Deel 1 | Lichamelijke oorzaken van overgewicht
Herken de oorzaken die succesvol afvallen in de weg kunnen staan

Je zou toch heel raar staan te kijken als je bij de huisarts binnenkwam en je arts zei, nog voor je ging zitten: 'U krijgt van mij een ontstekingsremmer', zonder eerst te onderzoeken wat er met jou aan de hand is. Toch gebeurt dit al tientallen jaren bij de behandeling van overgewicht. Er wordt een dieet en een bewegingsadvies gegeven zonder rekening te houden met de mogelijke andere oorzaken van gewichtstoename. In dit eerste deel van deze serie kun je lezen hoe je deze 'andere oorzaken' van overgewicht op een eenvoudige manier kunt herkennen.

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Auteur

Cora de Fluiter

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Referenties

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    The structure of nuclear thyroid hormone receptors contains Zinc (Zn) ions, crucial for the functional properties of the protein. Iodothyronine 5' deiodinase, which is mainly responsible for peripheral T3 production, has recently been demonstrated to be a selenium (Se)-containing enzyme. A highly significant linear correlation between the T3/T4 ratio and indices of Se status was observed in the older group of subjects. Abstract
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    If Se is deficient, the deiodinase activity would be inhibited, the level of circulation T4 will be elevated, and the concentration T3 in peripheral tissues will be decreased. Se deficiency will also accelerate the iodine depletion of thyroid and may even exacerbate some detrimental effects of iodine deficiency. Possibly Se deficiency is involved in the occurrence and development of iodine deficient disorders. Keshan disease, with Se deficiency as the major cause, was also observed a change of thyroid hormone metabolism Abstract
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    Many gut peptides have been shown to influence energy intake. The most well studied in this regard are cholecystokinin (CCK), pancreatic polypeptide, peptide YY, glucagon-like peptide-1 (GLP-1), oxyntomodulin and ghrelin. With the exception of ghrelin, these hormones act to increase satiety and decrease food intake. Local effects such as the inhibition of gastric emptying might contribute to the decrease in energy intake. Circulating gut hormones have also been shown to act directly on neurons in hypothalamic and brainstem centres of appetite control. In this way, hormonal signals from the gut may be translated into the subjective sensation of satiety Article
  16. De Vriese C, Delporte C. Curr Opin Clin Nutr Metab Care. 2007 Sep;10(5):615-9 Influence of ghrelin on food intake and energy homeostasis
    Ghrelin is an endogenous orexigenic peptide recently discovered in the stomach. Ghrelin is involved in short-term regulation of food intake since its plasma levels increase before meals and decrease strongly postprandially Abstract
  17. Foster-Schubert KE, McTiernan A, Frayo RS, Schwartz RS, Rajan KB, Yasui Y, Tworoger SS, Cummings DE. J Clin Endocrinol Metab. 2005 Feb;90(2):820-5. Epub 2004 Dec 7 Human plasma ghrelin levels increase during a one-year exercise program
    Weight loss resulting from decreased caloric intake raises levels of the orexigenic hormone, ghrelin. In summary, ghrelin levels increase with weight loss achieved without reduced food intake, consistent with a role for ghrelin in the adaptive response constraining weight loss and, thus, in long-term body weight regulation.Abstract
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    Body fat, body weight, and resting metabolic rate significantly decreased in the weight-loss group before the increase in ghrelin. These findings suggest that ghrelin responds in a compensatory manner to changes in energy homeostasis in healthy young women, and that ghrelin exhibits particular sensitivity to changes in body weight. Article
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    Diet-induced weight loss is associated with an increase in fasting ghrelin. Weight loss is associated with an improved postprandial plasma ghrelin response to a carbohydrate meal, whereas the response to a fat meal is not modified. Abstract
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    Thirty minutes after the start of eating, satiety signals arise from the intestinal tract and, in between meals, from the adipose tissue and liver. Satiety signals are sedative and arrest the processing of food in the intestine, hence leading to termination of eating.Abstract
  21. Goldstone AP. Prog Brain Res. 2006;153:57-73 The hypothalamus, hormones, and hunger: alterations in human obesity and illness
    While obese subjects have appropriate reductions in orexigenic ghrelin, other gut-hormone disturbances may contribute to obesity such as reduced anorexigenic PYY and PP. Abstract
  22. Small CJ, Bloom SR. Curr Drug Targets CNS Neurol Disord. 2004 Oct;3(5):379-88 Gut hormones as peripheral anti obesity targets
    Obese subjects have lower basal fasting PYY levels and have a smaller post prandial rise. Abstract
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    In MOB-MS women the fasting PYY(3-36) levels were lower compared to lean controls and OB-MS, whilst postprandially in both OB-MS and MOB-MS, it was much lower than in lean women Article
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    So, adipocytes synthesize and express leptin, the product of Ob gene, a regulator of long-term food intake, in amounts proportional to the fat amount Abstract
  25. Scarpace PJ, Zhang Y. Front Biosci. 2007 May 1;12:3531-44 Elevated leptin: consequence or cause of obesity?
    Chronic overexpression of central leptin induces a leptin resistance that mimics many of the characteristics associated with diet-induced or adult-onset obesity including reduced leptin receptors, diminished signaling, and impaired responsiveness to exogenous leptin. Once leptin resistance takes hold, each subsequent exposure to high-density food faces diminished counter-regulatory responses, leading to exacerbated weight gain Abstract
  26. Moschos S, Chan JL, Mantzoros CS. Fertil Steril. 2002 Mar;77(3):433-44 Leptin and reproduction: a review
    Leptin may act as the critical link between adipose tissue and the reproductive system, indicating whether adequate energy reserves are present for normal reproductive function. Future interventional studies involving leptin administration are expected to further clarify this role of leptin and may provide new therapeutic options for the reproductive dysfunction associated with states of relative leptin deficiency or resistance Abstract
  27. Banks WA. Peptides. 2004 Mar;25(3):331-8 The many lives of leptin
    Obesity in humans and many animals is associated with a leptin resistant state rather than a leptin deficiency. Consideration of the BBB data would favor the view that ancestral levels of leptin were much lower than those currently considered normal and are consistent with leptin acting as a metabolic switch, informing the brain when fat reserves are adequate to direct energy expenditures towards activities other than seeking calories. Abstract
  28. Banks WA. Physiol Behav. 2006 Nov 30;89(4):472-6. Epub 2006 Aug 10 The blood-brain barrier as a regulatory interface in the gut-brain axes
    Leptin transport is also inhibited in starvation and by hypertriglyceridemia. Since hypertriglyceridemia occurs in both starvation and obesity, we have postulated that the peripheral resistance induced by hypertriglyceridemia may have evolved as an adaptive mechanism in response to starvation. Abstract
  29. Banks WA, Coon AB, Robinson SM, Moinuddin A, Shultz JM, Nakaoke R, Morley JE. Triglycerides induce leptin resistance at the blood-brain barrier
    We conclude that triglycerides are an important cause of leptin resistance as mediated by impaired transport across the BBB and suggest that triglyceride-mediated leptin resistance may have evolved as an anti-anorectic mechanism during starvation. Decreasing triglycerides may potentiate the anorectic effect of leptin by enhancing leptin transport across the BBB. Article
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    It is hypothesized that this naturally occurring leptin resistance allowed temporary neutralization of satiety mechanisms and evolved as a response to survive subsequent periods of famine Abstract
  31. Butera PC. Physiol Behav. 2010 Feb 9;99(2):175-80. Epub 2009 Jun 23. Estradiol and the control of food intake
    A key role of estradiol in the control of food intake and energy balance in humans is evidenced by the fact that the incidence of obesity increases greatly after menopauseArticle
  32. Banks WA. Curr Pharm Des. 2008;14(16):1606-14 The blood-brain barrier as a cause of obesity
    Triglycerides are elevated in both starvation and obesity We postulate that hypertriglyceridemia evolved as a starvation signal to the brain that acts in part to inhibit the transport of the leptin across the BBB. The hypertriglyceridemia of obesity invokes this aspect of the starvation response, inducing leptin resistance at the BBB Abstract
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    The risks attributable to obesity (baseline BMI >or= 25 kg/m2) were 23.0% for hypertension, 70.8% for diabetes, 27.9% for hypertriglyceridemia, and 24.1% for hyperuricemia Abstract
  34. Hirschberg AL, Naessén S, Stridsberg M, Byström B, Holtet J. Gynecol Endocrinol. 2004 Aug;19(2):79-87 Impaired cholecystokinin secretion and disturbed appetite regulation in women with polycystic ovary syndrome
    We conclude that women with PCOS have reduced postprandial CCK secretion and deranged appetite regulation associated with increased levels of testosterone. Impaired CCK secretion may play a role in the greater frequency of binge eating and overweight in women with PCOS Abstract
  35. Wurtman JJ. Clin Neuropharmacol. 1988;11 Suppl 1:S139-45 Carbohydrate cravings: a disorder of food intake and mood
    Obese individuals who crave carbohydrates, exhibit positive changes in mood after carbohydrate intake Abstract
  36. Wurtman JJ., Drugs. 1990;39 Suppl 3:49-52., Carbohydrate craving. Relationship between carbohydrate intake and disorders of mood
    The brain neurotransmitter, serotonin, seems to be involved in the abnormal regulation of mood and food intake that underlies diet failures or weight gain in individuals who suffer from carbohydrate craving obesity (CCO), premenstrual syndrome (PMS) and seasonal affective disorder (SAD) Abstract
  37. Wurtman JJ. J Am Diet Assoc. 1984 Sep;84(9):1004-7. The involvement of brain serotonin in excessive carbohydrate snacking by obese carbohydrate cravers
    A specific hunger for carbohydrate-rich foods has been observed in animals and human beings and appears to be regulated by the brain neurotransmitter serotonin. Consumption of a carbohydrate-rich meal increases the synthesis and release of brain serotonin (by enhancing the brain uptake of its precursor, tryptophan). Abstract
  38. Lieberman HR, Wurtman JJ, Chew B,.Am J Clin Nutr. 1986 Dec;44(6):772-8, Changes in mood after carbohydrate consumption among obese individuals
    Moreover, noncarbohydrate cravers experienced an increase in depression, while carbohydrate cravers reported feeling less depressed. Findings suggest that snacking habits of obese individuals may be related to subsequent mood states Abstract
  39. Wurtman RJ, Wurtman JJ, Obes Res. 1995 Nov;3 Suppl 4:477S-480S., Brain serotonin, carbohydrate-craving, obesity and depression
    Carbohydrate consumption--acting via insulin secretion and the "plasma tryptophan ratio"--increases serotonin release; protein intake lacks this effect. Hence many patients learn to overeat carbohydrates (particularly snack foods, like potato chips or pastries, which are rich in carbohydrates and fats) to make themselves feel better. This tendency to use certain foods as though they were drugs is a frequent cause of weight gain, and can also be seen in patients who become fat when exposed to stress, or in women with premenstrual syndrome, or in patients with "winter depression," or in people who are attempting to give up smoking. Nicotine, like dietary carbohydrates, increases brain serotonin secretion; nicotine withdrawal has the opposite effect. Abstract
  40. Dye L, Blundell JE., Hum Reprod. 1997 Jun;12(6):1142-51., Menstrual cycle and appetite control: implications for weight regulation
    Hormonal fluctuations associated with the menstrual cycle influence appetite control and eating behaviour. Energy intake varies during the reproductive cycle in humans and animals, with a periovulatory nadir and a luteal phase peak. Patterns of macronutrient selection show less consistency but a number of studies report carbohydrate cravings in the premenstrual phase, particularly in women with premenstrual syndrome Abstract
  41. Miller AL. Altern Med Rev. 2005 Mar;10(1):5-13. Epidemiology, etiology, and natural treatment of seasonal affective disorder
    There is much more seasonal difference in higher latitudes than in lower latitudes. In a significant portion of the population of the northern United States, the shorter days of fall and winter precipitate a syndrome that can consist of depression, fatigue, hypersomnolence, hyperphagia, carbohydrate craving, weight gain, and loss of libido.Article
  42. Møller SE., Pharmacol Toxicol. 1992;71 Suppl 1:61-71, Serotonin, carbohydrates, and atypical depressio
    At least three categories of atypical depression have been described. The hysteroid dysphoria is characterized by repeated episodes of depressed mood in response to feeling rejected, and a craving for sweets and chocolate. Two other issues are characterized by a cyclical occurrence of changes of mood and appetite, i.e., the late the premenstrual syndrome (PMS), and the major depression with seasonal pattern or seasonal affective disorder (SAD). Abstract
  43. Jimerson DC, Wolfe BE, Metzger ED, Finkelstein DM, Cooper TB, Levine JM., Arch Gen Psychiatry. 1997 Jun;54(6):529-34., Decreased serotonin function in bulimia nervosa,
    Our study provides new evidence that impaired central nervous system serotonergic responsiveness may contribute to the onset or maintenance of abnormal eating patterns in patients with bulimia nervosa. Abstract
  44. Marsh K, Barclay A, Colagiuri S, Brand-Miller J. Curr Diab Rep. 2011 Apr;11(2):120-7. Glycemic index and glycemic load of carbohydrates in the diabetes diet
    These findings, together with the fact that there are no demonstrated negative effects of a low GI diet, suggest that the GI should be an important consideration in the dietary management and prevention of diabetes.Abstract
  45. Bell SJ, Sears B. Crit Rev Food Sci Nutr. 2003;43(4):357-77. Low-glycemic-load diets: impact on obesity and chronic diseases
    The continued intake of high-glycemic load meals is associated with an increased risk of chronic diseases such as obesity, cardiovascular disease, and diabetes.Abstract
  46. Robert JJ., Ann Pediatr (Paris). 1990 Mar;37(3):143-9., Hyperinsulinism syndromes caused by insulin resistance
    Resistance to insulin consists in a decrease in insulin's biologic action and is manifested mainly by hyperinsulinism. Abstract
  47. Del Prato S. Presse Med. 1992 Sep 9;21(28):1312-7. Hyperinsulinism. Causes and mechanism
    A high plasma insulin concentration in the presence of a normal or high plasma glucose level appears to be a common feature of glucose intolerance, obesity, and hypertension Abstract
  48. Rodríguez A, Catalán V, Gómez-Ambrosi J, Frühbeck G., Curr Pharm Des. 2007;13(21):2169-75., Visceral and subcutaneous adiposity: are both potential therapeutic targets for tackling the metabolic syndrome?
    The metabolic syndrome represents a constellation of co-morbidities that include central adiposity, insulin resistance, dyslipidemia and hypertension, which results from an elevated prevalence of obesity Abstract
  49. Vogeser M, König D, Frey I, Predel HG, Parhofer KG, Berg A. Clin Biochem. 2007 Sep;40(13-14):964-8. Epub 2007 Jun 2 Fasting serum insulin and the homeostasis model of insulin resistance (HOMA-IR) in the monitoring of lifestyle interventions in obese persons
    HOMA-IR index (homeostasis model of insulin resistance) was calculated as fasting serum glucose*fasting serum insulin/22.5, with lower values indicating a higher degree of insulin sensitivity. Individual changes in the carbohydrate metabolism achieved by a lifestyle intervention program were displayed by fasting serum insulin concentrations and the HOMA-IR but not by fasting glucose measurement alone.[Abstract]
  50. Geloneze B, Tambascia MA. Arq Bras Endocrinol Metabol. 2006 Apr;50(2):208-15. Epub 2006 May 23 Laboratorial evaluation and diagnosis of insulin resistance
    HOMA is a mathematical model that predicts IS simply by measuring insulinemia and fasting blood glucose and shows good correlation with hyperinsulinemic-euglycemic clamp method, considered a gold standard in the measurement of IS.Abstract
  51. 33 Zimmet PZ. Diabetes Care. 1993 Dec;16 Suppl 3:56-70 Hyperinsulinemia--how innocent a bystander?
    Epidemiological data support a key role for hyperinsulinemia in these disorders but it is far from conclusive except for the fact that hyperinsulinemia and insulin resistance may be present many years before the onset of impaired glucose tolerance and NIDDM, and clearly play a role in their etiology.Abstract
  52. Fonseca VA. Clin Cornerstone. 2008;9(2):51-9; discussion 60-1. Identification and treatment of prediabetes to prevent progression to type 2 diabetes
    Overt type 2 diabetes is usually preceded by a condition known as prediabetes, which is characterized by impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). Both IFG and IGT exhibit elevated glucose levels that are not sufficient to be classified as diabetes but that represent the development of insulin resistance. Achieving glycemic control in patients with prediabetes through lifestyle and pharmacologic interventions can effectively prevent or delay the development of diabetes and its associated complications.Abstract
  53. Lobo RA. Maturitas. 2008 May 20;60(1):10-8. Epub 2008 Apr 14. Metabolic syndrome after menopause and the role of hormones
    MBS may occur in 40% of PM women and is largely determined by overweight status and obesity. Weight gain, particularly an increase in central fat mass increases in PM women, beginning a few years prior to menopause Abstract
  54. Yáñez M, Albala C. Rev Med Chil. 1995 Dec;123(12):1520-4 Body fat distribution: anthropometric indicators
    There are two types of fat distribution in obese subjects. The abdominal, superior, android or apple shaped and the gluteo-femoral, gynecoid, inferior or pear shaped. In the former, fat is accumulated in the abdomen and in the latter, in the gluteal region. The superior distribution is associated with a higher risk of cardiovascular diseases. Among anthropometric measurements of fat distribution, the ratio between waist circumference measured at the level of the navel and hip circumference, measured at the level of greater trochanters, is the best indicator. Using the cutoff points of 0.8 for women and 1 for men, it has a good correlation with visceral fat. Abstract
  55. Björntorp P. Ann Med. 1992 Feb;24(1):15-8. Abdominal fat distribution and disease: an overview of epidemiological data
    Recent prospective, epidemiological research has demonstrated the power of an increased waist/hip circumference ratio (WHR) to predict both cardiovascular disease (CVD) and non-insulin dependent diabetes mellitus (NIDDM) in men and women. Abstract
  56. Sobngwi E, Boudou P, Mauvais-Jarvis F, Leblanc H, Velho G, Vexiau P, Porcher R, Hadjadj S, Pratley R, Tataranni PA, Calvo F, Gautier JF. Lancet. 2003 May 31;361(9372):1861-5 Effect of a diabetic environment in utero on predisposition to type 2 diabetes
    Exposure to a diabetic environment in utero is associated with increased occurrence of impaired glucose tolerance and a defective insulin secretory response in adult offspring, independent of genetic predisposition to type 2 diabetes Abstract
  57. Wroblewska-Seniuk K, Wender-Ozegowska E, Szczapa J. Pediatr Diabetes. 2009 Nov;10(7):432-40. Long-term effects of diabetes during pregnancy on the offspring
    Children born to mothers with gestational diabetes seem to be at risk for obesity and metabolic disturbances Abstract
  58. Fetita LS, Sobngwi E, Serradas P, Calvo F, Gautier JF. J Clin Endocrinol Metab. 2006 Oct;91(10):3718-24 Consequences of fetal exposure to maternal diabetes in offspring
    Thus, fetal exposure to maternal diabetes may contribute to the worldwide diabetes epidemic. Public health interventions targeting high-risk populations should focus on long-term follow-up of subjects who have been exposed in utero to a diabetic environment and on a better glycemic control during pregnancy. Article
  59. Lustig RH. Nat Clin Pract Endocrinol Metab. 2006 Aug;2(8):447-58. Childhood obesity: behavioral aberration or biochemical drive? Reinterpreting the First Law of Thermodynamics
    Insulin and leptin share a common central signaling pathway, and it seems that insulin functions as an endogenous leptin antagonist. Suppressing insulin ameliorates leptin resistance, with ensuing reduction of caloric intake, increased spontaneous activity, Abstract
  60. Lustig RH. Pediatr Ann. 2006 Dec;35(12):898-902, 905-7. The 'skinny' on childhood obesity: how our western environment starves kids' brains
    The insulin drives energy into fat, and interferes with leptin signaling in the VMH. This results in weight gain and the sense of starvation, which results in decreased SNS activity, reducing energy expenditure and physical activity; and increased vagal activity, which promotes yet further insulin release and energy storage. Thus, hyperinsulinemia turns the leptin negative feedback system into a "vicious cycle" of obesity. Abstract
  61. Ravussin E. Int J Obes Relat Metab Disord. 1995 Dec;19 Suppl 7:S8-S9 Low resting metabolic rate as a risk factor for weight gain: role of the sympathetic nervous system
    Resting metabolic rate (RMR) comprises 50-80% of daily energy expenditure, and is highly variable between subjects even after adjusting for body weight and body composition. RMR is believed to be genetically determined. Individuals with a low RMR for a given body size are at higher risk of significant weight gain, relative to those with a high RMR Abstract
  62. Shetty PS. Eur J Clin Nutr. 1999 Apr;53 Suppl 1:S14-33 Adaptation to low energy intakes: the responses and limits to low intakes in infants, children and adults
    Reduction in energy intake below the acceptable level of requirement for an individual results in a series of physiological and behavioural responses, which are considered as an adaptation to the low energy intake. This ability of the human body to adapt to a lowering of the energy intake is without doubt beneficial to the survival of the individual Abstract
  63. Rössner S. Nord Med. 1990;105(6-7):190-1 Fasting--wrong in obesity?
    Fasting has been advocated as an effective way to reduce body weight. However, few data support any long-term effect of this therapy. On the contrary, evidence is accumulating that the repeated weight loss and concomitant weight gain, typical of fasting in many individuals, will lead to a subsequently higher body weight. Each weight cycle seems to increase the risk of a higher waist/hip ratio, greater metabolic efficiency and a food preference towards fat. All these trends result in further problems associated with weight loss and a vicious circle is established. Abstract
  64. Josephine Connolly, Theresa Romano and Marisa Patruno Family Practice Vol. 16, No. 2, 196-201 Effects of dieting and exercise on resting metabolic rate and implications for weight management
    Resting metabolic rate accounts for 6075% of total energy expenditure in sedentary people.2 Therefore, it is a major determinant of energy balance and changes in weight. Factors which decrease resting metabolic rate would be associated with difficulty maintaining weight or weight loss, or frank weight gain. On the contrary, anything that increases resting metabolic rate would facilitate weight loss and maintenance of weight loss. Caloric restriction is known to produce a short-term reduction in resting metabolic rate. Article
  65. Frankenfield DC, Rowe WA, Smith JS, Cooney RN. J Am Diet Assoc. 2003 Sep;103(9):1152-9 Validation of several established equations for resting metabolic rate in obese and nonobese people
    Of the calculation standards tested, the Mifflin standard provided an accurate estimate of actual resting metabolic rate in the largest percentage of nonobese and obese individuals and therefore deserves consideration as the standard for calculating resting metabolic rate in obese and nonobese adults Abstract
  66. MD Mifflin, ST St Jeor, LA Hill, BJ Scott, SA Daugherty and YO Koh American Journal of Clinical Nutrition, Vol 51, 241-247 A new predictive equation for resting energy expenditure in healthy individuals
    REE (males) = 10 x weight (kg) + 6.25 x height (cm) - 5 x age (y) + 5; REE (females) = 10 x weight (kg) + 6.25 x height (cm) - 5 x age (y) 161 Article
  67. Dobratz JR, Sibley SD, Beckman TR, Valentine BJ, Kellogg TA, Ikramuddin S, Earthman CP. JPEN J Parenter Enteral Nutr. 2007 May-Jun;31(3):217-27 Predicting energy expenditure in extremely obese women
    The Mifflin-St Jeor equation was most accurate method for REE assessment in extremely obese women Abstract
  68. Frankenfield D, Roth-Yousey L, Compher C., J Am Diet Assoc. 2005 May;105(5):775-89, Comparison of predictive equations for resting metabolic rate in healthy nonobese and obese adults: a systematic review.
    Of these equations, the Mifflin-St Jeor equation was the most reliable, predicting RMR within 10% of measured in more nonobese and obese individuals than any other equation, and it also had the narrowest error range Abstract
  69. Elliott B., Nurse Pract. 2000 Mar;25(3):92-4, 99-105, Diagnosing and treating hypothyroidism
    Typical symptoms are consistent with declining metabolic functions and range from vague complaints of fatigue in subclinical deficiency to overt clinical symptoms involving changes in mentation and memory, lethargy, weight gain, cold intolerance, constipation, and goitrous enlargement of the thyroid gland Abstract
  70. Lovejoy JC, Champagne CM, de Jonge L, Xie H, Smith SR. Int J Obes (Lond). 2008 Jun;32(6):949-58. Epub 2008 Mar 11 Increased visceral fat and decreased energy expenditure during the menopausal transition
    Twenty-four hour Energy Expenditure (EE) and sleeping EE decreased significantly with age; however, the decrease in sleeping EE was 1.5-fold greater in women who became postmenopausal compared with premenopausal controls (-7.9 vs -5.3%). Fat oxidation decreased by 32% in women who became postmenopausal (P<0.05), but did not change in those who remained premenopausal Abstract
  71. Poehlman ET, Tchernof A. Coron Artery Dis. 1998;9(12):799-803. Traversing the menopause: changes in energy expenditure and body composition.
    Thus, it appears that the loss of ovarian function induces a reduction in resting metabolic rate, physical activity energy expenditure, fat-free mass, and an increase in fat mass and abdominal adipose tissue accumulation Abstract
  72. Sapin R, Schlienger JL. Ann Biol Clin (Paris). 2003 Jul-Aug;61(4):411-20 Thyroxine (T4) and tri-iodothyronine (T3) determinations: techniques and value in the assessment of thyroid function
    Hormonal production of the thyroid gland is constituted of thyroxine or T4 (80%) and triiodothyronine or T3 (20%). In the circulation, whole T4 originates from thyroid secretion but most of T3 (80%) is produced extrathyroidally from T4 deiodination Abstract
  73. Kabadi MU. Thyroidology. 1993 Aug;5(2):41- Role of thyrotropin in triiodothyronine generation in hypothyroidism
    T3 is the main active thyroid hormone and TSH is the major modulator of its synthesis and release by the thyroid gland Abstract
  74. Heitman B, Irizarry A. Nurse Pract. 1995 Mar;20(3):54-60 Hypothyroidism: common complaints, perplexing diagnosis
    The disease affects every major organ system and metabolic process. The diagnosis of primary hypothyroidism can be perplexing to the clinician because of its insidious onset and wide array of nonspecific manifestations. Complaints of fatigue, muscle weakness, lethargy, and weight gain are often at first attributed to emotional or other health problems Abstract
  75. Redmond GP. Int J Fertil Womens Med. 2002 May-Jun;47(3):123-7 Hypothyroidism and women's health
    Hypothyroidism affects 4% to 10% of women, increasing with age. Symptoms, which are often nonspecific and subtle, can include: lethargy, mild weight gain, edema, cold intolerance, constipation, mental impairment, dry skin, depression, irregular menses, hoarseness, myalgias, hyperlipidemia, and bradycardia. Because estrogen increases levels of thyroid binding globulin, women who are on HRT or OCs, or are pregnant, usually have total T4 levels above the reference range Abstract
  76. Fox CS, Pencina MJ, D'Agostino RB, Murabito JM, Seely EW, Pearce EN, Vasan RS. Arch Intern Med. 2008 Mar 24;168(6):587-92 Relations of thyroid function to body weight: cross-sectional and longitudinal observations in a community-based sample
    Thyroid function (as assessed by serum TSH concentration) within the reference range is associated with body weight in both sexes. Our findings raise the possibility that modest increases in serum TSH concentrations within the reference range may be associated with weight gain Abstract
  77. Gaby AR. Altern Med Rev. 2004 Jun;9(2):157-79 Sub-laboratory hypothyroidism and the empirical use of Armour thyroid
    Evidence is presented that many people have hypothyroidism undetected by conventional laboratory thyroid-function tests, and cases are reported to support the empirical use of Armour thyroid. Clinical evaluation can identify individuals with sub-laboratory hypothyroidism who are likely to benefit from thyroid-replacement therapy. In a significant proportion of cases, treatment with thyroid hormone has resulted in marked improvement in chronic symptoms that had failed to respond to a wide array of conventional and alternative treatments. Article
  78. Wémeau JL, Lefebvre J, Linquette M. Nouv Presse Med. 1979 Feb 3;8(6):415-9. Low triiodothyronine (T3) syndrome
    As first described in serious systemic illnesses isolated decreased T3 plasma concentration was related to impaired peripheral conversion of T4, to T3 with preferential production of reverse T3 (rT3). A "low T3 syndrome" was seen in 47 out of 109 patients with extra-thyroidal diseases. Metabolic state, TSH and TSH responses to TRH were normal despite of low T3 concentration. Euthyroidism seems mainly due to T4 itself in these patients Abstract
  79. Roti E, Minelli R, Salvi M. Int J Obes Relat Metab Disord. 2000 Jun;24 Suppl 2:S113-5 Thyroid hormone metabolism in obesity
    Serum thyroid hormone concentrations and their metabolic fate are within the normal range limits in obese subjects. Also serum TSH concentrations and its response to TRH are normal, suggesting that tissue availability of thyroid hormones is normally preserved in these subjects. In contrast, during caloric restriction serum T3 concentrations decrease as a consequence of its reduced production rate from peripheral deiodination of T4. Opposite, serum rT3 concentrations markedly increase as a result of its decreased metabolic clearance rate Abstract
  80. Jackson MJ, Dillon SA, Broome CS, McArdle A, Hart CA, McArdle F. Proc Nutr Soc. 2004 Nov;63(4):513-7 Are there functional consequences of a reduction in selenium intake in UK subjects?
    Dietary Se levels in the UK have fallen over the last 20 years and recent surveys indicate that average Se intakes are 30-40 microg/d, which is well below the current UK reference nutrient intake for adult men (75 microg/d) or women (60 microg/d). Abstract
  81. Wuehler SE, Peerson JM, Brown KH. Public Health Nutr. 2005 Oct;8(7):812-9 Use of national food balance data to estimate the adequacy of zinc in national food supplies: methodology and regional estimates
    The mean per capita absorbable zinc content of national food supplies ranged from 2.98-3.01 mg day(-1) in Western Europe and USA & Canada to 2.09 mg day(-1) in Southeast Asia. The estimated percentage of individuals at risk of inadequate zinc intake ranged from 9.3-9.5% in the regions of North Africa & Eastern Mediterranean and USA & Canada to 33.1% in Southeast Asia. Overall, approximately 20.5% of the world's population is estimated to be at risk of inadequate zinc intake. Data on the absorbable zinc content of national food supplies can be used to determine whether further assessments of population zinc status and development of intervention Abstract
  82. Sonka J, Sucharda P, Kotásková H. Cas Lek Cesk. 1992 Feb 21;131(3):68-72 Energy metabolism in obesity
    Inadequate intake of food and stress modify the T3/rT3 ratio. Many common drugs interfere with energy metabolism, namely those used in psychiatry and all hormones and their antagonists mentioned above and used for a long time. Obesity should not be considered as a simple result of overeating and lack of physical activity.Abstract
  83. Complementary Compounding Services Reverse T3 Dominance
    Reverse T3 dominance, also known as Wilsons Syndrome, is a condition that exhibits most hypothyroid symptoms although circulating levels of T3 and T4 are within normal test limits. Article
  84. Elliott B., Nurse Pract. 2000 Mar;25(3):92-4, 99-105, Diagnosing and treating hypothyroidism
    Hypothyroidism is a common endocrine disorder affecting 1.4% to 2.0% of women and 0.1% to 0.2% of men. The prevalence of both overt and subclinical hypothyroidism increases with age, affecting 5% to 10% of women over age 50 and 1.25% of men over age 60, with an increasing incidence in women ages 40 to 50. Typical symptoms are consistent with declining metabolic functions and range from vague complaints of fatigue in subclinical deficiency to overt clinical symptoms involving changes in mentation and memory, lethargy, weight gain, cold intolerance, constipation, and goitrous enlargement of the thyroid gland Abstract
  85. No authors listed Drug Ther Bull. 2006 Jul;44(7):53-6.Hypothyroidism in the pregnant woman
    Around another 2.5% of pregnant women have subclinical ('compensated') hypothyroidism, which is defined as a raised plasma TSH concentration with a normal free T4 concentration Abstract
  86. Lazarus JH, Premawardhana LD. J Clin Pathol. 2005 May;58(5):449-52 Screening for thyroid disease in pregnancy
    Although gestational hyperthyroidism is uncommon (0.2%), hypothyroidism (autoimmune disease or suboptimal iodine intake) occurs in 2.5% of women and is predictive of reduced neonatal and child neuropsychological development and maternal obstetric complications. T4 supply is crucial to fetal nervous system maturation; currently, the recommended daily iodine intake is 200 microg, and this is not always achieved, even in the UK Abstract
  87. Lazarus JH., Minerva Endocrinol. 2005 Jun;30(2):71-87,Thyroid disease in pregnancy and childhood
    Fetal brain development depends on T4 transport into the fetus which in turn depends on sufficient maternal iodine supply. There is current concern that adequate iodisation is not present in large parts of Europe. There is increasing evidence that thyroid autoimmunity is associated with fetal loss but the mechanism is unclear and therapy requires carefully conducted studies Abstract
  88. J H Lazarus, F Ammari, R Oretti, A B Parkes, C J Richards, and B Harris, Br J Gen Pract. 1997 May; 47(418): 305308. Clinical aspects of recurrent postpartum thyroiditis
    Postpartum thyroiditis (PPT), characterized by transient hyperthyroidism and transient hypothyroidism, occurs in 5-9% of women. It is accompanied by the presence of circulating antithyroid peroxidase antibodies (TPOAb) which have been associated with an increase in depressive symptomatology compared with TPOAb-negative women. There was a 70% chance of developing recurrent PPT after a first attack, and a 25% risk even in women who were only anti-TPO positive without thyroid dysfunction during the first postpartum period. The recurrence of postpartum depression was not related to thyroid function. Patients noted to have thyroid dysfunction or just to be euthyroid but anti-TPO positive after pregnancy should be assessed carefully after a subsequent pregnancy Article
  89. Martino E, Bartalena L, Bogazzi F, Braverman LE., Endocr Rev. 2001 Apr;22(2):240-54. The effects of amiodarone on the thyroid
    Amiodarone is a benzofuranic-derivative iodine-rich drug widely used for the treatment of tachyarrhythmias and, to a lesser extent, of ischemic heart disease. It often causes changes in thyroid function tests (typically an increase in serum T(4) and rT(3), and a decrease in serum T(3), concentrations), mainly related to the inhibition of 5'-deiodinase activity, resulting in a decrease in the generation of T(3) from T(4) and a decrease in the clearance of rT(3). In 14-18% of amiodarone-treated patients, there is overt thyroid dysfunction, either amiodarone-induced thyrotoxicosis (AIT) or amiodarone-induced hypothyroidism (AIH). Abstract
  90. Livingstone C, Rampes H., J Psychopharmacol. 2006 May;20(3):347-55. Epub 2005 Sep 20 Lithium: a review of its metabolic adverse effects
    Treatment with lithium has long been recognized to be associated with metabolic adverse effects notably hypothyroidism, hyperparathyroidism, weight gain and nephrogenic diabetes insipidus. Article
  91. Verrotti A, Scardapane A, Manco R, Chiarelli F. J Pediatr Endocrinol Metab. 2008 May;21(5):401-8. Antiepileptic drugs and thyroid function
    Antiepileptic drugs (AED) are a heterogeneous group of compounds widely used in both adults and children. These drugs are related to various adverse effects involving several organs and endocrinological and metabolic functions. In particular, relevant effects on thyroid function have been described. Subclinical hypothyroidism and alterations in thyroid hormone serum levels are reported in the literature; phenytoin, valproate and carbamazepine, in particular, seem to be involved in these alterations. Abstract

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