Dietary fiber and weight regulation

Effect of two doses of a mixture of soluble fibres on body weight and metabolic variables in overweight or obese patients: a randomised trial

The aim of the study was to compare the effect of the administration of a mixture of fibres on body weight-loss, satiety, lipid profile and glucose metabolism. We included 200 overweight or obese patients in a parallel, double-blind, placebo-controlled clinical trial, who were randomised to receive, in the context of an energy-restricted diet for a period of 16 weeks, a mixed fibre dose (3 g Plantago ovata husk and 1 g glucomannan) twice (b.i.d. group) or three times daily (t.i.d. group) or placebo. Weight change was the primary efficacy endpoint. Satiety, dietary compliance, lipid profile, glucose tolerance, insulin resistance and high-sensitivity C-reactive protein were secondary endpoints. Weight loss tended to be higher after both doses of fibre (-4.52 (SD 0.56) and -4.60 (SD 0.55) kg) than placebo (-0.79 (SD 0.58) kg); the differences in changes between groups were not statistically significant. Postprandial satiety increased in both fibre groups compared to the placebo. The differences between groups in LDL-cholesterol levels were significant (P = 0.03), with greater reductions in the two fibre-supplemented groups (-0.38 (SD 0.10) and -0.24 (SD 0.09) mmol/l in the b.i.d. and t.i.d. groups v. -0.06 (SD 0.09) mmol/l in placebo group). A similar pattern was observed for changes in total cholesterol:HDL-cholesterol and HDL-cholesterol:LDL-cholesterol ratios. Interventions were well tolerated and had no effects on HDL-cholesterol, glucose and insulin concentrations, glucose tolerance or high-sensitivity C-reactive protein. In conclusion, a 16-week dietary supplement of soluble fibre in overweight or obese patients was well tolerated, induced satiety and had beneficial effects on some CVD risk factors, the most important of which was a significant decrease in plasma LDL-cholesterol concentrations.

Whole-grain intake as a marker of healthy body weight and adiposity

OBJECTIVE

To review evidence relating to the consumption of whole grains and healthy body weight (BW).

DESIGN

Systematic review and analysis of observational studies reporting whole-grain consumption and measures of BW and adiposity, including the effect on macronutrient intakes and lifestyle factors.

SETTING

Medline and other databases were searched for the period 1990 to 2006 to produce a full reference list; observational studies were retained for further analysis if they included an appropriate control group and reported whole-grain intake and body mass index (BMI) or a measure of adiposity.

SUBJECTS

Fifteen trials were identified which included data from 119 829 male and female subjects aged 13 years and over.

RESULTS

The combined and weighted mean difference in BMI from 15 studies representing 20 treatment groups (n = 119 829) using a random-effects model was 0.630 kg/m2 lower when high versus low whole-grain intake was compared, P < 0.0001 (95 % confidence interval (CI) 0.460, 0.800 kg/m2). In high consumers, adiposity assessed as waist circumference was reduced by 2.7 (95 % CI 0.2, 5.2) cm, P = 0.03 (six data sets, n = 4178) or as waist:hip ratio by 0.023 (95 % CI 0.016, 0.030), P < 0.0001 (four data sets, n = 20 147). Higher intake of whole grains led to increased dietary fibre intake (9 g, P < 0.01), while total and saturated fat intakes decreased by 11 g and 3.9 g, respectively.

CONCLUSION

A higher intake of whole grains (about three servings per day) was associated with lower BMI and central adiposity. In addition, people who consume more whole grains are likely to have a healthier lifestyle as fewer of them smoke, they exercise more frequently and they tend to have lower fat and higher fibre intakes.

Stellenwert der Ernährung bei Adipositas

The goal of good concepts for treating obesity is to achieve sustained changes in lifestyle. Formula diets are in fact superior to hypocaloric diets, but the results of diet only approaches are consistently disappointing. Formula diets or very low calorie diets should thus be undertaken in conjunction with an overall therapeutic concept under a physician's supervision together with psychological and nutritional education as well as guidance in exercise therapy. These treatment strategies can be carried out successfully in the outpatient setting. On a long-term basis, reducing the costs of health care will only be feasible by implementing prevention programs during childhood and adolescence. Preventive measures focusing on nutrition should lay the foundation in kindergartens and schools to control the epidemic-like spread of obesity.

Insoluble cereal fiber reduces appetite and short-term food intake and glycemic response to food consumed 75 min later by healthy men

BACKGROUND

Insoluble fiber consumption is associated with reduced risk of obesity and diabetes, but its mechanisms of action are unknown.

OBJECTIVE

The objective was to describe the effect of insoluble fiber on appetite, short-term food intake, and blood glucose (BG) before and after a meal 75 min later in healthy men.

DESIGN

In a crossover design, high-fiber (HF; 33 g insoluble fiber) cereal, low-fiber (LF) cereal, white bread (WB), and water control were administered to young men after an overnight fast. Caloric treatments had similar energy, macronutrient content, volume, and weight. In the first experiment, subjective appetite and BG were measured at 15-min intervals before and after an ad libitum meal at 75 min. In the second experiment, a preset pizza meal (850 kcal) was consumed at 75 min. Appetite and blood glucose were measured for 150 min at fasting and at 15-min intervals before and after the fixed meal.

RESULTS

In experiment 1, ad libitum food intake was lower after the HF cereal and WB than after the LF cereal and water (937 +/- 86, 970 +/- 65, 1109 +/- 90, 1224 +/- 89 kcal, respectively; P < 0.001). Appetite was lower (P < 0.05) after the HF cereal than after the WB but not different from the LF cereal. The BG area under the curve (AUC) did not differ among the HF cereal, WB, and LF cereal from 0 to 75 min, but the postmeal BG increased after the WB and LF cereal but not after the HF cereal. In experiment 2, the HF cereal, but not the LF cereal or WB, increased fullness before and prevented an increase in the BG AUC after the preset meal (P < 0.05).

CONCLUSION

A serving of 33 g insoluble fiber reduced appetite, lowered food intake, and reduced glycemic response to a meal consumed 75 min later.

Whole grains and adiposity: little association among British adults

OBJECTIVES

To examine associations of whole-grain intake with body weight and adiposity in two nationally representative samples of British adults.

SUBJECTS/METHODS

A total of 2064 adults aged 16-64 years in 1986-1987, 1599 adults aged 19-64 years in 2000-2001. Whole-grain intake (g day(-1) and 16-g amounts) was estimated from consumption of all foods with >or=10, >or=25 or >or=51% whole-grain content, using 7-day weighed dietary records. Body weight, body mass index (BMI) and, in 2000-2001, waist circumference (WC) were measured. BMI and WC were considered as continuous and categorical variables. For each survey, associations of whole-grain intake with body weight and anthropometric indices were examined in men and women separately, before and after adjustment for age, occupational social class, smoking habit, region, season and, in 2000-2001, misreporting.

RESULTS

In 1986-1987, whole-grain intake was inversely associated with percentage of men classified using BMI as obese (P=0.008, trend), independent of other factors. However, intake was not associated with body weight or prevalence of overweight. No corresponding associations were observed among women. In 2000-2001, whole-grain intake was not associated with body weight, BMI or WC.

CONCLUSIONS

Two national surveys of British adults, with detailed quantitative estimates of whole-grain intake, provide little evidence of an association of whole-grain intake with body weight or measures of adiposity.

Predictors of weight loss in low-income mothers of young children

OBJECTIVE

To identify predictors of weight loss in a tri-ethnic population of low-income mothers.

DESIGN

An 8-week dietary and physical activity program was tested. Demographic data were collected at baseline; anthropometric, dietary, physical activity, and psychosocial data were measured at baseline and week 8.

SUBJECTS/SETTING

A convenience sample of 114 Hispanic, African-American, and white, low-income mothers with a body mass index > or = 25 (calculated as kg/m2) participated in the intervention.

INTERVENTION

Weight-loss classes that incorporated nutrition, physical activity, and behavior modification were administered for 8 weeks.

MAIN OUTCOME MEASURES

Anthropometry (body weight, weight loss).

STATISTICAL ANALYSES PERFORMED

Analysis of variance, chi2 tests, and Spearman and Pearson correlations were used to test for associations between baseline and change data and total weight loss. Hierarchical regression was employed to assess the marginal importance of factors beyond socioeconomic influences.

RESULTS

Correlates of weight loss included less satisfaction with appearance (r=0.24), greater percentage of energy from protein (r=-0.22), enhanced nutrition knowledge (r=-0.23), and higher scores for benefits of weight loss (r =-0.20) at baseline; and the change in healthful eating attitudes (r=-0.28) and social support (r=-0.21) at 8 weeks. The predictive models of baseline and change variables represented 11.4% and 13.8% of the variance, respectively.

CONCLUSIONS

Weight-management programs serving low-income mothers should provide techniques to enhance social support, attitudes toward healthful eating, benefits of weight loss, and nutrition knowledge.

Effect of adding exercise to a diet containing glucomannan

The aim of this study was to examine the effect of adding a total-body exercise program to an 8-week diet supplemented with glucomannan on weight loss, body composition, blood parameters, and physical performance in overweight men and women. Sedentary men and women who were overweight (body mass index>25 kg m(-2)) (men: 18-57 years, 27.0+/-11.2 years, 177.5+/-7.6 cm, 102.4+/-14.9 kg; women: 18-52 years, 33.4+/-12.1 years, 160.6+/-4.6 cm, 79.9+/-9.3 kg) completed an 8-week diet with 3000 mg glucomannan combined with either no exercise (No-Ex) (10 men, 10 women) or a resistance and endurance exercise training program (Ex) (12 men, 10 women). The diet emphasized healthy food choices and portion size control. The exercise training consisted of 3 weekly sessions of approximately 1 hour of a nonlinear periodized total-body resistance exercise program followed by 30 minutes of endurance exercise. After the intervention, there were reductions (P<.05) in body mass (men, -2.7+/-1.4 and -3.0+/-4.0 kg; women, -2.2+/-1.5 and -3.3+/-1.5 kg; No-Ex and Ex, respectively), fat mass (men, -2.3+/-1.6 and -3.9+/-2.5 kg; women, -2.6+/-1.4 and -3.6+/-1.1 kg; No-Ex and Ex, respectively), total cholesterol (TC) (men, -17.9+/-21.5 and -18.8+/-19.4 mg dL(-1); women, -9.3+/-20.0 and -10.1+/-19.5 mg dL(-1); No-Ex and Ex, respectively), and low-density lipoprotein cholesterol. Exercise significantly improved high-density lipoprotein cholesterol (HDL-C) (No-Ex, -2.0+/-4.7 and -2.3+/-4.5 mg dL(-1) vs Ex, 4.4+/-10.8 and 1.6+/-3.6 mg dL(-1); men and women, respectively), TC/HDL-C ratio, squat and bench press 1-repetition maximum, and distance covered during a shuttle-run test. In addition, exercise appeared to augment the reduction in fat mass (by 63% and 50%; men and women, respectively) and waist circumference, but did not affect total weight loss. Addition of a resistance and endurance exercise training program to a glucomannan diet regimen significantly improved measures of body composition, HDL-C, and TC/HDL-C ratio.

Beneficial effects of a 5-week low-glycaemic index regimen on weight control and cardiovascular risk factors in overweight non-diabetic subjects

The glycaemic index (GI) has been developed in order to classify food according to the postprandial glycaemic response. This parameter is of interest, especially for people prone to glucose intolerance; however, the effects of a low-GI (LGI) diet on body weight, carbohydrate and lipid metabolism remain controversial. We studied the effects of either a LGI or high-GI (HGI) diet on weight control and cardiovascular risk factors in overweight, non-diabetic subjects. The study was a randomized 5-week intervention trial. The thirty-eight subjects (BMI 27.3 (sem 0.2) kg/m2) followed an intervention diet in which usual starch was replaced ad libitum with either LGI or HGI starch. Mean body weight decrease was significant in the LGI group ( - 1.1 (sEM 0.3) kg, P = 0.004) and was significantly greater than in the HGI group ( - 0.3 (sEM 0.2) kg, P = 0.04 between groups). Hunger sensation scales showed a trend towards a decrease in hunger sensation before lunch and dinner in the LGI group when compared with the HGI group (P = 0.09). No significant increase in insulin sensitivity was noticed. The LGI diet also decreased total cholesterol by 9.6 % (P < 0.001), LDL-cholesterol by 8.6 % (P = 0.01) and both LDL-:HDL-cholesterol ratio (10.1 %, P = 0.003) and total:HDL-cholesterol ratio (8.5 %, P = 0.001) while no significant changes were observed in the HGI group. Lowering the GI of daily meals with simple dietary recommendations results in increased weight loss and improved lipid profile and is relatively easy to implement with few constraints. These potential benefits of consuming a LGI diet can be useful to develop practical dietetic advice.

The NHF-NRG In Balance-project: the application of Intervention Mapping in the development, implementation and evaluation of weight gain prevention at the worksite

Very few examples of theory-driven and systematically developed weight gain prevention interventions for adults have been described in the literature. The present paper systematically describes the development, implementation and evaluation framework of a weight gain prevention programme directed at young adults at the worksite, namely the NHF-NRG In Balance-project. It not only can be used as a guide to systematically develop weight gain prevention interventions, but also gives an overview of the current theoretical and empirical knowledge-base in the field of obesity prevention. The outline of the paper follows the Intervention Mapping protocol, which includes a systematic inventory of important health issues, their risk behaviours and determinants of these risk behaviours, and specification of the proximal objectives of the programme directed at both energy intake and energy expenditure. The objectives are translated into behaviour change methods and strategies, which are combined in a stepwise intervention programme, and used for a detailed evaluation plan (process and effect evaluation). The NHF-NRG In Balance-project combines mass media and individually tailored communications with worksite environmental changes to raise awareness, to motivate and to enable energy balance behaviour changes. A quasi-experimental pre-test-multiple post-test control group design was applied in 12 worksites (>500 employees).

Food cravings and energy regulation: the characteristics of craved foods and their relationship with eating behaviors and weight change during 6 months of dietary energy restriction

OBJECTIVE

To examine characteristics of craved foods in relation to dietary energy restriction (ER) with high (HG) and low glycemic load (LG) diets.

DESIGN

Assessments of food cravings before and during a randomized controlled trial of HG and LG diets provided for 6 months.

SUBJECTS

Thirty-two healthy, overweight women aged 20-42 years.

MEASUREMENTS

Self-reported food cravings and dietary intake, body weight, weight history and measures of eating behaviors.

RESULTS

Foods craved at baseline were more than twice as high in energy density as the habitual diet (3.7+/-1.5 vs 1.7+/-0.3 kcal/g; P<0.001), and on average were lower in protein (P<0.001) and fiber (P<0.001) and higher in fat (P=0.002). There were no statistically significant changes in nutritional characteristics of craved foods after 6 months of ER. There was a significant relationship between reported portion size of craved food consumed at baseline and lifetime high body mass index (r=0.49, P=0.005). Additionally, there was a significant association between susceptibility to hunger and craving frequency at baseline, and there were significant relationships between hunger score, craving frequency, strength and percentage of time that cravings are given in to after 6 months of ER. In multiple regression models, subjects who lost a greater percentage of weight craved higher energy-dense foods at month 6 of ER, but also reported giving in to food cravings less frequently (adjusted R (2)=0.31, P=0.009).

CONCLUSION

High energy density and fat content, and low protein and fiber contents were identifying characteristics of craved foods. The relationships between craving variables and hunger score suggest that the relative influence of hunger susceptibility on cravings may be important before and especially after ER. Portion size of craved foods and frequency of giving in to food cravings appear to be important areas for focus in lifestyle modification programs for long-term weight loss.

Dietary fibre, nuts and cardiovascular diseases

Dietary fibre has a range of metabolic health benefits. Through a variety of mechanisms, dietary fibre, and the viscous variety in particular, slows down gastric emptying and intestinal transit, decreases the rate of intestinal carbohydrate absorption, and increases faecal bile acid excretion. Therefore, consumption of some types of soluble fibre can enhance satiety, which is associated with a lower BMI, and reduce blood cholesterol and the postprandial glucose response. Surprisingly, the consumption of insoluble fibre from whole grains, though metabolically inert, has been associated with a reduction in the risk of developing coronary heart disease and diabetes in epidemiological studies. The likely reason is that whole grains, like nuts, legumes and other edible seeds, contain many bioactive phytochemicals and various antioxidants. After cereals, nuts are the vegetable foods that are richest in fibre, which may partly explain their benefit on the lipid profile and cardiovascular health.

Long-Term Low-Calorie Low-Protein Vegan Diet and Endurance Exercise are Associated with Low Cardiometabolic Risk

BACKGROUND

Western diets, which typically contain large amounts of energy-dense processed foods, together with a sedentary lifestyle are associated with increased cardiometabolic risk. We evaluated the long-term effects of consuming a low-calorie low-protein vegan diet or performing regular endurance exercise on cardiometabolic risk factors.

METHODS

In this cross-sectional study, cardiometabolic risk factors were evaluated in 21 sedentary subjects, who had been on a low-calorie low-protein raw vegan diet for 4.4 +/- 2.8 years, (mean age, 53.1 +/- 11 yrs), 21 body mass index (BMI)-matched endurance runners consuming Western diets, and 21 age- and gender-matched sedentary subjects, consuming Western diets.

RESULTS

BMI was lower in the low-calorie low-protein vegan diet (21.3 +/- 3.1 kg/m(2)) and endurance runner (21.1 +/- 1.6 kg/m(2)) groups than in the sedentary Western diet group (26.5 +/- 2.7 kg/m(2)) (p < 0.005). Plasma concentrations of lipids, lipoproteins, glucose, insulin, C-reactive protein, blood pressure (BP), and carotid artery intima-media thickness were lower in the low-calorie low-protein vegan diet and runner groups than in the Western diet group (all p < 0.05). Both systolic and diastolic BP were lower in the low-calorie low-protein vegan diet group (104 +/- 15 and 62 +/- 11 mm Hg) than in BMI-matched endurance runners (122 +/- 13 and 72 +/- 9 mmHg) and Western diet group (132 +/- 14 and 79 +/- 8 mm Hg) (p < 0.001); BP values were directly associated with sodium intake and inversely associated with potassium and fiber intake.

CONCLUSIONS

Long-term consumption of a low-calorie low-protein vegan diet or regular endurance exercise training is associated with low cardiometabolic risk. Moreover, our data suggest that specific components of a low-calorie low-protein vegan diet provide additional beneficial effects on blood pressure.

Whole flaxseeds but not sunflower seeds in rye bread reduce apparent digestibility of fat in healthy volunteers

OBJECTIVE

The aim of this study was to measure the apparent digestibility of fat and the transit time upon addition of whole sunflower seeds (SU) or flaxseeds (FL) to rye breads consumed as part of a whole diet.

METHOD

In a randomized crossover study, gross intake and faecal excretion of fat and energy were measured in 11 young healthy men aged 24.6+/-2.7 years. During each 7 days intervention periods, the subjects received a basal diet plus 300 g of one of four rye breads: (1) rye bread; (2) rye bread with SU; (3) rye bread with FL; (4) low extraction rate rye bread with SU and FL. Fat binding properties of rye breads (1) and (3) were determined by in vitro digestion.

RESULTS

Addition of whole SU or FL to breads increased daily gross intake of fat and energy (P<0.001). The amounts of apparently digested fat (g/day) and energy were lowered when subjects consumed the SU or FL rye bread (P<0.001). The effect on energy digestibility of FL was more pronounced than that of SU. The in vitro fat digestibility of rye breads and whole diets show fat-binding properties of FL when compared to the rye bread diet (P<0.05).

CONCLUSIONS

Enrichment of bread with whole FL does not appear to result in increased fat and energy intake when added to breads, but the results rather indicate an impairment of nutrient utilization.

The effects of the fibre content and physical structure of carrots on satiety and subsequent intakes when eaten as part of a mixed meal

Previous research indicates that vegetables yield relatively high satiety scores, and that fibre content and structure may both contribute to these effects. This study evaluated the effects of the fibre content and physical structure (gross anatomy and cell structure) of carrots on postprandial satiety and subsequent food intakes when consumed as part of a mixed meal. Using a randomised, repeated-measures, within-subject cross-over design, young women consumed a standardised breakfast and test lunches on three occasions, 4 weeks apart. The test lunches (3329 kJ) comprised boiled rice (200 g) with sweet and sour sauce (200 g) that included chicken (200 g) and carrots (200 g) in three conditions: whole carrots (fibre and structure; n 34), blended carrots (fibre but no structure; n 34) or carrot nutrients (no fibre or structure; n 32). The carrot nutrients had the same energy, major nutrients and portion weight as the other two conditions. Post-lunch satiety was assessed by visual analogue scales. Intakes were covertly weighed at a meal eaten ad libitum (3 h later), and for the remainder of the day using food diaries. Compared with the meal with carrot nutrients, meals with whole carrots and blended carrots resulted in significantly (P<0.05) higher satiety. There were significant (P<0.05) differences between conditions in intakes at the meal eaten ad libitum and for the remainder of the day, and intakes consistently decreased in the order: carrot nutrients, blended carrots, whole carrots, indicating that both fibre content and structure played a role in these effects.

Physical activity and risk of colon and rectal cancers: the European prospective investigation into cancer and nutrition

We investigated several aspects of the role of physical activity in colon and rectal cancer etiology that remain unclear in the European Prospective Investigation into Nutrition and Cancer. This cohort of 413,044 men and women had 1,094 cases of colon and 599 cases of rectal cancer diagnosed during an average of 6.4 years of follow-up. We analyzed baseline data on occupational, household, and recreational activity to examine associations by type of activity, tumor subsite, body mass index (BMI), and energy intake. The multivariate hazard ratio for colon cancer was 0.78 [95% confidence interval (95% CI), 0.59-1.03] among the most active participants when compared with the inactive, with evidence of a dose-response effect (P(trend) = 0.04). For right-sided colon tumors, the risk was 0.65 (95% CI, 0.43-1.00) in the highest quartile of activity with evidence of a linear trend (P(trend) = 0.004). Active participants with a BMI under 25 had a risk of 0.63 (95% CI, 0.39-1.01) for colon cancer compared with the inactive. Finally, an interaction between BMI and activity (P(interaction) = 0.03) was observed for right-sided colon cancers; among moderately active and active participants with a BMI under 25, a risk of 0.38 (95% CI, 0.21-0.68) was found as compared with inactive participants with BMI >30. No comparable decreased risks were observed for rectal cancer for any type of physical activity for any subgroup analyses or interactions considered. We found that physical activity reduced colon cancer risk, specifically for right-sided tumors and for lean participants, but not rectal cancer.

Effects of a combination fiber system on appetite and energy intake in overweight humans

Appetite management may aid energy balance through moderation of the size (satiation) and/or frequency (satiety) of eating occasions. This double-blind, randomized, cross-over design study explored the effects of the addition of alginate and guar gum to a breakfast bar on appetite and food intake. Following baseline evaluations of health, appetite and diet, participants were randomized to receive the fiber containing bar or control bar. They reported to the laboratory after an overnight fast, rated their appetite and consumed the relevant 55 g bar within 10 min in place of their normal breakfast meal. Appetite ratings were again made immediately after consuming the bar and at 30 minute intervals for 5 h. This was repeated for 5 consecutive days (Monday-Friday) followed by a 9-day washout period and a similar 5-day treatment period with the alternate bar. Gastrointestinal tolerance was rated daily. Sensory ratings of the bars were obtained on the first and fifth study days. Twenty-four-hour diet recalls were conducted on three random days during baseline and each intervention period. No significant treatment effects were observed in self-reported appetitive sensations over each 5-hour post-loading period. There also was no evidence of a cumulative effect over the five treatment days. Daily energy intake was not different on the two treatments. Although these data do not support the efficacy of including guar and an alginate fiber combination in a solid food matrix for moderation of appetite and acute food intake, further testing of the concept under different conditions and with different forms of guar and alginate may prove worthwhile.

Long-term effects of 2 energy-restricted diets differing in glycemic load on dietary adherence, body composition, and metabolism in CALERIE: a 1-y randomized controlled trial

BACKGROUND

There remains no consensus about the optimal dietary composition for sustained weight loss.

OBJECTIVE

The objective was to examine the effects of 2 dietary macronutrient patterns with different glycemic loads on adherence to a prescribed regimen of calorie restriction (CR), weight and fat loss, and related variables.

DESIGN

A randomized controlled trial (RCT) of diets with a high glycemic load (HG) or a low glycemic load (LG) at 30% CR was conducted in 34 healthy overweight adults with a mean (+/-SD) age of 35 +/- 6 y and body mass index (kg/m(2)) of 27.6 +/- 1.4. All food was provided for 6 mo in diets controlled for confounding variables, and subjects self-administered the plans for 6 additional months. Primary and secondary outcomes included energy intake measured by doubly labeled water, body weight and fatness, hunger, satiety, and resting metabolic rate.

RESULTS

All groups consumed significantly less energy during CR than at baseline (P < 0.01), but changes in energy intake, body weight, body fat, and resting metabolic rate did not differ significantly between groups. Both groups ate more energy than provided (eg, 21% and 28% CR at 3 mo and 16% and 17% CR at 6 mo with HG and LG, respectively). Percentage weight change at 12 mo was -8.04 +/- 4.1% in the HG group and -7.81 +/- 5.0% in the LG group. There was no effect of dietary composition on changes in hunger, satiety, or satisfaction with the amount and type of provided food during CR.

CONCLUSIONS

These findings provide more detailed evidence to suggest that diets differing substantially in glycemic load induce comparable long-term weight loss.

Carob pulp preparation rich in insoluble dietary fibre and polyphenols increases plasma glucose and serum insulin responses in combination with a glucose load in humans

Dietary fibre consumption is associated with improved glucose homeostasis. In contrast, dietary polyphenols have been suggested to exert both beneficial and detrimental effects on glucose and insulin metabolism. Recently, we reported that a polyphenol-rich insoluble dietary fibre preparation from carob pulp (carob fibre) resulted in lower postprandial acylated ghrelin levels after a liquid meal challenge test compared with a control meal without supplementation. The effects may, however, differ when a different food matrix is used. Thus, we investigated the effects of carob fibre on glucose, insulin and ghrelin responses in healthy humans in combination with a glucose load. In a randomized single-blind cross-over study involving twenty healthy subjects (aged 22-62 years), plasma glucose, total and acylated ghrelin, and serum insulin were repeatedly assessed before and after the ingestion of 200 ml water with 50 g glucose and 0, 5, 10 or 20 g carob fibre over a period of 180 min. The intake of 5 and 10 g carob fibre increased the plasma glucose by 47 % and 64 % (P < 0.001), and serum insulin by 19.9 and 24.8 % (P < 0.001), compared with the control. Plasma acylated ghrelin concentrations did not change significantly after the consumption of carob-enriched glucose solution. Total ghrelin decreased only after 10 g carob fibre (P < 0.001) compared with control. In conclusion, we showed that polyphenol-rich carob fibre, administered within a water-glucose solution, increases postprandial glucose and insulin responses, suggesting a deterioration in glycaemic control.

Prevalence of obesity, food choices and socio-economic status: a cross-sectional study in the north-west of Iran

AIM

To document the epidemiological features and influencing factors of obesity in the north-west of Iran, to provide baseline information for setting up a regional population-based centre to control and prevent obesity-related disorders in the area.

METHODS

In this cross-sectional study, a total of 300 subjects were selected/studied in Tabriz, one of the major cities in Iran. Data on basic characteristics, anthropometric measurements, dietary assessment and physical activity were collected. Obesity was defined as body mass index > or =30 kg m(-2) for both women and men.

RESULTS

Total prevalence of obesity in the area was 22.4% (95% confidence interval (CI): 18.0-27.6). The prevalence of obesity was 24% (95% CI: 18.5-31.4) for women and 18% (95% CI: 12.5-25.6) for men. For both women and men obesity prevalence showed a positive association with age (P<0.001), while there was a negative correlation of obesity with education and income (P<0.001). Fruit consumption decreased the risk of obesity in both women and men (odds ratio (OR)=0.60, 95% CI: 0.49-0.71 vs. OR=0.62, 95% CI: 0.51-0.74, respectively). The same significant pattern was observed for the consumption of green vegetables (OR=0.71, 95% CI: 0.57-0.63 vs. OR=0.86, 95% CI: 0.77-0.98 for women and men, respectively), legumes (OR=0.70, 95% CI: 0.59-0.84 vs. OR=0.78, 95% CI: 0.66-0.91 for women and men, respectively) and dairy products (OR=0.73, 95% CI: 0.61-0.91 vs. OR=0.77, 95% CI: 0.63-0.93 for women and men, respectively).

CONCLUSIONS

Our study showed that educational attainment, higher income and consumption of certain food groups (i.e. vegetables, fruits, legumes and dairy products) may decrease the risk of obesity. Our findings also indicate the crucial necessity of establishing a population-based centre for obesity in the area. The essential information is now achieved to propose to local health authorities to act accordingly. However, more population-based investigations on dietary choices are needed to develop effective preventive strategies to control overweight and obesity disorders in different regions.

Dietary strategies for the prevention of obesity

The rising tide of obesity has led to a resurgence of interest in dietary strategies to prevent excess weight gain. Data from controlled intervention studies is sparse, but nonetheless evidence from other diverse sources has identified a number of specific dietary factors and aspects of eating behaviour that either promote or protect against obesity. The present paper reviews the evidence in relation to energy density, the macronutrient composition of the diet, including the nature of carbohydrate foods and sugar-rich drinks, portion size and snacking habits. It concludes that there is now sufficient evidence to develop clear dietary guidelines to prevent weight gain that are largely consistent with those for the prevention of CVD and cancer. However, coordinated action across multiple stakeholders is also required if these guidelines are to be translated into sustained changes in eating habits.

Effects of a healthy meal course on spontaneous energy intake, satiety and palatability

Many food components can influence satiety or energy intake. Combined together, these food components could represent an interesting dietary strategy in the prevention and treatment of obesity. The aims of this study were: 1) to determine the effect of a functional food in the form of a healthy meal course on subsequent energy intake and satiety; 2) to verify if it is possible to maintain palatability while preserving the satiating effects of the test meal. Thirteen subjects were invited to eat two lunch sessions: healthy and control meal courses (2090 kJ/meal). Anthropometric and ad libitum food intake measurements, and visual analogue scales (VAS) were performed during the two lunch sessions. The healthy main course acutely decreased energy intake during the rest of the meal ( − 744 kJ, P ≤ 0·0001) and lipid ( − 6 %, P ≤ 0·0001) compared with the control meal. VAS ratings during the course of the testing showed a meal effect for hunger, desire to eat and prospective food consumption (P ≤ 0·05) and a time effect for all appetite sensations (P ≤ 0·0001). VAS scores on hunger ratings were lower for the healthy meal (P ≤ 0·05), whereas fullness ratings were higher shortly after the healthy main course (P ≤ 0·05). The healthy meal produced a slightly higher palatability rating but this effect was not statistically significant. These results suggest that it is possible to design a healthy meal that decreases spontaneous energy intake and hunger without compromising palatability.

Liquid calories, sugar, and body weight

The consumption of sugar-sweetened beverages has been linked to rising rates of obesity in the United States. The standard explanation is that energy-containing liquids are less satiating than are solid foods. However, purely physiologic mechanisms do not fully account for the proposed links between liquid sugar energy and body weight change. First, a reevaluation of published epidemiologic studies of consumption of sweetened beverages and overweight shows that most such studies either are cross-sectional or are based on passive surveillance of temporal trends and thus permit no conclusions about causal links. Second, research evidence comparing the short-term satiating power of different types of liquids and of solids remains inconclusive. Numerous clinical studies have shown that sugar-containing liquids, when consumed in place of usual meals, can lead to a significant and sustained weight loss. The principal ingredient of liquid meal replacement shakes is sugar, often high-fructose corn syrup, which is present in amounts comparable to those in soft drinks. Far from suppressing satiety, one such liquid shake is marketed on the grounds that it helps control hunger and prevents hunger longer when consumed for the purpose of weight loss. These inconsistencies raise the question whether the issue of sugars and body weight should continue to be framed purely in metabolic or physiologic terms. The effect of sugar consumption on body weight can also depend on behavioral intent, context, and the mode of use, availability, and cost of sweetened liquids.

Dietary fiber intake, dietary glycemic index and load, and body mass index: a cross-sectional study of 3931 Japanese women aged 18–20 years

OBJECTIVE

Few observational studies have investigated dietary fiber intake and dietary glycemic index (GI) and glycemic load (GL) simultaneously in relation to obesity, particularly in non-Western populations. We examined the associations between dietary fiber intake and dietary GI and GL, and body mass index (BMI) in young Japanese women.

DESIGN

Cross-sectional study.

SUBJECTS

A total of 3931 female Japanese dietetic students aged 18-20 years from 53 institutions in Japan.

METHODS

Dietary fiber intake and dietary GI and GL (GI for glucose=100) were assessed by a validated, self-administered, diet history questionnaire. BMI was calculated from self-reported body weight and height.

RESULTS

Mean values of BMI, dietary fiber intake, dietary GI and dietary GL were 21.0 kg/m(2), 6.5 g/4186 kJ, 65.1 and 82.1/4186 kJ, respectively. White rice (GI=77) was the major contributor to dietary GI and GL (45.8%). After controlling for potential dietary and nondietary confounding factors, dietary fiber intake was negatively correlated with BMI (adjusted mean=21.1 kg/m(2) in the lowest and 20.7 kg/m(2) in the highest quintiles; P for trend=0.0007). Conversely, dietary GI and GL were independently positively correlated with BMI (20.8 and 21.2 kg/m(2); P for trend=0.03, and 20.5 and 21.5 kg/m(2); P for trend=0.0005, respectively).

CONCLUSIONS

Dietary fiber intake showed an independent negative association with BMI, and dietary GI and GL showed an independent positive association with BMI among relatively lean young Japanese women.

Lifestyle correlates of anthropometric estimates of body adiposity in an Italian middle-aged and elderly population: a covariance analysis

OBJECTIVE

To study the relationship between behavioural factors, body adiposity and muscle mass.

SUBJECTS AND METHODS

A total of 1415 Italian individuals (705 men and 710 women) aged 40-74 years from a population-based survey carried out in the town of Bollate (Milan). Analysis of covariance was used to refine and improve the precision of the comparisons.

RESULTS

Men: Smoking and sedentary behaviour were related to larger waist circumference (WC) and smaller hip circumference (HC). Increased WC was also associated with high-fat diet and moderate-to-heavy drinking (compared to light drinkers). Those more educated (completed high school) were leaner and ex-smokers had higher body mass index (BMI) than non-smokers. Women: BMI was inversely related with education, the more educated having also lower muscle mass. The light drinkers were leaner and moderate-to-heavy drinkers had less muscle mass than abstainers. Moderate-to-heavy drinkers had larger WC than light drinkers. A strong negative trend was found in the relationship between dietary fibre and WC. Overall adiposity (BMI) and, more weakly, HC and peripheral subcutaneous fat increased with more TV watching, whereas BMI lowered, together with WC and muscle mass (as measured by the mid-arm circumference), with more walking/cycling.

CONCLUSIONS

Modifiable habits such as smoking (men) and moderate-to-heavy alcohol drinking are associated with a pattern that is particularly deleterious to health: increased intra-abdominal fat and less muscle mass. Prevention strategies should be simultaneously aimed at promoting physical activities and reducing sedentary behaviours. A low-fat, fibre-rich diet seems to be closely related to a healthy distribution of body fat.

The benefits of early intervention in obese diabetic patients with FBCx: a new dietary fibre

BACKGROUND

Obesity and diabetes have become epidemic in the US. Dietary fibres have been reported to reduce the absorption of dietary fat, prevent weight gain, and reduce blood lipid levels. In the current double-blind study, obese patients with type 2 diabetes were recruited for a 3-month study to examine the health effects of a new dietary fibre, FBCx.

METHODS

Sixty-six participants were recruited and were randomized into FBCx or placebo groups. They were instructed to take two 1-g tablets per fat-containing meal and not to change their eating patterns or daily routine. Three-day dietary records and fasting blood samples were collected prior to enrollment in the study and at the end of months 1, 2 and 3.

RESULTS

Dietary records showed that some participants changed their eating patterns; therefore body weight data were adjusted according to energy intake. As a group, in the 30 days leading into the study, all participants experienced an average weight gain of 1.0 +/- 0.4 kg, while those in the placebo group continued to gain weight during the study, those in the FBCx group maintained their weight. Those in the FBCx group required more energy to maintain their body weight while those in the placebo group required less (p < 0.05). Participants with hypertriglyceridemia showed a reduction (-0.48 +/- 0.24 mmol/L, - 8.2%) in total cholesterol with FBCx, while those with placebo had an increase (0.24 +/- 0.21 mmol/L, 5.2%, p < 0.05). Adiponectin was increased in the FBCx but reduced in the placebo group (p < 0.05).

CONCLUSIONS

FBCx has thus shown promising benefits in weight maintenance, a reduction of blood lipids and an increase in adiponectin levels. It can be easily incorporated into a diabetic management regimen.

Effect of dietary soluble fiber on neurohormonal profiles in serum and brain of rats

This study was conducted to investigate the effect of dietary soluble fiber administration and /or high fat diet on serum and brain neurohormonal profiles, adipose tissue mass and body weight gain in Sprague-Dawley rats. Four groups of rats were respectively fed 10% fat diet (C), 10% fat plus pectin diet (P), 20% fat diet (HFC) and 20% fat plus pectin diet (HFP) for 4 weeks. In HFP group, the food and energy intake, body weight gain, FER including fecal excretion were the smallest (p<0.05). Serum HDL-cholesterol, triglyceride and glucose level were also the lowest in HFP group (p<0.05). The weight of brain, epididymal fat pad and adrenal gland except liver didn't show any significant differences among groups. Interestingly serum norepinephrine concentration of HFP group tended to be higher, but dopamine concentration tended to be lower than those of HFC group. However serum catecholamine concentration didn't show any significant differences among all groups. Norepinephrine and epinephrine contents of right portion of midbrain of P and HFP groups were remarkably lower than those of the C group. These results suggested that soluble fiber pectin consumption might affect neurohormonal profiles in serum and brain according to dietary fat level.

Study protocol of a cluster randomised controlled trial investigating the effectiveness of a tailored energy balance programme for recent retirees

BACKGROUND

People in transitional life stages, such as occupational retirement, are likely to gain weight and accumulate abdominal fat mass caused by changes in physical activity and diet. Hence, retirees are an important target group for weight gain prevention programmes, as described in the present paper.

METHODS/DESIGN

A systematic and stepwise approach (Intervention Mapping) is used to develop a low-intensity energy balance intervention programme for recent retirees. This one-year, low-intensity multifaceted programme aims to prevent accumulation of abdominal fat mass and general weight gain by increasing awareness of energy balance and influencing related behaviours of participants' preference. These behaviours are physical activity, fibre intake, portion size and fat consumption. The effectiveness of the intervention programme is tested in a cluster randomised controlled trial. Measurements of anthropometry, physical activity, energy intake, and related psychosocial determinants are performed at baseline and repeated at 6 months for intermediate effect, at 12 months to evaluate short-term intervention effects and at 24 months to test the sustainability of the effects.

DISCUSSION

This intervention programme is unique in its focus on retirees and energy balance. It aims at increasing awareness and takes into account personal preferences of the users by offering several options for behaviour change. Moreover, the intervention programme is evaluated at short-term and long-term and includes consecutive outcome measures (determinants, behaviour and body composition).

Prevalence of obesity, food choices and socio-economic status: a cross-sectional study in the north-west of Iran

Aim

To document the epidemiological features and influencing factors of obesity in the north-west of Iran, to provide baseline information for setting up a regional population-based centre to control and prevent obesity-related disorders in the area.

Methods

In this cross-sectional study, a total of 300 subjects were selected/studied in Tabriz, one of the major cities in Iran. Data on basic characteristics, anthropometric measurements, dietary assessment and physical activity were collected. Obesity was defined as body mass index ≥ 30 kg m− 2for both women and men.

Results

Total prevalence of obesity in the area was 22.4% (95% confidence interval (CI): 18.0–27.6). The prevalence of obesity was 24% (95% CI: 18.5–31.4) for women and 18% (95% CI: 12.5–25.6) for men. For both women and men obesity prevalence showed a positive association with age (P < 0.001), while there was a negative correlation of obesity with education and income (P < 0.001). Fruit consumption decreased the risk of obesity in both women and men (odds ratio (OR) = 0.60, 95% CI: 0.49–0.71 vs. OR = 0.62, 95% CI: 0.51–0.74, respectively). The same significant pattern was observed for the consumption of green vegetables (OR = 0.71, 95% CI: 0.57–0.63 vs. OR = 0.86, 95% CI: 0.77–0.98 for women and men, respectively), legumes (OR = 0.70, 95% CI: 0.59–0.84 vs. OR = 0.78, 95% CI: 0.66–0.91 for women and men, respectively) and dairy products (OR = 0.73, 95% CI: 0.61–0.91 vs. OR = 0.77, 95% CI: 0.63–0.93 for women and men, respectively).

Conclusions

Our study showed that educational attainment, higher income and consumption of certain food groups (i.e. vegetables, fruits, legumes and dairy products) may decrease the risk of obesity. Our findings also indicate the crucial necessity of establishing a population-based centre for obesity in the area. The essential information is now achieved to propose to local health authorities to act accordingly. However, more population-based investigations on dietary choices are needed to develop effective preventive strategies to control overweight and obesity disorders in different regions.

Lupin-enriched bread increases satiety and reduces energy intake acutely

BACKGROUND

Protein and fiber may be important determinants of satiety. Lupin kernel flour is a novel food ingredient that is rich in protein and fiber.

OBJECTIVE

The objective was to investigate the effects of lupin kernel flour-enriched bread (LB) on satiety and energy intake in humans.

DESIGN

Two randomized controlled crossover trials were performed to compare the acute effects of LB with those of white bread (WB). In study 1, the subjects (n = 16) completed 4 treatments 1 wk apart: WB breakfast (as toast) and WB lunch (as sandwiches), WB breakfast and LB lunch, LB breakfast and WB lunch, and LB breakfast and LB lunch. Energy intake at all breakfast meals was matched (1655 kJ), and ad libitum energy intake at lunch, 3 h after breakfast, was measured. In study 2, the subjects (n = 17) completed 2 treatments 1 wk apart: WB breakfast and LB breakfast (each 1655 kJ). Blood samples were taken at baseline and at regular intervals for 3 h after breakfast.

RESULTS

In study 1, the LB breakfast resulted in significantly higher self-reported satiety (P < 0.001) and lower energy intake (kJ) at lunch (-488; 95% CI: -798, -178) than did the WB breakfast. The LB lunch resulted in a significantly lower within-meal energy intake (kJ) at lunch (-1028; 95% CI: -1338, -727) than did the WB lunch. In study 2, compared with the WB breakfast, the LB breakfast significantly altered the 3-h postmeal plasma ghrelin response (P = 0.04) and resulted in significantly lower mean 3-h plasma ghrelin concentrations (P = 0.009).

CONCLUSION

A novel food enriched in protein and fiber derived from lupin kernel flour significantly influences energy intake acutely.

Consumption of whole-grain cereals during weight loss: effects on dietary quality, dietary fiber, magnesium, vitamin B-6, and obesity

OBJECTIVE

While various weight-management approaches produce weight loss, they may differ in dietary quality. We monitored changes in nutrient intakes in overweight and obese subjects on three different weight-management programs.

DESIGN

Randomized clinical trial (pilot study) with two 12-week phases: phase 1, weekly counseling; phase 2, monitoring only.

SUBJECTS/SETTING

One hundred eighty nonsmoking, sedentary overweight and obese adults began this outpatient study; 134 (body mass index [calculated as kg/m(2)]=30.9+/-2.4; age=42.3+/-1.2 years) were used in analyses.

INTERVENTION

Twenty-four weeks of exercise only (control group), hypocaloric diet plus exercise, or hypocaloric diet with fiber-rich whole-grain cereals plus exercise.

MAIN OUTCOME MEASURES

At weeks 0, 12, and 24, diet quality was assessed by 3-day food records and body weight was measured.

STATISTICAL ANALYSES PERFORMED

Three-way analysis of variance with repeated measures.

RESULTS

The hypocaloric diet with fiber-rich whole-grain cereals plus exercise decreased energy intake more than exercise only (P=0.032). By week 12, the hypocaloric diet with fiber-rich whole-grain cereals plus exercise and the hypocaloric diet plus exercise decreased total fat more than exercise only, which was sustained in the hypocaloric diet with fiber-rich whole-grain cereals plus exercise at 24 weeks (P<0.001). At weeks 12 and 24, the hypocaloric diet with fiber-rich whole-grain cereals plus exercise reduced saturated fat intake more than exercise only. The hypocaloric diet with fiber-rich whole-grain cereals plus exercise increased total fiber, insoluble fiber (both P<0.001), magnesium (P=0.004), and vitamin B-6 (P=0.002) intakes more than the hypocaloric diet plus exercise and exercise only. Calcium and vitamin E intakes were inadequate in all groups. Weight loss was similar in the hypocaloric diet with fiber-rich whole-grain cereals plus exercise and the hypocaloric diet plus exercise.

CONCLUSIONS

Weight-reduction strategies may be associated with reduced intake of micronutrients, such as calcium and vitamin E. However, a hypocaloric diet with fiber-rich whole-grain cereal is effective for improving or maintaining other aspects of dietary quality during weight loss.

Biomedical issues of dietary fiber beta-glucan

Beta-glucan is a polysaccharide in the form of fiber and the main element of fiber in grains such as barley, oats, yeast and mushrooms. Many studies have examined the efficacy of beta-glucan in terms of the lipid lowering effects, blood sugar reduction, weight reduction, immune modulator, and anticarcinogenic effect. However, there is no comprehensive review article on the biomedical issues regarding beta-glucan. The authors searched for systematic reviews and clinical experiments for each relevant topic and reviewed the biomedical effects of beta-glucan, for the purpose of developing research strategies for the future.

Eating patterns and dietary composition in relation to BMI in younger and older adults

OBJECTIVE

To compare relative associations of eating patterns and dietary composition with body mass index (BMI) in younger (aged 20-59 years, n=1792) and older (aged 60-90 years, n=893) participants in the Continuing Survey of Food Intakes by Individuals, collected 1994-1996.

METHODS

Data from two 24-h dietary recalls from individuals reporting physiologically plausible energy intake (within +/-22% of predicted energy requirements, based on previously published methods) were used.

RESULTS

Mean reported energy intake was 96 and 95% of predicted energy requirements in younger and older subjects, respectively. Older subjects were less likely than younger subjects to skip a meal, but snacking was common in both age groups. Fiber density was significantly higher in the older group. A higher BMI in both age groups was associated with a higher total daily energy intake, and higher energy intakes at all eating occasions. In both age groups, eating frequency was positively associated with energy intake, and eating more than three times a day was associated with being overweight or obese. In the younger group but not the older group, a lower fiber density coupled with higher percentage of energy from fat was independently associated with having a higher BMI.

CONCLUSIONS

While no one eating occasion contributes more than any other to excess adiposity, eating more often than three times a day may play a role in overweight and obesity in both younger and older persons. A reduced satiety response to dietary fiber in addition to lower energy expenditure may potentially further contribute to weight gain in older persons.

Effects of resistant starch, a non-digestible fermentable fiber, on reducing body fat

OBJECTIVE

To assess the effects of energy dilution with non-fermentable and fermentable fibers on abdominal fat and gut peptide YY (PYY) and glucagon-like peptide (GLP)-1 expressions, three rat studies were conducted to: determine the effects of energy dilution with a non-fermentable fiber, compare similar fiber levels of fermentable and non-fermentable fibers, and compare similar metabolizable energy dilutions with fermentable and non-fermentable fibers.

RESEARCH METHODS AND PROCEDURES

In Study 1, rats were fed one of three diets with different metabolizable energy densities. In Study 2, rats were fed diets with similar fiber levels using high amylose-resistant cornstarch (RS) or methylcellulose. In Study 3, rats were fed diets with a similar dilution of metabolizable energy using cellulose or RS. Measurements included food intake, body weight, abdominal fat, plasma PYY and GLP-1, gastrointestinal tract weights, and gene transcription of PYY and proglucagon.

RESULTS

Energy dilution resulted in decreased abdominal fat in all studies. In Study 2, rats fed fermentable RS had increased cecal weights and plasma PYY and GLP-1, and increased gene transcription of PYY and proglucagon. In Study 3, RS-fed rats had increased short-chain fatty acids in cecal contents, plasma PYY (GLP-1 not measured), and gene transcription for PYY and proglucagon.

DISCUSSION

Inclusion of RS in the diet may affect energy balance through its effect as a fiber or a stimulator of PYY and GLP-1 expression. Increasing gut hormone signaling with a bioactive functional food such as RS may be an effective natural approach to the treatment of obesity.

Filling yet fattening: stereotypical beliefs about the weight gain potential and satiation of foods

To what extent are stereotypes concerning the weight-gain potential and perceived hunger satisfaction of food names not congruent with views of the nutrient profiles of those same foods? Respondents rated the same 22 food names and descriptions in terms of weight-gain potential and hunger satisfaction. Half of the 22 snacks included foods from the lower two tiers of the USDA Food Guide Pyramid (fruits, vegetables, and grains: FV&G) and the other half from the upper two tiers (meats, dairy, fats, and sweets: MDF&S). FV&G and MDF&S snack names and descriptions were paired for data analyses based on energy content. Name and description ratings for weight-gain potential were not correlated, while these ratings for hunger satisfaction were strongly correlated. For weight-gain potential, fat and fiber content predicted snack-name ratings, while energy and sugar content predicted description ratings. For perceived hunger satisfaction, protein content predicted snack name ratings while energy and fat content predicted description ratings. The MDF&S snack named in each pair was always considered a greater weight gain promoter compared to its corresponding FV&G snack named. However, the description of the FV&G snack in each pair was often judged to promote greater weight-gain than the description of its corresponding MDF&S snack. Also, MDF&S names were generally judged as more filling than FV&G foods named with similar calorie content; however, a trend in the opposite direction was evident when rating the nutrient descriptions of these same foods. Apparently, food names have acquired reputation for promoting obesity and (to a lesser extent) hunger satisfaction that are not based on their nutrient profiles.

Dietary patterns and changes in body weight in women

OBJECTIVE

Our objective was to examine the association between adherence to dietary patterns and weight change in women.

RESEARCH METHODS AND PROCEDURES

Women (51,670, 26 to 46 years old) in the Nurses' Health Study II were followed from 1991 to 1999. Dietary intake and body weight were ascertained in 1991, 1995, and 1999. A Western pattern, characterized by high intakes of red and processed meats, refined grains, sweets and desserts, and potatoes, and a prudent pattern, characterized by high intakes of fruits, vegetables, whole grains, fish, poultry, and salad dressing, were identified with principal component analysis, and associations between patterns and change in body weight were estimated.

RESULTS

Women who increased their Western pattern score had greater weight gain (multivariate adjusted means, 4.55 kg for 1991 to 1995 and 2.86 kg for 1995 to 1999) than women who decreased their Western pattern score (2.70 and 1.37 kg for the two time periods), adjusting for baseline lifestyle and dietary confounders and changes in confounders over time (p < 0.001 for both time periods). Furthermore, among women who increased their prudent pattern score, weight gain was smaller (multivariate-adjusted means, 1.93 kg for 1991 to 1995 and 0.66 kg for 1995 to 1999) than among women who decreased their prudent pattern score (4.83 and 3.35 kg for the two time periods) (p < 0.001). The largest weight gain between 1991 and 1995 and between 1995 and 1999 was observed among women who decreased their prudent pattern score while increasing their Western pattern score (multivariate adjusted means, 6.80 and 4.99 kg), whereas it was smallest for the opposite change in patterns (0.87 and -0.64 kg) (p < 0.001).

DISCUSSION

Adoption of a Western dietary pattern is associated with larger weight gain in women, whereas a prudent dietary pattern may facilitate weight maintenance.

A low-fat vegan diet improves glycemic control and cardiovascular risk factors in a randomized clinical trial in individuals with type 2 diabetes

OBJECTIVE

We sought to investigate whether a low-fat vegan diet improves glycemic control and cardiovascular risk factors in individuals with type 2 diabetes.

RESEARCH DESIGN AND METHODS

Individuals with type 2 diabetes (n = 99) were randomly assigned to a low-fat vegan diet (n = 49) or a diet following the American Diabetes Association (ADA) guidelines (n = 50). Participants were evaluated at baseline and 22 weeks.

RESULTS

Forty-three percent (21 of 49) of the vegan group and 26% (13 of 50) of the ADA group participants reduced diabetes medications. Including all participants, HbA(1c) (A1C) decreased 0.96 percentage points in the vegan group and 0.56 points in the ADA group (P = 0.089). Excluding those who changed medications, A1C fell 1.23 points in the vegan group compared with 0.38 points in the ADA group (P = 0.01). Body weight decreased 6.5 kg in the vegan group and 3.1 kg in the ADA group (P < 0.001). Body weight change correlated with A1C change (r = 0.51, n = 57, P < 0.0001). Among those who did not change lipid-lowering medications, LDL cholesterol fell 21.2% in the vegan group and 10.7% in the ADA group (P = 0.02). After adjustment for baseline values, urinary albumin reductions were greater in the vegan group (15.9 mg/24 h) than in the ADA group (10.9 mg/24 h) (P = 0.013).

CONCLUSIONS

Both a low-fat vegan diet and a diet based on ADA guidelines improved glycemic and lipid control in type 2 diabetic patients. These improvements were greater with a low-fat vegan diet.

Food behaviors and other strategies to prevent and treat pediatric overweight

OBJECTIVE

To summarize the evidence for the following six strategies to prevent or treat overweight among children: promoting breastfeeding, promoting physical activity, reducing TV/video viewing, increasing fruit and vegetable consumption, reducing sugar-sweetened drink consumption, and reducing portion sizes.

METHODS

Summarization of the relevant literature including review articles, relevant newly published work, the Institute of Medicine's Report on Preventing Childhood Obesity and the Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity, 2001. This is not a comprehensive review.

RESULTS

Evidence for the association between each strategy and overweight varies. For breastfeeding, physical activity, and TV viewing, there are large review studies. Breastfed children may have a small reduction in risk for overweight. Participation in physical activity may reduce the risk of overweight among school-aged children and adolescents. For preschool- and school-aged children, reducing TV viewing time may reduce their risk of overweight, but most studies report small significant associations. Evidence for an association between each dietary factor and overweight is limited and inconclusive. The biggest gaps in evidence are for the effectiveness of interventions using these strategies. The reviewed interventions based on increasing physical activity (n=7) were effective. Two randomized trials suggest that reducing TV viewing reduces overweight. No intervention studies were found that examined the effectiveness of changing fruit and vegetable consumption, sugar-sweetened drink consumption, or portion sizes. Further clarification of the effect of breastfeeding on obesity is needed.

CONCLUSIONS

These six strategies are reasonable ways to attempt prevention or treatment of overweight in children. Strength of the evidence varies by strategy. The key finding is that more applied research is needed to determine the effectiveness of these and other strategies.

Eating behavior and weight change in healthy postmenopausal women: results of a 4-year longitudinal study

BACKGROUND

The association of psychological eating behavior constructs with overweight and obesity during early adult life and middle age has been documented in several studies. However, the association of eating behavior with unexplained weight change in old age is relatively unexplored.

METHODS

Body weight, eating behavior (dietary restraint, disinhibition, and hunger as assessed by the Eating Inventory), reported dietary intake, and physical activity level were assessed at baseline in 36 nonobese postmenopausal women aged 61.3 +/- 3.1 years (mean +/- standard deviation). Measurements were repeated 4.4 +/- 0.9 years later, and changes in body weight were examined in relation to baseline and follow-up eating behavior scores, reported dietary intake, and physical activity level.

RESULTS

Participants had no major changes in health or lifestyle characteristics over the study interval. Weight change ranged from -7.5 to +5.8 kg (mean -0.3 +/- 3.5 kg), and there were no significant changes in reported dietary intake. Mean hunger score (calculated as the mean of baseline and follow-up hunger score) predicted weight change per year over the study period (bivariate r = 0.386, p =.020), even in statistical models adjusted for mean dietary intake variables (partial r = 0.658, p =.003). Restraint, disinhibition, and physical activity level did not predict weight change.

CONCLUSIONS

Reported hunger assessed by the Eating Inventory was associated with unintentional weight change in healthy postmenopausal women. The Eating Inventory questionnaire may provide a clinically useful tool for identifying older individuals at risk of undesirable weight change, and particularly unintentional weight loss, a factor strongly associated with increased morbidity and premature death in this population.

Weight loss and long-term follow-up of severely obese individuals treated with an intense behavioral program

OBJECTIVE

To review weight loss and maintenance for severely obese individuals enrolled in intensive behavioral weight loss program using very-low or low-energy diets.

DESIGN

Chart review of consecutively treated patients between 1995 and 2002 seen at three weight loss centers.

SUBJECTS

One thousand five hundred and thirty one patients with severe obesity (>or=40 kg/m(2)) treated in three cities ('Study Group'). Of these, 1100 completed the 12-week core curriculum ('Completer Group'). Weight loss >or=100 lbs (>45 kg) was seen in 268 patients ('100-Pound Group').

MEASUREMENTS

Charts were reviewed for baseline characteristics, weekly weights, follow-up weights and side effects.

RESULTS

In the Study Group, average weight loss+/-s.e. for 998 women was 23.9+/-0.6 kg (18.5% of initial body weight (IBW)) and for 533 men was 36.0+/-1.0 kg (22.5%) over 30 weeks. For Completers, average weight loss for women was 30.8+/-0.6 kg (23.9%) and for men was 42.6+/-1.1 kg (26.7%) over 39 weeks. In the 100-Pound Group, average weight loss for women was 58.2+/-1.2 kg (41.5%) in 65 weeks and for men was 65.7+/-1.5 kg (37.5%) in 51 weeks. Side effects, assessed in 100 patients losing >45 kg, were mild to moderate in severity. Severe adverse events unrelated to the diet were noted in 5% of patients and during weight loss 1% had elective cholecystectomies. Follow-up weights were available for 86% of Completers at an average of 72 weeks with average maintenance of 23 kg or 59% of weight loss; follow-up weights were available for 94% of the 100-Pound Group at an average of 95 weeks with average maintenance of 41 kg or 65% of weight loss maintained.

CONCLUSIONS

Intensive behavioral treatment with meal replacements is a safe and effective weight-loss strategy for selected severely obese individuals.

Oligofructose promotes satiety in healthy human: a pilot study

OBJECTIVE

The administration of a fermentable dietary fibre (oligofructose) in rats increases satietogenic gut peptides and lowered spontaneous energy intake. The aim of the study was to assess the relevance of those effects of oligofructose on satiety and energy intake in humans.

DESIGN

Single-blinded, crossover, placebo-controlled design, pilot study.

SUBJECTS

Volunteers included five men and five women aged 21-39 years, BMI ranging from 18.5 to 27.4 kg/m(2), were randomly assigned as described below.

INTERVENTIONS

Subjects were included in two 2-week experimental phases during which they received either fibre (oligofructose (OFS)) or placebo (dextrine maltose (DM)); a 2-week washout period was included between crossover phases. In total, 8 g OFS or 8 g DM were ingested twice daily (16 g/day in total). Energy intake, hunger, satiety, fullness and prospective food consumption were assessed with analogue scales at the end of each experimental phase.

RESULTS

During breakfast, OFS significantly increases the satiety (P=0.04) without any difference on other sensations as compared to DM treatment periods. After lunch, no significant differences are observed between treatment period. At dinner, OFS significantly increases satiety (P=0.04), reduces hunger (P=0.04) and prospective food consumption (P=0.05). The energy intake at breakfast and lunch are significantly lower (P=0.01, 0.03, respectively) after OFS treatment than after DM treatment. Total energy intake per day is 5% lower during OFS than in DM period.

CONCLUSION

Oligofructose treatment increases satiety following breakfast and dinner, reduces hunger and prospective food consumption following dinner. This pilot study presents a rationale to propose oligofructose supplements in the management of food intake in overweight and obese patients.

Carob pulp preparation rich in insoluble dietary fiber and polyphenols enhances lipid oxidation and lowers postprandial acylated ghrelin in humans

Ghrelin is an orexigenic hormone that may affect substrate utilization in humans. Ghrelin is influenced by macronutrients, but the effects of insoluble dietary fiber and polyphenols are unknown. We investigated the effects of a polyphenol-rich insoluble dietary fiber preparation from carob pulp (carob fiber) on postprandial ghrelin responses and substrate utilization. Dose-dependent effects of the consumption of carob fiber were investigated in a randomized, single-blind, crossover study in 20 healthy subjects, aged 22-62 y. Plasma total and acylated ghrelin, triglycerides, and serum insulin and nonesterified fatty acids (NEFA) levels were repeatedly assessed before and after ingestion of an isocaloric standardized liquid meal with 0, 5, 10, or 20 g of carob fiber over a 300-min period. The respiratory quotient (RQ) was determined after consumption of 0 or 20 g of carob fiber. Carob fiber intake lowered acylated ghrelin to 49.1%, triglycerides to 97.2%, and NEFA to 67.2% compared with the control meal (P < 0.001). Total ghrelin and insulin concentrations were not affected by consumption of a carob fiber-enriched liquid meal. Postprandial energy expenditure was increased by 42.3% and RQ was reduced by 99.9% after a liquid meal with carob fiber compared with a control meal (P < 0.001). We showed that the consumption of a carob pulp preparation, an insoluble dietary fiber rich in polyphenols, decreases postprandial responses of acylated ghrelin, triglycerides, and NEFA and alters RQ, suggesting a change toward increased fatty acid oxidation. These results indicate that carob fiber might exert beneficial effects in energy intake and body weight.

High-fibre, low-fat diet predicts long-term weight loss and decreased type 2 diabetes risk: the Finnish Diabetes Prevention Study

AIMS/HYPOTHESIS

The aim of this study was to investigate the association of dietary macronutrient composition and energy density with the change in body weight and waist circumference and diabetes incidence in the Finnish Diabetes Prevention Study.

SUBJECTS AND METHODS

Overweight, middle-aged men (n=172) and women (n=350) with impaired glucose tolerance were randomised to receive either 'standard care' (control) or intensive dietary and exercise counselling. Baseline and annual examinations included assessment of dietary intake with 3-day food records and diabetes status by repeated 75-g OGTTs. For these analyses the treatment groups were combined and only subjects with follow-up data (n=500) were included.

RESULTS

Individuals with low fat (<median) and high fibre (>median) intakes lost more weight compared with those consuming a high-fat (>median), low-fibre (<median) diet (3.1 vs 0.7 kg after 3 years). In separate models, hazard ratios for diabetes incidence during a mean follow-up of 4.1 years were (highest compared with lowest quartile) 0.38 (95% CI 0.19-0.77) for fibre intake, 2.14 (95% CI 1.16-3.92) for fat intake, and 1.73 (95% CI 0.89-3.38) for saturated-fat intake, after adjustment for sex, intervention assignment, weight and weight change, physical activity, baseline 2-h plasma glucose and intake of the nutrient being investigated. Compared with the low-fat/high-fibre category, hazard ratios were 1.98 (95% CI 0.98-4.02), 2.68 (95% CI 1.40-5.10), and 1.89 (95% CI 1.09-3.30) for low-fat/low-fibre, high-fat/high-fibre, and high-fat/low-fibre, respectively.

CONCLUSIONS/INTERPRETATION

Dietary fat and fibre intake are significant predictors of sustained weight reduction and progression to type 2 diabetes in high-risk subjects, even after adjustment for other risk factors.

Vegetarian Diets and Weight Status

The increasing global health problems of overweight and obesity are associated with coronary heart disease, hypertension, diabetes, osteoarthritis, and certain cancers, among other health concerns. Vegetarian diets are associated with reduced body weight, lower incidence of certain chronic disease, and lower medical costs compared with non-vegetarian diets. We reviewed the literature to ascertain the extent to which and by what mechanism(s) a plant-based diet may mediate body weight.