Homeostatic and non-homeostatic appetite control along the spectrum of physical activity levels: An updated perspective

Health-enhancing physical activity in obesity management: the need to (seriously) go beyond weight loss

There are many false hopes around the impact of physical activity and exercise in obesity management, especially regarding weight loss. Narrowly focusing on weight loss only leads to disappointment for patients and practitioners. Indeed, in persons with overweight or obesity, exercise training, specifically aerobic (i.e. endurance) training, is associated with significant additional weight and fat loss compared to the absence of training. However the magnitude of this effect remains modest, amounting to only 2-3 kg additional weight or fat loss on average. We therefore argue that this conversation needs to be re-oriented towards the many potential health benefits of physical activity that can be seen beyond weight loss. Exercise training has been shown to improve the cardiometabolic risk profile by effects including decreasing abdominal visceral fat and improving insulin sensitivity. Aerobic, as well as combined aerobic and resistance (i.e. strength) training, increase cardiorespiratory fitness, a major risk factor for ill health. Resistance training improves muscle strength, another major component of physical fitness, even in the absence of a significant change in muscle mass. Beyond body mass loss, recognizing the broad value of physical activity/exercise in improving health and quality of life of people with obesity is a crucial perspective shift.

Impact of physical activity on caloric and macronutrient intake in children and adolescents: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Physical activity is widely promoted to maintain and improve health across all ages. Investigating how physical activity affects subsequent food intake provides insight into the factors that contribute to maintaining energy balance and effective weight management.

OBJECTIVE

This systematic review and meta-analysis summarizes the evidence on the effect of acute physical activity on subsequent food intake in children and adolescents.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA) were applied. Randomized controlled trials (RCTs) objectively measuring post-exercise energy intake in children and adolescents aged 5 to 18 years were included. Studies with self-reported food intake were excluded. The databases PubMed, Web of Science and Cochrane Library were searched for RCTs, and the data were summarized at a qualitative and quantitative level. Version 2 of the Cochrane risk-of-bias tool for randomized trials was used to assess risk of bias. Changes in energy intake were examined with random effects meta-analysis. (PROSPERO: CRD42022324259).

RESULTS

Out of 9582 studies, 22 RCTs with cross-over design remained eligible for meta-analysis. The primary outcome was post-intervention energy intake up to the next 24 h. Heterogeneity of studies was moderate, with an I2 of 57%. The median (interquartile range, IQR) energy expended while exercising was 240 (158) kcal. Meta-analysis of 41 study arms (exercise n = 780 and control n = 478) showed no differences in total energy intake between the exercise and control group with a mean difference MD = 23.31 [-27.54, 74.15] kcal. No subgroup differences were found. Macronutrient intake and appetite sensations where not substantially affected.

CONCLUSION

Engaging in exercise is a suitable means of raising activity-induced energy expenditure, without causing any noticeable changes in food intake or hunger within a single day.

Food reward associations with motivational eating behavior traits and body mass index in Portuguese former elite athletes

BACKGROUND

Motivational eating behavior traits (i.e. eating motivations and intuitive eating) have an important role in body weight regulation, as do food reward processes. Their associations might help explain different responses to food stimulus in the current environment but have never been explored. This study's primary goal was to investigate food reward associations with eating motivations, intuitive eating dimensions and body mass index in former Portuguese elite athletes with overweight/obesity. As a first step, a cultural adaptation of the Leeds Food Preference Questionnaire (LFPQ) was created and validated in an online-surveyed Portuguese sample.

RESULTS

Step 1: Analysis from an online survey (N = 348; 69.8% female) conducted to validate the food images from the cultural adaptation of the LFPQ showed that most food images were properly recognized in terms of their fat and sweet content by the Portuguese population, except for some savory items. Step 2: Regarding our primary analysis in 94 former elite athletes with overweight/obesity, self-determined motivations to regulate eating and (to a lower extent) more body-food congruent choices (both markers for healthier eating behaviors) were associated with more favorable food reward outcomes, as opposed to non-self-determined motivations. Less emotional (more intuitive) eaters presented higher implicit wanting for low-fat sweet foods compared to more emotional eaters.

CONCLUSION

These findings suggest LFPQ usefulness to evaluate food preferences and detect relevant associations between food reward and motivational eating behavior traits in former elite athletes with overweight/obesity. Health professionals are encouraged to create need-supportive environments that foster self-determined motivations and help individuals make healthier food choices. © 2023 Society of Chemical Industry.

Consequences of Anorexia of Aging in Hospital Settings: An Updated Review

The anorexia of aging is a widespread problem amongst older people, particularly in the hospital setting with up to 60% affected. Despite its high prevalence anorexia often goes undiagnosed in hospital, due to a lack of standardized assessment and evidence-based management, but also lack of knowledge regarding consequences. This review summarizes current evidence for anorexia of aging specific to the hospital setting, giving an overview of correlates of appetite in hospital and consequences of anorexia. It highlights an overall scarcity of research on this important clinical problem for hospitalized cohorts. The few studies point to the importance of anorexia of aging in major health burdens for older people, namely malnutrition, sarcopenia and reduced physical performance, as well as higher mortality. Further research is needed to assess temporal sequence in pathways of causality and to develop effective interventions to combat anorexia.

Associations of menopausal status and eating behaviour with subjective measures of sleep

Eating and sleeping behaviour are known to interact with each other, yet research is limited in the context of menopausal women. The aim of this study was to examine whether menopausal status is associated with perceived problems in sleeping. Furthermore, we studied different aspects of eating behaviour as potential risk factors for poor sleep in menopausal women. The present study is exploratory in nature, thus the results should be interpreted as hypothesis-generating. We analysed the sleeping and eating behaviour of 1098 women aged 47-55 years and represented different menopausal statuses with regression analyses. Over 20% of them reported fairly poor or poor perceived sleep quality. A higher number of postmenopausal women reported experiencing at least fairly poor sleep quality compared with the other menopausal groups. However, in regression models controlled for several confounding factors menopausal status was not associated with measures of sleep. Women who reported more snacking-type eating behaviour were more likely to report shorter sleep duration, and more daytime tiredness. Externally cued eating was associated with shorter sleep duration and emotional eating was associated with experiencing daytime tiredness. However, after adjusting for multiple testing, it appears that eating behaviour is associated only with daytime tiredness. Menopausal women with sleeping problems may benefit from nutritional interventions targeting eating behaviour.

Higher energy flux may improve short-term appetite control in adolescents with obesity: the NEXT study

Recent evidence suggests better appetite control in states of high-energy flux (HEF) in adults and lean children. Nevertheless, it is unknown whether this extends to youth with obesity. This study compares the effects of low, moderate or HEF on short-term appetitive control in adolescents with obesity. Sixteen adolescents with obesity (12-16 years, Tanner stages 3-5, 11 females) randomly completed three conditions: (i) low-energy flux (LEF); (ii) moderate energy flux (MEF; + 250 kcal) and (iii) HEF (HEF; + 500 kcal). Energy flux was achieved in MEF and HEF through elevated energy intake (EI) and concomitant increase in energy expenditure using cycling exercise (65 % VO2peak). Ad libitum EI, macronutrient intake and relative EI were assessed at dinner, subjective appetite sensations taken at regular intervals and food reward measured before dinner. Ad libitum EI at dinner was greater in LEF compared with HEF (P = 0·008), and relative EI (REI) was higher in LEF compared with MEF (P = 0·003) and HEF (P < 0·001). The absolute consumption of carbohydrates was lower in LEF compared with MEF (P = 0·047) and HEF (P < 0·001). Total AUC for hunger and desire to eat was lower in HEF compared with LEF (P < 0·001) and MEF (P = 0·038). Total AUC for prospective food consumption was lower on HEF compared with LEF (P = 0·004). Food choice sweet bias was higher in HEF (P = 0·005) compared with LEF. To conclude, increasing energy flux may improve short-term appetite control in adolescents with obesity.

No Changes in Body Composition and Adherence to the Mediterranean Diet after a 12-Week Aerobic Training Intervention in Women with Systemic Lupus Erythematosus: The EJERCITA-LES Study

Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease linked to high cardiovascular risk. To reach an adequate body composition status while maintaining proper dietary habits are effective strategies for reducing cardiovascular risk, both being potentially modified through exercise. This study aimed to evaluate the effects of a 12-week aerobic training intervention on anthropometry, body composition and adherence to the Mediterranean diet in women with SLE. A total of 58 women with SLE were assigned to either an exercise group (EG; n = 26) or a comparison group (CG; n = 32) in this non-randomized controlled trial. The EG comprised 12 weeks of aerobic exercise (two sessions/week) between 40-75% of the individual's heart rate reserve (calculated as maximum heart rate - resting heart rate) and the CG received usual care. At baseline and after the intervention, the anthropometry (i.e., weight, waist circumference, waist-to-hip ratio, and body mass index) and body composition (i.e., fat mass and lean mass) were assessed using a stadiometer, an anthropometric tape, and a bioimpedance device, respectively. Dietary habits were assessed with the Mediterranean Diet score. There were no between-group differences in neither anthropometric nor body composition parameters (all p > 0.05). Similarly, no between-group differences were obtained in the adherence to the Mediterranean diet after the exercise intervention (all p > 0.05). Contrary to the initial hypothesis, these results suggest that the 12-week aerobic training intervention performed in this study did not improve anthropometry, body composition or adherence to the Mediterranean diet in women with SLE.

No effect of prefrontal transcranial direct current stimulation (tDCS) on food craving, food reward and subjective appetite in females displaying mild-to-moderate binge-type behaviour

Previous work suggests there may be an effect of transcranial direct current stimulation (tDCS) on appetite control in people at risk of overconsumption, however findings are inconsistent. This study aimed to further understand the potential eating behaviour trait-dependent effect of tDCS, specifically in those with binge-type behaviour. Seventeen females (23 ± 7 years, 25.4 ± 3.8 kg m-2) with mild-to-moderate binge eating behaviour completed two sessions of double-blind, randomised and counterbalanced anodal and sham tDCS applied over the right dorsolateral prefrontal cortex at 2.0 mA for 20 min. Subjective appetite visual analogue scales (VAS), the Food Craving Questionnaire-State (FCQ-S), and Leeds Food Preference Questionnaire (LFPQ) were completed pre- and post-tDCS. Participants then consumed a fixed-energy meal, followed by the VAS, FCQ-S and LFPQ. No difference between pre- and post-tDCS scores were found across fullness (p = 0.275, BF10 = 0.040), prospective consumption (p = 0.127, BF10 = 0.063), desire to eat (p = 0.247, BF10 = 0.054) or FCQ-S measures (p = 0.918, BF10 = 0.040) when comparing active and sham protocols. Only explicit liking and wanting for high-fat sweet foods were significantly different between conditions, with increased scores following active tDCS. When controlling for baseline hunger, the significant differences were removed (p = 0.138 to 0.161, BF10 = 0.810 to 1.074). The present data does not support the eating behaviour trait dependency of tDCS in a specific cohort of female participants with mild-to-moderate binge eating scores, and results align with those from individuals with healthy trait scores. This suggests participants with sub-clinical binge eating behaviour do not respond to tDCS. Future work should further explore effects in clinical and sub-clinical populations displaying susceptibility to overconsumption and weight gain.

Physical Exercise and Appetite Regulation: New Insights

Physical exercise is considered an important physiological intervention able to prevent cardiovascular diseases, obesity, and obesity-related cardiometabolic imbalance. Nevertheless, basic molecular mechanisms that govern the metabolic benefits of physical exercise are poorly understood. Recent data unveil new mechanisms that potentially explain the link between exercise, feeding suppression, and obesity.

The complex pattern of the effects of prolonged frequent exercise on appetite control, and implications for obesity

From a public health perspective, much of the interest in the relationship between exercise and appetite rests on the implications for energy balance and obesity. Energy balance reflects a dynamic 2-way interaction between energy expenditure (EE) and energy intake (EI). Physical activity and exercise, and appetite are the behavioural components of EE and EI, respectively. Beyond EE, exercise is a powerful and complex physiological stimulus acting on several bodily systems. There are multiple effects of frequent and prolonged exercise on appetite which include inter alia an increase in fasting hunger, an enhancement of post-prandial satiety, a modulation of the hedonic responses to food and improvements in eating behaviour traits. These lead to variable adjustments in EI and in a reduction in the susceptibility to overconsumption. Frequent and prolonged physical activity and exercise behaviour can strengthen and sensitise the appetite control system, whilst physical inactivity and sedentariness (low level of EE) fails to downregulate EI and can permit overconsumption. Not all of the effects of exercise operate uniformly to drive appetite in the same direction. The complexity of the interaction between EE and EI means that the effects of prolonged exercise are characterised by substantial individual heterogeneity. This leads to variable effects on energy balance and body mass.

Long-term aerobic and combined exercises enhance the satiety response and modulate the energy intake in patients with type 2 diabetes mellitus (T2DM): A randomized controlled trial

BACKGROUND

Energy homeostasis plays a vital role in achieving glycemic control in people with type 2 diabetes mellitus (T2DM). Exercise is known to increase energy expenditure. However, its role in energy intake has not been explored in people with T2DM. Thus, this study aimed at determining the impact of long-term aerobic and combined exercises in modulating hunger, satiety and energy intake in T2DM.

METHODS

A randomized controlled trial, with 108 people with T2DM, aged 35-60 years were assigned into an aerobic, combined (aerobic and resistance) and a control group. Primary outcomes were subjective levels of hunger and satiety measured by a 100 mm visual analogue scale in relation to a standard breakfast meal (453 kcal) and energy and macronutrient intake determined by a 3-day diet diary at 0, 3 and 6 months.

RESULTS

Aerobic and combined groups exhibited reduced hunger and increased satiety at 3 and 6 months (p < 0.05). The combined group demonstrated a profound increase in satiety at 3 and 6 months compared to aerobics (3 months; p = 0.008, 6 months; p = 0.002) and controls (3 months; p = 0.006, 6 months, p = 0.014). Mean daily energy intake was reduced only at 6 months in the aerobic group (p = 0.012), whereas it was reduced in the combined group at 3 and at 6 months compared to controls (3 months: p = 0.026, 6 months: p = 0.022).

CONCLUSIONS

Long-term aerobic and combined exercises produced a reduction in hunger, energy intake and increase satiety in people with T2DM. Despite energy expenditure, exercise seems to play a significant role in reducing energy intake as well. Combined exercises show more advantages over aerobic exercise since combined exercises have a greater impact on satiety and energy intake in people with T2DM.

TRIAL REGISTRATION NUMBER

SLCTR/2015/029, https://slctr.lk/trials/slctr-2015-029 .

Perceived Stress Is Directly Associated with Major Consumption of Sugar-Sweetened Beverages among Public University Students

Stress is a condition that has been related to the development of risk behaviors for health such as sugar-sweetened beverages (SSBs) consumption. The aim of this study was to examine the link between SSBs consumption and perceived stress level in university students. This was an observational, cross-sectional and single-time-point study where the subjects were recruited as a non-probabilistic sample of first-year university students. The students reported their SSBs consumption through a validated questionnaire, as well as their perceived stress level, evaluated through the Cohen scale. Comparisons were made between the means of all variables. Factorial analysis of variance was conducted to explore the effect of the variables’ interaction on the stress level. One-way analysis of variance was performed to assess differences between the sexes. Men consumed more SSBs (6101.17 ± 3772.50 mL/week) compared to women (4294.06 ± 3093.8 mL/week). However, women had higher scores of perceived stress and showed a strong association of stress with the SSBs consumption pattern (r and p-value). This study shows for the first time the association that exists between stress and SSBs consumption and indicates that it is related to sex in the young population.

Effects of acute exercise and exercise training on plasma GDF15 concentrations and associations with appetite and cardiometabolic health in individuals with overweight or obesity - A secondary analysis of a randomized controlled trial

Growth Differentiation Factor 15 (GDF15) is seemingly involved in appetite control. Acute exercise increases GDF15 concentrations in lean humans, but acute and long-term effects of exercise on GDF15 in individuals with overweight/obesity are unknown. We investigated the effects of acute exercise and exercise training on GDF15 concentrations in individuals with overweight/obesity and associations with appetite and cardiometabolic markers. 90 physically inactive adults (20-45 years) with overweight/obesity were randomized to 6-months habitual lifestyle (CON, n=16), or isocaloric exercise of moderate (MOD, n=37) or vigorous intensity (VIG, n=37), 5 days/week. Testing was performed at baseline, 3, and 6 months. Plasma GDF15 concentrations, other metabolic markers, and subjective appetite were assessed fasted and in response to acute exercise before an ad libitum meal. Cardiorespiratory fitness, body composition, insulin sensitivity, and intraabdominal adipose tissue were measured. At baseline, GDF15 increased 18% (95%CI: 4; 34) immediately after acute exercise and 32% (16; 50) 60 min post-exercise. Fasting GDF15 increased 21% (0; 46) in VIG after 3 months (p=0.045), but this attenuated at 6 months (13% (-11; 43), p=0.316) and was unchanged in MOD (11% (-6; 32), p=0.224, across 3 and 6 months). Post-exercise GDF15 did not change in MOD or VIG. GDF15 was not associated with appetite or energy intake. Higher GDF15 was associated with lower cardiorespiratory fitness, central obesity, dyslipidemia, and poorer glycemic control. In conclusion, GDF15 increased in response to acute exercise but was unaffected by exercise training. Higher GDF15 concentrations were associated with a less favorable cardiometabolic profile but not with markers of appetite. This suggests that GDF15 increases in response to acute exercise independent of training state. Whether this has an impact on free-living energy intake and body weight management needs investigation.

A comparison of meal-related appetite, food reward and eating behaviour traits in people with and without spinal cord injury

Persons with a spinal cord injury (SCI) are at a heightened risk of obesity. However, little is known about the effect of SCI on factors that influence energy intake. This study compared measures of food reward, eating behaviour traits, and appetite perceptions between adults with and without SCI. Twenty wheelchair dependent persons with chronic (>1 year) SCI (C1-T12) and twenty non-SCI individuals matched for BMI, age and sex participated. Following a familiarisation visit, participants consumed a breakfast meal, normalised for resting metabolic rate (RMR), and provided subjective appetite perceptions every 30 min for 4 h. Subsequently, energy intake was determined via an ad libitum lunch meal. Explicit liking, explicit wanting, implicit wanting and relative preference were assessed in a hungry and fed state via the Leeds Food Preference Questionnaire prior to and following the lunch meal. Eating behaviour traits were assessed via the Adult Eating Behaviour Questionnaire, Control of Eating Questionnaire, Reasons Individuals Stop Eating Questionnaire, and Three-Factor Eating Questionnaire Revised 18-item version. Sweet appeal bias was greater for explicit liking, explicit wanting, and relative preference in the group with SCI compared to the non-SCI group (p ≤ 0.024). The group with SCI also reported higher levels of cognitive restraint and satiety responsiveness (p ≤ 0.029). No group differences in postprandial appetite perceptions (p ≥ 0.690) or energy intake relative to RMR were seen (p = 0.358). However, the group with SCI demonstrated a trend toward a lower absolute energy intake (p = 0.063). In conclusion, food reward for sweet foods was greater in the group with SCI. Further, our findings suggest that acute appetite perceptions, including satiety profiles, are not different between persons with and without SCI.

The role of physical activity in the regulation of body weight: The overlooked contribution of light physical activity and sedentary behaviors

The role of physical activity (PA) in the regulation of body weight is still a major topic of debate. This may be because studies have essentially focused on the effects of moderate/vigorous PA (MVPA) on body weight while overlooking the other components of PA, namely, light-intensity PA (LPA, daily life activities) and sedentary behaviors (SB, too much sitting). In this review, we will (i) describe the history of changes in PA behaviors that occurred with modernization; (ii) review data from cross-sectional and longitudinal studies that examined the associations between PA, SB, and measures of obesity; (iii) review interventional studies that investigated the effects of changes in PA and SB on body weight and adiposity; and (iv) discuss experimental studies that addressed potential biological mechanisms underlying the effects of PA and SB on weight regulation. Overall recent findings support the importance of considering all components of PA to better understand the regulation of energy balance and suggest an important role for LPA and SB in addition to MVPA on body weight regulation. Longitudinal large-scale rigorous studies are needed to advance our knowledge of the role of PA/SB in combating the obesity epidemic.

How Does the Level of Physical Activity Influence Eating Behavior? A Self-Determination Theory Approach

Physical activity and diet are two predominant determinants of population health status that may influence each other. Physical activity has been identified as a behavior that may lead to a healthier diet and regulates eating behaviors. This research aimed to investigate how the level of physical activity is associated with the motivation related to eating behaviors and, consequently, the eating style individuals have on a daily basis. This was a cross-sectional study in which participants completed an online questionnaire that assessed the following variables: the level of physical activity, the motivation toward eating behavior, and the type of eating behavior. In total, 440 individuals (180 men and 260 women) who regularly exercised in gyms and fitness centers aged between 19 and 64 years (M = 33.84; SD = 10.09) took part in the study. The data were collected following the Declaration of Helsinki and with the approval of the Ethics Committee of the Polytechnic of Leiria. For the statistical analysis, mean and standard deviations were first calculated, as well as bivariate correlations between all the variables of interest. Then, structural equation model analyses were performed considering the levels of physical activity as the independent variable, motivations toward eating behavior as the mediators, and eating styles as the dependent variables. It was concluded that a greater level of physical activity leads to a more self-determined type of eating regulation, which in turn results in less constricted eating behaviors that are influenced by external factors and emotional factors.

Cognitive work on a walking desk does not lead to compensatory appetitive responses in healthy young adults

CONTEXT

In addition to the low energy expenditure induced by sedentary behaviors such as sitting, it has been shown that intense cognitive work can lead to an increase in food intake. Walking Desk provide the opportunity for office workers to replace prolonged sitting at work with light intensity physical activity.

OBJECTIVE

To compare the effects of sitting vs standing vs walking during a cognitive task on energy intake, appetite sensations, food reward and overall energy balance.

METHODS

Fifteen normal weight (BMI: 24.1 ± 1.2 kg m-2) young men (23.4 ± 2.1 years) randomly performed three conditions: sitting desk (SitD), standing desk (StD) and walking desk (WD), while performing a 45-min cognitive task. Energy expenditure was measured by indirect calorimetry, regular appetite sensations were assessed using visual analogue scales, energy intake measured during an ad libitum meal and the relative energy intake calculated. Pre and post-test meal food reward was evaluated through the Leeds Food Preference Questionnaire.

RESULTS

Relative energy intake decreased by 150 kcal in WD compared with SitD, however it did not reach statistical significance. There were no differences in appetite sensations nor food reward between the three conditions. Energy expenditure was significantly higher in WD (141.8 ± 13 kcal) than in SitD (78.7 ± 5 8 kcal) and StD (85.9 ± 8 kcal) (p ≤ 0.05).

CONCLUSION

Walking desk use can decrease sedentary time while working without any appetitive compensation. The small reduction in energy balance with walking while working could induce significant health benefits if repeated over time. Future longer studies need to clarify whether active desks can contribute to the prevention or management of weight gain.

Effects of different diets used to induce obesity/metabolic syndrome on bladder function in rats

Preclinical and human studies on the relationship between obesity/metabolic syndrome (MetS) and lower urinary tract dysfunction (LUTD) are inconsistent. We compared the temporal effects of feeding four different diets used to induce obesity/MetS, including 60% fructose, 2% cholesterol +10% lard, 30% fructose + 20% lard, or 32.5% lard diet, up to 42 wk, on metabolic parameters and bladder function in male Sprague-Dawley rats. Rats fed a 30% fructose + 20% lard or 32.5% lard diet consumed less food (grams), but only the 32.5% lard diet group took in more calories. Feeding rats a 60% fructose or 30% fructose + 20% lard diet led to glucose intolerance and increased blood pressure. Higher body weight and increased cholesterol levels were observed in the rats maintained on a 2% cholesterol +10% lard diet, whereas exposure to a 32.5% lard diet affected most of the above parameters. Voiding behavior measurement showed that voiding frequency and the total voided volume were lower in the experimental diet groups except for the 30% fructose + 20% lard group. The mean voided volume was lower in the 30% fructose + 20% lard and 32.5% lard groups compared with the control group. Cystometric analysis revealed a decreased bladder capacity, mean voided volume, intermicturition interval, and compliance in the 32.5% lard diet group. In conclusion, experimental diets including 60% fructose, 30% fructose + 20% lard, or 2% cholesterol + 10% lard diet differently affected physiological and metabolic parameters and bladder function to a limited extent, while exposure to a 32.5% lard diet had a greater impact.

Mood and physical activity are associated with appetite in hospitalised older men and women

BACKGROUND

The anorexia of ageing is important in the development of malnutrition, frailty and sarcopenia amongst the older population and is a particular problem for hospital inpatients. This study assessed appetite-related factors in a group of hospitalised older adults, to identify potential preventive strategies.

DESIGN

Cross sectional observational study.

SETTING

Eleven wards in one large hospital in England.

SUBJECTS

Older inpatients aged ≥70 years, admitted non-electively.

METHODS

Appetite was assessed using the four-item Simplified Nutritional Appetite Questionnaire (SNAQ). Associations between SNAQ score and appetite-related factors present in the dataset were assessed in continuous analyses, including habitual physical activity, mood, medication, cognition and living circumstances.

RESULTS

200 participants, mean age of 80.7 years (SD 6.9); 40% were women. Prevalence of poor appetite was 43%. In univariate analyses, lower medication count, higher habitual physical activity and better mood were associated with higher SNAQ scores during admission. In a multivariate analysis, independent associations of higher habitual physical activity and better mood with higher SNAQ scores during hospital admission remained.

CONCLUSION

In this group of older adults, better mood and higher habitual physical activity were independently associated with better appetite during hospital admission. These are potentially modifiable factors and could be targets for future research into interventions for the anorexia of ageing in the hospitalised older population.

Assessment of Energy and Nutrient Intake and the Intestinal Microbiome (ErNst study): Protocol and Methods of a Cross-sectional Human Observational Study (Preprint)

BACKGROUND

On the national level, nutritional monitoring requires the assessment of reliable representative dietary intake data. To achieve this, standardized tools need to be developed, validated, and kept up-to-date with recent developments in food products and the nutritional behavior of the population. Recently, the human intestinal microbiome has been identified as an essential mediator between nutrition and host health. Despite growing interest in this connection, only a few associations between the microbiome, nutrition, and health have been clearly established. Available studies paint an inconsistent picture, partly due to a lack of standardization.

OBJECTIVE

First, we aim to verify if food consumption, as well as energy and nutrient intake of the German population, can be recorded validly by means of the dietary recall software GloboDiet, which will be applied in the German National Nutrition Monitoring. Second, we aim to obtain high-quality data using standard methods on the microbiome, combined with dietary intake data and additional fecal sample material, and to also assess the functional activity of the microbiome by measuring microbial metabolites.

METHODS

Healthy female and male participants aged between 18 and 79 years were recruited. Anthropometric measurements included body height and weight, BMI, and bioelectrical impedance analysis. For validation of the GloboDiet software, current food consumption was assessed with a 24-hour recall. Nitrogen and potassium concentrations were measured from 24-hour urine collections to enable comparison with the intake of protein and potassium estimated by the GloboDiet software. Physical activity was measured over at least 24 hours using a wearable accelerometer to validate the estimated energy intake. Stool samples were collected in duplicate for a single time point and used for DNA isolation and subsequent amplification and sequencing of the 16S rRNA gene to determine microbiome composition. For the identification of associations between nutrition and the microbiome, the habitual diet was determined using a food frequency questionnaire covering 30 days.

RESULTS

In total, 117 participants met the inclusion criteria. The study population was equally distributed between the sexes and 3 age groups (18-39, 40-59, and 60-79 years). Stool samples accompanying habitual diet data (30-day food frequency questionnaire) are available for 106 participants. Current diet data and 24-hour urine samples for the validation of GloboDiet are available for 109 participants, of which 82 cases also include physical activity data.

CONCLUSIONS

We completed the recruitment and sample collection of the ErNst study with a high degree of standardization. Samples and data will be used to validate the GloboDiet software for the German National Nutrition Monitoring and to compare microbiome composition and nutritional patterns.

TRIAL REGISTRATION

German Register of Clinical Studies DRKS00015216; https://drks.de/search/de/trial/DRKS00015216.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/42529.

Longitudinal associations between physical activity and other health behaviours during the COVID-19 pandemic: a fixed effects analysis

Government enforced restrictions on movement during the COVID-19 pandemic are likely to have had profound impacts on the daily behaviours of many individuals, including physical activity (PA). Given the associations between PA and other health behaviours, changes in PA during the pandemic may have been detrimental for other health behaviours. This study aimed to evaluate whether changes in PA during and after the first national lockdown in the United Kingdom (UK) were associated with concurrent changes in alcohol consumption, sleep, nutrition quality, diet quantity and sedentary time. Data were derived from the UCL COVID-19 Social Study, in which 52,784 adults were followed weekly across 22 weeks of the pandemic from 23rd March to 23rd August 2020. Fixed effects regression models showed that greater PA was positively associated with improved sleep and nutrition quality. However, increases in PA also showed modest associations with increased alcohol consumption and sedentary time. Encouraging people to engage in PA may lead to wider changes in other health behaviours in times of adversity. These associations could be a result of increases in available leisure time for many people during COVID-19 restrictions and are of ongoing importance given the emerging long-term changes to lifestyle and working patterns.

Aging and Neural Vulnerabilities in Overeating: A Conceptual Overview and Model to Guide Treatment

Given the vulnerability of older adults to chronic disease and physical disability, coupled with the threat that obesity poses to healthy aging, there is an urgent need to understand the causes of positive energy balance and the struggle that many older adults face with intentional weight loss. This paper focuses on neural vulnerabilities related to overeating in older adults, and moderating variables that can have either favorable or unfavorable effect these vulnerabilities. Research from our laboratory on older adults with obesity suggests that they are prone to similar neural vulnerabilities for overeating that have been observed in younger and middle-aged populations. In addition, following brief postabsorptive states, functional brain networks both in the resting state and in response to active imagery of desired food are associated with 6-month weight loss. Data reviewed suggest that the sensorimotor network is a central hub in the process of valuation and underscores the central role played by habits in overeating. Finally, we demonstrate how research on the neural vulnerabilities for overeating offers a useful framework for guiding clinical decision-making in weight management.

Associations of physical activity and sedentary behavior with appetite sensations and eating regulation behaviors before and during the initial year following bariatric surgery

Background

Bariatric surgery produces weight loss in part by impacting appetite and eating behavior. Research suggests physical activity (PA) assists with regulation of appetite and eating during non-surgical weight loss, although whether PA carries similar benefits in the context of bariatric surgery is unknown.

Objective

Evaluate associations of moderate-to-vigorous intensity PA (MVPA) and sedentary time (ST) with appetite sensations (hunger [homeostatic/hedonic], satiety) and eating regulation behaviors (restraint, disinhibition) before and during the initial year following bariatric surgery.

Method

Adult bariatric patients received an accelerometer to measure MVPA/ST and a smartphone to complete appetite/eating ratings at four semi-random times daily for 10 days at pre- and 3-, 6-, and 12-months post-surgery. Data were analyzed using generalized linear mixed models.

Results

Higher MVPA levels related to more satiety across time (p = 0.045) and more restraint at 3-months post-surgery (p < 0.001). At pre-surgery, higher MVPA levels also related to more disinhibition (p's < 0.01), although participants reported more disinhibition on days they performed less MVPA than usual (p = 0.017). MVPA did not relate to hunger. Lower ST levels related to more hedonic hunger (p = 0.003), especially at 12-months post-surgery (p < 0.001), and participants reported more homeostatic hunger on days they accumulated more ST than usual (p = 0.044). Additionally, higher ST levels related to more disinhibition at 3-months post-surgery (p's < 0.01) and lower restraint at pre-surgery (p's < 0.05). ST did not relate to satiety.

Conclusions

This study is the first to show that MVPA and ST each associate with appetite and eating regulation in daily life before and during post-surgical weight loss. Results, while preliminary and requiring experimental confirmation, highlight potential for targeting bariatric patients' activity behaviors to enhance modulation of appetite, control of food intake, and resistance to overeating.

Attenuation of Post-Exercise Energy Intake Following 12 Weeks of Sprint Interval Training in Men and Women with Overweight

An acute bout of sprint interval training (SIT) performed with psychological need-support incorporating autonomy, competence, and relatedness has been shown to attenuate energy intake at the post-exercise meal, but the long-term effects are not known. The aim of this trial was to investigate the effects of 12 weeks of SIT combined with need-support on post-exercise food consumption. Thirty-six physically inactive participants with overweight and obesity (BMI: 29.6 ± 3.8 kg·m−2; V˙O2peak 20.8 ± 4.1 mL·kg−1·min−1) completed three sessions per week of SIT (alternating cycling for 15 s at 170% V˙O2peak and 60 s at 32% V˙O2peak) with need-support or traditional moderate-intensity continuous training (MICT) without need-support (continuous cycling at 60% V˙O2peak). Assessments of appetite, appetite-related hormones, and ad libitum energy intake in response to acute exercise were conducted pre- and post-intervention. Fasting appetite and blood concentrations of active ghrelin, leptin, and insulin did not significantly differ between groups or following the training. Post-exercise energy intake from snacks decreased significantly from pre- (807 ± 550 kJ) to post- SIT (422 ± 468 kJ; p < 0.05) but remained unaltered following MICT. SIT with psychological need-support appears well-tolerated in a physically inactive population with overweight and offers an alternative to traditional exercise prescription where dietary intake is of concern.

Type, Intensity, and Duration of Exercise as Regulator of Gut Microbiome Profile

ABSTRACT

Gut microbiome profile is related to individual health. In metabolic syndrome, there is a change in the gut microbiome profile, indicated by an increase in the ratio of Firmicutes to Bacteroidetes. Many studies have been conducted to determine the effect of exercise on modifying the gut microbiome profile. The effectiveness of exercise is influenced by its type, intensity, and duration. Aerobic training decreases splanchnic blood flow and shortens intestinal transit time. High-intensity exercise improves mitochondrial function and increases the essential bacteria in lactate metabolism and urease production. Meanwhile, exercise duration affects the hypothalamic-pituitary-adrenal axis. All of these mechanisms are related to each other in producing the effect of exercise on the gut microbiome profile.

Effects of Movement Behaviors on Overall Health and Appetite Control: Current Evidence and Perspectives in Children and Adolescents

PURPOSE OF REVIEW

To present the definitions and recommendations for movement behaviors in children and adolescents, including physical activity (PA), sedentary behaviors (SB), and sleep, and to provide an overview regarding their impact on health and obesity outcomes from childhood to adulthood, as well as interactions with appetite control.

RECENT FINDINGS

PA represents a variable proportion of daily energy expenditure and one can be active with high SB or vice versa. Studies have described movements across the whole day on a continuum from sleep to SB to varying intensities of PA. More PA, less SB (e.g., less screen time) and longer sleep are positively associated with indicators of physical health (e.g., lower BMI, adiposity, cardiometabolic risk) and cognitive development (e.g., motor skills, academic achievement). However, less than 10% of children currently meet recommendations for all three movement behaviors. Movement behaviors, adiposity, and related cardiometabolic diseases in childhood track into adolescence and adulthood. Furthermore, low PA/high SB profiles are associated with increased energy intake. Recent studies investigating energy balance regulation showed that desirable movement behavior profiles are associated with better appetite control and improved eating habits. Early identification of behavioral phenotypes and a comprehensive approach addressing all key behaviors that directly affect energy balance will allow for individual strategies to prevent or treat obesity and its comorbidities. Investigating exercise as a potential "corrector" of impaired appetite control offers a promising weight management approach.

Impact of Frailty on Dietary Habits among Community-Dwelling Older Persons during the COVID-19 Pandemic in Japan

Background

The coronavirus disease (COVID-19) pandemic has resulted in reduced physical activity and social interaction. These restrictions may have affected the food intake habits of frail older people more than non-frail older people.

Objectives

To investigate the association between frailty and change in dietary habit during the pandemic.

Design

Cross-sectional mail survey

Setting

Community-based

Participants

The study questionnaire was mailed to 4,436 older residents of Higashiura, Aich Japan, who were aged ≥75 years and who did not need care as of April 1, 2020. Of these, 2,738 participants provided complete answers to the questionnaires (75–96 years old, 49.3% males).

Measurements

The participants’ frailty status and changes in food consumption during social isolation were assessed. Frailty status was assessed using the five-item frailty screening index (i.e., weight loss, low physical function, low physical activity, cognition, and exhaustion). Any participant who reported an increase or a decrease in ≥1 of the 12 food categories was defined as having change in dietary habit. Using multivariate logistic regression analysis, the odds ratios (ORs) and 95% confidence intervals (CIs) of frailty for changes in diet were estimated by adjusting for age, sex, BMI, and living alone. In each of the 12 food categories, the proportion of participants with increased and decreased food intake was compared between the groups.

Results

Among the participants, 470 (17.2%) were frail, and 1,097 (40.1%) experienced a change in dietary habit under social restriction. The adjusted OR (95% CI) of the frail group for a change in dietary habit was 2.01 (1.63–2.47, p<0.001). Participants with decreased consumption of meat, fish, seaweed and mushroom, and fruits and those with increased consumption of eggs, bread, and noodles tended to be frail.

Conclusion

The nutritional intervention for frail older people should be strengthened during the pandemic.

Dynamic associations between anxiety, stress, physical activity, and eating regulation over the course of a behavioral weight loss intervention

Negative emotional experiences are associated with dysregulated eating behaviors that impede weight management. While weight loss interventions promote physical activity and self-regulation of eating, no studies have examined how physical activity may directly influence eating by attenuating associations between negative emotions and eating.

OBJECTIVE

The current study examined how momentary negative emotions (stress and anxiety), moderate-to-vigorous intensity physical activity (MVPA), and their interactions predict eating dysregulation (i.e., intensity of eating temptations, inability to resist eating tempting foods, overeating), as well as how these associations change during a weight loss intervention.

METHODS

Women with overweight/obesity (N = 55) completed 14-day ecological momentary assessment (EMA) protocols with objective measurement of physical activity (i.e., bout-related MVPA time) before and after a three-month internet-based weight loss program.

RESULTS

Three-way interactions emerged predicting overeating and eating tempting foods. When women experienced higher than usual levels of momentary anxiety or stress at end-of-treatment, they were less likely to subsequently overeat or eat tempting foods when they had recently engaged in more MVPA (relative to their usual level). No significant associations were found for ratings of temptation intensity.

CONCLUSIONS

Findings suggest MVPA may exert direct effects on eating regulation. Specifically, MVPA appears to increasingly buffer the effect of negative emotional states on dysregulated eating behavior over the course of a weight loss intervention. Future work is needed to develop ways of communicating to patients how activity can have both indirect and direct effects on body weight, and examine whether such knowledge improves outcomes.

The Effects of Exercise on Appetite in Older Adults: A Systematic Review and Meta-Analysis

Background: The effect of physical activity and exercise on hunger and satiety has been well-studied in younger adults, but the influence of aging is less understood. While some evidence suggests that acute bouts of exercise induce a compensatory eating drive, long-term activity may improve satiety sensitivity. The objective of this study was to investigate the effects of exercise on appetite in older adults.

Methods: We systematically reviewed available literature investigating the effect of exercise on appetite in older adults adults (CRD42020208953). PubMed, PsycINFO, Academic Search Complete, the Sports Medicine & Education Index, and Web of Science, were searched for peer-reviewed articles published in English with no date restriction. Included studies implemented a primary exercise or physical activity intervention with a control group, on a generally healthy population ≥60 years of age. Selected studies included at least one appetite outcome. Risk of bias was assessed using the 11-point Physiotherapy Evidence Database (PEDro) tool. Standardized mean difference summary statistics (Hedge's g effect sizes) and 95% confidence intervals were reported.

Results: We identified 15 reports (13 studies) which met all inclusion criteria (5 resistance training, 3 aerobic, 6 mixed modalities). Studies included 443 participants (Age = 68.9 ± 5.2, 82.3% female) and had generally “good” bias scores (PEDro = 6.4 ± 0.88). Random effects meta-analyses revealed that the exercising group showed statistically significant reductions in glucose [SMD = −0.34 (95% CI: −0.67, −0.02), p < 0.05, PEDro =6.4 ± 0.45] and leptin [SMD = −0.92 (95% CI: −1.28, −0.57), p < 0.00001, PEDro = 6.2 ± 0.75].

Discussion: This systematic review revealed that exercise and physical activity may modulate resting hunger and satiety in older adults. Decreases in fasting leptin and glucose hormones suggest that exercise promotes satiety sensitivity in adults aged 60+. This review highlights that engaging in exercise and activity programs may provide a meaningful avenue for improving chronic and functional disease burden in later life by promoting appetite control and balanced energy intake. Recommendations for future research include investigations of appetite in response to varied exercise modalities within more diverse and representative samples of older adults.

Associations of quantity and quality of carbohydrate sources with subjective appetite sensations during 3-year weight-loss maintenance: Results from the PREVIEW intervention study

BACKGROUND & AIMS

The association of quantity and quality of carbohydrate sources with appetite during long-term weight-loss maintenance (WLM) after intentional weight loss (WL) is unclear. We aimed to investigate longitudinal associations of quantity and quality of carbohydrate sources with changes in subjective appetite sensations during WLM.

METHODS

This secondary analysis evaluated longitudinal data from the 3-year WLM phase of the PREVIEW study, a 2 × 2 factorial (diet-physical activity arms), multi-center, randomized trial. 1279 individuals with overweight or obesity and prediabetes (25-70 years; BMI≥25 kg m^-2) were included. Individuals were merged into 1 group to assess longitudinal associations of yearly changes in appetite sensations. Quantity and quality of carbohydrate sources including total carbohydrate, glycemic index (GI), glycemic load (GL), and total dietary fiber were assessed via 4-day food diaries at 4 timepoints (26, 52, 104, and 156 weeks) during WLM. Visual analog scales were used to assess appetite sensations in the previous week.

RESULTS

During WLM, participants consumed on average 160.6 (25th, 75th percentiles 131.1, 195.8) g·day^-1 of total carbohydrate, with GI 53.8 (48.7, 58.8) and GL 85.3 (67.2, 108.9) g day^-1, and 22.3 (17.6, 27.3) g·day^-1 of dietary fiber. In the available-case analysis, multivariable-adjusted linear mixed models with repeated measures showed that each 30-g increment in total carbohydrate was associated with increases in hunger (1.36 mm year^-1, 95% CI 0.77, 1.95, P < 0.001), desire to eat (1.10 mm year^-1, 0.59, 1.60, P < 0.001), desire to eat something sweet (0.99 mm year^-1, 0.30, 1.68, P = 0.005), and weight regain (0.20%·year^-1, 0.03, 0.36, P = 0.022). Increasing GI was associated with weight regain, but not associated with increases in appetite sensations. Each 20-unit increment in GL was associated with increases in hunger (0.92 mm year^-1, 0.33, 1.51, P = 0.002), desire to eat (1.12 mm year^-1, 0.62, 1.62, P < 0.001), desire to eat something sweet (1.13 mm year^-1, 0.44, 1.81, P < 0.001), and weight regain (0.35%·year^-1, 0.18, 0.52, P < 0.001). Surprisingly, dietary fiber was also associated with increases in desire to eat, after adjustment for carbohydrate or GL.

CONCLUSIONS

In participants with moderate carbohydrate and dietary fiber intake, and low to moderate GI, we found that higher total carbohydrate, GL, and total fiber, but not GI, were associated with increases in subjective desire to eat or hunger over 3 years. This study was registered as ClinicalTrials.gov, NCT01777893.

Health Behaviors of Austrian Secondary Level Pupils at a Glance: First Results of the From Science 2 School Study Focusing on Sports Linked to Mixed, Vegetarian, and Vegan Diets

Attaining healthy behaviors is essential at any life stage, particularly childhood, due to the strong link between children’s lifestyle and the subsequent adult state of health. This multidisciplinary study aimed to assess lifestyle behaviors of Austrian pupils of secondary schools I and II, with a specific focus on PA habits and diet types based on a large sample. In total, 8845 children/adolescents participated in the short standardized online survey on relevant health-related aspects nationwide. Valid and complete data was provided by 8799 pupils, including 1.14% of the eligible 771,525; 63% girls, 76% having a normal body weight, 70% attending secondary schools II, and more pupils/students living in rural vs. urban areas (3:1 ratio). Across the total sample, 11.8% were considered overweight/obese with a higher prevalence of overweight/obesity in boys than girls (15.5% vs. 9.6%) and urban vs. rural participants (13.9% vs. 10.8%; p < 0.05). The majority of participants (84.5%) reported a mixed diet, while 7.2% and 8.5% reported a vegan and vegetarian diet, respectively. Vegans reported a lesser alcohol intake (p < 0.05) compared to non-vegan pupils (no difference in dietary subgroups for smoking). Although overall PA and dietary behaviors suggest an appropriate health status among Austrian youth, attention should be focused on policies to increase healthy lifestyle habits at best through a dual approach to health permanently combining regular PA, sports, and exercise with a healthy diet, which would contribute to matching the current recommendations for improving individual and public health.

The future of human malnutrition: rebalancing agency for better nutritional health

The major threat to human societies posed by undernutrition has been recognised for millennia. Despite substantial economic development and scientific innovation, however, progress in addressing this global challenge has been inadequate. Paradoxically, the last half-century also saw the rapid emergence of obesity, first in high-income countries but now also in low- and middle-income countries. Traditionally, these problems were approached separately, but there is increasing recognition that they have common drivers and need integrated responses. The new nutrition reality comprises a global ‘double burden’ of malnutrition, where the challenges of food insecurity, nutritional deficiencies and undernutrition coexist and interact with obesity, sedentary behaviour, unhealthy diets and environments that foster unhealthy behaviour. Beyond immediate efforts to prevent and treat malnutrition, what must change in order to reduce the future burden? Here, we present a conceptual framework that focuses on the deeper structural drivers of malnutrition embedded in society, and their interaction with biological mechanisms of appetite regulation and physiological homeostasis. Building on a review of malnutrition in past societies, our framework brings to the fore the power dynamics that characterise contemporary human food systems at many levels. We focus on the concept of agency, the ability of individuals or organisations to pursue their goals. In globalized food systems, the agency of individuals is directly confronted by the agency of several other types of actor, including corporations, governments and supranational institutions. The intakes of energy and nutrients by individuals are powerfully shaped by this ‘competition of agency’, and we therefore argue that the greatest opportunities to reduce malnutrition lie in rebalancing agency across the competing actors. The effect of the COVID-19 pandemic on food systems and individuals illustrates our conceptual framework. Efforts to improve agency must both drive and respond to complementary efforts to promote and maintain equitable societies and planetary health.

Is Energy Expenditure or Physical Activity Considered When Energy Intake Is Measured? A Scoping Review 1975-2015

The health-transitions humans have delivered during the 20th Century associated with the nutrition is that from undernutrition to obesity, which perseveres in the current years of the 21st Century. Energy intake (EI) is a contributing factor and therefore a fascination in nutritional sciences. However, energy expenditure (EE) has not been usually considered as a conjoint factor. Thus, this study aimed to review if studies on adults consider data on dietary intake, specifically EI, and included data on EE and physical activity (PA). A search of MEDLINE from 1975 to December 2015 was managed. Our scoping review consisted of keywords related to EI, dietary allowances, and nutritional requirements. From 2229 acknowledged articles, 698 articles were finally taken fulfilling inclusion and quality criteria. A total of 2,081,824 adults (53.7% females) were involved, and most studies had been conducted in EEUU (241), Canada (42), Australia (30), Japan (32), and Brazil (14). In Europe, apart from UK (64), the Netherlands (31) and France (26) led the classification, followed by Sweden (18), Denmark (17), and France (26). Mediterranean countries are represented with 27 studies. A total of 76.4% did not include EE and 93.1% did not include PA. Only 23.6% of the studies contained both EI and EE. A large methodological diversity was perceived, with more than 14 different methods regarding EI, and more than 10 for EE. PA was only analyzed in scarce articles, and scarcely considered for interpretation of data and conclusions. Moreover, PA was often measured by subjective questionnaires. Dietary surveys show a large diversity regarding methodology, which makes comparability of studies difficult. EE and PA are missing in around 80% of studies or are not included in the interpretation of results. Conclusions regarding EI or diet adequacy in adults should not be taken without analyzing EE and PA.

Effect of exercise training interventions on energy intake and appetite control in adults with overweight or obesity: A systematic review and meta-analysis

This systematic review examined the impact of exercise training interventions on energy intake (EI) and appetite control in adults with overweight/obesity (≥18 years including older adults). Articles were searched up to October 2019. Changes in EI, fasting appetite sensations, and eating behavior traits were examined with random effects meta-analysis, and other outcomes were synthesized qualitatively. Forty-eight articles were included (median [range] BMI = 30.6 [27.0-38.4] kg/m² ). Study quality was rated as poor, fair, and good in 39, seven, and two studies, respectively. Daily EI was assessed objectively (N = 4), by self-report (N = 22), with a combination of the two (N = 4) or calculated from doubly labeled water (N = 1). In studies rated fair/good, no significant changes in pre-post daily EI were found and a small but negligible (SMD < 0.20) postintervention difference when compared with no-exercise control groups was observed (five study arms; MD = 102 [1, 203] kcal). There were negligible-to-small pre-post increases in fasting hunger and dietary restraint, decrease in disinhibition, and some positive changes in satiety and food reward/preferences. Within the limitations imposed by the quality of the included studies, exercise training (median duration of 12 weeks) leads to a small increase in fasting hunger and a small change in average EI only in studies rated fair/good. Exercise training may also reduce the susceptibility to overconsumption (PROSPERO: CRD42019157823).

Effect of Combined Interval and Continuous Exercise Training on Gastric Emptying, Appetite, and Adaptive Responses in Men With Overweight and Obesity

Background/Objectives: Characterizing compensatory and adaptive responses to exercise assists in understanding changes in energy balance and health outcomes with exercise interventions. This study investigated the effects of a short-term exercise intervention (combining high intensity interval (HII) and continuous exercise) on (1) gastric emptying, appetite and energy intake; and (2) other adaptive responses including cardiorespiratory fitness, in inactive men with overweight/obesity. Methods: Fifteen men (BMI: 29.7 ± 3.3 kg/m-2) completed a 4-wk supervised exercise intervention, consisting of 5 exercise sessions per week alternating between HII (30 s at 100% VO2max followed by 30 s recovery) and continuous (at 50% VO2max) training on a cycle ergometer, progressing from 30 to 45 min session duration. Gastric emptying (13C-octanoic acid breath test), appetite (visual analog scale), energy intake (ad libitum lunch meal), body composition (air displacement plethysmography), non-exercise activity (accelerometery) VO2max, blood pressure, and fasting concentrations of glucose, insulin, and ghrelin were measured before and after (≥48 h) the intervention. Results: Gastric emptying, glucose, insulin and ghrelin were unchanged, but energy intake at the ad libitum lunch test meal significantly increased at post-intervention (+171 ± 116 kcal, p < 0.01). Body weight (-0.9 ± 1.1 kg), waist circumference (-2.3 ± 3.5 cm) and percent body fat (-0.9 ± 1.1%) were modestly reduced (P < 0.05). VO2max increased (+4.4 ± 2.1 ml.kg.min-1) by 13% and systolic (-6.2 ± 8.4 mmHg) and diastolic (-5.8 ± 2.2 mmHg) blood pressure were significantly reduced (P ≤ 0.01 for all). Conclusions: Four weeks of exercise training did not alter gastric emptying, indicating gastric emptying may only adapt to a higher volume/longer duration of exercise or changes in other characteristics associated with regular exercise. The combination of HII and continuous exercise training had beneficial effects on body composition, cardiorespiratory fitness, and blood pressure and warrants further investigation in larger randomized controlled trials.

Behavioural mediators of reduced energy intake in a physical activity, diet, and sleep behaviour weight loss intervention in adults

Reduced energy intake is a major driver of weight loss and evidence suggests that physical activity, dietary, and sleep behaviours interact to influence energy intake. Energy restriction can be challenging to sustain. Therefore to improve intervention efficacy, evaluation of how changes in physical activity, diet, and sleep behaviours mediate reduced energy intake in adults with overweight/obesity who participated in a six-month multiple-behaviour-change weight loss intervention was undertaken. This was a secondary analysis of a 3-arm randomised controlled trial. Adults with body mass index (BMI) 25-40 kg/m² were randomised to either: a physical activity and diet intervention; physical activity, diet, and sleep intervention; or wait-list control. Physical activity, dietary intake, and sleep was measured at baseline and six-months using validated measures. The two intervention groups were pooled and compared to the control. Structural equation modelling was used to estimate the mediated effects (AB Coefficient) of the intervention on total energy intake. One hundred and sixteen adults (70% female, 44.5y, BMI 31.7 kg/m²) were enrolled and 70% (n = 81) completed the six-month assessment. The significant intervention effect on energy intake at six-months (-1011 kJ/day, 95% CI -1922, -101) was partially mediated by reduced fat intake (AB = -761.12, 95% CI -1564.25, -53.74) and reduced consumption of energy-dense, nutrient-poor foods (AB = -576.19, 95% CI -1189.23, -97.26). In this study, reducing fat intake and consumption of energy-dense, nutrient-poor foods was an effective strategy for reducing daily energy intake in adults with overweight/obesity at six-months. These strategies should be explicitly targeted in future weight loss interventions.

Effect of Acute Exercise and Cycling Desk on Energy Intake and Appetite Response to Mental Work: The CORTEX Study

BACKGROUND

While mental work has been shown to favor overconsumption, the present study compared the effect of a cognitive task alone, followed by acute exercise, or performed on a cycling desk, on short-term food intake and appetite in adults.

METHODS

A total of 19 normal-weight adults randomly completed: resting session (CON), 30-minute cognitive task (CT), 30-minute cognitive task followed by a 15-minute high-intensity interval exercise bout (CT-EX), and 30-minute cognitive task performed on a cycling desk (CT-CD). Energy expenditure was estimated (heart rate-workload relationship), and energy intake (EI; ad libitum) and appetite (visual analog scales) were assessed.

RESULTS

Energy expenditure was higher in CT-EX (P < .001) compared with the other conditions and in CT-CD compared with CON and CT (P < .01). EI was higher in CON (P < .05) and CT-CD compared with CT (P < .01). Relative EI was higher in CON compared with CT (P < .05) and lower in CT-EX compared with CT, CT-CD, and CON (all Ps < .001). Area under the curve desire to eat was higher in CON compared with CT (P < .05) and CT-EX (P < .01). Area under the curve prospective food consumption was higher in CON compared with CT-EX (P < .01). Overall composite appetite score was not different between conditions.

CONCLUSION

While cycling desks are recommended to break up sedentary time, the induced increase in energy expenditure might not be enough to significantly reduce overall short-term relative EI after mental work.

Anhedonia, positive affect dysregulation, and risk and maintenance of binge-eating disorder

Low positive affect has been identified as an antecedent of binge-eating episodes among individuals with binge-eating disorder (BED), yet positive affect has received far less attention in eating disorders research than its counterpart, negative affect. In this article, we argue that the low levels of positive affect which occur with anhedonia (i.e., loss of interest or pleasure in activities) may contribute to the onset and maintenance of BED. We introduce a theoretical model in which anhedonia increases the risk for BED through its interrelationships with dysregulated eating and weight gain, and we describe potential direct (e.g., reward-related processes) as well as indirect (e.g., influences on depressive symptoms and physical activity) pathways by which anhedonia may lead to adverse eating- and weight-related outcomes. We also propose a momentary maintenance model in which low positive affect and positive affect dysregulation occurring with anhedonia maintain binge eating directly and indirectly through maladaptive health behaviors, such as decreased physical activity, less healthy eating, and fewer social interactions, which in turn maintain anhedonia. We draw upon outside literature to present evidence that aligns with the proposed risk and maintenance models and conclude by outlining avenues for future research-including methodological/measurement, theoretical, and clinical research directions.

Effects of energy balance on appetite and physiological mediators of appetite during strenuous physical activity: secondary analysis of a randomised crossover trial

Energy deficit is common during prolonged periods of strenuous physical activity and limited sleep, but the extent to which appetite suppression contributes is unclear. The aim of this randomised crossover study was to determine the effects of energy balance on appetite and physiological mediators of appetite during a 72-h period of high physical activity energy expenditure (about 9·6 MJ/d (2300 kcal/d)) and limited sleep designed to simulate military operations (SUSOPS). Ten men consumed an energy-balanced diet while sedentary for 1 d (REST) followed by energy-balanced (BAL) and energy-deficient (DEF) controlled diets during SUSOPS. Appetite ratings, gastric emptying time (GET) and appetite-mediating hormone concentrations were measured. Energy balance was positive during BAL (18 (sd 20) %) and negative during DEF (–43 (sd 9) %). Relative to REST, hunger, desire to eat and prospective consumption ratings were all higher during DEF (26 (sd 40) %, 56 (sd 71) %, 28 (sd 34) %, respectively) and lower during BAL (–55 (sd 25) %, −52 (sd 27) %, −54 (sd 21) %, respectively; Pcondition < 0·05). Fullness ratings did not differ from REST during DEF, but were 65 (sd 61) % higher during BAL (Pcondition < 0·05). Regression analyses predicted hunger and prospective consumption would be reduced and fullness increased if energy balance was maintained during SUSOPS, and energy deficits of ≥25 % would be required to elicit increases in appetite. Between-condition differences in GET and appetite-mediating hormones identified slowed gastric emptying, increased anorexigenic hormone concentrations and decreased fasting acylated ghrelin concentrations as potential mechanisms of appetite suppression. Findings suggest that physiological responses that suppress appetite may deter energy balance from being achieved during prolonged periods of strenuous activity and limited sleep.

An Increase in Fat-Free Mass is Associated with Higher Appetite and Energy Intake in Older Adults: A Randomised Control Trial

Cross-sectional studies in younger adults have demonstrated a positive association between energy intake (EI) and fat-free mass (FFM), with this relationship seemingly mediated by resting metabolic rate (RMR). Establishing a causal effect longitudinally would be prudent in older adults suffering from loss of appetite. We investigated the effects of FFM on RMR, appetite and EI in 39 healthy older adults (age: 66 ± 4 years, BMI: 25.1 ± 3.5 kg∙m²) assigned to either 12-week resistance training + protein supplementation group (RT + PRO) or control group (CON). Body composition, subjective appetite, leptin, insulin, RMR and laboratory-measured ad libitum EI were measured at baseline, weeks 6 and 12 of the intervention, while daily EI at baseline and week 12. FFM (+1.2 kg; p = 0.002), postprandial subjective appetite (+8 mm; p = 0.027), ad libitum EI (+119 kcal; p = 0.012) and daily EI (+133 kcal; p = 0.010) increased from baseline to week 12 in the RT + PRO. RMR, fasted subjective appetite, leptin and insulin concentrations remained unchanged (all p > 0.05). The increases ad libitum EI correlated with increases in FFM (r = 0.527, p = 0.001), with 54% of the change in EI attributed to FFM changes. In conclusion, FFM increases were associated with an increased ad libitum EI and postprandial appetite in older adults.

Body Fatness Influences Associations of Body Composition and Energy Expenditure with Energy Intake in Healthy Women

OBJECTIVE

This study aimed to investigate the influence of body fatness on the associations of body composition and energy expenditure (EE) with energy intake (EI).

METHODS

Data from 93 women (BMI = 25.5 [SD 4.2] kg/m² ) recruited for two studies (Study 1, n = 48, BMI = 25.0-34.9 kg/m² ; Study 2, n = 45, BMI = 18.5-24.9 kg/m² ) were examined. Body composition, resting metabolic rate (RMR), and test meal EI were assessed during a laboratory probe day. Physical activity, total daily EE (TDEE), and self-reported free-living 24-hour EI were collected during 7 days.

RESULTS

In the whole sample, fat-free mass (r = 0.45; P < 0.001), RMR (r = 0.41; P < 0.001), and TDEE (r = 0.39; P < 0.001), but not fat mass (r = 0.17; P = 0.11), were positively associated with free-living 24-hour EI. Body fat percentage moderated the associations of RMR (β = -1.88; P = 0.02) and TDEE (β = -1.91; P = 0.03) with mean free-living 24-hour EI. Fat mass was negatively associated with test meal EI only in the leaner group (r = -0.43; P = 0.004), and a weak nonlinear association was observed in the whole sample (r²  = 0.092; P = 0.04).

CONCLUSIONS

Body fat percentage appears to moderate the associations between EE and daily EI. Furthermore, the negative association between fat mass and test meal EI observed in leaner individuals was absent in those with higher body fatness. Therefore, higher levels of body fatness may weaken the coupling between EE and EI.

A Motivational Pathway Linking Physical Activity to Body-Related Eating Cues

OBJECTIVE

To explore the motivational transfer between physical activity (PA) and body-related eating cues, through self-determined motivations to exercise (SDM Ex) and regulate eating (SDM Eat).

DESIGN

Cross-sectional.

SETTING

Participants completed an online inventory on PA and eating behaviors and motivations in 2017-2018.

PARTICIPANTS

A convenience sample of 300 adults (71% women; 34.4 ± 10.7 years; 23.2 ± 3.4 kg/m²), recruited through Facebook and cooperating Portuguese gyms.

VARIABLES MEASURED

Moderate-to-vigorous physical activity (independent), SDM Ex and SDM Eat (mediators), and body-related eating cues (dependent) variables assessed through validated self-reported measures.

ANALYSIS

Structural equation modeling and serial mediation procedures were used to test the hypothetical model.

RESULTS

Physical activity was positively associated with SDM Ex, which was, in turn, associated with SDM Eat, which in turn positively predicted reliance on hunger/satiety cues and (more strongly) body-food choice congruence. The path through exercise and eating motivations was the leading mediating path in the PA and body-food choice congruence association.

CONCLUSIONS AND IMPLICATIONS

This study lends support to the motivational transfer hypothesis between SDM Ex and SDM Eat in normal-weight adults, suggesting that more physically active individuals present higher SDM Ex and SDM Eat, and therefore, greater attentiveness to body-related eating cues and necessities. Encouraging PA might also improve individuals' eating self-regulation, especially if self-determined motivations are targeted in future interventions.

'I have been all in, I have been all out and I have been everything in-between': A 2-year longitudinal qualitative study of weight loss maintenance

BACKGROUND

Qualitative studies investigating weight management experiences are usually cross-sectional or of short duration, which limits understanding of the long-term challenges.

METHODS

Eleven women [mean (SD) age 44.9 (9.8) years; body mass index 40.3 (4.0) kg m^-2 ] participated in this longitudinal qualitative study, which included up to 20 weeks of total diet replacement (825-853 kcal day^-1 ) and ongoing support for weight loss maintenance (WLM), to 2 years. Semi-structured interviews were conducted at baseline and programme end, as well as at key intervals during the intervention. Questions examined five theoretical themes: motivation, self-regulation, habits, psychological resources and social/environmental influences. Data were coded and analysed in nvivo (https://qsrinternational.com/nvivo) using the framework method.

RESULTS

In total, 64 interviews were completed (median, n = 6 per participant). Mean (SD) weight loss was 15.7 (9.6) kg (14.6% body weight) at 6 months and 9.6 (9.9) kg (8.8% body weight) at 2 years. The prespecified theoretical model offered a useful framework to capture the variability of experiences. Negative aspects of obesity were strong motivations for weight loss and maintenance. Perceiving new routines as sustainable and developing a 'maintenance mindset' was characteristic of 'Maintainers', whereas meeting emotional needs at the expense of WLM goals during periods of stress and negative mood states was reported more often by 'Regainers'. Optimistic beliefs about maintaining weight losses appeared to interfere with barrier identification and coping planning for most participants.

CONCLUSIONS

People tended to be very optimistic about WLM without acknowledging barriers and this may undermine longer-term outcomes. The potential for regain remained over time, mainly as a result of emotion-triggered eating to alleviate stress and negative feelings. More active self-regulation during these circumstances may improve WLM, and these situations represent important targets for intervention.

Difference in Housing Temperature-Induced Energy Expenditure Elicits Sex-Specific Diet-Induced Metabolic Adaptations in Mice

OBJECTIVE

The aim of this study was to test whether increased energy expenditure (EE), independent of physical activity, reduces acute diet-induced weight gain through tighter coupling of energy intake to energy demand and enhanced metabolic adaptations.

METHODS

Indirect calorimetry and quantitative magnetic resonance imaging were used to assess energy metabolism and body composition during 7-day high-fat/high-sucrose (HFHS) feeding in male and female mice housed at divergent temperatures (20°C vs. 30°C).

RESULTS

As previously observed, 30°C housing resulted in lower total EE and energy intake compared with 20°C mice regardless of sex. Interestingly, housing temperature did not impact HFHS-induced weight gain in females, whereas 30°C male mice gained more weight than 20°C males. Energy intake coupling to EE during HFHS feeding was greater in 20°C versus 30°C housing, with females greater at both temperatures. Fat mass gain was greater in 30°C mice compared with 20°C mice, whereas females gained less fat mass than males. Strikingly, female 20°C mice gained considerably more fat-free mass than 30°C mice. Reduced fat mass gain was associated with greater metabolic flexibility to HFHS, whereas fat-free mass gain was associated with diet-induced adaptive thermogenesis.

CONCLUSIONS

These data reveal that EE and sex interact to impact energy homeostasis and metabolic adaptation to acute HFHS feeding, altering weight gain and body composition change.

Daily energy balance and eating behaviour during a 14-day cold weather expedition in Greenland

We assessed energy compensation, appetite, and reward value of foods during a 14-day military expedition in Greenland realized by 12 male French soldiers, during which energy compensation was optimized by providing them with easy-to-eat palatable foods in excess. Although daily energy expenditure (estimated by accelerometry) stayed relatively constant throughout the expedition (15 ± 9 MJ·day−1), energy intake (EI; estimated by self-reported diaries) was 17% higher during the D8–D14 period compared with the D1–D7 period, leading to a neutral energy balance (EB). Body fat mass (BFM) significantly decreased (–1.0 ± 0.7 kg, p < 0.001) but not body mass (BM). Neither hunger scores (assessed by visual analog scales) nor components of the reward value of food (explicit liking (EL) and food preference) were significantly altered. However, changes in EL at D10 were positively correlated with changes in BM (r = 0.600, p < 0.05) and BFM (r = 0.680, p < 0.05) and changes in hunger in the EI of the relevant period (r = 0.743, p < 0.01 for D1–D7, r = 0.652, p < 0.05 for D8–14). This study shows that the negative EB and BM loss can be attenuated by an appropriate food supply and that subjective components of eating behaviour, such as hunger and EL, may be useful to predict the magnitude of energy compensation.

Novelty Energy intake increases during of a 14-day expedition in the cold. Energy compensation was likely facilitated by providing participants with easy-to-eat palatable and familiar foods. Hunger scores and EL for energy-dense foods were associated with high EIs and low BM changes.

An exploratory investigation of the impact of 'fast' and 'feed' days during intermittent energy restriction on free-living energy balance behaviours and subjective states in women with overweight/obesity

BACKGROUND/OBJECTIVES

This controlled-feeding randomised controlled trial examined free-living appetite and physical activity (PA) on 'fast' and 'feed' days during intermittent energy restriction (IER), compared to continuous energy restriction (CER).

SUBJECTS/METHODS

Forty-six women with overweight/obesity (age = 35 ± 10 years, BMI = 29.1 ± 2.3 kg/m²) were randomised to IER (n = 24; alternate fast days at 25% energy requirements and ad libitum feed days) or CER (n = 22; 75% energy requirements daily) to ≥5% weight loss (WL) or up to 12 weeks. Self-reported energy intake (EI; online food record), objectively measured PA (SenseWear Armband) and retrospective daily hunger and food cravings were measured over 7 days at baseline, week 2 and final week. Intent-to-treat analyses were performed using linear mixed models.

RESULTS

Final WL (M_Δ = 4.7 [95% confidence interval 4.2, 5.2] kg, 5.9%) did not differ between IER and CER (interaction P = 0.307). During IER, feed-day EI did not differ from baseline and was lower in the final week compared to week 2 (M_Δ = 295 [81, 509] kcal, P = 0.004). Daily hunger was greater on fast compared to feed days (M_Δ = 15 [10, 21] mm, P < 0.001), but food cravings did not differ. Light PA was lower on fast relative to feed days (M_Δ = 18 [2, 34] min/day, P = 0.024), with no other differences in PA. Compared to CER, IER increased hunger and led to smaller improvements in craving control (both interactions P ≤ 0.034).

CONCLUSIONS

IER fast days were associated with increased free-living hunger and lower light PA compared to feed days, but had no impact on food cravings or self-reported ad libitum daily EI. IER may be less favourable than CER for the free-living day-to-day control of hunger and food cravings.

Effect of a 10-month residential multidisciplinary weight loss intervention on food reward in adolescents with obesity

BACKGROUND

While multidisciplinary weight loss (WL) programs have been suggested to improve the sensitivity of appetite control system, this study examined for the first time the effect of a specific multidisciplinary intervention on the hedonic aspects of food intake in adolescents with obesity.

STUDY DESIGN

Twenty-four adolescents (11-15 years) with obesity (mean BMI: 35.7 ± 4.5 kg/m²; BMI percentile: 98.7 ± 0.5) took part in a 10-month inpatient WL program, which included physical activity, nutritional education and psychological support. Height, weight, body composition, food reward (pre- and post-meal), ad libitum energy intake, appetite sensations and eating behavior traits were assessed at baseline, 5 months and at the end of the 10-month intervention. Analyses were conducted with linear mixed models and paired t-tests.

RESULTS

The mean WL was 8.9 ± 6.9 kg. Appetite sensations and pre-meal hedonic ratings of liking for all food categories (HF: high-fat; LF: low-fat; SA: savory; SW: sweet) increased after 5 months (fasting hunger, p = 0.02; fasting desire to eat, p = 0.01; daily hunger, p = 0.001; pre-meal liking for HFSA, p = 0.03; LFSA, p = 0.04; HFSW, p = 0.009; LFSW, p = 0.005). In contrast, appetite sensations (fasting and daily), emotional eating (p < 0.001), uncontrolled eating (p = 0.009), and pre-meal explicit liking (for all food categories) decreased between months 5 and 10. Post-meal liking for HFSA (p < 0.001), LFSA (p = 0.002), HFSW (p = 0.02) and LFSW (p < 0.001) decreased between baseline and month 5 and remained unchanged between months 5 and 10.

CONCLUSION

These findings suggest that adaptive mechanisms to WL occurring in the short-to-medium term are attenuated in the longer term with the persistence of WL. These results indicate improvements in the reward response to food in adolescents with obesity and may contribute to the beneficial effect of multicomponent WL interventions in this population. Future studies are required to confirm these findings and elucidate underlying mechanisms.