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Guo J, Robinson JL, Gardner C, Hall KD. Objective versus Self-Reported Energy Intake Changes During Low-Carbohydrate and Low-Fat Diets. Obesity (Silver Spring) 2019; 27:420-426. [PMID: 30672127 PMCID: PMC6392435 DOI: 10.1002/oby.22389] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/09/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE This study aimed to compare self-reported with objective measurements of energy intake changes (∆EI) during a 1-year weight-loss intervention with subjects randomized to low-carbohydrate versus low-fat diets. METHODS Repeated body weight measurements were used as inputs to an objective mathematical model to calculate ∆EIModel and to compare with self-reported energy intake changes assessed by repeated 24-hour recalls (∆EIRecall ). RESULTS ∆EIRecall indicated a relatively persistent state of calorie restriction of ~500 to 600 kcal/d at 3, 6, and 12 months with no significant differences between the diets. ∆EIModel demonstrated large early decreases in calorie intake > 800 kcal/d followed by an exponential return to ~100 kcal/d below baseline at the end of the year. Accounting for self-reported physical activities did not materially affect the results. Discrepancies between ∆EIModel and ∆EIRecall became progressively greater over time. The low-carbohydrate diet resulted in ∆EIModel that was 162 ± 53 kcal/d lower than the low-fat diet over the first 3 months (P = 0.002), but no significant diet differences were found thereafter. CONCLUSIONS Self-reported ∆EI measurements were inaccurate. Model-based calculations of ∆EI found that instructions to follow the low-carbohydrate diet resulted in greater calorie restriction than the low-fat diet in the early phases of the intervention, but these diet differences were not sustained.
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Affiliation(s)
- Juen Guo
- National Institute of Diabetes and Digestive and Kidney
Diseases
| | | | | | - Kevin D. Hall
- National Institute of Diabetes and Digestive and Kidney
Diseases
- To whom correspondence should be addressed:
Kevin D. Hall, Ph.D., National Institute of Diabetes & Digestive &
Kidney Diseases, 12A South Drive, Room 4007, Bethesda, MD 20892,
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52
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Guo J, Brager DC, Hall KD. Reply to DM Thomas et al. Am J Clin Nutr 2018; 108:901-902. [PMID: 30052705 PMCID: PMC6455029 DOI: 10.1093/ajcn/nqy154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Juen Guo
- Laboratory of Biological Modeling, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Danielle C Brager
- School of Mathematical and Statistical Sciences, Arizona State University, Tempe, AZ (DCB)
| | - Kevin D Hall
- Laboratory of Biological Modeling, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD,Address correspondence to KDH (e-mail: )
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53
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Affiliation(s)
- Kevin D Hall
- Laboratory of Biological Modeling, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD,Address correspondence to KDH (e-mail: )
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54
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Affiliation(s)
- Kevin D Hall
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
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55
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Abstract
PURPOSE OF REVIEW Summarize the physiological effects of low-carbohydrate diets as they relate to weight loss, glycemic control, and metabolic health. RECENT FINDINGS Low-carbohydrate diets are at least as effective for weight loss as other diets, but claims about increased energy expenditure and preferential loss of body fat are unsubstantiated. Glycemic control and hyperinsulinemia are improved by low-carbohydrate diets, but insulin sensitivity and glucose-stimulated insulin secretion may be impaired, especially in the absence of weight loss. Fasting lipid parameters are generally improved, but such improvements may depend on the quality of dietary fat and the carbohydrates they replaced. Postprandial hyperlipemia is a potential concern given the high fat content typical of low-carbohydrate diets. SUMMARY Low-carbohydrate diets have several potential benefits for treatment of obesity and type 2 diabetes, but more research is required to better understand their long-term consequences as well as the variable effects on the endocrine control of glucose, lipids, and metabolism.
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Affiliation(s)
| | - Stephanie T Chung
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
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56
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Affiliation(s)
- Kevin D Hall
- Laboratory of Biological Modeling, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | | | - Andrew W Brown
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Bloomington
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57
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Affiliation(s)
- Kevin D Hall
- Laboratory of Biological Modeling, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
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58
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Rosenbaum M, Agurs-Collins T, Bray MS, Hall KD, Hopkins M, Laughlin M, MacLean PS, Maruvada P, Savage CR, Small DM, Stoeckel L. Accumulating Data to Optimally Predict Obesity Treatment (ADOPT): Recommendations from the Biological Domain. Obesity (Silver Spring) 2018; 26 Suppl 2:S25-S34. [PMID: 29575784 PMCID: PMC6945498 DOI: 10.1002/oby.22156] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 02/12/2018] [Accepted: 02/12/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND The responses to behavioral, pharmacological, or surgical obesity treatments are highly individualized. The Accumulating Data to Optimally Predict obesity Treatment (ADOPT) project provides a framework for how obesity researchers, working collectively, can generate the evidence base needed to guide the development of tailored, and potentially more effective, strategies for obesity treatment. OBJECTIVES The objective of the ADOPT biological domain subgroup is to create a list of high-priority biological measures for weight-loss studies that will advance the understanding of individual variability in response to adult obesity treatments. This list includes measures of body composition, energy homeostasis (energy intake and output), brain structure and function, and biomarkers, as well as biobanking procedures, which could feasibly be included in most, if not all, studies of obesity treatment. The recommended high-priority measures are selected to balance needs for sensitivity, specificity, and/or comprehensiveness with feasibility to achieve a commonality of usage and increase the breadth and impact of obesity research. SIGNIFICANCE The accumulation of data on key biological factors, along with behavioral, psychosocial, and environmental factors, can generate a more precise description of the interplay and synergy among them and their impact on treatment responses, which can ultimately inform the design and delivery of effective, tailored obesity treatments.
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Affiliation(s)
- Michael Rosenbaum
- Columbia University, Vagelos College of Physicians & Surgeons, New York, New York, USA
| | - Tanya Agurs-Collins
- National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Molly S Bray
- Department of Nutritional Sciences, University of Texas at Austin, Austin, Texas, USA
| | - Kevin D Hall
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Mark Hopkins
- School of Food Science and Nutrition, University of Leeds, Leeds, England
| | - Maren Laughlin
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Paul S MacLean
- School of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Padma Maruvada
- School of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Cary R Savage
- Center for Brain, Biology and Behavior, Department of Psychology, University of Nebraska, Lincoln, Nebraska, USA
| | - Dana M Small
- Yale University Medical School, New Haven, Connecticut, USA
| | - Luke Stoeckel
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
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59
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Guo J, Brager DC, Hall KD. Simulating long-term human weight-loss dynamics in response to calorie restriction. Am J Clin Nutr 2018; 107:558-565. [PMID: 29635495 PMCID: PMC6248630 DOI: 10.1093/ajcn/nqx080] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 12/20/2017] [Indexed: 01/09/2023] Open
Abstract
Background Mathematical models have been developed to predict body weight (BW) and composition changes in response to lifestyle interventions, but these models have not been adequately validated over the long term. Objective We compared mathematical models of human BW dynamics underlying 2 popular web-based weight-loss prediction tools, the National Institutes of Health Body Weight Planner (NIH BWP) and the Pennington Biomedical Research Center Weight Loss Predictor (PBRC WLP), with data from the 2-year Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy (CALERIE) study. Design Mathematical models were initialized using baseline CALERIE data, and changes in body weight (ΔBW), fat mass (ΔFM), and energy expenditure (ΔEE) were simulated in response to time-varying changes in energy intake (ΔEI) objectively measured using the intake-balance method. No model parameters were adjusted from their previously published values. Results The PBRC WLP model simulated an exaggerated early decrease in EE in response to calorie restriction, resulting in substantial underestimation of the observed mean (95% CI) BW losses by 3.8 (3.5, 4.2) kg. The NIH WLP simulations were much closer to the data, with an overall mean ΔBW bias of -0.47 (-0.92, -0.015) kg. Linearized model analysis revealed that the main reason for the PBRC WLP model bias was a parameter value defining how spontaneous physical activity expenditure decreased with caloric restriction. Both models exhibited substantial variability in their ability to simulate individual results in response to calorie restriction. Monte Carlo simulations demonstrated that ΔEI measurement uncertainties were a major contributor to the individual variability in NIH BWP model simulations. Conclusions The NIH BWP outperformed the PBRC WLP and accurately simulated average weight-loss and energy balance dynamics in response to long-term calorie restriction. However, the substantial variability in the NIH BWP model predictions at the individual level suggests cautious interpretation of individual-level simulations. This trial was registered at clinicaltrials.gov as NCT00427193.
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Affiliation(s)
- Juen Guo
- Laboratory of Biological Modeling, National Institute of Diabetes and Digestive
and Kidney Diseases, Bethesda, MD
| | - Danielle C Brager
- School of Mathematical and Statistical Sciences, Arizona State University,
Tempe, AZ
| | - Kevin D Hall
- Laboratory of Biological Modeling, National Institute of Diabetes and Digestive
and Kidney Diseases, Bethesda, MD,Address correspondence to KDH (e-mail: )
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60
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Abstract
Several putative explanations of the obesity epidemic relate to the changing food environment. Individual dietary macronutrients have each been theorized to be the prime culprit for population obesity, but these explanations are unlikely. Rather, obesity probably resulted from changes in the caloric quantity and quality of the food supply in concert with an industrialized food system that produced and marketed convenient, highly processed foods from cheap agricultural inputs. Such foods often contain high amounts of salt, sugar, fat, and flavor additives and are engineered to have supernormal appetitive properties driving increased consumption. Ubiquitous access to convenient and inexpensive food also changed normative eating behavior, with more people snacking, eating in restaurants, and spending less time preparing meals at home. While such changes in the food environment provide a likely explanation of the obesity epidemic, definitive scientific demonstration is hindered by the difficulty in experimentally isolating and manipulating important variables at the population level.
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Affiliation(s)
- Kevin D Hall
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
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61
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Abstract
Weight loss can be achieved through a variety of modalities, but long-term maintenance of lost weight is much more challenging. Obesity interventions typically result in early weight loss followed by a weight plateau and progressive regain. This review describes current understanding of the biological, behavioral, and environmental factors driving this near-ubiquitous body weight trajectory and the implications for long-term weight management. Treatment of obesity requires ongoing clinical attention and weight maintenance-specific counseling to support sustainable healthful behaviors and positive weight regulation.
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Affiliation(s)
- Kevin D Hall
- National Institute of Diabetes and Digestive and Kidney Diseases, 12A South Drive, Room 4007, Bethesda, MD 20892, USA.
| | - Scott Kahan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; George Washington University School of Medicine, 1020 19th Street NW, Suite 450, Washington, DC 20036, USA
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62
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Hall KD, Sanghvi A, Göbel B. Proportional Feedback Control of Energy Intake During Obesity Pharmacotherapy. Obesity (Silver Spring) 2017; 25:2088-2091. [PMID: 29071809 PMCID: PMC5757521 DOI: 10.1002/oby.21978] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/18/2017] [Accepted: 08/04/2017] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Obesity pharmacotherapies result in an exponential time course for energy intake whereby large early decreases dissipate over time. This pattern of declining drug efficacy to decrease energy intake results in a weight loss plateau within approximately 1 year. This study aimed to elucidate the physiology underlying the exponential decay of drug effects on energy intake. METHODS Placebo-subtracted energy intake time courses were examined during long-term obesity pharmacotherapy trials for 14 different drugs or drug combinations within the theoretical framework of a proportional feedback control system regulating human body weight. RESULTS Assuming each obesity drug had a relatively constant effect on average energy intake and did not affect other model parameters, our model correctly predicted that long-term placebo-subtracted energy intake was linearly related to early reductions in energy intake according to a prespecified equation with no free parameters. The simple model explained about 70% of the variance between drug studies with respect to the long-term effects on energy intake, although a significant proportional bias was evident. CONCLUSIONS The exponential decay over time of obesity pharmacotherapies to suppress energy intake can be interpreted as a relatively constant effect of each drug superimposed on a physiological feedback control system regulating body weight.
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Affiliation(s)
- Kevin D. Hall
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
- To whom correspondence should be addressed: Kevin D. Hall, Ph.D., National Institute of Diabetes & Digestive & Kidney Diseases, 12A South Drive, Room 4007, Bethesda, MD 20892, , Phone: 301-402-8248, Fax: 301-402-0535
| | - Arjun Sanghvi
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Britta Göbel
- Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
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63
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Abstract
This corrects the article DOI: 10.1038/ejcn.2017.21.
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64
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Kerns JC, Guo J, Fothergill E, Howard L, Knuth ND, Brychta R, Chen KY, Skarulis MC, Walter PJ, Hall KD. Increased Physical Activity Associated with Less Weight Regain Six Years After "The Biggest Loser" Competition. Obesity (Silver Spring) 2017; 25:1838-1843. [PMID: 29086499 PMCID: PMC5757520 DOI: 10.1002/oby.21986] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/27/2017] [Accepted: 08/09/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this study was to explore how physical activity (PA) and energy intake (EI) changes were related to weight loss and regain following "The Biggest Loser" competition. METHODS At baseline, week 6 and week 30 of the competition, and 6 years after the competition, body composition was measured via dual-energy x-ray absorptiometry, resting energy expenditure was measured by using indirect calorimetry, and EI and PA were measured by using doubly labeled water. RESULTS Six years after the competition, median weight loss in 14 of "The Biggest Loser" participants was 13%, with those maintaining a greater weight loss (mean ± SE) of 24.9% ± 3.8% having increased PA by 160% ± 23%, compared with a PA increase of 34% ± 25% (P = 0.0033) in the weight regainers who were 1.1% ± 4.0% heavier than the precompetition baseline. EI changes were similar between weight loss maintainers and regainers (-8.7% ± 5.6% vs. -7.4% ± 2.7%, respectively; P = 0.83). Weight regain was inversely associated with absolute changes in PA (r = -0.82; P = 0.0003) but not with changes in EI (r = -0.15; P = 0.61). EI and PA changes explained 93% of the individual weight loss variability at 6 years. CONCLUSIONS Consistent with previous reports, large and persistent increases in PA may be required for long-term maintenance of lost weight.
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Affiliation(s)
| | - Juen Guo
- National Institute of Diabetes and Digestive and Kidney Diseases
| | - Erin Fothergill
- National Institute of Diabetes and Digestive and Kidney Diseases
| | - Lilian Howard
- National Institute of Diabetes and Digestive and Kidney Diseases
| | | | - Robert Brychta
- National Institute of Diabetes and Digestive and Kidney Diseases
| | - Kong Y. Chen
- National Institute of Diabetes and Digestive and Kidney Diseases
| | | | - Peter J. Walter
- National Institute of Diabetes and Digestive and Kidney Diseases
| | - Kevin D. Hall
- National Institute of Diabetes and Digestive and Kidney Diseases
- To whom correspondence should be addressed: Kevin D. Hall, PhD, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, 12A South Drive, Room 4007, Bethesda, MD 20892-5621, phone: 301-402-8248, fax: 301-402-0535,
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65
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66
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Hall KD, Guo J. Obesity Energetics: Body Weight Regulation and the Effects of Diet Composition. Gastroenterology 2017; 152:1718-1727.e3. [PMID: 28193517 PMCID: PMC5568065 DOI: 10.1053/j.gastro.2017.01.052] [Citation(s) in RCA: 196] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 01/19/2017] [Accepted: 01/23/2017] [Indexed: 12/14/2022]
Abstract
Weight changes are accompanied by imbalances between calorie intake and expenditure. This fact is often misinterpreted to suggest that obesity is caused by gluttony and sloth and can be treated by simply advising people to eat less and move more. Rather various components of energy balance are dynamically interrelated and weight loss is resisted by counterbalancing physiological processes. While low-carbohydrate diets have been suggested to partially subvert these processes by increasing energy expenditure and promoting fat loss, our meta-analysis of 32 controlled feeding studies with isocaloric substitution of carbohydrate for fat found that both energy expenditure (26 kcal/d; P <.0001) and fat loss (16 g/d; P <.0001) were greater with lower fat diets. We review the components of energy balance and the mechanisms acting to resist weight loss in the context of static, settling point, and set-point models of body weight regulation, with the set-point model being most commensurate with current data.
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67
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Friend DM, Devarakonda K, O'Neal TJ, Skirzewski M, Papazoglou I, Kaplan AR, Liow JS, Guo J, Rane SG, Rubinstein M, Alvarez VA, Hall KD, Kravitz AV. Basal Ganglia Dysfunction Contributes to Physical Inactivity in Obesity. Cell Metab 2017; 25:312-321. [PMID: 28041956 PMCID: PMC5299005 DOI: 10.1016/j.cmet.2016.12.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 10/22/2016] [Accepted: 11/30/2016] [Indexed: 01/15/2023]
Abstract
Obesity is associated with physical inactivity, which exacerbates the health consequences of weight gain. However, the mechanisms that mediate this association are unknown. We hypothesized that deficits in dopamine signaling contribute to physical inactivity in obesity. To investigate this, we quantified multiple aspects of dopamine signaling in lean and obese mice. We found that D2-type receptor (D2R) binding in the striatum, but not D1-type receptor binding or dopamine levels, was reduced in obese mice. Genetically removing D2Rs from striatal medium spiny neurons was sufficient to reduce motor activity in lean mice, whereas restoring Gi signaling in these neurons increased activity in obese mice. Surprisingly, although mice with low D2Rs were less active, they were not more vulnerable to diet-induced weight gain than control mice. We conclude that deficits in striatal D2R signaling contribute to physical inactivity in obesity, but inactivity is more a consequence than a cause of obesity.
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Affiliation(s)
- Danielle M Friend
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda MD 20892, USA
| | - Kavya Devarakonda
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda MD 20892, USA
| | - Timothy J O'Neal
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda MD 20892, USA
| | - Miguel Skirzewski
- Section of Molecular Neurobiology, Eunice Shriver Kennedy National Institutes of Child Health and Human Development, National Institutes of Health, Bethesda MD 20892, USA
| | - Ioannis Papazoglou
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda MD 20892, USA
| | - Alanna R Kaplan
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda MD 20892, USA
| | - Jeih-San Liow
- National Institute of Mental Health, National Institutes of Health, Bethesda MD 20892, USA
| | - Juen Guo
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda MD 20892, USA
| | - Sushil G Rane
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda MD 20892, USA
| | - Marcelo Rubinstein
- Instituto de Investigaciones en Ingeniería Genética y Biología Molecular, CONICET, C1428ADN Buenos Aires, Argentina; Department of Physiology, Molecular and Cellular Biology, FCEN, Universidad de Buenos Aires, C1428EGA Buenos Aires, Argentina; Department of Molecular and Integrative Physiology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Veronica A Alvarez
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda MD 20892, USA
| | - Kevin D Hall
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda MD 20892, USA
| | - Alexxai V Kravitz
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda MD 20892, USA; National Institute on Drug Abuse, National Institutes of Health, Bethesda MD 20892, USA.
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68
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O'Neal TJ, Friend DM, Guo J, Hall KD, Kravitz AV. Increases in Physical Activity Result in Diminishing Increments in Daily Energy Expenditure in Mice. Curr Biol 2017; 27:423-430. [PMID: 28111149 DOI: 10.1016/j.cub.2016.12.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 10/19/2016] [Accepted: 12/05/2016] [Indexed: 02/06/2023]
Abstract
Exercise is a common component of weight loss strategies, yet exercise programs are associated with surprisingly small changes in body weight [1-4]. This may be due in part to compensatory adaptations, in which calories expended during exercise are counteracted by decreases in other aspects of energy expenditure [1, 5-10]. Here we examined the relationship between a rodent model of voluntary exercise- wheel running- and total daily energy expenditure. Use of a running wheel for 3 to 7 days increased daily energy expenditure, resulting in a caloric deficit of ∼1 kcal/day; however, total daily energy expenditure remained stable after the first week of wheel access, despite further increases in wheel use. We hypothesized that compensatory mechanisms accounted for the lack of increase in daily energy expenditure after the first week. Supporting this idea, we observed a decrease in off-wheel ambulation when mice were using the wheels, indicating behavioral compensation. Finally, we asked whether individual variation in wheel use within a group of mice would be associated with different levels of daily energy expenditure. Despite a large variation in wheel running, we did not observe a significant relationship between the amount of daily wheel running and total daily energy expenditure or energy intake across mice. Together, our experiments support a model in which the transition from sedentary to light activity is associated with an increase in daily energy expenditure, but further increases in physical activity produce diminishingly small increments in daily energy expenditure.
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Affiliation(s)
- Timothy J O'Neal
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD 20892, USA; Laboratory of Biological Modeling, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD 20892, USA
| | - Danielle M Friend
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD 20892, USA
| | - Juen Guo
- Laboratory of Biological Modeling, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD 20892, USA
| | - Kevin D Hall
- Laboratory of Biological Modeling, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD 20892, USA
| | - Alexxai V Kravitz
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD 20892, USA; National Institute on Drug Abuse, NIH, Baltimore, MD 21224, USA.
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69
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Abstract
The carbohydrate-insulin model of obesity theorizes that diets high in carbohydrate are particularly fattening due to their propensity to elevate insulin secretion. Insulin directs the partitioning of energy toward storage as fat in adipose tissue and away from oxidation by metabolically active tissues and purportedly results in a perceived state of cellular internal starvation. In response, hunger and appetite increases and metabolism is suppressed, thereby promoting the positive energy balance associated with the development of obesity. Several logical consequences of this carbohydrate-insulin model of obesity were recently investigated in a pair of carefully controlled inpatient feeding studies whose results failed to support key model predictions. Therefore, important aspects of carbohydrate-insulin model have been experimentally falsified suggesting that the model is too simplistic. This review describes the current state of the carbohydrate-insulin model and the implications of its recent experimental tests.
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Affiliation(s)
- K D Hall
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
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70
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Hall KD, Chen KY, Guo J, Leibel RL, Mayer LE, Reitman ML, Rosenbaum M, Smith SR, Walsh BT, Ravussin E. Reply to DS Ludwig and CB Ebbeling. Am J Clin Nutr 2016; 104:1488-1490. [PMID: 27802997 PMCID: PMC5081725 DOI: 10.3945/ajcn.116.143628] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Kevin D Hall
- From the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (KDH, e-mail: ; KYC; JG; MLR); Columbia University, New York, NY (RLL, LESM, MR, BTW); Pennington Biomedical Research Center, Baton Rouge, LA (ER); and The Translational Research Institute for Metabolism and Diabetes, Orlando, FL (SRS)
| | - Kong Y Chen
- From the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (KDH, e-mail: ; KYC; JG; MLR); Columbia University, New York, NY (RLL, LESM, MR, BTW); Pennington Biomedical Research Center, Baton Rouge, LA (ER); and The Translational Research Institute for Metabolism and Diabetes, Orlando, FL (SRS)
| | - Juen Guo
- From the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (KDH, e-mail: ; KYC; JG; MLR); Columbia University, New York, NY (RLL, LESM, MR, BTW); Pennington Biomedical Research Center, Baton Rouge, LA (ER); and The Translational Research Institute for Metabolism and Diabetes, Orlando, FL (SRS)
| | - Rudolph L Leibel
- From the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (KDH, e-mail: ; KYC; JG; MLR); Columbia University, New York, NY (RLL, LESM, MR, BTW); Pennington Biomedical Research Center, Baton Rouge, LA (ER); and The Translational Research Institute for Metabolism and Diabetes, Orlando, FL (SRS)
| | - Laurel Es Mayer
- From the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (KDH, e-mail: ; KYC; JG; MLR); Columbia University, New York, NY (RLL, LESM, MR, BTW); Pennington Biomedical Research Center, Baton Rouge, LA (ER); and The Translational Research Institute for Metabolism and Diabetes, Orlando, FL (SRS)
| | - Marc L Reitman
- From the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (KDH, e-mail: ; KYC; JG; MLR); Columbia University, New York, NY (RLL, LESM, MR, BTW); Pennington Biomedical Research Center, Baton Rouge, LA (ER); and The Translational Research Institute for Metabolism and Diabetes, Orlando, FL (SRS)
| | - Michael Rosenbaum
- From the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (KDH, e-mail: ; KYC; JG; MLR); Columbia University, New York, NY (RLL, LESM, MR, BTW); Pennington Biomedical Research Center, Baton Rouge, LA (ER); and The Translational Research Institute for Metabolism and Diabetes, Orlando, FL (SRS)
| | - Steven R Smith
- From the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (KDH, e-mail: ; KYC; JG; MLR); Columbia University, New York, NY (RLL, LESM, MR, BTW); Pennington Biomedical Research Center, Baton Rouge, LA (ER); and The Translational Research Institute for Metabolism and Diabetes, Orlando, FL (SRS)
| | - B Timothy Walsh
- From the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (KDH, e-mail: ; KYC; JG; MLR); Columbia University, New York, NY (RLL, LESM, MR, BTW); Pennington Biomedical Research Center, Baton Rouge, LA (ER); and The Translational Research Institute for Metabolism and Diabetes, Orlando, FL (SRS)
| | - Eric Ravussin
- From the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (KDH, e-mail: ; KYC; JG; MLR); Columbia University, New York, NY (RLL, LESM, MR, BTW); Pennington Biomedical Research Center, Baton Rouge, LA (ER); and The Translational Research Institute for Metabolism and Diabetes, Orlando, FL (SRS)
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Polidori D, Sanghvi A, Seeley RJ, Hall KD. How Strongly Does Appetite Counter Weight Loss? Quantification of the Feedback Control of Human Energy Intake. Obesity (Silver Spring) 2016; 24:2289-2295. [PMID: 27804272 PMCID: PMC5108589 DOI: 10.1002/oby.21653] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/27/2016] [Accepted: 07/26/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To quantify the feedback control of energy intake in response to long-term covert manipulation of energy balance in free-living humans. METHODS A validated mathematical method was used to calculate energy intake changes during a 52-week placebo-controlled trial in 153 patients treated with canagliflozin, a sodium glucose co-transporter inhibitor that increases urinary glucose excretion, thereby resulting in weight loss without patients being directly aware of the energy deficit. The relationship between the body weight time course and the calculated energy intake changes was analyzed using principles from engineering control theory. RESULTS It was discovered that weight loss leads to a proportional increase in appetite resulting in eating above baseline by ∼100 kcal/day per kilogram of lost weight-an amount more than threefold larger than the corresponding energy expenditure adaptations. CONCLUSIONS While energy expenditure adaptations have often been considered the main reason for slowing of weight loss and subsequent regain, feedback control of energy intake plays an even larger role and helps explain why long-term maintenance of a reduced body weight is so difficult.
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Affiliation(s)
- David Polidori
- Janssen Research & Development, LLC, San Diego, California, USA
| | - Arjun Sanghvi
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Randy J Seeley
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Kevin D Hall
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA.
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Hall KD, Kerns JC, Brychta R, Knuth ND. Response to "Overstated metabolic adaptation after 'The Biggest Loser' intervention". Obesity (Silver Spring) 2016; 24:2026. [PMID: 27581560 DOI: 10.1002/oby.21635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 07/23/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Kevin D Hall
- Laboratory of Biological Modeling, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA.
| | - Jennifer C Kerns
- Hospitalist Section, Washington DC Veterans Affairs Medical Center, Washington, DC, USA
| | - Robert Brychta
- Laboratory of Biological Modeling, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Nicholas D Knuth
- Department of Kinesiology, Towson University, Baltimore, Maryland, USA
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Knuth ND, Johannsen DL, Tamboli RA, Marks-Shulman PA, Huizenga R, Chen KY, Abumrad NN, Ravussin E, Hall KD. Erratum: Metabolic adaptation following massive weight loss is related to the degree of energy imbalance and changes in circulating leptin. Obesity (Silver Spring) 2016; 24:2248. [PMID: 27670403 PMCID: PMC6330887 DOI: 10.1002/oby.21634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Affiliation(s)
| | - Kevin D Hall
- Integrative Physiology Section, Laboratory of Biological Modeling, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20892, USA.
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Hall KD, Chen KY, Guo J, Lam YY, Leibel RL, Mayer LE, Reitman ML, Rosenbaum M, Smith SR, Walsh BT, Ravussin E. Energy expenditure and body composition changes after an isocaloric ketogenic diet in overweight and obese men. Am J Clin Nutr 2016; 104:324-33. [PMID: 27385608 PMCID: PMC4962163 DOI: 10.3945/ajcn.116.133561] [Citation(s) in RCA: 204] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 06/06/2016] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Kevin D Hall
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD;
| | - Kong Y Chen
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Juen Guo
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Yan Y Lam
- Pennington Biomedical Research Center, Baton Rouge, LA
| | | | | | - Marc L Reitman
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | | | - Steven R Smith
- The Translational Research Institute for Metabolism and Diabetes, Orlando, FL
| | | | - Eric Ravussin
- Pennington Biomedical Research Center, Baton Rouge, LA
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76
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Fothergill E, Guo J, Howard L, Kerns JC, Knuth ND, Brychta R, Chen KY, Skarulis MC, Walter M, Walter PJ, Hall KD. Persistent metabolic adaptation 6 years after "The Biggest Loser" competition. Obesity (Silver Spring) 2016; 24:1612-9. [PMID: 27136388 PMCID: PMC4989512 DOI: 10.1002/oby.21538] [Citation(s) in RCA: 376] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 04/18/2016] [Accepted: 04/19/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To measure long-term changes in resting metabolic rate (RMR) and body composition in participants of "The Biggest Loser" competition. METHODS Body composition was measured by dual energy X-ray absorptiometry, and RMR was determined by indirect calorimetry at baseline, at the end of the 30-week competition and 6 years later. Metabolic adaptation was defined as the residual RMR after adjusting for changes in body composition and age. RESULTS Of the 16 "Biggest Loser" competitors originally investigated, 14 participated in this follow-up study. Weight loss at the end of the competition was (mean ± SD) 58.3 ± 24.9 kg (P < 0.0001), and RMR decreased by 610 ± 483 kcal/day (P = 0.0004). After 6 years, 41.0 ± 31.3 kg of the lost weight was regained (P = 0.0002), while RMR was 704 ± 427 kcal/day below baseline (P < 0.0001) and metabolic adaptation was -499 ± 207 kcal/day (P < 0.0001). Weight regain was not significantly correlated with metabolic adaptation at the competition's end (r = -0.1, P = 0.75), but those subjects maintaining greater weight loss at 6 years also experienced greater concurrent metabolic slowing (r = 0.59, P = 0.025). CONCLUSIONS Metabolic adaptation persists over time and is likely a proportional, but incomplete, response to contemporaneous efforts to reduce body weight.
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Affiliation(s)
- Erin Fothergill
- National Institute of Diabetes and Digestive and Kidney Diseases
| | - Juen Guo
- National Institute of Diabetes and Digestive and Kidney Diseases
| | - Lilian Howard
- National Institute of Diabetes and Digestive and Kidney Diseases
| | | | | | - Robert Brychta
- National Institute of Diabetes and Digestive and Kidney Diseases
| | - Kong Y. Chen
- National Institute of Diabetes and Digestive and Kidney Diseases
| | | | - Mary Walter
- National Institute of Diabetes and Digestive and Kidney Diseases
| | - Peter J. Walter
- National Institute of Diabetes and Digestive and Kidney Diseases
| | - Kevin D. Hall
- National Institute of Diabetes and Digestive and Kidney Diseases
- To whom correspondence should be addressed: Kevin D. Hall, PhD, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, 12A South Drive, Room 4007, Bethesda, MD 20892-5621, phone: 301-402-8248, fax: 301-402-0535,
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Katan MB, de Ruyter JC, Kuijper LDJ, Chow CC, Hall KD, Olthof MR. Impact of Masked Replacement of Sugar-Sweetened with Sugar-Free Beverages on Body Weight Increases with Initial BMI: Secondary Analysis of Data from an 18 Month Double-Blind Trial in Children. PLoS One 2016; 11:e0159771. [PMID: 27447721 PMCID: PMC4957753 DOI: 10.1371/journal.pone.0159771] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 07/06/2016] [Indexed: 01/10/2023] Open
Abstract
Background Substituting sugar-free for sugar-sweetened beverages reduces weight gain. This effect may be more pronounced in children with a high body mass index (BMI) because their sensing of kilocalories might be compromised. We investigated the impact of sugar-free versus sugary drinks separately in children with a higher and a lower initial BMI z score, and predicted caloric intakes and degree of compensation in the two groups. Methods and Findings This is a secondary, explorative analysis of our double-blind randomized controlled trial (RCT) which showed that replacement of one 250-mL sugary drink per day by a sugar—free drink for 18 months significantly reduced weight gain. In the 477 children who completed the trial, mean initial weights were close to the Dutch average. Only 16% were overweight and 3% obese. Weight changes were expressed as BMI z-score, i.e. as standard deviations of the BMI distribution per age and sex group. We designated the 239 children with an initial BMI z-score below the median as ‘lower BMI’ and the 238 children above the median as ‘higher BMI’. The difference in caloric intake from experimental beverages between treatments was 86 kcal/day both in the lower and in the higher BMI group. We used a multiple linear regression and the coefficient of the interaction term (initial BMI group times treatment), indicated whether children with a lower BMI responded differently from children with a higher BMI. Statistical significance was defined as p ≤ 0.05. Relative to the sugar sweetened beverage, consumption of the sugar—free beverage for 18 months reduced the BMI z-score by 0.05 SD units within the lower BMI group and by 0.21 SD within the higher BMI group. Body weight gain was reduced by 0.62 kg in the lower BMI group and by 1.53 kg in the higher BMI group. Thus the treatment reduced the BMI z-score by 0.16 SD units more in the higher BMI group than in the lower BMI group (p = 0.04; 95% CI -0.31 to -0.01). The impact of the intervention on body weight gain differed by 0.90 kg between BMI groups (p = 0.09; 95% CI -1.95 to 0.14). In addition, we used a physiologically-based model of growth and energy balance to estimate the degree to which children had compensated for the covertly removed sugar kilocalories by increasing their intake of other foods. The model predicts that children with a lower BMI had compensated 65% (95% CI 28 to 102) of the covertly removed sugar kilocalories, whereas children with a higher BMI compensated only 13% (95% CI -37 to 63). Conclusions The children with a BMI above the median might have a reduced tendency to compensate for changes in caloric intake. Differences in these subconscious compensatory mechanisms may be an important cause of differences in the tendency to gain weight. If further research bears this out, cutting down on the intake of sugar-sweetened drinks may benefit a large proportion of children, especially those who show a tendency to become overweight. Trial Registration ClinicalTrials.gov NCT00893529
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Affiliation(s)
- Martijn B. Katan
- Department of Health Sciences, EMGO Institute for Health and Care Research, VU University, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands
| | - Janne C. de Ruyter
- Department of Health Sciences, EMGO Institute for Health and Care Research, VU University, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands
| | - Lothar D. J. Kuijper
- Department of Health Sciences, EMGO Institute for Health and Care Research, VU University, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands
| | - Carson C. Chow
- Laboratory of Biological Modeling, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, United States of America
| | - Kevin D. Hall
- Laboratory of Biological Modeling, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, United States of America
| | - Margreet R. Olthof
- Department of Health Sciences, EMGO Institute for Health and Care Research, VU University, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands
- * E-mail:
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Bond ND, Guo J, Hall KD, McPherron AC. Modeling Energy Dynamics in Mice with Skeletal Muscle Hypertrophy Fed High Calorie Diets. Int J Biol Sci 2016; 12:617-30. [PMID: 27076790 PMCID: PMC4829546 DOI: 10.7150/ijbs.13525] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 02/17/2016] [Indexed: 11/26/2022] Open
Abstract
Retrospective and prospective studies show that lean mass or strength is positively associated with metabolic health. Mice deficient in myostatin, a growth factor that negatively regulates skeletal muscle mass, have increased muscle and body weights and are resistant to diet-induced obesity. Their leanness is often attributed to higher energy expenditure in the face of normal food intake. However, even obese animals have an increase in energy expenditure compared to normal weight animals suggesting this is an incomplete explanation. We have previously developed a computational model to estimate energy output, fat oxidation and respiratory quotient from food intake and body composition measurements to more accurately account for changes in body composition in rodents over time. Here we use this approach to understand the dynamic changes in energy output, intake, fat oxidation and respiratory quotient in muscular mice carrying a dominant negative activin receptor IIB expressed specifically in muscle. We found that muscular mice had higher food intake and higher energy output when fed either chow or a high-fat diet for 15 weeks compared to WT mice. Transgenic mice also matched their rate of fat oxidation to the rate of fat consumed better than WT mice. Surprisingly, when given a choice between high-fat diet and Ensure® drink, transgenic mice consumed relatively more calories from Ensure® than from the high-fat diet despite similar caloric intake to WT mice. When switching back and forth between diets, transgenic mice adjusted their intake more rapidly than WT to restore normal caloric intake. Our results show that mice with myostatin inhibition in muscle are better at adjusting energy intake and output on diets of different macronutrient composition than WT mice to maintain energy balance and resist weight gain.
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Affiliation(s)
- Nichole D Bond
- 1. Genetics of Development and Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892 USA
| | - Juen Guo
- 2. Laboratory of Biological Modeling, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892 USA
| | - Kevin D Hall
- 2. Laboratory of Biological Modeling, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892 USA
| | - Alexandra C McPherron
- 1. Genetics of Development and Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892 USA
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MacLeod EL, Hall KD, McGuire PJ. Computational modeling to predict nitrogen balance during acute metabolic decompensation in patients with urea cycle disorders. J Inherit Metab Dis 2016; 39:17-24. [PMID: 26260782 PMCID: PMC4713290 DOI: 10.1007/s10545-015-9882-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 07/06/2015] [Accepted: 07/07/2015] [Indexed: 12/29/2022]
Abstract
Nutritional management of acute metabolic decompensation in amino acid inborn errors of metabolism (AA IEM) aims to restore nitrogen balance. While nutritional recommendations have been published, they have never been rigorously evaluated. Furthermore, despite these recommendations, there is a wide variation in the nutritional strategies employed amongst providers, particularly regarding the inclusion of parenteral lipids for protein-free caloric support. Since randomized clinical trials during acute metabolic decompensation are difficult and potentially dangerous, mathematical modeling of metabolism can serve as a surrogate for the preclinical evaluation of nutritional interventions aimed at restoring nitrogen balance during acute decompensation in AA IEM. A validated computational model of human macronutrient metabolism was adapted to predict nitrogen balance in response to various nutritional interventions in a simulated patient with a urea cycle disorder (UCD) during acute metabolic decompensation due to dietary non-adherence or infection. The nutritional interventions were constructed from published recommendations as well as clinical anecdotes. Overall, dextrose alone (DEX) was predicted to be better at restoring nitrogen balance and limiting nitrogen excretion during dietary non-adherence and infection scenarios, suggesting that the published recommended nutritional strategy involving dextrose and parenteral lipids (ISO) may be suboptimal. The implications for patients with AA IEM are that the medical course during acute metabolic decompensation may be influenced by the choice of protein-free caloric support. These results are also applicable to intensive care patients undergoing catabolism (postoperative phase or sepsis), where parenteral nutritional support aimed at restoring nitrogen balance may be more tailored regarding metabolic fuel selection.
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Affiliation(s)
- Erin L MacLeod
- Division of Genetics and Metabolism, Children's National Health System, Washington, DC, USA
| | - Kevin D Hall
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Peter J McGuire
- National Human Genome Research Institute, National Institutes of Health, 49 Convent Drive, 4A62, Bethesda, MD, 20892, USA.
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Bennett BJ, Hall KD, Hu FB, McCartney AL, Roberto C. Nutrition and the science of disease prevention: a systems approach to support metabolic health. Ann N Y Acad Sci 2015; 1352:1-12. [PMID: 26415028 DOI: 10.1111/nyas.12945] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 08/26/2015] [Indexed: 12/31/2022]
Abstract
Progress in nutritional science, genetics, computer science, and behavioral economics can be leveraged to address the challenge of noncommunicable disease. This report highlights the connection between nutrition and the complex science of preventing disease and discusses the promotion of optimal metabolic health, building on input from several complementary disciplines. The discussion focuses on (1) the basic science of optimal metabolic health, including data from gene-diet interactions, microbiome, and epidemiological research in nutrition, with the goal of defining better targets and interventions, and (2) how nutrition, from pharma to lifestyle, can build on systems science to address complex issues.
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Affiliation(s)
- Brian J Bennett
- Departments of Genetics and Nutrition, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Kevin D Hall
- Integrative Physiology Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Frank B Hu
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Anne L McCartney
- Food and Nutritional Sciences, University of Reading, Reading, United Kingdom
| | - Christina Roberto
- Departments of Social and Behavioral Sciences and Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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81
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Affiliation(s)
- Kevin D Hall
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20892, USA.
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Hall KD, Bemis T, Brychta R, Chen KY, Courville A, Crayner EJ, Goodwin S, Guo J, Howard L, Knuth ND, Miller BV, Prado CM, Siervo M, Skarulis MC, Walter M, Walter PJ, Yannai L. Calorie for Calorie, Dietary Fat Restriction Results in More Body Fat Loss than Carbohydrate Restriction in People with Obesity. Cell Metab 2015; 22:427-36. [PMID: 26278052 PMCID: PMC4603544 DOI: 10.1016/j.cmet.2015.07.021] [Citation(s) in RCA: 166] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 07/06/2015] [Accepted: 07/23/2015] [Indexed: 10/23/2022]
Abstract
Dietary carbohydrate restriction has been purported to cause endocrine adaptations that promote body fat loss more than dietary fat restriction. We selectively restricted dietary carbohydrate versus fat for 6 days following a 5-day baseline diet in 19 adults with obesity confined to a metabolic ward where they exercised daily. Subjects received both isocaloric diets in random order during each of two inpatient stays. Body fat loss was calculated as the difference between daily fat intake and net fat oxidation measured while residing in a metabolic chamber. Whereas carbohydrate restriction led to sustained increases in fat oxidation and loss of 53 ± 6 g/day of body fat, fat oxidation was unchanged by fat restriction, leading to 89 ± 6 g/day of fat loss, and was significantly greater than carbohydrate restriction (p = 0.002). Mathematical model simulations agreed with these data, but predicted that the body acts to minimize body fat differences with prolonged isocaloric diets varying in carbohydrate and fat.
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Affiliation(s)
- Kevin D Hall
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Thomas Bemis
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Robert Brychta
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Kong Y Chen
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Amber Courville
- Clinical Center Nutrition Department, National Institutes of Health, Bethesda, MD 20892, USA
| | - Emma J Crayner
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Stephanie Goodwin
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Juen Guo
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Lilian Howard
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | | | - Bernard V Miller
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | | | - Mario Siervo
- Newcastle University, Newcastle upon Tyne NE4 5PL, UK
| | - Monica C Skarulis
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Mary Walter
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Peter J Walter
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Laura Yannai
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
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Ferrannini G, Hach T, Crowe S, Sanghvi A, Hall KD, Ferrannini E. Energy Balance After Sodium-Glucose Cotransporter 2 Inhibition. Diabetes Care 2015; 38:1730-5. [PMID: 26180105 PMCID: PMC4542276 DOI: 10.2337/dc15-0355] [Citation(s) in RCA: 246] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 06/12/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Sodium-glucose cotransporter 2 (SGLT2) inhibitors cause substantially less weight loss than expected from the energy excreted via glycosuria. Our aim was to analyze this phenomenon quantitatively. RESEARCH DESIGN AND METHODS Eighty-six patients with type 2 diabetes (HbA1c 7.8 ± 0.8% [62 ± 9 mmol/mol], estimated glomerular filtration rate [eGFR] 89 ± 19 mL ⋅ min(-1) ⋅ 1.73 m(-2)) received empagliflozin (25 mg/day) for 90 weeks with frequent (n = 11) assessments of body weight, eGFR, and fasting plasma glucose (FPG). Time-dependent glucose filtration was calculated as the product of eGFR and FPG; time-dependent glycosuria was estimated from previous direct measurements. The relation of calorie-to-weight changes was estimated using a mathematical model of human energy metabolism that simulates the time course of weight change for a given change in calorie balance and calculates the corresponding energy intake changes. RESULTS At week 90, weight loss averaged -3.2 ± 4.2 kg (corresponding to a median calorie deficit of 51 kcal/day [interquartile range (IQR) 112]). However, the observed calorie loss through glycosuria (206 kcal/day [IQR 90]) was predicted to result in a weight loss of -11.3 ± 3.1 kg, assuming no compensatory changes in energy intake. Thus, patients lost only 29 ± 41% of the weight loss predicted by their glycosuria; the model indicated that this difference was accounted for by a 13% (IQR 12) increase in calorie intake (269 kcal/day [IQR 258]) coupled with a 2% (IQR 5) increase in daily energy expenditure (due to diet-induced thermogenesis). This increased calorie intake was inversely related to baseline BMI (partial r = -0.34, P < 0.01) and positively to baseline eGFR (partial r = 0.29, P < 0.01). CONCLUSIONS Chronic glycosuria elicits an adaptive increase in energy intake. Combining SGLT2 inhibition with caloric restriction is expected to be associated with major weight loss.
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Affiliation(s)
| | - Thomas Hach
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - Susanne Crowe
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - Arjun Sanghvi
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Kevin D Hall
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
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84
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Sanghvi A, Redman LM, Martin CK, Ravussin E, Hall KD. Validation of an inexpensive and accurate mathematical method to measure long-term changes in free-living energy intake. Am J Clin Nutr 2015; 102:353-8. [PMID: 26040640 PMCID: PMC4515869 DOI: 10.3945/ajcn.115.111070] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 05/12/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Accurate measurement of free-living energy intake (EI) over long periods is imperative for understanding obesity and its treatment. Unfortunately, traditional methods rely on self-report and are notoriously inaccurate. Although EI can be indirectly estimated by the intake-balance method, this technique is prohibitively labor-intensive and expensive, requiring repeated measures of energy expenditure via doubly labeled water (DLW) along with multiple dual-energy X-ray absorptiometry (DXA) scans to measure changes in body energy stores. OBJECTIVE Our objective was to validate a mathematical method to measure long-term changes in free-living energy intake. DESIGN We measured body weight and EI changes (ΔEI) over 4 time intervals by using the intake-balance method in 140 individuals who underwent 2 y of caloric restriction as part of the Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy study. We compared the ΔEI values calculated by using DLW/DXA with those obtained by using a mathematical model of human metabolism whose only inputs were the initial demographic information and repeated body weight data. RESULTS The mean ΔEI values calculated by the model were within 40 kcal/d of the DLW/DXA method throughout the 2-y study. For individual subjects, the overall root mean square deviation between the model and DLW/DXA method was 215 kcal/d, and most of the model-calculated ΔEI values were within 132 kcal/d of the DLW/DXA method. CONCLUSIONS Accurate and inexpensive estimates of ΔEI that are comparable to the DLW/DXA method can be obtained by using a mathematical model and repeated body weight measurements.
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Affiliation(s)
- Arjun Sanghvi
- National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD; and
| | | | | | - Eric Ravussin
- Pennington Biomedical Research Center, Baton Rouge, LA
| | - Kevin D Hall
- National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD; and
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85
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Vandevijvere S, Chow CC, Hall KD, Umali E, Swinburn BA. Increased food energy supply as a major driver of the obesity epidemic: a global analysis. Bull World Health Organ 2015; 93:446-56. [PMID: 26170502 PMCID: PMC4490816 DOI: 10.2471/blt.14.150565] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 02/12/2015] [Accepted: 02/16/2015] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE We investigated associations between changes in national food energy supply and in average population body weight. METHODS We collected data from 24 high-, 27 middle- and 18 low-income countries on the average measured body weight from global databases, national health and nutrition survey reports and peer-reviewed papers. Changes in average body weight were derived from study pairs that were at least four years apart (various years, 1971-2010). Selected study pairs were considered to be representative of an adolescent or adult population, at national or subnational scale. Food energy supply data were retrieved from the Food and Agriculture Organization of the United Nations food balance sheets. We estimated the population energy requirements at survey time points using Institute of Medicine equations. Finally, we estimated the change in energy intake that could theoretically account for the observed change in average body weight using an experimentally-validated model. FINDINGS In 56 countries, an increase in food energy supply was associated with an increase in average body weight. In 45 countries, the increase in food energy supply was higher than the model-predicted increase in energy intake. The association between change in food energy supply and change in body weight was statistically significant overall and for high-income countries (P < 0.001). CONCLUSION The findings suggest that increases in food energy supply are sufficient to explain increases in average population body weight, especially in high-income countries. Policy efforts are needed to improve the healthiness of food systems and environments to reduce global obesity.
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Affiliation(s)
- Stefanie Vandevijvere
- School of Population Health, University of Auckland, 261 Morrin Road, Auckland, New Zealand
| | - Carson C Chow
- Laboratory of Biological Modeling, National Institutes of Health, Bethesda, United States of America
| | - Kevin D Hall
- Laboratory of Biological Modeling, National Institutes of Health, Bethesda, United States of America
| | - Elaine Umali
- School of Population Health, University of Auckland, 261 Morrin Road, Auckland, New Zealand
| | - Boyd A Swinburn
- School of Population Health, University of Auckland, 261 Morrin Road, Auckland, New Zealand
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86
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Abstract
The prevalence of childhood overweight and obesity has risen substantially worldwide in less than one generation. In the USA, the average weight of a child has risen by more than 5 kg within three decades, to a point where a third of the country's children are overweight or obese. Some low-income and middle-income countries have reported similar or more rapid rises in child obesity, despite continuing high levels of undernutrition. Nutrition policies to tackle child obesity need to promote healthy growth and household nutrition security and protect children from inducements to be inactive or to overconsume foods of poor nutritional quality. The promotion of energy-rich and nutrient-poor products will encourage rapid weight gain in early childhood and exacerbate risk factors for chronic disease in all children, especially those showing poor linear growth. Whereas much public health effort has been expended to restrict the adverse marketing of breastmilk substitutes, similar effort now needs to be expanded and strengthened to protect older children from increasingly sophisticated marketing of sedentary activities and energy-dense, nutrient-poor foods and beverages. To meet this challenge, the governance of food supply and food markets should be improved and commercial activities subordinated to protect and promote children's health.
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Affiliation(s)
- Tim Lobstein
- World Obesity Federation (formerly the International Association for the Study of Obesity), London, UK.
| | - Rachel Jackson-Leach
- World Obesity Federation (formerly the International Association for the Study of Obesity), London, UK
| | - Marjory L Moodie
- Deakin Health Economics, Deakin University, Melbourne, VIC, Australia
| | - Kevin D Hall
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Steven L Gortmaker
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA
| | - Boyd A Swinburn
- WHO Collaborating Centre for Obesity Prevention Deakin University, Melbourne, VIC, Australia; School of Population Health, University of Auckland, New Zealand
| | - W Philip T James
- World Obesity Federation (formerly the International Association for the Study of Obesity), London, UK
| | - Youfa Wang
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York, NY, USA
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87
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MacLean PS, Wing RR, Davidson T, Epstein L, Goodpaster B, Hall KD, Levin BE, Perri MG, Rolls BJ, Rosenbaum M, Rothman AJ, Ryan D. NIH working group report: Innovative research to improve maintenance of weight loss. Obesity (Silver Spring) 2015; 23:7-15. [PMID: 25469998 PMCID: PMC5841916 DOI: 10.1002/oby.20967] [Citation(s) in RCA: 365] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 10/21/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The National Institutes of Health, led by the National Heart, Lung, and Blood Institute, organized a working group of experts to discuss the problem of weight regain after weight loss. A number of experts in integrative physiology and behavioral psychology were convened with the goal of merging their perspectives regarding the barriers to scientific progress and the development of novel ways to improve long-term outcomes in obesity therapeutics. The specific objectives of this working group were to: (1) identify the challenges that make maintaining a reduced weight so difficult; (2) review strategies that have been used to improve success in previous studies; and (3) recommend novel solutions that could be examined in future studies of long-term weight control. RESULTS Specific barriers to successful weight loss maintenance include poor adherence to behavioral regimens and physiological adaptations that promote weight regain. A better understanding of how these behavioral and physiological barriers are related, how they vary between individuals, and how they can be overcome will lead to the development of novel strategies with improved outcomes. CONCLUSIONS Greater collaboration and cross-talk between physiological and behavioral researchers is needed to advance the science and develop better strategies for weight loss maintenance.
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Affiliation(s)
- Paul S. MacLean
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Rena R. Wing
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Terry Davidson
- Department of Psychology, American University, Washington, DC, USA
| | - Leonard Epstein
- Department of Pediatrics, University of Buffalo, Buffalo, New York, USA
| | - Bret Goodpaster
- Florida Hospital Translational Institute for Metabolism and Diabetes and Sanford Burnham Medical Research Institute, Orlando, Florida, USA
| | - Kevin D. Hall
- Laboratory of Biological Modeling, Integrative Physiology Section, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Barry E. Levin
- Department of Neurology and Neurosciences, Rutgers-New Jersey Medical School, Neurology Service, East Orange VA Medical Center, East Orange, New Jersey, USA
| | - Michael G. Perri
- College of Public Health and Health Professions, Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Barbara J. Rolls
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Michael Rosenbaum
- Department of Pediatrics, Columbia University, New York, New York, USA
| | | | - Donna Ryan
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
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88
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Knuth ND, Johannsen DL, Tamboli RA, Marks-Shulman PA, Huizenga R, Chen KY, Abumrad NN, Ravussin E, Hall KD. Metabolic adaptation following massive weight loss is related to the degree of energy imbalance and changes in circulating leptin. Obesity (Silver Spring) 2014; 22:2563-9. [PMID: 25236175 PMCID: PMC4236233 DOI: 10.1002/oby.20900] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 08/20/2014] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To measure changes in resting metabolic rate (RMR) and body composition in obese subjects following massive weight loss achieved via bariatric surgery or calorie restriction plus vigorous exercise. METHODS Body composition and RMR were measured in 13 pairs of obese subjects retrospectively matched for sex, body mass index, weight, and age who underwent either Roux-en-Y gastric bypass surgery (RYGB) or participated in "The Biggest Loser" weight loss competition (BLC). RESULTS Both groups had similar final weight loss (RYGB: 40.2 ± 12.7 kg, BLC: 48.8 ± 14.9 kg; P = 0.14); however, RYGB lost a larger proportion of their weight as fat-free mass (FFM) (RYGB: 30 ± 12%, BLC: 16 ± 8% [P < 0.01]). In both groups, RMR decreased significantly more than expected based on measured body composition changes. The magnitude of this metabolic adaptation was correlated with the degree of energy imbalance (r = 0.55, P = 0.004) and the decrease in circulating leptin (r = 0.47, P = 0.02). CONCLUSIONS Calorie restriction along with vigorous exercise in BLC participants resulted in preservation of FFM and greater metabolic adaption compared to RYGB subjects despite comparable weight loss. Metabolic adaptation was related to the degree of energy imbalance and the changes in circulating leptin.
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Affiliation(s)
- Nicolas D. Knuth
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892
| | | | | | | | | | - Kong Y. Chen
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892
| | - Naji N. Abumrad
- Vanderbilt University School of Medicine, Nashville, TN, 37232
| | - Eric Ravussin
- Pennington Biomedical Research Center, Baton Rouge, LA 70808
| | - Kevin D. Hall
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892
- To whom correspondence should be addressed: Kevin D. Hall, Ph.D., National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, 12A South Drive, Room 4007, Bethesda, MD 20892,
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89
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Brown AW, Hall KD, Thomas D, Dhurandhar NV, Heymsfield SB, Allison DB. Order of magnitude misestimation of weight effects of children's meal policy proposals. Child Obes 2014; 10:542-4. [PMID: 25496036 PMCID: PMC4442575 DOI: 10.1089/chi.2014.0081] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Andrew W. Brown
- Office of Energetics, Nutrition and Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL
| | - Kevin D. Hall
- Laboratory of Biological Modeling, National Institute of Diabetes and Digestive and Kidney Diseases/National Institutes of Health, Bethesda, MD
| | - Diana Thomas
- Center for Quantitative Obesity Research, Montclair State University, Montclair, NJ
| | - Nikhil V. Dhurandhar
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA
| | - Steven B. Heymsfield
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA
| | - David B. Allison
- Office of Energetics, Nutrition Obesity Research Center, and Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL
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90
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Abstract
OBJECTIVE Despite the fact that most obesity drugs primarily work by reducing metabolizable energy intake, elucidation of the time course of energy intake changes during long-term obesity pharmacotherapy has been prevented by the limitations of self-report methods of measuring energy intake. METHODS A validated mathematical model of human metabolism was used to provide the first quantification of metabolizable energy intake changes during long-term obesity pharmacotherapy using body weight data from randomized, placebo-controlled trials that evaluated 14 different drugs or drug combinations. RESULTS Changes in metabolizable energy intake during obesity pharmacotherapy were reasonably well-described by an exponential pattern comprising three simple parameters, with early large changes in metabolizable energy intake followed by a slow transition to a smaller persistent drug effect. CONCLUSIONS Repeated body weight measurements along with a mathematical model of human metabolism can be used to quantify changes in metabolizable energy intake during obesity pharmacotherapy. The calculated metabolizable energy intake changes followed an exponential time course, and therefore different drugs can be evaluated and compared using a common mathematical framework.
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Affiliation(s)
- Britta Göbel
- Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
| | - Arjun Sanghvi
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Kevin D. Hall
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
- To whom correspondence should be addressed: Kevin D. Hall, Ph.D., National Institute of Diabetes & Digestive & Kidney Diseases, 12A South Drive, Room 4007, Bethesda, MD 20892, , Phone: 301-402-8248, Fax: 301-402-0535
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91
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Abstract
There is limited insight into the mechanisms, progression, and related comorbidities of obesity through simple modeling tools such as linear regression. Keeping in mind the words of the late George E. P. Box that “all models are wrong, some are useful,” this symposium presented 4 useful mathematical models or methodologic refinements. Presenters placed specific emphasis on how these novel models and methodologies can be applied to further our knowledge of the etiology of obesity.
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Affiliation(s)
- John A. Dawson
- Department of Biostatistics, Section on Statistical Genetics and Office of Energetics, University of Alabama at Birmingham, Birmingham, AL,To whom correspondence should be addressed. E-mail:
| | - Kevin D. Hall
- Laboratory of Biological Modeling, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD
| | - Diana M. Thomas
- Department of Mathematical Sciences, Montclair State University, Montclair, NJ
| | - James W. Hardin
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC
| | - David B. Allison
- Office of Energetics and Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL; and
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92
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Brady I, Hall KD. Dispatch from the field: is mathematical modeling applicable to obesity treatment in the real world? Obesity (Silver Spring) 2014; 22:1939-41. [PMID: 24895253 PMCID: PMC4149602 DOI: 10.1002/oby.20804] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 05/18/2014] [Indexed: 11/10/2022]
Abstract
Mathematical models of human weight dynamics have been validated in research settings, but are they applicable in the real world of clinical obesity treatment? We compared model calculations to weight loss data from 49 patients in a medically-supervised, outpatient weight loss program. A range of expected weight losses was defined for each patient based on uncertainties in their baseline energy requirements and physical activity changes. Assuming that energy intake was within the prescribed range, the observed and model-calculated weight losses were highly correlated (r=0.9, p<0.0001) and the mean calculated loss of 14.0±9.1 kg (mean±SD) achieved over 13.2±9.4 weeks was not significantly different from the data (13.2±8.9 kg; p=0.14). However, the model identified 14 patients whose weight losses were less than expected, suggesting the possibility of non-compliance. Therefore, mathematical models can be clinically useful tools for prospective goal-setting and assessment of compliance, both of which are important considerations for treating obesity.
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Affiliation(s)
| | - Kevin D. Hall
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
- To whom correspondence should be addressed: Kevin D. Hall, Ph.D., National Institute of Diabetes & Digestive & Kidney Diseases, 12A South Drive, Room 4007, Bethesda, MD 20892, , Phone: 301-402-8248, Fax: 301-402-0535
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93
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Affiliation(s)
- Kevin D Hall
- From the National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD.
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94
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Müller MJ, Baracos V, Bosy-Westphal A, Dulloo AG, Eckel J, Fearon KCH, Hall KD, Pietrobelli A, Sørensen TIA, Speakman J, Trayhurn P, Visser M, Heymsfield SB. Functional body composition and related aspects in research on obesity and cachexia: report on the 12th Stock Conference held on 6 and 7 September 2013 in Hamburg, Germany. Obes Rev 2014; 15:640-56. [PMID: 24835453 PMCID: PMC4107095 DOI: 10.1111/obr.12187] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 04/04/2014] [Indexed: 12/24/2022]
Abstract
The 12th Stock Conference addressed body composition and related functions in two extreme situations, obesity and cancer cachexia. The concept of 'functional body composition' integrates body components into regulatory systems relating the mass of organs and tissues to corresponding in vivo functions and metabolic processes. This concept adds to an understanding of organ/tissue mass and function in the context of metabolic adaptations to weight change and disease. During weight gain and loss, there are associated changes in individual body components while the relationships between organ and tissue mass are fixed. Thus an understanding of body weight regulation involves an examination of the relationships between organs and tissues rather than individual organ and tissue masses only. The between organ/tissue mass relationships are associated with and explained by crosstalks between organs and tissues mediated by cytokines, hormones and metabolites that are coupled with changes in body weight, composition and function as observed in obesity and cancer cachexia. In addition to established roles in intermediary metabolism, cell function and inflammation, organ-tissue crosstalk mediators are determinants of body composition and its change with weight gain and loss. The 12th Stock Conference supported Michael Stocks' concept of gaining new insights by integrating research ideas from obesity and cancer cachexia. The conference presentations provide an in-depth understanding of body composition and metabolism.
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Affiliation(s)
- M J Müller
- Institute of Human Nutrition and Food Sciences, Christian-Albrechts-University, Kiel, Germany
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95
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Hall KD, Hammond RA, Rahmandad H. Dynamic interplay among homeostatic, hedonic, and cognitive feedback circuits regulating body weight. Am J Public Health 2014; 104:1169-75. [PMID: 24832422 DOI: 10.2105/ajph.2014.301931] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Obesity is associated with a prolonged imbalance between energy intake and expenditure, both of which are regulated by multiple feedback processes within and across individuals. These processes constitute 3 hierarchical control systems-homeostatic, hedonic, and cognitive-with extensive interaction among them. Understanding complex eating behavior requires consideration of all 3 systems and their interactions. Existing models of these processes are widely scattered, with relatively few attempts to integrate across mechanisms. We briefly review available empirical evidence and dynamic models, discussing challenges and potential for better integration. We conclude that developing richer models of dynamic interplay among systems should be a priority in the future study of obesity and that systems science modeling offers the potential to aid in this goal.
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Affiliation(s)
- Kevin D Hall
- Kevin D. Hall is with the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD. Ross A. Hammond is with the Brookings Institution, Washington, DC. Hazhir Rahmandad is with the Department of Industrial and Systems Engineering at Virginia Tech, Falls Church, VA
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96
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Chow CC, Hall KD. Short and long-term energy intake patterns and their implications for human body weight regulation. Physiol Behav 2014; 134:60-5. [PMID: 24582679 DOI: 10.1016/j.physbeh.2014.02.044] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 02/17/2014] [Accepted: 02/18/2014] [Indexed: 11/17/2022]
Abstract
Adults consume millions of kilocalories over the course of a few years, but the typical weight gain amounts to only a few thousand kilocalories of stored energy. Furthermore, food intake is highly variable from day to day and yet body weight is remarkably stable. These facts have been used as evidence to support the hypothesis that human body weight is regulated by active control of food intake operating on both short and long time scales. Here, we demonstrate that active control of human food intake on short time scales is not required for body weight stability and that the current evidence for long term control of food intake is equivocal. To provide more data on this issue, we emphasize the urgent need for developing new methods for accurately measuring energy intake changes over long time scales. We propose that repeated body weight measurements can be used along with mathematical modeling to calculate long-term changes in energy intake and thereby quantify adherence to a diet intervention and provide dynamic feedback to individuals that seek to control their body weight.
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Affiliation(s)
- Carson C Chow
- Laboratory of Biological Modeling, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, United States
| | - Kevin D Hall
- Laboratory of Biological Modeling, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, United States.
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97
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Abstract
BACKGROUND Clinicians and policy makers need the ability to predict quantitatively how childhood bodyweight will respond to obesity interventions. METHODS We developed and validated a mathematical model of childhood energy balance that accounts for healthy growth and development of obesity, and that makes quantitative predictions about weight-management interventions. The model was calibrated to reference body composition data in healthy children and validated by comparing model predictions with data other than those used to build the model. FINDINGS The model accurately simulated the changes in body composition and energy expenditure reported in reference data during healthy growth, and predicted increases in energy intake from ages 5-18 years of roughly 1200 kcal per day in boys and 900 kcal per day in girls. Development of childhood obesity necessitated a substantially greater excess energy intake than for development of adult obesity. Furthermore, excess energy intake in overweight and obese children calculated by the model greatly exceeded the typical energy balance calculated on the basis of growth charts. At the population level, the excess weight of US children in 2003-06 was associated with a mean increase in energy intake of roughly 200 kcal per day per child compared with similar children in 1971-74 [corrected]. The model also suggests that therapeutic windows when children can outgrow obesity without losing weight might exist, especially during periods of high growth potential in boys who are not severely obese. INTERPRETATION This model quantifies the energy excess underlying obesity and calculates the necessary intervention magnitude to achieve bodyweight change in children. Policy makers and clinicians now have a quantitative technique for understanding the childhood obesity epidemic and planning interventions to control it. FUNDING Intramural Research Program of the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.
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98
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Simmons WK, Rapuano KM, Kallman SJ, Ingeholm JE, Miller B, Gotts SJ, Avery JA, Hall KD, Martin A. Category-specific integration of homeostatic signals in caudal but not rostral human insula. Nat Neurosci 2013; 16:1551-2. [PMID: 24077565 PMCID: PMC3835665 DOI: 10.1038/nn.3535] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 09/05/2013] [Indexed: 11/30/2022]
Abstract
Prevailing theories hold that the insula is functionally organized along its caudal-to-rostral axis, with posterior regions coding lower-level sensory information, and anterior regions coding higher-level stimulus significance relative to the body’s homeostatic needs. Contrary to predictions of this model, the response of the taste-sensitive region of the caudal, but not rostral, insula to food images was directly related to the body’s homeostatic state as indexed by levels of peripheral glucose.
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Affiliation(s)
- W Kyle Simmons
- 1] Laureate Institute for Brain Research, Tulsa, Oklahoma, USA. [2] Faculty of Community Medicine, The University of Tulsa, Tulsa, Oklahoma, USA. [3] Laboratory of Brain and Cognition, National Institute of Mental Health (NIHM), National Institutes of Health (NIH), Bethesda, Maryland, USA
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99
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Affiliation(s)
- K D Hall
- National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
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100
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Schoeller DA, Thomas D, Archer E, Heymsfield SB, Blair SN, Goran MI, Hill JO, Atkinson RL, Corkey BE, Foreyt J, Dhurandhar NV, Kral JG, Hall KD, Hansen BC, Heitmann BL, Ravussin E, Allison DB. Self-report-based estimates of energy intake offer an inadequate basis for scientific conclusions. Am J Clin Nutr 2013; 97:1413-5. [PMID: 23689494 PMCID: PMC6546220 DOI: 10.3945/ajcn.113.062125] [Citation(s) in RCA: 134] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Dale A Schoeller
- Department of Nutritional Sciences University of Wisconsin-Madison Madison,
WI
| | - Diana Thomas
- Department of Mathematical Sciences Montclair State University Montclair,
NJ
| | - Edward Archer
- Department of Exercise Science University of South Carolina Columbia,
SC
| | | | - Steven N Blair
- Arnold School of Public Health University of South Carolina Columbia,
SC
| | - Michael I Goran
- University of Southern California (USC) Diabetes and Obesity Research
Institute Department of Preventive Medicine USC Keck School of Medicine Los Angeles,
CA
| | - James O Hill
- Anschutz Health and Wellness Center University of Colorado Aurora, CO
| | | | - Barbara E Corkey
- Obesity Research Center Department of Medicine Boston University School of
Medicine Boston, MA
| | | | - Nikhil V Dhurandhar
- Infection and Obesity Laboratory Pennington Biomedical Research Center
Baton Rouge, LA
| | - John G Kral
- Department of Surgery SUNY Downstate Medical Center New York, NY
| | - Kevin D Hall
- Laboratory of Biological Modeling National Institute of Diabetes and
Digestive and Kidney Diseases National Institutes of Health Bethesda, MD
| | - Barbara C Hansen
- Department of Internal Medicine College of Medicine University of South
Florida Tampa, FL
| | - Berit Lilienthal Heitmann
- Institute of Preventive Medicine Research Unit for Dietary Studies
Frederiksberg Hospital Frederiksberg Denmark
| | - Eric Ravussin
- Pennington Biomedical Research Center Louisiana State University System
Baton Rouge, LA
| | - David B Allison
- Nutrition Obesity Research Center University of Alabama at Birmingham 1665
University Boulevard University of Alabama at Birmingham Birmingham, AL 35294-0022
- Nutrition Obesity Research Center University of Alabama at Birmingham
1665 University Boulevard University of Alabama at Birmingham Birmingham, AL 35294-0022
E-mail:
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