treatment with very low energy diet (VLED) on disease activity in patients with PsA (CASPAR criteria) and obesity (body mass index BMI ≥ 33 kg/m2). VLED (640 kcal/day) was taken during 12–16 weeks, depending on pre-treatment BMI. Afterwards, an energy-restricted diet was gradually reintroduced. Weight loss treatment was given within a structured framework for support and medical follow-up. Treatment with conventional synthetic and/or biologic disease-modifying anti-rheumatic drugs was held constant from 3 months before, until 6 months after baseline. Patients were assessed with BMI, 66/68 joints count, Leeds enthesitis index, psoriasis body surface area (BSA), questionnaires and CRP at baseline, 3 and 6 months. Primary outcome was the percentage of patients reaching minimal disease activity (MDA) and secondary outcomes were reaching Psoriatic Arthritis Response Criteria (PsARC) and American College of Rheumatology (ACR) response criteria. Totally 41/46 patients completed the study, 63% women, median age 54 years (IQR 48–62). At baseline increased BMI was associated with higher disease activity and poorer function. The median weight loss was 18.7 kg (IQR 14.6–26.5) or 18.6% (IQR 14.7–26.3) of the baseline weight. A majority of the disease activity parameters improved significantly after weight loss, including 68/66 tender/swollen joints count, CRP, BSA, Leeds enthesitis index, HAQ and patient VAS for global health, pain and fatigue. A larger weight loss resulted in more improvement in a dose-response manner. The percentage of patients with MDA increased from 29 to 54%, (p= 0.002). PsARC was reached by 46.3%. The ACR 20, 50 and 70 responses were 51.2%, 34.1% and 7.3% respectively. Short-term weight loss treatment with VLED was associated with significant positive effects on disease activity in joints, entheses and skin in patients with PsA and obesity. The study supports the hypothesis of obesity as a promotor of disease activity in PsA. ClinicalTrials.gov identifier: NCT02917434, registered on September 21, 2016—retrospectively registered

Bariatric surgery is associated with remission of diabetes and prevention of diabetic complications in patients with obesity and type 2 diabetes. Long-term effects of bariatric surgery on microvascular complications in patients with prediabetes are unknown. The aim of this study was to examine the effects of bariatric surgery on incidence of microvascular complications in patients with obesity stratified by baseline glycaemic status.

Background:Different definitions of the metabolic syndrome are used, and at least one of these does not include indices of glucose intolerance and/or insulin resistance as obligatory components. In this paper, we examine the predictive power of indices having and not having these obligatory components.Methods:A total of 1135 men and women, aged 37–61 years, were randomly selected from the populations of Mölndal and Örebro, Sweden. Mortality rate and incidence of cardiovascular morbidity were analyzed in subjects with and without the metabolic syndrome according to the definitions of WHO (World Health Organization), EGIR (European Group for the study of Insulin Resistance), and ATPIII (Adult Treatment Panel–III Guidelines). Atherosclerotic morbidity was traced until December 2002 and mortality until December 2003. Due to lack of data, our WHO definition does not include information on micro-albuminuria.Results:There were 17 deaths during the 3–8 year follow-up. As compared to subjects without the metabolic syndrome, all-cause mortality was increased significantly in subjects with the syndrome defined according to WHOnon u-alb(hazards ratio [HR] 2.98, 95% CI 1.07, 8.28, p= 0.036) but not according to EGIR (HR 1.93, 95% CI 0.67, 5.55, p= 0.230) or ATPIII (HR 0.88, 95% CI 0.20, 3.89, p= 0.870). Incident cases of ischemic heart, cerebrovascular, and/or peripheral arterial disease (n= 18) were related to the metabolic syndrome according to WHOnon u-alband EGIR but not according to ATPIII.Conclusions:Inclusion of glucose intolerance and/or insulin resistance as obligatory criteria in the definition of the metabolic syndrome seems to be important for the ability to predict all-cause mortality and incident cardiovascular morbidity.

Objective: Accumulation of visceral fat is recognized as a predictor of obesity‐related metabolic disturbances. Factors that are predominantly expressed in this depot could mediate the link between visceral obesity and associated diseases. Research Methods and Procedures: Paired subcutaneous and omental adipose tissue biopsies were obtained from 10 obese men. Gene expression was analyzed by DNA microarrays in triplicate and by real‐time polymerase chain reaction. Serum C3 and C4 were analyzed by radial immunodiffusion assays in 91 subjects representing a cross section of the general population. Body composition was measured by computerized tomography. Results: Complement components C2, C3, C4, C7, and Factor Bhad higher expression in omental compared with subcutaneous adipose tissue (∼2‐, 4‐, 17‐, 10‐, and 7‐fold, respectively). In addition, adipsin, which belongs to the alternative pathway, and the classical pathway components C1QB, C1R, and C1Swere expressed in both depots. Analysis of tissue distribution showed high expression of C2, C3, and C4in omental adipose tissue, and only liver had higher expression of these genes. Serum C3 levels correlated with both visceral and subcutaneous adipose tissue in both men (r= 0.65 and p< 0.001 and r= 0.52 and p< 0.001, respectively) and women (r= 0.34 and p= 0.023 and r= 0.49 and p< 0.001, respectively), whereas C4 levels correlated with only visceral fat in men (r= 0.36, p= 0.015) and with both depots in women (visceral: r= 0.58, p< 0.001; and subcutaneous: r= 0.51, p< 0.001). Discussion: Recent studies show that the metabolic syndrome is associated with chronically elevated levels of several immune markers, some of which may have metabolic effects. The high expression of complement genes in intra‐abdominal adipose tissue might suggest that the complement system is involved in the development of visceral adiposity and/or contributes to the metabolic complications associated with increased visceral fat mass.

Bovine neutrophils were harvested from a teat cistern following endotoxin infusion and were compared with blood neutrophils by measurements of chemiluminescent and phagocytic activity towards C3-and IgG-opsonized and unopsonized yeast particles. Both phagocytosis and luminol-dependent chemiluminescence elicited by all three particles were enhanced in the teat cells. The increase in the luminoldependent chemiluminescence towards C3-and IgG-opsonized particles was due to an enhanced extracellular release of myeloperoxidase. The observed increase in phagocytosis of unopsonized yeast was shown to reflect the interaction between up-regulated CR3 receptors on the surface of the teat neutrophils and the yeast particles. A high chemiluminescent activity of the teat neutrophils in both the luminol-and lucigenin-dependent systems in the absence of a phagocytic prey indicated that the NADPH oxidase was permanently active and that myeloperoxidase was continuously released by the cells. Treatment of neutrophils with cytochalasin B showed that the chemiluminescence and phagocytosis of teat neutrophils were less sensitive to this drug than that of blood neutrophils. These results indicate that the teat neutrophils have up-regulated their receptors for IgG-and C3-opsonized and unopsonized yeast on the cell surface by the action of actin. The cells also have a permanently active NADPH oxidase dependent on the association with actin and show a higher

Background: Obesity is overrepresented in patients with psoriatic arthritis (PsA) and associated with increased disease activity. We have previously shown in 41 patients with PsA (Caspar criteria) and obesity (body mass index; BMI ≥33 kg/m2) that weight loss treatment with Very Low Energy Liquid Diet (VLED), 640 kcal/day during 12–16 weeks, followed by a structured reintroduction of an energy restricted diet resulted in a median weight loss of 18.6% and concomitantly a significant improvement of the disease activity in joints, entheses and skin. Methods: The patients were assessed with 66/68 joints count, Leeds enthesitis index (LEI), body surface area, blood pressure, BMI, questionnaires and fasting blood samples at the 12- and 24-month visits. Results: In total, 39 and 35 PsA patients attended the 12- and the 24-month visits, respectively. Median weight loss since baseline was 16.0% (IQR 10.5–22.4) and 7.4% (IQR 5.1–14.0) at the 12- and 24-months follow-up. The 66/68 swollen/tender joints score, LEI, CRP and HAQ score were still significantly reduced at the 12- and 24-month visits compared to baseline. The number of patients with Minimal Disease Activity increased from 28.2% (11/39) at baseline, to 38.5% (15/39; p= 0.008) and 45.7% (16/35; p= 0.016) at the 12- and 24-month visits. Conclusions: Weight loss treatment, with VLED included in the program, was associated with long-term improvement of measures of disease activity, self-reported function and markers of the metabolic syndrome after 24-months follow-up. Trial registration: ClinicalTrials.gov identifier: NCT02917434, Registered September 28, 2016- Retrospectively registered.