Mej Lean - Academia.edu (original) (raw)

Papers by Mej Lean

International Journal of Obesity, 1999

BACKGROUND: Sibutramine, an inhibitor of serotonin and noradrenaline uptake, reduces appetite to ... more BACKGROUND: Sibutramine, an inhibitor of serotonin and noradrenaline uptake, reduces appetite to cause weight loss. This study tested the hypothesis that an increase in energy expenditure also contributes to this weight loss. In addition, the effects of sibutramine on adrenaline induced changes in heart rate and cardiac output were determined METHODS: Nineteen obese females randomly received either sibutramine 15 mg daily or placebo for 12 weeks along with dietary advice. Resting energy expenditure (REE) was measured and then energy expenditure was measured during a 30 min infusion of adrenaline (25 ngaminakg IBW). Cardiac output and heart rate, measured by Duplex Colour Doppler ultrasonography, were similarly measured in the basal state and post adrenaline. All measurements were recorded at baseline and then after 12 weeks. RESULTS: Ten patients who received sibutramine reduced their weight by 8.1 AE 3.8% while 9 placebo treated subjects reduced their weight by 5.1 AE 4.4%, P 0.13. In absolute terms, REE decreased in placebo subjects from 1500 AE 201 kcala24 h to 1357 AE 231 kcala24 h (9.4 AE 9.9%) and in sibutramine subjects from 1540 AE 184 kcala24 h to 1444 AE 128 kcala24 h (5.3 AE 12.0%), P 0.77. The increased weight loss in the sibutramine group was associated with an increase in the FFM adjusted REE (2.2 AE 16.1%) unlike the expected decrease (5.8 AE 9.5%) in the placebo group (P 0.11). There was some suggestion (P 0.09) that the usual positive correlation between loss of weight and decline in REE was lost in the sibutramine group (r 7 0.30) compared with placebo (r 0.35). There was a negative correlation between loss of FFM and decline in REEakg FFM and (P 0.029) which was not evident in placebo (P 0.83). Adrenaline induced energy expenditure was similar in the two groups at the end of the 12 week period and there were no signi®cant cardiovascular changes between the two groups. CONCLUSIONS: Sibutramine limits the decline in REE associated with weight loss, equivalent to about 100 kcalad. This could allow greater numbers of people to maintain a greater degree of weight loss.

International Journal of Obesity, 2002

OBJECTIVE: To identify the reasons for seeking weight loss in overweight or obese but otherwise h... more OBJECTIVE: To identify the reasons for seeking weight loss in overweight or obese but otherwise healthy men. DESIGN: Interviews, prior to intervention, with subjects who had volunteered to participate in a work-site-based weight loss study. SUBJECTS: Ninety-one overweight=obese male workers. Mean age 41, range 18-55 y, mean body mass index (BMI) 31.0, range 26.2-41.6 kg=m 2. MEASUREMENTS: Anthropometric measurements; body weight and height. Body mass index calculated. A short interview using open questions to determine the individuals reason for seeking weight loss. RESULTS: The message that weight loss is beneficial to health for the overweight was recognized by all subjects regardless of BMI, and was reported as the main factor for attempting weight loss. Improved fitness and effects on appearance and well-being were reported half as often as the primary reason for weight loss. CONCLUSION: Overweight lay members of the public have accepted the health education message that weight loss can improve health. Overweight but otherwise healthy men who responded, of their own accord, to an electronic mail message offering help to lose weight did not regard obesity and overweight as primarily a cosmetic issue. This is still, however, important, especially to younger people.

$Research paper thumbnail of Associations of indices of adiposity with atherogenic lipoprotein subfractions$

International Journal of Obesity, 1998

OBJECTIVE: To investigate the associations of indices of adiposity with cardiovascular risk facto... more OBJECTIVE: To investigate the associations of indices of adiposity with cardiovascular risk factors. SUBJECTS: 93 men and 98 women aged 18±69 y. OUTCOME MEASURES: Body mass index (BMI), waist to hip ratio (WHR), waist circumference, waist to height ratio, blood pressure, fasting concentrations of blood glucose, insulin, plasma lipids and lipoprotein subfractions, apoproteins, lipoprotein(a) and post-heparin lipases. RESULTS: BMI and waist showed similar associations (P`0.01) with a cluster of major cardiovascular risk factors including total cholesterol, low density lipoprotein-cholesterol and very low density lipoprotein-cholesterol in men, and ratio of low density lipoprotein-ahigh density lipoprotein-cholesterol for both genders. Large waist circumference was signi®cantly (P`0.01) associated (controlled for age and smoking) with features of the metabolic syndrome, including raised insulin concentration (men: r 0.37, women: r 0.49), reduced high density lipoprotein 2 (men: r 0.30, women: r 0.34), increased very low density lipoprotein 1 mass (men: r 0.31, women: r 0.42), raised small, dense low density lipoprotein (men: r 0.30, women: r 0.31), elevated blood pressure (men: r 0.27, women: r 0.28), increased triglyceride (men: r 0.43, women: r 0.48) and apolipoprotein-B (men: r 0.32, women: r 0.35). Waist circumference also correlated with hepatic lipasealipoprotein lipase ratio in women (r 0.52). Height adjustment did not substantially change relationships between waist circumference and risk factors. WHR correlated with fewer risk factors. CONCLUSION: For the purpose of health promotion to prevent cardiovascular disease associated with overweight and intra-abdominal fat accumulation, the general public should be advised to be aware of the risk associated with large waist circumference.

The British Journal of Diabetes & Vascular Disease, 2001

This article examines the merits of body mass index (BMI), waist and hip measurements as indicato... more This article examines the merits of body mass index (BMI), waist and hip measurements as indicators of total body fat and diabetes risk. Diabetes risk increases with obesity, with the accumulation of central fat being closely related with insulin resistance. This promotes other features of metabolic syndrome, including glucose intolerance, to increase vascular risk.

International Journal of Obesity, 1997

OBJECTIVE: To investigate the effect of a dietary intervention to reduce body weight on red cell ... more OBJECTIVE: To investigate the effect of a dietary intervention to reduce body weight on red cell aggregation (RCA), factor VII activity, plasminogen activator inhibitor (PAI) activity, tissue plasminogen activator (t-PA) antigen, ®brinogen, whole blood and plasma viscosity, haematocrit and lipids. DESIGN: Open single stranded study of dietary intervention for weight loss in a volunteer sample. SUBJECTS: Forty-®ve subjects whose BMI exceeded 26 kgam 2 were recruited and received dietetic advice designed to reduce body weight by 0.5 kg per week. MEASUREMENTS: Body weight and waist and hip circumferences, dietary intake by seven day weighed inventory, RCA, factor VII activity, PAI activity, t-PA antigen, ®brinogen, whole blood and plasma viscosity, haematocrit and lipids. RESULTS: After 12 weeks of dietary intervention there were reductions in body weight and BMI by 5.9 (s.d. 3.3) kg and 1.9 (s.d. 1.0) kgam 2 respectively in males, and 4.1 (s.d. 2.9) kg and 1.6 (s.d. 1.1) kgam 2 in females (P`0.0001). Factor VII activity (P 0.0043), RCA (P 0.01) and t-PA antigen (P 0.016) were reduced in females after weight reduction but no differences were found in PAI activity, whole blood, plasma viscosity or haematocrit. The changes in factor VII activity and RCA were appropriate for the changes in BMI on the basis of the relationships of the risk factors with BMI in a cross sectional survey of a representative Scottish population. Plasma total cholesterol was reduced (P 0.016) but HDL cholesterol and triglycerides remained unchanged. There were signi®cant associations between the reductions in factor VII activity and BMI (r 0.395, P 0.013) and between the reductions in RCA and waist to hip ratio (r 0.350, P 0.04). No relationship was seen between changes in serum cholesterol and changes in factor VII activity or RCA. CONCLUSIONS: Modest weight loss, of 5% body weight, with conventional dietary intervention reduces two established risk factors for ischaemic heart disease (factor VII activity and RCA) which are generally elevated in those with increased body weight.

International Journal of Obesity, 2000

OBJECTIVE: To assess the ef®cacy and tolerability of orlistat (Xenical 1) in producing and mainta... more OBJECTIVE: To assess the ef®cacy and tolerability of orlistat (Xenical 1) in producing and maintaining weight loss over a 12-month period. DESIGN: Patients were randomized to double-blind treatment with either orlistat 120 mg or placebo three times daily, in conjunction with a low-energy diet, for 12 months. SETTING: Five centres in the UK. SUBJECTS: 228 obese adult patients with body mass index between 30 and 43 kgam 2 and mean weight 97 kg (range 74 ± 144 kg). INTERVENTIONS: All patients were prescribed a low-energy diet, providing 30% of energy from fat, designed to produce an individually tailored energy de®cit of approximately 600 kcaladay, for a run-in period of 4 weeks and then 12 months, plus orlistat 120 mg or placebo three times daily. MAIN OUTCOME MEASURES: Change in body weight (the primary ef®cacy parameter), waist circumference and adverse events were reviewed regularly, together with serum lipids, insulin, glucose and plasma levels of fat-soluble vitamins and b b carotene. RESULTS: Based on an intent-to-treat analysis, after 1 y of treatment patients receiving orlistat had lost an average of 8.5% of their initial body weight compared with 5.4% for placebo-treated patients; 35% of the orlistat group lost at least 5% of body weight compared with 21% of the placebo group (P`0.05), and 28% and 17%, respectively (P 0.04) lost at least 10% of body weight. Orlistat-treated patients showed signi®cant decreases (P`0.05) in serum levels of total cholesterol, low density lipoprotein cholesterol, and in the low density lipoprotein : high density lipoprotein ratio in comparison with placebo. Both groups had similar adverse-event pro®les, except for gastrointestinal events, which were 26% more frequent in the orlistat group but were mostly mild and transient. To maintain normal plasma levels of fat-soluble vitamins, supplements of vitamins A, D and E were given to 1.8%, 8.0% and 3.6%, respectively, of orlistattreated patients, compared with 0.9% of placebo-treated patients for each vitamin type. After 1 y, the decrease in vitamin E and b b carotene was signi®cantly greater in orlistat-treated patients compared with those receiving placebo (P`0.001). No signi®cant change was found in the mean vitamin E : total cholesterol ratio in either group after 52 weeks. Conclusions: Orlistat, in conjunction with a low-energy diet, produced greater and more frequent signi®cant weight loss than placebo during 1 y of treatment. One-third of orlistat-treated patients achieved clinically relevant weight loss (! 5% initial body weight). There was also an improvement in relevant serum lipid parameters. Fat-soluble vitamin supplements may be required during chronic therapy. Orlistat was well tolerated and offers a promising new approach to the long-term management of obesity.

Low-Calories Sweeteners: Present and Future, 1999

International journal of obesity (2005), 2013

To document changes in body mass index (BMI) and waist circumference (WC) over a 10-year period 1... more To document changes in body mass index (BMI) and waist circumference (WC) over a 10-year period 1998-2008, in representative surveys of adults. Adults aged 18-72 in the Scottish Health Surveys conducted in 1998, 2003 and 2008 were divided, separately for men and women, into eleven 5-year age bands. 'Synthetic birth-cohorts' were created by dividing participants into thirteen 5-years-of-birth bands (n=20 423). Weight, height and WC were objectively measured by trained observers. SUBJECTS with data available on BMI/WC were 7743/6894 in 1998, 5838/4437 in 2003 and 4688/925 in 2008 with approximately equal gender distributions. Mean BMI and waist were both greater in successive surveys in both men and women. At most specific ages, people were consistently heavier in 2008 than in 1998 by about 1-1.5 BMI units, and WCs were greater by about 2-6 cm in men and 5-7 cm in women. Greater increases were seen at younger ages between 1998 and 2003 than between 2003 and 2008, however incre...

International journal of obesity (2005), 2010

International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity, 2001

To compare anthropometric measurements and to define their behavioural associations in migrant an... more To compare anthropometric measurements and to define their behavioural associations in migrant and British-born South Asians (who have increased cardiovascular risk) or Italians (who have reduced cardiovascular risk), and in the general population of British women living in the west of Scotland. Cross-sectional survey of women aged 20-42 y, selected mainly from birth registration data, which included 63 migrant South Asians, 56 British-born South Asians, 39 migrant Italians, 51 British-born Italians, and 50 subjects representative of the general population of women, all resident in the west of Scotland. Height, weight, body mass index (BMI), and waist and hip circumferences. With age adjustment, migrant South Asians (0.88) had greater waist-to-hip ratio than British-born South Asians (0.84; P<0.05), while there was no difference between migrant (0.81) and British-born (0.79) Italian groups. Both migrant (P<0.001) and British-born South Asian (P<0.05) groups had higher waist...

British Journal of Nutrition, 2014

Iodine insufficiency is now a prominent issue in the UK and other European countries due to low i... more Iodine insufficiency is now a prominent issue in the UK and other European countries due to low intakes of dairy products and seafood (especially where iodine fortification is not in place). In the present study, we tested a commercially available encapsulated edible seaweed (Napiers Hebridean Seagreens®Ascophyllum nodosumspecies) for its acceptability to consumers and iodine bioavailability and investigated the impact of a 2-week daily seaweed supplementation on iodine concentrations and thyroid function. Healthy non-pregnant women of childbearing age, self-reporting low dairy product and seafood consumption, with no history of thyroid or gastrointestinal disease were recruited. Seaweed iodine (712 μg, in 1 g seaweed) was modestly bioavailable at 33 (interquartile range (IQR) 28–46) % of the ingested iodine dose compared with 59 (IQR 46–74) % of iodine from the KI supplement (n22). After supplement ingestion (2 weeks, 0·5 g seaweed daily,n42), urinary iodine excretion increased fro...

QJM, 2000

A model to explain interpersonal trust development, a secure situational trust emerging from cons... more A model to explain interpersonal trust development, a secure situational trust emerging from consultations, which is carried forward as learnt trust and and its consequences for cooperative behaviour in doctor/patient partnerships derived from the con-modified in each subsequent consultation. The model comprises three types of situational trust text of business relationships is applied to patient/ physician relationships. Threshold barriers exist (calculus-based, knowledge-based, and identification trust) and five cooperation criteria from which against all human behaviours or actions and trust is the process by which barriers to cooperation and to determine an individual's tendency for cooperative behaviour. These model components can compliance are overcome. Dispositional trust (a psychological trait to be trusting) is dominant in the be identified and mapped from a range of qualitative data, with the aim of enhancing cooperative behavi-early stages of a relationship and contributes to the weight of subsequent trust development. Co-oper-our and efficiently achieving optimal patient compliance.

Coronary Health Care, 1997

The Clinical Forum is intended to touch upon an area of medicine or nursing where controversy sti... more The Clinical Forum is intended to touch upon an area of medicine or nursing where controversy still exists and consensus has not yet been reached. The theme in our third issue is the management of a young woman with morbid obesity who has been overweight all her life. Three specialist opinions were sought on the following case history. CASE HISTORY A 22-year-old woman changed medical practices and was found by the practice nurse to be very significantly overweight at 21 st (133 kg) for her height (5" 5"). Further enquiry revealed that she was put on her first diet when aged 10. When she was 16 years old, 5" 2" and 151/2 st (98 kg), she went to her previous GP for advice and was admitted to hospital, where she was given 250 calories per day for a month. She lost P/E st (9.5 kg) and was discharged on an appetite suppressant and 1000 calories per day. After a year, she stopped taking the drugs and returned to serial dieting, counting calories, craving food, fighting hunger and gaining weight. She feels despondent and would like to know if anything could be done to help. EXPERT OPINION-GEORGINA ALDERSLADE Unfortunately, a cycle of unsuccessful dieting is an all too familiar scenario, although it would now be very unusual for a client to be admitted to hospital for weight loss, unless the obesity was considered to be life-threatening. The case history makes no mention of referral to a state-registered dietitian (Department of Health 1994). Referral as a child

Critical Reviews in Food Science and Nutrition, 2016

Nutritional intervention and impact of polyphenol on glycohaemoglobin (HbA1c) in non-diabetic and... more Nutritional intervention and impact of polyphenol on glycohaemoglobin (HbA1c) in non-diabetic and type 2 diabetic subjects: systematic review and meta-analysis. Critical Reviews in Food Science and Nutrition.

Practical Diabetes International, 2010

International Journal of Obesity, 2001

Sibutramine offers three types of benefit in weight management: by enhancing weight loss, by impr... more Sibutramine offers three types of benefit in weight management: by enhancing weight loss, by improving weight maintenance and by reducing the comorbidities of obesity. The clinical effects of sibutramine are explained through its known mode of action as a serotonin (5-HT) and noradrenaline reuptake inhibitor (SNRI). This dual mechanism of action results in two synergistic physiological effects-a reduction in energy intake and an increase in energy expenditure, which combine to promote and maintain weight loss.

Medicine, 2003

www.nhlbi.nih.gov/guidelines/obesity/ob\_gdlns.pdf (This large, evidence-based report on obesity p... more www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.pdf (This large, evidence-based report on obesity provides a wealth of information on all aspects of the disease.) Nature Insight 2000; 404. (An entire issue devoted to obesity, including medical aspects, genetics and treatment.

British Journal of Nutrition, 2005

The effects of moderate red wine consumption on the antioxidant status and indices of lipid perox... more The effects of moderate red wine consumption on the antioxidant status and indices of lipid peroxidation and oxidative stress associated with CHD were investigated. A randomised, controlled study was performed with twenty free-living healthy volunteers. Subjects in the red wine group consumed 375 ml red wine daily for 2 weeks. We measured the total concentration of phenolics and analysed the individual phenolics in the wine and plasma by HPLC with tandem MS. The antioxidant capacity of plasma was measured with electron spin resonance spectroscopy while homocysteine and fasting plasma lipids were also determined. The production of conjugated dienes and thiobarbituric acid-reactive substances (TBARS) were measured in Cu-oxidised LDL. Plasma total phenolic concentrations increased significantly after 2 weeks of daily red wine consumption (P≤0·001) and trace levels of metabolites, mainly glucuronides and methyl glucuronides of (+)-catechin and (−)-epicatechin, were detected in the plasm...

British Journal of Nutrition, 1998

This study reports results from a randomized controlled intervention trial, focusing on: (1) the ... more This study reports results from a randomized controlled intervention trial, focusing on: (1) the identification of successful consumer strategies for increasing fruit and vegetable intakes to the recommended levels of more than five (80 g) portions per day and (2) impact on overall diet and nutrient intakes. Adult men and women (n 170) fulfilling the main recruitment criterion of eating less than five fruit and vegetable portions per day but contemplating increasing intakes were recruited. Complete valid dietary data was provided by 101 intervention (fifty-nine estimated fruit and vegetable intakes, and forty-two simultaneous weighed total dietary and estimated fruit and vegetable intakes) and twenty-four control subjects (weighed total dietary intakes). Intervention advice included the specific association of high fruit and vegetable intake with reduced risk of disease, practicalities, and portion definition with a target intake of greater than five 80 g fruit and vegetable portion...