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Bass R, Alvarez JA. Nutritional status in the era of highly effective CFTR modulators. Pediatr Pulmonol 2024; 59 Suppl 1:S6-S16. [PMID: 39105341 DOI: 10.1002/ppul.26806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/07/2023] [Accepted: 11/29/2023] [Indexed: 08/07/2024]
Abstract
Advances in cystic fibrosis (CF) diagnostics and therapeutics have led to improved health and longevity, including increased body weight and decreased malnutrition in people with CF. Highly effective CFTR modulator therapies (HEMT) are associated with increased weight through a variety of mechanisms, accelerating trends of overweight and obesity in the CF population. Higher body mass index (BMI) is associated with improved pulmonary function in CF, yet the incremental improvement at overweight and obese BMIs is not clear. Improvements in pulmonary health with increasing BMI are largely driven by increases in fat-free mass (FFM), and impact of HEMT on FFM is uncertain. While trends toward higher weight and BMI are generally seen as favorable in CF, the increased prevalence of overweight and obesity has raised concern for potential risk of traditional age- and obesity-related comorbidities. Such comorbidities, including impaired glucose tolerance, hypertension, cardiac disease, hyperlipidemia, fatty liver, colon cancer, and obstructive sleep apnea, may occur on top of pre-existing CF-related comorbidities. CF nutrition recommendations are evolving in the post-modulator era to more individualized approaches, in contrast to prior blanket high-fat, high-calorie prescriptions for all. Ultimately, it will be essential to redefine goals for optimal weight and nutritional status to allow for holistic health and aging in people with CF.
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Affiliation(s)
- Rosara Bass
- Division of Pediatric Gastroenterology Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jessica A Alvarez
- Division of Endocrinology, Lipids, and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Volek JS, Kackley ML, Buga A. Nutritional Considerations During Major Weight Loss Therapy: Focus on Optimal Protein and a Low-Carbohydrate Dietary Pattern. Curr Nutr Rep 2024:10.1007/s13668-024-00548-6. [PMID: 38814519 DOI: 10.1007/s13668-024-00548-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE OF REVIEW Considering the high prevalence of obesity and related metabolic impairments in the population, the unique role nutrition has in weight loss, reversing metabolic disorders, and maintaining health cannot be overstated. Normal weight and well-being are compatible with varying dietary patterns, but for the last half century there has been a strong emphasis on low-fat, low-saturated fat, high-carbohydrate based approaches. Whereas low-fat dietary patterns can be effective for a subset of individuals, we now have a population where the vast majority of adults have excess adiposity and some degree of metabolic impairment. We are also entering a new era with greater access to bariatric surgery and approval of anti-obesity medications (glucagon-like peptide-1 analogues) that produce substantial weight loss for many people, but there are concerns about disproportionate loss of lean mass and nutritional deficiencies. RECENT FINDINGS No matter the approach used to achieve major weight loss, careful attention to nutritional considerations is necessary. Here, we examine the recent findings regarding the importance of adequate protein to maintain lean mass, the rationale and evidence supporting low-carbohydrate and ketogenic dietary patterns, and the potential benefits of including exercise training in the context of major weight loss. While losing and sustaining weight loss has proven challenging, we are optimistic that application of emerging nutrition science, particularly personalized well-formulated low-carbohydrate dietary patterns that contain adequate protein (1.2 to 2.0 g per kilogram reference weight) and achieve the beneficial metabolic state of euketonemia (circulating ketones 0.5 to 5 mM), is a promising path for many individuals with excess adiposity.
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Affiliation(s)
- Jeff S Volek
- Department of Human Sciences, The Ohio State University, 305 Annie & John Glenn Ave, Columbus, OH, 43210, USA.
| | - Madison L Kackley
- Department of Human Sciences, The Ohio State University, 305 Annie & John Glenn Ave, Columbus, OH, 43210, USA
| | - Alex Buga
- Department of Human Sciences, The Ohio State University, 305 Annie & John Glenn Ave, Columbus, OH, 43210, USA
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Sun Q, Liu C, Li S, Ren J, Wang Z. The different association between fat mass distribution and intake of three major nutrients in pre- and postmenopausal women. PLoS One 2024; 19:e0304098. [PMID: 38809895 PMCID: PMC11135700 DOI: 10.1371/journal.pone.0304098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 05/06/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Obesity, characterized by excessive body fat accumulation, is associated with various chronic health conditions. Body fat plays a crucial role in health outcomes, and nutrient intake is a contributing factor. Menopause further influences body fat, but the precise relationships between nutrients and fat mass distribution in pre- and post-menopausal women are unclear. METHODS Data from 4751 adult women aged ≥18 years old (3855 pre-menopausal, 896 post-menopausal) with completed information were obtained from the National Health and Examination Survey (NHANES) from 2011 to 2018. Multivariate linear regression models were used to examine the associations between protein, carbohydrate, fat intake and total percent fat (TPF), android percent fat (APF), gynoid percent fat (GPF), android to gynoid ratio (A/G), subcutaneous adipose tissue mass (SAT), visceral adipose tissue mass (VAT). Subgroup analyses, stratified by menopausal status, were also conducted. Additionally, we employed smoothing curve fitting techniques to investigate potential non-linear relationships between fat mass distribution and nutrient intake. RESULTS Compared with pre-menopausal women, post-menopausal women had higher body fat, BMI, and metabolic indicators but lower nutrient intake (All p<0.05). In the overall analysis, we found significant correlations between nutrient intake and fat mass. Specifically, protein intake was negatively correlated with TPF (β = -0.017, 95% CI: -0.030, -0.005), APF (β = -0.028, 95% CI: -0.044, -0.012), GPF (β = -0.019, 95% CI: -0.030, -0.008), while fat intake showed positive correlations with these measures (SAT: β = 2.769, 95% CI: 0.860, 4.678). Carbohydrate intake exhibited mixed associations. Notably, body fat mass-nutrient intake correlations differed by menopausal status. Generally speaking, protein intake showed negative correlations with body fat distribution in pre-menopausal women but positive correlations in post-menopausal women. Carbohydrate intake revealed significant negative associations with abdominal and visceral fat in post-menopausal women, while fat intake was consistently positive across all fat distribution indices, especially impacting visceral fat in post-menopausal women. CONCLUSION Dietary intake plays a crucial role in body fat distribution, with menopausal status significantly influencing the impact of nutrients on specific fat distribution metrics. The study emphasizes the need for dietary guidelines to consider the nutritional needs and health challenges unique to women at different life stages, particularly concerning menopausal status, to effectively manage obesity.
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Affiliation(s)
- Qin Sun
- Department of Obstetrics and Gynecology, Yulin Hospital, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Congrong Liu
- Department of Obstetrics and Gynecology, Yulin Hospital, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Shuxin Li
- Department of Obstetrics and Gynecology, Yulin Hospital, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Juanjuan Ren
- Department of Obstetrics and Gynecology, Yulin Hospital, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Zhaoxia Wang
- Department of Obstetrics and Gynecology, Yulin Hospital, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
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Mohebati S, Shakeri M, Ranjbar S, Jalali M, Nouri M, Faghih S. The association of dietary carbohydrate quality and quantity with obesity among Iranian adolescents: a case-control study. BMC Pediatr 2024; 24:176. [PMID: 38461264 PMCID: PMC10924309 DOI: 10.1186/s12887-024-04671-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 02/24/2024] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND Adolescent obesity is considered as a major health concern worldwide which is closely linked to the quality of diet. The purpose of the present study was to assess the carbohydrate quality and quantity in relation to odds of overweight and obesity in adolescents. METHODS This case-control study with a 1:1 ratio was conducted on 406 adolescents (14 to 18 years old) matched for age and gender. Participants were selected by multistage cluster random sampling method from March to October 2019 in Shiraz, Iran. Dietary intakes of the study population were assessed by a validated semi-quantitative food frequency questionnaire. Also anthropometric indices were measured using standard methods and demographic information was recorded via face to face interview. The relation between low carbohydrate diet score (LCDS) and carbohydrate quality index (CQI), and odds of obesity was evaluated by multiple Logistic regression. RESULTS After adjusting the role of potential confounders, the participants in the third tertiles of LCDS (OR = 0.443, 95% CI = (0.260 to 0.755)) and CQI (OR = 0.005, 95% CI = (0.001 to 0.025)) had less odds of being overweight and obese compared to the first tertile. CONCLUSION The present study found an inverse relationship between dietary quantity and quality of carbohydrate intake and the odds of overweight and obesity in a sample of Iranian adolescents.
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Affiliation(s)
- Shabnam Mohebati
- Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahboobeh Shakeri
- Endoocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sara Ranjbar
- Department of Nutritional sciences, Texas Tech University, Lubbock, TX, USA
| | - Mohammad Jalali
- Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehran Nouri
- Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Shiva Faghih
- Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
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Kanai R, Kinoshita S, Kanbe I, Sameda M, Yamaoka S, Horikawa O, Watanabe Y, Tatsuno I, Shirai K, Oshiro T, Saiki A. Once-weekly semaglutide administered after laparoscopic sleeve gastrectomy: Effects on body weight, glycemic control, and measured nutritional metrics in Japanese patients having both obesity and type 2 diabetes. OBESITY PILLARS (ONLINE) 2024; 9:100098. [PMID: 38230266 PMCID: PMC10789635 DOI: 10.1016/j.obpill.2023.100098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 12/31/2023] [Accepted: 12/31/2023] [Indexed: 01/18/2024]
Abstract
Background Glucagon-like peptide (GLP)-1 analogue may be useful for controlling weight recurrence and diabetes relapse after bariatric surgery, but may also adversely affect the measured nutritional metrics. This study aimed to investigate the effect of treatment with once-weekly semaglutide after laparoscopic sleeve gastrectomy (LSG) in patients with type 2 diabetes (T2D). We also examined the effects of combined use with a low-energy, high-protein formula diet (FD). Methods This study was a single-center retrospective database analysis. We enrolled 29 Japanese patients with T2D who underwent LSG, and more than 12 months later received semaglutide. The patients were divided retrospectively into a FD group (=6) and a conventional diet (CD) group (n = 23). Results BMI and HbA1c decreased significantly by 10.7 kg/m2 and 1.1 %, respectively, 12 months after LSG, and decreased by an additional 1.6 kg/m2 and 0.6 % after 12-months of treatment with semaglutide. Decreases in serum albumin, vitamin B12 and zinc were observed only after semaglutide administration. A ratio of energy from protein, fat and carbohydrates changed from 13:31:56 before to 19:30:50 after LSG, and from 17:32:51 before to 15:29:56 after semaglutide. Skeletal muscle ratio, which is the ratio of skeletal muscle mass to body weight, increased after LSG, but did not change after semaglutide. FD group showed a significant increase in skeletal muscle mass per 1 % body weight compared to CD group during semaglutide treatment. Conclusion Semaglutide after LSG in patients with obesity and T2D resulted in additional weight reduction and improved glycemic control, but worsened measured nutritional metrics. Administration of a low-energy, high protein formula diet may ameliorate adverse nutritional effects of semaglutide in patients with T2D after LSG. (Ethics Committee of Toho University Sakura Medical Center approval number S18061).
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Affiliation(s)
- Rieko Kanai
- Department of Medical Nutrition, Toho University Sakura Medical Center, Sakura, Japan
| | - Sachiho Kinoshita
- Department of Medical Nutrition, Toho University Sakura Medical Center, Sakura, Japan
| | - Izumi Kanbe
- Department of Medical Nutrition, Toho University Sakura Medical Center, Sakura, Japan
| | - Mariko Sameda
- Department of Medical Nutrition, Toho University Sakura Medical Center, Sakura, Japan
| | - Shuhei Yamaoka
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
| | - Osamu Horikawa
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
| | - Yasuhiro Watanabe
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
| | - Ichiro Tatsuno
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
- Chiba Prefectural University of Health Sciences, Chiba, Japan
| | - Kohji Shirai
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
- Department of Internal Medicine, Mihama Hospital, Chiba, Japan
| | - Takashi Oshiro
- Department of Surgery, Toho University Sakura Medical Center, Sakura, Japan
| | - Atsuhito Saiki
- Department of Medical Nutrition, Toho University Sakura Medical Center, Sakura, Japan
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
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Golzarand M, Toolabi K, Mirmiran P. The effects of protein intake higher than the recommended value on body composition changes after bariatric surgery: A meta-analysis of randomized controlled trials. Clin Nutr 2024; 43:708-718. [PMID: 38320462 DOI: 10.1016/j.clnu.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/23/2024] [Accepted: 01/29/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND & AIMS There is a lack of a meta-analysis to comprehensively assess the effectiveness of higher protein intake in addition to the recommended value on body composition post-bariatric surgery. We aimed to perform a meta-analysis of randomized controlled trials to determine the effects of protein intake higher than the recommended value on body composition changes after bariatric surgery. METHODS Electronic databases, including Scopus, PubMed/Medline, and Web of Sciences, were searched until July 2023. Studies that assessed the effect of protein intake higher than the recommended value on postoperative body composition, i.e., weight, body mass index (BMI), fat mass (FM), fat-free mass (FFM), percent fat mass (PFM), and percent total weight loss (%TWL), were eligible. For each outcome, the mean and standard deviation (for changes from baseline) were used to synthesize the data. RESULTS Eight trials were included in the current study. The results of the meta-analysis indicated protein intake higher than the recommended value after bariatric surgery led to more weight loss by 4.95 kg (95 % CI: -9.41 to -0.49) and FM loss by 7.64 kg (95 % CI: -14.01 to -1.28) compared with the control group. However, it had no significant effects on postoperative changes in BMI, FFM, PFM, or %TWL. There were no significant differences in body composition between protein sources obtained from diet and supplementation. When data was stratified based on the amount of added protein, we found a significant reduction in weight (MD: -7.80 kg; 95 % CI: -14.50 to -1.10) in patients who consumed protein ≥ 40 g/d in addition to the recommended value. Besides, protein intake higher than the recommended value declined FFM loss in patients who underwent laparoscopic sleeve gastrectomy (LSG) (MD: 6.52 kg; 95 % CI: 0.99 to 12.02). CONCLUSION The results of the current meta-analysis indicated that protein intake higher than the recommended value might cause greater weight and FM loss after bariatric surgery than a normal protein diet. However, our findings did not support the role of additional protein in the preservation of FFM, except in patients with LSG.
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Affiliation(s)
- Mahdieh Golzarand
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Karamollah Toolabi
- Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
| | - Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Soltani S, Jayedi A, Abdollahi S, Vasmehjani AA, Meshkini F, Shab-Bidar S. Effect of carbohydrate restriction on body weight in overweight and obese adults: a systematic review and dose-response meta-analysis of 110 randomized controlled trials. Front Nutr 2023; 10:1287987. [PMID: 38125726 PMCID: PMC10731359 DOI: 10.3389/fnut.2023.1287987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/01/2023] [Indexed: 12/23/2023] Open
Abstract
Introduction Carbohydrate-restricted diets are one of the most effective dietary interventions for weight loss. However, the optimum carbohydrate intake for implementing the most effective weight-loss interventions is still being discussed. We aimed to determine the optimum carbohydrate intake for short- and long-term weight loss in adults with overweight and obesity. Methods We searched PubMed, Scopus, Web of Science, and CENTRAL from inception to May 2021 for randomized controlled trials examining the effect of a carbohydrate-restricted diet (≤45% of energy intake) as compared to a control diet (carbohydrate intake >45% of energy intake) on body weight in adults with overweight/obesity. A random-effects dose-response meta-analysis was conducted to calculate the mean difference for each 10% decrease in carbohydrate intake at the 6-month follow-up (1 to 6 months), 12-month follow-up (6 to 12 months), and follow-up longer than 12 months. The shape of the dose-dependent effects was also evaluated. The certainty of the evidence was rated using the GRADE approach. The minimal clinically important difference (MCID) threshold was defined as 5% weight loss (equal to 4.39 kg). Results A total of 110 trials were selected for the present meta-analysis. In the linear dose-response meta-analysis, each 10% decrease in carbohydrate intake reduced body weight by 0.64 kg (95% CI: -0.79 to -0.49; n = 101 trials with 4,135 participants, high-certainty evidence) at the 6-month follow-up and by 1.15 kg (95% CI: -1.61 to -0.69; 42 trials with 2,657 participants, moderate-certainty evidence) at the 12-month follow-up. Non-linear dose-response meta-analyses indicated a monotonic reduction in body weight with the decrease in carbohydrate intake, with the greatest reduction at 5% at the 6-month follow-up (mean difference 5%: -3.96 kg, 95% CI: -4.92 to -3.00) and 10% at the 12-month follow-up (mean difference 10%: -6.26 kg, 95% CI: -10.42 to -2.10). At follow-up longer than 12 months, dose-response analyses suggested a non-linear effect, wherein carbohydrate intakes higher than 40% and lower than 30% were not effective for weight loss. Discussion Carbohydrate restriction is an effective dietary strategy for important weight loss in adults with overweight and obesity. At 6-month and 12-month follow-ups, body weight decreased proportionally, more than the MCID threshold, along with the decrease in carbohydrate intake. At follow-up longer than 12 months, there was a non-linear effect, with the greatest reduction at 30% carbohydrate intake. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42022315042.
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Affiliation(s)
- Sepideh Soltani
- Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ahmad Jayedi
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Shima Abdollahi
- Department of Nutrition, School of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Azam Ahmadi Vasmehjani
- Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Fatemeh Meshkini
- Department of Biochemistry, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
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Simon OG, Manu SA, Nwaogu CJ, Omotoriogun TC. Supplementing a grain diet with insects instead of fruits sustains the body condition of an omnivorous bird. Ecol Evol 2023; 13:e10141. [PMID: 37250450 PMCID: PMC10213486 DOI: 10.1002/ece3.10141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 05/02/2023] [Accepted: 05/12/2023] [Indexed: 05/31/2023] Open
Abstract
Omnivores utilize dietary sources which differ in nutrients, hence dietary limitations due to environmental change or habitat alteration could cause nutrient limitations, and thus deterioration of body condition if omnivory is obligate. We investigated how the body condition of the omnivorous Village weaver Ploceus cucullatus (weavers), which forages predominantly on grains, responds to the supplementation of its grain diet with insects instead of fruits. Forty wild-caught weavers held in aviaries were fed a combination of grains and fruits, or grains and insects ad libitum for 8 weeks. We determined diet preference by recording the number of birds on each diet option per minute for 1 h and the amount of food left-over after 3 h of foraging. Fortnightly, we assessed indices of body condition including body mass, pectoral muscle, and fat scores, packed cell volume (PCV), and hemoglobin concentration (HBC). We modeled the number of foragers, food left-over, and body condition indices as functions of diet, while accounting for time (weeks) and sex effects. Grains were the preferred diet, but males ate more fruits and insects than females. Weavers fed on grains and fruits lost body and pectoral muscle mass and accumulated less fat than those fed on grains and insects. This effect was sex-dependent: females supplemented with fruits lost more pectoral muscle mass than males of the same group and males but not females, supplemented with insects accumulated more fat reserve than those supplemented with fruits. PCV and HBC did not differ between diets but increased over the 8 weeks. Weavers are likely obligate rather than facultative omnivores, with insects as being a more nutritive supplement than fruits. Nutrient limitation arising from environmental change or habitat alteration could impair body condition and affect physiological function to environmental seasonality in obligate omnivores like the weavers.
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Affiliation(s)
- Ojodomo G. Simon
- A. P. Leventis Ornithological Research InstituteUniversity of JosJosNigeria
- Department of ZoologyAhmadu Bello UniversityZariaNigeria
| | - Shiiwua A. Manu
- A. P. Leventis Ornithological Research InstituteUniversity of JosJosNigeria
- Department of ZoologyUniversity of JosJosNigeria
| | - Chima J. Nwaogu
- A. P. Leventis Ornithological Research InstituteUniversity of JosJosNigeria
- FitzPatrick Institute of African OrnithologyUniversity of Cape TownCape TownSouth Africa
| | - Taiwo C. Omotoriogun
- A. P. Leventis Ornithological Research InstituteUniversity of JosJosNigeria
- Biotechnology Unit, Department of Biological SciencesElizade UniversityIlara‐MokinNigeria
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Soto-Mota A, Pereira MA, Ebbeling CB, Aronica L, Ludwig DS. Evidence for the carbohydrate-insulin model in a reanalysis of the Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) trial. Am J Clin Nutr 2023; 117:599-606. [PMID: 36811468 DOI: 10.1016/j.ajcnut.2022.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) trial demonstrated that meaningful weight loss can be achieved with either a "healthy low-carbohydrate diet" (LCD) or "healthy low-fat diet" (LFD). However, because both diets substantially decreased glycemic load (GL), the dietary factors mediating weight loss remain unclear. OBJECTIVES We aimed to explore the contribution of macronutrients and GL to weight loss in DIETFITS and examine a hypothesized relationship between GL and insulin secretion. DESIGN This study is a secondary data analysis of the DIETFITS trial, in which participants with overweight or obesity (aged 18-50 y) were randomized to a 12-mo LCD (N = 304) or LFD (N = 305). RESULTS Measures related to carbohydrate intake (total amount, glycemic index, added sugar, and fiber) showed strong associations with weight loss at 3-, 6-, and 12-mo time points in the full cohort, whereas those related to total fat intake showed weak to no associations. A biomarker of carbohydrate (triglyceride/HDL cholesterol ratio) predicted weight loss at all time points (3-mo: β [kg/biomarker z-score change] = 1.1, P = 3.5 × 10-9; 6-mo: β = 1.7, P = 1.1 × 10-9; and 12-mo: β = 2.6, P = 1.5 × 10-15), whereas that of fat (low-density lipoprotein cholesterol + HDL cholesterol) did not (all time points: P = NS). In a mediation model, GL explained most of the observed effect of total calorie intake on weight change. Dividing the cohort into quintiles of baseline insulin secretion and GL reduction revealed evidence of effect modification for weight loss, with P = 0.0009 at 3 mo, P = 0.01 at 6 mo, and P = 0.07 at 12 mo. CONCLUSIONS As predicted by the carbohydrate-insulin model of obesity, weight loss in both diet groups of DIETFITS seems to have been driven by the reduction of GL more so than dietary fat or calories, an effect that may be most pronounced among those with high insulin secretion. These findings should be interpreted cautiously in view of the exploratory nature of this study. TRIAL REGISTRATION ClinicalTrials.gov (NCT01826591).
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Affiliation(s)
- Adrian Soto-Mota
- Metabolic Diseases Research Unit, National Institute for Medical Sciences and Nutrition Salvador Zubiran, Tlalpan, Mexico City, Mexico; Monterrey Institute of Technology and Higher Education, Xochimilco, Mexico City, Mexico
| | - Mark A Pereira
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, MN, USA
| | - Cara B Ebbeling
- New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Lucia Aronica
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - David S Ludwig
- New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
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Vorlet J, Carrard I. Barriers and facilitators of intuitive eating in postmenopausal women: A qualitative study. Health Psychol Open 2023; 10:20551029231157515. [PMID: 36814441 PMCID: PMC9940212 DOI: 10.1177/20551029231157515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
This qualitative descriptive research explored barriers and facilitators of the intuitive eating (IE) implementation process, as experienced by six postmenopausal women classified as 'overweight' or 'obese'. The data was analysed using deductive and inductive thematic analysis and six themes were identified. IE implementation included developing scepticism about weight loss diets, dealing with hunger and satiety cues, making nutritious food choices for one's body, struggling with emotional eating, learning to accept one's body and challenging weight stigma and sociocultural norms of beauty and thinness. IE allowed women to develop a more peaceful relationship with their diet, and was accepted as a welcome alternative to dieting.
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Affiliation(s)
- Jeanne Vorlet
- Metabolic Center, Intercantonal Hopital De La Broye Site Payerne, Switzerland,Jeanne Vorlet, Metabolic Center, Hopital Intercantonal De La Broye, Payerne/Estavayer-le-Lac, Addiction Suisse, Avenue Louis-Ruchonnet 141003, Lausanne, Switzerland.
| | - Isabelle Carrard
- Department of Nutrition and Dietetics, HES-SO Genève, Switzerland
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Giglio BM, Lobo PCB, Pimentel GD. Effects of whey protein supplementation on adiposity, body weight, and glycemic parameters: A synthesis of evidence. Nutr Metab Cardiovasc Dis 2023; 33:258-274. [PMID: 36543706 DOI: 10.1016/j.numecd.2022.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 11/25/2022]
Abstract
AIMS The aim of this review was to analyze the evidence of whey protein supplementation on body weight, fat mass, lean mass and glycemic parameters in subjects with overweight or type 2 diabetes mellitus (T2DM) undergoing calorie restriction or with ad libitum intake. DATA SYNTHESIS Overweight and obesity are considered risk factors for the development of chronic noncommunicable diseases such as T2DM. Calorie restriction is a dietary therapy that reduces weight and fat mass, promotes the improvement of glycemic parameters, and decreases muscle mass. The maintenance of muscle mass during weight loss is necessary in view of its implication in preventing chronic diseases and improving functional capacity and quality of life. The effects of increased protein consumption on attenuating muscle loss and reducing body fat during calorie restriction or ad libitum intake in overweight individuals are discussed. Some studies have demonstrated the positive effects of whey protein supplementation on improving satiety and postprandial glycemic control in short term; however, it remains unclear whether long-term whey protein supplementation can positively affect glycemic parameters. CONCLUSIONS Although whey protein is considered to have a high nutritional quality, its effects in the treatment of overweight, obese individuals and those with T2DM undergoing calorie restriction or ad libitum intake are still inconclusive.
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Affiliation(s)
- Bruna M Giglio
- Faculty of Nutrition, Federal University of Goias, Goiânia, GO, Brazil
| | - Patrícia C B Lobo
- Faculty of Nutrition, Federal University of Goias, Goiânia, GO, Brazil
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12
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Carrasco C, Pérez-Palacios T, Luengo LM, Gómez S, Fajardo M, Gómez MDLÁ, Rodríguez AB. Nutritional quality and physiological effects of halal meat: A pilot study in non-Muslim consumers. FOOD BIOSCI 2022. [DOI: 10.1016/j.fbio.2022.101935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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13
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Roth A, Sattelmayer M, Schorderet C, Gafner S, Allet L. Effects of exercise training and dietary supplement on fat free mass and bone mass density during weight loss – a systematic review and meta-analysis. F1000Res 2022; 11:8. [PMID: 36071711 PMCID: PMC9396077 DOI: 10.12688/f1000research.75539.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 11/20/2022] Open
Abstract
Background: After a diet- or surgery induced weight loss almost 1/3 of lost weight consists of fat free mass (FFM) if carried out without additional therapy. Exercise training and a sufficient supply of protein, calcium and vitamin D is recommended to reduce the loss of FFM. Objective: To investigate the effect of exercise training, protein, calcium, and vitamin D supplementation on the preservation of FFM during non-surgical and surgical weight loss and of the combination of all interventions together in adults with obesity. Methods: A systematic review was performed with a pairwise meta-analysis and an exploratory network meta-analysis according to the PRISMA statement. Results: Thirty studies were included in the quantitative analysis. The pairwise meta-analysis showed for Exercise Training + High Protein vs. High Protein a moderate and statistically significant effect size (SMD 0.45; 95% CI 0.04 to 0.86), for Exercise Training + High Protein vs. Exercise Training a high but statistically not significant effect size (SMD 0.91; 95% CI -0.59 to 2.41) and for Exercise Training alone vs. Control a moderate but statistically not significant effect size (SMD 0.67; 95% CI -0.25 to 1.60). In the exploratory network meta-analysis three interventions showed statistically significant effect sizes compared to Control and all of them included the treatment Exercise Training. Conclusions: Results underline the importance of exercise training and a sufficient protein intake to preserve FFM during weight loss in adults with obesity. The effect of calcium and vitamin D supplementation remains controversial and further research are needed.
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Affiliation(s)
- Anja Roth
- Bern University of Applied Sciences, Bern, Switzerland
| | - Martin Sattelmayer
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, Valais, HES-SO Valais Wallis, Leukerbad, Switzerland
| | - Chloé Schorderet
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, Valais, HES-SO Valais Wallis, Sion, Switzerland
| | - Simone Gafner
- Geneva School of Health Sciences, Genève, Switzerland
- Geneva School of Health Sciences, HES‑SO, University of Applied Sciences and Arts Western Switzerland, 47 Avenue de Champel, 1206 Geneva, Switzerland
| | - Lara Allet
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, Valais, HES-SO Valais Wallis, Sion, Switzerland
- Geneva University Hospitals and Faculty of Medicine, Genève, Switzerland
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14
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Nakamura Y, Tamura T, Narita A, Shimizu A, Sutoh Y, Takashima N, Matsui K, Miyagawa N, Kadota A, Miura K, Otonari J, Ikezaki H, Hishida A, Nagayoshi M, Okada R, Kubo Y, Tanaka K, Shimanoe C, Ibusuki R, Nishimoto D, Oze I, Ito H, Ozaki E, Matsui D, Mikami H, Kusakabe M, Suzuki S, Watanabe M, Arisawa K, Katsuura-Kamano S, Kuriki K, Nakatochi M, Momozawa Y, Kubo M, Takeuchi K, Wakai K. A genome-wide association study on adherence to low-carbohydrate diets in Japanese. Eur J Clin Nutr 2022; 76:1103-1110. [PMID: 35132194 DOI: 10.1038/s41430-022-01090-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 01/19/2022] [Accepted: 01/24/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Low-carbohydrate diets (LCD) are useful for weight reduction, and 50-55% carbohydrate consumption is associated with minimal risk. Genetic differences were related to nutritional consumption, food preferences, and dietary patterns, but whether particular genetic differences in individuals influence LCD adherence is unknown. SUBJECTS/METHODS We conducted a GWAS on adherence to LCD utilizing 14,076 participants from the Japan Multi-Institutional Collaborative Cohort study. We used a previously validated semiquantitative food frequency questionnaire to estimate food consumption. Association of the imputed variants with the LCD score by Halton et al. we used linear regression analysis adjusting for sex, age, total dietary energy consumption, and components 1 to 10 by principal component analysis. We repeated the analysis with adjustment for alcohol consumption (g/day) in addition to the above-described variables. RESULTS Men and women combined analysis without adjustment for alcohol consumption; we found 395 variants on chromosome 12 associated with the LCD score having P values <5 × 10-8. A conditional analysis with the addition of the dosage data of rs671 on chromosome 12 as a covariate, P values for all 395 SNPs on chromosome 12 turned out to be insignificant. In the analysis with additional adjustment for alcohol consumption, we did not identify any SNPs associated with the LCD score. CONCLUSION We found rs671 was inversely associated with adherence to LCD, but that was strongly confounded by alcohol consumption.
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Affiliation(s)
- Yasuyuki Nakamura
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan. .,Yamashina Racto Clinic and Medical Examination Center, Kyoto, Japan.
| | - Takashi Tamura
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akira Narita
- Department of Integrative Genomics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Atsushi Shimizu
- Division of Biomedical Information Analysis, Iwate Tohoku Medical Megabank Organization, Iwate Medical University, Shiwa-gun, Iwate, Japan.,Division of Biomedical Information Analysis, Institute for Biomedical Sciences, Iwate Medical University, Shiwa-gun, Iwate, Japan
| | - Yoichi Sutoh
- Division of Biomedical Information Analysis, Iwate Tohoku Medical Megabank Organization, Iwate Medical University, Shiwa-gun, Iwate, Japan
| | - Naoyuki Takashima
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan.,Department of Public Health, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Kenji Matsui
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan.,Division of Bioethics and Healthcare Law, The National Cancer Center, Tokyo, Japan
| | - Naoko Miyagawa
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan.,Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Aya Kadota
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan.,NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan.,NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan
| | - Jun Otonari
- Department of Psychosomatic Medicine, International University of Health and Welfare Narita Hospital, Narita, Japan.,Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroaki Ikezaki
- Department of Comprehensive General Internal Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Asahi Hishida
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mako Nagayoshi
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Rieko Okada
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoko Kubo
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keitaro Tanaka
- Department of Preventive Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | | | - Rie Ibusuki
- School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Daisaku Nishimoto
- School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan.,Department of International Island and Community Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Isao Oze
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Hidemi Ito
- Division of Cancer Information and Control, Aichi Cancer Center Research Institute, Nagoya, Japan.,Division of Descriptive Cancer Epidemiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Etsuko Ozaki
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Daisuke Matsui
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Haruo Mikami
- Cancer Prevention Center, Chiba Cancer Center Research Institute, Chiba, Japan
| | - Miho Kusakabe
- Cancer Prevention Center, Chiba Cancer Center Research Institute, Chiba, Japan
| | - Sadao Suzuki
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Miki Watanabe
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kokichi Arisawa
- Department of Preventive Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Sakurako Katsuura-Kamano
- Department of Preventive Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kiyonori Kuriki
- Laboratory of Public Health, Division of Nutritional Sciences, School of Food and Nutritional Sciences, University of Shizuoka, Shizuoka, Japan
| | - Masahiro Nakatochi
- Public Health Informatics Unit, Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukihide Momozawa
- Laboratory for Genotyping Development, RIKEN Center for Integrative Medical Sciences, Kanagawa, Japan
| | - Michiaki Kubo
- Laboratory for Genotyping Development, RIKEN Center for Integrative Medical Sciences, Kanagawa, Japan
| | - Kenji Takeuchi
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Wakai
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
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15
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Competing paradigms of obesity pathogenesis: energy balance versus carbohydrate-insulin models. Eur J Clin Nutr 2022; 76:1209-1221. [PMID: 35896818 PMCID: PMC9436778 DOI: 10.1038/s41430-022-01179-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 02/07/2023]
Abstract
The obesity pandemic continues unabated despite a persistent public health campaign to decrease energy intake (“eat less”) and increase energy expenditure (“move more”). One explanation for this failure is that the current approach, based on the notion of energy balance, has not been adequately embraced by the public. Another possibility is that this approach rests on an erroneous paradigm. A new formulation of the energy balance model (EBM), like prior versions, considers overeating (energy intake > expenditure) the primary cause of obesity, incorporating an emphasis on “complex endocrine, metabolic, and nervous system signals” that control food intake below conscious level. This model attributes rising obesity prevalence to inexpensive, convenient, energy-dense, “ultra-processed” foods high in fat and sugar. An alternative view, the carbohydrate-insulin model (CIM), proposes that hormonal responses to highly processed carbohydrates shift energy partitioning toward deposition in adipose tissue, leaving fewer calories available for the body’s metabolic needs. Thus, increasing adiposity causes overeating to compensate for the sequestered calories. Here, we highlight robust contrasts in how the EBM and CIM view obesity pathophysiology and consider deficiencies in the EBM that impede paradigm testing and refinement. Rectifying these deficiencies should assume priority, as a constructive paradigm clash is needed to resolve long-standing scientific controversies and inform the design of new models to guide prevention and treatment. Nevertheless, public health action need not await resolution of this debate, as both models target processed carbohydrates as major drivers of obesity.
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16
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Kirkpatrick CF, Willard KE, Maki KC. Keto is Trending: Implications for Body Weight and Lipid Management. Curr Cardiol Rep 2022; 24:1093-1100. [PMID: 35794438 DOI: 10.1007/s11886-022-01731-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Very-low-carbohydrate (VLC) and ketogenic diets (KDs) have been used for weight loss and more recently in patients with insulin resistance and type 2 diabetes. The impact of VLC and KDs on lipids/lipoproteins is a concern. The purpose of this review is to discuss the impact of KDs on body weight and lipids/lipoproteins. RECENT FINDINGS VLC/KDs contribute to greater weight loss in the short term (< 6 months) compared to higher carbohydrate diets, but there is typically no difference between the diets by 12 months. Triglyceride and high-density lipoprotein cholesterol levels generally improve, but there is a variable response in low-density lipoprotein cholesterol levels, with some individuals experiencing a dramatic increase, particularly those with latent genetic dyslipidemias. Healthcare professionals should educate patients on the risks and benefits of following VLC/KDs and encourage the consumption of carbohydrate-rich foods associated with positive health outcomes.
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Affiliation(s)
- Carol F Kirkpatrick
- Midwest Biomedical Research, Suite 3, Addison, IL, USA. .,Kasiska Division of Health Sciences, Idaho State University, Pocatello, ID, 83209, USA.
| | | | - Kevin C Maki
- Midwest Biomedical Research, Suite 3, Addison, IL, USA.,Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN, 47405, USA
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17
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Abstract
Obesity remains a serious relevant public health concern throughout the world despite related countermeasures being well understood (i.e. mainly physical activity and an adjusted diet). Among different nutritional approaches, there is a growing interest in ketogenic diets (KD) to manipulate body mass (BM) and to enhance fat mass loss. KD reduce the daily amount of carbohydrate intake drastically. This results in increased fatty acid utilisation, leading to an increase in blood ketone bodies (acetoacetate, 3-β-hydroxybutyrate and acetone) and therefore metabolic ketosis. For many years, nutritional intervention studies have focused on reducing dietary fat with little or conflicting positive results over the long term. Moreover, current nutritional guidelines for athletes propose carbohydrate-based diets to augment muscular adaptations. This review discusses the physiological basis of KD and their effects on BM reduction and body composition improvements in sedentary individuals combined with different types of exercise (resistance training or endurance training) in individuals with obesity and athletes. Ultimately, we discuss the strengths and the weaknesses of these nutritional interventions together with precautionary measures that should be observed in both individuals with obesity and athletic populations. A literature search from 1921 to April 2021 using Medline, Google Scholar, PubMed, Web of Science, Scopus and Sportdiscus Databases was used to identify relevant studies. In summary, based on the current evidence, KD are an efficient method to reduce BM and body fat in both individuals with obesity and athletes. However, these positive impacts are mainly because of the appetite suppressive effects of KD, which can decrease daily energy intake. Therefore, KD do not have any superior benefits to non-KD in BM and body fat loss in individuals with obesity and athletic populations in an isoenergetic situation. In sedentary individuals with obesity, it seems that fat-free mass (FFM) changes appear to be as great, if not greater, than decreases following a low-fat diet. In terms of lean mass, it seems that following a KD can cause FFM loss in resistance-trained individuals. In contrast, the FFM-preserving effects of KD are more efficient in endurance-trained compared with resistance-trained individuals.
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18
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Koerich ACC, Borszcz FK, Thives Mello A, de Lucas RD, Hansen F. Effects of the ketogenic diet on performance and body composition in athletes and trained adults: a systematic review and Bayesian multivariate multilevel meta-analysis and meta-regression. Crit Rev Food Sci Nutr 2022; 63:11399-11424. [PMID: 35757868 DOI: 10.1080/10408398.2022.2090894] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This systematic review with meta-analysis aimed to determine the effects of the ketogenic diet (KD) against carbohydrate (CHO)-rich diets on physical performance and body composition in trained individuals. The MEDLINE, EMBASE, CINAHL, SPORTDiscus, and The Cochrane Library were searched. Randomized and non-randomized controlled trials in athletes/trained adults were included. Meta-analytic models were carried out using Bayesian multilevel models. Eighteen studies were included providing estimates on cyclic exercise modes and strength one-maximum repetition (1-RM) performances and for total, fat, and free-fat masses. There were more favorable effects for CHO-rich than KD on time-trial performance (mode [95% credible interval]; -3.3% [-8.5%, 1.7%]), 1-RM (-5.7% [-14.9%, 2.6%]), and free-fat mass (-0.8 [-3.4, 1.9] kg); effects were more favorable to KD on total (-2.4 [-6.2, 1.8] kg) and fat mass losses (-2.4 [-5.4, 0.2] kg). Likely modifying effects on cyclic performance were the subject's sex and VO2max, intervention and performance durations, and mode of exercise. The intervention duration and subjects' sex were likely to modify effects on total body mass. KD can be a useful strategy for total and fat body losses, but a small negative effect on free-fat mass was observed. KD was not suitable for enhancing strength 1-RM or high-intensity cyclic performances.
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Affiliation(s)
- Ana Clara C Koerich
- Department of Nutrition, Health Sciences Center, Federal University of Santa Catarina, University Campus, Trindade, Florianópolis, Santa Catarina, Brazil
| | - Fernando Klitzke Borszcz
- Physical Effort Laboratory, Sports Center, Federal University of Santa Catarina, University Campus, Pantanal, Florianópolis, Santa Catarina, Brazil
| | - Arthur Thives Mello
- Department of Nutrition, Health Sciences Center, Federal University of Santa Catarina, University Campus, Trindade, Florianópolis, Santa Catarina, Brazil
| | - Ricardo Dantas de Lucas
- Physical Effort Laboratory, Sports Center, Federal University of Santa Catarina, University Campus, Pantanal, Florianópolis, Santa Catarina, Brazil
| | - Fernanda Hansen
- Department of Nutrition, Health Sciences Center, Federal University of Santa Catarina, University Campus, Trindade, Florianópolis, Santa Catarina, Brazil
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19
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Preservation of Fat-free Mass in the first year after Bariatric Surgery: A systematic review and meta-analysis of 122 studies and 10758 participants. Surg Obes Relat Dis 2022; 18:964-982. [DOI: 10.1016/j.soard.2022.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 02/07/2022] [Accepted: 02/21/2022] [Indexed: 02/07/2023]
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20
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Avirineni BS, Singh A, Zapata RC, Stevens RD, Phillips CD, Chelikani PK. Diets Containing Egg or Whey Protein and Inulin Fiber Improve Energy Balance and Modulate Gut Microbiota in Exercising Obese Rats. Mol Nutr Food Res 2022; 66:e2100653. [PMID: 35108450 DOI: 10.1002/mnfr.202100653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 12/11/2021] [Indexed: 11/11/2022]
Abstract
SCOPE Dietary protein, prebiotic fiber and exercise individually have been shown to aid in weight loss; however less is known of their combined effects on energy balance. We determined the effects of diets high in protein and fiber, with exercise, on energy balance, hormones and gut microbiota. METHODS AND RESULTS Obese male rats were fed high-fat diets with high protein and fiber contents from egg protein and cellulose, egg protein and inulin, whey protein and cellulose, or whey protein and inulin, together with treadmill exercise. We found that inulin enriched diets decreased energy intake and respiratory quotient, increased energy expenditure, and upregulated transcripts for cholecystokinin (CCK), peptide YY and proglucagon in distal gut. Notably, CCK1-receptor blockade attenuated the hypophagic effects of diets and in particular whey-inulin diet, and β-adrenergic blockade reduced energy expenditure across all diets. Egg-cellulose, egg-inulin and whey-inulin diets decreased weight gain, adiposity, hepatic lipidosis and decreased lipogenic transcripts, improved glycemic control and up-regulated hepatic glucose metabolism transcripts, and decreased plasma insulin and leptin. Importantly, diet was linked to altered gut microbial composition and plasma metabolomics, and a subset of predicted metagenome pathways and plasma metabolites significantly correlated, with plasma butyric acid the most strongly associated to metagenome function. CONCLUSION Combination of dietary egg or whey protein with inulin and exercise improved energy balance, glucose metabolism, upregulated anorectic hormones, and selectively modulated gut microbiota and plasma metabolites. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Bharath S Avirineni
- Department of Production Animal Health, Faculty of Veterinary Medicine, University of Calgary, AB, T2N 4N1, Canada
| | - Arashdeep Singh
- Department of Production Animal Health, Faculty of Veterinary Medicine, University of Calgary, AB, T2N 4N1, Canada.,Present Address: Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, 32610, USA
| | - Rizaldy C Zapata
- Department of Production Animal Health, Faculty of Veterinary Medicine, University of Calgary, AB, T2N 4N1, Canada.,Division of Endocrinology and Metabolism, School of Medicine, University of California San Diego, La Jolla, 92093, USA
| | - Richard D Stevens
- Department of Natural Resources Management, Texas Tech University, Lubbock, TX, 79409, USA
| | - Caleb D Phillips
- Department of Biological Sciences, Texas Tech University, Lubbock, TX, 79409, USA
| | - Prasanth K Chelikani
- Department of Production Animal Health, Faculty of Veterinary Medicine, University of Calgary, AB, T2N 4N1, Canada.,School of Veterinary Medicine, Texas Tech University, Amarillo, TX, 79106, USA.,Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, 79409, USA
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21
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Weight loss did not modify macronutrient specific response of hormones and satiety in overweight and obese people without metabolic disease – results from a clinical trial. Clin Nutr 2022; 41:948-957. [DOI: 10.1016/j.clnu.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 01/24/2022] [Accepted: 02/04/2022] [Indexed: 11/18/2022]
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22
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Sajjadi SF, Mirzababaei A, Pooyan S, Rasaei N, Yekaninejad MS, Shiraseb F, Mirzaei K. The Association Between Low Carbohydrate Diet and Resting Metabolic Rate in Overweight and Obese Women: A Cross-Sectional Study. Clin Nutr Res 2022; 11:50-61. [PMID: 35223681 PMCID: PMC8844535 DOI: 10.7762/cnr.2022.11.1.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 11/19/2022] Open
Abstract
Resting metabolic rate (RMR) accounts for most daily energy expenditure. The low carbohydrate diet (LCD) attenuates decreases in RMR. This study aims to investigate the relationship between an LCD and RMR status among overweight and obese women. We enrolled 291 overweight and obese women in this cross-sectional study. Body mass index (BMI), fat mass, fat-free mass, visceral fat, and insulin level were assessed. RMR was measured using indirect calorimetry. LCD score (LCDS) was measured using a validated semi-quantitative food frequency questionnaire. Analysis of variance, independent sample t-test, and Multinomial logistic regression tests were used. Results showed no relationship between LCDS and deviation of normal RMR (DNR) even after adjust for confounders (increased [Inc.] RMR: odds ratio [OR], 0.97; 95% confidence interval [CI], 0.92–1.01; p = 0.20; decreased [Dec.] RMR: OR, 0.97; 95% CI, 0.94–1.00; p = 0.14). Some components of LCDS had no significant association with DNR, such as carbohydrate and Dec. RMR in adjusted model (OR, 1.62; 95% CI, 0.98–1.37; p = 0.08) and monounsaturated fatty acids and Dec. RMR in adjusted model (OR, 0.48; 95% CI, 0.21–1.10, p = 0.08). However, refined grains had a significant association with Inc. RMR in crude model (OR, 0.87; 95% CI, 0.77–0.99, p = 0.04). There is no association between LCDS and RMR status.
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Affiliation(s)
- Seyedeh Forough Sajjadi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran 14155-6117, Iran
| | - Atieh Mirzababaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran 14155-6117, Iran
| | - Sara Pooyan
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran 14155-6117, Iran
| | - Niloufar Rasaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran 14155-6117, Iran
| | - Mir-Saeed Yekaninejad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran 14155-6117, Iran
| | - Farideh Shiraseb
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran 14155-6117, Iran
| | - Khadijeh Mirzaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran 14155-6117, Iran
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23
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Zhang N, Cheng Y, Luo R, Chang D, Liu T, Wang Z, Guo K, Ge S, Xu G. Low-Carbohydrate-Diet Score and Mortality in Adults With and Without Chronic Kidney Disease: Results From the Third National Health and Nutrition Examination Survey. J Ren Nutr 2021; 32:301-311. [PMID: 34972598 DOI: 10.1053/j.jrn.2021.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 05/02/2021] [Accepted: 05/23/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE The long-term safety of consuming low-carbohydrate diets (LCDs) remains controversial. As high protein and high fat might accelerate chronic kidney disease (CKD) progression, the impact of LCD on mortality might be different in subjects with CKD and subjects without CKD. Therefore, the objective of this study was to assess the association of LCD with mortality among individuals with and without CKD. METHODS Data from 1158 subjects with CKD and 9523 subjects without CKD in the Third National Health and Nutrition Examination Survey were analyzed. The LCD score was calculated based on a 24-hour dietary recall interview. Mortality was from baseline until 31 December 2015. Cox proportional hazards regression models were fitted to estimate multivariable-adjusted hazard ratios and 95% confidence intervals. RESULTS During the median follow-up of 24 years, 751 (65%) deaths and 2624 (28%) deaths were recorded in the CKD group and the non-CKD group, respectively. The multivariable-adjusted hazard ratio for all-cause mortality comparing the highest versus lowest quarters of LCD score was 1.51 (95% confidence interval, 1.01-2.25, P for trend = 0.045) in the CKD group. However, there were no association between the LCD score and all-cause mortality in the non-CKD group. CONCLUSIONS The LCD scores were found significantly positively associated with all-cause mortality in adults with CKD, but not in adults without CKD.
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Affiliation(s)
- Nanhui Zhang
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yichun Cheng
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ran Luo
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dan Chang
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tingting Liu
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zufeng Wang
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kanglin Guo
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuwang Ge
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Gang Xu
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Tzenios N, Lewis ED, Crowley DC, Chahine M, Evans M. Examining the Efficacy of a Very-Low-Carbohydrate Ketogenic Diet on Cardiovascular Health in Adults with Mildly Elevated Low-Density Lipoprotein Cholesterol in an Open-Label Pilot Study. Metab Syndr Relat Disord 2021; 20:94-103. [PMID: 34918971 PMCID: PMC8972001 DOI: 10.1089/met.2021.0042] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: The objective of this open-label pilot study was to investigate the efficacy of a very-low-carbohydrate ketogenic diet (VLCKD), known as Nic's Ketogenic Diet, for 140 days on cardiometabolic markers in healthy adults with mildly elevated low-density lipoprotein cholesterol (LDL-C). Methods: Study assessments were conducted at Day 0, 28, 56, 70, 84, 112, and 140, and weight and blood pressure (BP) were measured and fasting blood was collected for analysis of plasma lipids. A DEXA scan was performed and body mass index recorded on Day 0, 70, and 140. Blood glucose, inflammatory, and thyroid markers were measured on Day 0 and 140. Compliance was assessed using weekly 3-day food records and daily blood glucose and ketone monitoring. Results: The results showed that body fat percentage decreased by 2.25% and 4.41% at Day 70 and 140, respectively (P ≤ 0.012). Significant reductions in android, gynoid, and android/gynoid fat ratio and increases in muscle mass occurred by Day 70 and 140. Total cholesterol, LDL-C, and high-density lipoprotein cholesterol were increased and systolic BP and glycated hemoglobin (HbA1c) were decreased at Day 140 (P < 0.05). Following this VLCKD for 140 days was found to be safe and was well tolerated. Conclusion: The VLCKD showed beneficial changes in body composition and cardiometabolic markers in eutrophic and overweight participants in a 140-day study suggesting a future role for this diet in populations at cardiovascular disease risk. Future research with larger sample size in a randomized double blind clinical trial is warranted to confirm these results. Clinical Trial Registration number: NCT04195594.
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Affiliation(s)
- Nikolaos Tzenios
- Public Health and Medical Research, Charisma University, Grace Bay, Turks and Caicos Islands.,Global Clinical Scholars Research Training Program, Department of Postgraduate Medical Education, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Mohamad Chahine
- Biological and Chemical Technology, International Medical Institute, Kursk State Medical University, Kursk, Russian Federation
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Woelber JP, Tennert C, Ernst SF, Vach K, Ratka-Krüger P, Bertz H, Urbain P. Effects of a Non-Energy-Restricted Ketogenic Diet on Clinical Oral Parameters. An Exploratory Pilot Trial. Nutrients 2021; 13:nu13124229. [PMID: 34959780 PMCID: PMC8703871 DOI: 10.3390/nu13124229] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/23/2021] [Accepted: 11/23/2021] [Indexed: 01/01/2023] Open
Abstract
Ketogenic diets (KDs) may be a helpful complement in the prevention of and therapy for several diseases. Apart from their non-cariogenic properties, it is still unclear how KDs affect oral parameters. The aim of this study was to investigate the influence of a KD on clinical periodontal parameters. Twenty generally healthy volunteers with an average age of 36.6 years underwent a KD for 6 weeks. Their compliance was monitored by measuring their urinary ketones daily and by keeping 7-day food records. Clinical oral parameters included plaque (PI), gingival inflammation (GI), a complete periodontal status (probing depths, bleeding on probing), and general physical and serologic parameters at baseline and after 6 weeks. The results showed a trend towards lower plaque values, but with no significant changes from baseline to the end of the study with regard to the clinical periodontal parameters. However, their body weight and BMI measurements showed a significant decrease. The regression analyses showed that the fat mass and the BMI were significantly positively correlated to periodontal inflammation, while HDL, fiber, and protein intake were negatively correlated to periodontal inflammation. The KD change did not lead to clinical changes in periodontal parameters in healthy participants under continued oral hygiene, but it did lead to a significant weight loss.
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Affiliation(s)
- Johan Peter Woelber
- Department of Operative Dentistry and Periodontology, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany; si.- (S.F.E.); (P.R.-K.)
- Correspondence:
| | - Christian Tennert
- Department of Restorative, Preventive and Pediatric Dentistry, University of Berne, Freiburgstrasse 7, 3010 Bern, Switzerland;
| | - Simon Fabian Ernst
- Department of Operative Dentistry and Periodontology, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany; si.- (S.F.E.); (P.R.-K.)
| | - Kirstin Vach
- Institute of Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, Zinkmattenstr. 6A, 79108 Freiburg, Germany;
| | - Petra Ratka-Krüger
- Department of Operative Dentistry and Periodontology, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany; si.- (S.F.E.); (P.R.-K.)
| | - Hartmut Bertz
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany; (H.B.); (P.U.)
| | - Paul Urbain
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany; (H.B.); (P.U.)
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A protein-supplemented very-low-calorie diet does not mitigate reductions in lean mass and resting metabolic rate in subjects with overweight or obesity: A randomized controlled trial. Clin Nutr 2021; 40:5726-5733. [PMID: 34749132 DOI: 10.1016/j.clnu.2021.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/21/2021] [Accepted: 10/06/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND & AIMS The European Food Safety Authority recently recommended an increase in the protein content of total diet replacement (TDR) products from 50 to 75 g/day. The rationale was to minimize reductions in lean mass (LM) and resting metabolic rate (RMR) that occur with weight loss, and thereby facilitate maintenance of lost weight. We sought to directly compare the efficacy of TDR regimens with the new vs the current protein requirement. METHODS We randomized 108 adults with overweight or obesity (body mass index 28-40 kg/m2) to very-low-calorie diets (VLCD) with either 52 or 77 g/day protein for 8 weeks (total energy intake of 600 or 700 kcal/day, respectively). LM was determined by dual energy X-ray absorptiometry and RMR by indirect calorimetry. RESULTS Attrition rate was 22% in both groups. Both VLCDs decreased body weight, fat mass, LM, and RMR (all P < 0.05). Significant time-by-group interactions were detected for weight and fat mass (both P < 0.05), with corresponding reductions being smaller in the higher-protein than the standard-protein VLCD, likely because of the added calories. On the other hand, reductions in LM (6% from baseline) and RMR (9-10% from baseline) did not differ between groups (P = 0.155 and P = 0.389, respectively), and the contribution of LM to total weight loss was identical (27 ± 2% of lost weight, P = 0.973). CONCLUSIONS Our results indicate that the proposed increase in the protein content of TDR products does not attenuate reductions in LM and RMR in individuals with overweight and obesity who are treated with <800 kcal/day VLCDs for 2 months. CLINICAL TRIAL REGISTRY ClinicalTrials.gov # NCT04156165.
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27
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De Pergola G, Zupo R, Lampignano L, Paradiso S, Murro I, Cecere A, Bartolomeo N, Ciccone MM, Giannelli G, Triggiani V. Effects of a Low Carb Diet and Whey Proteins on Anthropometric, Hematochemical, and Cardiovascular Parameters in Subjects with Obesity. Endocr Metab Immune Disord Drug Targets 2021; 20:1719-1725. [PMID: 32520693 PMCID: PMC8226150 DOI: 10.2174/1871530320666200610143724] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/13/2020] [Accepted: 05/04/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND The best way to lose body weight, without using drugs and/or suffering hunger and stress, has not yet been defined. The present study tested a low carbohydrate diet, enriched with proteins, in subjects with overweight and obesity. METHODS The study enrolled 22 uncomplicated overweight and obese subjects. Several parameters were examined before and after 6 weeks of a low-carbohydrate diet, enriched with 18 g of whey proteins. Anthropometric (body mass index, waist circumference) variables, fasting hormones (insulin, TSH, FT3, FT4), and metabolic (glucose, prealbumin, and lipid levels) parameters were measured. 25- OH-vitamin D (25 (OH) D), parathyroid hormone (PTH) and osteocalcin, were also quantified. Body composition parameters (fat mass, fat-free mass, body cell mass, total body water) were measured by electrical bioimpedance analysis. As cardiovascular parameters, blood pressure, endothelium flowmediated dilation (FMD), and common carotid artery intima-media thickness were also measured. RESULTS The low-carbohydrate diet integrated with proteins induced a significant decrease in body weight (P < 0.001), waist circumference (P < 0.001), fat mass (P < 0.001), diastolic blood pressure (P < 0.01), triglycerides (P < 0.001), total cholesterol (P < 0.001), pre-albumin (P < 0.001), insulin (P < 0.001), HOMAIR (P < 0.001), FT3 (P < 0.05), and c-IMT (P < 0.001), and a significant increase in FMD (P < 0.001) and 25 (OH) D (P < 0.001) was also observed. CONCLUSION All these results suggest that a short-term non-prescriptive low carbohydrate diet, enriched with whey proteins, may be a good way to start losing fat mass and increase health.
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Affiliation(s)
- Giovanni De Pergola
- Clinical Nutrition Unit, Medical Oncology, Department of Biomedical Science and Human Oncology, University of Bari, School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Roberta Zupo
- National Institute of Gastroenterology "S. de Bellis", Research Hospital, Castellana Grotte, Italy
| | - Luisa Lampignano
- National Institute of Gastroenterology "S. de Bellis", Research Hospital, Castellana Grotte, Italy
| | - Silvia Paradiso
- Clinical Nutrition Unit, Medical Oncology, Department of Biomedical Science and Human Oncology, University of Bari, School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Isanna Murro
- Clinical Nutrition Unit, Medical Oncology, Department of Biomedical Science and Human Oncology, University of Bari, School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Annagrazia Cecere
- Section of Cardiovascular Disease, Department of Organ Transplantation, University of Bari, School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Nicola Bartolomeo
- Medical Statistics, Department of Biomedical Science and Human Oncology, University of Bari, School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Marco M Ciccone
- Section of Cardiovascular Disease, Department of Organ Transplantation, University of Bari, School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Gianluigi Giannelli
- Scientific Direction, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, 70013 Bari, Italy
| | - Vincenzo Triggiani
- Section of Endocrinology and Metabolic Diseases, Department of Emergency and Organ Transplantation University of Bari, School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy
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Alternative Dietary Patterns for Americans: Low-Carbohydrate Diets. Nutrients 2021; 13:nu13103299. [PMID: 34684300 PMCID: PMC8537012 DOI: 10.3390/nu13103299] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/04/2021] [Accepted: 09/09/2021] [Indexed: 12/11/2022] Open
Abstract
The decades-long dietary experiment embodied in the Dietary Guidelines for Americans (DGA) focused on limiting fat, especially saturated fat, and higher carbohydrate intake has coincided with rapidly escalating epidemics of obesity and type 2 diabetes (T2D) that are contributing to the progression of cardiovascular disease (CVD) and other diet-related chronic diseases. Moreover, the lack of flexibility in the DGA as it pertains to low carbohydrate approaches does not align with the contemporary trend toward precision nutrition. We argue that personalizing the level of dietary carbohydrate should be a high priority based on evidence that Americans have a wide spectrum of metabolic variability in their tolerance to high carbohydrate loads. Obesity, metabolic syndrome, and T2D are conditions strongly associated with insulin resistance, a condition exacerbated by increased dietary carbohydrate and improved by restricting carbohydrate. Low-carbohydrate diets are grounded across the time-span of human evolution, have well-established biochemical principles, and are now supported by multiple clinical trials in humans that demonstrate consistent improvements in multiple established risk factors associated with insulin resistance and cardiovascular disease. The American Diabetes Association (ADA) recently recognized a low carbohydrate eating pattern as an effective approach for patients with diabetes. Despite this evidence base, low-carbohydrate diets are not reflected in the DGA. As the DGA Dietary Patterns have not been demonstrated to be universally effective in addressing the needs of many Americans and recognizing the lack of widely available treatments for obesity, metabolic syndrome, and T2D that are safe, effective, and sustainable, the argument for an alternative, low-carbohydrate Dietary Pattern is all the more compelling.
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29
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Huang G, Pencina K, Li Z, Apovian CM, Travison TG, Storer TW, Gagliano-Jucá T, Basaria S, Bhasin S. Effect of Protein Intake on Visceral Abdominal Fat and Metabolic Biomarkers in Older Men With Functional Limitations: Results From a Randomized Clinical Trial. J Gerontol A Biol Sci Med Sci 2021; 76:1084-1089. [PMID: 33417663 DOI: 10.1093/gerona/glab007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND It remains controversial whether high protein diets improve cardiometabolic profile. We investigated whether increasing protein intake to 1.3 g/kg/day in functionally limited older adults with usual protein intake ≤RDA (0.8 g/kg/day) improves visceral fat accumulation and serum cardiovascular risk markers more than the recommended daily allowance (RDA). METHODS The Optimizing Protein Intake in Older Men Trial was a placebo-controlled, randomized trial in which 92 functionally limited men, ≥65 years, with usual protein intake ≤RDA were randomized for 6 months to: 0.8 g/kg/day protein plus placebo; 1.3 g/kg/day protein plus placebo; 0.8 g/kg/day protein plus testosterone enanthate 100 mg weekly; or 1.3 g/kg/day protein plus testosterone enanthate 100 mg weekly. In this substudy, metabolic and inflammatory serum markers were measured in 77 men, and visceral adipose tissue (VAT) was assessed using dual-energy x-ray absorptiometry in 56 men. RESULTS Treatment groups were similar in their baseline characteristics. Randomization to 1.3 g/kg/day protein group was associated with greater reduction in VAT compared to 0.8 g/kg/day group (between-group difference: -17.3 cm2, 95% confidence interval [CI]: -29.7 to -4.8 cm2, p = .008), regardless of whether they received testosterone or placebo. Changes in fasting glucose, fasting insulin, HOMA-IR, leptin, adiponectin, IL-6, and hs-CRP did not differ between the 0.8 versus 1.3 g/kg/day protein groups regardless of testosterone use. CONCLUSIONS Protein intake >RDA decreased VAT in functionally limited older men but did not improve cardiovascular disease risk markers. CLINICAL TRIALS REGISTRATION NUMBER NCT01275365.
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Affiliation(s)
- Grace Huang
- Department of Medicine, Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Karol Pencina
- Department of Medicine, Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Zhuoying Li
- Department of Medicine, Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Caroline M Apovian
- Department of Medicine, Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center, Massachusetts, USA
| | - Thomas G Travison
- Department of Medicine, Institute for Aging Research, Hebrew SeniorLife, Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Thomas W Storer
- Department of Medicine, Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Thiago Gagliano-Jucá
- Department of Medicine, Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Shehzad Basaria
- Department of Medicine, Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Shalender Bhasin
- Department of Medicine, Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital, Boston, Massachusetts, USA
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30
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Hansen TT, Astrup A, Sjödin A. Are Dietary Proteins the Key to Successful Body Weight Management? A Systematic Review and Meta-Analysis of Studies Assessing Body Weight Outcomes after Interventions with Increased Dietary Protein. Nutrients 2021; 13:nu13093193. [PMID: 34579069 PMCID: PMC8468854 DOI: 10.3390/nu13093193] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/06/2021] [Accepted: 09/10/2021] [Indexed: 11/23/2022] Open
Abstract
The primary aim was to systematically review the current evidence investigating if dietary interventions rich in protein lead to improved body weight management in adults with excessive body weight. The secondary aim was to investigate potential modifying effects of phenotyping. A systematic literature search in PubMed, Web of Science, and Cochrane Library identified 375 randomized controlled trials with 43 unique trials meeting the inclusion criteria. The Cochrane collaboration tool was used for a thorough risk of bias assessment. Based on 37 studies evaluating effects of dietary protein on body weight, the participants with increased protein intake (ranging from 18–59 energy percentage [E%]) were found to reduce body weight by 1.6 (1.2; 2.0) kg (mean [95% confidence interval]) compared to controls (isocaloric interventions with energy reduction introduced in certain studies). Individuals with prediabetes were found to benefit more from a diet high in protein compared to individuals with normoglycemia, as did individuals without the obesity risk allele (AA genotype) compared to individuals with the obesity risk alleles (AG and GG genotypes). Thus, diets rich in protein would seem to have a moderate beneficial effect on body weight management.
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31
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Lim CGY, Whitton C, Rebello SA, van Dam RM. Diet Quality and Lower Refined Grain Consumption are Associated With Less Weight Gain in a Multi-Ethnic Asian Adult Population. J Nutr 2021; 151:2372-2382. [PMID: 33978192 DOI: 10.1093/jn/nxab110] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/18/2021] [Accepted: 03/26/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The prevalence of obesity is increasing in many Asian countries. However, longitudinal data on the impacts of dietary factors on weight gain in Asian populations are sparse. OBJECTIVES We evaluated the relationship between changes in intakes of nutrients, foods, and beverages and diet quality and long-term changes in body weight. METHODS We used data (n = 3064) from the Singapore Multi-Ethnic Cohort, a prospective cohort including Chinese, Indian, and Malay residents aged 21-65 years. Dietary intakes were assessed using an FFQ, and body weight and waist circumference were measured during health examinations. Diet quality was evaluated using the Dietary Approaches to Stop Hypertension (DASH) and Alternative Healthy Eating Index (AHEI-2010) scores. Data were collected at baseline (2004-2010) and follow-up (2011-2016), with a mean follow-up of 6.0 years. Linear regression was used to assess the associations between dietary changes and weight change, adjusted for socio-demographic and lifestyle variables. RESULTS Improvements in dietary quality scores (DASH, -0.34 kg per 5 points; AHEI-2010, -0.35 kg per 10 points) and replacement of carbohydrates with protein (-0.44 kg per 5% of energy) were significantly associated with less weight gain. Increased intakes of white rice (+0.25 kg per serving/d), soft drinks (+0.69 kg), red meat (+0.58 kg), and poultry with skin (+0.74 kg) were directly associated with weight gain. The replacement of 1 serving per day of white rice with whole grains (-0.68 kg), vegetables (-0.33 kg), poultry without skin (-0.79 kg), and eggs (-0.87 kg) was associated with less weight gain. Similar associations were observed between changes in dietary factors and changes in waist circumference. CONCLUSIONS Among Asian adults, increasing dietary quality, reducing soft drink consumption, and replacing white rice with whole grains, vegetables, and selected high-protein foods was associated with less weight gain.
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Affiliation(s)
- Charlie G Y Lim
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Clare Whitton
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,School of Public Health, Curtin University, Perth, Australia
| | - Salome A Rebello
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Department of Nutrition and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Haghighat N, Ashtary-Larky D, Bagheri R, Wong A, Cheraghloo N, Moradpour G, Nordvall M, Asbaghi O, Moeinvaziri N, Amini M, Sohrabi Z, Dutheil F. Effects of 6 Months of Soy-Enriched High Protein Compared to Eucaloric Low Protein Snack Replacement on Appetite, Dietary Intake, and Body Composition in Normal-Weight Obese Women: A Randomized Controlled Trial. Nutrients 2021; 13:nu13072266. [PMID: 34208986 PMCID: PMC8308358 DOI: 10.3390/nu13072266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 12/16/2022] Open
Abstract
(1) Background: The favorable effects of high protein snacks on body composition and appetite status in lean and athletic populations have been illustrated previously. However, the effects of soy-enriched high protein snacks have not been investigated in women with normal-weight obesity (NWO). Consequently, we aimed at comparing the effects of six months of soy-enriched high protein snack replacement on appetite, body composition, and dietary intake in women with NWO. (2) Methods: One hundred seven (107) women with NWO [(age: 24 ± 3 yrs, BMI: 22.7 ± 2.3 kg/m2, body fat percentage (BFP): 38 ± 3.2%)] who were assigned to one of two groups; high protein snack (HP, n = 52) containing 50 g soybean or isocaloric low-protein snack (protein: 18.2 g, carbohydrate: 15 g, fat: 10 g, energy: 210 kcal) or isocaloric low protein snack (LP, n = 55) containing 3.5 servings of fruit (protein: <2 g, carbohydrate: ≈50 g, fat: <1 g, energy: ≈210 kcal) as part of their daily meals (as a snack at 10 a.m.), successfully completed the study interventions. Body mass (BM), body mass index (BMI), waist circumference (WC), BFP, skeletal muscle mass, dietary intake, and appetite levels were evaluated prior to and after the six-month intervention. (3) Results: Appetite (HP = -12 mm and LP = -0.6 mm), energy intake (HP = -166.2 kcal/day and LP = 91.3 kcal), carbohydrate intake (HP = -58.4 g/day and LP = 6.4 g/day), WC (HP = -4.3 cm and LP = -0.9 cm), and BFP (HP = -3.7% and LP = -0.9%) were significantly (p < 0.05) reduced, while skeletal muscle mass (HP = 1.2 kg and LP = 0.3 kg) significantly increased in the HP compared to the LP group, respectively. (4) Conclusions: Six months of a soy-enriched high protein snack replacement decreased appetite and improved body composition in women with NWO. Our findings suggest that soy-enriched high protein snacks are an efficacious strategy for body composition improvement.
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Affiliation(s)
- Neda Haghighat
- Laparoscopy Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz 71348-14336, Iran; (N.H.); (G.M.); (N.M.)
| | - Damoon Ashtary-Larky
- Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz 61357-15794, Iran;
| | - Reza Bagheri
- Department of Exercise Physiology, University of Isfahan, Isfahan 81746-73441, Iran;
| | - Alexei Wong
- Department of Health and Human Performance, Marymount University, Arlington, VA 22207, USA;
- Correspondence: (A.W.); (M.A.)
| | - Neda Cheraghloo
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran 1417613151, Iran;
| | - Gholamreza Moradpour
- Laparoscopy Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz 71348-14336, Iran; (N.H.); (G.M.); (N.M.)
| | - Michael Nordvall
- Department of Health and Human Performance, Marymount University, Arlington, VA 22207, USA;
| | - Omid Asbaghi
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran 1416753955, Iran;
| | - Nader Moeinvaziri
- Laparoscopy Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz 71348-14336, Iran; (N.H.); (G.M.); (N.M.)
| | - Masoud Amini
- Laparoscopy Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz 71348-14336, Iran; (N.H.); (G.M.); (N.M.)
- Correspondence: (A.W.); (M.A.)
| | - Zahra Sohrabi
- Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz 71348-14336, Iran;
| | - Frédéric Dutheil
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Preventive and Occupational Medicine, WittyFit, F-63000 Clermont-Ferrand, France;
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A comparison of dietary quality and nutritional adequacy of popular energy-restricted diets against the Australian Guide to Healthy Eating and the Mediterranean Diet. Br J Nutr 2021; 128:1357-1370. [PMID: 34155964 DOI: 10.1017/s0007114521002282] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
There is limited information regarding the nutrition profile and diet quality of meal plans from currently popular weight loss (WL) diets in Australia. This includes the energy content (kilojoules), the macronutrient distribution and the micronutrient composition. Further, these diets have not been compared with current government guidelines and healthy eating principles (HEP) for nutritional adequacy. Popular diets were identified through grey literature, trending searches and relative popularity in Australia. Meal plans for each diet were analysed using Foodworks Dietary Software to determine food group intake, micronutrient and macronutrient distribution. The results indicated that all popular diets assessed deviated from government recommended HEP such as the Australian Guide to Healthy Eating and the Mediterranean diet. In most cases, both popular diets and the HEP had low intakes of multiple food groups, low intakes of essential micronutrients and a distorted macronutrient distribution. Popular diets may not provide adequate nutrition to meet needs, particularly in the long term and potentially resulting in micronutrient deficiency. When energy restricting for WL, meal plans should be highly individualised in conjunction with a qualified nutrition professional to ensure adequate dietary intake.
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Tanaka K, Taoda A, Kashiwagi H. Resistance Exercise After Laparoscopic Surgery Enhances Improvement in Exercise Tolerance in Geriatric Patients With Gastrointestinal Cancer. Cureus 2021; 13:e15454. [PMID: 34258117 PMCID: PMC8256392 DOI: 10.7759/cureus.15454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2021] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Early mobilization after cancer surgery is generally recommended. However, the effects of postoperative resistance exercise during a hospital stay have been rarely investigated. This study aimed to clarify the effects of resistance exercise after laparoscopic surgery on exercise tolerance and skeletal muscle mass in geriatric patients with gastrointestinal cancer. METHODS This single-center retrospective observational study included patients with gastrointestinal cancer who admitted for laparoscopic surgery. Exercise tolerance and skeletal muscle mass were assessed using a six-minute walking test (6MWT) and skeletal muscle index (SMI) at admission and discharge, respectively. Intergroup comparisons of absolute changes in 6MWT and SMI were analyzed by the unpaired t-test or Mann-Whitney U test according to whether resistance exercise was performed or not. Multivariable linear regression analyses were used to analyze the association of resistance exercise with changes in 6MWT and SMI. The analyses were adjusted for age, sex, cancer stage, postoperative complication, and preoperative exercise tolerance and skeletal muscle mass. RESULTS Altogether, 66 patients (mean age 69.9 years; 60.6% men) were recruited. Of them, 72.7% performed the resistance exercise and started at a median of 4.5 postoperative days. There were no significant intergroup differences in absolute changes in the 6MWT and the SMI (p = 0.153, p = 0.476, respectively). Multivariable linear regression analysis showed that resistance exercise was independently and positively associated with the 6MWT at discharge (β = 1.70, 95% confidence interval, 1.88 to 71.09) and did not significantly contribute to the SMI at discharge (95% confidence interval, -0.21 to 0.27). CONCLUSION Resistance exercise may enhance the improvement in postoperative exercise tolerance in geriatric patients with gastrointestinal cancer who underwent laparoscopic surgery.
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Affiliation(s)
- Kohei Tanaka
- Rehabilitation Medicine, Osaka Police Hospital, Osaka, JPN
| | - Ayano Taoda
- Rehabilitation Medicine, Osaka Police Hospital, Osaka, JPN
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Vogtschmidt YD, Raben A, Faber I, de Wilde C, Lovegrove JA, Givens DI, Pfeiffer AFH, Soedamah-Muthu SS. Is protein the forgotten ingredient: Effects of higher compared to lower protein diets on cardiometabolic risk factors. A systematic review and meta-analysis of randomised controlled trials. Atherosclerosis 2021; 328:124-135. [PMID: 34120735 DOI: 10.1016/j.atherosclerosis.2021.05.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/25/2021] [Accepted: 05/19/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Higher protein (HP) diets may lead to lower cardiometabolic risk, compared to lower protein (LP) diets. This systematic review and meta-analysis aims to investigate the effects of HP versus LP diets on cardiometabolic risk factors in adults, using the totality of the current evidence from randomised controlled trials (RCTs). METHODS Systematic searches were conducted in electronic databases, up to November 2020. Random effects meta-analyses were conducted to pool the standardised mean differences (SMD) and 95% confidence intervals (CI). The main outcomes were weight loss, body mass index (BMI), waist circumference, fat mass, systolic and diastolic BP, total cholesterol, HDL-and LDL-cholesterol, triacylglycerol, fasting glucose and insulin, and glycated haemoglobin. RESULTS Fifty-seven articles reporting on 54 RCTs were included, involving 4344 participants (65% female, mean age: 46 (SD 10) years, mean BMI: 33 (SD 3) kg/m2), with a mean study duration of 18 weeks (range: 4 to 156 weeks). Compared to LP diets (range protein (E%):10-23%), HP diets (range protein (E%): 20-45%) led to more weight loss (SMD -0.13, 95% CI: -0.23, -0.03), greater reductions in fat mass (SMD -0.14, 95% CI: -0.24, -0.04), systolic BP (SMD -0.12, 95% CI: -0.21, -0.02), total cholesterol (SMD -0.11, 95% CI: -0.19, -0.02), triacylglycerol (SMD -0.22, 95% CI: -0.30, -0.14) and insulin (SMD -0.12, 95% CI: -0.22, -0.03). No significant differences were observed for the other outcomes. CONCLUSIONS Higher protein diets showed small, but favourable effects on weight loss, fat mass loss, systolic blood pressure, some lipid outcomes and insulin, compared to lower protein diets.
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Affiliation(s)
- Yakima D Vogtschmidt
- KingdomHugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Whiteknights Campus, Harry Nursten Building, Reading RG6 6DZ, United Kingdom; Institute for Cardiovascular and Metabolic Research, University of Reading, Reading RG6 6DZ, United Kingdom; Institute for Food, Nutrition and Health, University of Reading, Reading RG6 6AR, United Kingdom.
| | - Anne Raben
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Rolighedsvej 30, 1958, Frederiksberg C, Denmark; Steno Diabetes Center Copenhagen (SDCC), Niels Steensens Vej 2, 2820, Gentofte, Denmark
| | - Ilona Faber
- Department of Food Science, University of Copenhagen, Rolighedsvej 26, 1958, Frederiksberg C, Denmark
| | - Claudia de Wilde
- Center of Research on Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, 5000, LE Tilburg, the Netherlands
| | - Julie A Lovegrove
- KingdomHugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Whiteknights Campus, Harry Nursten Building, Reading RG6 6DZ, United Kingdom; Institute for Cardiovascular and Metabolic Research, University of Reading, Reading RG6 6DZ, United Kingdom; Institute for Food, Nutrition and Health, University of Reading, Reading RG6 6AR, United Kingdom
| | - D Ian Givens
- Institute for Cardiovascular and Metabolic Research, University of Reading, Reading RG6 6DZ, United Kingdom; Institute for Food, Nutrition and Health, University of Reading, Reading RG6 6AR, United Kingdom
| | - Andreas F H Pfeiffer
- German Center for Diabetes Research, Partner Potsdam, Berlin, Germany; Department of Endocrinology, Diabetes and Nutrition, Campus Benjamin Franklin, Charité University of Medicine, 12200, Berlin, Germany
| | - Sabita S Soedamah-Muthu
- Institute for Food, Nutrition and Health, University of Reading, Reading RG6 6AR, United Kingdom; Center of Research on Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, 5000, LE Tilburg, the Netherlands
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Effects of intermittent fasting combined with resistance training on body composition: a systematic review and meta-analysis. Physiol Behav 2021; 237:113453. [PMID: 33984329 DOI: 10.1016/j.physbeh.2021.113453] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 04/23/2021] [Accepted: 05/03/2021] [Indexed: 12/11/2022]
Abstract
This systematic review and meta-analysis evaluated the influence of intermittent fasting (IF) in combination with resistance training (RT) on body composition outcomes. Studies examining IF vs. non-IF diets in individuals performing RT, published up to February 2021, were identified through PubMed, the Cochrane Library, Web of Science, Embase, and SCOPUS databases. Eight studies, including 221 participants were analyzed using a random-effects model to calculate weighted mean differences (WMDs) with 95% confidence intervals (CIs). Results indicated that IF had a significant effect on body mass (WMD = -2.08 kg; 95% CI: -3.04, -1.13), fat mass (WMD = -1.36 kg; 95% CI: -1.94, -0.78), body mass index (WMD = -0.52 kg/m2; 95% CI: -0.85, -0.19), and body fat percentage (WMD = -1.49%; 95% CI: -2.24, -0.74) relative to non-IF diets, without a significant effect for fat-free mass (WMD = -0.27 kg; 95% CI: -0.82, 0.28). The present systematic review and meta-analysis demonstrates potentially beneficial effects of IF in combination with RT for reducing body mass and body fat relative to non-IF control diets, with similar preservation of fat-free mass.
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Muscogiuri G, Barrea L, Caprio M, Ceriani F, Chavez AO, El Ghoch M, Frias-Toral E, Mehta RJ, Mendez V, Paschou SA, Pazderska A, Savastano S, Colao A. Nutritional guidelines for the management of insulin resistance. Crit Rev Food Sci Nutr 2021; 62:6947-6960. [PMID: 33797999 DOI: 10.1080/10408398.2021.1908223] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Obesity and its related co-morbidities, namely type 2 diabetes (T2D), pose a significant global public health problem. Insulin resistance (IR) in muscle and liver is the core pathophysiologic defect that underlies obesity preceding and predicting the onset of T2D in susceptible humans. There is a broad population with IR that has no indication for prescription of medications, who still need medical consultation and specific advice in this respect. This prevalent need can be achieved by appropriate diet, exercise, and other behavioral therapies for lifestyle interventions. Despite a well-recognized role of IR in the progression to metabolic diseases, no specific nutritional recommendations exist to manage this condition, to the best of our knowledge. An international panel of experts reviewed and critically appraised the updated literature published about this topic. This review primarily examines the evidence for areas of consensus and ongoing uncertainty or controversy about diet and exercise approaches for IR. The aim of this article is to present the most common IR states, namely obesity and Polycystic Ovary Syndrome (PCOS), and provide nutritional advice to manage IR, hyperinsulinemia, and reactive hypoglycemia. These nutritional guidelines could prevent progression or worsening of IR with resultant beta-cell failure and, as a result, T2D.
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Affiliation(s)
- Giovanna Muscogiuri
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università "Federico II" di Napoli, Via Sergio Pansini, 5, Naples, Italy.,Cattedra Unesco "Educazione alla salute e allo sviluppo sostenibile", Federico II University, Naples, Italy.,Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università "Federico II" di Napoli, Via Sergio Pansini, 5, Naples, Italy
| | - Luigi Barrea
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università "Federico II" di Napoli, Via Sergio Pansini, 5, Naples, Italy.,Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Napoli, Italy
| | - Massimiliano Caprio
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele Pisana, Rome, Italy.,Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
| | - Florencia Ceriani
- Nutrition School, Universidad de la República (UdelaR), Montevideo, Uruguay
| | - Alberto O Chavez
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Marwan El Ghoch
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
| | - Evelyn Frias-Toral
- School of Medicine, Universidad Católica Santiago de Guayaquil, Guayaquil, Ecuador
| | | | - Verna Mendez
- Department of Internal Medicine, Hospital General de Zona 49, Mexican Institute of Social Security, Los Mochis, Sinaloa, México
| | - Stavroula A Paschou
- Division of Endocrinology, Diabetes and Metabolism, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Agnieszka Pazderska
- Endocrinology Unit, St James's Hospital, Dublin, Ireland.,Clinical Senior Lecturer, Trinity College Dublin, Dublin, Ireland
| | - Silvia Savastano
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università "Federico II" di Napoli, Via Sergio Pansini, 5, Naples, Italy.,Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università "Federico II" di Napoli, Via Sergio Pansini, 5, Naples, Italy
| | - Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università "Federico II" di Napoli, Via Sergio Pansini, 5, Naples, Italy.,Cattedra Unesco "Educazione alla salute e allo sviluppo sostenibile", Federico II University, Naples, Italy.,Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università "Federico II" di Napoli, Via Sergio Pansini, 5, Naples, Italy
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Buga A, Kackley ML, Crabtree CD, Sapper TN, Mccabe L, Fell B, LaFountain RA, Hyde PN, Martini ER, Bowman J, Pan Y, Scandling D, Brownlow ML, O'Connor A, Simonetti OP, Kraemer WJ, Volek JS. The Effects of a 6-Week Controlled, Hypocaloric Ketogenic Diet, With and Without Exogenous Ketone Salts, on Body Composition Responses. Front Nutr 2021; 8:618520. [PMID: 33869263 PMCID: PMC8044842 DOI: 10.3389/fnut.2021.618520] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 02/23/2021] [Indexed: 01/16/2023] Open
Abstract
Background: Ketogenic diets (KDs) that elevate beta-hydroxybutyrate (BHB) promote weight and fat loss. Exogenous ketones, such as ketone salts (KS), also elevate BHB concentrations with the potential to protect against muscle loss during caloric restriction. Whether augmenting ketosis with KS impacts body composition responses to a well-formulated KD remains unknown. Purpose: To explore the effects of energy-matched, hypocaloric KD feeding (<50 g carbohydrates/day; 1.5 g/kg/day protein), with and without the inclusion of KS, on weight loss and body composition responses. Methods: Overweight and obese adults were provided a precisely defined hypocaloric KD (~75% of energy expenditure) for 6 weeks. In a double-blind manner, subjects were randomly assigned to receive ~24 g/day of a racemic BHB-salt (KD + KS; n = 12) or placebo (KD + PL; n = 13). A matched comparison group (n = 12) was separately assigned to an isoenergetic/isonitrogenous low-fat diet (LFD). Body composition parameters were assessed by dual x-ray absorptiometry and magnetic resonance imaging. Results: The KD induced nutritional ketosis (>1.0 mM capillary BHB) throughout the study (p < 0.001), with higher fasting concentrations observed in KD + KS than KD + PL for the first 2 weeks (p < 0.05). There were decreases in body mass, whole body fat and lean mass, mid-thigh muscle cross-sectional area, and both visceral and subcutaneous adipose tissues (p < 0.001), but no group differences between the two KDs or with the LFD. Urine nitrogen excretion was significantly higher in KD + PL than LFD (p < 0.01) and trended higher in KD + PL compared to KD + KS (p = 0.076), whereas the nitrogen excretion during KD + KS was similar to LFD (p > 0.05). Conclusion: Energy-matched hypocaloric ketogenic diets favorably affected body composition but were not further impacted by administration of an exogenous BHB-salt that augmented ketosis. The trend for less nitrogen loss with the BHB-salt, if manifested over a longer period of time, may contribute to preserved lean mass.
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Affiliation(s)
- Alex Buga
- Department of Human Sciences, The Ohio State University, Columbus, OH, United States
| | - Madison L. Kackley
- Department of Human Sciences, The Ohio State University, Columbus, OH, United States
| | | | - Teryn N. Sapper
- Department of Human Sciences, The Ohio State University, Columbus, OH, United States
| | - Lauren Mccabe
- Department of Human Sciences, The Ohio State University, Columbus, OH, United States
| | - Brandon Fell
- Department of Human Sciences, The Ohio State University, Columbus, OH, United States
| | - Rich A. LaFountain
- Department of Human Sciences, The Ohio State University, Columbus, OH, United States
| | - Parker N. Hyde
- Department of Human Sciences, The Ohio State University, Columbus, OH, United States
| | - Emily R. Martini
- Department of Human Sciences, The Ohio State University, Columbus, OH, United States
| | - Jessica Bowman
- Department of Human Sciences, The Ohio State University, Columbus, OH, United States
| | - Yue Pan
- Department of Radiology, Davis Heart & Lung Research Institute, The Ohio State University, Columbus, OH, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
- Department of Radiology, Wexner Medical Center, The Ohio State University, Columbus, OH, United States
| | - Debbie Scandling
- Department of Radiology, Davis Heart & Lung Research Institute, The Ohio State University, Columbus, OH, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
- Department of Radiology, Wexner Medical Center, The Ohio State University, Columbus, OH, United States
| | - Milene L. Brownlow
- Research and Development Department, Metagenics, Inc., Aliso Viejo, CA, United States
| | - Annalouise O'Connor
- Research and Development Department, Metagenics, Inc., Aliso Viejo, CA, United States
| | - Orlando P. Simonetti
- Department of Radiology, Davis Heart & Lung Research Institute, The Ohio State University, Columbus, OH, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
- Department of Radiology, Wexner Medical Center, The Ohio State University, Columbus, OH, United States
| | - William J. Kraemer
- Department of Human Sciences, The Ohio State University, Columbus, OH, United States
| | - Jeff S. Volek
- Department of Human Sciences, The Ohio State University, Columbus, OH, United States
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39
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Martínez-Gómez MG, Roberts BM. Metabolic Adaptations to Weight Loss: A Brief Review. J Strength Cond Res 2021; 36:2970-2981. [PMID: 33677461 DOI: 10.1519/jsc.0000000000003991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Martínez-Gómez, MG and Roberts, BM. Metabolic adaptations to weight loss: A brief review. J Strength Cond Res XX(X): 000-000, 2021-As the scientific literature has continuously shown, body mass loss attempts do not always follow a linear fashion nor always go as expected even when the intervention is calculated with precise tools. One of the main reasons why this tends to happen relies on our body's biological drive to regain the body mass we lose to survive. This phenomenon has been referred to as "metabolic adaptation" many times in the literature and plays a very relevant role in the management of obesity and human weight loss. This review will provide insights into some of the theoretical models for the etiology of metabolic adaptation as well as a quick look into the physiological and endocrine mechanisms that underlie it. Nutritional strategies and dietetic tools are thus necessary to confront these so-called adaptations to body mass loss. Among some of these strategies, we can highlight increasing protein needs, opting for high-fiber foods or programming-controlled diet refeeds, and diet breaks over a large body mass loss phase. Outside the nutritional aspects, it might be wise to increase the physical activity and thus the energy flux of an individual when possible to maintain diet-induced body mass loss in the long term. This review will examine these protocols and their viability in the context of adherence and sustainability for the individual toward successful body mass loss.
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Affiliation(s)
- Mario G Martínez-Gómez
- CarloSportNutrition, Spain; and University of Alabama at Birmingham, Birmingham, Alabama
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40
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Ashtary-Larky D, Bagheri R, Asbaghi O, Tinsley GM, Kooti W, Abbasnezhad A, Afrisham R, Wong A. Effects of resistance training combined with a ketogenic diet on body composition: a systematic review and meta-analysis. Crit Rev Food Sci Nutr 2021; 62:5717-5732. [PMID: 33624538 DOI: 10.1080/10408398.2021.1890689] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
We evaluated the effects of ketogenic diets (KDs) on body mass (BM), fat mass (FM), fat-free mass (FFM), body mass index (BMI), and body fat percentage (BFP) compared to non-KDs in individuals performing resistance training (RT). Online electronic databases including PubMed, the Cochrane Library, Web of Science, Embase, SCOPUS, and Ovid were searched to identify initial studies until February 2021. Data were pooled using both fixed and random-effects methods and were expressed as weighted mean difference (WMD) and 95% confidence intervals (CI). Out of 1372 studies, 13 randomized controlled trials (RCTs) that enrolled 244 volunteers were included. The pooled results demonstrated that KDs significantly decreased BM [(WMD = -3.67 kg; 95% CI: -4.44, -2.90, p < 0.001)], FM [(WMD = -2.21 kg; 95% CI: -3.09, -1.34, p < 0.001)], FFM [(WMD = -1.26 kg; 95% CI: -1.82, -0.70, p < 0.001)], BMI [(WMD = -1.37 kg.m-2; 95% CI: -2.14, -0.59, p = 0.022)], and BFP [(WMD = -2.27%; 95% CI: -3.63, -0.90, p = 0.001)] compared to non-KDs. We observed beneficial effects of KDs compared to non-KDs on BM and body fat (both FM and BFP) in individuals performing RT. However, adherence to KDs may have a negative effect on FFM, which is not ameliorated by the addition of RT.
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Affiliation(s)
- Damoon Ashtary-Larky
- Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Reza Bagheri
- Department of Exercise Physiology, University of Isfahan, Isfahan, Iran
| | - Omid Asbaghi
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Grant M Tinsley
- Department of Kinesiology & Sport Management, Texas Tech University, Lubbock, Texas, USA
| | - Wesam Kooti
- Lung Diseases & Allergy Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Amir Abbasnezhad
- Nutritional Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Reza Afrisham
- Department of Clinical Biochemistry, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Alexei Wong
- Department of Health and Human Performance, Marymount University, Arlington, Texas, USA
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41
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Breukelman GJ, Basson AK, Djarova TG, Shaw BS, du Preez CJ, Shaw I. Establishing a proof of concept for the effects of low-carbohydrate, high-fat diet (LCHFD) and physical activity on body composition in type 2 diabetes. Heliyon 2021; 7:e06266. [PMID: 33665433 PMCID: PMC7900685 DOI: 10.1016/j.heliyon.2021.e06266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/06/2020] [Accepted: 02/09/2021] [Indexed: 12/20/2022] Open
Abstract
Overweight and obesity are both a risk factor for developing and exacerbating type 2 diabetes (T2D). While the most common diet used to treat overweight and obesity focus on high-carbohydrate, low-fat, energy deficit diets, recently, low-carbohydrate, high-fat diets (LCHFD) have become popular in targeting obesity. This proof-of-concept study attempted to determine if an LCHFD could improve body composition variables, or if a concurrent treatment of LCHFD and physical activity would create an interference effect in individuals with T2D. Overweight and obese with T2D (n = 39) were assigned into either a 16-week combined physical activity and LCHFD group (ConG), LCHFD-only group (DieG) or control group (NonG). No statistically significant (p > 0.01) changes were found in body mass in the ConG (2.0%, F = 0.039, P = 0.846) and DieG (2.5%, F = 0.188, P = 0.669); for body mass index in the ConG (2.2%, F = 0.046, P = 0.832) and DieG (2.3%, F = 0.098, P = 0.758.); and waist-to-hip ratio in the ConG (0%, F = 0.002, P = 0.968) and DieG (0%, F = 0.023, P = 0.882). However, clinically significant changes were observed in HbA1c in the ConG male group (23% decrease); percentage body fat for the ConG (16.7%, F = 1.682, P = 0.208, g = 0.534) and DieG (13.0%, F = 0.638, P = 0435, g = 0.361); for waist circumferences in the ConG (5.4%, F = 0.686, P = 0.416, g = 0.341) and DieG (6.3%, F = 1.327, P = 0.264, g = 0.520); and for hip circumference in the ConG (5.8%, F = 0.993, P = 0.329, g = 0.410) and DieG (7.0%, F = 2.668, P = 0.119, g = 0.737). Results indicate that moderate clinically significant changes in body composition are achievable with LCHFD and/or daily walking in obese adults living with T2D. However, more robust research is required to determine the effects of LCHFD, with or without concurrent physical activity, on obesity and other diabetic complication markers.
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Affiliation(s)
- Gerrit J Breukelman
- Department of Human Movement Science, University of Zululand, KwaDlangezwa, 3886, South Africa
| | - Albertus K Basson
- Department Biochemistry and Microbiology, University of Zululand, KwaDlangezwa, 3886, South Africa
| | - Trayana G Djarova
- Department Biochemistry and Microbiology, University of Zululand, KwaDlangezwa, 3886, South Africa
| | - Brandon S Shaw
- Department of Human Movement Science, University of Zululand, KwaDlangezwa, 3886, South Africa
| | - Cornelia J du Preez
- Department of Consumer Sciences, University of Zululand, KwaDlangezwa, 3886, South Africa
| | - Ina Shaw
- Department of Human Movement Science, University of Zululand, KwaDlangezwa, 3886, South Africa
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RMR-Related MAP2K6 Gene Variation on the Risk of Overweight/Obesity in Children: A 3-Year Panel Study. J Pers Med 2021; 11:jpm11020091. [PMID: 33540643 PMCID: PMC7913067 DOI: 10.3390/jpm11020091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 12/19/2022] Open
Abstract
From a pilot GWAS, seven MAP2K6 (MEK6) SNPs were significantly associated with resting metabolic rate (RMR) in obese children aged 8-9 years. The aim of this study was to investigate how RMR-linked MEK6 variation affected obesity in Korean children. With the follow-up students (77.9%) in the 3-year panel study, the changes of the variables associated with obesity (such as anthropometrics, blood biochemistry, and dietary intake) were collected. After the MEK6 SNPs were screened by Affymetrix Genome-Wide Human SNP array 6.0, the genotyping of the seven MEK6 SNPs was performed via SNaPshot assay. As the prevalence of obesity (≥85th percentile) increased from 19.4% to 25.5%, the rates of change of the variables RMR, body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), and dietary intake (energy and carbohydrate intakes) increased. The rate of overweight/obesity was higher in all mutant alleles of the seven MEK6 SNPs than it was in the matched children without mutant alleles. However, over the 3-year study period, RMRs were only significantly increased by the mutants of two single nucleotide polymorphisms (SNPs), rs996229 and rs756942, mainly related to male overweight/obesity as both WC and SBP levels increased. In the mutants of two of the SNPs, the odds ratio of overweight/obesity risk was six times higher in the highest tercile of fat intake and SBP than those of the lowest tercile. For personalized medicine to prevent pediatric obesity, SBP, WC, and dietary fat intake should be observed, particularly if boys have mutants of MEK6 SNPs, rs9916229, or rs756942.
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Amin A, Frampton J, Liu Z, Franco-Becker G, Norton M, Alaa A, Li JV, Murphy KG. Differential effects of L- and D-phenylalanine on pancreatic and gastrointestinal hormone release in humans: A randomized crossover study. Diabetes Obes Metab 2021; 23:147-157. [PMID: 32991046 DOI: 10.1111/dom.14204] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/11/2020] [Accepted: 09/25/2020] [Indexed: 12/16/2022]
Abstract
AIM To investigate the effects of L-phenylalanine on gastroenteropancreatic hormone release, glucose levels, subjective appetite and energy intake in humans, and to determine whether these effects were stereoisomer-specific by comparing them with D-phenylalanine. MATERIALS AND METHODS A dose-finding, non-randomized, unblinded, crossover study was conducted during October-December 2017 at the NIHR Imperial Clinical Research Facility in five participants, in which the tolerability of escalating doses of oral L-phenylalanine was assessed (0, 3, 6 and 10 g). Also, an acute, randomized, double-blind, placebo-controlled crossover study was conducted during January-May 2018 at the NIHR Imperial Clinical Research Facility in 11 participants, in which the effects of oral 10 g L-phenylalanine relative to D-phenylalanine and placebo on gastroenteropancreatic hormone (insulin, glucagon, glucose-dependent insulinotropic polypeptide [GIP], peptide tyrosine tyrosine [PYY], glucagon-like peptide-1) and glucose concentrations, visual analogue scales for subjective appetite and energy intake at an ad libitum meal served 70 minutes postingestion, were investigated. RESULTS L-phenylalanine was well-tolerated and increased insulin and glucagon concentrations prior to meal ingestion at several time points relative to placebo and D-phenylalanine (P < .05). L-phenylalanine also increased GIP concentrations relative to D-phenylalanine (P = .0420) and placebo (P = .0249) 70 minutes following ingestion. L-phenylalanine reduced postprandial glucose area under the curve (AUC)70-150mins relative to placebo (P = .0317) but did not affect subjective appetite or energy intake (P > .05). D-phenylalanine increased postprandial PYY AUC70-150mins concentrations relative to placebo (P = .0002). CONCLUSIONS Ingestion of L-phenylalanine, but not D-phenylalanine, increases insulin, glucagon and GIP concentrations without appearing to have a marked effect on appetite.
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Affiliation(s)
- Anjali Amin
- Section of Endocrinology and Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - James Frampton
- Section for Nutrition Research, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Zhigang Liu
- Section for Nutrition Research, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Georgia Franco-Becker
- Section for Nutrition Research, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Mariana Norton
- Section of Endocrinology and Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Aos Alaa
- Section for Nutrition Research, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Jia V Li
- Section for Nutrition Research, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Kevin G Murphy
- Section of Endocrinology and Investigative Medicine, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
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Naureen Z, Miggiano GAD, Aquilanti B, Velluti V, Matera G, Gagliardi L, Zulian A, Romanelli R, Bertelli M. Genetic test for the prescription of diets in support of physical activity. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020011. [PMID: 33170161 PMCID: PMC8023120 DOI: 10.23750/abm.v91i13-s.10584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/17/2020] [Indexed: 01/03/2023]
Abstract
Owing to the fields of nutrigenetics and nutrigenomics today we can think of devising approaches to optimize health, delay onset of diseases and reduce its severity according to our genetic blue print. However this requires a deep understanding of nutritional impact on expression of genes that may result in a specific phenotype. The extensive research and observational studies during last two decades reporting interactions between genes, diet and physical activity suggest a cross talk between various genetic and environmental factors and lifestyle interventions. Although considerable efforts have been made in unraveling the mechanisms of gene-diet interactions the scientific evidences behind developing commercial genetic tests for providing personalized nutrition recommendations are still scarce. In this scenario the current mini-review aims to provide useful insights into salient feature of nutrition based genetic research and its commercial application and the ethical issue and concerns related to its outcome.
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Affiliation(s)
- Zakira Naureen
- Department of Biological Sciences and Chemistry, College of Arts and Sciences, University of Nizwa, Nizwa, Oman.
| | | | - Barbara Aquilanti
- UOC Nutrizione Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Valeria Velluti
- UOC Nutrizione Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Giuseppina Matera
- UOC Nutrizione Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Lucilla Gagliardi
- UOC Nutrizione Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | | | | | - Matteo Bertelli
- MAGI'S LAB, Rovereto (TN), Italy; MAGI EUREGIO, Bolzano, Italy; EBTNA-LAB, Rovereto (TN), Italy.
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Funderburk L, Heileson J, Peterson M, Willoughby DS. Efficacy of L-Leucine Supplementation Coupled with a Calorie-Restricted Diet to Promote Weight Loss in Mid-Life Women. J Am Coll Nutr 2020; 40:699-707. [PMID: 33030983 DOI: 10.1080/07315724.2020.1815607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This study evaluated the effect of leucine supplementation coupled with a calorie-restricted diet over a 12-week period in mid-life overweight and obese women on body composition and resting metabolic rate (RMR). METHOD This study was a randomized, single-blind, placebo-controlled trial in which 34 women were randomly assigned to either 10 g leucine (LEU) or placebo daily, while following a calorie-restricted diet A dual energy x-ray absorptiometry (DXA) analysis, metabolic rate assessment via a BodyGem® and anthropometrics were performed at baseline and after the 12-week study to determine changes in fat mass, lean mass and RMR. Main variables were analyzed using 2 (condition) by 2 (time) mixed design ANOVAs with repeated measures. Odds ratio was calculated by counting the number of individuals gaining or maintaining lean mass (p ≤ .05). RESULTS Both groups lost a significant amount of weight due to both fat and lean mass loss, but there was no significant difference between groups, with RMR remaining unchanged over the course of the study and not significantly different between groups. The loss in lean mass was noticeably less, though not statistically significant (p = 0.644) for the women in the LEU group, with 38% vs. 6%, gaining or retaining lean mass during the intervention relative to the placebo. CONCLUSIONS Our findings demonstrate that a greater proportion of mid-life overweight or obese women taking LEU supplements gained or maintained lean mass during intentional weight loss, though it did not reach a level of statistical significance.
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Affiliation(s)
| | - Jeffery Heileson
- Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, USA
| | - Matthew Peterson
- Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, USA
| | - Darryn S Willoughby
- Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, USA
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Maston G, Franklin J, Gibson AA, Manson E, Hocking S, Sainsbury A, Markovic TP. Attitudes and Approaches to Use of Meal Replacement Products among Healthcare Professionals in Management of Excess Weight. Behav Sci (Basel) 2020; 10:E136. [PMID: 32906702 PMCID: PMC7551264 DOI: 10.3390/bs10090136] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 01/01/2023] Open
Abstract
Meal replacement product-based diets are an effective weight loss intervention used in the management of obesity. Historically, these diets have been underutilised by HealthCare Professionals (HCPs). An online survey of mixed methods design was distributed to HCPs to capture current perceptions and prescribing patterns of meal replacement products (MRPs) in the management of overweight and obesity. A total of 303 HCPs working in weight management across Australia began the survey and 197 (65%) completed it. While over 70% of HCPs have prescribed MRP currently or in the past, MRPs are only prescribed to a median 7% of patients seeking weight management treatment. Qualitative analysis identified potential barriers to MRP prescription, which include experience with patient non-compliance, perceived poor long-term weight loss durability and safety concerns regarding the product and its use as a total meal replacement program. Safety concerns are centred on the perceived risk of weight cycling and its potential negative psychological impact. MRP prescription is 66% more likely to occur if HCPs had formal training in the use of MRPs relative to those who did not, with a relative risk (RR) of 1.7 (95% CI 1.4, 2.0). This study highlights the potential barriers to the prescription of MRPs, which are centred around safety concerns. This also indicates that formal training may enhance the likelihood of prescribing MRPs, suggesting that once HCPs have a comprehensive understanding of the products and the evidence behind their use, their prescription is likely to be increased.
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Affiliation(s)
- Gabrielle Maston
- Faculty of Medicine and Health, The University of Sydney, The Boden Collaboration for Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, Camperdown, NSW 2050, Australia; (S.H.); (T.P.M.)
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia; (J.F.); (E.M.)
| | - Janet Franklin
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia; (J.F.); (E.M.)
| | - Alice A. Gibson
- School of Public Health, Faculty of Medicine and Health, Centre for Health Policy, The University of Sydney, NSW 2050, Australia;
| | - Elisa Manson
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia; (J.F.); (E.M.)
| | - Samantha Hocking
- Faculty of Medicine and Health, The University of Sydney, The Boden Collaboration for Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, Camperdown, NSW 2050, Australia; (S.H.); (T.P.M.)
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia; (J.F.); (E.M.)
| | - Amanda Sainsbury
- Faculty of Science, School of Human Sciences, The University of Western Australia, Crawley, WA 6009, Australia;
| | - Tania P. Markovic
- Faculty of Medicine and Health, The University of Sydney, The Boden Collaboration for Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, Camperdown, NSW 2050, Australia; (S.H.); (T.P.M.)
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia; (J.F.); (E.M.)
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Rehabilitation Nutrition for Injury Recovery of Athletes: The Role of Macronutrient Intake. Nutrients 2020; 12:nu12082449. [PMID: 32824034 PMCID: PMC7468744 DOI: 10.3390/nu12082449] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 12/15/2022] Open
Abstract
An adequate and balanced diet is of utmost importance in recovery and rehabilitation. "Rehabilitation nutrition" for injury recovery of athletes is similar to sports nutrition, except for the differences that concern the prevention of the risk or presence of sarcopenia, malnutrition, or dysphagia. Rehabilitation nutrition also aims, combined with training, to an adequate long-term nutritional status of the athlete and also in physical condition improvement, in terms of endurance and resistance. The aim of this paper is to define the proper nutrition for athletes in order to hasten their return to the sports after surgery or injury. Energy intake should be higher than the energy target in order to fight sarcopenia-that is 25-30 kcal/kg of body weight. Macro- and micro-nutrients play an important role in metabolism, energy production, hemoglobin synthesis, lean mass and bone mass maintenance, immunity, health, and protection against oxidative damage. Nutritional strategies, such as supplementation of suboptimal protein intake with leucine are feasible and effective in offsetting anabolic resistance. Thus, maintaining muscle mass, without gaining fat, becomes challenging for the injured athlete. A dietary strategy should be tailored to the athlete's needs, considering amounts, frequency, type and, most of all, protein quality. During rehabilitation, simultaneous carbohydrates and protein intake can inhibit muscle breakdown and muscle atrophy. The long-term intake of omega-3 fatty acids enhances anabolic sensitivity to amino acids; thus, it may be beneficial to the injured athlete. Adequate intakes of macronutrients can play a major role supporting athletes' anabolism.
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Rosendahl-Riise H, Dierkes J, Ådnanes S, Skodvin VA, Strand E, Ranhoff AH. Weight changes and mobility in the early phase after hip fracture in community-dwelling older persons. Eur Geriatr Med 2020; 11:545-553. [PMID: 32557251 PMCID: PMC7438288 DOI: 10.1007/s41999-020-00342-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/02/2020] [Indexed: 11/26/2022]
Abstract
Aim To investigate body weight changes and their effect on mobility during the first two months following a hip fracture. Findings The loss of body weight was observed in three out of four patients in the early phase after hip fracture and was associated with decreased mobility measured by the NMS. Message Bodyweight loss is common and may further reduce mobility in hip fracture patients, but these findings need more research. Purpose Hip fractures in older persons are associated with reduced mobility and loss of independence. Few studies address the nutritional status and mobility in the early phase after hip fracture. The objective of the present study was, therefore, to investigate weight changes and their effect on mobility during the first two months following hip fracture in community-dwelling older persons without dementia. Methods Patients (> 60 years) admitted for a first hip fracture were recruited from two tertiary referral hospitals in Bergen, Norway. The patients' weights and dietary intakes were determined in the hospital and at home after two months. Mobility was assessed based on the New Mobility Score (NMS) (scale 0–9, with values > 5 regarded as sufficient mobility). Results We included 64 patients (median age 80 years, 48 women, 16 men) with information on weight collected in the hospital. Follow-up measurements were available for 32 patients, corresponding to an attrition rate of 50%. The patients had a median weight loss of 1.8 kg (IQR = − 3.7, 0 kg). Most of them had reduced mobility at two months after the surgery [median NMS = 5 (IQR = 3–6)]. Both age and the weight change after surgery were predictors of the NMS at follow-up. Conclusion Bodyweight loss was observed in three out of four patients in the early phase after hip fracture and was associated with decreased mobility measured by the NMS. The results should be interpreted with caution as half of the patients dropped out of the study and did not participate in the follow-up visit.
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Affiliation(s)
- Hanne Rosendahl-Riise
- Mohn Nutrition Research Laboratory, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jutta Dierkes
- Center for Nutrition, Mohn Nutrition Research Laboratory, Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Laboratory Medicine and Pathology, Haukeland University Hospital, Bergen, Norway
| | - Svanhild Ådnanes
- Center for Nutrition, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Vilde Aabel Skodvin
- Center for Nutrition, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Elin Strand
- Department of Clinical Science, University of Bergen, Bergen, Norway
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The effect of 12 weeks of euenergetic high-protein diet in regulating appetite and body composition of women with normal-weight obesity: a randomised controlled trial. Br J Nutr 2020; 124:1044-1051. [PMID: 32513334 DOI: 10.1017/s0007114520002019] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Normal-weight obesity (NWO) syndrome is associated with metabolic diseases. The present study aimed to investigate the effects of 12 weeks of a high-protein (HP) v. a standard protein (SP) diet on appetite, anthropometry and body composition in NWO women. In this clinical trial, fifty NWO women were randomly allocated to HP (n 25) or SP (n 25) diet groups. Women in the HP and SP groups consumed 25 and 15 % of their total energy intake from protein for 12 weeks. Weight, fat mass (FM), lean body mass (LBM), waist circumference (WC) and appetite were evaluated at baseline and following their 3-month intervention. After 12 weeks, the LBM was higher in HP compared with no significant changes in the SP group (mean between-group difference = 1·5 kg; 95 % CI 3·1, 0·01; effect size (d) = 0·4). Furthermore, the HP group had lower FM (mean between-group difference -1·1 kg; 95 % CI 1, -3·3; d = -0·2), body fat percentage (BFP) (mean between-group difference -2 %; 95 % CI 0·7, -5·2; d = -0·3) and WC (mean between-group difference -1·4 cm; 95 % CI 0·6, -3·6; d = -0·2) at the end of the study in comparison with the SP group. In both groups, weight and appetite were unchanged over time without significant differences between groups. Twelve weeks of euenergetic diets with different dietary protein contents resulted in no significant weight loss in women with NWO. However, an HP diet significantly improved body composition (LBM, FM, BFP and WC) in this population.
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50
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Chow LS, Manoogian ENC, Alvear A, Fleischer JG, Thor H, Dietsche K, Wang Q, Hodges JS, Esch N, Malaeb S, Harindhanavudhi T, Nair KS, Panda S, Mashek DG. Time-Restricted Eating Effects on Body Composition and Metabolic Measures in Humans who are Overweight: A Feasibility Study. Obesity (Silver Spring) 2020; 28:860-869. [PMID: 32270927 PMCID: PMC7180107 DOI: 10.1002/oby.22756] [Citation(s) in RCA: 189] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/14/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE In contrast to intentionally restricting energy intake, restricting the eating window may be an option for treating obesity. By comparing time-restricted eating (TRE) with an unrestricted (non-TRE) control, it was hypothesized that TRE facilitates weight loss, alters body composition, and improves metabolic measures. METHODS Participants (17 women and 3 men; mean [SD]: 45.5 [12.1] years; BMI 34.1 [7.5] kg/m2 ) with a prolonged eating window (15.4 [0.9] hours) were randomized to TRE (n = 11: 8-hour window, unrestricted eating within window) versus non-TRE (n = 9: unrestricted eating) for 12 weeks. Weight, body composition (dual x-ray absorptiometry), lipids, blood pressure, 2-hour oral glucose tolerance, 2-week continuous glucose monitoring, and 2-week physical activity (actigraphy assessed) were measured during the pre- and end-intervention periods. RESULTS The TRE group significantly reduced the eating window (end-intervention window: 9.9 [2.0] hours) compared with the non-TRE group (end-intervention window: 15.1 [1.1] hours) (P < 0.01). Compared with non-TRE, TRE decreased the number of eating occasions, weight, lean mass, and visceral fat (all P ≤ 0.05). Compared with preintervention measures, the TRE group reduced the number of eating occasions (-21.9% [30.1%]) and reduced weight (-3.7% [1.8%]), fat mass (-4% [2.9%]), lean mass (-3.0% [2.7%]), and visceral fat (-11.1% [13.4%]) (all P ≤ 0.05). Physical activity and metabolic measures remained unchanged. CONCLUSIONS In the setting of a randomized trial, TRE presents a simplified view of food intake that reduces weight.
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Affiliation(s)
- Lisa S Chow
- Division of Diabetes, Endocrinology, and Metabolism, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Alison Alvear
- Division of Diabetes, Endocrinology, and Metabolism, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Honoree Thor
- Division of Diabetes, Endocrinology, and Metabolism, University of Minnesota, Minneapolis, Minnesota, USA
| | - Katrina Dietsche
- Division of Diabetes, Endocrinology, and Metabolism, University of Minnesota, Minneapolis, Minnesota, USA
| | - Qi Wang
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - James S Hodges
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Nicholas Esch
- Division of Diabetes, Endocrinology, and Metabolism, University of Minnesota, Minneapolis, Minnesota, USA
| | - Samar Malaeb
- Division of Diabetes, Endocrinology, and Metabolism, University of Minnesota, Minneapolis, Minnesota, USA
| | - Tasma Harindhanavudhi
- Division of Diabetes, Endocrinology, and Metabolism, University of Minnesota, Minneapolis, Minnesota, USA
| | - K Sreekumaran Nair
- Division of Endocrinology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | | | - Douglas G Mashek
- Division of Diabetes, Endocrinology, and Metabolism, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Minneapolis, Minnesota, USA
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