Feasibility pilot study of a Japanese teaching kitchen program

Background

This pilot study examined the feasibility of a new lifestyle modification program involving a "Teaching Kitchen" in Japan. Our goal was to explore (1) feasibility of the program; (2) acceptability for class frequency (weekly vs. bi-weekly); and (3) changes in biometrics, dietary intakes, and lifestyle factors.

Methods

A total of 24 employees with obesity in a Japanese company were recruited. Participants were randomly divided into two groups (weekly or bi-weekly group), each attending the program consisting of four two-hour classes (lectures on nutrition, exercise, mindfulness, and culinary instructions). Participants were observed for changes in dietary intakes, biometrics, and health related quality of life over the subsequent 3 months. We tested the between-group differences in changes using linear mixed-effect models.

Results

The program completion rates were 83.3% in total (91.7% for weekly group and 75.0% for bi-weekly group). From baseline to post-intervention, significant decreases were observed in weight (p < 0.001), body mass index (p < 0.001), diastolic blood pressure (p = 0.03), body fat mass (p < 0.001), and dietary intakes in total fat (p = 0.03) and sodium (p = 0.008) among 17 participants who were available for measurements. Improvements in biometrics remained significant 1 month after the intervention (all p ≤ 0.03 in 14 participants). Participants' health related quality of life was significantly improved in bodily pain, general health, vitality, and mental component score (all p ≤ 0.047).

Conclusions

The new Japanese Teaching Kitchen program is feasible with high program completion rates in Japanese office workers with obesity. While this was a small feasibility study, significant multiple improvements in dietary intakes, biometrics, and health related quality of life suggest that this line of inquiry warrants further exploration to address obesity and obesity-related diseases in Japan.

Ideal body weight-based determination of minimum oral calories beneficial to function and survival in ALS

Introduction

This study sought to identify the optimal caloric intake to improve function and survival in ALS patients by comparing oral intake per ideal body weight (IBW) and its discrepancy with total energy expenditure (TEE) using the Shimizu formula.

Methods

A retrospective analysis of 104 ALS patients was conducted, categorizing them based on their average intake during the first week after admission using two primary intake cutoffs: 25 kcal/kgIBW and 30 kcal/kgIBW. The variance between oral intake and TEE was also evaluated using -300 kcal and 0 kcal as reference points.

Results

Oral caloric intake per IBW and functional decline rate (rs = -0.35, p < 0.001), but the variance from TEE was not significantly correlated (-0.11, p = 0.27). Survival data showed that patients consuming less than 25 kcal/kgIBW had a median survival of 24 months, increasing to 38 months for those consuming between 25-30 kcal/kgIBW and 63 months for those consuming 30 kcal/kgIBW or more. Deviations from the TEE did not significantly affect survival (p = 0.36). Among patients consuming less than their TEE, those consuming less than 25 kcal/kgIBW had a shorter median survival (24 months) compared to their counterparts (46 months) (p = 0.022). Consumption of less than 25 kcal/kgBW emerged as a significant negative predictor of patient outcome, independent of factors such as age, gender or disease progression.

Discussion

Intakes of 25 kcal/kgIBW or more are correlated with improved ALS outcomes, and larger, multi-regional studies are recommended for deeper insights.

Desire for thinness among young Japanese women from the perspective of objective and subjective ideal body shape

I examined the actual situation of the desire to be thin among young Japanese women from the perspective of ideal body shape and actual measured body shape. In total, 90 young Japanese women were evaluated using a questionnaire (perceived body shape and desired body composition change) and assessments of sarcopenia (muscle strength, physical ability, and muscle mass). Participants were classified into the underweight (body mass index [BMI] < 18.5 kg/m2, 74%), normal-weight (18.5 ≤ BMI < 25 kg/m2, 20%), or obese (25 ≤ BMI < 30 kg/m2, 6%) groups. The normal-weight group needed to gain an average of 2.2 kg to reach the objective ideal weight, but participants desired to lose an average of 4.5 kg. The underweight group needed to gain an average of 10.3 kg to reach the objective ideal weight, but participants desired to maintain their current body weight. Data on muscle mass for the diagnosis of sarcopenia showed low values for the underweight group. Most participants were classified into the normal-weight and underweight groups, but these groups showed a high percentage of women with a desire to be thin. The body shape of young adult women should be carefully considered not only as a health issue of thinness during the fertile period but also as a countermeasure to sarcopenia (low skeletal muscle mass) during the aging process.

Negative Association between Caloric Intake and Estimated Glomerular Filtration Rate in a Chinese Population: Mediation Models Involving Mitochondrial Function

BACKGROUND

With the shortening of leukocyte telomere length (LTL) and decrease in the copy number of mitochondrial DNA, mitochondrial dysfunction and oxidative stress are considered important drivers of the aging process. Although previous experimental studies report that caloric intake is associated with age-related renal dysfunction through the changes in mitochondrial function, there are insufficient epidemiological data to establish this association.

OBJECTIVE

We aimed to explore the association between caloric intake and renal function and to investigate whether mitochondrial DNA copy number (mtDNAcn) mediated this association by cross-sectional analysis.

METHODS

A total of 403 individuals from a Chinese rural cohort (women = 66.50%; mean age = 53.94 ± 10.27 years) with an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 and with differences in the glucose tolerance status (diabetes, n = 106; prediabetes, n = 125; normal glucose tolerance, n = 172) were included. Dietary data were obtained by a 24-h food recall, and caloric intake was normalized by ideal body weight. The mtDNAcn and LTL were detected using real-time PCR assay. The associations between caloric intake, aging markers, and renal function were analyzed by partial correlation analysis and multiple linear regression analysis. Mediation analysis was applied to examine the role of mtDNAcn in the association between caloric intake and eGFR.

RESULTS

Caloric intake was higher while age-adjusted mtDNAcn was lower in individuals with eGFR <90 mL/min/1.73 m2 (n = 140) than in those with eGFR ≥90 mL/min/1.73 m2 (n = 263). After adjusting for multiple factors, linear regression analysis revealed that caloric intake was negatively associated with eGFR and mtDNAcn, while mtDNAcn was positively associated with eGFR. Moreover, mediation analysis indicated that the indirect effect of caloric intake on eGFR through mtDNAcn was significant (β = -0.0505, 95% confidence interval -0.0931 to -0.0190).

CONCLUSIONS

Caloric intake was negatively associated with eGFR in a Chinese population, and the association was partly mediated by decreased mtDNAcn.

Standard medical nutrition therapy of 25 kcal/kg ideal bodyweight/day often does not reach even resting energy expenditure for patients with type 2 diabetes

AIMS/INTRODUCTION

In Japan, an ideal bodyweight (IBW) calculated by 22 × height (m)2 has commonly been used in the planning of medical nutrition therapy (MNT). However, there have been concerns regarding calorie deficits in fulfilling resting energy expenditure (REE) for patients with type 2 diabetes undergoing MNT as defined by 25 kcal/kg IBW/day. The objective of the present study was to measure REE in patients with type 2 diabetes and verify the validity of MNT with 25 kcal/kg IBW/day.

MATERIALS AND METHODS

A retrospective cross-sectional study was carried out in 52 patients with type 2 diabetes (mean age was 65.9 ± 7.3 years, bodyweight 65.0 ± 11.3 kg, body mass index 24.9 ± 3.8 kg/m2 ). REE was measured by indirect calorimetry.

RESULTS

The mean REE was 1,601.0 ± 253.1 kcal/day. Assuming that all patients strictly observed daily energy intake as 25 kcal/kg IBW/day, 41 of 52 patients (78.9%) did not reach their REE. The greater the bodyweight, the greater the difference between assumed energy intake as 25 kcal/kg IBW and REE.

CONCLUSIONS

We call attention to the potential risk of total dietary energy intake set to 25 kcal/kg IBW/day. Clinicians should carefully plan MNT to not fall below a patient's REE to prevent sarcopenia and ensure MNT continuity.

Postprandial Increase in Energy Expenditure Correlates with Body Weight Reduction in Patients with Type 2 Diabetes Receiving Diet Therapy

AIM

The clinical significance of energy expenditure (EE) in the treatment of type 2 diabetes has not been fully elucidated. Here we analyzed the relationships between EE and clinical measurements in patients with type 2 diabetes receiving diet therapy.

METHODS

A total of 100 patients (34 women and 66 men) with type 2 diabetes admitted to our hospital for glycemic control were enrolled. The participants received an energy-restricted diet during their hospitalization (median, 15 days). EE was measured in the fasted (FEE) and postprandial (PPEE) states using indirect calorimetry. The postprandial increment of EE (ΔEE) was calculated from the FEE and PPEE (ΔEE=PPEE-FEE).

RESULTS

FEE, PPEE, and ΔEE were 0.997±0.203, 1.104±0.213, and 0.107±0.134 kcal/min, respectively. Body weight decreased from 68.7±16.6 to 66.8±16.0 kg (p＜0.0001) during hospitalization. FEE and PPEE showed positive correlations with height, body weight, body mass index, and abdominal circumference at admission, but ΔEE was not correlated with these anthropometric measurements. On the other hand, ΔEE was inversely correlated with the body weight change. The association between ΔEE and the body weight change was independent of age, sex, and HbA1c.

CONCLUSIONS

Postprandial increase in energy expenditure may be a determinant of individual differences in weight reduction in patients with type 2 diabetes on diet therapy. As a simple surrogate for diet-induced thermogenesis, ΔEE may serve as a useful predictive marker for the efficacy of diet therapy.

Effect of Glycemic Control on Chylomicron Metabolism and Correlation between Postprandial Metabolism of Plasma Glucose and Chylomicron in Patients with Type 2 Diabetes Treated with Basal-bolus Insulin Therapy with or without Vildagliptin

Aim: Glucagon-like peptide-1 can reduce both postprandial plasma glucose (PG) and chylomicron (CM) levels in patients with type 2 diabetes. However, there have been no reports regarding the relationship between the postprandial metabolism of PG and CM.

Methods: Patients with type 2 diabetes who were admitted for glycemic control were randomized to insulin alone (Ins; n = 16) or insulin plus vildagliptin 100 mg (InsV; n = 16) groups. The insulin dose was adjusted to maintain normal blood glucose levels. The daily profiles of serum TG, remnant lipoprotein cholesterol (RemL-C), and apolipoprotein B48 (ApoB48) were estimated by frequent blood collection on admission and before discharge, and the daily glucose fluctuation profile was also estimated using continuous glucose monitoring (CGM) before discharge.

Results: The daily profiles of serum TG and RemL-C indicated a significant decrease before discharge compared with on admission; however, no significant changes in serum ApoB48 levels were observed in either group. At discharge, daily glucose fluctuation profile and the change in the serum ApoB48 level from fasting to the peak of the daily profile was significantly smaller in the InsV group than in the Ins group. The increment of serum ApoB48 level was significantly correlated with the mean amplitude of glycemic excursions calculated using CGM data only in the Ins group (R² = 0.5242, P <0.001).

Conclusions: Short-term glycemic control decreased serum TG and RemL-C levels, but not ApoB48 levels, and the postprandial metabolism of PG and CM might be regulated by the same mechanism except GLP-1 effect.

In-hospital weight loss, prescribed diet and food acceptance

Background

Weight loss and malnutrition may be caused by many factors, including type of disease and treatment.

Aim

The present study investigated the occurrence of in-hospital weight loss and related factors.

Method

This cross-sectional study investigated the following variables of 456 hospitalized patients: gender, age, disease, weight variation during hospital stay, and type and acceptance of the prescribed diet. Repeated measures analysis of variance (ANOVA) was used for comparing patients' weight in the first three days in hospital stay and determining which factors affect weight. The generalized estimating equation was used for comparing the food acceptance rates. The significance level was set at 5%.

Results

The most prescribed diet was the regular (28.8%) and 45.5% of the patients lost weight during their stay. Acceptance of hospital food increased from the first to the third days of stay (p=0.0022) but weight loss was still significant (p<0.0001). Age and type of prescribed diet did not affect weight loss during the study period but type of disease and gender did. Patients with neoplasms (p=0.0052) and males (p=0.0002) lost more weight.

Conclusion

Weight loss during hospital stay was associated only with gender and type of disease.

Effect of Caloric Intake 25 or 30 kcal/kg/day on the Glycemic Control in Obese Patients With Type 2 Diabetes

Background

The recommended total dietary energy intake prescribed medical nutrition therapy for obese or overweight patients with type 2 diabetes in Japan is often set at 25 kcal/kg ideal body weight (IBW)/day. This study was conducted to determine the impact of the total dietary energy intake (25 or 30 kcal/kg IBW/day) on the glycemic control, lipid profile, and satisfaction level in overweight patients with type 2 diabetes.

Methods

We performed interview and a designed prospective, randomized, controlled, multicenter study trial. Recruitment for interview for doctors and hospitalization of the obese or overweight patients with type 2 diabetes began from September 2008 and continued until June 2010. The subjects were randomly assigned to 25 kcal/kg IBW/day group (25 kcal group) or 30 kcal/kg IBW/day group (30 kcal group). The primary endpoint was the body weight of the subjects at the time of hospitalization, at the time of discharge from the hospital, and at 3, 6 and 12 months after discharge from the hospital.

Results

The glycemic control, lipid control and body weight were similar between the 25 and 30 kcal groups during the 12-month follow-up, and the degree of satisfaction in respect of the medical treatment was significantly higher in the 30 kcal group than in the 25 kcal group at 1 year after discharge.

Conclusions

It is considered to be preferable for the caloric intake to be set at 30kcal/kg IBW/day rather than at 25 kcal/kg IBW/day for obese or overweight patients with type 2 diabetes.