Bariatric Times - June 2008 - (Page 38)

Research Perspective such increase in energy intake could lead to substantial weight gain. Sleep loss causes yet other hormone changes that have a metabolic link to obesity. Studies have found, for instance, that partial sleep loss raises afternoon and evening levels of cortisol.21–24 Cortisol, in turn, has the potential to promote weight gain in several ways. First, the hormone increases fat accumulation via its adipogenic actions and its stimulatory effects on adipocyte fatty acid uptake.27–28 Secondly, elevated cortisol causes neuroendocrine changes that stimulate appetite (i.e., increase in neuropeptide Y [NPY] and decreases in corticotropin-releasing hormone [CRH] and melanocortin release).27–29 Finally, cortisol reduces insulin sensitivity,27,30 and, in doing so, may increase obesity risk and impair glucose tolerance. Studies have found associations between sleep assist in weight gain/regain prevention, we, as well as our patients, need to strive to achieve 7 to 8 hours of sleep daily. Steps to encourage patients to obtain better sleep habits may include: 1) education concerning sleep loss and obesity risk, 2) the practice of techniques for improved sleep duration and quality (see reference 1), and 3) postoperative sleep logs. Such steps may help to increase the amount of sleep our patients obtain regularly, along with improvement in long-term weight loss outcomes and overall health. Bariatric Times • June 2008 activity,17 decreasing total energy expenditure and increasing obesity risk. Biologically, sleep restriction contributes to obesity by affecting change in neuroendocrine regulation of appetite and energy expenditure. Population and controlled laboratory studies find with sleep deprivation an increase in ghrelin and decrease in leptin.5,6,20–24 Ghrelin is a gut hormone produced primarily by the parietal cells of the gastric fundus.25 Production of the hormone is highest before meals and during periods of low-calorie intake, suggesting its importance in hunger. Ghrelin has strong orexigenic actions, stimulating appetite and food consumption and, in laboratory animals, has suppressive effects on fat oxidation and energy expenditure.25 Leptin is a product of adipose tissue and acts as an adipostat, signaling the 16. 17. 18. 19. 20. 21. REFERENCES 1. 2. National Sleep Foundation. Available at: www.sleepfoundation.org. Kripke DF, Simons RN, Garfinkel L, et al. Short and long sleep and sleeping pills. Is increased mortality associated? Arch Gen Psychiatry. 1979;36:103–16. National Center for Health Statistics. Percentage of adults who reported an average of < 6 hours of sleep per 24-hour period by sex and age group—United States: 1985 and 2004. Morb 22. 3. 23. factors for childhood overweight: A prospective study from birth to 9.5 years. J Pediatr. 2004;145:20–5. Reilly JJ, Armstrong J, Dorosty AR, et al. Early life risk factors for obesity in childhood: Cohort study. BMJ. 2005;330:1357. Gupta NK, Mueller WH, Chan W, et al. Is obesity associated with poor sleep quality in adolescents? Am J Hum Biol. 2002;14:762–8. Imaki M, Hatanaka Y, Ogawa Y, et al. An epidemiological study on the relationship between hours of sleep and lifestyle factors in Japanese factory workers. J Physiol Anthropol Appl Hum Sci. 2002;21:115–20. Ohida T, Kamal AM, Uchiyama M, et al. The influence of lifesyle and health status factors on sleep among the Japanese general population. Sleep. 2001;24:333–8. Spiegel K, Tasali E, Penev P, et al. Brief communication: Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels and increased hunger and appetite. Ann Intern Med. 2004;141:846–50. Spiegel K, Leproult R, L’Hermite-Baterlaux M, et al. Leptin levels are dependent on sleep duration: Relationships with sympathovagal balance, carbohydrate regulation, cortisol, and thyrotropin. J Clin Endocrinol Metab. 2004;89:5762–71. Spiegel K, Knutson K, Leproult R, et al. Sleep loss: a novel risk factor for insulin resistance and type 2 diabetes. J Appl Physiol. 2005;99:2008–19. Copinschi G. Metabolic and endocrine effects of sleep deprivation. Essent Psychopharmacol. 2005;6:341–7. (review) Biologically, sleep restriction contributes to obesity by affecting change in neuroendocrine regulation of appetite and energy expenditure. POPULATION AND CONTROLLED LABORATORY STUDIES FIND WITH SLEEP DEPRIVATION AN INCREASE IN GHRELIN AND DECREASE IN LEPTIN.5,6,20–24 hypothalamus as to the size of adipose depots.26 Under normal conditions, leptin has actions that are opposite those of ghrelin on appetite, fat oxidation, and energy expenditure.25–26 Conditions that increase ghrelin and/or reduce leptin, such as sleep restriction, have the potential to promote weight gain. A recent human laboratory study of partial sleep deprivation (4-hour sleep periods) showed marked changes in ghrelin and leptin after only two nights of shortened sleep duration.20 According to the study findings, the ratio of ghrelin-toleptin with sleep restriction increased by more than 70 percent and was strongly associated with hunger, as well as increased appetite and cravings for caloriedense nutrients of high carbohydrate content, such as cake, candies, cookies, ice cream, pastry, bread, pasta, cereal, and chips. The study investigators estimated that the increase in appetite and food selection associated with changes in leptin and ghrelin with sleep deprivation could account for a 350 to 500cal/day increase in daily caloric consumption. Over time, loss and elevated evening cortisol, reduced insulin sensitivity, and glucose intolerance.20–22 Adiponectin is a hormone with anti-obesity actions that may also be affected by sleep restriction. Levels of adiponectin, a product of adipose tissue, are low in association with shortened sleep duration.31 Under normal conditions, adiponectin stimulates fat oxidation, inhibits lipogenesis, improves insulin sensitivity, and has suppressive actions against proinflammatory cytokines that may adversely influence insulin sensitivity and glucose homeostasis.32 A decline in adiponectin, as may occur with sleep debt, could, thereby, increase the risk for obesity as well as diabetes. In all of the ways discussed above, and possibly many more that remain unknown, chronic sleep loss is linked to weight gain and obesity. Fortunately, sleep loss is a modifiable variable and, in the absence of major health issues, can generally be improved or resolved with sustained effort. As discussed earlier, the lowest risk for weight gain among adults occurs with sleep durations of 7 to 8 hours. Thus, to 4. Mortal Wkly Rep. 2005. Trenell M, Marshall N, Rogers N. Sleep and metablic control: Waking to a problem? Clin Exp Pharmacol Physiol. 2007;34:1–9. Knutson KL, Spiegel K, Penev P et al. The metabolic consequences of sleep deprivation. Sleep Med Rev. 2007;11:163–78. (review) Taheri S, Lin L, Austin D, et al. Short sleep duration is associated with reduced leptin, elevated ghrelin and increased body mass index. Plos Med. 2004;1:e62. Rontoyanni VG, Baic S, Cooper AR. Association between nocturnal sleep duration, body fatness, and dietary intake in Greek women. Nutrition. 2007;23:773–7. Gangwisch JE, Malaspoina D, Boden-Albala B, et al. Inadequate sleep as a risk factor for obesity: Analysis of NHANES I. Sleep. 2005;28:1289–96. Hasler G, Buysse DJ, Klaghofer R, et al. The association between short sleep duration and obesity in young adults: A 13-year prospective study. Sleep. 2004;27:661–6. Patel SR, Malhotra A, White DP, et al. Association between reduced sleep duration and weight gain in women. Am J Epidemiol. 2006;164:947–54. Lopez-Garcia E, Faubel R, Leon-Munoz L, et al. Sleep duration, general and abdominal obesity, and weight change among the older adult population of Spain. Am J Clin Nutr. 2008;87:310–16. Chaput JP, Despres JP, Bouchard C, et al. The association between sleep duration and weight gain in adults: A 6-year prospective study from the Quebec Family Study. Sleep. 2008;31:517–23. Taheri S. The link between short sleep duration and obesity: We should recommend more sleep to prevent obesity. Arch Dis Child. 2006;91:881–884. (review) Taveras EM, Rifas-Shiman SL, Oken E, et al. Short sleep duration in infancy and the risk of childhood overweight. Arch Pediatr Adolesc Med. 2008;162:3054–11. Agras WS, Hammer LD, McNicholas F, et al. Risk 24. Van Cauter E, Holmback U, Knutson K, et al. Impact of sleep and sleep loss on neuroendocrine and metabolic function. Horm Res. 2007;67:2–9. (review) Heiman ML, Witcher DR. Ghrelin in obesity. Metab Syndr Relat Disord. 2006;4:37–42. Anubhuti AS. Leptin and its metabolic indicates—an update. Diabetes Obes Metab. 2008; Feb. 18. Peeke PM, Chrousos GP. Hypercortisolism and obesity. Ann NY Acad Sci. 1995;771:665–76. (review) Mattsson C, Olsson T. Estrogens and glucocorticoid hormones in adipose tissue metabolism. Curr Med Chem. 2007;14:2918–24. Cavagnini F, Croci M, Putignano P, et al. Glucocorticoids and neuroendocrine function. Int J Obes Relat Metab Disord. 2000;24:S77–9. Van Dijk G, de Vries K, Benthem L, et al. Neuroendocrinology of insulin resistance: Metabolic and endocrine aspects of adiposity. Eur J Pharmacol. 2003;480:31. (review) Kotani K, Sakane N, Saiga K, et al. Serum adiponectin levels and lifestyle factors in Japanese men. Heart Vessels. 2007;22:21–6. Matsuzawa Y. The metabolic syndrome and adipocytokines. FEBS Lett. 2006;580:2917–21. 5. 25. 26. 6. 27. 7. 28. 8. 29. 9. 30. 31. 10. 32. 11. 12. 13. AUTHOR CORRESPONDENCE: Cynthia Buffington, PhD, Florida Hospital Celebration Health; Phone: (407) 3034620; E-mail: Cynthia.buffington@flhosp.org. 14. 15. http://www.sleepfoundation.org

Table of Contents Feed for the Digital Edition of Bariatric Times - June 2008

Bariatric Times - June 2008 Endoluminal Treatment Options for Morbid Obesity: Devices and Techniques for Natural Orifice Approaches The Multidisciplinary Approach to Weight Loss: Defining the Roles of the Necessary Providers Acute Bleeding after Gastric Bypass Editorial Message Contents ASMBS: 25 Years Editorial Board Surgical Site Infection In The Morbidly Obese Patient: A Review Consultant's Corner The Link Between Sleep Loss and Obesity: Understanding the Mechanisms Responsible for Weight Gain with Sleep Deprivation Volume Matters Journal Watch Advertiser Index

Bariatric Times - June 2008

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