Should obese patients be counselled to follow a low-glycaemic index diet? No

Effect of biscuits formulated with high-amylose maize flour on satiety-related sensations and food intake

The amount of amylose within a food may elicit lower glycemic and insulin postprandial responses and thus potentially modulate the satiating effect. In this context, the effect of biscuits formulated with high amylose starch (HAS) flour on satiety-related sensations and food intake was studied. Three types of biscuits were produced: control biscuit (CRT, 0% of HAS), Amy-25 (25% HAS), and Amy-50 (50% HAS). Fifteen healthy volunteers were enrolled to conduct two in vivo experiments. In experiment 1, volunteers consumed biscuits ad libitum and their sensations of satiety and food intake were evaluated. In experiment 2, volunteers received a quantity of biscuits equivalent to the 20% of the daily estimated energy requirements, and both satiety-related sensations and food intake were checked at subsequent meal. The Amy-50 significantly reduced food intake at subsequent meal (p ˂ 0.05), compared to Amy-25 and CRT. The satiety-related sensations were not significantly affected in both experiments, excepted for intra-meal hunger variation induced by Amy-25 which resulted significantly higher (p ˂ 0.05) than Amy-50 and CRT. These findings support the need to reformulate carbohydrate rich foods commonly consumed in a dietary context, to provide consumers healthier alternatives to prevent and tackle obesity and related chronic diseases.

Lower Postprandial Thermogenic Response to an Unprocessed Whole Food Meal Compared to an Iso-Energetic/Macronutrient Meal Replacement in Young Women: A Single-Blind Randomized Cross-Over Trial

In contrast to ultra-processed foods that are associated with increased weight gain and obesity risk, nutritionally engineered dietary supplements, including meal replacement (MR) bars and shakes, are generally promoted as healthy. Limited data is available comparing the metabolic and hunger responses of whole food (WF) versus MR meals. The purpose of this study was to directly compare the thermic effect (TEM), respiratory exchange ratio (RER), hunger/taste ratings, and glucose response of two different breakfast meals containing MR and WF products in young healthy women. Eight volunteers completed two iso-caloric (529 kcals)/macronutrient (50% carbohydrates; 26% fat; 24% protein) test meals in a single-blind, randomized crossover design: (1) whole food meal; or (2) meal replacement. TEM was significantly higher following MR compared with WF (percent mean difference: 7.76 ± 3.78%; absolute mean difference: 0.053 ± 0.026 kcal/minute, p = 0.048), whereas WF substrate utilization demonstrated lower carbohydrate oxidation (RER) than MR (mean difference: -0.024 ± 0.008, p = 0.005). No differences existed for blood glucose response and feelings of hunger, desire to eat, and satiety among trials. Consumption of an MR meal increases postprandial thermogenesis and RER compared to a WF meal, which may impact weight control and obesity risk over the long-term.

The effect on satiety of ingesting isosweet and isoenergetic sucrose- and isomaltulose-sweetened beverages: a randomised crossover trial

Generating feelings of satiety may be important in maintaining weight control. It has been hypothesised that the circulating concentration of glucose is a major determinant of satiety, yet the relationship between postprandial glycaemia and satiety is inconclusive. Our aim was to assess satiety following ingestion of beverages differing in glycaemic index (GI) containing either 50 g of sucrose (GI 65) or isomaltulose (PalatinoseTM) (GI 32). The beverages were matched for sweetness using a triangle sensory test. Seventy-seven participants were randomised to the order in which they received each beverage, 2 weeks apart. A standard lunch was given at 12.00 hours. Satiety was measured using 100-mm visual analogue scales (VAS) administered at 14.00 hours (baseline) and at 30, 60, 90, 120, 150 and 180 min after ingesting the beverage. Weighed diet records were kept from 17.00 to 24.00 hours. Mean differences for isomaltulose compared with sucrose AUC VAS were ‘How hungry do you feel?’ 109 (95 % CI –443, 661) mm × min; ‘How satisfied do you feel?’ 29 (95 % CI –569, 627) mm × min; ‘How full do you feel?’ −91 (95 % CI –725, 544) mm × min and ‘How much do you think you can eat?’ 300 (95 % CI –318, 919) mm × min. There was no between-treatment difference in satiety question responses or in dietary energy intake −291 (95 % CI −845, 267) kJ over the remainder of the day. In this experiment, feelings of satiety were independent of the GI of the test beverages. Any differences in satiety found between foods chosen on the basis of GI could be attributable to food properties other than the glycaemic-inducing potential of the food.

Non-adherence to established dietary guidelines associated with increased mortality: the Copenhagen General Population Study

AIMS

The relevance of adherence to established dietary guidelines is repeatedly challenged. We hypothesised that non-adherence to established dietary guidelines is associated with an excess risk of cardiovascular, non-cardiovascular and all-cause mortality.

METHODS

We studied 100,191 white adult Danes aged 20-100 years recruited in 2003-2015 and followed up until December 2018. During follow-up equalling 865,600 person-years, 9273 individuals died. Participants' diets were assessed at baseline by a food frequency questionnaire focusing on key foods defining a healthy diet according to Danish dietary guidelines. Individuals were divided into five categories ranging from very high to very low adherence to dietary guidelines and studied with Cox and Fine-Gray regression models. At study inclusion, we collected demographic and lifestyle characteristics by questionnaire, made a physical examination and took a blood sample.

RESULTS

Cardiovascular, non-cardiovascular and all-cause mortality increased gradually with increasing non-adherence to dietary guidelines. Cardiovascular mortality was 30% higher (95% confidence interval 7-57%), non-cardiovascular mortality 54% higher (32-79%) and all-cause mortality 43% higher (29-59%) in individuals with very low adherence to dietary guidelines compared with those with very high adherence after adjustments for age, sex, education, income, smoking, leisure time physical activity and alcohol intake. Mortality risk estimates were similar in all strata of adjusted variables.

CONCLUSION

Non-adherence to Danish food-based dietary guidelines is associated with up to 43% increased all-cause mortality in a dose-response manner. The mortality excess was seen for both cardiovascular and non-cardiovascular causes. The public has good reasons to have confidence in and to adhere to established dietary guidelines.

Lemon juice, but not tea, reduces the glycemic response to bread in healthy volunteers: a randomized crossover trial

PURPOSE

The inhibition of enzymes that hydrolyze starch during digestion could constitute an opportunity to slow down the release, and ultimately the uptake, of starch-derived glucose. Simple dietary approaches consisting in pairing starch-rich foods with beverages that have the capacity to inhibit such enzymes could be an effective and easily implementable strategy. The objective of this work was to test the impact of black tea and lemon juice on the glycemic response to bread and subsequent energy intake in healthy adults.

METHODS

A randomized crossover study was conducted with equal portions of bread (100 g) and 250 ml of water, black tea or lemon juice. Capillary blood glucose concentrations were monitored during 180 min using the finger-prick method. Ad libitum energy intake was assessed 3 h later.

RESULTS

Tea had no effect on the glycemic response. Lemon juice significantly lowered the mean blood glucose concentration peak by 30% (p < 0.01) and delayed it more than 35 min (78 vs. 41 min with water, p < 0.0001). None of the tested beverages had an effect on ad libitum energy intake.

CONCLUSION

These results are in agreement with previous in vitro studies showing that lowering the pH of a meal can slow down starch digestion through premature inhibition of salivary α-amylase. Furthermore, the effect of lemon juice was similar to what has been repeatedly observed with vinegar and other acidic foods. Including acidic beverages or foods in starchy meals thus appears to be a simple and effective strategy to reduce their glycemic impact.

Salmon in Combination with High Glycemic Index Carbohydrates Increases Diet-Induced Thermogenesis Compared with Salmon with Low Glycemic Index Carbohydrates⁻An Acute Randomized Cross-Over Meal Test Study

The study investigated the acute effects of meals containing either salmon or veal in combination with carbohydrates with high or low glycemic index (GI) on diet-induced thermogenesis (DIT) (primary endpoint), appetite sensations, and energy intake (EI). Twenty-five overweight men and women ingested four iso-caloric test meals: salmon with mashed potatoes (high GI) (SM), salmon with wholegrain pasta (low GI) (SP), veal with mashed potatoes (VM) and veal with wholegrain pasta (VP). Energy expenditure was measured in the fasting state and six times postprandially for 25 min with 5-min breaks between each measurement. Appetite sensations were measured every 30 min. Blood samples, from arterialized venous blood, were drawn every 20 min until an ad libitum buffet-style lunch was served 3.5 h later. DIT was 40% higher after the SM meal compared to the SP meal (p = 0.002). Prospective food consumption was lower after the SM meal compared with the VP meal (p = 0.01). There were no differences in satiety, hunger, fullness, or ad libitum EI between the test meals (all p > 0.05). In conclusion, salmon with high GI carbohydrates increased DIT compared to salmon with low GI carbohydrates. This indicates that DIT is sensitive to the GI of the carbohydrates after intake of salmon but not veal.

Meals based on cod or veal in combination with high or low glycemic index carbohydrates did not affect diet-induced thermogenesis, appetite sensations, or subsequent energy intake differently

The objective of this study was to investigate the acute effects of meals containing protein from either cod or veal in combination with high or low glycemic index (GI) carbohydrates, on diet-induced thermogenesis (DIT) (primary endpoint), appetite, energy intake (EI), as well as postpranidal ghrelin, glucose, and insulin responses. Twenty-three overweight men and women (mean ± SD age: 30.0 ± 7.6 y, BMI: 27.2 ± 1.4 kg/m²) consumed 4 test meals: cod with mashed potatoes (high GI carbohydrate), cod with wholegrain pasta (low GI carbohydrate), veal with mashed potatoes, and veal with wholegrain pasta (∼2010 kJ, ∼25.5 E% protein, ∼41.0 E% carbohydrate, ∼33.5 E% fat). Energy expenditure was measured at baseline and six times postprandially, each lasting 25 min. Additionally, appetite sensations were measured every half hour. Arterialized venous blood samples were drawn every 20 min until an ad libitum buffet-style lunch was served 3.5 h later. DIT did not differ between test meals (P > 0.05), and there were no differences in appetite sensations or ad libitum EI (all, P > 0.05). Meal-time interactions were found for glucose and insulin (P = 0.04 and P < 0.001). Pairwise comparisons revealed that glucose and insulin peaks were higher after the meals with high GI carbohydrates. No differences were found between meals with cod or veal in combination with carbohydrates with low or high GI on DIT, appetite sensations, or EI in overweight men and women. However, as expected meals with high GI carbohydrates resulted in higher glucose and insulin responses compared to meals with low GI carbohydrates regardless of protein source.

Sea buckthorn decreases and delays insulin response and improves glycaemic profile following a sucrose-containing berry meal: a randomised, controlled, crossover study of Danish sea buckthorn and strawberries in overweight and obese male subjects

PURPOSE

Berries and mixed berry products exert acute effects on postprandial glycaemia and insulinemia, but very few berries have been studied, and primarily in normal weight subjects. Sea buckthorn and strawberry are compositionally widely different berries and may likely produce different responses. The effects of strawberry and sea buckthorn on postprandial glycaemia and insulinemia were examined in overweight or obese male subjects. Subjective appetite sensations and ad libitum intake were also examined.

METHODS

The study was conducted as a randomised, controlled, single-blinded, three-way crossover study. Eighteen subjects were studied in three 2-h meal tests followed by a subsequent ad libitum meal. Test meals contained added sucrose and either sea buckthorn, strawberry or no berries with added fructose (control). Blood samples were collected at t = 0, 30, 45, 60, 90 and 120 min. Subjective appetite sensations were recorded at t = 0, 15, 30, 45, 60, 90, 120, and 140 min and subsequent ad libitum intake was recorded. Statistical differences in all continuous measures were evaluated based on the existence of a meal or a time-meal interaction by repeated measures linear model analyses or by differences in AUC by linear mixed models.

RESULTS

None of the berries affected postprandial glucose. However, sea buckthorn improved glycaemic profile (44.7%, p < 0.01) compared to control. Sea buckthorn also resulted in a decrease in plasma insulin concentration at 30 min (39.6%, p < 0.01) and at 45 min (16.5%, p < 0.05) compared to control and the maximal increase in plasma insulin was lower following sea buckthorn compared with control (23.6%, p < 0.01). Strawberry did not affect postprandial insulin concentrations compared to control. No differences between control and each of the two berries were observed for any of the appetite parameters, except for desire for something sweet, which was increased following the sea buckthorn meal compared to control.

CONCLUSIONS

There was no effect on postprandial glucose response to a sugar challenge given together with purees of strawberry or sea buckthorn. Sea buckthorn decreased and delayed the insulin response and improved glycaemic profile compared with control. Strawberry had no such effects. No important differences were seen for the appetite measures. Sea buckthorn might be useful as a culinary tool for lowering meal insulin response.

Effect of Glycemic Index of Breakfast on Energy Intake at Subsequent Meal among Healthy People: A Meta-Analysis

Meals with low glycemic index (GI) may suppress short-term appetite and reduce subsequent food intake compared with high-GI meals. However, no meta-analysis has been conducted to synthesize the evidence. This meta-analytic study was conducted to assess the effect of high- and low-GI breakfast on subsequent short-term food intake. Trials were identified through MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled trials, and manual searches of bibliographies until May 2015. Randomized controlled and cross-over trials comparing the effect of low- with high-GI breakfast on subsequent energy intake among healthy people were included. Nine studies consisting of 11 trials met the inclusion criteria. Only one trial was classified with high methodological quality. A total of 183 participants were involved in the trials. The meta-analytic results revealed no difference in breakfast GI (high-GI vs. low-GI) on subsequent short-term energy intake. In conclusion, it seems that breakfast GI has no effect on short-term energy intake among healthy people. However, high quality studies are still warranted to provide more concrete evidence.

Sugar-sweetened and artificially-sweetened beverages in relation to obesity risk

The goal of this review was to critically evaluate the scientific evidence in humans on the potential effect of sweetened beverages on weight gain and risk of obesity in youth and adults. Two categories of these beverages were reviewed. Sugar-sweetened beverages (SSBs) include soft drinks, colas, other sweetened carbonated beverages, and fruit drinks with added sugar. Artificially sweetened beverages (ASBs), also referred to as non-nutritive sweetened beverages, are marketed and used as a replacement for SSBs for those who want to reduce sugar and caloric intake. The totality of evidence to date demonstrates a pattern across observational and experimental studies of an increased risk of weight gain and obesity with higher intake of SSBs. However, it remains difficult to establish the strength of the association and the independence from other potentially confounding factors. The primary reason for unclear conclusions regarding the robustness of any effect of SSBs is due to the heterogeneity and methodologic limitations of both observational and experimental studies on this topic. Although some observational studies have suggested that ASBs may cause increased risk of obesity and cardiometabolic diseases, there is no clear mechanism for this pathway, and the epidemiologic studies are highly inconsistent. An important issue with the observational studies on ASBs and obesity or disease risk is reverse causality bias, with higher-quality studies demonstrating this possibility. The field needs higher-quality experimental studies in humans, with relevant direct comparisons between sweetened beverages and their sweetened solid-food alternatives.

Body weight regulation and obesity: dietary strategies to improve the metabolic profile

This review discusses dietary strategies that may improve the metabolic profile and body weight regulation in obesity. Recent evidence demonstrated that long-term health effects seem to be more beneficial for low-glycemic index (GI) diets compared to high-protein diets. Still, these results need to be confirmed by other prospective cohort studies and long-term clinical trials, and the discrepancy between these study designs needs to be explored in more detail. Furthermore, the current literature is mixed with regard to the efficacy of increased meal frequency (or snacking) regimens in causing metabolic alterations, particularly in relation to body weight control. In conclusion, a growing body of evidence suggests that dietary strategies with the aim to reduce postprandial insulin response and increase fat oxidation, and that tend to restore metabolic flexibility, have a place in the prevention and treatment of obesity and associated metabolic disorders.

Molecular weight of barley β-glucan influences energy expenditure, gastric emptying and glycaemic response in human subjects

Barley β-glucan (BG) has been shown to reduce glycaemic response (GR) in some studies. It is hypothesised that this reduction may be a function of its physical properties that delay gastric emptying (GE). The effect of these changes in GR and GE on diet-induced thermogenesis (DIT) is not known. The aim of the present study was to assess the effect of BG of different molecular weights and purities on GR, GE and DIT in healthy subjects. This was a randomised, single-blind, repeated-measures design where fifteen healthy subjects were tested on three occasions following an overnight fast. Following the baseline measurements, the volunteers were fed a soup containing high-molecular-weight BG (HBG), a soup containing low-molecular-weight BG (LBG) or a control soup with no BG (CHO). Following the consumption of the breakfast, GR was measured using finger-prick blood samples, GE was determined using the 13C-octanoic acid breath test and DIT was measured using indirect calorimetry. There was a difference in GR AUC between the soups after 60 min but not after 120 min. The CHO and LBG meals had a greater GR than the HBG meal. There were differences in all GE time points, with the HBG meal having the slowest GE time. There was a correlation between the GR and the initial GE times. There were differences in total DIT between the three test meals with the HBG meal having the lowest DIT. The present study indicates that HBG has the ability to delay GE due to increased viscosity, resulting in a decreased GR and DIT.

Glycaemic index of meals affects appetite sensation but not energy balance in active males

BACKGROUND

Foods with low glycaemic index (LGI) are reported to suppress appetite mainly in overweight population but have not been investigated in athletic adults.

OBJECTIVE

The aim of this study was to compare the short-term effects of LGI and high GI (HGI) meals over a day on subsequent subjective appetite sensation, energy intake, energy expenditure, energy balance and resting metabolic rate in physically active males.

METHODS

This cross-sectional randomized crossover study included 14 active males (mean ± SD; age 34.5 ± 8.9 years, body mass index 22.8 ± 2.1 kg m(-2)) to consume LGI and HGI meals on two separate days. On each trial day, participants consumed a breakfast in the laboratory and then left with a packed lunch, dinner and snacks. Appetite scores, energy intake and expenditure were assessed.

RESULTS

The area under the curve for appetite scores of the HGI trial was significantly smaller than that of the LGI trial during the laboratory period (p = 0.027) and throughout the day (p = 0.009). No significant differences in energy intake, energy expenditure, energy balance and resting metabolic rate were found between groups, between the trial days and between the corresponding post-trial days.

CONCLUSIONS

These results show that frequent ingestion of the HGI meals, contrary to the previous reports, suppresses appetite more than that of LGI meals, but did not affect energy balance in physically active normal-weight males.

Food-based ingredients to modulate blood glucose

Maintenance of normal blood glucose levels is important for avoiding chronic diseases such as type 2 diabetes, cardiovascular problems, and obesity. Type 2 diabetes is one of the major health problems affecting the world population and this condition can be exacerbated by poor diet, low physical activity, and genetic abnormalities. Food plays an important role in the management of blood glucose and associated complications in diabetes. This is attributed to the ability of food-based ingredients to modulate blood glucose without causing any adverse health consequences. This chapter focuses on four important food groups such as cereals, legumes, fruits, and spices that have active ingredients such as soluble dietary fiber, polyphenols, and antinutrients with the ability to reduce glycemic and insulin response in humans. Other food ingredients such as simple sugars, sugar alcohols, and some proteins are also discussed in moderation.

Glycaemic index methodology

The glycaemic index (GI) concept was originally introduced to classify different sources of carbohydrate (CHO)-rich foods, usually having an energy content of >80 % from CHO, to their effect on post-meal glycaemia. It was assumed to apply to foods that primarily deliver available CHO, causing hyperglycaemia. Low-GI foods were classified as being digested and absorbed slowly and high-GI foods as being rapidly digested and absorbed, resulting in different glycaemic responses. Low-GI foods were found to induce benefits on certain risk factors for CVD and diabetes. Accordingly it has been proposed that GI classification of foods and drinks could be useful to help consumers make 'healthy food choices' within specific food groups. Classification of foods according to their impact on blood glucose responses requires a standardised way of measuring such responses. The present review discusses the most relevant methodological considerations and highlights specific recommendations regarding number of subjects, sex, subject status, inclusion and exclusion criteria, pre-test conditions, CHO test dose, blood sampling procedures, sampling times, test randomisation and calculation of glycaemic response area under the curve. All together, these technical recommendations will help to implement or reinforce measurement of GI in laboratories and help to ensure quality of results. Since there is current international interest in alternative ways of expressing glycaemic responses to foods, some of these methods are discussed.

Impact of postprandial glycaemia on health and prevention of disease

Postprandial glucose, together with related hyperinsulinemia and lipidaemia, has been implicated in the development of chronic metabolic diseases like obesity, type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). In this review, available evidence is discussed on postprandial glucose in relation to body weight control, the development of oxidative stress, T2DM, and CVD and in maintaining optimal exercise and cognitive performance. There is mechanistic evidence linking postprandial glycaemia or glycaemic variability to the development of these conditions or in the impairment in cognitive and exercise performance. Nevertheless, postprandial glycaemia is interrelated with many other (risk) factors as well as to fasting glucose. In many studies, meal-related glycaemic response is not sufficiently characterized, or the methodology with respect to the description of food or meal composition, or the duration of the measurement of postprandial glycaemia is limited. It is evident that more randomized controlled dietary intervention trials using effective low vs. high glucose response diets are necessary in order to draw more definite conclusions on the role of postprandial glycaemia in relation to health and disease. Also of importance is the evaluation of the potential role of the time course of postprandial glycaemia.

Metabolic changes after a hypocaloric, low-glycemic-index diet in obese children

BACKGROUND

A low glycemic index (LGI) diet has been proposed as a treatment for obesity in adults; few studies have evaluated LGI diets in obese children.

AIM

The purpose of the study was to compare the effects of two diets, with similar energy intakes, but different glycemic indexes in a pediatric outpatient setting.

SUBJECTS AND METHODS

A parallel- group, randomized controlled trial was conducted, and 22 obese outpatient children with a body mass index (BMI) Z-score >2 (11 females and 11 males, BMI 28.9±2.9 kg/m²) were included in the study. Patients were randomly allocated to a hypocaloric LGI (GI:60), or to a hypocaloric high glycemic index (HGI) diet (GI:90). The LGI and HGI diets were almost equivalent for macronutrient composition. Anthropometric and biochemical parameters were measured at baseline and after 6 months.

RESULTS

In both groups there were significant decreases in BMI, BMI Z-score, blood pressure, and high-sensitivity C-reactive protein. Only LGI diets produced a significant decrease in waist circumference and homeostasis model assessment. Analysis of variance demonstrated that the BMI Z-score decrease from baseline values was significantly greater after the LGI diet than after the HGI diet [-0.20 (95% confidence interval (CI) -0.29 to -0.10) vs -0.34 (95%CI -0.43 to -0.24)], mean difference between groups -0.14 (95%CI -0.27 to -0.01), p<0.05). Changes in triglyceride concentrations were significantly lower in LGI as compared to HGI diet (p<0.05).

CONCLUSIONS

This study demonstrates that a hypocaloric LGI diet has beneficial metabolic effects in comparison to a hypocaloric HGI diet in obese children.

Fiber, protein, and lupin-enriched foods: role for improving cardiovascular health

Cardiovascular diseases (CVD) are the leading cause of death globally (World Health Organisation, 2011). Many of the risk factors for CVD are modifiable, including overweight and obesity. Numerous strategies have been proposed to fight CVD, with a special focus being placed on dietary interventions for weight management. The literature suggests that two nutrients, fiber and protein, may play significant roles in weight control and hence cardiovascular health. Increasing both protein and fiber in the diet can be difficult because popular low-carbohydrate and high-protein diets tend to have considerably low-fiber intakes (Slavin, 2005). One approach to obtain both is to develop functional foods using unique ingredients. Lupin flour is a novel food ingredient derived from the endosperm of lupin. It contains 40-45% protein, 25-30% fiber, and negligible sugar and starch (Petterson and Crosbie, 1990). Research conducted to date reveals that lupin-enriched foods, which are naturally high in protein and fiber, may have a significant effect on CVD risk factors. This review explores whether there is a role for fiber-, protein-, and lupin-enriched foods in improving cardiovascular health.

The individual and combined effects of glycemic index and protein on glycemic response, hunger, and energy intake

Although high protein and low glycemic index (GI) foods are thought to promote satiety, little is known about the effects of GI, protein, and their interaction on hunger and energy intake several hours following a mixed meal. This study investigated the long term effects of GI, protein, and their combined effects on glucose, insulin, hunger, and energy intake in healthy, sedentary, overweight, and obese adults (BMI of 30.9 ± 3.7 kg/m(2)). Sixteen individuals participated separately in four testing sessions after an overnight fast. The majority (75%) were non-Hispanic Blacks. Each consumed one of four breakfast meals (high GI/low protein, high GI/high protein, low GI/low protein, low GI/high protein) in random order. Visual analog scales (VAS) and blood samples were taken at baseline, 15 min, and at 30 min intervals over 4 h following the meal. After 4 h, participants were given the opportunity to consume food ad libitum from a buffet style lunch. Meals containing low GI foods produced a smaller glucose (P < 0.002) and insulin (P = 0.0001) response than meals containing high GI foods. No main effects for protein or interactions between GI and protein were observed in glucose or insulin responses, respectively. The four meals had no differential effect on observed energy intake or self-reported hunger, satiety, and prospective energy intake. Low GI meals produced the smallest postprandial increases in glucose and insulin. There were no effects for GI, protein, or their interaction on appetite or energy intake 4 h after breakfast.

Dietary approaches to the treatment of obesity

Various dietary strategies can effectively reduce weight, as shown by this review. Those that are coupled with behavior therapy and ongoing support tend to produce longer lasting effects. Improvements in health parameters are observed with each dietary strategy. Improvements in diabetes and CVD risk factors have been observed with diets ranging from 10% fat to 45% fat. HP diets seem to be particularly effective in reducing fat mass and TAG, especially in individuals with dyslipidemia and who are at risk for type 2 diabetes. Likewise, LC diets have been shown to be effective in decreasing TAG and VLDL and increasing HDL. Although low-GI diets do not seem to be superior to any other diet for weight loss, there is evidence to suggest that they may provide some metabolic benefit for those with type 2 diabetes. Clearly, all of these diets have benefits but they can be realized only when they are followed. A common theme across studies is poor long-term adherence and weight regain. Dansinger and colleagues found a strong association between diet adherence and clinically significant weight loss, suggesting that “sustained adherence to a diet” rather than “following a certain type of diet” is the key to successful weight management.

The dietary treatment of obesity

In no sector of therapeutics is the theory so simple as in weight control. The major gap lies in translating this theory into practice. In the final analysis, the answer lies in personal choice, because many diets seem to work, but not universally in all studies. A reduced calorie diet is obviously essential, although the composition remains to be individually tailored. For this, health care professionals must become “personal trainers” and realize the importance of lifestyle prescriptions with regard to diet and exercise in all consultations, fitting them to the needs of patient. It may be argued that medical practitioners do not have the necessary time or behavioral skills for these long-term interventions, which might be better handled by a team of other health professionals. Prevention is, of course, better than treatment, and therefore a major effort must be made to target children, from breast feeding to education throughout schooling. No more surveys are needed; “we know the enemy and it is us.” In the words of the Lancet editorial concerning obesity: “Our public health leaders must replace prevarication with imagination.”

A low glycemic index diet does not affect postprandial energy metabolism but decreases postprandial insulinemia and increases fullness ratings in healthy women

At present, it is difficult to determine whether glycemic index (GI) is an important tool in the prevention of lifestyle diseases, and long-term studies investigating GI with diets matched in macronutrient composition, fiber content, energy content, and energy density are still scarce. We investigated the effects of 2 high-carbohydrate (55%) diets with low GI (LGI; 79) or high GI (HGI; 103) on postprandial blood profile, subjective appetite sensations, energy expenditure (EE), substrate oxidation rates, and ad libitum energy intake (EI) from a corresponding test meal (LGI or HGI) after consuming the diets ad libitum for 10 wk. Two groups of a total of 29 healthy, overweight women (age: 30.5 ± 6.6 y; BMI: 27.6 ± 1.5 kg/m(2)) participated in the 10-wk intervention and a subsequent 4-h meal test. The breakfast test meals differed in GI but were equal in total energy, macronutrient composition, fiber content, and energy density. The LGI meal resulted in lower plasma glucose, serum insulin, and plasma glucagon-like peptide (GLP)-1 and higher plasma glucose-dependent insulinotropic polypeptide concentrations than the HGI meal (P ≤ 0.05). Ratings of fullness were slightly higher and the desire to eat something fatty was lower after the test meal in the LGI group (P < 0.05). Postprandial plasma GLP-2, plasma glucagon, serum leptin, plasma ghrelin, EE, substrate oxidation rates, and ad libitum EI at lunch did not differ between groups. In conclusion, postprandial glycemia, insulinemia, and subjective appetite ratings after a test meal were better after 10-wk ad libitum intake of a LGI compared to a HGI diet. EE and substrate oxidation rates were, however, not affected. These findings give some support to recommendations to consume a LGI diet.

Role of low-glycemic index diet in management of childhood obesity

Conventional dietary recommendation for obesity management is a low-fat energy-restricted diet, which however, only have modest and non-sustained effects on weight reduction. Alternative dietary interventions, including low-glycemic index (GI) diet, have been proposed. Glycemic index is a measure of blood glucose excursion per unit of carbohydrate. Foods with high GI are rapidly digested, absorbed and transformed into glucose. These processes cause accelerated and transient surges in blood glucose and insulin, earlier return of hunger sensation and excessive caloric intake. Conversely, low-GI diet decreases blood glucose and insulin excursion, promotes greater fat oxidation, decreases lipogenesis and increases satiety. Modern food-processing technology has produced many food products with high GI which may contribute to the burgeoning epidemic of obesity especially in children/adolescents. Epidemiological and clinical trials suggest a role for low-GI diet in the management of childhood obesity and associated cardio-metabolic risks although results are not always consistent. In this article, we shall review the physiological basis and current evidence for and against low-GI diet in obesity management, with particular focus in children and adolescents.

Associations between dairy consumption and body weight: a review of the evidence and underlying mechanisms

As the incidence of obesity is reaching 'epidemic' proportions, there is currently widespread interest in the impact of dietary components on body-weight and food intake regulation. The majority of data available from both epidemiological and intervention studies provide evidence of a negative but modest association between milk and dairy product consumption and BMI and other measures of adiposity, with indications that higher intakes result in increased weight loss and lean tissue maintenance during energy restriction. The purported physiological and molecular mechanisms underlying the impact of dairy constituents on adiposity are incompletely understood but may include effects on lipolysis, lipogeneis and fatty acid absorption. Furthermore, accumulating evidence indicates an impact of dairy constituents, in particular whey protein derivatives, on appetite regulation and food intake. The present review summarises available data and provides an insight into the likely contribution of dairy foods to strategies aimed at appetite regulation, weight loss or the prevention of weight gain.

Hyperphagia induced by sucrose: relation to circulating and CSF glucose and corticosterone and orexigenic peptides in the arcuate nucleus

Sucrose-rich diets compared to starch-rich diets are known to stimulate overeating under chronic conditions. The present study in normal-weight rats established an acute "preload-to-test meal" paradigm for demonstrating sucrose-induced hyperphagia and investigating possible mechanisms that mediate this behavioral phenomenon. In this acute paradigm, the rats were first given a small (15 kcal) sucrose preload (30% sucrose) for 30 min compared to an equicaloric, starch preload (25% starch with 5% sucrose) and then allowed to freely consume a subsequent test meal of lab chow. The sucrose preload, when compared to a starch preload equal in energy density and palatability, consistently increased food intake in the subsequent test meal occurring between 60 and 120 min after the end of the preload. Measurements of hormones, metabolites and hypothalamic peptides immediately preceding this hyperphagia revealed marked differences between the sucrose vs starch groups that could contribute to the increase in food intake. Whereas the sucrose group compared to the starch group immediately after the preload (at 10 min) had elevated levels of glucose in serum and cerebrospinal fluid (CSF) along with reduced expressions of neuropeptide Y (NPY) and agouti-related protein (AgRP) in the arcuate nucleus (ARC), the subsequent effects (at 30-60 min) just preceding the test meal hyperphagia were the reverse. Along with lower levels of glucose, they included markedly elevated serum and CSF levels of corticosterone and mRNA levels of NPY and AgRP in the ARC. In addition to establishing an animal model for sucrose-induced hyperphagia, these results demonstrate peripheral and central mechanisms that may mediate this behavioral phenomenon.

Evaluation of three new strategies to fight obesity in families

Aims. To evaluate 3 strategies to reduce weight in obese families. Research design and methods. 142 obese parents and 119 obese children kept a fat-calorie restriction diet. On top of this diet, the families were randomized in a three-factorial design to one or more of three weight-loss strategies: (1) an additional diet preferring carbohydrates having a low glycemic index (dual diet), (2) financial incentive, and (3) telemonitoring of weight and physical activity. Results. All children improved their BMI-SDS by 0.18 ± 0.25 (P < .001) independently of the weight-loss strategy. In parents, relative losses of weight (kg) were −6.4% versus −4.0% for dual diet versus calorie restriction (P = .029), −6.9% versus −3.4% for with or without financial incentive (P = .002), and −8.0% versus −4.8% for with or without telemonitoring (P = .033). The weight loss after financial incentive plus dual diet plus telemonitoring was −14.4%. Conclusions. All strategies were effective in adults, in particular when combined. Children improved their BMI-SDS regardless of the strategy.

Effect of carbohydrate digestibility on appetite and its relationship to postprandial blood glucose and insulin levels

BACKGROUND/OBJECTIVES

'Slowly digestible' carbohydrates have been claimed to reduce appetite through their effects on postprandial glucose and insulin levels, but literature is inconsistent. The inconsistencies between studies might be explained by factors other than glycemic effects per se, for example, nutritional or physical properties. We tested this possibility by examining postprandial glucose, insulin and appetite responses to drinks differing only in rate and extent of digestibility of carbohydrates. This was accomplished by comparing different glucose polymers: maltodextrin (rapidly digestible) versus medium-chain pullulan (slowly but completely digestible) versus long-chain pullulan (indigestible).

SUBJECTS/METHODS

In a randomized double-blind balanced crossover design, 35 subjects received drinks with 15 g test carbohydrate polymers. Key outcome measures were appetite scores, digestibility (in vitro test and breath hydrogen), and (in a subset) glucose and insulin levels.

RESULTS

Digestibility, glucose and insulin data confirmed the rapid, slow and nondigestible nature of the test carbohydrates. Despite its low digestibility, only long-chain pullulan reduced appetite compared with the maltodextrin control, whereas the medium-chain pullulan did not.

CONCLUSIONS

We conclude that glycemic responses per se have minimal effects on appetite, when tested in products differing in only carbohydrate digestibility rate and extent.

The satiety effect of disguised liquid preloads administered acutely and differing only in their nutrient content tended to be weaker for lipids but did not differ between proteins and carbohydrates in human subjects

Whether protein is the macronutrient with the strongest satiety effect remains a matter of debate because of the diversity of study designs employed. The aim of the present study was to compare the effect of different liquid preloads made up of proteins, fats or carbohydrates only, under stringently controlled conditions, on satiety. Fifty-six subjects participated in the present study which consisted of four randomised test days, i.e. 1 d per macronutrient and one control day. During each test day, the subjects were required to consume the preload in full, and then their subsequent food intake was measured. The volunteers were divided into two groups: the first (T0) group, which consumed the preload immediately before lunch, and the second (T1) group, which consumed it 1 h beforehand. The main results showed that the participants consumed significantly less at lunch following the consumption of all three preloads than on the no-preload day, and consumed less after the consumption of the carbohydrate preload than after the consumption of the lipid preload. When energy from the preload was included, overall energy intake was significantly greater in all the three preload conditions than in the situation involving no preload, with only partial compensation for preload energy in all conditions. Total daily energy intake was highest after the lipid preload ingestion, but this could be a chance finding since it was not significantly higher than that observed after protein or carbohydrate preload ingestion. No significant effects of the interval between the preload and test meal ingestion were found. These results do not confirm the greater satiety effect of proteins than of carbohydrates, but partially confirm the weaker effect of fats.

The glycemic index: physiological significance

The glycemic index (GI) is a physiological assessment of a food's carbohydrate content through its effect on postprandial blood glucose concentrations. Evidence from trials and observational studies suggests that this physiological classification may have relevance to those chronic Western diseases associated with overconsumption and inactivity leading to central obesity and insulin resistance. The glycemic index classification of foods has been used as a tool to assess potential prevention and treatment strategies for diseases where glycemic control is of importance, such as diabetes. Low GI diets have also been reported to improve the serum lipid profile, reduce C-reactive protein (CRP) concentrations, and aid in weight control. In cross-sectional studies, low GI or glycemic load diets (mean GI multiplied by total carbohydrate) have been associated with higher levels of high-density lipoprotein cholesterol (HDL-C), with reduced CRP concentrations, and, in cohort studies, with decreased risk of developing diabetes and cardiovascular disease. In addition, some case-control and cohort studies have found positive associations between dietary GI and risk of various cancers, including those of the colon, breast, and prostate. Although inconsistencies in the current findings still need to be resolved, sufficient positive evidence, especially with respect to renewed interest in postprandial events, suggests that the glycemic index may have a role to play in the treatment and prevention of chronic diseases.

Extended prandial glycemic profiles of foods as assessed using continuous glucose monitoring enhance the power of the 120-minute glycemic index

BACKGROUND

The glycemic index (GI) is routinely measured 120 minutes after food intake (GI120). The purpose of this prospective open label study was to assess (1) the dynamics of glycemia over the 210 minutes following food consumption and (2) the evolution of GIs based on 120-, 150-, 180-, and 210-minute glycemic profiles.

METHOD

Twenty healthy subjects (mean +/- SE; 21.9 +/- 1.39 years of age; body mass index 23.6 +/- 0.63 kg/m(2); 7 men and 13 women) completed the study. Each subject consumed 10 different foods with known GI120 on three separate occasions at four different times of day according to a defined meal plan over a 9-day period; 32 meals were evaluated. The GIs for intervals of 120, 150, 180 and 210 minutes after food consumption were determined using a continuous glucose monitoring system (CGMS) to measure glycemia. The Wilcoxon signed-rank test was applied to compare the GIs.

RESULTS

Glycemia returned to baseline within 120 minutes for honey and tomato soup; within 210 minutes for white bread, choco-rice cookies, fish and potatoes, wafers, and meat ravioli with cheese; and later for dark chocolate, apricot dumplings, and choco-wheat cookies. The extended GIs were higher than the respective GI120s in eight of the foods.

CONCLUSIONS

The 120-minute glycemic index fails to fully account for changes in glycemia after ingestion of a mixed meal because glycemia remains above baseline for a longer period. The CGMS is a convenient method to determine the glucose response/GIs over intervals extended up to 210 minutes, which is adequate time for the absorption of most foods.

Appetite control: methodological aspects of the evaluation of foods

This report describes a set of scientific procedures used to assess the impact of foods and food ingredients on the expression of appetite (psychological and behavioural). An overarching priority has been to enable potential evaluators of health claims about foods to identify justified claims and to exclude claims that are not supported by scientific evidence for the effect cited. This priority follows precisely from the principles set down in the PASSCLAIM report. The report allows the evaluation of the strength of health claims, about the effects of foods on appetite, which can be sustained on the basis of the commonly used scientific designs and experimental procedures. The report includes different designs for assessing effects on satiation as opposed to satiety, detailed coverage of the extent to which a change in hunger can stand alone as a measure of appetite control and an extensive discussion of the statistical procedures appropriate for handling data in this field of research. Because research in this area is continually evolving, new improved methodologies may emerge over time and will need to be incorporated into the framework. One main objective of the report has been to produce guidance on good practice in carrying out appetite research, and not to set down a series of commandments that must be followed.

Randomized trial on the effects of a 7-d low-glycemic diet and exercise intervention on insulin resistance in older obese humans

BACKGROUND

The optimal combination of diet and exercise that produces the greatest reversal of obesity-related insulin resistance is unknown.

OBJECTIVES

We examined the effects of a combined 7-d low-glycemic index (low-GI) diet and exercise training intervention on insulin sensitivity in older obese humans.

DESIGN

Participants [n = 32; mean (+/-SEM) age: 66 +/- 1 y; body mass index (in kg/m(2)): 33.8 +/- 0.7] were randomly assigned to a parallel, double-blind, controlled-feeding trial and underwent supervised aerobic exercise (EX; 60 min/d at 80-85% maximum heart rate) in combination with either a low-GI (LoGI + EX: 41.1 +/- 0.4) or a high-GI (HiGI + EX: 80.9 +/- 0.6) diet. All meals were provided and were isocaloric to individual energy requirements. Insulin sensitivity and hepatic glucose production were assessed with a 40-mU x m(-2) x min(-1) hyperinsulinemic euglycemic clamp combined with a [6,6-(2)H(2)]-glucose infusion.

RESULTS

After the intervention, small decreases were observed in body weight (-1.6 +/- 0.2 kg; P < 0.0001) and fat mass (-1.7 +/- 0.9%; P = 0.004) in both groups. Maximal aerobic capacity ( O(2)max) also improved slightly (0.06 +/- 0.02 L/min; P = 0.004). Resting systolic blood pressure, fasting glucose, insulin, triglycerides, and cholesterol all decreased after the study (all P < 0.05). Larger changes in systolic blood pressure and O(2max) were seen in the LoGI + EX group. Insulin-stimulated glucose disposal (P < 0.001), insulin suppression of hepatic glucose production (P = 0.004), and postabsorptive fat oxidation (P = 0.03) improved equally in both groups after the intervention.

CONCLUSIONS

These findings suggest that the metabolic improvements after short-term exercise training in older obese individuals are dependent on increased physical activity and are not influenced by a low-GI diet. However, a low-GI diet has added benefit in alleviating hypertension, thus reducing the risk of diabetic and vascular complications.

Use of the glycemic index for weight loss and glycemic control: a review of recent evidence

This article summarizes current findings regarding the use of low-glycemic index (GI) diets for weight loss and type 2 diabetes control. Results from cross-sectional studies evaluating the association between dietary GI and body mass index had equivocal results, especially when dietary fiber was included in the model. Of five prospective cohort studies, two reported increased risk of type 2 diabetes diagnosis with higher dietary GI or glycemic load (GL). Risk of type 2 diabetes appeared to have a stronger association with carbohydrate intake or GL than with GI. Evidence from intervention studies using a low-GI approach for weight loss produced inconsistent results, especially for longer-term studies. In intervention studies with type 2 diabetes patients, consumption of a low-GI diet resulted in lower hemoglobin A1c concentrations in participants of shorter-term studies. Recent evidence adds to the controversy regarding the effectiveness of consuming low-GI diets for glycemic control and weight reduction.

Consumption of sugars and body weight

The role of dietary sugars in the current obesity epidemic is much debated and opposing views can be found in the lay as well as scientific literature. Here we have reviewed the recent scientific literature on consumption of sugars and body weight. Main focus was on three questions: (i) What is the evidence that intake of dietary sugars is associated with higher body weight than intake of non-sugar carbohydrates? (ii) What is the evidence that sugars in liquid form are associated with higher body weight than sugars in solid form? (iii) What is the evidence that diets with a low glycaemic index (GI) or glycaemic load (GL) are associated with lower body weight than diets high in GI or GL? We conclude that (i) there is insufficient evidence that an exchange of sugar for non-sugar carbohydrates in the context of a reduced-fat ad libitum diet or energy-restricted diet results in lower body weights; (ii) observational studies suggest a possible relationship between consumption of sugar-sweetened beverages and body weight, but there is currently insufficient supporting evidence from randomized controlled trials of sufficient size and duration; (iii) at this moment there is insufficient evidence to support a difference between liquid and solid sugar intake in body-weight control and (iv) there is some, although not consistent, evidence for a lower body weight on diets with a lower GL, but the effect is likely to be small. There is currently no convincing evidence for a role of GI independent of GL.

The dietary treatment of obesity

Dietary modulation is an essential part of weight loss and maintaining its reduction. Although simple in behavioral terms (eat less, exercise more), the tremendous difficulty of weight loss and maintenance has inspired many different diet regimens, in search of an easier, more efficient way to lose weight. Contemporary issues in this matter are the composition of diets (low fat versus low carbohydrate), the choice of carbohydrate (the glycemic index), and the role of calcium and dairy products. This article discusses the scientific evidence of the various dietary manipulations for weight loss and the challenges of maintaining a reduced obese state.

The effects of 6-week low glycemic load diet based on low glycemic index foods in overweight/obese children--pilot study

OBJECTIVE

To evaluate the effectiveness of a 6-week low Glycemic Load (GL) diet intervention based on low Glycemic Index (GI) foods on body weight, body composition, metabolic risk factors and satiety in overweight/obese pre-pubertal children.

METHODS

Following a pediatric examination 8 healthy, average age 11 year old, Caucasian, pre-pubertal overweight/obese (BMI = 24, 7 +/- 3.8 kg/m(2)) children participated in the study. The Low GL diet intervention was based on the replacement of at least 50% of the high GI foods with Low-GI foods. The children with one of their parents participated in weekly nutrition consultations. Body composition, fasting glucose, insulin, cholesterol and triglyceride were measured before and after the study. Dietary changes were made based on weekly 4-day food-diaries.

RESULTS

Despite no change in body weight, there was a significant (p < 0.05) reduction in % body fat (29.4 +/- 4.2 vs. 25.4 +/- 5.3), Waist-to-Hip Ratio (WHR 0.87 +/- 0.053 vs. 0.86 +/- 0.05), decrease in self-reported hunger level (4.37 +/- 0.74 vs. 1.75 +/- 0.75) and the total number of risk factors (28 vs. 15). There was a strong negative correlation between fasting glucose and insulin levels at baseline and in the magnitude of change after the study (r = -0.93 and r = -0.85 respectively; p < 0.01).

CONCLUSIONS

A 6 week study demonstrated the practicality and effectiveness of this Low GL dietary approach. Despite of the unchanged body weight, Low GL diet consultations positively modified body fat content and cardiovascular risk factors in overweight or obese children.

Metabolic effects of dietary fiber consumption and prevention of diabetes

A high dietary fiber (DF) intake is emphasized in the recommendations of most diabetes and nutritional associations. It is accepted that viscous and gel-forming properties of soluble DF inhibit macronutrient absorption, reduce postprandial glucose response, and beneficially influence certain blood lipids. Colonic fermentation of naturally available high fiber foods can also be mainly attributed to soluble DF, whereas no difference between soluble and insoluble DF consumption on the regulation of body weight has been observed. However, in prospective cohort studies, it is primarily insoluble cereal DF and whole grains, and not soluble DF, that is consistently associated with reduced diabetes risk, suggesting that further, unknown mechanisms are likely to be involved. Recent research indicates that DF consumption contributes to a number of unexpected metabolic effects independent from changes in body weight, which include improvement of insulin sensitivity, modulation of the secretion of certain gut hormones, and effects on various metabolic and inflammatory markers that are associated with the metabolic syndrome. In this review, we briefly summarize novel findings from recent interventions and prospective cohort studies. We discuss concepts and potential mechanisms that might contribute to the further understanding of the involved processes.

Nutrition transition and its relationship to the development of obesity and related chronic diseases

The prevalence of overweight and obesity has also increased substantially in the nutritional transition countries, and the health burden of obesity-related complications is growing. The introduction of fast-food chains and Westernized dietary habits providing meals with fast-food characteristics seems to be a marker of the increasing prevalence of obesity. The mechanisms involved are probably that the supply of foods is characterized by large portion sizes with a high energy density, and sugar-rich soft drinks. The high energy density of foods is partly brought about by a high dietary fat content, and it has been shown that even in a Chinese population the increase from about 15% to 20% in the proportion of calories from fat is sufficient to explain some weight gain in the population. In addition, fast food from major chains in most countries still contains unacceptably high levels of industrially produced trans fatty acids that have powerful biological effects, and contribute to type 2 diabetes and coronary artery disease. New evidence also suggests that a high intake of trans fat may produce abdominal obesity, an important factor in the metabolic syndrome, type 2 diabetes and cardiovascular disease. The optimal diet for the prevention of weight gain, obesity, metabolic syndrome and type 2 diabetes is fat-reduced, without any industrially produced trans fatty acids, fibre-rich, high in low energy density carbohydrates (fruit, vegetables and whole grain products) and with a restricted intake of energy-containing drinks.

Carbohydrate intake and obesity

The prevalence of obesity has increased rapidly worldwide and the importance of considering the role of diet in the prevention and treatment of obesity is widely acknowledged. This paper reviews data on the effects of dietary carbohydrates on body fatness. Does the composition of the diet as related to carbohydrates affect the likelihood of passive over-consumption and long-term weight change? In addition, methodological limitations of both observational and experimental studies of dietary composition and body weight are discussed. Carbohydrates are among the macronutrients that provide energy and can thus contribute to excess energy intake and subsequent weight gain. There is no clear evidence that altering the proportion of total carbohydrate in the diet is an important determinant of energy intake. However, there is evidence that sugar-sweetened beverages do not induce satiety to the same extent as solid forms of carbohydrate, and that increases in sugar-sweetened soft drink consumption are associated with weight gain. Findings from studies on the effect of the dietary glycemic index on body weight have not been consistent. Dietary fiber is associated with a lesser degree of weight gain in observational studies. Although it is difficult to establish with certainty that fiber rather than other dietary attributes are responsible, whole-grain cereals, vegetables, legumes and fruits seem to be the most appropriate sources of dietary carbohydrate.

Adequate nutrition followed by revisional bariatric surgery to optimize homeostatic eating control

Terms as treatment failure or ineffective treatment after bariatric surgery are not clearly defined and difficult to handle. About one third of all persons who were formerly treated with a Lapband have either mechanical problems or do not lose enough weight. The current review argues in favor of adequate nutrition to suppress hunger and optimize satiety together with effective but least malabsorptive revisional surgery. This approach aims at switching the gut-brain axis, thereby facilitating homeostatic eating control.