Greater Healthful Dietary Variety Is Associated with Greater 2-Year Changes in Weight and Adiposity in the Preventing Overweight Using Novel Dietary Strategies (POUNDS Lost) Trial

Exploring culinary diversity to enhance Mediterranean diet adherence: A randomized controlled trial

We Investigated how promoting diverse, healthy food options affects long-term dietary choices. We hypothesized that encouraging exploration of nutritious plant-based foods would lead to lasting improvements in diet. Participants (N = 211) were randomly assigned into two groups for a 6-week intervention: The fixed menu group was given the same large menu every week, while the changing menu group received a new small menu each week. At the end of the intervention both groups were exposed to the same menu suggestions. Food diversity evaluation was based on weekly reports collected during the intervention. Self-reported adherence to Mediterranean diet components was assessed using the I-MEDAS screener. The proportion of plant-based foods in participants' diets was estimated using a 0-100% scale based on self-report. Both items were evaluated using online questionnaires given to participants at baseline, at the end of the intervention, as well as three and six months after the intervention concluded. Results mean(SD) demonstrated that participants in fixed menu group explored a significantly wider array of items 26.33(11.64) than those in the changing menus group [19.79(10.29), t(202) = 4.25, p < 0.001, Cohen's d = 0.60]. A repeated measures analysis of covariance rmANCOVA revealed that short-term increase in I-MEDAS and PBD score were noted in both groups; however, only participants with the fixed menu sustained this increase at months follow-up [diff = 1.50, t(132) = 4.50, p < 0.001 Our findings suggest that manipulating the rate of exposure to food suggestions may affect overall dietary variety. It seems that early presentation with options may increase overall dietary variety and may even support longer-term habits. This study contributes to developing effective interventions and highlights the challenge of promoting exploratory behavior in nutrition.

Is There an Ideal Diet? Some Insights from the POUNDS Lost Study

Diets for weight loss have a long history but an ideal one has not yet been clearly identified. To compare low-fat and lower carbohydrate diets, we designed The Preventing Overweight by Novel Dietary Strategies (POUNDS) Lost study. This is a 2 × 2 factorial study with diets of 20% or 40% fat and 15% or 25% protein with a graded carbohydrate intake of 35, 45, 55 and 65%. Weight loss, overall, was modest at nearly 6% with all four diets, and no significant dietary difference. The variability in weight loss in each diet group was significant, ranging from greater than 20% to a small weight gain. Studies of genetic variations in relation to weight loss showed that the diet that was selected could significantly affect weight loss, emphasizing that there is no ideal diet and more than one diet can be used to treat obesity. Weight loss was also influenced by the level of baseline triiodothyronine or thyroxine, and baseline carbohydrate and insulin resistance. Achieving a stable Health Eating Food Diversity Index, eating more protein, eating more fiber, engaging in more physical activity, sleeping better and eating less ultra-processed foods were beneficial strategies for weight loss in this trial. Although there is no "ideal diet", both the DASH diet and the Mediterranean diet have clinical trials showing their significant benefit for cardiovascular risk factors. Finally, the lesson of the "Last Chance Diet", which recommended a diet with protein from gelatin, proved that some diets could be hazardous.

Isocaloric replacement of ultraprocessed foods was associated with greater weight loss in the POUNDS Lost trial

OBJECTIVE

Higher intake of ultraprocessed foods (UPFs) is associated with obesity. We examined whether replacing UPFs (NOVA 4) with minimally processed foods and culinary ingredients (NOVA 1 + 2) was associated with differential weight change in this secondary prospective analysis of the Preventing Overweight Using Novel Dietary Strategies (POUNDS) Lost trial.

METHODS

We estimated percent energy intake (%kcal) from the four NOVA groups using 24-h dietary recalls in a subset of 356 participants. Multivariable-adjusted substitution models examined whether replacing %kcal from UPFs with NOVA 1 + 2 was associated with greater weight, body fat percentage, trunk fat, and waist circumference reduction at 6 months; changes in parameters were compared among NOVA 1 + 2 tertiles (T).

RESULTS

Participants were on average 52.3 years of age, 85% White, 55% female, and 58.2% nonsmoking, with a mean BMI of 32.7 kg/m2. Replacing 10%kcal of UPFs with NOVA 1 + 2 was associated with greater 6-month weight (ß = 0.51, 95% CI: -0.93 to -0.09, p = 0.02), body fat percentage (ß = 2.7, 95% CI: -5.10 to -0.43, p = 0.02), and trunk fat reduction (ß = 3.9, 95% CI: -7.01 to -0.70, p = 0.02), but not waist circumference reduction. Participants in T3 (-8.33 kg) versus T1 (-5.32 kg) of NOVA 1 + 2 had greater weight loss (p < 0.001).

CONCLUSIONS

Isocaloric substitution of UPFs with NOVA 1 + 2 was associated with marginally greater weight loss under energy restriction. These modest findings support more research exploring the mechanisms linking UPFs with body weight regulation beyond energy intake.

Associations between dietary variety, portion size and body weight: prospective evidence from UK Biobank participants

'Dietary variety' has been identified as a factor associated with food intake. Whilst this relationship may have longer-term benefits for body weight management when eating low-energy, nutrient-dense foods, it may increase the risk of overconsumption (and body adiposity) when foods are high energy density. This study sought to further explore pathways underpinning the relationship between dietary variety and body weight, by considering energy density as a moderating factor and portion size as a mediating factor in this relationship. Using prospective data from the UK Biobank, dietary variety scores (DVS), cumulative portion size and energy density were derived from 24-h dietary recall questionnaires at baseline and follow-up. BMI, whole-body fat percentage and fat-free mass were included as outcomes. Contrary to predictions, linear multiple regression models found some evidence of a negative, direct association between DVS and body weight outcomes at baseline (b = -0·13). Though dietary variety was significantly associated with larger portions across time points (b = 41·86-82·64), a moderated mediation effect was not supported at baseline or follow-up (Index ≤ 0·035). Taken together, these findings provide population-level evidence to support a positive association between variety and food intake, which in turn has potential implications for body weight management, both in terms of moderating food intake and benefitting diet quality.

Blood pressure variation and ultra-processed food consumption in children with obesity

To investigate the influence of ultra-processed food (UPF) consumption on systolic (SBP) and diastolic (DBP) blood pressure in children with obesity, using dietary and urinary markers. We conducted a secondary analysis of a randomized clinical trial involving children with obesity, aged 7 to 12 years. Over a period of six months, the children and their guardians attended monthly individual consultations and educational activities aimed at promoting a reduction in UPF consumption. During each visit, measurements of blood pressure, body weight, height, and 24-h dietary recall were recorded. Additionally, spot urine samples were collected at baseline, and at the second and fifth-month follow-ups. A total of 96 children were included in the analysis. Energy intake, UPF intake and blood pressure showed a quadratic pattern of change, with a decrease in the first two months and an increase thereafter. There was an association between UPF consumption and DBP. The intake of UPF was correlated with the urinary sodium-to-potassium (Na/K) ratio (r = 0.29; p = 0.008) and the dietary Na/K ratio (r = 0.40; p < 0.001). For every 100 g increase in UPF, DBP increased by 0.28 mmHg (p-value = 0.01). After further adjustment for changes in body mass index (BMI), and physical activity, the increase in DBP was 0.22 mmHg.    Conclusion: Our findings indicate that reducing UPF consumption may have an impact on blood pressure in children with obesity. Additional adjustment for BMI and physical activity did not influence the results. Therefore, reducing UPF consumption can be considered as a strategy against hypertension. What is Known: • Ultra-processed food consumption is associated with an increased risk of cardiovascular disease; however, this evidence is still limited in children. • Intake of calories from ultra-processed food in relation to the total calories is increasing worldwide. What is New: • Ultra-processed food consumption has an effect on the diastolic blood pressure, independent of changes in weight. • The intake of ultra-processed food was correlated to the dietary sodium-to-potassium ratio (r = 0.40; p < 0.001).

Forty Years after Poverty Reduction in China: The Role of Women's Empowerment in Enhancing Food Security and Diet Diversity

This study analyzed the role of women's empowerment in diversifying the diet of households through their own production. Developed from empowerment and food security theories, this study constructed measures from the household dietary diversity score (HDDS) and Women's Empowerment Index (WEI). The study focused on poverty-stricken regions in China and conducted a thematic questionnaire-based household survey on gender and food consumption in 2021. Based on micro-level evidence from 1199 rural households, this research found a low score of women's empowerment and an average WEI of 0.689; the status of diet diversity, measured by the HDDS, varied by income and social class; and the average rate was low. Agricultural production diversity and women's empowerment are positively associated with diet diversity. There is strong evidence that women's employment mitigates the side effects of decreasing production diversity on households' diet security. As a result, women's empowerment can potentially mitigate the adverse consequences of low agricultural diversification in household diet quality in less developed areas. This study provides evidence for repurposing food and agricultural policies toward healthy diets and gender-responsive agrifood systems.

Associations of dietary diversity with the gut microbiome, fecal metabolites, and host metabolism: results from 2 prospective Chinese cohorts

BACKGROUND

Dietary diversity is essential for human health. The gut ecosystem provides a potential link between dietary diversity, host metabolism, and health, yet this mechanism is poorly understood.

OBJECTIVES

Here, we aimed to investigate the relation between dietary diversity and the gut environment as well as host metabolism from a multiomics perspective.

METHODS

Two independent longitudinal Chinese cohorts (a discovery and a validation cohort) were included in the present study. Dietary diversity was evaluated with FFQs. In the discovery cohort (n = 1916), we performed shotgun metagenomic and 16S ribosomal ribonucleic acid (rRNA) sequencing to profile the gut microbiome. We used targeted metabolomics to quantify fecal and serum metabolites. The associations between dietary diversity and the microbial composition were replicated in the validation cohort (n = 1320).

RESULTS

Dietary diversity was positively associated with α diversity of the gut microbiota. We identified dietary diversity-related gut environment features, including the microbial structure (β diversity), 68 microbial genera, 18 microbial species, 8 functional pathways, and 13 fecal metabolites. We further found 332 associations of dietary diversity and related gut environment features with circulating metabolites. Both the dietary diversity and diversity-related features were inversely correlated with 4 circulating secondary bile acids. Moreover, 16 mediation associations were observed among dietary diversity, diversity-related features, and the 4 secondary bile acids.

CONCLUSIONS

These results suggest that high dietary diversity is associated with the gut microbial environment. The identified key microbes and metabolites may serve as hypotheses to test for preventing metabolic diseases.

Association of Non-alcoholic Fatty Liver Disease With Salt Intake and Dietary Diversity in Chinese Medical Examination Adults Aged 18-59 Years: A Cross-Sectional Study

Objectives

Given the significance of dietary factors in the development of non-alcoholic fatty liver disease (NAFLD). We conducted a cross-sectional study to investigate the association of NAFLD with salt intake and dietary diversity in a medical examination population aged 18–59 years.

Methods

Data from two Chinese health management centers were utilized between January 2017 and December 2019. The general information, laboratory tests, lifestyle habits, and diet of the participants were all evaluated. Based on alcohol consumption and abdominal ultrasound results, a total of 23,867 participants were divided into the NAFLD (n = 7,753) and control (n = 16,114) groups. Salt intake and dietary diversity were calculated separately for study participants using the spot urine method and dietary diversity scores (DDS). The multilevel logistic model and subgroup analysis were used to analyze the relationship between salt intake, dietary diversity, and NAFLD.

Results

We found that the prevalence of NAFLD was 32.48%. Salt intake was associated with increased NAFLD (Q2 vs. Q1: OR = 1.201, 95% CI 1.094-1.317, P < 0.001; Q3 vs. Q1: OR = 1.442, 95% CI 1.316-1.580, P < 0.001; Q4 vs. Q1: OR = 1.604, 95% CI 1.465-1.757, P < 0.001), whereas sufficient dietary diversity was a protective factor for NAFLD (Sufficient DDS vs. Insufficient DDS: OR: 0.706, 95% CI 0.517-0.965, P < 0.05). The effects of salt intake and dietary diversity on NAFLD were equally stable in the subgroup analysis.

Conclusions

We can conclude that NAFLD is highly prevalent in medical examination adults aged 18-59 years in China. Furthermore, the risk of salt intake for NAFLD and the protective effect of dietary diversity on NAFLD should be taken into account in the management of NAFLD.

Dietary Diversity Indicators and Their Associations with Dietary Adequacy and Health Outcomes: A Systematic Scoping Review

Dietary diversity has long been recognized as a key component of diet quality and many dietary diversity indicators (DDIs) have been developed. This systematic scoping review aimed to present a comprehensive inventory of DDIs and summarize evidence linking DDIs and dietary adequacy or health outcomes in adolescents and adults. Two search strategies were developed to identify peer-reviewed articles published in English up until June 2018 and were applied to Medline, Web of Science, and Scopus. A 2-stage screening process was used to select the studies to be reviewed. Four types of DDIs were identified among 161 articles, the majority of them belonging to the food group-based indicator type (n = 106 articles). Fifty studies indicated that DDIs were proxies of nutrient adequacy, but there was a lack of evidence about their relation with nutrients to limit. Associations between DDIs and health outcomes were largely inconsistent among 137 studies, especially when the outcomes studied were body weight (n = 60) and noncommunicable diseases (n = 41). We conclude that the ability of DDIs to reflect diet quality was found to be principally limited to micronutrient adequacy and that DDIs do not readily relate to health outcomes. These findings have implications for studies in low- and lower-middle-income economies where DDIs are often used to assess dietary patterns and overall diet quality.

Temporal and mediation relations of weight loss, and changes in insulin resistance and blood pressure in response to 2-year weight-loss diet interventions: the POUNDS Lost trial

PURPOSE

Body weight and insulin resistance (IR) are closely correlated, and their temporal sequences in affecting blood pressure (BP) remain poorly defined. We examined the temporal sequences of weight loss and IR change, and their relations with BP in the Pounds Lost trial, a randomized weight-loss diet intervention study.

METHODS

The present study included overweight/obese adults, who were randomized in a 2 × 2 factorial design to low-calorie diets containing 20 or 40% fat and 15 or 25% protein (diets with 65, 55, 45 and 35% carbohydrate). Weight, IR, systolic and diastolic BP levels were measured at baseline, 6 and 24 months. After excluding the subjects who took antihypertensive drugs, cross-lagged path and mediation analyses were performed among 540 participants.

RESULTS

After adjusting for age, race, sex, and diet groups, the cross-lagged path coefficient from baseline weight to 24-month IR (β₁ = 0.135, P = 0.04) was significantly greater than the path coefficient (β₂ = 0.022, P > 0.05) from baseline IR to 24-month weight (P < 0.05 for the difference in βs), indicating that weight-loss preceded change of IR. The mediation effects of 24-month IR on the 24-month systolic BP and diastolic BP were estimated at 20.94% (P = 0.004) and 17.03% (P = 0.034), respectively.

CONCLUSIONS

Our data indicate that weight loss precedes change of IR, which mediates a significant proportion of the effects of weight loss on changes of BP in response to the diet interventions.

TRIAL REGISTRATION

NCT00072995 First Posted November 17, 2003 Last Update Posted January 30, 2013 this study was not 'retrospectively registered'.

The Long-Term Dietitian and Psychological Support of Obese Patients Who Have Reduced Their Weight Allows Them to Maintain the Effects

The role of post-therapeutic support after weight loss in obesity treatment is not fully understood. Therefore, weight maintenance after a successful weight loss intervention is not very common, especially in obese individuals. This randomized controlled study was conducted to explore the efficacy of following dietary and psychological support in a group of 36 obese individuals. Participants (22 women, 14 men aged 35.58 ± 9.85 years, BMI 35.04 ± 3.80 kg/m²) who completed a 12-month weight loss phase (balanced energy-restricted diet) were randomly allocated to receive 18-month support (SG) or no additional care (CG). The support phase included some elements of Ten Top Tips (TTT), cognitive behavioral therapy (CBT), motivational interviewing (MI) in combination with nutritional education and assessment of the level of physical activity. The primary outcome was the maintenance of anthropometric parameters at an 18-month follow-up. The secondary outcomes included evaluation of biochemical parameters and single nucleotide polymorphisms (SNPs) in genes connected with obesity. A comparison of SG vs. CG after a 30-month period of the study revealed significant differences in weight changes (−3.83 ± 6.09 vs. 2.48 ± 6.24 kg), Body Mass Index (−1.27 ± 2.02 vs. 0.72 ± 2.12 kg/m²), visceral adipose tissue (−0.58 ± 0.63 vs. 0.45 ± 0.74 L), and waist circumference (−4.83 ± 4.05 vs. 1.83 ± 5.97 cm). Analysis of SNPs (rs9939609 FTO, rs987237 TFAP2B, and rs894160 PLIN1) provided further insight into the potential modulating effect of certain genotypes on weight loss and maintenance and extended the knowledge of the potential benefits of personalized medicine. Post-therapeutical support in current clinical practice may increase the chances of long-term weight loss maintenance in obesity treatment even in patients with a genetic predisposition to excessive weight.

From famine to therapeutic weight loss: Hunger, psychological responses, and energy balance-related behaviors

Understanding physiological and behavioral responses to energy imbalances is important for the management of overweight/obesity and undernutrition. Changes in body composition and physiological functions associated with energy imbalances provide the structural and functional context in which to consider psychological and behavioral responses. Compensatory changes in physiology and behavior are more pronounced in response to negative than positive energy balances. The physiological and psychological impact of weight loss (WL) occur on a continuum determined by (i) the degree of energy deficit (ED), (ii) its duration, (iii) body composition at the onset of the energy deficit, and (iv) the psychosocial environment in which it occurs. Therapeutic WL and famine/semistarvation both involve prolonged EDs, which are sometimes similar in magnitude. The key differences are that (i) the body mass index (BMI) of most famine victims is lower at the onset of the ED, (ii) therapeutic WL is intentional and (iii) famines are typically longer in duration (partly due to the voluntary nature of therapeutic WL and disengagement with WL interventions). The changes in psychological outcomes, motivation to eat, and energy intake in therapeutic WL are often modest (bearing in mind the nature of the measures used) and can be difficult to detect but are quantitatively significant over time. As WL progresses, these changes become more marked. It appears that extensive WL beyond 10%-20% in lean individuals has profound effects on body composition and physiological function. At this level of WL, there is a marked erosion of psychological functioning, which appears to run in parallel to WL. Psychological resources dwindle and become increasingly focused on alleviating escalating hunger and food seeking behavior. Functional changes in fat-free mass, characterized by catabolism of skeletal muscle and organs may be involved in the drive to eat associated with semistarvation. Higher levels of body fat mass may act as a buffer to protect fat-free mass, functional integrity and limit compensatory changes in energy balance behaviors. The increase in appetite that accompanies therapeutic WL appears to be very different to the intense and all-consuming drive to eat that occurs during prolonged semistarvation. The mechanisms may also differ but are not well understood, and longitudinal comparisons of the relationship between body structure, function, and behavior in response to differing EDs in those with higher and lower BMIs are currently lacking.

Evidence-based weight loss interventions: Individualized treatment options to maximize patient outcomes

Against the backdrop of obesity as a major public health problem, we examined three questions: How much weight loss is needed to benefit patients with obesity? How well do current therapies do in producing weight loss? What strategies can be used to improve patient outcomes using evidence-based studies. This paper reviews literature on the outcomes of lifestyle, diet, medications and surgical treatments for obesity using literature searches for obesity treatments. Current treatments, including lifestyle, diet and exercise, produce a weight loss of 5% to 7% on average. Despite continued attempts to identify superior dietary approaches, most careful comparisons find that low carbohydrate diets are not significantly better than low fat diets for weight loss. The four medications currently approved by the US Food and Drug Administration for long-term management of obesity are not as effective as surgery, adding about 5% on average to lifestyle approaches to weight loss. Two new medications that are under investigation, semaglutide and tirzepatide, significantly improve on this. For all treatments for weight loss, including lifestyle, medications and surgery, there is enormous variability in the amount of weight lost. Examination of this literature has yielded evidence supporting baseline and process predictors, but the effect sizes associated with these predictors are small and there are no prospective studies showing that a personalized approach based on genotype or phenotype will yield uniform success. Because obesity is a chronic disease it requires a 'continuous treatment model' across the lifespan.

New Diet Quality Index for children and adolescents in Costa Rica

Introduction

Introduction: there is an increasing interest in the study of total diet quality indicators through the study of food groups in certain dietary patterns. Objective: to analyze the diet of students in Costa Rica with construction of a contextualized new diet quality index. Material and methods: a cross-sectional study was performed in a population of 2,677 students from 64 educational centers. Data on habits and food intake frequency were collected through interviews and questionnaires. A new Diet Quality Index was constructed and applied, which assessed the adjustment of intake frequency for 22 food groups, corrected with five preventive dietary factors and five risk factors for chronic non-communicable diseases. Descriptive statistics were evaluated using the program SPSS, version 24.0. A p-value ˂ 0.05 was considered significant. Results: the population was made up of 1,259 (43%) men and 1,418 women (57%). According to the new Diet Quality Index-Costa Rica classification, 1.2% (n = 33) of participants have a healthy diet; 9.0% (n = 239) require dietary changes, and 89.8% (n = 2 395) have an unhealthy diet because of excessive intake of processed foods (rich in sodium and fat) and a low consumption of fruits and vegetables. Significant differences were found in the averages of the Diet Quality Index-Costa Rica by sex, educational level, and socioeconomic status. Conclusions: around 90% of the studied population do not comply with the recommendations issued for a healthy diet. Nutritional education should be strengthened in Costa Rican education centers.

Fiber Intake Predicts Weight Loss and Dietary Adherence in Adults Consuming Calorie-Restricted Diets: The POUNDS Lost (Preventing Overweight Using Novel Dietary Strategies) Study

BACKGROUND

The effects of dietary composition on weight loss are incompletely understood. In addition to energy intake, fiber intake, energy density, macronutrient composition, and demographic characteristics have all been suggested to contribute to weight loss.

OBJECTIVE

The primary aim of this analysis was to assess the role of dietary fiber as a predictor of weight loss in participants who consumed calorie-restricted diets (-750 kcal/d from estimated energy needs) for 6 mo, using data from the POUNDS Lost (Preventing Overweight Using Novel Dietary Strategies) Study-a randomized trial that examined the effects of calorie-restricted diets varying in macronutrient composition on weight loss in adults.

METHODS

Data were randomly partitioned to a training data set (70%) in which the effects of fiber and other weight-loss predictors were identified using adjusted Least Absolute Shrinkage and Selection Operator and model averaging. The retained predictors were then fit on the testing data set to assess predictive performance.

RESULTS

Three hundred and forty-five participants (53.9% female) provided dietary records at baseline and 6 mo. Mean ± SD age and BMI for the full sample was 52.5 ± 8.7 y and 32.6 ± 3.9 kg/m2, respectively. Mean ± SD (99% CI) weight change at 6 mo for the full sample was -7.27 ± 5.6 kg (-8.05, -6.48 kg). The final, best fit model (R2 = 0.41) included fiber, energy density, fat, age, adherence, baseline weight, race, and changes from baseline in carbohydrate, fiber, PUFA, and MUFA intake, but the most influential predictor was fiber intake ($\hat{\beta }$ = -0.37; P < 0.0001). In addition, fiber was strongly associated with adherence to the macronutrient prescriptions (P < 0.0001). Interactions between race and adherence, age, baseline weight, carbohydrate, energy density, and MUFAs were also retained in the final model.

CONCLUSION

Dietary fiber intake, independently of macronutrient and caloric intake, promotes weight loss and dietary adherence in adults with overweight or obesity consuming a calorie-restricted diet. This trial was registered at clinicaltrials.gov as NCT00072995.

Lessons Learned from the POUNDS Lost Study: Genetic, Metabolic, and Behavioral Factors Affecting Changes in Body Weight, Body Composition, and Cardiometabolic Risk

PURPOSE OF REVIEW

This paper reviews the genetic and non-genetic factors that provided predictions of, or were associated with, weight loss and other metabolic changes in the POUNDS Lost clinical trial of weight loss. This trial randomized 811 individuals who were overweight or obese to one of four diets that contained either 15% or 25% protein and 20% or 40% fat in a 2 × 2 factorial design. A standard behavioral weight loss program was available for all participants who were followed for 2 years with an 80% completion rate.

RECENT FINDINGS

Nineteen genes and five genetic risk scores were used along with demographic, behavioral, endocrine, and metabolic measurements. Genetic variations in most of the genes were associated with weight loss, but this association often varied with the dietary assignment. A number of demographic and behavioral factors, including attendance at behavioral sessions and food cravings were predictive of weight changes. A high baseline level of free triiodothyronine or free thyroxine predicted the magnitude of weight loss. Several perfluoroakyl compounds predicted more rapid weight regain. Genetic evidence from POUNDS Lost provides guidance toward selection of a personalized weight loss diet and improvement in metabolic profile. There is still room for additional research into the predictors of weight loss.

Associations between the rate, amount, and composition of weight loss as predictors of spontaneous weight regain in adults achieving clinically significant weight loss: A systematic review and meta-regression

Weight regain following weight loss is common although little is known regarding the associations between amount, rate, and composition of weight loss and weight regain. Forty-three studies (52 groups; n = 2379) with longitudinal body composition measurements were identified in which weight loss (≥5%) and subsequent weight regain (≥2%) occurred. Data were synthesized for changes in weight and body composition. Meta-regression models were used to investigate associations between amount, rate, and composition of weight loss and weight regain. Individuals lost 10.9% of their body weight over 13 weeks composed of 19.6% fat-free mass, followed by a regain of 5.4% body weight over 44 weeks composed of 21.6% fat-free mass. Associations between the amount (P < 0.001) and rate (P = 0.049) of weight loss and their interaction (P = 0.042) with weight regain were observed. Fat-free mass (P = 0.017) and fat mass (P < 0.001) loss both predicted weight regain although the effect of fat-free mass was attenuated following adjustment. The amount (P < 0.001), but not the rate of weight loss (P = 0.150), was associated with fat-free mass loss. The amount and rate of weight loss were significant and interacting factors associated with weight regain. Loss of fat-free mass and fat mass explained greater variance in weight regain than weight loss alone.

Aspects of Dietary Diversity Differ in Their Association with Atherosclerotic Cardiovascular Risk in a Racially Diverse US Adult Population

The study objectives were to measure dietary diversity (DD) of an urban US population and to determine if associations of 10 year atherosclerotic cardiovascular (ASCVD) risk with DD were independent of dietary quality. Participants were drawn from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study, wave 4 (n = 2066, 1259 African Americans (AA), 807 Whites (W). Three DD measures were derived from 2 days of 24 h recall data collected with the USDA automated-multiple-pass-method. Count was based on consumption of at least half an equivalent of food from 21 subgroups. Evenness was calculated using Berry Index (BI) and BI-adjusted by food health values. Dissimilarity was calculated by Mahalanobis Distance. Diet quality was assessed by Mean Nutrient Adequacy (MAR) and DASH scores. Associations of DD and quality with ASCVD risk, calculated using 2013 American College of Cardiology and American Heart Association guidelines, were assessed with multivariable regression. Covariates included income, education, food security, and energy/kg weight. Count and MAR were positively associated whereas dissimilarity was negatively associated with ASCVD risk. There was no evidence that evenness contributed to cardiovascular health. The findings suggest more diversity in food attributes and diets rich in micronutrients rather than increased count support cardiovascular health.

Using an introduced index to assess the association between food diversity and metabolic syndrome and its components in Chinese adults

BACKGROUND

It is reported that an increase in food diversity would lower the risk of cardiac-cerebral vascular diseases.

METHODS

A new index was introduced to develop a Chinese healthy food diversity (HFD) index, exploring the association with metabolic syndrome (MetS) and its components among Chinese adults. Two sets of data were used. The primary data were from a cross-sectional survey conducted in 2016 called the Chinese Urban Adults Diet and Health Study (CUADHS); the verification data were from the China Health and Nutrition Survey (CHNS) of 2009. The Chinese HFD index was developed according to the Chinese Dietary Guideline, with food consumption information from 24-h dietary recalls. The association between the index and MetS and its components was explored in logistic regression models.

RESULTS

Among 1520 participants in the CUADHS, the crude prevalence of MetS was 36.4%, which was 29.0% after the standardisation of age and gender by the 2010 Chinese national census. In the CUADHS, the HFD index ranged from 0.04 to 0.63. The value of the index among participants who are male, young, poorly educated, drinking or smoking, and with high energy intakes was significantly lower than that of their counterparts. In the verification dataset of the CHNS, there were 2398 participants, and the distribution of different genders and age groups was more balanced. The crude prevalence of MetS in the CHNS was 27.3% and the standardised prevalence was 19.5%. The Chinese HFD index ranged from 0.02 to 0.62. In the CUADHS, the Chinese HFD index was not significantly associated with MetS in covariate-adjusted models or with its components. In the CHNS, the Chinese HFD index had a significantly negative correlation with MetS and its components (i.e., elevated fasting glucose and elevated waist circumference) in covariate-adjusted models.

CONCLUSIONS

Increased food diversity may decrease the risk of MetS, which is important in dietary interventions of cardiac-cerebral vascular disease. This underscores the necessity of continued investigation into the role of HFD in the prevention of MetS and provides an integral framework for ongoing research.

Understanding the Relationship Between Food Variety, Food Intake, and Energy Balance

PURPOSE OF REVIEW

In accordance with US dietary guidance, incorporating variety into the diet can align with energy balance, though greater food variety in some categories may make energy balance more challenging. Thus, experimental and epidemiologic evidence is summarized on the relationship between food variety, food and energy intake, and energy balance.

RECENT FINDINGS

Lab-based, experimental research consistently demonstrates that greater variety within foods or sensory characteristics of food increases food and energy intake within an eating occasion. Epidemiologic evidence is less consistent, potentially driven by differing methodologies, particularly in defining and measuring food variety. Moreover, the effect of variety on energy balance appears to be moderated by food energy density. Integrating insights from experimental and epidemiologic research are essential for strengthening food variety guidance including developing evidence-based definitions of food variety, understanding moderators of the relationship, and developing practical guidance interpretable to consumers.

Hyperpalatability and the Generation of Obesity: Roles of Environment, Stress Exposure and Individual Difference

PURPOSE OF REVIEW

This review investigates how exposure to palatable food and its associated cues alters appetite regulation and feeding behaviour to drive overeating and weight gain.

RECENT FINDINGS

Both supraphysiological and physiological feeding systems are affected by exposure to palatable foods and its associated cues. Preclinical research, largely using rodents, has demonstrated that palatable food modulates feeding-related neural systems and food-seeking behaviour by recruiting the mesolimbic reward pathway. This is supported by studies in adolescents which have shown that mesolimbic activity in response to palatable food cues and consumption predicts future weight gain. Additionally, stress exposure, environmental factors and individual susceptibility have been shown to modulate the effects of highly palatable foods on behaviour. Further preclinical research using free-choice diets modelling the modern obesogenic environment is needed to identify how palatable foods drive overeating. Moreover, future clinical research would benefit from more appropriate quantification of palatability, making use of rating systems and surveys.

Medication Adherence, When Lifestyle Is the Medicine

Giving patients insight, knowledge, and skills, although important, may not alone be enough for behavior change maintenance. Rather, the health care provider (HCP) has an important role in fostering behavior change and maintenance by asking, "Why do people change?" and "What can I do to help?" This review highlights 4 evidence-based factors related to medication adherence, when lifestyle is the medicine. (1) Autonomy is the belief that one is the origin of his or her own actions, and must be supported by the HCP (eg, "My HCP listens to how I would like to do things regarding my health"). (2) Competence and confidence ensure that patients believe they can succeed. These are gained through mastery experience, vicarious experience, and through positive and constructive feedback on past performance (eg, "My HCP conveys confidence in my ability to make changes regarding my health"). (3) Coping planning is being able to formulate a plan of intention, with the awareness of barriers and emotional regulation that can inhibit patient behavior (eg, "I feel able to share my feelings with my HCP"). (4) Personal values of the patients are used to understand how and why they cope when there is a threat to these values (eg, "My HCP tries to understand how I see my health before suggesting any changes").

Impact on dietary intake of a self-directed, gender-tailored diabetes prevention program in men

AIM

To investigate changes in dietary intake following a 6-mo randomised controlled trial of the self-directed, gender-tailored type 2 diabetes mellitus (T2DM) Prevention Using LifeStyle Education (PULSE) program in men.

METHODS

Men aged 18-65 years, with a body mass index (BMI) 25-40 kg/m², and at high risk for developing T2DM were recruited from the Hunter Region of New South Wales, Australia. Eligible participants were randomised into one of two groups: (1) waitlist control; or (2) PULSE intervention. Dietary intake was assessed at baseline and immediately post-program using the Australian Eating Survey food frequency questionnaire and diet quality measured using the Australian Recommended Food Score (ARFS).

RESULTS

One hundred and one participants (n = 48, control; n = 53, intervention, mean age 52.3 ± 9.7 years, BMI of 32.6 ± 3.3 kg/m²) commenced the study. Following the active phase, differences between groups were observed for proportion of total energy consumed from healthful (core) foods (+7.6%EI, P < 0.001), energy-dense, nutrient-poor foods (-7.6%EI, P < 0.001), sodium (-369 mg, P = 0.047), and diet quality (ARFS) (+4.3, P = 0.004), including sub-scales for fruit (+1.1, P = 0.03), meat (+0.9, P = 0.004) and non-meat protein (+0.5, P = 0.03).

CONCLUSION

The PULSE prevention program’s nutrition messages led to significant improvements in dietary intake in men at risk of T2DM.