Christine G. Salaita

Office of Extramural Research

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Jack A. Yanovski

Eunice Kennedy Shriver National Institute of Child Health and Human Development

Susan Z. Yanovski

National Institute of Diabetes and Digestive and Kidney Diseases

Marian Tanofsky‐Kraff

Eunice Kennedy Shriver National Institute of Child Health and Human Development

Jennifer R McDuffie

Duke Medical Center

Denise E. Wilfley

Washington University in St. Louis

Jami F. Young

Children's Hospital of Philadelphia

Merel Kozlosky

National Institutes of Health Clinical Center

James C. Reynolds

National Institutes of Health Clinical Center

Roslyn B. Mannon

University of Alabama at Birmingham

Sheila M. Brady

Eunice Kennedy Shriver National Institute of Child Health and Human Development

Cooperative Institutions

National Institutes of Health

Eunice Kennedy Shriver National Institute of Child Health and Human Development

National Institute of Diabetes and Digestive and Kidney Diseases

Uniformed Services University of the Health Sciences

National Institutes of Health Clinical Center

United States Department of Health and Human Services

Duke University

Virginia Commonwealth University

University of Colorado Anschutz Medical Campus

Colorado State University

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Sex-Associated Differences in Free Fatty Acid Flux of Obese Adolescents

The Journal of Clinical Endocrinology & Metabolism (2013)

Diane C. Adler‐Wailes Vipul Periwal Asem H. Ali Sheila M. Brady Jennifer R McDuffie

In obesity, increases in free fatty acid (FFA) flux can predict development of insulin resistance. Adult women release more FFA relative to resting energy expenditure (REE) and have greater FFA clearance rates than men. In adolescents, it is unknown whether sex differences in FFA flux occur. Our objective was to determine the associations of sex, REE, and body composition with FFA kinetics in obese adolescents. Participants were from a convenience sample of 112 non-Hispanic white and black adolescents (31% male; age range, 12–18 years; body mass index SD score range, 1.6–3.1) studied before initiating obesity treatment. Glucose, insulin, and FFA were measured during insulin-modified frequently sampled iv glucose tolerance tests. Minimal models for glucose and FFA calculated insulin sensitivity index (SI) and FFA kinetics, including maximum (l0 + l2) and insulin-suppressed (l2) lipolysis rates, clearance rate constant (cf), and insulin concentration for 50% lipolysis suppression (ED50). Relationships of FFA measures to sex, REE, fat mass (FM), lean body mass (LBM) and visceral adipose tissue (VAT) were examined. In models accounting for age, race, pubertal status, height, FM, and LBM, we found sex, pubertal status, age, and REE independently contributed to the prediction of l2 and l0 + l2 (P < .05). Sex and REE independently predicted ED50 (P < .05). Sex, FM/VAT, and LBM were independent predictors of cf. Girls had greater l2, l0 + l2 and ED50 (P < .05, adjusted for REE) and greater cf (P < .05, adjusted for FM or VAT) than boys. Independent of the effects of REE and FM, FFA kinetics differ significantly in obese adolescent girls and boys, suggesting greater FFA flux among girls.

10.1210/jc.2012-3817

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Citations (19)

Prediction of maximal oxygen uptake by bioelectrical impedance analysis in overweight adolescents.

PubMed (2009)

Mary D. Roberts Bart Drinkard Lisa M. Ranzenhofer Christine G. Salaita Nancy G. Sebring

Maximal oxygen uptake (VO(2max)), the gold standard for measurement of cardiorespiratory fitness, is frequently difficult to assess in overweight individuals due to physical limitations. Reactance and resistance measures obtained from bioelectrical impedance analysis (BIA) have been suggested as easily obtainable predictors of cardiorespiratory fitness, but the accuracy with which ht(2)/Z can predict VO(2max) has not previously been examined in overweight adolescents.

Bioelectrical Impedance Analysis

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Citations (6)

Book Review: Comprehensive Guide to Transplant Nutrition

Progress in Transplantation (2004)

Christine G. Salaita

10.1177/152692480401400112

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Preventing Excessive Weight Gain in Adolescents: Interpersonal Psychotherapy for Binge Eating

FOCUS The Journal of Lifelong Learning in Psychiatry (2009)

Marian Tanofsky‐Kraff Denise E. Wilfley Jami F. Young Laura Mufson Susan Z. Yanovski

The most prevalent disordered eating pattern described in overweight youth is loss of control (LOC) eating, during which individuals experience an inability to control the type or amount of food they consume. LOC eating is associated cross-sectionally with greater adiposity in children and adolescents and seems to predispose youth to gain weight or body fat above that expected during normal growth, thus likely contributing to obesity in susceptible individuals. No prior studies have examined whether LOC eating can be decreased by interventions in children or adolescents without full-syndrome eating disorders or whether programs reducing LOC eating prevent inappropriate weight gain attributable to LOC eating. Interpersonal psychotherapy, a form of therapy that was designed to treat depression and has been adapted for the treatment of eating disorders, has shown efficacy in reducing binge eating episodes and inducing weight stabilization among adults diagnosed with binge eating disorder. In this paper, we propose a theoretical model of excessive weight gain in adolescents at high risk for adult obesity who engage in LOC eating and associated overeating patterns. A rationale is provided for interpersonal psychotherapy as an intervention to slow the trajectory of weight gain in at-risk youth, with the aim of preventing or ameliorating obesity in adulthood. (Reprinted with permission from Obesity June 2007; 15:1345–1355)

Binge eating

Interpersonal psychotherapy

Binge-eating disorder

10.1176/foc.7.4.foc502

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STEROIDS HAVE NO CALORIES: WEIGHT GAIN POST TRANSPLANTATION IS NOT PREVENTED BY STEROID AVOIDANCE

Transplantation (2004)

Eric A. Elster Claire Mas Chamberlin Christine G. Salaita Allan D. Kirk D.H. Hale

O433 Aims: Obesity is a major health care issue in the general, end stage renal disease (ESRD), and renal transplant populations. Previous studies have suggested that chronic corticosteroids increase body weight following transplant. With the recent adoption of steroid free immunosuppressive strategies, we evaluated the effect of steroid avoidance on body mass index. Methods: We examined 101 renal transplant recipients enrolled in NIH clinical transplant trials that received one of three immunosuppressive regimens: 1) steroid free depletional induction therapy with Alemtuzumab followed by sirolimus or tacrolimus monotherapy; 2) steroid free high dose (20mg/kg) rabbit ATG (hRATG) induction followed by sirolimus or tacrolimus monotherapy; and 3) standard triple immunosuppression that included prednisone. Some recipients of hRATG had acute rejections and were converted to chronic prednisone therapy. Results The results are shown in the table below. Similar to the ESRD population on dialysis, recipients prior to transplant were overweight (BMI 26.0±0.5 kg/m2). There were no significant differences in pretransplant BMI between treatment groups. Despite of the avoidance of steroids, BMI increased post transplant in both depletional steroid free strategies as well as standard therapy recipients. This increase in BMI represented an average weight gain of 4.6±1.4 kg post transplant. The lowest increase in BMI was seen in the hRATG group, although this was not statistically different than either the Alemtuzumab or standard therapy groups. Additionally, steroid withdrawal at a mean of 100 days post transplant had no impact on weight gain. Interestingly, the addition of chronic steroids following an acute rejection episode in the hRATG group was associated with a significant loss of weight compared to both Alemtuzumab and standard patients (p=0.01). Conclusions: These results demonstrate the overall increase in weight gain following kidney transplantation. Alternative strategies to prevent significant weight gain aside from steroid withdrawal should be considered. Understanding the underlying physiologic milieu that controls weight gain needs to be explored further.Figure*p=0.01 compared to Standard and Alemtuzumab

Sirolimus

Immunosuppression

10.1097/00007890-200407271-00446

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Insulin Resistance, Hyperinsulinemia, and Energy Intake in Overweight Children

The Journal of Pediatrics (2008)

Joan C. Han Margaret S. Rutledge Merel Kozlosky Christine G. Salaita Jennifer Gustafson

Hyperinsulinemia

Homeostatic model assessment

10.1016/j.jpeds.2007.12.036

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Citations (25)

Children's descriptions of the foods consumed during loss of control eating episodes

Eating Behaviors (2006)

Kelly R. Theim Marian Tanofsky‐Kraff Christine G. Salaita Ann F. Haynos Margaret C. Mirch

Overeating

Calorie

Binge eating

10.1016/j.eatbeh.2006.10.001

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Citations (55)

Solid organ transplantation at the National Institutes of Health: development of a research-based transplantation practice.

PubMed (2005)

Allan D. Kirk Hale Da E C Ford David E. Kleiner Kampen Rl

The National Institutes of Health has established a clinical transplant research program focusing on translational research in kidney transplantation. The program has been developed with a multidisciplinary approach under a common administrative structure that integrates transplant physicians and surgeons with clinical laboratory and data analysis support personnel. The program has achieved excellent clinical outcomes despite focusing exclusively on investigational methods and serving a diverse and medically complex patient population. Novel approaches toward consenting, computer integration, and tissue acquisition have been layered over interventional and observational studies to serve the scientific mission while delivering quality transplant care.

Translational Research

Clinical Practice

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Citations (2)

Effects of Metformin on Body Weight and Body Composition in Obese Insulin-Resistant Children

Diabetes (2011)

Jack A. Yanovski Jonathan Krakoff Christine G. Salaita Jennifer R McDuffie Merel Kozlosky

OBJECTIVE Metformin can decrease adiposity and ameliorate obesity-related comorbid conditions, including abnormalities in glucose homeostasis in adolescents, but there are few data evaluating the efficacy of metformin among younger children. Our objective was to determine whether metformin treatment causes weight loss and improves obesity-related comorbidities in obese children, who are insulin-resistant. RESEARCH DESIGN AND METHODS This study was a randomized double-blind placebo-controlled trial consisting of 100 severely obese (mean BMI 34.6 ± 6.6 kg/m2) insulin-resistant children aged 6–12 years, randomized to 1,000 mg metformin (n = 53) or placebo (n = 47) twice daily for 6 months, followed by open-label metformin treatment for 6 months. All children and their parents participated in a monthly dietitian-administered weight-reduction program. RESULTS Eighty-five percent completed the 6-month randomized phase. Children prescribed metformin had significantly greater decreases in BMI (difference −1.09 kg/m2, CI −1.87 to −0.31, P = 0.006), body weight (difference −3.38 kg, CI −5.2 to −1.57, P < 0.001), BMI Z score (difference between metformin and placebo groups −0.07, CI −0.12 to −0.01, P = 0.02), and fat mass (difference −1.40 kg, CI −2.74 to −0.06, P = 0.04). Fasting plasma glucose (P = 0.007) and homeostasis model assessment (HOMA) insulin resistance index (P = 0.006) also improved more in metformin-treated children than in placebo-treated children. Gastrointestinal symptoms were significantly more prevalent in metformin-treated children, which limited maximal tolerated dosage in 17%. During the 6-month open-label phase, children treated previously with placebo decreased their BMI Z score; those treated continuously with metformin did not significantly change BMI Z score further. CONCLUSIONS Metformin had modest but favorable effects on body weight, body composition, and glucose homeostasis in obese insulin-resistant children participating in a low-intensity weight-reduction program.

10.2337/db10-1185

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Citations (183)

Supplementation of Energy‐restricted Diets with Coconut Oil Improves Nitrogen Balance Without Elevation of Blood Cholesterol Levels

Journal of Food Science (2000)

M.Z.A. Nomani Betty A. Forbes P. Mossahebi Christine G. Salaita M.J. Loth‐Haglin

ABSTRACT: Thirty‐six growing male rats were fed 1 of 6 diets for 4 wk: (1) semipurified basal diet (B) with 10% corn oil, 21.6% fat calories (FC), 14 g B diet/day; (2) B + 1 g of coconut oil (32% FC); (3) B + 1 g olive oil; (4) B + 1 g corn oil; (5) B + 2.25 g starch (18.7% FC); and (6) B + 2 g coconut oil (40% FC). Weight gain and nitrogen balance were higher (p < 0.;05) for supplemented diet groups. Serum cholesterol and triglyceride levels were not different (p > 0.05). It may be suggested that under restricted energy intake conditions (67% to 75% of the requirements) a high‐fat diet (32% to 40% fat calories), including a diet rich in highly saturated coconut oil, can serve as a source of energy and contribute to improved nitrogen balance, without elevating blood cholesterol levels.

Coconut oil

Calorie

Nitrogen balance

Corn oil

10.1111/j.1365-2621.2000.tb09419.x

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Citations (2)