This study tests the hypothesis that a high‐fat postnatal diet increases fat mass and reduces improved insulin sensitivity (IS) found in the low‐protein model of maternal undernutrition. Offspring from Wistar dams fed either a 20% (control (CON)) or 8% (low protein (LP)) protein diet during gestation and lactation were randomly assigned to a control (con) or cafeteria (caf) diet at weaning (21 days) until 3 months of age at which point IS was measured (hyperinsulinemic–euglycemic clamp). Fat mass, growth, energy intake (EI) and expenditure (EE), fuel utilization, insulin secretion, and leptin and adiponectin levels were measured to identify a possible role in any changes in IS. IS was increased in LP‐con in comparison to CON‐con animals. Cafeteria feeding prevented this increase in LP animals but had no effect in CON animals (insulin‐stimulated glucose infusion rates (GIRs; mg/min/kg); CON‐con: 13.9 ± 1.0, CON caf: 12.1 ± 2.1, LP‐con: 25.4 ± 2.0, LP‐caf: 13.7 ± 3.7, P < 0.05). CON‐caf animals had similar percent epididymal white adipose tissue (%EWAT; CON‐con: 1.71 ± 0.09 vs. CON‐caf: 1.66 ± 0.08) and adiponectin (µg/ml: CON‐con: 4.61 ± 0.34 vs. CON‐caf: 3.67 ± 0.18) except hyperinsulinemia and relative hyperleptinemia in comparison to CON‐con. Differently, LP‐caf animals had increased %EWAT (LP‐con: 1.11 ± 0.06 vs. LP‐caf: 1.44 ± 0.08, P < 0.05) and adiponectin (µg/ml: LP‐con: 5.38 ± 0.39 vs. LP‐caf: 3.75 ± 0.35, P < 0.05) but did not show cafeteria‐induced hyperinsulinemia or relative hyperleptinemia. An increased propensity to store visceral fat in LP animals may prevent the elevated IS in LP offspring.

It is possible to treat the obese individual with type II diabetes. Of course the aims are to produce excellent diabetes control and to prevent complications. A logical, stepwise approach can be taken, based on the individual's weight and blood sugar levels. Such an approach has been given above and is outlined in Table 1. With logical therapy, the patient's lifestyle can be improved, their weight reduced and diabetes controlled. If and when they develop complications these can be treated appropriately as part of the "package". It is neither necessary nor appropriate to ignore obesity in the treatment of diabetes.

Objectives: To determine the efficacy of two dietary therapies in both the short term (hospitalisation) and the longer term treatment of severe obesity.Design: A descriptive study of two patient groups with obesity defined by a body mass index of greater than 30 kg/m2.Setting: A multidisciplinary weight control program in a tertiary care hospital.Patients: All admissions to hospital of patients on the weight control program for initiation of weight loss during a period of 48 months.Intervention: A standard kilojoule reduction regimen or the use of complete, followed by partial, long term meal substitution with a very low energy liquid diet (VLED), coupled with an exercise and a behavioural modification program.Outcome measures: Weight loss during and after hospitalisation was measured in both dietary regimen groups.Results: Both diets induced weight loss in hospital. Men prescribed VLED lost significantly more weight, 8.3 +/- 0.8 kg (mean +/- SEM) than women prescribed this diet (5.5 +/- 0.5 kg) or standard kilojoule restriction (5.1 +/- 0.8 kg).Conclusions: VLED and standard kilojoule restriction are both effective for the treatment of severe obesity, particularly in a controlled environment (hospitalisation). In the longer term, VLED is an effective method of maintaining weight loss. Lack of continuing weight loss may reflect the patients who were initially placed on this regimen - small eaters with a presumed high metabolic efficiency.

We studied the effects of sleep apnea on neuroendocrine function in a cross-sectional study of 225 consecutive men undergoing sleep studies and in a longitudinal study of 43 men with severe obstructive sleep apnea before and after 3 months of successful treatment with nasal continuous positive airways pressure to eliminate upper airways obstruction. Blood samples were collected at 0600-0630 h on awakening for measurement of plasma insulin-like growth factor I (IGF-I), total and free testosterone, sex hormone-binding globulin (SHBG), LH, FSH, PRL, T4, T4-binding globulin, and cortisol. The plasma hormone levels were analyzed in relation to the severity of sleep apnea, as indicated by the desaturation index (the hourly rate of episodes of arterial oxygen desaturation greater than 4% of the stable baseline) and the mean minimal oxygen saturation during the desaturation episodes. In the cross-sectional study plasma IGF-I, free and total testosterone, and SHBG levels were significantly lower in relation to the severity of sleep apnea, whereas plasma LH, FSH, PRL, T4, T4-binding globulin, and cortisol were not. The decreases in plasma IGF-I and total and free testosterone were independent of the effects of aging and adiposity by covariance analysis. In the longitudinal study plasma IGF-I, total testosterone, and SHBG, but not free testosterone, significantly increased after 3 months of nasal continuous positive airways pressure treatment. We conclude that sleep apnea causes reversible neuroendocrine dysfunction in men, which is manifested by decreased plasma. IGF-I, testosterone, and SHBG levels. This neuroendocrine dysfunction is related to the severity of the sleep apnea, as indicated by the nadir levels of arterial oxygen desaturation and the rate of desaturation episodes. These hormonal measurements may provide biochemical markers for both the severity of sleep apnea and its response to therapeutic intervention. In addition, sleep apnea may be a previously unrecognized confounder of the neuroendocrine correlates of aging.

Plasma medroxyprogesterone acetate (MPA) concentrations were measured in 61 patients with advanced breast cancer, after 3 weeks' treatment using 200 mg PO 8-hourly, to determine whether the previously reported wide interpatient variations correlated with tumour response or toxicity. Seventeen patients (28%) responded to the drug, and their mean plasma MPA concentration was 97 ng/ml ±68 SD, compared with 115 ng/ml ±87 SD for the patients whose disease progressed. Side-effects attributed to MPA were seen in 18 patients, who had a mean drug concentration of 113 ng/ml±104 SD. This was not significantly higher than that of the patients who did not experience drug toxicity.

Intravenous administration of the fatty acid oxidation inhibitor 2-tetradecylglycidic acid had no effect on the proportion of pyruvate dehydrogenase complex in the active form in heart, diaphragm or gastrocnemius muscles or in liver, kidney or adipose tissue of fed normal rats. The compound reversed the effect of 48h starvation (which decreased the proportion of active complex) in heart muscle, partially reversed the effect of starvation in kidney, but had no effect in the other tissues listed. The compound failed to reverse the effect of alloxan-diabetes (which decreased the proportion of active complex) in any of these tissues. In perfused hearts of fed normal rats, 2-tetradecylglycidate reversed effects of palmitate (which decreased the proportion of active complex), but it had no effect in the absence of palmitate. In perfused hearts of 48h-starved rats the compound increased the proportion of active complex to that found in fed normal rats in the presence or absence of insulin. In perfused hearts of diabetic rats the compound normalized the proportion of active complex in the presence of insulin, but not in its absence. Palmitate reversed the effects of 2-tetradecylglycidate in perfused hearts of starved or diabetic rats. Evidence is given that 2-tetradecylglycidate only reverses effects of starvation and alloxan-diabetes on the proportion of active complex in heart muscle under conditions in which it inhibits fatty acid oxidation. It is concluded that effects of starvation and alloxan-diabetes on the proportion of active complex in heart muscle are dependent on fatty acid oxidation. Insulin had no effect on the proportion of active complex in hearts or diaphragms of fed or starved rats in vitro. In perfused hearts of alloxan-diabetic rats, insulin induced a modest increase in the proportion of active complex in the presence of albumin, but not in its absence.