French may be headed for similar obesity and heart problems as U.S.

Feb 7 2006

Just 2 pounds of weight gain can greatly increase a person's risk for the metabolic syndrome, a dangerous condition that can lead to type 2 diabetes and coronary heart disease, finds a Kaiser Permanente study.

An estimated 50 million Americans have the metabolic syndrome, a combination of conditions, including abdominal obesity, high triglycerides, low HDL cholesterol, elevated blood pressure, and insulin resistance. Now the French may be headed for similar problems. The new study, led by an American researcher working with scientists at France's Institute National de la Sante et de la Recherche Medicale (INSERM), followed a normal-weight group of 3,770 French men and women for six years. They found that each kilogram (2.2 pounds) of weight gain increased the risk of the metabolic syndrome by 22 percent. After six years, 21 percent who gained nine kilograms or more (19.8 pounds or more) developed the syndrome. The results will appear in the February issue of the International Journal of Epidemiology.

The study was funded by a Trans-Atlantic Fellowship and awarded to Kaiser Permanente investigator Teresa Hillier, MD, MS, by the American Diabetes Association-European Association for the Study of Diabetes (ADA-EASD). Dr. Hillier spent a year (2004-2005) in Paris at INSERM working on this study and other projects.

From a public health perspective, says Hillier, it is especially important to note that the more pounds normal-weight people gain, the more their risk increases for developing the metabolic syndrome. Secondly, insulin levels had the greatest proportional increase among all metabolic syndrome parameters across all weight-change groups, nearly doubling for both men and women. "This is important new information because it shows that even mild weight gain is associated with insulin resistance," says Hillier, lead author of the article and an investigator at Kaiser Permanente's Center for Health Research in Portland, Ore. Finally, she notes, "many people whose weight remained stable or who lost modest amounts of weight did not develop the metabolic syndrome."

The study included adult participants aged 30-64 at baseline who were recruited between 1994 and 1996 from 10 government health examination centers in western-central France. After six years, there was an average worsening in both men and women in all measures -- weight, BMI, waist girth, glucose, insulin, HDL cholesterol, and blood pressure -- except for HDL cholesterol in women.

"These findings show that even modest weight gain in normal-weight people is an important indicator for the metabolic syndrome and thus for diabetes and heart disease risk," says Hillier. "They also tell us that we need to pay particular attention to even modest increases in weight and waist circumference, which had a marked impact on increasing insulin levels (or insulin resistance)."

For France, which has had the lowest prevalence of obesity among nine northern European countries and among the lowest of Westernized countries in the world, these results raise some important social and cultural questions. The so-called French paradox -- the belief that there is something in the French lifestyle, red wine perhaps that protects them against obesity, heart disease, and diabetes -- may be a myth or it may be a truism that is passing into history. As more and more French men and women adopt a lifestyle that is increasingly American -- fast foods, processed foods, more soda pop and caloric intake, little or no exercise -- they may be entering the front end of the obesity and diabetes epidemics that began in America nearly 20 years ago.

Kaiser Permanente has research offices in California, Oregon, Hawaii, Georgia, Colorado, Maryland, and Ohio. Results of research conducted by Kaiser Permanente physicians and investigators have been published in the Journal of the American Medical Association, the New England Journal of Medicine, the Permanente Journal, the American Journal of Public Health, Pediatrics, and other clinical journals.

Kaiser Permanente is America's leading integrated health plan. Founded in 1945, it is a nonprofit, group practice prepayment program with headquarters in Oakland, Calif. Kaiser Permanente serves the health care needs of 8.3 million members in 9 states and the District of Columbia. Today it encompasses the nonprofit Kaiser Foundation Health Plan, Inc., Kaiser Foundation Hospitals and their subsidiaries, and the for-profit Permanente Medical Groups. Nationwide, Kaiser Permanente includes approximately 145,000 technical, administrative and clerical employees and caregivers, and more than 12,000 physicians representing all specialties.

http://www.kaiserpermanente.org/