Publications by authors named "J P Lomenick"

22 Publications

A 52-week pilot study of the effects of exenatide on body weight in patients with hypothalamic obesity.

Obesity (Silver Spring) 2016 06 2;24(6):1222-5. Epub 2016 May 2.

Division of Pediatric Endocrinology, Vanderbilt University, Nashville, Tennessee, USA.

Objective: Hypothalamic obesity (HO) is a common complication of hypothalamic tumors, and effective therapies are lacking. The objective of this pilot study was to investigate changes in body weight before and during treatment with exenatide.

Methods: This was a prospective, open-label, 52-week pilot study of exenatide (10 mcg b.i.d.) in adults with HO. Ten patients enrolled, and eight completed the study. Study measures included indirect calorimetry, body composition, buffet meals, diet recall, actigraphy, and hormone assays.

Results: Participants had obesity with a baseline weight of 137.2 ± 37.6 kg. Exenatide therapy was well tolerated. Change in weight with exenatide therapy was not significant (-1.4 ± 4.3 kg [95% CI -4.9 to 2.2], P = 0.40), but six out of eight completers lost weight (-6.2 to -0.2 kg). Participants reported significantly lower intake on food recall during treatment compared with baseline (7837.8 ± 2796.6 vs. 6258.4 ± 1970.7 kJ [95% CI -2915.8 to -242.6], P = 0.027), but there was no change in intake during buffet meals.

Conclusions: Significant weight loss was not observed in patients with HO treated with exenatide, but 75% of completers had stable or decreasing weight. Further studies are needed to evaluate weight loss efficacy in patients with HO.
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June 2016

Insulin resistance is not associated with thermogenic effect of a high-fat meal in obese children.

Nutr Res 2014 Jun 11;34(6):486-90. Epub 2014 Jun 11.

Division of Pediatric Endocrinology, Vanderbilt University, Nashville, TN, USA. Electronic address:

In adults, insulin resistance may decrease the thermogenic effect of food, contributing to weight gain. We aimed to determine the effect of insulin resistance on energy expenditure in children with long-standing obesity. We hypothesized that thermogenic effect of food would decrease with increasing insulin resistance. Energy expenditure was measured using whole room indirect calorimetry in obese children 7 to 18 years old. Participants were fed a high-fat meal with energy content equal to 35% of measured resting energy expenditure. Thermogenic effect of food was measured for 180 minutes posttest meal and expressed as a percent of calories consumed. Body composition was assessed using whole-body dual-energy x-ray absorptiometry. Fasting glucose, insulin, and hemoglobin A1C were measured. Complete data were available for 25 children (median age, 12.1 years; 52% male). As expected, a significant decrease in resting energy expenditure was observed with increasing Tanner stage (P = .02 by Kruskal-Wallis test). Insulin sensitivity, as determined by homeostasis model assessment index equation, did not significantly affect resting energy expenditure (P = .3) or thermogenic effect of food (P = .7) after adjustment for Tanner stage. In conclusion, our study did not find an association between insulin resistance and energy expenditure in obese children.
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June 2014

Generic levothyroxine compared with synthroid in young children with congenital hypothyroidism.

J Clin Endocrinol Metab 2013 Feb 4;98(2):653-8. Epub 2013 Jan 4.

Department of Pediatrics, Division of Endocrinology, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-9170, USA.

Context: Clinicians who prescribe levothyroxine (LT4) for hypothyroidism often feel strongly about using a brand-name drug instead of a generic.

Objective: The objective of the study was to determine whether Synthroid resulted in better control of congenital hypothyroidism than generic LT4.

Design: This was a 5-year retrospective study.

Setting: The study was conducted at 1 tertiary care center.

Patients: Children who were 0-36 months old with congenital hypothyroidism followed up at our center from 2006 to 2011 were treated with either Synthroid exclusively (35 subjects) or generic LT4 exclusively (27 subjects).

Interventions: We recorded the subjects' TSH and free T(4) measurements, how often their LT4 dose was adjusted, and the duration of follow-up.

Main Outcome Measure: TSH variance between the groups was measured. Secondary end points were the frequency of LT4 dose changes and the variance in free T(4).

Results: Using the Wilcoxon rank sum test, there was no difference in TSH SD in the Synthroid group compared with the generic group (median 3.0 vs 2.2, P = .27). Using a linear mixed model, children treated with the generic LT4 had lower TSH estimated SD [1.35 with 95% confidence interval (CI) (1.194, 1.526)] than the Synthroid group [1.66 with 95% CI (1.536, 1.803)]. Similarly, no difference was observed in free T(4) SD between the groups using the Wilcoxon rank sum test (median 0.29 generic vs 0.36 Synthroid, P = .11), but the generic group had lower free T(4) estimated SD than the Synthroid group using the linear mixed model [0.216 with 95% CI (0.187, 0.249) vs 0.298 with 95% CI (0.273,0.326)]. Frequency of LT4 dosing adjustments was similar between the groups, both in total (median 2.0 for generic vs 3.0 for Synthroid, P = .097) and when adjusted for number of TSH checks (ratio 0.25 generic vs 0.31 Synthroid, P = .45).

Conclusions: In our study of congenital hypothyroidism, generic LT4 treatment resulted in similar or better control of hypothyroidism compared with Synthroid, as assessed by the clinical outcomes of TSH variance and the frequency of LT4 dosing adjustments.
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February 2013

Energy expenditure in obese children with pseudohypoparathyroidism type 1a.

Int J Obes (Lond) 2013 Aug 11;37(8):1147-53. Epub 2012 Dec 11.

Division of Pediatric Endocrinology, Vanderbilt Children's Hospital, Nashville, TN 37232, USA.

Context: Patients with pseudohypoparathyroidism type 1a (PHP-1a) develop early-onset obesity. The abnormality in energy expenditure and/or energy intake responsible for this weight gain is unknown.

Objective: The aim of this study was to evaluate energy expenditure in children with PHP-1a compared with obese controls.

Patients: We studied 6 obese females with PHP-1a and 17 obese female controls. Patients were recruited from a single academic center.

Measurements: Resting energy expenditure (REE) and thermogenic effect of a high fat meal were measured using whole room indirect calorimetry. Body composition was assessed using whole body dual energy x-ray absorptiometry. Fasting glucose, insulin, and hemoglobin A1C were measured.

Results: Children with PHP-1a had decreased REE compared with obese controls (P<0.01). After adjustment for fat-free mass, the PHP-1a group's REE was 346.4 kcals day(-1) less than obese controls (95% CI (-585.5--106.9), P<0.01). The thermogenic effect of food (TEF), expressed as percent increase in postprandial energy expenditure over REE, was lower in PHP-1a patients than obese controls, but did not reach statistical significance (absolute reduction of 5.9%, 95% CI (-12.2-0.3%), P=0.06).

Conclusions: Our data indicate that children with PHP-1a have decreased REE compared with the obese controls, and that may contribute to the development of obesity in these children. These patients may also have abnormal diet-induced thermogenesis in response to a high-fat meal. Understanding the causes of obesity in PHP-1a may allow for targeted nutritional or pharmacologic treatments in the future.
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August 2013

A cheerleader with weight loss and amenorrhea.

Adolesc Med State Art Rev 2012 Aug;23(2):332-9

Division of Adolescent and Young Adult Health, Department of Pediatrics, Vanderbilt University School of Medicine, Monroe Carell, Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA.

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August 2012