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Is There an Optimal Diet for Weight Management and Metabolic Health?
... Preventing weight gain is, therefore, critical to maintain health and prevent premature mortality. In addition, weight loss in people with obesity improves and can even eliminate many of these abnormalities [1][2][3]. Highprotein intake (both absolute amounts and as percentage of total dietary energy intake) is commonly recommended to help people avoid body weight gain and to help people with obesity lose weight as acutely protein is more satiating and has a greater thermic effect of feeding than carbohydrate and fat [4][5][6]. However, the results from long-term observational and several randomized controlled diet intervention studies do not demonstrate a beneficial effect of high-protein intake on body weight or metabolic health; on the contrary, high-protein intake is associated with both weight gain and obesity and increased risk for developing cardiometabolic diseases [6,7 weight loss, but the beneficial effect is small and appears to be limited to the first few weeks of diet intervention and to diets that increase protein intake at the expense of carbohydrate intake [2,6]. ...
... Highprotein intake (both absolute amounts and as percentage of total dietary energy intake) is commonly recommended to help people avoid body weight gain and to help people with obesity lose weight as acutely protein is more satiating and has a greater thermic effect of feeding than carbohydrate and fat [4][5][6]. However, the results from long-term observational and several randomized controlled diet intervention studies do not demonstrate a beneficial effect of high-protein intake on body weight or metabolic health; on the contrary, high-protein intake is associated with both weight gain and obesity and increased risk for developing cardiometabolic diseases [6,7 weight loss, but the beneficial effect is small and appears to be limited to the first few weeks of diet intervention and to diets that increase protein intake at the expense of carbohydrate intake [2,6]. Moreover, high-protein intake without marked carbohydrate restriction blunts the beneficial metabolic effects associated with weight loss [8,9]. ...
... It is well established that obesity and a hypercaloric, Western-type diet are involved in the pathogenesis of atherosclerosis but the underlying mechanisms and specific nutrients responsible for the adverse effect are still unclear, because of the complex interaction among not only the types but also sources of macronutrient intake. Saturated, but not unsaturated, fat intake is associated with increased LDL-cholesterol and high carbohydrate intake raises plasma triglycerides and reduces HDL-cholesterol [2,35]. High-protein intake often occurs at the expense of carbohydrate intake and is often accompanied by high saturated fatty acid intake, which can confound the interpretation of results from studies that sought to evaluate the effect of protein intake on plasma lipids. ...
Purpose of review:
High-protein intake is commonly recommended to help people manage body weight. However, high-protein intake could have adverse health consequences. Here we review the latest findings concerning the effect of high-protein intake on cardiometabolic health.
Recent findings:
Calorie-reduced, high-protein, low-carbohydrate diets lower plasma glucose in people with type 2 diabetes (T2D). However, when carbohydrate intake is not markedly reduced, high-protein intake often does not alter plasma glucose and increases insulin and glucagon concentrations, which are risk factors for T2D and ischemic heart disease. High-protein intake does not alter plasma triglyceride and cholesterol concentrations but promotes atherogenesis in animal models. The effect of high-protein intake on liver fat remains unclear. In population studies, high-protein intake is associated with increased risk for T2D, nonalcoholic fatty liver disease, and possibly cardiovascular diseases.
Summary:
The relationship between protein intake and cardiometabolic health is complex and influenced by concomitant changes in body weight and overall diet composition. Although a high-protein, low-carbohydrate, reduced-energy diet can have beneficial effects on body weight and plasma glucose, habitual high-protein intake, without marked carbohydrate and energy restriction, is associated with increased cardiometabolic disease risk, presumably mediated by the changes in the hormonal milieu after high-protein intake.
... Keywords: Glycaemic index, Genetic testing, Nutrigenetics, Weight loss, Ketogenic, BMI, Cholesterol Background Obesity is characterised by excessive fat accumulation, and it is well established that the percentage of the population that is either obese or overweight is rising over time [1]. Obesity is also associated with several health issues, including the development of metabolic syndrome, hypertension, cardiovascular disease, arthritis, and various cancers [2]. The causes of obesity are not simply the consumption of a greater amount of energy than is utilised; instead, obesity is a complex disorder, with many biological, psychological, and sociological factors combining in its development [3]. ...
... A considerable number of health interventions have been trialled to reduce obesity [2]. In terms of dietary interventions, the efficacy of these trials is mixed, with a sizeable proportion of dieters regaining more weight than they initially lose [4]. ...
Background:
Obesity and its related metabolic disturbances represent a huge health burden on society. Many different weight loss interventions have been trialled with mixed efficacy, as demonstrated by the large number of individuals who regain weight upon completion of such interventions. There is evidence that the provision of genetic information may enhance long-term weight loss, either by increasing dietary adherence or through underlying biological mechanisms.
Methods:
The investigators followed 114 overweight and obese subjects from a weight loss clinic in a 2-stage process. 1) A 24-week dietary intervention. The subjects self-selected whether to follow a standardized ketogenic diet (n = 53), or a personalised low-glycemic index (GI) nutrigenetic diet utilising information from 28 single nucleotide polymorphisms (n = 61). 2) After the 24-week diet period, the subjects were monitored for an additional 18 months using standard guidelines for the Keto group vs standard guidelines modified by nutrigenetic advice for the low-Glycaemic Index nutrigenetic diet (lowGI/NG) group.
Results:
After 24 weeks, the keto group lost more weight: - 26.2 ± 3.1 kg vs - 23.5 ± 6.4 kg (p = 0.0061). However, at 18-month follow up, the subjects in the low-GI nutrigenetic diet had lost significantly more weight (- 27.5 ± 8.9 kg) than those in the ketogenic diet who had regained some weight (- 19.4 ± 5.0 kg) (p < 0.0001). Additionally, after the 24-week diet and 18-month follow up the low-GI nutrigenetic diet group had significantly greater (p < 0.0001) improvements in total cholesterol (ketogenic - 35.4 ± 32.2 mg/dl; low-GI nutrigenetic - 52.5 ± 24.3 mg/dl), HDL cholesterol (ketogenic + 4.7 ± 4.5 mg/dl; low-GI nutrigenetic + 11.9 ± 4.1 mg/dl), and fasting glucose (ketogenic - 13.7 ± 8.4 mg/dl; low-GI nutrigenetic - 24.7 ± 7.4 mg/dl).
Conclusions:
These findings demonstrate that the ketogenic group experienced enhanced weight loss during the 24-week dietary intervention. However, at 18-month follow up, the personalised nutrition group (lowGI/NG) lost significantly more weight and experienced significantly greater improvements in measures of cholesterol and blood glucose. This suggests that personalising nutrition has the potential to enhance long-term weight loss and changes in cardiometabolic parameters.
Trial registration:
NCT04330209, Registered 01/04/2020, retrospectively registered.
... Regarding the long-term efficacy of LCDs on patients with type 2 diabetes, the existing evidence has suggested that after 12 months the efficacy of LCDs attenuated, and even patients' quality of life, was lower, at a non-significant level though [57]. Additionally, regarding weight loss, long-term data suggest that LCDs were no better than other approaches [58], even when genotype patterns of insulin secretion were taken into account [33]. However, some metabolic effects could be favorable after 1 year of follow-up [59]. ...
The popularity of low-carbohydrate diets (LCDs) in the last few decades has motivated several research studies on their role in a variety of metabolic and non-morbid conditions. The available data of the results of these studies are put under the research perspective of the present literature review of clinical studies in search of the effects of LCDs on Obesity and Diabetes Mellitus. The electronic literature search was performed in the databases PubMed, Cochrane, and Embase. The literature search found seven studies that met the review’s inclusion and exclusion criteria out of a total of 2637 studies. The included studies involved randomized controlled trials of at least 12 weeks’ duration, in subjects with BMI ≥ 25 kg/m2, with dietary interventions. The results of the study on the effects of LCDs on obesity showed their effectiveness in reducing Body Mass Index and total body fat mass. In addition, LCDs appear to cause drops in blood pressure, low-density lipoprotein (LDL), and triglycerides, and seem to improve high-density lipoprotein (HDL) values. Regarding the effectiveness of LCDs in Diabetes Mellitus, their effect on reducing insulin resistance and fasting blood glucose and HbA1c values are supported. In conclusion, the results suggest the critical role of LCDs to improve the health of people affected by obesity or diabetes.
... According to the Centers for Disease Control and Prevention (CDC) in the United States, the obesity prevalence increased from 30.5% to 41.9% during the period 1999-2020 [2]. Current treatment options, including calorie restriction, bariatric surgery, and pharmacotherapy either present with poor long-term efficacy and/or serious side effects [3][4][5][6]. One attractive option to combat obesity is to take advantage of the molecular properties of thermogenic brown and beige adipocytes to raise energy expenditure by activating the non-shivering thermogenesis (NST) program. ...
Non-shivering thermogenesis (NST) has strong potential to combat obesity, however, a safe molecular approach to activate this process has not yet been identified. The sulfur amino acid taurine has the ability to safely activate NST and confer protection against obesity and metabolic disease in both mice and humans, but the mechanism of action is unknown. In this study, we discover that a suite of taurine biosynthetic enzymes, especially that of cysteamine dioxygenase (ADO), significantly increases in response to beta-3 adrenergic signaling in inguinal tissues (IWAT) in order increase intracellular concentrations of taurine. We further show that ADO is critical for thermogenic mitochondrial function as its ablation in thermogenic adipocytes significantly reduces taurine levels which lead to declines in mitochondrial oxygen consumption rates. Finally, we demonstrate via assay for transposase-accessible chromatin with sequencing (ATAC-Seq) that taurine supplementation has the ability to remodel the chromatin landscape to increase the chromatin accessibility and transcription of genes, such as glucose-6-phosphate isomerase 1 (Gpi1), that are critical for NST. Taken together, our studies highlight a potential mechanism for taurine in the activation of NST that can be leveraged toward the treatment of obesity and metabolic disease
... Due to unstable working hours, work assignments and work settings, they exhibited increased unhealthy dietary behaviors such as skipping breakfast, night eating, ready-prepared meal consumption, eating out, emotional eating, soft drinks consumption, poor dietary regularity, and unbalanced nutritional diet, etc. Although changes of body weight and BMI are generally considered to be caused by the imbalances between calorie intake and expenditure, a review suggested that differences of impact on weight management between low-fat diets, low-carbohydrate diets, and Mediterranean approaches were marginal (62). A more scientific and balanced nutritional diet is the key to weight management. ...
Objective
The COVID-19 pandemic has become a major public health concern over the past 3 years, leading to adverse effects on front-line healthcare workers. This study aimed to develop a Body Mass Index (BMI) change prediction model among doctors and nurses in North China during the COVID-19 pandemic, and further identified the predicting effects of lifestyles, sleep quality, work-related conditions, and personality traits on BMI change.Methods
The present study was a cross-sectional study conducted in North China, during May-August 2022. A total of 5,400 doctors and nurses were randomly recruited from 39 COVID-19 designated hospitals and 5,271 participants provided valid responses. Participants’ data related to social-demographics, dietary behavior, lifestyle, sleep, personality, and work-related conflicts were collected with questionnaires. Deep Neural Network (DNN) was applied to develop a BMI change prediction model among doctors and nurses during the COVID-19 pandemic.ResultsOf participants, only 2,216 (42.0%) individuals kept a stable BMI. Results showed that personality traits, dietary behaviors, lifestyles, sleep quality, burnout, and work-related conditions had effects on the BMI change among doctors and nurses. The prediction model for BMI change was developed with a 33-26-20-1 network framework. The DNN model achieved high prediction efficacy, and values of R2, MAE, MSE, and RMSE for the model were 0.940, 0.027, 0.002, and 0.038, respectively. Among doctors and nurses, the top five predictors in the BMI change prediction model were unbalanced nutritional diet, poor sleep quality, work-family conflict, lack of exercise, and soft drinks consumption.Conclusion
During the COVID-19 pandemic, BMI change was highly prevalent among doctors and nurses in North China. Machine learning models can provide an automated identification mechanism for the prediction of BMI change. Personality traits, dietary behaviors, lifestyles, sleep quality, burnout, and work-related conditions have contributed to the BMI change prediction. Integrated treatment measures should be taken in the management of weight and BMI by policymakers, hospital administrators, and healthcare workers.
... In fact, people who follow a hypocaloric diet are able to continue losing weight over time, while people who follow a VLCKD tend to regain a bit of weight during or after the reintroduction phase [59]. Our study, in fact, showed that in two different time spans the results on body weight and body composition are similar, but it could be interesting to schedule a follow-up visit after 6 or 12 months to check weight maintenance, as this is the most challenging aspect of diet therapy [60]. To avoid weight gain after a diet period, it is important to define realistic goals to gradually change lifestyle habits and maintain weight loss over time [41]. ...
The best nutritional strategy to fight the rise in obesity remains a debated issue. The Mediterranean diet (MD) and the Very Low-Calorie Ketogenic diet (VLCKD) are effective at helping people lose body weight (BW) and fat mass (FM) while preserving fat-free mass (FFM). This study aimed to evaluate the time these two diets took to reach a loss of 5% of the initial BW and how body composition was affected. We randomized 268 subjects with obesity or overweight in two arms, MD and VLCKD, for a maximum of 3 months or until they reached 5% BW loss. This result was achieved after one month of VLCKD and 3 months of MD. Both diets were effective in terms of BW (p < 0.0001) and FM loss (p < 0.0001), but the MD reached a higher reduction in both waist circumference (p = 0.0010) and FM (p = 0.0006) and a greater increase in total body water (p = 0.0017) and FFM (p = 0.0373) than VLCKD. The population was also stratified according to gender, age, and BMI. These two nutritional protocols are both effective in improving anthropometrical parameters and body composition, but they take different time spans to reach the goal. Therefore, professionals should evaluate which is the most suitable according to each patient’s health status.
... Alongside poor diets among adolescents, the rise of adolescent obesity is primarily brought about by sedentary lifestyles and excessive food intake, a growing global phenomenon, compared to the persistent public health concern that is childhood obesity [7][8][9]. A similar report observed a 20.1% prevalence of obesity and overweight among middle and high school students in South Korea [10]. ...
... This result is higher than the average for the 28 European Union countries, which was 15.4% and 34.8% for obese and overweight people, respectively (Zgliczyński, 2017). Overall, the percentage of people with excess body weight is rising (Thom & Lean, 2017). ...
Background
Food choices made by most people mainly depend on food preferences. Knowing how certain factors affect food preferences can help dietitians working with women to understand the relationship between individual factors and the challenges faced by the women in changing eating habits. The aim of the study was to examine the food preferences of women and to assess the impact of the sense of smell, age, body mass index (BMI), smoking and hormonal status (phase of the menstrual cycle, hormonal contraception) on the declared pleasure derived from eating various types of food.
Methods
A total of 190 women living in the Górnośląsko-Zagłębiowska Metropolis in Poland aged 18–75 (19.29–26.71 RNO) years participated in the study. The collected survey data included age, BMI, smoking, phase of the menstrual cycle and hormonal contraception. Olfactory sensitivity was measured by T08 olfactometer. Additionally, food preferences were assessed, using 24 different food types, which were presented as pictures. To evaluate food preferences 10 cm visual analogue scale was used.
Results
The most liked foods were: fruits (M = 8.81, SD = 1.67), sweet desserts (M = 8.44, SD = 2.30), vegetables and salads (M = 8.08, SD = 2.24), chocolate (M = 7.84, SD = 2.76), and poultry (M = 7.30, SD = 2.47). The least liked foods were: salty products (M = 4.98, SD = 3.03), milk soup (M = 3.30, SD = 3.13), and seafood (M = 2.99, SD = 3.28). The influence of the analyzed factors on the degree of liking six food types was shown. Women with better ability to name scents preferred sausages/ham and beef/pork. Women with a higher BMI had lower preference for jellybeans and broth. Women who were heavier smokers had lower preference for milk soup. In women using hormonal contraception, pleasure from eating sausages and ham was higher than compared to women in all phases of the monthly cycle. In women in the follicular phase the pleasure from eating pasta was lower when compared to women in the ovulatory phase, the luteal phase and those using hormonal contraception. In women in the ovulatory phase the pleasure from eating candies and jellybeans was lower when compared to women in the follicular phase, the luteal phase and those using hormonal contraception. In women in the ovulatory phase, also pleasure from eating broth was lower when compared to women in the luteal phase and those using hormonal contraception.
Conclusions
Among women in Poland, the top five preferred food types are fruits, sweet desserts, vegetables/salads, chocolate and poultry. To confirm the extent to which the declared pleasure derived from eating these food types translates into health condition, further research on the consumption of these food types is necessary. The impact of the sense of smell, BMI, smoking, or menstrual cycle phase and hormonal contraception on the declared pleasure derived from eating was observed for six out of twenty-four food types. The hormonal status was the factor most significantly influencing food preferences.
... [26][27][28] The relationship between MetS or its individual components as a risk factor for GDM is plausible given their shared relationship to future risk of CVD. Importantly, metabolic factors can be modified by diet, lifestyle 29,30 and pharmacological agents. 31 Consideration of assessing metabolic markers in early antenatal care may provide information about potential future risk for GDM, allowing for early detection and management. ...
Gestational diabetes (GDM) is associated with several adverse outcomes for the mother and child. Higher levels of individual lipids associate with risk of GDM, and metabolic syndrome, a clustering of risk factors also increases risk for GDM. Metabolic factors can be modified by diet and lifestyle. This review comprehensively evaluates the association between metabolic syndrome and its components, measured in early pregnancy, and risk for GDM. Databases (CINAHL, PubMed, Embase, and Cochrane Library) were searched from inception to 5 May 2021. Eligible studies included ≥1 metabolic factor (waist circumference, blood pressure, fasting plasma glucose, triglycerides, and high‐density lipoprotein cholesterol, measured at <16 week’s gestation. At least two authors independently screened potentially eligible studies. Heterogeneity was quantified using I2. Data were pooled by random‐effects models and expressed as odds ratio and 95% confidence intervals. Of 7213 articles identified, 40 unique articles were included in meta‐analysis. In analyses adjusting for maternal age and body mass index, GDM was increased with increasing fasting plasma glucose (OR 1.92; 95% CI 1.39‐2.64, k=7 studies) or having metabolic syndrome (OR 2.52; 1.65, 3.84, k=3). Women with overweight (OR 2.17; 95% CI 1.89, 2.50, k=12) or obesity (OR 4.34; 95% CI 2.79‐6.74, k=9) also were at increased risk for GDM. Early pregnancy assessment of glucose or the metabolic syndrome, offers a potential opportunity to detect and treat individual risk factors as an approach toward GDM prevention; weight loss for pregnant women with overweight or obesity is not recommended. This article is protected by copyright. All rights reserved.
... IER differs from continuous energy restriction (CER) by the specific time spent on fasting. There are many variations in IER diets such as alternate-day fasting (ADF) ( Figure 1) and time-restricted feeding (TRF) ( Figure 2); the main differences between them are the different times spent fasting and spent without restriction [18,19]. ADF consists of alternate fast days, three to four times a week, while TRF is characterized by food consumption in restricted hours with different variations in the duration of fasting time. ...
Obesity is a disease defined by an elevated body mass index (BMI), which is the result of excessive or abnormal accumulation of fat. Dietary intervention is fundamental and essential as the first-line treatment for obese patients, and the main rule of every dietary modification is calorie restriction and consequent weight loss. Intermittent energy restriction (IER) is a special type of diet consisting of intermittent pauses in eating. There are many variations of IER diets such as alternate-day fasting (ADF) and time-restricted feeding (TRF). In the literature, the IER diet is known as an effective method for bodyweight reduction. Furthermore, IER diets have a beneficial effect on systolic or diastolic pressure, lipid profile, and glucose homeostasis. In addition, IER diets are presented as being as efficient as a continuous energy restriction diet (CER) in losing weight and improving metabolic parameters. Thus, the IER diet could present an alternative option for those who cannot accept a constant food regimen.
... These data indicate that the abnormal serum lipid profile observed in subjects with T2DM could not solely be attributable to dietary FAs intake but might be explained by the status of hyperinsulinemia or abnormal endogenic lipid metabolism mediated by insulin resistance. Moreover, the contribution of dietary patterns to circulating lipid levels was also shown by other population-based studies (Thom and Lean, 2017;Kahleova et al., 2018). The health education of patients with diabetes might further promote their management of dietary patterns and dietary subgroup FA intake, which may be the possible reason for the indistinctive difference in dietary FA intake between the two groups. ...
Background
The correlation between dietary fatty acid (FA) intake and serum lipid profile levels with cognition in the aged population has been reported by previous studies. However, the association of dietary FA intake and serum lipid profile levels with cognition in subjects with type 2 diabetes mellitus (T2DM) is seldom reported.
Objective
A cross-sectional study was conducted to explore the correlation between dietary FA intake and serum lipid profiles with cognition in the aged Chinese population with T2DM.
Methods
A total of 1,526 aged Chinese subjects were recruited from communities. Fasting blood samples were collected for parameter measurement. The food frequency questionnaire (FFQ) method was applied for a dietary survey. Cognition was assessed using the Montreal Cognitive Assessment (MoCA) test. Dietary FA intake and serum lipid levels were compared between subjects with T2DM and control subjects. A logistic regression analysis was carried out for analyzing the association of FA intake and serum lipid levels with the risk of mild cognitive impairment (MCI) in subjects with T2DM and control subjects.
Results
There was a significant difference in the serum lipid level between the T2DM group and the control group. Results of the logistic regression analysis demonstrated the potential associations of serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), and dietary n-3 polyunsaturated fatty acids (PUFAs) intake with the risk of MCI in subjects with T2DM, but the associations were not observed in control subjects.
Conclusion
The T2DM phenotype might affect the relationship between dietary FA intake, circulating lipids, and cognitive performance. Large prospective cohort studies are needed to uncover the underlying mechanism of how dietary FA intake and serum lipid levels affect cognition in aged subjects with T2DM.
... Total energy and nutrient intake data were automatically estimated by multiplying the number of portions consumed by the set quantity of each food portion size and its nutrient composition according to the UK Nutrient Databank food composition tables (2012-2013 and 2013-2014) (29). Energy density, saturated fatty acid (SFA), free sugars, and fiber density were selected because of their significant roles in the development of obesity and type 2 diabetes and their high frequency of intake in daily life (4,9,30). Energy density (kJ/g) was calculated by dividing total food energy (in kilojoules) by total food weight (grams); all beverages were excluded because of their disproportionate influence on total energy density value (31). ...
OBJECTIVE
To identify dietary patterns (DPs) characterized by a set of nutrients of concern and their association with incident type 2 diabetes (T2D).
RESEARCH DESIGN AND METHODS
A total of 120,343 participants from the U.K. Biobank study with at least two 24 h dietary assessments were studied. Reduced rank regression was used to derive DPs explaining variability in energy density, free sugars, saturated fat, and fiber intakes. We investigated prospective associations with T2D using Cox proportional hazard models.
RESULTS
Over 8.4 years of follow-up from the latest dietary assessment, 2,878 participants developed T2D. Two DPs were identified that jointly explained a total of 63% variation in four nutrients. DP1 was characterized by high intakes of chocolate and confectionery, butter, low-fiber bread, and sugars and preserves, and low intakes of fruits and vegetables. DP1 was linearly associated with T2D in multivariable models without BMI adjustment (per z score, hazard ratio [HR] 1.11 [95% CI 1.08–1.14]) and after BMI adjustment (HR 1.09 [95% CI 1.06–1.12]). DP2 was characterized by high intakes of sugar-sweetened beverages, fruit juice, table sugars and preserves, and low intakes of high-fat cheese and butter, but showed no clear association with T2D. There were significant interactions between both DPs and age, with increased risks among younger people in DP1 (HR 1.13 [95% CI 1.09–1.18]) and DP2 (HR 1.10 [95% CI 1.05–1.15]), as well as with DP1 and BMI, with increased risks among people with obesity (HR 1.11 [95% CI 1.07–1.16]).
CONCLUSIONS
A DP characterized by high intakes of chocolate, confectionery, butter, low-fiber bread, and added sugars, and low in fresh fruits and vegetables intake is associated with a higher incidence of T2D, particularly among younger people and those with obesity.
... Overall findings tend to support evidence from existing RCTs and observational studies showing that people with markers indicating higher risk for diabetes, prediabetes or IR have lower risk when they reduce calorie, carbohydrate, or saturated fat intake and/or increase fiber or protein intake (lean animal protein or plant protein) compared with their peers [114]. For purposes of weight loss, the ability to sustain and maintain an eating plan that results in an energy deficit, irrespective of macronutrient composition or eating pattern, is very important for success [165][166][167][168]. Studies investigating specific weight loss eating plans using a broad range of macronutrient composition in people with T2DM have produced mixed results regarding efficiency and efficacy on body weight, HbA1c, lipid profiles, and BP [140,141,144,[169][170][171][172][173][174][175][176]. ...
As years progress, we are found more often in a postprandial than a postabsorptive state. Chrononutrition is an integral part of metabolism, pancreatic function, and hormone secretion. Eating most calories and carbohydrates at lunch time and early afternoon, avoiding late evening dinner, and keeping consistent number of daily meals and relative times of eating occasions seem to play a pivotal role for postprandial glycemia and insulin sensitivity. Sequence of meals and nutrients also play a significant role, as foods of low density such as vegetables, salads, or soups consumed first, followed by protein and then by starchy foods lead to ameliorated glycemic and insulin responses. There are several dietary schemes available, such as intermittent fasting regimes, which may improve glycemic and insulin responses. Weight loss is important for the treatment of insulin resistance, and it can be achieved by many approaches, such as low-fat, low-carbohydrate, Mediterranean-style diets, etc. Lifestyle interventions with small weight loss (7–10%), 150 min of weekly moderate intensity exercise and behavioral therapy approach can be highly effective in preventing and treating type 2 diabetes. Similarly, decreasing carbohydrates in meals also improves significantly glycemic and insulin responses, but the extent of this reduction should be individualized, patient-centered, and monitored. Alternative foods or ingredients, such as vinegar, yogurt, whey protein, peanuts and tree nuts should also be considered in ameliorating postprandial hyperglycemia and insulin resistance. This review aims to describe the available evidence about the effects of diet, chrononutrition, alternative dietary interventions and exercise on postprandial glycemia and insulin resistance.
... Despite a better understanding of the relation between the degree of energy restriction, the magnitude of weight loss, and metabolic health, the most beneficial nutrient composition of an ER diet is still a subject of intense debate (4,5). Numerous trials have been carried out to try to identify the optimal ER diet to augment weight loss or to maximize health improvements. ...
Background:
Despite the established relation between energy restriction and metabolic health, the most beneficial nutrient composition of a weight-loss diet is still subject of debate.
Objectives:
The aim of the study was to examine the additional effects of nutrient quality on top of energy restriction(ER).
Methods:
A parallel-designed 12-week 25%ER dietary intervention study was conducted. Participants aged 40-70 years with abdominal obesity were randomized over three groups: a 25%ER high nutrient quality diet (n = 40); a 25%ER low nutrient quality diet (n = 40); or a habitual diet (n = 30). Both ER diets were nutritionally adequate, the high nutrient quality ER diet was enriched in monounsaturated and n-3 polyunsaturated fatty acids, fiber, and plant protein and reduced in fructose. Before and after the intervention intra-hepatic lipids, body fat distribution, fasting and postprandial responses to a mixed meal shake challenge test of cardio-metabolic risk factors, lipoproteins, vascular measurements, and adipose tissue transcriptome were assessed.
Results:
The high quality ER diet (-8.4 ± 3.2) induced 2.1 kg more weight loss (P = 0.007) than the low quality ER diet (-6.3 ± 3.9), reduced fasting serum total cholesterol (P = 0.014) and plasma triglycerides (P < 0.001), promoted an anti-atherogenic lipoprotein profile and induced a more pronounced decrease in adipose tissue gene expression of energy metabolism pathways than the low quality ER diet. Explorative analyses showed that the difference in weight loss between both ER diets were specifically present in insulin sensitive subjects (HOMA-IR ≤ 2.5), in whom the high nutrient quality diet induced 3.9 kg more weight loss than the low nutrient quality diet.
Conclusion:
A high nutrient quality 25%ER diet is more beneficial for cardiometabolic health than a low nutrient quality 25%ER diet. Overweight insulin sensitive subjects may benefit more from a high than a low nutrient quality ER diet with respect to weight loss, due to potential attenuation of glucose-induced lipid synthesis in adipose tissue. Trial registration: ClinicalTrials.gov NCT02194504.
... Energy-restricted diets, in particular commercial Low-Energy Diets (LED), have been shown to be a successful strategy to promote body weight (BW) loss in overweight and obesity [1,2]. However, the optimal macronutrient composition for successful BW loss remains unresolved [3][4][5]. Whilst a higher protein (HP) intake is hypothesised to promote BW loss [6][7][8][9], it is often confounded by the accompanying lower carbohydrate (CHO) content [10]. To provide substantiation for protein-induced BW loss, the European Food Safety Authority [11] deemed it necessary to untangle the effect of dietary protein from CHO. ...
Both higher protein (HP) and lower carbohydrate (LC) diets may promote satiety and enhance body weight (BW) loss. This study investigated whether HP can promote these outcomes independent of carbohydrate (CHO) content. 121 women with obesity (BW: 95.1 ± 13.0 kg, BMI: 35.4 ± 3.9 kg/m2) were randomised to either HP (1.2 g/kg BW) or normal protein (NP, 0.8 g/kg BW) diets, in combination with either LC (28 en%) or normal CHO (NC, 40 en%) diets. A low-energy diet partial diet replacement (LEDpdr) regime was used for 8 weeks, where participants consumed fixed-energy meal replacements plus one ad libitum meal daily. Four-day dietary records showed that daily energy intake (EI) was similar between groups (p = 0.744), but the difference in protein and CHO between groups was lower than expected. Following multiple imputation (completion rate 77%), decrease in mean BW, fat mass (FM) and fat-free mass (FFM) at Week 8 in all was 7.5 ± 0.7 kg (p < 0.001), 5.7 ± 0.5 kg (p < 0.001), and 1.4 ± 0.7 kg (p = 0.054) respectively, but with no significant difference between diet groups. LC (CHO×Week, p < 0.05), but not HP, significantly promoted postprandial satiety during a preload challenge. Improvements in blood biomarkers were unrelated to LEDpdr macronutrient composition. In conclusion, HP did not promote satiety and BW loss compared to NP LEDpdr, irrespective of CHO content.
... The purpose of this study is to analyze the effectiveness of teleexercise on decreasing the bodyweight of an obese office employees, or if it must be combined with nutrition counseling and education intervention, as recommended by some researchers (Anderson et al., 2001;Jensen et al., 2014;Thom & Lean, 2017;Wing & Phelan, 2005). As far as we know, this is the first study that compare the effectiveness of teleexercise intervention vs. combined tele-exercise and nutrition counseling in office obese employee in Indonesia, while the prevalence of obesity in office employee is still threatening. ...
How to cite: Kuswari, M., Rimbawan, R., Hardinsyah, H., Dewi, M., & Gifari, N. (2021). Effect of tele-exercise versus combination of tele-exercise with tele-counselling on obese office employee's weight loss. ARGIPA (Arsip Gizi Dan Pangan), 6(2), 131-139. https://doi.org/10.22236/argipa.v6i2.7710 ABSTRACT Obesity is one of five death risks globally. This is worsened by the increasing sedentary nature of work, where adults spend most of their time. The ongoing COVID-19 pandemic causes many employees to work from home. Online exercise in home or tele-exercise may potentially manage this. The purpose of this study was to analyze the effectiveness of tele-exercise on decreasing body weight of obese employee, or if it must be combined with nutrition tele-counseling. The design of this study is Pre-Post-Test Quasi-Experimental. This study was conducted on obese office employee in Jakarta with two intervention groups, one who receive tele-exercise intervention and the other who receive tele-exercise and nutrition tele-counseling. Subjects were divided into tele-exercise (n=25) and tele-exercise and nutrition tele-counseling (n=38). Subjects received tele-exercise 30 minutes per session, three sessions per week for six weeks. Tele-counseling was done by WhatsApp application every day, consisting of balanced nutrition education and calorie restriction for weight loss. Paired t-test was done on subject's body weight before and after intervention. The group who received tele-exercise and tele-counseling experienced weight loss significantly with average bodyweight from 77.36±11.83 kg to 75.49±11.58 kg (Δ=-1.87 kg, p<0.05), while the same didn't happen on another group (Δ=0.36, p>0.05). This research showed that tele-exercise is not very effective on decreasing obese office employee's body weight, but must be combined with nutrition tele-exercise to achieve significant weight loss. ABSTRAK Obesitas adalah satu dari lima risiko kematian secara global. Masalah obesitas diperparah oleh meningkatnya sifat sedenter dari pekerjaan, saat orang dewasa menghabiskan sebagian besar waktu mereka. Pandemi COVID-19 yang masih melanda Indonesia sejak tahun lalu menyebakan banyak pekerja yang Work from Home (WfH). Olahraga di rumah dengan metode daring atau yang biasa disebut dengan tele-exercise berpotensi menangani hal ini. Tujuan dari studi ini adalah menganalisis keefektifan tele-exercise dalam mengurangi berat badan dari pekerja yang obesitas, atau harus dikombinasikan dengan intervensi edukasi gizi. Desain penelitian menggunakan Pretest-Posttest Quasy Experiment 132 Design. Penelitian ini dilakukan pada karyawan yang menyandang status gizi obesitas di Jakarta, dan dibagi menjadi dua kelompok, yakni kelompok yang menerima intervensi tele-exercise (n=25) dan kelompok yang menerima kombinasi tele-exercise dan tele-counseling (n=38). Subjek mendapatkan intervensi tele-exercise latihan kombinasi selama 30 menit setiap sesi, tiga kali seminggu selama 6 minggu secara live. Edukasi gizi dilakukan dengan mengguakan media WhatsApp, yang terdiri dari edukasi gizi seimbang dan restriksi kalori untuk penurunan berat badan dan IMT, dan dilakukan setiap hari. Paired t-test dilakukan pada variable berat badan subjek antara sebelum dan sesudah intervensi. Kelompok yang menerima dua jenis intervensi mengalami penurunan berat badan dari rataan sebesar 77,36±11,83 kg menjadi 75,49±11,58 kg (Δ=-1,87 kg, p<0,05), sementara hal yang sama tidak terjadi pada kelompok lainnya (Δ=0,36 kg, p>0,05). Kelompok yang menerima intervensi Tele-exercise dan Tele-counseling mengalami penurunan berat badan secara signifikan, namun tidak pada kelompok intervensi Tele-exercise saja. Hal ini menunjukkan bahwa tele-exercise saja tidak cukup efektif dalam penurunan berat badan, namun harus dikombinasikan dengan tele-counseling gizi.
... Practical applications. Health behavior such as physical activity and diet are essential for body weight control [43]. A greater NetC w/kg therefore represents a potential target for morbid obesity management through the daily total energy expenditure increase (TEE), especially in sedentary people with obesity who are in the so-called "unregulated zone", in which appetite and food intake are not affected by TEE; thus, food intake drives body weight gain [44]. ...
Higher mass-normalized net energy cost of walking (NetCw/kg) and mechanical pendular recovery are observed in obese compared to lean adults. This study aimed to investigate the effect of different classes of obesity on the energetics and mechanics of walking and to explore the relationships between body mass, NetCw/kg and gait mechanics by using principal component analysis (PCA). NetCw/kg and gait mechanics were computed in severely obese (SOG; n = 18, BMI = 40.1 ± 4.4 kg·m−2), moderately obese (MOG; n = 17, BMI = 32.2 ± 1.5 kg·m−2) and normal-weight (NWG; n = 13, BMI = 22.0 ± 1.5 kg·m−2) adults during five walking trials (0.56, 0.83, 1.11, 1.39, 1.67 m·s−1) on an instrumented treadmill. NetCw/kg was significantly higher in SOG compared to NWG (p = 0.019), with no significant difference between SOG and MOG (p = 0.14), nor between MOG and NWG (p = 0.27). Recovery was significantly higher in SOG than in NWG (p = 0.028), with no significant difference between SOG and MOG (p = 0.13), nor between MOG and NWG (p = 0.35). PCA models explained between 17.0% and 44.2% of the data variance. This study showed that: (1) obesity class influences the gait energetics and mechanics; (2) PCA was able to identify two components, showing that the obesity class is associated with lower walking efficiency and better pendulum-like characteristics.
... Practical applications. Health behavior such as physical activity and diet are essential for body weight control [43]. A greater NetC w/kg therefore represents a potential target for morbid obesity management through the daily total energy expenditure increase (TEE), especially in sedentary people with obesity who are in the so-called "unregulated zone", in which appetite and food intake are not affected by TEE; thus, food intake drives body weight gain [44]. ...
Higher mass-normalized net energy cost of walking (NetCw/kg) and mechanical pendular recovery are observed in obese compared to lean adults. This study aimed to investigate the effect of different classes of obesity on the energetics and mechanics of walking and to explore the relationships between body mass, NetCw/kg and gait mechanics by using principal component analysis (PCA). NetCw/kg and gait mechanics were computed in severely obese (SOG; n = 18, BMI = 40.1 ± 4.4 kg·m−2), moderately obese (MOG; n = 17, BMI = 32.2 ± 1.5 kg·m−2) and normal-weight (NWG; n = 13, BMI = 22.0 ± 1.5 kg·m−2) adults during five walking trials (0.56, 0.83, 1.11, 1.39, 1.67 m·s−1) on an instrumented treadmill. NetCw/kg was significantly higher in SOG compared to NWG (p = 0.019), with no significant difference between SOG and MOG (p = 0.14), nor between MOG and NWG (p = 0.27). Recovery was significantly higher in SOG than in NWG (p = 0.028), with no significant difference between SOG and MOG (p = 0.13), nor between MOG and NWG (p = 0.35). PCA models explained between 17.0% and 44.2% of the data variance. This study showed that: (1) obesity class influences the gait energetics and mechanics; (2) PCA was able to identify two components, showing that the obesity class is associated with lower walking efficiency and better pendulum-like characteristics.
... In particular, obesity has a robust relationship with depressive symptoms (Blasco et al., 2020) and TG levels (Skinner et al., 2015). Proper dietary habits, such as a lower-carbohydrate diet (Thom & Lean, 2017) and physical activity, may subsequently reduce TG (Mitchell et al., 2019). Therefore, nurses should conduct specific health screening and provide tailored interventions to re- (Cameron et al., 2004;Lian et al., 2019;Moore et al., 2017;NCEP, 2002;Pratt & Brody, 2014;Pucci et al., 2017;Son & Kim, 2019). ...
The aim was to compare the metabolic syndrome in adults with and without depression in Korea using the 2013–2015 Korea National Health and Nutrition Examination Survey. A cross‐sectional study was conducted involving secondary data analysis. National survey data on the self‐reported medical diagnosis of depression and metabolic syndrome were collected between 2013 and 2015 and released for research purposes in 2017. We conducted a propensity score‐matched study that included adults (n = 494) with and without depression at a 1:1 ratio, to reduce the impact of potential confounding factors between groups. Depression was not significantly associated with changes in metabolic syndrome. However, participants with depression had significantly higher triglycerides than those without depression (p = .008), highlighting the importance of periodically checking triglycerides in depressed patients. Nurses need to check the subcomponents of metabolic syndrome in depressed patients periodically, especially regarding the management of triglycerides.
... In the third part of the study, we aimed to reduce the WD-induced metabolic risk via caloric restriction and/or change of diet composition. In accordance with the existing literature, caloric restriction induced weight loss and a decrease in metabolic complications as well as AT inflammation in obese mice, regardless of macronutrient composition [42,43]. A switch to an HSUD after obesity induction induced significant weight loss, ameliorated the metabolic health status, and reduced AT inflammation even without any caloric restriction. ...
Introduction:
The biggest risk factor for obesity and its associated comorbidities is a Western diet. This Western diet induces adipose tissue (AT) inflammation, which causes an AT dysfunction. Since AT is a vital endocrine organ, its dysfunction damages other organs, thus inducing a state of chronic inflammation and causing various comorbidities. Even though it is evident a Western diet, high in fat and carbohydrates, induces obesity and its complications, it is not known yet which macronutrient plays the most important role. Therefore, the aim of this study was to investigate the effect of macronutrient composition on obesity and to reverse the Western diet-induced metabolic risk via caloric restriction (CR) or a change of diet composition.
Materials and methods:
Male, C57BL/6JRj mice were fed with a diet high in fat, sucrose, fructose, sucrose and fructose, starch, a Western diet, or a control diet for 15 weeks. To assess reversibility of the metabolic risk, mice were first made obese via 15 weeks of WD and then put on either a CR or switched to a sucrose-rich diet.
Results:
A sucrose-rich and high-starch diet induced less obesity and a better metabolic profile than a Western diet, evidenced by less hepatic steatosis, lower plasma cholesterol, and less insulin resistance. Furthermore, these diets induced less intra-abdominal AT inflammation than a Western diet, since mRNA levels of pro-inflammatory markers were lower and there was less macrophage infiltration. Expression of tight junction markers in colon tissue was higher in the sucrose-rich and high-starch group than the Western group, indicating a better intestinal integrity upon sucrose-rich and high-starch feeding. Additionally, CR induced weight loss and decreased both metabolic abnormalities and AT inflammation, regardless of macronutrient composition. However, effects were more pronounced upon CR with sucrose-rich or high-starch diet. Even without CR, switching obese mice to a sucrose-rich diet induced weight loss and decreased AT inflammation and metabolic aberrations.
Discussion:
A diet high in sucrose or starch induces less obesity and obesity-associated complications. Moreover, switching obese mice to a sucrose-rich diet elicits weight loss and decreases obesity-induced metabolic complications, highlighting the potential of carbohydrates to treat obesity.
... Nevertheless, MD has the advantage of combining weight loss with CVD risk reduction [90]. This diet reduces the consumption of saturated animal fats in favor of unsaturated vegetable fats and a high intake of polyphenols and n-3 fatty acids with anti-inflammatory and antioxidant properties [91]. The phenolic compounds (polyphenols) are presented in Nutrients 2021, 13, 2149 9 of 14 extra virgin olive oil, whole grain cereals, nuts, legumes, vegetables, red wine, and fruits. ...
Among the various aspects of health promotion and lifestyle adaptation to the postmenopausal period, nutritional habits are essential because they concern all women, can be modified, and impact both longevity and quality of life. In this narrative review, we discuss the current evidence on the association between dietary patterns and clinical endpoints in postmenopausal women, such as body composition, bone mass, and risk markers for cardiovascular disease. Current evidence suggests that low-fat, plant-based diets are associated with beneficial effects on body composition, but further studies are needed to confirm these results in postmenopausal women. The Mediterranean diet pattern along with other healthy habits may help the primary prevention of bone, metabolic, and cardiovascular diseases in the postmenopausal period. It consists on the use of healthy foods that have anti-inflammatory and antioxidant properties, and is associated with a small but significant decrease in blood pressure, reduction of fat mass, and improvement in cholesterol levels. These effects remain to be evaluated over a longer period of time, with the assessment of hard outcomes such as bone fractures, diabetes, and coronary ischemia.
... The significant global burden of overweight and obesity requires lifestyle strategies facilitating successful long-term body weight management. Dietary weight loss programs are mainly based on a decrease in fat or carbohydrate content in food, along with an important reduction in meal size [13]. Although this reduction often results in initial weight loss, patients with obesity often fail to maintain the treatment [14]. ...
Energy restriction is a first therapy in the treatment of obesity, but the underlying biological mechanisms have not been completely clarified. We analyzed the effects of restriction of high-fat diet (HFD) on weight loss, circulating gut hormone levels and expression of hypothalamic neuropeptides. Ten-week-old male Wistar rats (n = 40) were randomly distributed into four groups: two fed ad libitum a normal diet (ND) (N group) or a HFD (H group) and two subjected to a 25% caloric restriction of ND (NR group) or HFD (HR group) for 9 weeks. A 25% restriction of HFD over 9 weeks leads to a 36% weight loss with regard to the group fed HFD ad libitum accompanied by normal values in adiposity index and food efficiency ratio (FER). This restriction also carried the normalization of NPY, AgRP and POMC hypothalamic mRNA expression, without changes in CART. Caloric restriction did not succeed in improving glucose homeostasis but reduced HFD-induced hyperinsulinemia. In conclusion, 25% restriction of HFD reduced adiposity and improved metabolism in experimental obesity, without changes in glycemia. Restriction of the HFD triggered the normalization of hypothalamic NPY, AgRP and POMC expression, as well as ghrelin and leptin levels.
... These nutrients include carotenoids, folate, vitamin C, vitamin E, selenium, flavonoids and various other phytochemicals [8]. Fruit and vegetables are also a very good source of natural fibre [9], and there is strong evidence that eating foods high in fibre reduces the risk of bowel cancer [10].Eating plenty of fruit and vegetables can also help keep a healthy body weight [11]. There is strong evidence that obesity increases the risk of 13 types of cancer, including bowel and breast (post-menopausal). ...
Background: The link between cancer and diet is just as mysterious as the disease itself. Much research has pointed toward certain foods and nutrients that may help prevent or conversely, contribute to certain types of cancer. This study focused on aspects of diet that are linked to cancer by the current scientific evidence. Only good-quality evidence is included here. Objectives: The objectives of this study were to present an updated review on the association between diet and cancer risk. Methods: Relevant studies were identified by searching PubMed, Scopus, SpringerLink, ArticleFirst, Wiley Online, and Science-Direct electronic databases using these search terms and keywords: cancer; prevention; diet; risk; nutrition. Furthermore, references from retrieved articles were also reviewed. Evidence from prospective studies confirmed significant inverse associations between diet and cancer risk. Results: High fibre foods like whole grains, pulses, fruit and vegetables help keep a healthy weight and reduce the risk of some cancers. Processed and red meats, which increase the risk of weight gain, also increase the risk of bowel cancer. Conclusion: Reviews of all studies have shown eating more fibre per day can reduce the risk of bowel cancer. Red and processed meat could increase the risk of cancer.
... Patients should additionally be counseled to participate in ≥30 minutes of exercise around 5-7 days per week [28]. Diet recommendations should be simple, sustainable, and cost-effective, advising patients to consume more fresh vegetables and fish than red meat and to decrease consumption of alcohol, sugar, salt, and fast foods [29]. Furthermore, preoperative consultation with a certified nutritionist may be beneficial to allow for more time for proper patient education on the necessary dietary changes and guidance to appropriate resources. ...
Purpose:
We sought to determine the role of body mass index (BMI) on quality indicators, such as length of stay and readmission. The National Surgical Quality Improvement Program (NSQIP) database was queried to examine the effect of obesity, defined as BMI >30, on outcomes after Minimally Invasive Radical Retropubic Prostatectomy (MI-RRP).
Materials and methods:
Utilizing the NSQIP database, patient records were identified using the Current Procedural Terminology (CPT) code 55866 (laparoscopy, surgical prostatectomy, radical retropubic) during a 10-year period (2007-2017). Obesity was classified according to the CDC classification. Chi-square tests were utilized to evaluate BMI distribution by surgery year. Logistic regression was used to evaluate the relationship of BMI with length of stay (LOS) and hospital readmission within 30 days, after controlling for preoperative variables.
Results:
Records of 49,238 patients who have undergone MI-RRP during 2007-2017 were evaluated. Mean yearly BMI rose from 28.5 to 29.2, while the percentage of surgical patients with BMI >30 rose by 5% (33% to 38%; p<0.0001) over the study period. Obese patients demonstrated higher morbidity, prolonged LOS, and increased readmission rates after MI-RRP. Obesity severity correlated negatively with quality indicators in a graded fashion.
Conclusions:
Obesity rates in patients undergoing MI-RRP increased from 2007-2017. Obese patients are at increased risk of morbidity, prolonged LOS, and readmission within 30 days, following MI-RRP. These patients should not be excluded from MI-RRP; rather, physicians should discuss these increased risks with their patients. Proper weight loss strategies should be instituted preoperatively to mitigate these risks.
... Dietary adherence is crucial for achieving any health and weight goal and should be considered when tailoring a weight loss plan. Practitioners need to ask themselves how they may optimize patient adherence [21], which might be chal-lenging if individuals feel hungry throughout the process. As shown in Figure 2 [22], a vegetarian meal with similar energy and macronutrient content as an omnivore meal can be more voluminous due to the lower calorie density of plant-based foods. ...
... 25 Among the available options, low-carbohydrate, ketogenic, low-fat, and Mediterranean diets, which incorporate virgin olive oil as the main fat source, vegetables and salads as carbohydrate source, and fish as the main protein source, have been classified as safe and effective by multiple studies. [25][26][27] Low-fat diets increase low-density lipoprotein cholesterol. Low-carbohydrate and ketogenic diets may improve triglycerides and high-density lipoprotein cholesterol. ...
In the last decade, endocrine therapy strategies in perimenopausal women with hormone-responsive early breast cancer (BC) have changed and now ovarian function suppression (OFS) is recommended for the majority of patients. Side effects OFS mimic menopausal symptoms, including hot flushes, sweats, weight gain and sexual dysfunction, which may negatively impact quality of life. Aims of the TAKE CARE project are the education of physicians and patients in order to have all the information (medical and non-medical) they need to manage menopausal symptoms by distributing educational materials useful to face menopause. Four different areas have been identified by surveys conducted among physicians and young patients: for each area, interventions and tools have been elaborated by a doctor and non-physicians professionals of these identified areas, in order to offer the widest information available. Clinical and practical suggestions have been provided. Based on the evidence given, we strongly suggest setting up a multidisciplinary team for the treatment planning of young BC patients, which could help patients to face and manage their new menopause condition. The reduction of side effects and the improvement in quality of life should be the best ally to treat young breast cancer patients.
... Adhering to a healthy diet − as for instance recommended by the World Health Organization [1] − benefits cardiovascular, metabolic and mental health [2][3][4], greater longevity [5] and also helps in maintaining a healthy weight [6]. As a result, many individuals monitor and manage their eating to some degree, for example by using smartphone apps [7], and follow a more or less explicit goal to eat healthily. ...
Background
Many people aim to eat healthily. Yet, affluent food environments encourage consumption of energy dense and nutrient-poor foods, making it difficult to accomplish individual goals such as maintaining a healthy diet and weight. Moreover, goal-congruent eating might be influenced by affects, stress and intense food cravings and might also impinge on these in turn. Directionality and interrelations of these variables are currently unclear, which impedes targeted intervention. Psychological network models offer an exploratory approach that might be helpful to identify unique associations between numerous variables as well as their directionality when based on longitudinal time-series data.
Methods
Across 14 days, 84 diet-interested participants (age range: 18–38 years, 85.7% female, mostly recruited via universities) reported their momentary states as well as retrospective eating episodes four times a day. We used multilevel vector autoregressive network models based on ecological momentary assessment data of momentary affects, perceived stress and stress coping, hunger, food craving as well as goal-congruent eating behaviour.
Results
Neither of the momentary measures of stress (experience of stress or stress coping), momentary affects or craving uniquely predicted goal-congruent eating. Yet, temporal effects indicated that higher anticipated stress coping predicted subsequent goal-congruent eating. Thus, the more confident participants were in their coping with upcoming challenges, the more they ate in line with their goals.
Conclusion
Most eating behaviour interventions focus on hunger and craving alongside negative and positive affect, thereby overlooking additional important variables like stress coping. Furthermore, self-regulation of eating behaviours seems to be represented by how much someone perceives a particular eating episode as matching their individual eating goal. To conclude, stress coping might be a potential novel intervention target for eating related Just-In-Time Adaptive Interventions in the context of intensive longitudinal assessment.
... Esses resultados ressaltam que adolescentes eutróficos ou com sobrepeso/obesidade que se percebem como acima do peso devem receber especial atenção em relação à alimentação, uma vez que apenas reduzir o consumo, muitas vezes de alimentos saudáveis, não deve ser a alternativa prioritária. 27 Neste estudo, após ajuste para possíveis fatores de confusão, observou-se pior qualidade da dieta entre adolescentes que se percebiam como acima do peso. Em análises adicionais, após estratificação por categoria de IMC, essa associação perdeu significância, o que sugere um papel importante do estado nutricional na relação entre percepção do peso e qualidade da alimentação. ...
Objective:
To evaluate the association between body weight perception and quality of diet among Brazilian adolescents.
Methods:
The sample was composed of 71,740 adolescents aged from 12 to 17 years-old enrolled in the Study of Cardiovascular Risks in Adolescents (Estudo de Riscos Cardiovasculares em Adolescentes - ERICA), carried out during 2013-2014. Body weight perception was self-reported. Food consumption was assessed by food record and quality of diet index for Brazilian adolescents (DQIA-BR) was calculated, considering the balance, diversity, and diet composition. The quality of diet was compared according to weight perception for the entire sample and after stratification by nutritional status. Linear regression models were used to assess the association between body weight perception and quality of diet.
Results:
Among the studied adolescents, 14.7 and 30.3% reported to be underweight or overweight in relation to their desired weight, respectively. Those who perceived themselves as overweight had lower quality of diet (DQIA-BR=16.0 vs. 17.4 points; p<0.001). After stratification by BMI, adolescents with normal weight (DQIA-BR=15.3 points) or overweight (DQIA-BR=16.1 points), but who perceived themselves as overweight showed lower quality of diet when compared to their peers. In adjusted analysis, overweight perception (β= -0.51; 95%CI -0.77; -0.24) was associated to lower quality of diet. However, this association was no longer significant after stratification by BMI status.
Conclusions:
Body weight perception can influence the consumption of healthy foods and the quality of diet, especially for those who consider themselves overweight. However, this association is influenced by nutritional status.
... Clinical Trial (DiRECT) demonstrated that short-duration (<6 years) type 2 diabetes is reversible in 64% of people who achieve weight losses of 10 kg, 3 but clinical and economic benefits of remission are dependent almost entirely on weight losses being maintained. 3,4 Significant weight loss is possible across a range of dietary approaches, 5 but the majority of people tend to regain weight over time, 6,7 ...
Aim:
To investigate whether appetite-related hormones were predictors of weight regain in the Diabetes Remission Clinical Trial (DiRECT).
Materials and methods:
DiRECT is a cluster-randomised clinical trial designed to assess the effect of weight-loss on type 2 diabetes remission. For this post hoc analysis, data were available for 253 (147 interventions, 106 controls) individuals with type 2 diabetes (aged 53.6±7.5 years, BMI 34.7±4.4 kg/m2, 59% males). Intervention participants received a 24-month weight-management programme and controls remained on usual diabetes care. Fasting plasma concentrations of leptin, ghrelin, GLP-1, and PYY were measured at baseline, 12 and 24-months in all participants, and at 5-months in a subset of interventions (n=56) and controls (n=22). Potential predictors were examined using multivariable linear regression models.
Results:
The intervention group lost 14.3±6.0% body-weight at 5-months but regained over time, with weight-losses of 10.0±7.5% at 12-months and 7.6±6.3% at 24-months. Weight-loss in controls was 1.1±3.7% and 2.1±5.0% at 12 and 24-months, respectively. Body-weight increased by 2.3% [95% CI: 0.4,4.1]; p=0.019) between 12 and 24-months for every 1 ng/ml increase in ghrelin between baseline and 12-months, and weight regain between 12 and 24-months was increased by 1.1% (95% CI: 0.2,2.0; p=0.023) body-weight for every 1 ng/ml increase in ghrelin at 12-months.
Conclusion:
The rise in ghrelin (but not any other measured hormone) during diet-induced weight-loss was a predictor of weight regain during follow-up, and concentrations remained elevated over time, suggesting a small but significant compensatory drive to regain weight. Attenuating the effects of ghrelin may improve WLM. This article is protected by copyright. All rights reserved.
... 64 In conclusion, there is some evidence that IF produces weight loss comparable to a CER diet. 13,16,[65][66][67][68] Preliminary evidence indicates that IF may be effective for weight loss, may decrease insulin resistance and fasting insulin, and may improve cardiovascular and metabolic health, although the long-term sustainability of these effects has not been studied. 11,17 Other benefits are not yet clearly established. ...
Intermittent fasting (IF) diets have recently gained popularity as a weight loss and antiaging method that attracts celebrity endorsements and public interest. Despite the growing use of IF, the debate over its safety and efficacy is still ongoing. Defined IF regimens include 5 different types: alternate-day fasting, periodic fasting, time-restricted feeding, less clearly defined IF (fast mimicking diet, juice fasting), and religious fasts. Our literature review highlights the effect of IF essentially on body weight and cardiometabolic risk factors. Intermittent fasting may be effective for weight loss and may improve cardiovascular and metabolic health, although the long-term sustainability of these effects has not been studied. While data on the safety of IF are sparse, the most frequent adverse effects (hunger, irritability, and impaired cognition) may dissipate within a month of the fasting period. Intermittent fasting is not recommended for pregnant or lactating women, children or adolescents during maturation, the elderly or underweight people, and individuals vulnerable to eating disorders.
... The increasing prevalence of obesity is a serious threat to global public health [1,2]. The obesity epidemic is a result of gene and environmental interactions as well as long-term imbalances in energy intake and consumption [3,4]. ...
BACKGROUND The mechanism of how intermittent fasting (IF) improves metabolism is not fully understood. Our study aimed to explore the effect of IF on lipid metabolism in obese mice, specifically on the intestinal flora. MATERIAL AND METHODS Diet-induced obese (DIO) mice were subjected to ad libitum (AL) feeding or IF (alternate-day fasting) for 30 days. We examined the lipid metabolism, fat distribution, gene expression of lipid metabolism, and intestinal flora in the mice. RESULTS Despite having access to the same high-fat diet as the AL-fed groups, IF mice displayed pronounced weight loss, and their lipid metabolism significantly improved, mainly reflected in lower serum lipid levels and ameliorated liver steatosis. IF also reduced metabolic endotoxemia in DIO mice. The 16S ribosomal deoxyribonucleic acid gene amplicon sequencing suggested that IF did not change the community richness but had a tendency to increase community diversity in the intestinal flora. In addition, IF significantly reduced the ratio of Firmicutes to Bacteroidetes and increased the relative abundance of Allobaculum in the intestinal flora. CONCLUSIONS IF can improve fat metabolism, reduce fat accumulation, promote white fat conversion to beige, and improve gut microbiota.
... Progressive calorie restriction and type of diet determine the pace of weight regulation, alter appetite signals, and inculcate correct food preferences. [5] Consistent physical activity is strongly associated with sustained weight loss and improvement in cardiometabolic health. ...
Obesity is a commonly encountered health-care problem that is an independent risk factor for chronic metabolic complications. Primary care physicians are the first point of contact in the management of obesity. Weight management is a step-wise intensification of interventions that initiates with lifestyle modification. Dietary and physical activity advices are integral components of all weight loss consultations and should ideally be imparted by a dietician or a nutritionist. In case of their nonavailability, the onus for lifestyle counseling rests with the physician. The prescription for a low-calorie diet coupled with increased physical activity might seem simple, but the success lies in compliance and sustainability of this advice. Compliance can be enhanced through patient-specific diet and activity plans along with corrections in eating and activity behavior. Barriers in patient's environment must also be addressed to achieve sustainable weight loss. This review covers practical insights in standard lifestyle management techniques, which can help the physicians to set better weight loss goals, adapt to patient specific lifestyle counseling, and apply strategies to enhance compliance for sustained weight loss.
... Progressive calorie restriction and type of diet determine the pace of weight regulation, alter appetite signals, and inculcate correct food preferences. [5] Consistent physical activity is strongly associated with sustained weight loss and improvement in cardiometabolic health. ...
Obesity is a commonly encountered health-care problem that is an independent risk factor for chronic metabolic complications. Primary care physicians are the first point of contact in the management of obesity. Weight management is a step-wise intensification of interventions that initiates with lifestyle modification. Dietary and physical activity advices are integral components of all weight loss consultations and should ideally be imparted by a dietician or a nutritionist. In case of their nonavailability, the onus for lifestyle counseling rests with the physician. The prescription for a low-calorie diet coupled with increased physical activity might seem simple, but the success lies in compliance and sustainability of this advice. Compliance can be enhanced through patient-specific diet and activity plans along with corrections in eating and activity behavior. Barriers in patient's environment must also be addressed to achieve sustainable weight loss. This review covers practical insights in standard lifestyle management techniques, which can help the physicians to set better weight loss goals, adapt to patient specific lifestyle counseling, and apply strategies to enhance compliance for sustained weight loss.
... Omega-3 fatty acids. Fats, which can be classified as saturated or unsaturated, form an essential part of the human diet and play a vital role in nutrition and health (87,88). Fats serve as a main source of energy, participate in cell signaling and responses, and play a structural role as part of the cell membrane. ...
The consumption of a healthy diet is critical for maintaining and promoting human health. In the context of the rapid transformation from a high-fat diet (HFD) to a Mediterranean diet (MD) leading to major systemic changes, we explored the necessity of a transitional standard diet (TSD) between these two varied diets and the adjuvant effect of probiotics. HFD-fed mice were used for studying the changes and benefits of a dietary intervention and probiotic treatment. By measuring multiple systemic alterations such as weight (group B vs. group E, P < 0.05), liver function (AST, group C vs. group E, P < 0.001), and histopathology, we found that an MD, TSD and Bifidobacterium longum all contribute to alleviating lipid deposition and liver injury. The downregulation of IL-17 (group B vs. group E, P < 0.01) and MIP-1α (group B vs. group E, P < 0.001) also demonstrated the anti-inflammatory effects of the TSD. Moreover, we performed multi-omics analysis combined with the 16S sequencing, transcriptome and metabolome results and found that the TSD increased the abundance of the Lactobacillus genus (group C vs. group E, P < 0.01) and effectively lowered lipid accumulation and systemic inflammation. Furthermore, B. longum played an important role in the synergistic effect. The results showed that a TSD might be useful for HFD-induced obesity before drastic dietary changes, and probiotics were also beneficial.
Genetic components may play an important role in the regulation of nutrient and energy metabolism. In the presence of specific genetic variants, metabolic dysregulation may occur, especially in relation to the processes of digestion, assimilation, and the physiological utilization of nutrients supplied to the body, as well as the regulation of various metabolic pathways and the balance of metabolic changes, which may consequently affect the effectiveness of applied reduction diets and weight loss after training. There are many well-documented studies showing that the presence of certain polymorphic variants in some genes can be associated with specific changes in nutrient and energy metabolism, and consequently, with more or less desirable effects of applied caloric reduction and/or exercise intervention. This systematic review focused on the role of genes encoding peroxisome proliferator-activated receptors (PPARs) and their coactivators in nutrient and energy metabolism. The literature review prepared showed that there is a link between the presence of specific alleles described at different polymorphic points in PPAR genes and various human body characteristics that are crucial for the efficacy of nutritional and/or exercise interventions. Genetic analysis can be a valuable element that complements the work of a dietitian or trainer, allowing for the planning of a personalized diet or training that makes the best use of the innate metabolic characteristics of the person who is the subject of their interventions.
Mindful eating has been linked to improvement in binge eating disorder, but this approach in obesity management has shown conflicting results. Our aim was to assess the effect of mindful eating associated with moderate calorie restriction on weight loss in women with obesity. Metabolic parameters, dietary assessment, eating behavior, depression, anxiety, and stress were also evaluated. A total of 138 women with obesity were randomly assigned to three intervention groups: mindful eating associated with moderate calorie restriction (ME + MCR), moderate calorie restriction (MCR), and mindful eating (ME), and they were followed up monthly for 6 months. ME + MCR joined seven monthly mindfulness-based intervention group sessions each lasting 90 minutes and received an individualized food plan with moderate calorie restriction (deficit of 500 kcal/d). MCR received an individualized food plan with moderate calorie restriction (deficit of 500 kcal/d), and ME joined seven monthly mindfulness-based intervention group sessions each lasting 90 minutes. Seventy patients completed the intervention. Weight loss was significant, but no statistically significant difference was found between the groups. There was a greater reduction in uncontrolled eating in the ME group than in the MCR group and a greater reduction in emotional eating in the ME group than in both the MCR and the ME+MCR groups. No statistically significant differences were found in the other variables evaluated between groups. The association between mindful eating with calorie restriction did not promote greater weight loss than mindful eating or moderate calorie restriction.
Most current nutrition policies and dietary recommendations still reflect decades of research addressing the mechanism of action or health risks of individual nutrients. Yet, most high-income countries including the UK are far from reaching the dietary intakes which are recommended for good health. Food-based dietary patterns (DPs) can help target specific combinations of foods that are associated with disease risk, recognising the coexistence of multiple nutrients within foods and their potential synergistic effects. Reduced rank regression (RRR) has emerged as a useful exploratory approach which uses a priori knowledge of the pathway from diet to disease to help identify DPs which are associated with disease risk in a particular population. Here we reviewed the literature with a focus on longitudinal cohort studies using RRR to derive DPs and reporting associations with non-communicable disease risk. We also illustrated the application of the RRR approach using data from the UK Biobank study, where we derived DPs that explained high variability in a set of nutrient response variables. The main DP was characterised by high intakes of chocolate and confectionery, butter and low-fibre bread, and low intakes of fresh fruit and vegetables and showed particularly strong associations with CVD, type 2 diabetes and all-cause mortality, which is consistent with previous studies that derived 'Western' or unhealthy DPs. These recent studies conducted in the UK Biobank population together with evidence from previous cohort studies contribute to the emerging evidence base to underpin food-based dietary advice for non-communicable disease prevention.
Resumen de la guía de manejo de Dislipidemia 2020 de la Asociación Americana de Endocrinólogos Clínicos.
Se aplica la calculadora de riesgo cardiovascular de la OMS 2021 y se presenta un caso clínico con Dislipidemia y su evolución con manejo farmacológico y no farmacológico durante 18 meses.
The prognosis for people with type 2 diabetes (T2D) remains concerning, yet its seriousness is often underestimated. T2D is a manifestation, in susceptible individuals, of the disease-process of obesity, and at diagnosis, 10-year survival rates for T2D are around 50%. Here, we will examine: (a) the role of weight loss in T2D, (b) use of total diet replacements (TDRs) to induce weight loss, (c) the Diabetes Remission Clinical Trial (DiRECT) protocol and key results, (d) other dietary interventions related to T2D remission, (e) remission in real life, and (f) future directions. Remission of short-duration T2D will usually require 10-15% body weight loss, and results from the DiRECT trial demonstrated that this can be achieved within routine care in nearly half of all people undertaking a supported, TDR-led behavioural weight management programme. In light of these findings, which have since been replicated in the Diabetes Intervention Accentuating Diet and Enhancing Metabolism (DIADEM-I) trial conducted in the Middle East and North Africa, it is now time to prioritize weight loss programmes for T2D remission from diagnosis, and with increasing acceptance and availability of digital healthcare, there is an opportunity to scale up delivery of remission programmes in a cost effective manner.
The molecular activation of non-shivering thermogenesis (NST) has strong potential to combat obesity and metabolic disease. However, the mechanisms surrounding the maintenance of NST once it is fully activated, remain unexplored. Here, we present 4-Nitrophenylphosphatase Domain and Non-Neuronal SNAP25-Like 1 (Nipsnap1) as a critical regulator of long-term thermogenic maintenance in brown adipose tissue (BAT). Nipsnap1 localizes to the mitochondrial matrix and increases its transcript and protein levels in response to both chronic cold and β 3 adrenergic signaling. Through the generation of BAT-specific Nipsnap1 knockout mice (N1-KO), we show that these mice are unable to sustain activated energy expenditure and fail to protect their body temperature in the face of an extended cold challenge. Mechanistically, we demonstrate that Nipsnap1 integrates with lipid metabolism and BAT-specific ablation of Nipsnap1 leads to severe defects in β-oxidation capacity. Our findings identify Nipsnap1 as a potent regulator of long-term NST maintenance.
Future personalized approaches to weight management are likely to include consideration of genetic influences on eating behaviors. This study explores whether genetic beliefs about eating behaviors influence dietary self-efficacy and confidence. In a survey of 261 individuals of various weight statuses, we find that endorsing genetic causes of two specific eating behaviors (taste preference and disinhibition) predicts poorer dietary self-efficacy for people who exhibit these eating behaviors. This suggests there may be utility to considering eating behaviors individually when it comes to predicting the influence of genetic information provision in the service of precision medicine interventions. Individuals with high disinhibited eating and/or bitter taster status may be particularly sensitive to interpreting genetic predisposition information in ways that undercut self-efficacy and confidence.
Greenhouse gases (GHGs) are the essential component for our planet earth to maintain an ambient condition for our survival. These gases in collaboration form an atmospheric layer which protects direct UV rays from reaching the earth. Human activities have increased the use of these gases artificially for many commercial purposes. Along with global warming and climate change greenhouse gases have adverse impacts on human health. Although human body has the capacity to cope with short-term exposure of these gases, long-term high concentration exposure becomes detrimental. The chronic exposure slowly affects multiple different organs primarily including the respiratory system, cardiovascular system, the central nervous system (CNS), the immune system, the digestive system and often the reproductive system. This chapter summarizes the mechanism of action and the adverse effects of greenhouse gases on human health and the primary target organs in an attempt to better understand the consequences of our actions.KeywordsGreenhouse gasesHuman healthCNSRespiratory systemCardiovascular systemImmune system
Appropriate diet can prevent, manage, or reverse noncommunicable health conditions such as obesity, cardiovascular disease, and diabetes. Consequently, the public’s interest in diet and nutrition has fueled the multi-billion-dollar weight loss industry and elevated its standing on social media and the internet. Although many dietary approaches are popular, their universal effectiveness and risks across overall populations are not clear. The objective of this scoping review was to identify and characterize systematic reviews (SRs) examining diet or fasting (intermittent energy restriction [IER]) interventions among adults who are healthy or may have chronic disease. An in-depth literature search of six databases was conducted for SRs published between January 2010 and February 2020. A total of 22,385 SRs were retrieved, and 1,017 full-text articles were screened for eligibility. Of these, 92 SRs met inclusion criteria. Covered diets were organized into 12 categories: high/restricted carbohydrate (n = 30), Mediterranean, Nordic, and Tibetan (n = 19), restricted or modified fat (n = 17), various vegetarian diets (n = 16), glycemic index (n = 13), high protein (n = 12), IER (n = 11), meal replacements (n = 11), paleolithic (n = 8), Dietary Approaches to Stop Hypretension (DASH; n = 6), Atkins, South Beach, and Zone (n = 5), and eight other brand diets (n = 4). Intermediate outcomes, such as body weight or composition and cardiometabolic, were commonly reported. Abundant evidence was found exploring dietary approaches in the general population. However, heterogeneity of diet definitions, focus on single macronutrients, and infrequent macronutrient subanalyses were observed. Based on this scoping review, the Evidence Analysis Center prioritized the need to collate evidence related to macronutrient modification, specifically restricted carbohydrate diets.
Do you blame yourself for unhealthy eating patterns? Have you struggled to understand the research about healthy eating? Which combination of foods or eating patterns are healthy? This guide could help you answer these questions for yourself. The guide first discusses how vital healthy eating is to your well-being. Next, the guide tackles obstacles to healthy eating. Then, the guide discusses major dietary approaches and their pros and cons. You will also learn about successful behavioral health approaches to weight management. Finally, the guide addresses how healthy eating requirements can change as you age and how diet may affect your brain health. Each section of this guide explores a topic by reviewing recent research, summarizing key information, and posing questions for you to consider as you develop an eating pattern that works for you.
Objective
To ascertain which of the Alternative Healthy Eating Index 2010 (AHEI), Dietary Inflammatory Index (DII ® ) and Mediterranean Diet Score (MDS) best predicted body mass index (BMI) and waist-to-hip circumference ratio (WHR).
Design
Body size was measured at baseline (1990-94) and in 2003-7. Diet was assessed at baseline using a food frequency questionnaire, along with age, sex, socioeconomic status, smoking, alcohol drinking, physical activity, and country of birth. Regression coefficients and 95% confidence intervals for the association of baseline dietary scores with follow-up BMI and WHR were generated using multivariable linear regression, adjusting for baseline body-size, confounders and energy intake.
Setting
Population-based cohort in Melbourne, Australia.
Participants
Included were data from 11,030 men and 16,774 women aged 40 to 69 years at baseline.
Results
Median (IQR) follow up was 11.6 (10.7 – 12.8) years. BMI and WHR at follow-up were associated with baseline DII ® (Q5 vs Q1 (BMI 0.41 95%CI (0.21, 0.61) and WHR 0.009 95%CI (0.006, 0.013)), and AHEI (Q5 vs Q1 (BMI -0.51 95%CI (-0.68, -0.35) and WHR -0.011 95%CI (-0.013, -0.008)). WHR, but not BMI, at follow-up was associated with baseline MDS (Group 3 most Mediterranean vs G1 (BMI -0.05 95%CI (-0.23, 0.13) and WHR -0.004 95%CI (-0.007, -0.001)). Based on Akaike’s Information Criterion and Bayesian Information Criterion statistics, AHEI was a stronger predictor of body size than the other diet scores.
Conclusion
Poor quality or pro-inflammatory diets predicted overall and central obesity. The AHEI may provide the best way to assess the obesogenic potential of diet.
In recent years, many studies have shown that the intestinal microflora has various effects that are linked to the critical physiological functions and pathological systems of the host. The intestinal microbial community is widely involved in the metabolism of food components such as protein, which is one of the essential nutrients in diets. Additionally, dietary protein/amino acids have been shown to have had a profound impact on profile and operation of gut microbiota. This review summarizes the current literature on the mutual interaction between intestinal microbiota and protein/amino acid metabolism for host mucosal immunity and health.
Background
Qualitative studies investigating weight management experiences are usually cross‐sectional or of short duration, which limits understanding of the long‐term challenges.
Methods
Eleven women [mean (SD) age 44.9 (9.8) years; body mass index 40.3 (4.0) kg m⁻²] participated in this longitudinal qualitative study, which included up to 20 weeks of total diet replacement (825–853 kcal day⁻¹) and ongoing support for weight loss maintenance (WLM), to 2 years. Semi‐structured interviews were conducted at baseline and programme end, as well as at key intervals during the intervention. Questions examined five theoretical themes: motivation, self‐regulation, habits, psychological resources and social/environmental influences. Data were coded and analysed in nvivo (https://qsrinternational.com/nvivo) using the framework method.
Results
In total, 64 interviews were completed (median, n = 6 per participant). Mean (SD) weight loss was 15.7 (9.6) kg (14.6% body weight) at 6 months and 9.6 (9.9) kg (8.8% body weight) at 2 years. The prespecified theoretical model offered a useful framework to capture the variability of experiences. Negative aspects of obesity were strong motivations for weight loss and maintenance. Perceiving new routines as sustainable and developing a ‘maintenance mindset’ was characteristic of ‘Maintainers’, whereas meeting emotional needs at the expense of WLM goals during periods of stress and negative mood states was reported more often by ‘Regainers’. Optimistic beliefs about maintaining weight losses appeared to interfere with barrier identification and coping planning for most participants.
Conclusions
People tended to be very optimistic about WLM without acknowledging barriers and this may undermine longer‐term outcomes. The potential for regain remained over time, mainly as a result of emotion‐triggered eating to alleviate stress and negative feelings. More active self‐regulation during these circumstances may improve WLM, and these situations represent important targets for intervention.
Humans in modern societies typically consume food at least three times daily, while laboratory animals are fed ad libitum. Overconsumption of food with such eating patterns often leads to metabolic morbidities (insulin resistance, excessive accumulation of visceral fat, etc.), particularly when associated with a sedentary lifestyle. Because animals, including humans, evolved in environments where food was relatively scarce, they developed numerous adaptations that enabled them to function at a high level, both physically and cognitively, when in a food-deprived/fasted state. Intermittent fasting (IF) encompasses eating patterns in which individuals go extended time periods (e.g., 16–48 hours) with little or no energy intake, with intervening periods of normal food intake, on a recurring basis. We use the term periodic fasting (PF) to refer to IF with periods of fasting or fasting mimicking diets lasting from 2 to as many as 21 or more days. In laboratory rats and mice IF and PF have profound beneficial effects on many different indices of health and, importantly, can counteract disease processes and improve functional outcome in experimental models of a wide range of age-related disorders including diabetes, cardiovascular disease, cancers and neurological disorders such as Alzheimer’s disease Parkinson’s disease and stroke. Studies of IF (e.g., 60% energy restriction on 2 days per week or every other day), PF (e.g., a 5 day diet providing 750–1100 kcal) and time-restricted feeding (TRF; limiting the daily period of food intake to 8 hours or less) in normal and overweight human subjects have demonstrated efficacy for weight loss and improvements in multiple health indicators including insulin resistance and reductions in risk factors for cardiovascular disease. The cellular and molecular mechanisms by which IF improves health and counteracts disease processes involve activation of adaptive cellular stress response signaling pathways that enhance mitochondrial health, DNA repair and autophagy. PF also promotes stem cell-based regeneration as well as long-lasting metabolic effects. Randomized controlled clinical trials of IF versus PF and isoenergetic continuous energy restriction in human subjects will be required to establish the efficacy of IF in improving general health, and preventing and managing major diseases of aging.
Background
Alternate‐day‐fasting (ADF) has been proposed as an effective dieting method. Studies have found that it also can increase life span in rodents, and reduce inflammation in humans. The aim of this paper was to systematically review the efficacy of ADF compared to very‐low‐calorie dieting (VLCD) in terms of weight loss, and reduction of fat mass and fat‐free mass.
Methods
Systematic review: PubMed literature searches were performed. Fixed review procedures were applied. Studies were evaluated for quality. Twenty‐eight studies were included. Meta‐analysis: 10/28 studies (four ADF and six matched VLCD) were further analyzed.
Results
After adjustment for BMI and duration, there was no significant difference in mean body weight loss (VLCD 0.88 kg more weight loss than ADF, 95% CI: −4.32, 2.56) or fat‐free mass (VLCD 1.69 kg more fat‐free mass loss than ADF, 95% CI: −3.62, 0.23); there was a significant difference observed in fat mass (ADF 3.31 kg more fat mass loss than VLCD, 95% CI: 0.05, 6.56). Meta‐analysis showed that, among ADF studies, the pooled change in body weight, fat mass and fat‐free mass was 4.30 kg (95% CI: 3.41, 5.20), 4.06 kg (95% CI: 2.99, 5.13) and 0.72 kg (95% CI: −0.07, 1.51), respectively, while among VLCD studies, the pooled change was 6.28 kg (95% CI: 6.08, 6.49), 4.22 kg (95% CI: 3.95, 4.50) and 2.24 kg (95% CI: 1.95, 2.52), respectively.
Conclusions
Our results from both the systematic review and the meta‐analysis suggest that ADF is an efficacious dietary method, and may be superior to VLCD for some patients because of ease of compliance, greater fat‐mass loss and relative preservation of fat‐free mass. Head‐to‐head randomized clinical trials are needed to further assess relative efficacy of these two approaches.
The aim of this systematic review and meta-analysis is to summarise the effects of intermittent energy restriction on weight and biological markers in long term intervention studies of >6 months duration. An electronic search was performed using the MEDLINE, EMBASE and the Cochrane Library databases for intervention trials lasting 6 months or longer investigating the effects of intermittent energy restriction. A total of nine studies were identified as meeting the pre-specified criteria. All studies included an intermittent energy restriction arm, with six being directly compared to continuous energy restriction. A total of 981 subjects were enrolled and randomised, with weight loss observed in all intermittent energy restriction arms regardless of study duration or follow up length. Eight interventions in six trials were used for the meta-analyses, with results indicating neither intermittent or continuous energy restriction being superior with respect to weight loss, 0.084 ± 0.114 (overall mean difference between groups ± standard error; p = 0.458). The effects of intermittent energy restriction in the long term remain unclear. The number of long term studies conducted is very limited, and participant numbers typically small (less than 50 completers), indicating the need for larger, long term trials of 12 months or more, to be conducted in order to understand the impact of intermittent energy restriction on weight loss and long term weight management. Blood lipid concentrations, glucose, and insulin were not altered by intermittent energy expenditure in values greater than those seen with continuous energy restriction.
Background
Obesity is common in the U.S. and many individuals turn to commercial programs to lose weight. Our objective was to directly compare weight loss, waist circumference, and systolic and diastolic blood pressure (SBP, DBP) outcomes between commercially available weight-loss programs. Methods
We conducted a systematic review by searching MEDLINE and the Cochrane Database of Systematic Reviews from inception to November 2014 and by using references identified by commercial programs. We included randomized, controlled trials (RCTs) of at least 12 weeks duration that reported comparisons with other commercial weight-loss programs. Two reviewers extracted information on mean change in weight, waist circumference, SBP and DBP and assessed risk of bias. ResultsWe included seven articles representing three RCTs. Curves participants lost 1.8 kg (95%CI: 0.1, 3.5 kg) more than Weight Watchers in one comparison. There was no statistically significant difference in waist circumference change among the included programs. The mean reduction in SBP for SlimFast participants was 4.5 mmHg (95%CI: 0.4, 8.6 mmHg) more than that of Atkins participants in one comparison. There was no significant difference in mean DBP changes among programs. Conclusions
There is limited evidence that any one of the commercial weight-loss programs has superior results for mean weight change, mean waist circumference change, or mean blood pressure change.
By reducing energy density, low-energy sweeteners (LES) might be expected to reduce energy intake (EI) and body weight (BW). To assess the totality of the evidence testing the null hypothesis that LES exposure (versus sugars or unsweetened alternatives) has no effect on EI or BW, we conducted a systematic review of relevant studies in animals and humans consuming LES with ad libitum access to food energy. In 62 of 90 animal studies exposure to LES did not affect or decreased BW. Of 28 reporting increased BW, 19 compared LES with glucose exposure using a specific ‘learning’ paradigm. Twelve prospective cohort studies in humans reported inconsistent associations between LES use and Body Mass Index (−0.002 kg/m2/year, 95%CI −0.009 to 0.005). Meta-analysis of short-term randomized controlled trials (RCTs, 129 comparisons) showed reduced total EI for LES- versus sugar-sweetened food or beverage consumption before an ad libitum meal (−94 kcal, 95%CI −122 to −66), with no difference versus water (−2 kcal, 95%CI −30 to 26). This was consistent with EI results from sustained intervention RCTs (10 comparisons). Meta-analysis of sustained intervention RCTs (4 weeks to 40 months) showed that consumption of LES versus sugar led to relatively reduced BW (nine comparisons; −1.35 kg, 95%CI −2.28 to −0.42), and a similar relative reduction in BW versus water (three comparisons; −1.24 kg, 95%CI −2.22 to −0.26). Most animal studies did not mimic LES consumption by humans, and reverse causation may influence the results of prospective cohort studies. The preponderance of evidence from all human RCTs indicates that LES do not increase EI or BW, whether compared with caloric or non-caloric (e.g., water) control conditions. Overall, the balance of evidence indicates that use of LES in place of sugar, in children and adults, leads to reduced EI and BW, and possibly also when compared with water.
Reducing saturated fat reduces serum cholesterol, but effects on other intermediate outcomes may be less clear. Additionally it is unclear whether the energy from saturated fats that are lost in the diet are more helpfully replaced by polyunsaturated fats, monounsaturated fats, carbohydrate or protein. This review is part of a series split from and updating an overarching review.
To assess the effect of reducing saturated fat intake and replacing it with carbohydrate (CHO), polyunsaturated (PUFA) or monounsaturated fat (MUFA) and/or protein on mortality and cardiovascular morbidity, using all available randomised clinical trials.
We updated our searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid) and EMBASE (Ovid) on 5 March 2014. We also checked references of included studies and reviews.
Trials fulfilled the following criteria: 1) randomised with appropriate control group; 2) intention to reduce saturated fat intake OR intention to alter dietary fats and achieving a reduction in saturated fat; 3) not multifactorial; 4) adult humans with or without cardiovascular disease (but not acutely ill, pregnant or breastfeeding); 5) intervention at least 24 months; 6) mortality or cardiovascular morbidity data available.
Two review authors working independently extracted participant numbers experiencing health outcomes in each arm, and we performed random-effects meta-analyses, meta-regression, subgrouping, sensitivity analyses and funnel plots.
We include 15 randomised controlled trials (RCTs) (17 comparisons, ˜59,000 participants), which used a variety of interventions from providing all food to advice on how to reduce saturated fat. The included long-term trials suggested that reducing dietary saturated fat reduced the risk of cardiovascular events by 17% (risk ratio (RR) 0.83; 95% confidence interval (CI) 0.72 to 0.96, 13 comparisons, 53,300 participants of whom 8% had a cardiovascular event, I² 65%, GRADE moderate quality of evidence), but effects on all-cause mortality (RR 0.97; 95% CI 0.90 to 1.05; 12 trials, 55,858 participants) and cardiovascular mortality (RR 0.95; 95% CI 0.80 to 1.12, 12 trials, 53,421 participants) were less clear (both GRADE moderate quality of evidence). There was some evidence that reducing saturated fats reduced the risk of myocardial infarction (fatal and non-fatal, RR 0.90; 95% CI 0.80 to 1.01; 11 trials, 53,167 participants), but evidence for non-fatal myocardial infarction (RR 0.95; 95% CI 0.80 to 1.13; 9 trials, 52,834 participants) was unclear and there were no clear effects on stroke (any stroke, RR 1.00; 95% CI 0.89 to 1.12; 8 trials, 50,952 participants). These relationships did not alter with sensitivity analysis. Subgrouping suggested that the reduction in cardiovascular events was seen in studies that primarily replaced saturated fat calories with polyunsaturated fat, and no effects were seen in studies replacing saturated fat with carbohydrate or protein, but effects in studies replacing with monounsaturated fats were unclear (as we located only one small trial). Subgrouping and meta-regression suggested that the degree of reduction in cardiovascular events was related to the degree of reduction of serum total cholesterol, and there were suggestions of greater protection with greater saturated fat reduction or greater increase in polyunsaturated and monounsaturated fats. There was no evidence of harmful effects of reducing saturated fat intakes on cancer mortality, cancer diagnoses or blood pressure, while there was some evidence of improvements in weight and BMI.
The findings of this updated review are suggestive of a small but potentially important reduction in cardiovascular risk on reduction of saturated fat intake. Replacing the energy from saturated fat with polyunsaturated fat appears to be a useful strategy, and replacement with carbohydrate appears less useful, but effects of replacement with monounsaturated fat were unclear due to inclusion of only one small trial. This effect did not appear to alter by study duration, sex or baseline level of cardiovascular risk. Lifestyle advice to all those at risk of cardiovascular disease and to lower risk population groups should continue to include permanent reduction of dietary saturated fat and partial replacement by unsaturated fats. The ideal type of unsaturated fat is unclear.
Background
Some popular weight loss diets restricting carbohydrates (CHO) claim to be more effective, and have additional health benefits in preventing cardiovascular disease compared to balanced weight loss diets.
Methods and Findings
We compared the effects of low CHO and isoenergetic balanced weight loss diets in overweight and obese adults assessed in randomised controlled trials (minimum follow-up of 12 weeks), and summarised the effects on weight, as well as cardiovascular and diabetes risk. Dietary criteria were derived from existing macronutrient recommendations. We searched Medline, EMBASE and CENTRAL (19 March 2014). Analysis was stratified by outcomes at 3–6 months and 1–2 years, and participants with diabetes were analysed separately. We evaluated dietary adherence and used GRADE to assess the quality of evidence. We calculated mean differences (MD) and performed random-effects meta-analysis. Nineteen trials were included (n = 3209); 3 had adequate allocation concealment. In non-diabetic participants, our analysis showed little or no difference in mean weight loss in the two groups at 3–6 months (MD 0.74 kg, 95%CI −1.49 to 0.01 kg; I2 = 53%; n = 1745, 14 trials; moderate quality evidence) and 1–2 years (MD 0.48 kg, 95%CI −1.44 kg to 0.49 kg; I2 = 12%; n = 1025; 7 trials, moderate quality evidence). Furthermore, little or no difference was detected at 3–6 months and 1–2 years for blood pressure, LDL, HDL and total cholesterol, triglycerides and fasting blood glucose (>914 participants). In diabetic participants, findings showed a similar pattern.
Conclusions
Trials show weight loss in the short-term irrespective of whether the diet is low CHO or balanced. There is probably little or no difference in weight loss and changes in cardiovascular risk factors up to two years of follow-up when overweight and obese adults, with or without type 2 diabetes, are randomised to low CHO diets and isoenergetic balanced weight loss diets.
Alternate day fasting (ADF; ad libitum "feed day", alternated with 25% energy intake "fast day"), is effective for weight loss and cardio-protection in obese individuals. Whether these effects occur in normal weight and overweight individuals remains unknown. This study examined the effect of ADF on body weight and coronary heart disease risk in non-obese subjects.
Thirty-two subjects (BMI 20--29.9 kg/m2) were randomized to either an ADF group or a control group for 12 weeks.
Body weight decreased (P < 0.001) by 5.2 +/- 0.9 kg (6.5 +/- 1.0%) in the ADF group, relative to the control group, by week 12. Fat mass was reduced (P < 0.001) by 3.6 +/- 0.7 kg, and fat free mass did not change, versus controls. Triacylglycerol concentrations decreased (20 +/- 8%, P < 0.05) and LDL particle size increased (4 +/- 1 A, P < 0.01) in the ADF group relative to controls. CRP decreased (13 +/- 17%, P < 0.05) in the ADF group relative to controls at week 12. Plasma adiponectin increased (6 +/- 10%, P < 0.01) while leptin decreased (40 +/- 7%, P < 0.05) in the ADF group versus controls by the end of the study. LDL cholesterol, HDL cholesterol, homocysteine and resistin concentrations remained unchanged after 12 weeks of treatment.
These findings suggest that ADF is effective for weight loss and cardio-protection in normal weight and overweight adults, though further research implementing larger sample sizes is required before solid conclusion can be reached.
Background Observational cohort studies and a secondary prevention trial have shown an inverse association between adherence to the Mediterranean diet and cardiovascular risk. We conducted a randomized trial of this diet pattern for the primary prevention of cardiovascular events. Methods In a multicenter trial in Spain, we randomly assigned participants who were at high cardiovascular risk, but with no cardiovascular disease at enrollment, to one of three diets: a Mediterranean diet supplemented with extra-virgin olive oil, a Mediterranean diet supplemented with mixed nuts, or a control diet (advice to reduce dietary fat). Participants received quarterly individual and group educational sessions and, depending on group assignment, free provision of extra-virgin olive oil, mixed nuts, or small nonfood gifts. The primary end point was the rate of major cardiovascular events (myocardial infarction, stroke, or death from cardiovascular causes). On the basis of the results of an interim analysis, the trial was stopped after a median follow-up of 4.8 years. Results A total of 7447 persons were enrolled (age range, 55 to 80 years); 57% were women. The two Mediterranean-diet groups had good adherence to the intervention, according to self-reported intake and biomarker analyses. A primary end-point event occurred in 288 participants. The multivariable-adjusted hazard ratios were 0.70 (95% confidence interval [CI], 0.54 to 0.92) and 0.72 (95% CI, 0.54 to 0.96) for the group assigned to a Mediterranean diet with extra-virgin olive oil (96 events) and the group assigned to a Mediterranean diet with nuts (83 events), respectively, versus the control group (109 events). No diet-related adverse effects were reported. Conclusions Among persons at high cardiovascular risk, a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced the incidence of major cardiovascular events. (Funded by the Spanish government's Instituto de Salud Carlos III and others; Controlled-Trials.com number, ISRCTN35739639 .).
The history of obesity research is a history of two competing hypotheses. Gary Taubes argues that the wrong hypothesis won out and that it is this hypothesis, along with substandard science, that has exacerbated the obesity crisis and the related chronic diseases. If we are to make any progress, he says, we have to look again at what really makes us fat
Since the 1950s, the conventional wisdom on obesity has been simple: it is fundamentally caused by or results from a net positive energy balance—another way of saying that we get fat because we overeat. We consume more energy than we expend. The conventional wisdom has also held, however, that efforts to cure the problem by inducing undereating or a negative energy balance—either by counselling patients to eat less or exercise more—are remarkably ineffective.
Put these two notions together and the result should be a palpable sense of cognitive dissonance. Take, for instance, The Handbook of Obesity , published in 1998 and edited by three of the most influential authorities in the field. “Dietary therapy,” it says, “remains the cornerstone of treatment and the reduction of energy intake continues to be the basis of successful weight reduction programs.” And yet it simultaneously describes the results of such dietary therapy as “poor and not long-lasting.”1
Rather than resolve this dissonance by questioning our beliefs about the cause of obesity, the tendency is to blame the public (and obese patients implicitly) for not faithfully following our advice. And we embrace the relatively new assumption that obesity must be a multifactorial and complex disorder. This makes our failures to either treat the disorder or rein in the burgeoning epidemics of obesity worldwide somehow understandable, acceptable.
Another possibility, though, is that our fundamental understanding of the aetiology of the disorder is indeed …
There is no established primary care solution for the rapidly increasing numbers of severely obese people with body mass index (BMI) > 40 kg/m(2).
This programme aimed to generate weight losses of ≥15 kg at 12 months, within routine primary care.
Feasibility study in primary care.
Patients with a BMI ≥40 kg/m(2) commenced a micronutrient-replete 810-833 kcal/day low-energy liquid diet (LELD), delivered in primary care, for a planned 12 weeks or 20 kg weight loss (whichever was the sooner), with structured food reintroduction and then weight-loss maintenance, with optional orlistat to 12 months.
Of 91 patients (74 females) entering the programme (baseline: weight 131 kg, BMI 48 kg/m(2), age 46 years), 58/91(64%) completed the LELD stage, with a mean duration of 14.4 weeks (standard deviation [SD] = 6.0 weeks), and a mean weight loss of 16.9 kg (SD = 6.0 kg). Four patients commenced weight-loss maintenance omitting the food-reintroduction stage. Of the remaining 54, 37(68%) started and completed food reintroduction over a mean duration of 9.3 weeks (SD = 5.7 weeks), with a further mean weight loss of 2.1 kg (SD = 3.7 kg), before starting a long-term low-fat-diet weight-loss maintenance plan. A total of 44/91 (48%) received orlistat at some stage. At 12 months, weight was recorded for 68/91 (75%) patients, with a mean loss of 12.4 kg (SD = 11.4 kg). Of these, 30 (33% of all 91 patients starting the programme) had a documented maintained weight loss of ≥15 kg at 12 months, six (7%) had a 10-15 kg loss, and 11 (12%) had a 5-10 kg loss. The indicative cost of providing this entire programme for wider implementation would be £861 per patient entered, or £2611 per documented 15 kg loss achieved.
A care package within routine primary care for severe obesity, including LELD, food reintroduction, and weight-loss maintenance, was well accepted and achieved a 12-month-maintained weight loss of ≥15 kg for one-third of all patients entering the programme.
To assess the effectiveness of a range of weight management programmes in terms of weight loss.
Eight arm randomised controlled trial.
Primary care trust in Birmingham, England.
740 obese or overweight men and women with a comorbid disorder identified from general practice records.
Weight loss programmes of 12 weeks' duration: Weight Watchers; Slimming World; Rosemary Conley; group based, dietetics led programme; general practice one to one counselling; pharmacy led one to one counselling; choice of any of the six programmes. The comparator group was provided with 12 vouchers enabling free entrance to a local leisure (fitness) centre.
The primary outcome was weight loss at programme end (12 weeks). Secondary outcomes were weight loss at one year, self reported physical activity, and percentage weight loss at programme end and one year.
Follow-up data were available for 658 (88.9%) participants at programme end and 522 (70.5%) at one year. All programmes achieved significant weight loss from baseline to programme end (range 1.37 kg (general practice) to 4.43 kg (Weight Watchers)), and all except general practice and pharmacy provision resulted in significant weight loss at one year. At one year, only the Weight Watchers group had significantly greater weight loss than did the comparator group (2.5 (95% confidence interval 0.8 to 4.2) kg greater loss,). The commercial programmes achieved significantly greater weight loss than did the primary care programmes at programme end (mean difference 2.3 (1.3 to 3.4) kg). The primary care programmes were the most costly to provide. Participants allocated to the choice arm did not have better outcomes than those randomly allocated to a programme.
Commercially provided weight management services are more effective and cheaper than primary care based services led by specially trained staff, which are ineffective. Trial registration Current Controlled Trials ISRCTN25072883.
After weight loss, changes in the circulating levels of several peripheral hormones involved in the homeostatic regulation of body weight occur. Whether these changes are transient or persist over time may be important for an understanding of the reasons behind the high rate of weight regain after diet-induced weight loss.
We enrolled 50 overweight or obese patients without diabetes in a 10-week weight-loss program for which a very-low-energy diet was prescribed. At baseline (before weight loss), at 10 weeks (after program completion), and at 62 weeks, we examined circulating levels of leptin, ghrelin, peptide YY, gastric inhibitory polypeptide, glucagon-like peptide 1, amylin, pancreatic polypeptide, cholecystokinin, and insulin and subjective ratings of appetite.
Weight loss (mean [±SE], 13.5±0.5 kg) led to significant reductions in levels of leptin, peptide YY, cholecystokinin, insulin (P<0.001 for all comparisons), and amylin (P=0.002) and to increases in levels of ghrelin (P<0.001), gastric inhibitory polypeptide (P=0.004), and pancreatic polypeptide (P=0.008). There was also a significant increase in subjective appetite (P<0.001). One year after the initial weight loss, there were still significant differences from baseline in the mean levels of leptin (P<0.001), peptide YY (P<0.001), cholecystokinin (P=0.04), insulin (P=0.01), ghrelin (P<0.001), gastric inhibitory polypeptide (P<0.001), and pancreatic polypeptide (P=0.002), as well as hunger (P<0.001).
One year after initial weight reduction, levels of the circulating mediators of appetite that encourage weight regain after diet-induced weight loss do not revert to the levels recorded before weight loss. Long-term strategies to counteract this change may be needed to prevent obesity relapse. (Funded by the National Health and Medical Research Council and others; ClinicalTrials.gov number, NCT00870259.).
This paper compares the efficacy of two widely used weight-loss diets differing in macronutrient composition - a low-carbohydrate diet versus a low-fat diet. Although "a calorie is a calorie" under the controlled conditions of a metabolic unit (i.e., only the level of calorie intake matters and not the source of calories), we conclude that these interrelationships are far more complex in the free-living situation. The different diet-related factors that condition energy balance, including total energy intake, satiety and hunger sensory triggers, and palatability, must be considered when assessing the efficacy of weight-reducing diets of different macronutrient composition.
The overconsumption of energy-dense foods leads to excessive energy intakes. The substitution of low-energy-dense vegetables for foods higher in energy density can help decrease energy intakes but may be difficult to implement if individuals dislike the taste of vegetables.
We investigated whether incorporating puréed vegetables to decrease the energy density of entrées at multiple meals reduced daily energy intakes and increased daily vegetable intakes.
In this crossover study, 20 men and 21 women ate ad libitum breakfast, lunch, and dinner in the laboratory once a week for 3 wk. Across conditions, entrées at meals varied in energy density from standard versions (100% condition) to reduced versions (85% and 75% conditions) by the covert incorporation of 3 or 4.5 times the amount of puréed vegetables. Entrées were accompanied by unmanipulated side dishes. Participants rated their hunger and fullness before and after meals.
Subjects consumed a consistent weight of foods across conditions of energy density; thus, the daily energy intake significantly decreased by 202 ± 60 kcal in the 85% condition (P < 0.001) and by 357 ± 47 kcal in the 75% condition (P < 0.0001). Daily vegetable consumption significantly increased from 270 ± 17 g of vegetables in the 100% condition to 487 ± 25 g of vegetables in the 75% condition (P < 0.0001). Despite the decreased energy intake, ratings of hunger and fullness did not significantly differ across conditions. Entrées were rated as similar in palatability across conditions.
Large amounts of puréed vegetables can be incorporated into various foods to decrease the energy density. This strategy can lead to substantial reductions in energy intakes and increases in vegetable intakes. This trial was registered at clinicaltrials.gov as NCT01165086.
Alternate day modified fasting (ADMF) is an effective strategy for weight loss in obese adults.
The objective of this study was to examine the dietary and physical activity adaptations that occur during short-term ADMF, and to determine how these modulations affect rate of weight loss.
Sixteen obese subjects (12 women/4 men) completed a 10-week trial consisting of 3 phases: 1) 2-week control phase, 2) 4-week ADMF controlled feeding phase, and 3) 4-week ADMF self-selected feeding phase.
Body weight decreased (P < 0.001) by 5.6 ± 1.0 kg post-treatment. Energy intake on the fast day was 26 ± 3% of baseline needs (501 ± 28 kcal/d). No hyperphagic response occurred on the feed day (95 ± 6% of baseline needs consumed, 1801 ± 226 kcal/d). Daily energy restriction (37 ± 7%) was correlated to rate of weight loss (r = 0.42, P = 0.01). Dietary fat intake decreased (36% to 33% of kcal, P < 0.05) with dietary counseling, and was related to rate of weight loss (r = 0.38, P = 0.03). Hunger on the fast day decreased (P < 0.05) by week 2, and remained low. Habitual physical activity was maintained throughout the study (fast day: 6416 ± 851 steps/d; feed day: 6569 ± 910 steps/d).
These findings indicate that obese subjects quickly adapt to ADMF, and that changes in energy/macronutrient intake, hunger, and maintenance of physical activity play a role in influencing rate of weight loss by ADMF.
Previous studies comparing low-carbohydrate and low-fat diets have not included a comprehensive behavioral treatment, resulting in suboptimal weight loss.
To evaluate the effects of 2-year treatment with a low-carbohydrate or low-fat diet, each of which was combined with a comprehensive lifestyle modification program.
Randomized parallel-group trial. (ClinicalTrials.gov registration number: NCT00143936)
3 academic medical centers.
307 participants with a mean age of 45.5 years (SD, 9.7 years) and mean body mass index of 36.1 kg/m(2) (SD, 3.5 kg/m(2)).
A low-carbohydrate diet, which consisted of limited carbohydrate intake (20 g/d for 3 months) in the form of low-glycemic index vegetables with unrestricted consumption of fat and protein. After 3 months, participants in the low-carbohydrate diet group increased their carbohydrate intake (5 g/d per wk) until a stable and desired weight was achieved. A low-fat diet consisted of limited energy intake (1200 to 1800 kcal/d; <or=30% calories from fat). Both diets were combined with comprehensive behavioral treatment.
Weight at 2 years was the primary outcome. Secondary measures included weight at 3, 6, and 12 months and serum lipid concentrations, blood pressure, urinary ketones, symptoms, bone mineral density, and body composition throughout the study.
Weight loss was approximately 11 kg (11%) at 1 year and 7 kg (7%) at 2 years. There were no differences in weight, body composition, or bone mineral density between the groups at any time point. During the first 6 months, the low-carbohydrate diet group had greater reductions in diastolic blood pressure, triglyceride levels, and very-low-density lipoprotein cholesterol levels, lesser reductions in low-density lipoprotein cholesterol levels, and more adverse symptoms than did the low-fat diet group. The low-carbohydrate diet group had greater increases in high-density lipoprotein cholesterol levels at all time points, approximating a 23% increase at 2 years.
Intensive behavioral treatment was provided, patients with dyslipidemia and diabetes were excluded, and attrition at 2 years was high.
Successful weight loss can be achieved with either a low-fat or low-carbohydrate diet when coupled with behavioral treatment. A low-carbohydrate diet is associated with favorable changes in cardiovascular disease risk factors at 2 years.
National Institutes of Health.
Controversy exists regarding the optimal rate of weight loss for long-term weight management success.
This study examined whether gradual initial weight loss was associated with greater long-term weight reduction than rapid initial loss.
Groups were drawn from participants in the TOURS trial, which included a sample of middle-aged (mean = 59.3 years) obese women (mean BMI = 36.8) who received a 6-month lifestyle intervention followed by a 1-year extended care program. Participants were encouraged to reduce caloric intake to achieve weight losses of 0.45 kg/week. Groups were categorized as "FAST" (> or =0.68 kg/week, n = 69), "MODERATE" (> or =0.23 and <0.68 kg/week, n = 104), and "SLOW" (<0.23 kg/week, n = 89) based on rate of weight loss during first month of treatment.
The FAST, MODERATE, and SLOW groups differed significantly in mean weight changes at 6 months (-13.5, -8.9, and -5.1 kg, respectively, ps < 0.001), and the FAST and SLOW groups differed significantly at 18 months (-10.9, -7.1, and -3.7 kg, respectively, ps < 0.001). No significant group differences were found in weight regain between 6 and 18 months (2.6, 1.8, and 1.3 kg, respectively, ps < 0.9). The FAST and MODERATE groups were 5.1 and 2.7 times more likely to achieve 10% weight losses at 18 months than the SLOW group.
Collectively, findings indicate both short- and long-term advantages to fast initial weight loss. Fast weight losers obtained greater weight reduction and long-term maintenance, and were not more susceptible to weight regain than gradual weight losers.
Prevalence of obesity is increasing globally. The effect of obesity on mortality and morbidity and its implication on the future prevalence of disability in the older population has not been conclusively analyzed.
To determine the influence of overweight and obesity on mortality and disability by quantifying the effect in terms of disability-free life expectancy and years lost to disability (YLD) in the older people.
For 5980 participants from the Rotterdam Study cohort, regression techniques were used to estimate the association of body mass index (BMI) and waist circumference (WC) separately with mortality, incident disability and recovery from disability. Disability was assessed using the Stanford Health Assessment Questionnaire Disability Index, an activity of daily living scale. Multistate life table methodology was used to calculate life expectancies.
In total, 15-year mortality risk, 6-year disability incidence, total life expectancy, healthy life expectancy and years of disabled life expectancy.
We observed 2388 deaths. Our analysis revealed no association between body mass index, or WC and mortality in the healthy population. Body mass index and WC were related to disability ('overweight' 25 < or =BMI <30, odd ratio (OR)=1.33, 95% confidence interval (CI) (1.10; 1.61), 'obesity I' 30< or = BMI <35, OR=2.03, 95% CI (1.55; 2.65)) and negatively to recovery from disability. We observed an increase of years lost to disability with increasing weight for men ('normal weight'-4.69 years, 'overweight'-5.87 years and 'obesity I'-7.06 years) and for women ('normal weight'-10.95 years, 'overweight'-12.82 years, 'obesity I'-15.17 years and 'obesity II/III'-13.13 years).
Results do not support the hypothesis that an increased body weight reduces total life expectancy in the older people. Although increased body weight was associated with a higher risk of becoming and remaining disabled. These results remained using WC.
Under-reporting of food intake is one of the fundamental obstacles preventing the collection of accurate habitual dietary intake data. The prevalence of under-reporting in large nutritional surveys ranges from 18 to 54% of the whole sample, but can be as high as 70% in particular subgroups. This wide variation between studies is partly due to different criteria used to identify under-reporters and also to non-uniformity of under-reporting across populations. The most consistent differences found are between men and women and between groups differing in body mass index. Women are more likely to under-report than men, and under-reporting is more common among overweight and obese individuals. Other associated characteristics, for which there is less consistent evidence, include age, smoking habits, level of education, social class, physical activity and dietary restraint.Determining whether under-reporting is specific to macronutrients or food is
problematic, as most methods identify only low energy intakes. Studies that have
attempted to measure under-reporting specific to macronutrients express nutrients as percentage of energy and have tended to find carbohydrate under-reported and protein over-reported. However, care must be taken when interpreting these results, especially when data are expressed as percentages. A logical conclusion is that food items with a negative health image (e.g. cakes, sweets, confectionery) are more likely to be under-reported, whereas those with a positive health image are more likely to be over-reported (e.g. fruits and vegetables). This also suggests that dietary fat is likely to be under-reported.However, it is necessary to distinguish between under-reporting and genuine under-eating for the duration of data collection. The key to understanding this problem, but one that has been widely neglected, concerns the processes that cause people to under-report their food intakes. The little work that has been done has simply confirmed the complexity of this issue. The importance of obtaining accurate estimates of habitual dietary intakes so as to assess health correlates of food consumption can be contrasted with the poor quality of data collected. This phenomenon should be considered a priority research area. Moreover, misreporting is not simply a nutritionist's problem, but requires a multidisciplinary approach (including psychology, sociology and physiology) to advance the understanding of under-reporting in dietary intake studies.
After weight loss, total energy expenditure -- in particular, energy expenditure at low levels of physical activity -- is lower than predicted by actual changes in body weight and composition. An important clinical issue is whether this reduction, which predisposes to weight regain, persists over time.
We aimed to determine whether this disproportionate reduction in energy expenditure persists in persons who have maintained a body-weight reduction of > or =10% for >1 y.
Seven trios of sex- and weight-matched subjects were studied in an in-patient setting while receiving a weight-maintaining liquid formula diet of identical composition. Each trio consisted of a subject at usual weight (Wt(initial)), a subject maintaining a weight reduction of > or =10% after recent (5-8 wk) completion of weight loss (Wt(loss-recent)), and a subject who had maintained a documented reduction in body weight of >10% for >1 y (Wt(loss-sustained)). Twenty-four-hour total energy expenditure (TEE) was assessed by precise titration of fed calories of a liquid formula diet necessary to maintain body weight. Resting energy expenditure (REE) and the thermic effect of feeding (TEF) were measured by indirect calorimetry. Nonresting energy expenditure (NREE) was calculated as NREE = TEE - (REE +TEF).
TEE, NREE, and (to a lesser extent) REE were significantly lower in the Wt(loss-sustained) and Wt(loss-recent) groups than in the Wt(initial) group. Differences from the Wt(initial) group in energy expenditure were qualitatively and quantitatively similar after recent and sustained weight loss.
Declines in energy expenditure favoring the regain of lost weight persist well beyond the period of dynamic weight loss.
Some obese subjects repeatedly fail to lose weight even though they report restricting their caloric intake to less than 1200 kcal per day. We studied two explanations for this apparent resistance to diet--low total energy expenditure and underreporting of caloric intake--in 224 consecutive obese subjects presenting for treatment. Group 1 consisted of nine women and one man with a history of diet resistance in whom we evaluated total energy expenditure and its main thermogenic components and actual energy intake for 14 days by indirect calorimetry and analysis of body composition. Group 2, subgroups of which served as controls in the various evaluations, consisted of 67 women and 13 men with no history of diet resistance.
Total energy expenditure and resting metabolic rate in the subjects with diet resistance (group 1) were within 5 percent of the predicted values for body composition, and there was no significant difference between groups 1 and 2 in the thermic effects of food and exercise. Low energy expenditure was thus excluded as a mechanism of self-reported diet resistance. In contrast, the subjects in group 1 underreported their actual food intake by an average (+/- SD) of 47 +/- 16 percent and overreported their physical activity by 51 +/- 75 percent. Although the subjects in group 1 had no distinct psychopathologic characteristics, they perceived a genetic cause for their obesity, used thyroid medication at a high frequency, and described their eating behavior as relatively normal (all P < 0.05 as compared with group 2).
The failure of some obese subjects to lose weight while eating a diet they report as low in calories is due to an energy intake substantially higher than reported and an overestimation of physical activity, not to an abnormality in thermogenesis.
Recent research suggests that the focus on dietary fat reduction has directly contributed to this growing burden of chronic disease.²,6- 9 In contrast to older, cross-sectional designs, high-quality prospective observational studies consistently show that total fat intake does not predict change in body fat, after controlling for confounding and reverse causation. Some foods previously relegated to the top of the pyramid because of high fat content (nuts, full-fat yogurt) are associated with lower rates of weight gain than common high-carbohydrate foods (processed grains, potato products, sugary beverages).⁹ Moreover, meta-analyses of clinical trials report that low-fat diets are inferior to comparisons controlled for treatment intensity, including low-carbohydrate diets,⁶ Mediterranean diets, and all higher-fat diets. Of particular importance, the major low-fat diet studies, such as the Women’s Health Initiative clinical trial and Look Ahead, failed to reduce risk for heart disease despite use of lower-intensity control conditions. In contrast, the PREDIMED study was terminated early when cardiovascular disease incidence decreased more rapidly than expected in the higher-fat diet groups compared with the low-fat control. Consistent with these findings, men and women adhering to low-fat/high-carbohydrate diets had higher, not lower, rates of premature death, although the type of dietary fats consumed importantly modified risk.⁷
Some experts maintain that there has long been consensus on the components of a healthful diet; that the low-fat diet recommendation was intended all along to increase consumption of vegetables, fruits, and whole grains rather than processed carbohydrates; and that responsibility for any adverse outcomes resides with the food industry for marketing unhealthful low-fat processed foods and the public for succumbing to this marketing. But these arguments disregard calls to increase consumption of all carbohydrates, irrespective of quality (including sugar), explicitly because of their lower energy density than fat³- 5; the pyramid’s emphasis on bread, cereal, and other processed grain products; the government’s call for thousands of new reduced-fat processed foods; marketing schemes involving industry, nutrition societies, and government officials that promoted low-fat food products of exceedingly low quality (eg, the now defunct Smart Choices Program); and ongoing topics of major controversy, for instance related to optimal macronutrient ratio, food processing, saturated fat, and fructose. Furthermore, encouraging intake of produce should not be conflated with reducing dietary fat. The Mediterranean diet illustrates how use of olive oil and other palatable fats in cooking and salad dressings can promote vegetable consumption.
Background:
The carbohydrate-insulin model of obesity posits that habitual consumption of a high-carbohydrate diet sequesters fat within adipose tissue because of hyperinsulinemia and results in adaptive suppression of energy expenditure (EE). Therefore, isocaloric exchange of dietary carbohydrate for fat is predicted to result in increased EE, increased fat oxidation, and loss of body fat. In contrast, a more conventional view that "a calorie is a calorie" predicts that isocaloric variations in dietary carbohydrate and fat will have no physiologically important effects on EE or body fat.
Objective:
We investigated whether an isocaloric low-carbohydrate ketogenic diet (KD) is associated with changes in EE, respiratory quotient (RQ), and body composition.
Design:
Seventeen overweight or obese men were admitted to metabolic wards, where they consumed a high-carbohydrate baseline diet (BD) for 4 wk followed by 4 wk of an isocaloric KD with clamped protein. Subjects spent 2 consecutive days each week residing in metabolic chambers to measure changes in EE (EEchamber), sleeping EE (SEE), and RQ. Body composition changes were measured by dual-energy X-ray absorptiometry. Average EE during the final 2 wk of the BD and KD periods was measured by doubly labeled water (EEDLW).
Results:
Subjects lost weight and body fat throughout the study corresponding to an overall negative energy balance of ∼300 kcal/d. Compared with BD, the KD coincided with increased EEchamber (57 ± 13 kcal/d, P = 0.0004) and SEE (89 ± 14 kcal/d, P < 0.0001) and decreased RQ (-0.111 ± 0.003, P < 0.0001). EEDLW increased by 151 ± 63 kcal/d (P = 0.03). Body fat loss slowed during the KD and coincided with increased protein utilization and loss of fat-free mass.
Conclusion:
The isocaloric KD was not accompanied by increased body fat loss but was associated with relatively small increases in EE that were near the limits of detection with the use of state-of-the-art technology. This trial was registered at clinicaltrials.gov as NCT01967563.
For more than a decade, pioneering animal studies conducted by investigators at Purdue University have provided evidence to support a central thesis: that the uncoupling of sweet taste and caloric intake by low-calorie sweeteners (LCS) can disrupt an animal's ability to predict the metabolic consequences of sweet taste, and thereby impair the animal's ability to respond appropriately to sweet-tasting foods. These investigators' work has been replicated and extended internationally. There now exists a body of evidence, from a number of investigators, that animals chronically exposed to any of a range of LCSs – including saccharin, sucralose, acesulfame potassium, aspartame, or the combination of erythritol + aspartame – have exhibited one or more of the following conditions: increased food consumption, lower post-prandial thermogenesis, increased weight gain, greater percent body fat, decreased GLP-1 release during glucose tolerance testing, and significantly greater fasting glucose, glucose area under the curve during glucose tolerance testing, and hyperinsulinemia, compared with animals exposed to plain water or – in many cases – even to calorically-sweetened foods or liquids. Adverse impacts of LCS have appeared diminished in animals on dietary restriction, but were pronounced among males, animals genetically predisposed to obesity; and animals with diet-induced obesity. Impacts have been especially striking in animals on high-energy diets: diets high in fats and sugars, and diets which resemble a highly-processed ‘Western’ diet, including trans-fatty acids and monosodium glutamate.
The epidemic of obesity took off from about 1980 and in almost all countries has been rising inexorably ever since. Only in 1997 did WHO accept that this was a major public health problem and, even then, there was no accepted method for monitoring the problem in children. It was soon evident, however, that the optimum population body mass index is about 21 and this is particularly true in Asia and Latin America where the populations are very prone to developing abdominal obesity, type 2 diabetes and hypertension. These features are now being increasingly linked to epigenetic programming of gene expression and body composition in utero and early childhood, both in terms of fat/lean