BULLÓ , MONICA, PILAR GARCÍA-LORDA, ISABEL MEGIAS, AND JORDI SALAS-SALVADÓ . Systemic inflammation, adipose tissue tumor necrosis factor, and leptin expression. Obes Res. 2003;11:525-531. Objectives: To explore the links between tumor necrosis factor ␣ (TNF␣) and leptin adipose tissue expression and low-grade systemic inflammation and to determine the relationship between inflammation and the degree of adiposity, the presence of type 2 diabetes, and other cardiovascular risk factors. Research Methods and Procedures: Ninety-one women (BMI 19 to 65 kg/m 2 ) were divided into tertiles of CRP. Insulin resistance was calculated using the HOMA method. Albumin, fibrinogen, C-reactive protein (CRP), interleukin-6, sTNFR1, sTNFR2, and leptin levels were measured in serum and plasma samples. TNF␣ and leptin expression were measured by reverse transcription-polymerase chain reaction in abdominal subcutaneous adipose tissue samples. Results: CRP was positively related to BMI and upper distribution of adiposity. TNF␣ and leptin adipose tissue expression were higher in the upper tertile of CRP. Also, peripheral levels of both soluble TNFRs and leptin were higher in patients with the greatest inflammation degree. Diabetes, dislipidemia, and hypertension were most prevalent in patients in the upper CRP tertile. Inflammatory markers of diabetic women were significantly different from those of nondiabetic women, even after adjusting for differences in body fat. BMI, type 2 diabetes, and adipose TNF␣ mRNA levels were significant predictors of serum CRP levels (r 2 ϭ 0.28, p Ͻ 0.001). Discussion: These results are in agreement with the hypothesis that the synthesis of adipose tissue TNF␣ and leptin could induce the production of interleukin-6, CRP, and other acute-phase reactants, thus contributing to the maintenance of chronic low-grade inflammation state involved in the progression of obesity and its associated comorbidities.

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Objective: The aims of this study were to assess the changes that have occurred in food patterns in Europe over the last 40 years based on food availability data and to compare the stability of the traditional Mediterranean diet in the south of Europe in this period. Design: An ecological study carried out on the basis of Food and Agriculture Organization food balance sheets for three geographical areas of Europe (Mediterranean, north and east) over two time periods: 1961 -1963 and 1998-2000. The average availability of total energy, energy provided from macronutrients and food groups was calculated for each area and each period studied. Results: Over the last 40 years total energy availability and energy availability from lipids have increased considerably in the three European areas, while the percentage of energy from carbohydrates has fallen. The greatest changes have occurred in Mediterranean Europe, with an increase of 20.1% in total energy availability, an increase of 48.1% in energy availability from lipids and a fall of 20.5% from carbohydrates. Moreover, Mediterranean Europe showed a significant fall in the energy supplied by cereals (29.9%) and wine (55.2%), while the contribution of milk (77.8%) and dairy products (23.6%) increased. Conclusions:The results of this study suggest that European Mediterranean countries should take nutrition policy action to maintain their traditional healthy food pattern, with a cultural added value. This implies actions at all levels, including raising awareness of consumers, collaboration with the food sector and a call to set the agenda of the concerned politicians and stakeholders.

A low-calorie diet is associated with an improvement in the systemic inflammatory status. This seems to be due to energy restriction rather than to adipose mass loss, since inflammatory levels return to baseline soon after weight stabilisation. Furthermore, a negative energy balance and fat mobilisation are associated with increased subcutaneous cytokine adipose expression.

INTRODUCTION:Tumor necrosis factor (TNFa) has been invoked as an adipostat. Accordingly, the adipose tissue expression of TNFa has been shown to be proportional to the degree of adiposity. The regulatory role of TNFa in obesity may be controlled by several mechanisms. These include the inhibitory effect on LPL activity, the mediation on glucose homeostasis or the effect on leptin. To assess the role of TNFa in obesity we measured adipocyte TNFa expression in 96 females with a wide range of adiposity and with or without type 2 diabetes. We analysed the relationship between TNFa expression, adipocyte LPL activity, insulin resistance and leptin in this population. RESULTS: The TNFa and leptin expression of the adipose tissue in obese and morbid obese patients were significantly higher than in controls. Obese and morbid obese patients had slightly higher levels of LPL activity, but these differences were not significant. We observed a significant relationship between adipose TNFa expression and body mass index (r ¼ 0.35, P < 0.001). TNFa expression was negatively related to LPL activity (r ¼ 7 0.28, P < 0.05) and positively related to leptin expression (r ¼ 0.35, P < 0.001). CONCLUSION: Our results indicate that obese women, even those with morbid obesity, over-express TNFa in subcutaneous adipose tissue in proportion to the magnitude of the fat depot and independently of the presence of type 2 diabetes. The TNFa system may be a homeostatic mechanism that prevents further fat deposition by regulating LPL activity and leptin production.

Objective: To explore the determinants of the tumor necrosis factor alpha (TNFa) system and their relationship with plasma leptin levels. Methods: We studied a cohort of 157 diabetic and non-diabetic females with a wide range of adiposity distributed into five groups: control -body mass index (BMI) Fasting glucose levels, plasma total triglycerides and cholesterol, high-, low-and very low-density lipoprotein cholesterol were assayed by enzymatic and colorimetric methods. Plasma TNFa levels were measured by ELISA assay and insulin and leptin levels by radioimmunoenzymatic assays. Both soluble TNFa (sTNFa) receptors were measured by immunoenzymometric assays. Results: All groups of patients showed significant increases in both sTNFa receptors relative to control. sTNFa receptor 1 (sTNFR1) was higher in morbid obese diabetic individuals compared with their nondiabetic counterparts ðP ¼ 0:003Þ; while sTNFR2 was significantly different between obese and morbid obese subjects ðP ¼ 0:036Þ: Bivariate correlation analysis showed a significant relationship between both plasma sTNFa receptors and BMI, percentage of body fat, fasting glucose, insulin and leptin. In multivariate analysis, both sTNF receptor plasma levels were predicted by percentage of body fat and the presence of diabetes (R 2 ¼ 0:20 for sTNFR1 and sTNFR2). When plasma leptin levels were added into the model, this protein and the presence of diabetes explained 27% of the variance of the plasma sTNFR1 levels. Conclusion: The presence of diabetes, adiposity or leptin levels are independent determinants of both sTNFa receptors. The independent association between plasma TNFa receptors and leptin levels in obese patients is consistent with the hypothesis that these proteins could be involved in the same pathway that regulates body adiposity.

These results suggest a high prevalence of co-morbid conditions in severely obese patients undergoing bariatric surgery. Age, ethnicity and gender influence the type of co-morbid conditions. More research is needed to understand why diabetes and other metabolic complications remain undiagnosed and untreated in a large number of these high risk patients.

The beneficial effects of nuts on cardiovascular health are well known. However, since nuts provide a high caloric and fat content, some concern exists regarding a potential detrimental effect on body weight and insulin resistance. The current data available did not support such a negative effect of nut consumption on the short term or when nuts are included on diets that meet energy needs. Furthermore, there is some intriguing evidence that nuts can help to regulate body weight and protect against type II diabetes. This, however, still has to be proved and more research is needed to address the specific effects of nuts on satiety, energy balance, body weight and insulin resistance.