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Mack I, Hahn H, Gödel C, Enck P, Bharucha AE. Global Prevalence of Fecal Incontinence in Community-Dwelling Adults: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2024; 22:712-731.e8. [PMID: 37734583 PMCID: PMC10948379 DOI: 10.1016/j.cgh.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND & AIMS Fecal incontinence (FI) can considerably impair quality of life. Through a systematic review and meta-analysis, we sought to determine the global prevalence and geographic distribution of FI and to characterize its relationship with sex and age. METHODS We searched PubMed, Web of Science, and Cochrane Library databases to identify population-based surveys of the prevalence of FI. RESULTS Of the 5175 articles identified, the final analysis included 80 studies; the median response rate was 66% (interquartile range [IQR], 54%-74%). Among 548,316 individuals, the pooled global prevalence of FI was 8.0% (95% confidence interval [CI], 6.8%-9.2%); by Rome criteria, it was 5.4% (95% CI, 3.1%-7.7%). FI prevalence was greater for persons aged 60 years and older (9.3%; 95% CI, 6.6%-12.0%) compared with younger persons (4.9%; 95% CI, 2.9%-6.9%) (odds ratio [OR], 1.75; 95% CI, 1.39-2.20), and it was more prevalent among women (9.1%; 95% CI, 7.6%-10.6%) than men (7.4%; 95% CI, 6.0%-8.8%]) (OR, 1.17; 95% CI, 1.06-1.28). The prevalence was highest in Australia and Oceania, followed by North America, Asia, and Europe, but prevalence could not be estimated in Africa and the Middle East. The risk of bias was low, moderate, and high for 19 (24%), 46 (57%), and 15 (19%) studies, respectively. Exclusion of studies with high risk of bias did not affect the prevalence of FI or heterogeneity. In the meta-regression, the high study heterogeneity (I2 = 99.61%) was partly explained by age. CONCLUSIONS Approximately 1 in 12 adults worldwide have FI. The prevalence is greater among women and older people.
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Affiliation(s)
- Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Heiko Hahn
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Celina Gödel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Adil E Bharucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
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Schraml J, Bauer K, Schild S, Klos B, Erschens R, Stengel A, Nieß A, Zipfel S, Mack I. Conventional weight loss therapy in morbid obesity during COVID-19 pandemic: degree of burdens at baseline and treatment efficacy. Front Psychiatry 2024; 15:1330278. [PMID: 38317768 PMCID: PMC10839038 DOI: 10.3389/fpsyt.2024.1330278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/03/2024] [Indexed: 02/07/2024] Open
Abstract
Introduction COVID-19 affected global physical and psychological health. The purpose of this study was to explore the pandemics impact on health-related quality of life (HRQoL), mental health (anxiety, depression, and perceived stress) and eating behavior in people with severe obesity participating in a multimodal conservative behavioral weight loss (BWL) program conducted via videoconferencing. Additionally, the efficacy of the six-month BWL program in a virtual video-based setting during the pandemic was examined. Methods 297 participants of a face-to-face multimodal behavioral weight loss program prior to the pandemic (PrePAN, May 2014-September 2019) and 146 participants of the in terms of content same intervention in a videoconference-based setting during the pandemic (PAN, July 2020-April 2022) were questioned and compared using standardized questionnaires for HRQoL, symptoms of depressive and anxiety disorders, perceived stress, and eating behavior at baseline and at the end of treatment. Results Symptoms for anxiety, depression and perceived stress were similar between PrePAN and PAN at baseline. In addition, PAN tended to show lower disinhibition of eating behavior and feelings of hunger than PrePAN. During the pandemic, the BWL intervention resulted in body weight loss (67%) or stabilization (16%) in most of the participants. It also contributed by improving physical HRQoL, lower worries, and improved eating behaviors compared to baseline. Conclusion During the COVID-19 pandemic, baseline mental health of people with morbid obesity was not worse than before the pandemic. Additionally, the BWL intervention in the virtual video-based setting stabilized and improved physical and mental health during the COVID-19 pandemic.
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Affiliation(s)
- Jessica Schraml
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Kerstin Bauer
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Sandra Schild
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Bea Klos
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Rebecca Erschens
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Department for Psychosomatic Medicine, Charité Center for Internal Medicine and Dermatology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- German Center for Mental Health (DZPG), Tübingen, Germany
| | - Andreas Nieß
- Department of Sports Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- German Center for Mental Health (DZPG), Tübingen, Germany
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
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Ponomarev S, Mack I, Choukér A. Editorial: Microbiota, nutrition and stress: modulators of immunity. Front Nutr 2023; 10:1328346. [PMID: 38045810 PMCID: PMC10691674 DOI: 10.3389/fnut.2023.1328346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 11/01/2023] [Indexed: 12/05/2023] Open
Affiliation(s)
- Sergey Ponomarev
- Laboratory of Immune System Physiology, State Scientific Center of Russian Federation, Institute of the Biomedical Problems, Russian Academy of Sciences, Russian Federation, Moscow, Russia
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Alexander Choukér
- Laboratory of Translational Research ‘Stress and Immunity', Department of Anesthesiology, LMU University Hospital, Ludwig-Maximilians-Universitó Munich (LMU), Munich, Germany
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Pruccoli J, Mack I, Klos B, Schild S, Stengel A, Zipfel S, Giel KE, Schag K. Mental Health Variables Impact Weight Loss, Especially in Patients with Obesity and Binge Eating: A Mediation Model on the Role of Eating Disorder Pathology. Nutrients 2023; 15:3915. [PMID: 37764699 PMCID: PMC10537364 DOI: 10.3390/nu15183915] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Various mental health and eating behavior variables have been independently associated with predicting weight loss in individuals with obesity. This study aims to investigate a mediation model that assesses the distinct contributions of these variables in predicting weight changes in patients with obesity following an outpatient behavioral weight loss intervention (BWLI). METHODS General mental health (depression, anxiety, stress, impulsivity), eating behavior (cognitive restraint, disinhibition, hunger), eating disorder pathology, and body mass index (BMI) were assessed in a group of 297 patients with obesity at the admission of a BWLI program. BMI was re-evaluated during the final treatment session. A mediation model was employed to examine whether mental health and eating behavior variables predicted BMI changes, with eating disorder pathology serving as a mediator. The model was tested both overall and within two patient subgroups: those with regular binge eating (≥four episodes/month) and those without. RESULTS In the overall sample (n = 238), the relationships between depression, impulsivity, and cognitive restraint with BMI change were mediated by eating disorder pathology. In the subgroup with regular binge eating (n = 99, 41.6%), the associations between stress and disinhibition with BMI change were additionally mediated by eating disorder pathology. In the subgroup without regular binge eating, eating disorder pathology showed no mediating effect. DISCUSSION Multiple mental health and eating behavior variables assessed at admission predicted BMI changes, particularly when mediated by eating disorder pathology in patients with regular binge eating. A comprehensive psychopathological assessment prior to starting BWLI may help identify multiple factors affecting prognosis and treatment outcomes. Long-term follow-up studies in this field are required.
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Affiliation(s)
- Jacopo Pruccoli
- Pediatric Neurology and Psychiatry Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Regional Center for Feeding and Eating Disorders in the Developmental Age, 40138 Bologna, Italy;
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, 72076 Tübingen, Germany; (B.K.); (S.S.); (A.S.); (S.Z.); (K.E.G.); (K.S.)
- Centre of Excellence for Eating Disorders Tübingen (KOMET), 72076 Tübingen, Germany
| | - Bea Klos
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, 72076 Tübingen, Germany; (B.K.); (S.S.); (A.S.); (S.Z.); (K.E.G.); (K.S.)
- Centre of Excellence for Eating Disorders Tübingen (KOMET), 72076 Tübingen, Germany
| | - Sandra Schild
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, 72076 Tübingen, Germany; (B.K.); (S.S.); (A.S.); (S.Z.); (K.E.G.); (K.S.)
- Centre of Excellence for Eating Disorders Tübingen (KOMET), 72076 Tübingen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, 72076 Tübingen, Germany; (B.K.); (S.S.); (A.S.); (S.Z.); (K.E.G.); (K.S.)
- Centre of Excellence for Eating Disorders Tübingen (KOMET), 72076 Tübingen, Germany
- DZPG (German Center for Mental Health), 72076 Tübingen, Germany
- Department for Psychosomatic Medicine, Charité Center for Internal Medicine and Dermatology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität at Berlin, and Berlin Institute of Health, 12203 Berlin, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, 72076 Tübingen, Germany; (B.K.); (S.S.); (A.S.); (S.Z.); (K.E.G.); (K.S.)
- Centre of Excellence for Eating Disorders Tübingen (KOMET), 72076 Tübingen, Germany
- DZPG (German Center for Mental Health), 72076 Tübingen, Germany
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, 72076 Tübingen, Germany; (B.K.); (S.S.); (A.S.); (S.Z.); (K.E.G.); (K.S.)
- Centre of Excellence for Eating Disorders Tübingen (KOMET), 72076 Tübingen, Germany
- DZPG (German Center for Mental Health), 72076 Tübingen, Germany
| | - Kathrin Schag
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, 72076 Tübingen, Germany; (B.K.); (S.S.); (A.S.); (S.Z.); (K.E.G.); (K.S.)
- Centre of Excellence for Eating Disorders Tübingen (KOMET), 72076 Tübingen, Germany
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Klos B, Steinbach C, Ketel J, Lambert C, Penders J, Doré J, Enck P, Mack I. Effects of isolation and confinement on gastrointestinal microbiota-a systematic review. Front Nutr 2023; 10:1214016. [PMID: 37492598 PMCID: PMC10364611 DOI: 10.3389/fnut.2023.1214016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/21/2023] [Indexed: 07/27/2023] Open
Abstract
Purpose The gastrointestinal (GI) microbiota is a complex and dynamic ecosystem whose composition and function are influenced by many internal and external factors. Overall, the individual GI microbiota composition appears to be rather stable but can be influenced by extreme shifts in environmental exposures. To date, there is no systematic literature review that examines the effects of extreme environmental conditions, such as strict isolation and confinement, on the GI microbiota. Methods We conducted a systematic review to examine the effects of isolated and confined environments on the human GI microbiota. The literature search was conducted according to PRISMA criteria using PubMed, Web of Science and Cochrane Library. Relevant studies were identified based on exposure to isolated and confined environments, generally being also antigen-limited, for a minimum of 28 days and classified according to the microbiota analysis method (cultivation- or molecular based approaches) and the isolation habitat (space, space- or microgravity simulation such as MARS-500 or natural isolation such as Antarctica). Microbial shifts in abundance, alpha diversity and community structure in response to isolation were assessed. Results Regardless of the study habitat, inconsistent shifts in abundance of 40 different genera, mainly in the phylum Bacillota (formerly Firmicutes) were reported. Overall, the heterogeneity of studies was high. Reducing heterogeneity was neither possible by differentiating the microbiota analysis methods nor by subgrouping according to the isolation habitat. Alpha diversity evolved non-specifically, whereas the microbial community structure remained dissimilar despite partial convergence. The GI ecosystem returned to baseline levels following exposure, showing resilience irrespective of the experiment length. Conclusion An isolated and confined environment has a considerable impact on the GI microbiota composition in terms of diversity and relative abundances of dominant taxa. However, due to a limited number of studies with rather small sample sizes, it is important to approach an in-depth conclusion with caution, and results should be considered as a preliminary trend. The risk of dysbiosis and associated diseases should be considered when planning future projects in extreme environments. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42022357589.
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Affiliation(s)
- Bea Klos
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Christina Steinbach
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Jasmin Ketel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Claude Lambert
- CIRI–Immunology Lab University Hospital, Saint-Étienne, France
- LCOMS/ENOSIS Université de Lorraine, Metz, France
| | - John Penders
- Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Maastricht University Medical Center, CAPHRI Care and Public Health Research Institute, Maastricht, Netherlands
- Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Maastricht University Medical Center, School of Nutrition and Translational Research in Metabolism, Maastricht, Netherlands
| | - Joël Doré
- UMR Micalis Institut, INRA, Paris-Saclay University, Jouy-En-Josas, France
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
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Klos B, Cook J, Crepaz L, Weiland A, Zipfel S, Mack I. Impact of energy density on energy intake in children and adults: a systematic review and meta-analysis of randomized controlled trials. Eur J Nutr 2023; 62:1059-1076. [PMID: 36460778 PMCID: PMC10030411 DOI: 10.1007/s00394-022-03054-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 11/10/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE The energy density (ED) of a diet can be leveraged to prevent weight gain or treat overweight and obesity. By lowering the ED of the diet, energy intake can be reduced while maintaining portion size. However, a reliable meta-analysis of data from randomized controlled trials (RCTs) is missing. Therefore, this meta-analysis synthesized the evidence of ED manipulation on energy intake in RCTs. METHODS The systematic literature search of multiple databases according to PRISMA criteria considered RCTs investigating the objectively measured energy intake from meals with different ED (lower ED (median 1.1 kcal/g) versus higher ED (median 1.5 kcal/g)) under controlled conditions. Subgroup analyses for age (children versus adults), meal type (preload versus entrée design), and intervention length (1 meal versus > 1 meal) were performed to achieve the most homogeneous result. RESULTS The meta-analysis of 38 included studies demonstrated that lowering ED considerably reduced energy intake - 223 kcal (95% CI: - 259.7, - 186.0) in comparison to the higher ED interventions. As heterogeneity was high among studies, subgroup analyses were conducted. Heterogeneity decreased in subgroup analyses for age and meal type combined, strengthening the results. An extended analysis showed a positive linear relationship between ED and energy intake. Dietary ED did not affect the amount of food intake. CONCLUSION Manipulating ED substantially affects energy intake whereas food intake remains constant. Thus, this approach can be regarded as a powerful tool for weight management through nutrition therapy. Registration on 08/08/2021: CRD42021266653.
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Affiliation(s)
- Bea Klos
- Internal Medicine VI, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstr. 5, 72076, Tübingen, Germany
| | - Jessica Cook
- Internal Medicine VI, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstr. 5, 72076, Tübingen, Germany
| | - Letizia Crepaz
- Internal Medicine VI, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstr. 5, 72076, Tübingen, Germany
| | - Alisa Weiland
- Internal Medicine VI, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstr. 5, 72076, Tübingen, Germany
| | - Stephan Zipfel
- Internal Medicine VI, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstr. 5, 72076, Tübingen, Germany
| | - Isabelle Mack
- Internal Medicine VI, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstr. 5, 72076, Tübingen, Germany.
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Lau T, Cook J, Archid R, Stengel A, Zipfel S, Mack I. Effects of Lifestyle and Educational Bridging Programs before Bariatric Surgery on Postoperative Weight Loss: A Systematic Review and Meta-Analysis. Obes Facts 2023; 16:1-10. [PMID: 36209729 PMCID: PMC9889730 DOI: 10.1159/000526945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/15/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To fulfill the requirements for bariatric surgery, patients often need to participate in mandatory preoperative lifestyle interventions. Currently, the efficacy of multi-month preoperative lifestyle intervention programs on body mass index (BMI) reduction from the start of the program (T0) through the immediate preoperative time point (T1) to 1 year post-surgery (T2) and how the amount of preoperative BMI reduction affects postoperative outcome (T1 to T2) is unclear. The aim of this meta-analysis was to analyze the effects of preoperative lifestyle interventions on BMI 1 year post-surgery. METHOD A systematic literature search was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Randomized controlled trials that implemented preoperative lifestyle interventions lasting 1-8 months before bariatric surgery were included. The BMI of the intervention group was compared with that of a control group before participation in the preoperative lifestyle interventions (T0), after completion of the program before surgery (T1), and 1 year post-surgery (T2). Finally, the impact of successful BMI reduction at T1 on BMI at T2 was analyzed. RESULTS N = 345 patients derived from 4 studies undergoing preoperative lifestyle interventions reduced their BMI at T1 by 1.5 units compared to the control group (95% CI: -2.73, -0.28). One year post-surgery, both groups had lost comparable BMI points. The influence of reduced BMI at T1 on weight status at T2 is unclear due to the lack of available studies. Other endpoints and subgroup analyses were rarely examined. CONCLUSIONS Preoperative lifestyle interventions reduce BMI before bariatric surgery more effectively than usual care. These differences are not detectable 1 year post-surgery. Although a short-term energy reduction period before surgery is clearly important to minimize surgery risks, it is currently unclear whether, and if so, under what circumstances, participation in a preoperative lifestyle intervention is beneficial.
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Affiliation(s)
- Teresa Lau
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany,
| | - Jessica Cook
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Rami Archid
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Department of Psychosomatic Medicine, Charité - University Medicin Berlin, Berlin, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
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Ziser K, Junne F, Herschbach A, Martus P, Jacoby J, Stuber F, Rahmani Azad Z, Mack I, Weiland A, Krauß I, Greule C, Sudeck G, Kastner L, Zurstiege G, Hoell A, Bethge W, Sammet T, Schliesing O, Zipfel S, Ehehalt S, Giel KE. Supporting families to achieve a healthy weight development for their child with overweight/obesity using the STARKIDS intervention: study protocol for a cluster-randomized controlled trial. Trials 2022; 23:590. [PMID: 35871013 PMCID: PMC9308115 DOI: 10.1186/s13063-022-06525-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 07/06/2022] [Indexed: 11/16/2022] Open
Abstract
Background Childhood and adolescent overweight and obesity are among the most serious health challenges today. Structured weight reduction programs can be helpful to reduce severe health consequences but evidence is partly scarce. The STARKIDS program aims to improve on some of these limitations and is designed to be a structured, stepwise, digitally supported intervention program for the whole family. It is divided into two intervention steps spanning over 1.5 years and aims at promoting a healthy weight development of children/adolescents with overweight/obesity and an increase in quality of life. Methods The STARKIDS intervention is evaluated in a cluster-randomized study design by comparing it with a control group receiving a one-time structured counselling in the pediatric practice. The study aims to include 1000 families with children/adolescents with overweight/obesity from 100 pediatric practices. The main outcomes are reduction in body mass index percentiles and improvements in children’s/adolescent’s quality of life, secondary outcomes refer to the contents of the intervention such as diet, physical activity, stress, and media habits. All outcomes are measured on three measurement time points: (T0) at baseline/inclusion in the study, (T1) baseline + 12 months which is the end of step 1 of the STARKIDS intervention, and (T2) baseline + 18 months which is the end of step 2 of the STARKIDS intervention. Discussion The stepwise, e-health-supported STARKIDS program is a low-threshold intervention program for families with children/adolescents with overweight/obesity. With the proof of concept, STARKIDS provides the potential to be implemented as a standard care tool for the prevention and intervention of childhood/adolescence obesity in the German health system. Trial registration German Clinical Trials Register (DRKS) DRKS00022813 (acknowledged primary register of the World Health Organization). Registered on 27 November 2020 (Universal Trial Number U1111-1254-9536).
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Giel KE, Schag K, Leehr EJ, Mack I, Schuster LS, Wiegand A, Zipfel S, Hallschmid M, Nieratschker V. OXTR DNA methylation differentiates men on the obesity spectrum with and without binge eating disorder. Clin Epigenetics 2022; 14:108. [PMID: 36042529 PMCID: PMC9429727 DOI: 10.1186/s13148-022-01318-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 07/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The neuropeptide oxytocin (OXT) plays a role in the regulation of eating behavior and metabolism. OXT functioning is altered in patients with eating and weight disorders, and a variant of the oxytocin receptor gene (OXTR) has been associated with impulsive eating behavior as it is seen in patients with binge eating disorder (BED). Gene × environment interactions could play a role in BED. One mechanism mediating this interaction is the epigenetic alteration of gene expression. We therefore investigated if DNA methylation of the OXTR differs between individuals with obesity depending on a comorbid BED. We analyzed DNA methylation of the OXTR in peripheral blood of 227 individuals on the obesity spectrum (mean age: 40.3 ± 13.1 yrs; mean BMI: 38.6 ± 7.3 kg/m2), 130 of which were diagnosed with BED. RESULTS There were no overall differences in OXTR methylation between participants with and those without BED (p > 0.05), while both subgroups were comparable regarding age and body mass index (BMI), but significantly differed in sex distribution (p = 0.035). We found no relationship between mean DNA methylation and BMI or self-reported eating disorder (ED) pathology. Analyzing potential sex differences revealed a significantly lower OXTR DNA methylation in male participants with BED as compared to those without BED (p = 0.017). No such difference was found in the female subsample (p > 0.05). CONCLUSIONS Clinically significant binge eating pathology might be associated with lower OXTR DNA methylation exclusively in males. The differential DNA methylation of OXTR in males with BED supports the view that BED represents a phenotype within the obesity spectrum that is characterized by specific vulnerability factors. A better understanding of the epigenetic underpinnings of the OXT system might contribute to the refinement of OXT administration approaches as potential interventions in eating and weight disorders.
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Affiliation(s)
- Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Osianderstr. 5, 72076, Tübingen, Germany. .,Centre of Excellence for Eating Disorders (KOMET), Osianderstr. 5, 72076, Tübingen, Germany.
| | - Kathrin Schag
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Osianderstr. 5, 72076, Tübingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), Osianderstr. 5, 72076, Tübingen, Germany
| | - Elisabeth Johanna Leehr
- Institute for Translational Psychiatry, University of Münster, Albert-Schweitzer-Straße 11, 48149, Münster, Germany
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Osianderstr. 5, 72076, Tübingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), Osianderstr. 5, 72076, Tübingen, Germany
| | - Lea-Sarah Schuster
- Department of Psychiatry and Psychotherapy, Medical University Hospital Tübingen, Calwerstraße 14, 72076, Tübingen, Germany
| | - Ariane Wiegand
- Department of Psychiatry and Psychotherapy, Medical University Hospital Tübingen, Calwerstraße 14, 72076, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Osianderstr. 5, 72076, Tübingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), Osianderstr. 5, 72076, Tübingen, Germany
| | - Manfred Hallschmid
- Institute of Medical Psychology and Behavioural Neurobiology, University of Tübingen, Otfried-Müller-Straße 25, 72076, Tübingen, Germany.,German Center for Diabetes Research (DZD), Otfried-Müller-Straße 10, 72076, Tübingen, Germany.,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen (IDM), Otfried-Müller-Straße 10, 72076, Tübingen, Germany
| | - Vanessa Nieratschker
- Department of Psychiatry and Psychotherapy, Medical University Hospital Tübingen, Calwerstraße 14, 72076, Tübingen, Germany
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10
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Abstract
Faecal incontinence, which is defined by the unintentional loss of solid or liquid stool, has a worldwide prevalence of ≤7% in community-dwelling adults and can markedly impair quality of life. Nonetheless, many patients might not volunteer the symptom owing to embarrassment. Bowel disturbances, particularly diarrhoea, anal sphincter trauma (obstetrical injury or previous surgery), rectal urgency and burden of chronic illness are the main risk factors for faecal incontinence; others include neurological disorders, inflammatory bowel disease and pelvic floor anatomical disturbances. Faecal incontinence is classified by its type (urge, passive or combined), aetiology (anorectal disturbance, bowel symptoms or both) and severity, which is derived from the frequency, volume, consistency and nature (urge or passive) of stool leakage. Guided by the clinical features, diagnostic tests and therapies are implemented stepwise. When simple measures (for example, bowel modifiers such as fibre supplements, laxatives and anti-diarrhoeal agents) fail, anorectal manometry and other tests (endoanal imaging, defecography, rectal compliance and sensation, and anal neurophysiological tests) are performed as necessary. Non-surgical options (diet and lifestyle modification, behavioural measures, including biofeedback therapy, pharmacotherapy for constipation or diarrhoea, and anal or vaginal barrier devices) are often effective, especially in patients with mild faecal incontinence. Thereafter, perianal bulking agents, sacral neuromodulation and other surgeries may be considered when necessary.
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Affiliation(s)
- Adil E Bharucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
| | - Charles H Knowles
- Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, London, UK
| | - Isabelle Mack
- University Hospital, Department of Psychosomatic Medicine, Tübingen, Germany
| | - Allison Malcolm
- Department of Gastroenterology, Royal North Shore Hospital and University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas Oblizajek
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Satish Rao
- Department of Gastroenterology, University of Georgia, Augusta, GA, USA
| | - S Mark Scott
- Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, London, UK
| | - Andrea Shin
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, IN, USA
| | - Paul Enck
- University Hospital, Department of Psychosomatic Medicine, Tübingen, Germany.
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Mack I, Schwille-Kiuntke J, Mazurak N, Niesler B, Zimmermann K, Mönnikes H, Enck P. A Nonviable Probiotic in Irritable Bowel Syndrome: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Study. Clin Gastroenterol Hepatol 2022; 20:1039-1047.e9. [PMID: 34214682 DOI: 10.1016/j.cgh.2021.06.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 06/08/2021] [Accepted: 06/24/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The aim of this study was to investigate the effectiveness of oral treatment with a nonviable probiotic lysate (BL) of Escherichia coli (DSM 17252) and Enterococcus faecalis (DSM 16440) in patients with irritable bowel syndrome (IBS). METHODS A phase IV, randomized, double-blind, placebo-controlled, multicenter (30 study sites), parallel group study was conducted in 389 patients of both sexes with IBS according to Rome III criteria. The treatment period was 26 weeks. The participants were allocated to either placebo or BL after a 2-week baseline period. The primary outcome was based on the European Medicines Agency IBS guideline: improvement in global assessment (GAI) and improvement in abdominal pain. RESULTS Patients (BL, n = 191; placebo, n = 198) had similar baseline values and dropout rates. Overall, the response was similar between BL and placebo for IBS-GAI (17.4% and 14.4%, respectively; P = ·4787) and abdominal pain (42.0% and 35.4%, respectively; P = ·1419). Some secondary outcome measures and sensitivity analyses pointed toward potentially higher sensitivity of the abdominal pain measures in diarrhea-predominant IBS (IBS-D) but not the other subtypes. For the GAI, no subgroup differences were detected. For IBS-D, post hoc analyses for abdominal pain response over time and stool consistency showed potentially promising effects of BL. Finally, the treatment with BL was well-tolerated. CONCLUSIONS BL is not effective across all IBS subtypes. However, BL may offer a treatment option for IBS-D that needs verification by an adequately powered drug trial; EudraCT-No.: 2012-002741-38.
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Affiliation(s)
- Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen
| | - Juliane Schwille-Kiuntke
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen; Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Tübingen
| | - Nazar Mazurak
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen
| | - Beate Niesler
- Department of Human Molecular Genetics, University Hospital Heidelberg, Heidelberg
| | | | - Hubert Mönnikes
- Department of Internal Medicine, Martin Luther Hospital, Berlin, Germany
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen.
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12
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Weiland A, Nannette LK, Zipfel S, Ehehalt S, Ziser K, Junne F, Mack I. Predictors of Weight Loss and Weight Loss Maintenance in Children and Adolescents With Obesity After Behavioral Weight Loss Intervention. Front Public Health 2022; 10:813822. [PMID: 35400038 PMCID: PMC8989956 DOI: 10.3389/fpubh.2022.813822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 03/02/2022] [Indexed: 12/12/2022] Open
Abstract
Objective Predictors of body weight loss (BWL) and body weight loss maintenance (BWLM) after behavioral weight loss intervention are well-investigated in adults. Less is known for children and adolescents and a systematic overview on the topic for this age group was aim of the review. Methods A systematic research according to PRISMA guidelines using several databases was performed. The outcome was the BMI z-Score of longitudinal studies. The extracted predictors were classified in clusters (Physiology, Behavior, Psychology, Environment) and compared with a theory-driven model based on international guidelines and known predictors for adults. Results Out of 2,623 articles 24 met the eligibility criteria, 23 investigating BWL and 8 BWLM. The expected key predictor in research for adults “Behavior” was hardly investigated in children. The most examined cluster was “Physiology” with the most significant predictors, in particular genetics (BWL) and blood parameters (BWLM). Factors in the cluster “Psychology” also predicted BWL and BWLM. The cluster “Environment,” which was highlighted in most intervention guidelines, was neglected in studies regarding BWLM and hardly investigated in studies with BWL. Conclusion The comparison with the theory-driven children model outlined research gaps and differences between predictors for adults and children providing further direction of research. Systematic Review Registration http://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42020200505.
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Affiliation(s)
- Alisa Weiland
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Lena Kasemann Nannette
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Stefan Ehehalt
- Public Health Department of Stuttgart, Stuttgart, Germany
| | - Katrin Ziser
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Magdeburg, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
- *Correspondence: Isabelle Mack
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13
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Le Morvan de Sequeira C, Hengstberger C, Enck P, Mack I. Effect of Probiotics on Psychiatric Symptoms and Central Nervous System Functions in Human Health and Disease: A Systematic Review and Meta-Analysis. Nutrients 2022; 14:nu14030621. [PMID: 35276981 PMCID: PMC8839125 DOI: 10.3390/nu14030621] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/25/2022] [Accepted: 01/25/2022] [Indexed: 12/01/2022] Open
Abstract
Background: The gut microbiota impacts on central nervous system (CNS) function via the microbiota–gut–brain axis. Thus, therapeutics targeting the gut microbiota such as probiotics have the potential for improving mental health. This meta-analysis synthesizes the evidence regarding the impacts of probiotics on psychological well-being, psychiatric symptoms and CNS functioning. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were applied for executing this review using the databases PubMed, Web of Science and Cochrane Library. The data were summarized at qualitative and quantitative level. Results: Fifty-four randomized placebo-controlled studies were included, of which 30 were eligible for meta-analysis. If investigated, the probiotics mostly exerted effects on CNS function. Most probiotics did not affect mood, stress, anxiety, depression and psychiatric distress when compared to placebo at the qualitative level. At quantitative level, depression and psychiatric distress improved slightly in the probiotic condition (depression: mean difference −0.37 (95% CI: −0.55, −0.20); p ≤ 0.0001; psychiatric distress: mean difference −0.33 (95% CI: −0.53, −0.13); p = 0.001). Conclusions: To date it is unclear to which extent and in which specific areas next generation probiotics selected and developed for their ability to improve psychiatric condition and potentially other CNS functions are promising.
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14
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Buck P, Goebel-Stengel M, Mack I, Zipfel S, Stengel A. Case report: Carbohydrate malabsorption in inpatients with anorexia nervosa. Front Psychiatry 2022; 13:1076658. [PMID: 36606130 PMCID: PMC9807622 DOI: 10.3389/fpsyt.2022.1076658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 11/24/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Gastrointestinal (GI) complaints are frequently observed in patients who suffer from anorexia nervosa (AN). These symptoms may hamper treatment and weight regain and are often perceived as the cause, not the consequence, of the disease. Since carbohydrate malabsorption also produces these symptoms, this might underly or contribute to these complaints. So far, the role of carbohydrate malabsorption (fructose malabsorption and lactose intolerance) in AN has not yet been investigated. METHODS For this case series, inpatients with AN of restrictive type (n = 3), purging type (n = 3), and atypical AN (n = 1) conducted hydrogen breath tests with 25 g of fructose and 50 g of lactose to investigate carbohydrate malabsorption. Results were then analyzed in association with body mass index (BMI) and patient-reported outcomes (disordered eating, body image disturbances, anxiety, depressive symptoms, perceived stress, and GI complaints). RESULTS Based on the hydrogen breath test results, three of the seven female patients were classified as lactose intolerant and one presented fructose malabsorption. Both hydrogen curves for fructose (r = -0.632, p < 0.001) and lactose (r = -0.704, p < 0.001) showed a negative correlation with BMI. No association was observed between hydrogen values and patient-reported outcomes. CONCLUSION In patients with AN, GI symptoms caused by intolerance of common monosaccharides and disaccharides may be an underestimated burden and should be considered in the diagnosis and therapy of patients with AN. Due to the observed correlation with BMI, GI complaints after ingestion of fructose or lactose likely develop with decreasing body weight and are potentially reversible with weight regain.
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Affiliation(s)
- Patrizia Buck
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Miriam Goebel-Stengel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Department of Internal Medicine, Helios Clinic, Rottweil, Germany
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Department for Psychosomatic Medicine, Charité Center for Internal Medicine and Dermatology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Germany
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15
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Riedlinger C, Mazurak N, Schäffeler N, Stengel A, Giel KE, Zipfel S, Enck P, Mack I. Gastrointestinal complaints in patients with anorexia nervosa in the timecourse of inpatient treatment. Front Psychiatry 2022; 13:962837. [PMID: 36061281 PMCID: PMC9436028 DOI: 10.3389/fpsyt.2022.962837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/25/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In patients with anorexia nervosa (AN), gastrointestinal (GI) symptoms are common and usually improve during or after nutritional rehabilitation. It is unclear when exactly GI symptoms change in the timecourse of treatment and to which extent. In this study, we analyzed the timecourse of GI symptoms and their relation to disease-specific, demographic, anthropometric, and psychological factors in inpatients with AN. METHODS In weekly intervals, the Gastrointestinal Symptom Rating Scale (GSRS) was completed, and body weight was measured over a mean of 9.5 weeks in inpatients with AN. A total of four self-report questionnaires assessing psychological factors were completed before and after inpatient treatment. Data from 38 inpatients with AN were analyzed using mixed linear models. RESULTS Abdominal pain and constipation improved significantly in the timecourse with 0.085 (p = 0.002) and 0.101 (p = 0.004) points per week on the GSRS and were predicted to normalize after 13 (p = 0.002) and 17 (p = 0.004) weeks, respectively. Total GI symptoms tended to normalize after 25 weeks (p = 0.079). Indigestion (borborygmus, abdominal distension, eructation, flatulence) was the most severely pathological symptom at admission and did not improve significantly (p = 0.197). Diarrhea and reflux were, on average, not pathological at admission and remained stable during treatment. In addition to treatment time, the strongest predictors were ED pathology at admission for the development of abdominal pain, constipation, reflux, and total GI symptoms; stress for the development of constipation and total GI symptoms; and depression for constipation. CONCLUSIONS Informing patients with AN about the course of GI symptoms and their improvement during weight rehabilitation may help support compliance during treatment.
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Affiliation(s)
- Caroline Riedlinger
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), Tübingen, Germany
| | - Nazar Mazurak
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), Tübingen, Germany
| | - Norbert Schäffeler
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), Tübingen, Germany.,Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), Tübingen, Germany
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), Tübingen, Germany
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), Tübingen, Germany
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16
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Le Morvan de Sequeira C, Kaeber M, Cekin SE, Enck P, Mack I. The Effect of Probiotics on Quality of Life, Depression and Anxiety in Patients with Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10163497. [PMID: 34441793 PMCID: PMC8397103 DOI: 10.3390/jcm10163497] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Functional gastrointestinal disorders such as irritable bowel syndrome (IBS) report clinical improvement following probiotic therapy, but whether psychiatric comorbidity and quality-of-life in IBS improves directly or in directly is unknown. This meta-analysis synthesized the evidence regarding the effects of probiotics on quality of life (QoL), anxiety and depression in IBS. Methods: The review was executed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the databases PubMed, Web of Science and Cochrane Library. For QoL, the data were meta-analyzed, and for anxiety and depression a qualitative analysis was performed. Results: Thirty-five placebo-controlled studies were included of which 11 were eligible for meta-analysis. QoL improved with probiotic and placebo similarly, with the probiotic interventions slightly superior (mean QoL difference—0.36 (95% CI: 0.07, 0.64); p = 0.01). Anxiety and depression were similar between placebo and probiotic groups following therapy. Conclusion: For IBS, probiotic therapy improved QoL, but had no effects on anxiety and depression. However, the applied probiotics were not developed for selective effects on psyche and the brain. Therefore, it remains to be shown whether or not patients with IBS would benefit from second generation probiotics developed for these central effects (psychobiotics).
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Dörsam AF, Weiland A, Sauer H, Giel KE, Stroebele-Benschop N, Zipfel S, Enck P, Mack I. The Role of Dishware Size in the Perception of Portion Size in Children and Adolescents with Obesity. Nutrients 2021; 13:nu13062062. [PMID: 34208625 PMCID: PMC8235649 DOI: 10.3390/nu13062062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/02/2021] [Accepted: 06/11/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose: The influence of dishware on portion size perception in children and adolescents is inconclusive. This study investigated how children and adolescents with both obesity and a normal weight perceived portion size in different sized and shaped dishware items. Methods: The study included 60 children and adolescents with overweight and obesity (OBE) and 27 children and adolescents with normal weight (NW) aged from 9 to 17 years. The participants estimated quantities in three pairs of drinking glasses, one pair of bowls and two pairs of plates which varied in size and shape. The children were instructed to state intuitively which portion they would choose for big or small thirst/hunger. Thereafter they were asked to determine the exact amount by answering which dishware item contained the larger/smaller portion (cognitive evaluation). Results: There were no substantial differences in the intuitive evaluation of portion sizes between OBE and NW. During the cognitive evaluation, OBE estimated the amount of water in the glasses more correctly compared to NW (61% vs. 43%; p = 0.008); OBE estimated the amount of lentils in the bowls and on the plates significantly less correctly (39%) compared to NW (56%; p = 0.013). Conclusions: Habit formation and environmental stimuli might play a greater role in estimating food amounts in dishware than the child’s and adolescent’s body weight.
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Affiliation(s)
- Annica Franziska Dörsam
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, 72076 Tübingen, Germany; (A.F.D.); (A.W.); (H.S.); (K.E.G.); (S.Z.); (P.E.)
| | - Alisa Weiland
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, 72076 Tübingen, Germany; (A.F.D.); (A.W.); (H.S.); (K.E.G.); (S.Z.); (P.E.)
| | - Helene Sauer
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, 72076 Tübingen, Germany; (A.F.D.); (A.W.); (H.S.); (K.E.G.); (S.Z.); (P.E.)
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, 72076 Tübingen, Germany; (A.F.D.); (A.W.); (H.S.); (K.E.G.); (S.Z.); (P.E.)
| | | | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, 72076 Tübingen, Germany; (A.F.D.); (A.W.); (H.S.); (K.E.G.); (S.Z.); (P.E.)
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, 72076 Tübingen, Germany; (A.F.D.); (A.W.); (H.S.); (K.E.G.); (S.Z.); (P.E.)
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, 72076 Tübingen, Germany; (A.F.D.); (A.W.); (H.S.); (K.E.G.); (S.Z.); (P.E.)
- Correspondence: ; Tel.: +49-7071-29-85614
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18
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Bauer K, Schild S, Sauer H, Teufel M, Stengel A, Giel KE, Schellhorn P, Junne F, Nieß A, Zipfel S, Mack I. Attitude Matters! How Attitude towards Bariatric Surgery Influences the Effects of Behavioural Weight Loss Treatment. Obes Facts 2021; 14:531-542. [PMID: 34521092 PMCID: PMC8546453 DOI: 10.1159/000517850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 06/09/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Multidisciplinary obesity services at university hospitals usually treat patients with more complex and severe obesity. In addition, patients with Class 3 obesity, in particular, have different attitudes regarding the choices of therapy. METHODS This explorative study investigated the effect of patient attitudes towards bariatric surgery on body weight change (primary outcome) and psychological improvement (secondary outcomes: quality of life, depression, anxiety, and eating behaviour) in a 6-month moderate behavioural weight loss (BWL) programme in a university outpatient setting. RESULTS 297 patients with mostly Class 3 obesity participated in the programme. The patients did not yet have any indications for bariatric surgery. Of the participants, 37% had a positive attitude towards bariatric surgery (POS), whereas 38% had a negative attitude (NEG). The drop-out rate was 8%. NEG participants lost significantly more body weight than the POS participants (intention-to-treat population: 4.5 [SD: 6.3] kg versus 0.4 [SD: 5.8] kg; p < 0.001). In both subgroups, anxiety, depression, the mental score for quality of life, and eating behaviour improved. CONCLUSION A BWL treatment in a clinical setting identified 2 distinct groups with different attitudes towards bariatric surgery that were associated with different body weight change outcomes. These groups may require differently targeted programmes to achieve the best body weight loss results.
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Affiliation(s)
- Kerstin Bauer
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany,
| | - Sandra Schild
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Helene Sauer
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Martin Teufel
- LVR-Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, Essen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charité Center for Internal Medicine and Dermatology, Berlin, Germany
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Philipp Schellhorn
- Department of Sports Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Magdeburg, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Andreas Nieß
- Department of Sports Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
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19
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Mazurak N, Cook J, Weiland A, Ritze Y, Urschitz M, Junne F, Zipfel S, Enck P, Mack I. Impact of Childhood Obesity and Psychological Factors on Sleep. Front Psychiatry 2021; 12:657322. [PMID: 34305673 PMCID: PMC8298750 DOI: 10.3389/fpsyt.2021.657322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 06/08/2021] [Indexed: 11/13/2022] Open
Abstract
The aim of the study was to analyze sleep duration and behaviors in relation to psychological parameters in children and adolescents with obesity seeking inpatient weight-loss treatment in comparison to normal-weight children, and whether or not these variables would improve during the time course of treatment. Sixty children or adolescents with overweight and obesity (OBE) and 27 normal-weight (NW) peers (age: 9-17) were assessed for subjective sleep measures through self-reported and parent-reported questionnaires, as well as body weight, body composition, and psychological questionnaires. The OBE participants were assessed upon admission and before discharge of an inpatient multidisciplinary weight-loss program. NW participants' data were collected for cross-sectional comparison. In comparison to NW, children and adolescents with OBE had a shorter self-reported sleep duration and had poorer sleep behaviors and more sleep-disordered breathing as reported by their parents. No change in sleep measures occurred during the inpatient treatment. Psychological factors including higher anxiety, depression, and destructive-anger-related emotion regulation were moderate predictors for unfavorable sleep outcomes, independent of weight status. Children with obesity had less favorable sleep patterns, and psychological factors influenced sleep in children, independent of weight. More research is needed on the relationship and direction of influence between sleep, psychological factors, and obesity, and whether they can be integrated in the prevention and management of childhood obesity and possibly also other pediatric diseases.
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Affiliation(s)
- Nazar Mazurak
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Tübingen, Germany
| | - Jessica Cook
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Tübingen, Germany
| | - Alisa Weiland
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Tübingen, Germany
| | - Yvonne Ritze
- Institute of Medical Psychology and Behavioral Neurobiology, University Hospital, Tübingen, Germany
| | - Michael Urschitz
- Division of Paediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Tübingen, Germany
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Tübingen, Germany
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Tübingen, Germany
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20
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Schäffeler N, Lohmiller J, Mack I, Archid R, Zipfel S, Stengel A. Patients With Super Obesity Do Not Perceive Themselves as Being at Higher Risk for a More Severe Course of COVID-19 Infection. Front Psychiatry 2021; 12:798662. [PMID: 35281205 PMCID: PMC8907511 DOI: 10.3389/fpsyt.2021.798662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/20/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has led to major health-related concerns in the population. Several risk factors for a severe course of COVID-19 disease have been identified, with obesity taking an important role. However, it is unclear whether this association is only known in the expert world or whether individuals also experience themselves as risk patients due to their obesity and whether the desire for weight reduction may also be associated with a hoped-for risk reduction. These questions were addressed in a cross-sectional study of patients who have presented to an obesity center in order to lose body weight. METHODS Patients (n = 155) of the obesity center were asked to complete an ad hoc questionnaire to assess whether the desire to lose weight is also associated with a hoped-for risk reduction with respect to COVID-19 disease during the middle of the pandemic in the period between October 2020 and April 2021. We additionally assessed their perceived general stress using the Perceived Stress Questionnaire (PSQ). RESULTS In our explorative study, overall worries correlated significantly with worries about contracting COVID-19 (r = 0.483, p < 0.001). There has been an association with concerns about severe COVID-19 progression and psychological distress from the COVID-19 pandemic (r = 0.543, p < 0.001). In addition, a correlation was found between persons who worry about contracting COVID-19 and feeling like an at-risk patient (r = 0.530, p < 0.001). Interestingly, the higher the BMI (>50 kg/m2), the lower were the worries in PSQ (ANOVA p = 0.046). However, COVID-19-related worry was nonetheless present in the higher BMI subgroups. The most intense worries were experienced by individuals with a BMI between 35 and 39 (PSQ worries 50.44), immediately followed by individuals with a BMI between 40 and 49 (PSQ worries 49.36). DISCUSSION AND CONCLUSION An increased risk for a more severe course of COVID-19 infection is not generally perceived by obese individuals. In particular, individuals with very high BMI (>50)-although being at very high risk for a severe course of the COVID-19 disease-do not display increased worries, which might point toward heightened denial.
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Affiliation(s)
- Norbert Schäffeler
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Jacqueline Lohmiller
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Rami Archid
- Department of General, Visceral, and Transplant Surgery, University of Tuebingen, Tuebingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charite-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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21
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Dörsam AF, Mack I, Kögel L, Zipfel S, Giel KE. How do patients with eating disorders perceive and evaluate food portion sizes? A systematic review. Eur Eat Disord Rev 2020; 28:398-409. [PMID: 32567175 DOI: 10.1002/erv.2743] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/31/2020] [Accepted: 04/24/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The selection of adequate portion sizes plays a key role in the nutritional treatment of eating disorders (EDs). There is limited knowledge concerning the estimation of portion sizes in individuals with EDs. METHOD We performed a systematic review according to the PRISMA statement to synthesise current evidence in this field. Of N = 584 hits, four full-texts were included in the qualitative synthesis. RESULTS While patients with anorexia nervosa (AN) tend to overestimate the size of energy-dense food items and small to medium sized meal portions, they do not show a different estimation compared to healthy controls when judging the amount of food pieces. Large portion sizes were associated with increased anxiety in patients with AN. DISCUSSION The overestimation of food portion sizes seems to be driven by attitudinal and/or higher cognitive factors associated with AN. Differences between the studies are discussed and suggestions for future studies are given.
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Affiliation(s)
- Annica Franziska Dörsam
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Competence Center for Eating Disorders (KOMET), Tübingen, Germany
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Competence Center for Eating Disorders (KOMET), Tübingen, Germany
| | - Laura Kögel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Competence Center for Eating Disorders (KOMET), Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Competence Center for Eating Disorders (KOMET), Tübingen, Germany
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Competence Center for Eating Disorders (KOMET), Tübingen, Germany
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22
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Cook J, Lehne C, Weiland A, Archid R, Ritze Y, Bauer K, Zipfel S, Penders J, Enck P, Mack I. Gut Microbiota, Probiotics and Psychological States and Behaviors after Bariatric Surgery-A Systematic Review of Their Interrelation. Nutrients 2020; 12:nu12082396. [PMID: 32785153 PMCID: PMC7468806 DOI: 10.3390/nu12082396] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/01/2020] [Accepted: 08/07/2020] [Indexed: 02/07/2023] Open
Abstract
The gastrointestinal (GI) microbiota plays an important role in health and disease, including brain function and behavior. Bariatric surgery (BS) has been reported to result in various changes in the GI microbiota, therefore demanding the investigation of the impact of GI microbiota on treatment success. The goal of this systematic review was to assess the effects of BS on the microbiota composition in humans and other vertebrates, whether probiotics influence postoperative health, and whether microbiota and psychological and behavioral factors interact. A search was conducted using PubMed and Web of Science to find relevant studies with respect to the GI microbiota and probiotics after BS, and later screened for psychological and behavioral parameters. Studies were classified into groups and subgroups to provide a clear overview of the outcomes. Microbiota changes were further assessed for whether they were specific to BS in humans through the comparison to sham operated controls in other vertebrate studies. Changes in alpha diversity appear not to be specific, whereas dissimilarity in overall microbial community structure, and increases in the abundance of the phylum Proteobacteria and Akkermansia spp. within the phylum Verrucomicrobia after surgery were observed in both human and other vertebrates studies and may be specific to BS in humans. Human probiotic studies differed regarding probiotic strains and dosages, however it appeared that probiotic interventions were not superior to a placebo for quality of life scores or weight loss after BS. The relationship between GI microbiota and psychological diseases in this context is unclear due to insufficient available data.
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Affiliation(s)
- Jessica Cook
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, 72072 Tübingen, Germany; (J.C.); (C.L.); (A.W.); (K.B.); (S.Z.); (P.E.)
| | - Christine Lehne
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, 72072 Tübingen, Germany; (J.C.); (C.L.); (A.W.); (K.B.); (S.Z.); (P.E.)
| | - Alisa Weiland
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, 72072 Tübingen, Germany; (J.C.); (C.L.); (A.W.); (K.B.); (S.Z.); (P.E.)
| | - Rami Archid
- Department of General, Visceral and Transplant Surgery, University Hospital, 72072 Tübingen, Germany;
| | - Yvonne Ritze
- Institute for Medical Psychology and Behavioral Neurobiology, University Hospital, 72072 Tübingen, Germany;
| | - Kerstin Bauer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, 72072 Tübingen, Germany; (J.C.); (C.L.); (A.W.); (K.B.); (S.Z.); (P.E.)
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, 72072 Tübingen, Germany; (J.C.); (C.L.); (A.W.); (K.B.); (S.Z.); (P.E.)
| | - John Penders
- Department of Medical Microbiology, School of Nutrition and Translational Research in Metabolism (NUTRIM) and Care and Public Health Research Institute(Caphri), Maastricht University Medical Centre, 6211 Maastricht, The Netherlands;
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, 72072 Tübingen, Germany; (J.C.); (C.L.); (A.W.); (K.B.); (S.Z.); (P.E.)
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, 72072 Tübingen, Germany; (J.C.); (C.L.); (A.W.); (K.B.); (S.Z.); (P.E.)
- Correspondence: ; Tel.: +49-7071-2985614; Fax: +49-7071-294382
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23
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Bauer K, Lau T, Schwille‐Kiuntke J, Schild S, Hauner H, Stengel A, Zipfel S, Mack I. Conventional weight loss interventions across the different
BMI
obesity classes: A systematic review and quantitative comparative analysis. Eur Eat Disorders Rev 2020; 28:492-512. [DOI: 10.1002/erv.2741] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/29/2020] [Accepted: 04/13/2020] [Indexed: 01/16/2023]
Affiliation(s)
- Kerstin Bauer
- Department of Psychosomatic Medicine and Psychotherapy University Hospital Tübingen Tübingen Germany
| | - Teresa Lau
- Department of Psychosomatic Medicine and Psychotherapy University Hospital Tübingen Tübingen Germany
| | - Juliane Schwille‐Kiuntke
- Department of Psychosomatic Medicine and Psychotherapy University Hospital Tübingen Tübingen Germany
- Institute of Occupational and Social Medicine and Health Services Research University of Tübingen Tübingen Germany
| | - Sandra Schild
- Department of Psychosomatic Medicine and Psychotherapy University Hospital Tübingen Tübingen Germany
| | - Hans Hauner
- Institute of Nutritional Medicine, School of Medicine Technical university of Munich Munich Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy University Hospital Tübingen Tübingen Germany
- Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine Charité‐Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy University Hospital Tübingen Tübingen Germany
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy University Hospital Tübingen Tübingen Germany
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24
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Mack I, Reiband N, Etges C, Eichhorn S, Schaeffeler N, Zurstiege G, Gawrilow C, Weimer K, Peeraully R, Teufel M, Blumenstock G, Giel KE, Junne F, Zipfel S. The Kids Obesity Prevention Program: Cluster Randomized Controlled Trial to Evaluate a Serious Game for the Prevention and Treatment of Childhood Obesity. J Med Internet Res 2020; 22:e15725. [PMID: 32329742 PMCID: PMC7210499 DOI: 10.2196/15725] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/02/2019] [Accepted: 12/16/2019] [Indexed: 12/12/2022] Open
Abstract
Background Health games provide opportunities for the treatment and prevention of childhood obesity. We developed a motion-controlled serious game for children that addresses 3 core topics of nutrition, physical activity, and stress coping. It is the first serious game that extensively targets the dietary energy density principle (DED-P) in relation to nutrition. The game is intended to provide an additional educational component for the prevention and treatment of obesity in children. Objective The Kids Obesity Prevention study aimed to evaluate the newly developed game and to evaluate how well children are able to understand and apply the DED-P. Methods This cluster randomized controlled trial collected data from 82 primary school children aged 9 to 12 years and their parents at baseline (T0), at 2 weeks after study commencement (T1), and at the 4-week follow-up (T2). The dropout rate was 3.6%. The intervention group (IG) played the game within 2 weeks (2 sessions with different game modules). One part of the game involves selection of food with the lower energy density when presented with a pair of foods. This allows assessment of whether the children have understood the DED-P and whether they can apply it to unknown foods under time pressure. The control group (CG) received a brochure about the food pyramid concept and physical activity. The primary outcome was the gain in knowledge (nutrition and stress coping) and measured with a pretested questionnaire. The secondary outcomes were the maintenance of knowledge, application of the DED-P, feelings during game play, game acceptance, and behavioral measures (physical activity, media consumption, and dietary intake). Results The knowledge score ranging from 0 to 100 increased from T0 (IG: 53 [SD 10], CG: 50 [SD 11]) to T1 (IG: 69 [SD 11], CG: 52 [SD 12]) in IG versus CG (P<.001). At T2, the knowledge score of IG remained at the same level as that of T1. Game data showed that after DED-P education, the classification under time pressure of unknown versus known food pairs according to their DED category was similar (hit rate around 70%). Overall, 95% of the children liked the game very much or much. No group changes were observed at the behavioral level. Conclusions The Kids Obesity Prevention program sustainably increased knowledge in the areas of nutrition and stress coping, and children were able to apply the DED-P. Trial Registration ClinicalTrials.gov NCT02551978; https://clinicaltrials.gov/ct2/show/NCT02551978
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Affiliation(s)
- Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Nadine Reiband
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany.,Department of School Psychology, University of Tübingen, Tübingen, Germany
| | - Carolin Etges
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Sabrina Eichhorn
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Norbert Schaeffeler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Guido Zurstiege
- Department of Media Studies Tübingen, University of Tübingen, Tübingen, Germany
| | - Caterina Gawrilow
- Department of School Psychology, University of Tübingen, Tübingen, Germany
| | - Katja Weimer
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Riyad Peeraully
- Department of Paediatric Surgery, Nottingham Children's Hospital, Nottingham, United Kingdom
| | - Martin Teufel
- LVR-Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, Essen, Germany
| | - Gunnar Blumenstock
- Institute for Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
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25
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Riedlinger C, Schmidt G, Weiland A, Stengel A, Giel KE, Zipfel S, Enck P, Mack I. Which Symptoms, Complaints and Complications of the Gastrointestinal Tract Occur in Patients With Eating Disorders? A Systematic Review and Quantitative Analysis. Front Psychiatry 2020; 11:195. [PMID: 32425816 PMCID: PMC7212454 DOI: 10.3389/fpsyt.2020.00195] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/27/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Eating disorders (ED) such as anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) are often accompanied by a variety of psychological and physical comorbidities. Gastrointestinal (GI) symptoms are a classical feature in most patients with ED. The heterogeneity of studies on this topic is high, making it difficult to have a clear overview. The aim of this systematic review is therefore to provide an overview of subjectively and objectively measured differences and changes in the GI tract in patients with EDs, along with the occurrence of GI complications. METHODS A systematic literature search was conducted in PubMed, Web of Science, and Google Scholar to find all relevant studies examining GI problems in AN, BN, and BED. Quantitative analyses were performed for objective GI physiology measures where applicable. RESULTS The review differentiated between ED types and also between studies that report GI outcomes of ED in (i) human studies with an ED diagnosis excluding case reports that provide an overview of GI problems in ED and (ii) case reports with an ED diagnosis describing rare GI complications in ED. GI symptoms and impaired gastric transit times were frequent features of EDs with specific differences found for the ED types. During the time course of treatment, GI symptoms changed and/or improved but not completely. GI complications extended the range of GI problems observed, including a variety of serious complications such as gastric dilatation. CONCLUSIONS Problems of the GI tract are frequent in patients with ED and it is likely that they complicate therapy, especially in patients with AN. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number: CRD42019100585.
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Affiliation(s)
- Caroline Riedlinger
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Competence Center for Eating Disorders (KOMET), Tübingen, Germany
| | - Greta Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Competence Center for Eating Disorders (KOMET), Tübingen, Germany
| | - Alisa Weiland
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Competence Center for Eating Disorders (KOMET), Tübingen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Competence Center for Eating Disorders (KOMET), Tübingen, Germany
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Competence Center for Eating Disorders (KOMET), Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Competence Center for Eating Disorders (KOMET), Tübingen, Germany
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Competence Center for Eating Disorders (KOMET), Tübingen, Germany
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Competence Center for Eating Disorders (KOMET), Tübingen, Germany
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Mack I, Erlanger TE, Lang P, Sinniger P, Perisa D, Heininger U. Dose-dependent effectiveness of acellular pertussis vaccine in infants: A population-based case-control study. Vaccine 2019; 38:1444-1449. [PMID: 31813648 DOI: 10.1016/j.vaccine.2019.11.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/23/2019] [Accepted: 11/27/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pertussis is a vaccine-preventable disease which is most severe in young infants. More than two decades after the introduction of acelluar pertussis vaccines (aPV) in national immunization programs in many countries worldwide, a resurgence of pertussis has been recognized. Suboptimal effectiveness of aPV has been blamed as one major reason but only few studies have evaluated dose-dependent vaccine effectiveness (VE) provided by aPV in current practice. METHODS We performed a population-based retrospective case-control study by comparing pertussis immunization data of children 2.5 months to 2 years of age hospitalized for pertussis and residing in Switzerland with immunization data of a random control sample of children aged 2 years and residing in Switzerland. VE was defined as the percentage of hospitalizations avoided by number of aPV doses. It was calculated as 1-infection rate ratio (IRR)*100. IRR was calculated by dividing infection rates of vaccinated children and infection rates of unvaccinated children. To get dose specific VE,infection rates were stratified by number doses received. RESULTS VE against hospitalization due to pertussis increased significantly with each consecutive aPV dose in a "3 + 1" primary course in infants: 42.1% (95% CI: 11.3-62.6), 83.9% (70.2-92.1), 98.2% (96.1-99.3), and 100% (97.9-100) after the 1st, 2nd, 3rd, and 4th dose, respectively. CONCLUSION Acellular pertussis vaccines continue to demonstrate protection against hospitalization due to pertussis in infants and young children. Therefore, together with advancing immunization of pregnant women and household contacts, better control of severe pertussis in young infants can be achieved by timely initiation of immunization.
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Affiliation(s)
- I Mack
- University of Basel Children's Hospital, Paediatric Infectious Diseases and Vaccinology Unit, Basel, Switzerland; University of Basel, Faculty of Medicine, Basel, Switzerland.
| | - T E Erlanger
- University Hospital Basel and University of Basel, Department of Clinical Research, Clinical Trial Unit, Basel, Switzerland
| | - P Lang
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Department of Public Health, Zurich, Switzerland
| | - P Sinniger
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Department of Public Health, Zurich, Switzerland
| | - D Perisa
- Swiss Federal Office of Public Health, Division of Infectious Diseases, Bern, Switzerland
| | - U Heininger
- University of Basel Children's Hospital, Paediatric Infectious Diseases and Vaccinology Unit, Basel, Switzerland; University of Basel, Faculty of Medicine, Basel, Switzerland
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27
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Mack I, Sauer H, Weimer K, Dammann D, Zipfel S, Enck P, Teufel M. Perceptions of tableware size in households of children and adolescents with obesity. Eat Weight Disord 2019; 24:585-594. [PMID: 29981003 DOI: 10.1007/s40519-018-0537-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 06/26/2018] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Portion size influences energy intake and is an important factor when developing weight management strategies. The effect of tableware on food intake is less clear, especially in children. To date, the relationship between the body weight of individuals and the tableware used in their households has not been investigated. The aim of this study was to analyze the sizes of tableware in households of children and adolescents with obesity (OBE) in comparison to participants with normal-weight matched for age and gender (NW). METHODS 60 OBE (32 female, 26 male) and 27 NW (12 female, 15 male) aged between 9 and 17 years participated in a structured interview on the tableware used at home. Responses were standardized based on the selection of different sizes of tableware and everyday objects presented to the children. RESULTS In households of NW, larger plates and bowls were used during meals and desserts compared to OBE. OBE drank out of larger bottles. Shapes and sizes of drinkware, the number of children drinking out of bottles and the cutlery used during dessert did not differ between the groups. CONCLUSIONS Drinking out of large bottles may be an unfavourable habit of OBE if they contain sugar-rich liquids. The use of smaller plates and bowls of OBE may result in multiple helpings being consumed and so contribute to an overall increased portion size. LEVEL OF EVIDENCE Level V, Descriptive study.
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Affiliation(s)
- Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, Medical Hospital, University of Tübingen, Osianderstr. 5, 72076, Tübingen, Germany.
| | - Helene Sauer
- Department of Psychosomatic Medicine and Psychotherapy, Medical Hospital, University of Tübingen, Osianderstr. 5, 72076, Tübingen, Germany
| | - Katja Weimer
- Department of Psychosomatic Medicine and Psychotherapy, Medical Hospital, University of Tübingen, Osianderstr. 5, 72076, Tübingen, Germany
| | - Dirk Dammann
- Fachkliniken Wangen i.A., Children Rehabilitation Hospital for Respiratory Diseases, Allergies and Psychosomatics, Wangen i.A., Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Medical Hospital, University of Tübingen, Osianderstr. 5, 72076, Tübingen, Germany
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, Medical Hospital, University of Tübingen, Osianderstr. 5, 72076, Tübingen, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, Medical Hospital, University of Tübingen, Osianderstr. 5, 72076, Tübingen, Germany.,LVR-Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, Essen, Germany
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28
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Mack I, Teufel M, Enck P. What role does tableware size play in energy consumption of children and adults? Eat Weight Disord 2019; 24:595-596. [PMID: 30941662 DOI: 10.1007/s40519-019-00682-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 03/19/2019] [Indexed: 11/26/2022] Open
Affiliation(s)
- Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tübingen, Tübingen, Germany.
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tübingen, Tübingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tübingen, Tübingen, Germany
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Ziser K, Finklenburg C, Behrens SC, Giel KE, Becker S, Skoda EM, Teufel M, Mack I, Zipfel S, Junne F. Perceived Stress Mediates the Relationship of Body Image and Depressive Symptoms in Individuals With Obesity. Front Psychiatry 2019; 10:852. [PMID: 31824352 PMCID: PMC6880609 DOI: 10.3389/fpsyt.2019.00852] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/30/2019] [Indexed: 11/30/2022] Open
Abstract
Obesity is a world-wide increasing condition classified by a BMI ≥ 30 kg/m2 that is frequently accompanied by various somatic comorbidities as well as an increased risk for mental comorbidities. Studies show associations of obesity with symptoms of depression, lower quality of life, and higher (perceived) stress compared to the general population. Body image has also been shown to play an important role in eating and weight disorders. The present study therefore aims to contribute to the understanding of the relationship of body image, perceived stress, and symptoms of depression in a morbidly obese population. N = 579 individuals with obesity were included upon presentation at a university clinic. The hypothesized mediating role of perceived stress in the relationship of body image dimensions and symptoms of depression could be confirmed. The results underline the importance of identifying promising stress management techniques and addressing perceived stress e.g. through mindfulness based approaches in the (lifestyle and/or weight) interventions for obesity taking into account the specific stressors of obesity affected individuals such as body image.
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Affiliation(s)
- Katrin Ziser
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Carina Finklenburg
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Simone Claire Behrens
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Sandra Becker
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Eva-Maria Skoda
- Department of Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University Duisburg-Essen, Essen, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University Duisburg-Essen, Essen, Germany
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
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Mack I, Penders J, Cook J, Dugmore J, Mazurak N, Enck P. Is the Impact of Starvation on the Gut Microbiota Specific or Unspecific to Anorexia Nervosa? A Narrative Review Based on a Systematic Literature Search. Curr Neuropharmacol 2018; 16:1131-1149. [PMID: 29345582 PMCID: PMC6187755 DOI: 10.2174/1570159x16666180118101354] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 12/06/2017] [Accepted: 01/11/2018] [Indexed: 12/30/2022] Open
Abstract
Background: The role of the gut microbiota in Anorexia Nervosa (AN) has long been neglected by researchers, although the fact that the former is known to play an important role in health, disease and weight regulation. Cycles of over-weight and underweight due to natural states of starvation and refeeding are normal in many vertebrates in their ecological niches. Objective: The aim of this review was to compare the similarities and differences of the gut microbiota in eating disorders with conditions of fasting and refeeding in other vertebrates. Method: A systematic literature search was conducted in Pubmed and Web of Science to find all relevant studies examining the gut microbiota in eating disorders and different states of fasting in vertebrates for this narrative review. Results: Gut microbiota appears to differ in AN versus normal-weight individuals. Induced fasting conditions in other ver-tebrates resulted in heterogeneous effects on gut microbiota with respect to their richness, diversity and community struc-tures. The findings for hibernating animals were generally consistent. A decrease in microbial richness and diversity was ob-served in the hibernating animal compared to the active animal, and the community structures were linked to these conditions. Some similarities and differences between AN and different states of fasting in other vertebrates were found. Conclusion: The complexity of the relationship between fasting and gut microbiota is difficult to interprete. A deeper bio-logical understanding is necessary to identify promising approaches for the modulation of the AN gut microbiota to support established psychotherapies
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Affiliation(s)
- Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tubingen, Tubingen, Germany
| | - John Penders
- Department of Medical Microbiology, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, Netherlands
| | - Jessica Cook
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia
| | - Jaslyn Dugmore
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia
| | - Nazar Mazurak
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tubingen, Tubingen, Germany
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tubingen, Tubingen, Germany
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Weimer K, Sauer H, Horing B, Valitutti F, Mazurak N, Zipfel S, Stengel A, Enck P, Mack I. Impaired Gastric Myoelectrical Reactivity in Children and Adolescents with Obesity Compared to Normal-Weight Controls. Nutrients 2018; 10:nu10060699. [PMID: 29857470 PMCID: PMC6024785 DOI: 10.3390/nu10060699] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 05/27/2018] [Accepted: 05/29/2018] [Indexed: 12/30/2022] Open
Abstract
Obesity often has its onset in childhood and can be accompanied by various comorbidities such as functional gastrointestinal disorders and altered gastric myoelectrical activity (GMA). This study investigates whether obesity in childhood and adolescence is already associated with altered GMA, and whether an inpatient weight loss program affects GMA. Sixty children with obesity (OBE) and 27 normal-weight children (NW) (12.9 ± 1.7 years; 51% female) were compared for their GMA at rest, after a stress test, and after a drink-to-full water load test. A continuous electrogastrogram (EGG) was recorded and analyzed with respect to gastric slow waves and tachygastric activity. OBE were examined upon admission (T1) and before discharge (T2) following an inpatient weight loss program; NW served as control group. Compared to NW, children with obesity showed flattened GMA as indicated by lower tachygastric reactivity after stress and water load test at T1. Data of OBE did not differ between T1 and T2. EGG parameters were associated neither with sex, age, and BMI nor with subjective stress and food intake. Children with obesity show impaired gastric myoelectrical reactivity in response to a stress and water load test compared to normal-weight controls, which does not change during an inpatient weight loss program.
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Affiliation(s)
- Katja Weimer
- Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Ulm, 89081 Ulm, Germany.
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tübingen, 72076 Tübingen, Germany.
| | - Helene Sauer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tübingen, 72076 Tübingen, Germany.
| | - Bjoern Horing
- Institute of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
| | - Francesco Valitutti
- Pediatric Gastroenterology and Liver Unit, Department of Pediatrics, Sapienza University of Rome, 00161 Rome, Italy.
| | - Nazar Mazurak
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tübingen, 72076 Tübingen, Germany.
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tübingen, 72076 Tübingen, Germany.
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tübingen, 72076 Tübingen, Germany.
- Department for Psychosomatic Medicine, Charité Center for Internal Medicine and Dermatology, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, 12200 Berlin, Germany.
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tübingen, 72076 Tübingen, Germany.
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tübingen, 72076 Tübingen, Germany.
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Leehr E, Giel KE, Schaeffeler N, Mack I, Thiel A, Zurstiege G, Zipfel S. Where Do You Look? Visual Attention to Human Bodies across the Weight Spectrum in Individuals with Normal Weight or with Obesity. Obes Facts 2018; 11:277-286. [PMID: 29991049 PMCID: PMC6189528 DOI: 10.1159/000489787] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/02/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE We investigated how individuals with normal weight (NW) versus individuals with obesity (OB) visually explore human bodies varying in BMI. METHODS 16 OB (BMI 37.5 ± 7.7 kg/m²) and 35 NW (BMI 21.5 ± 1.6 kg/m²) visually explored 35 natural photographs and 25 avatars depicting male and female bodies ranging from normal weight to obesity. Gaze behaviour was assessed using eye tracking technology. Additionally, participants rated the attractiveness of all body stimuli. RESULTS A comparison of the displayed gaze behaviour shown by both participant weight classes indicates that regarding visual stimuli of obese natural bodies, all participants (OB + NW) looked at the waist longer, whereas regarding visual stimuli of normal-weight bodies, all participants viewed the head longer. Overall, OB spent less time looking at the bodies than NW. All participants rated normal-weight bodies as more attractive than obese bodies. However, the NW sample rated the depicted obese bodies as even less attractive than the OB sample did. CONCLUSIONS The BMI of the explored body, but not the observer's BMI, produces differences in the visual exploration of human bodies. The displayed exploration pattern of obese bodies can cautiously be interpreted as a 'de-individualised' and 'obesity-focused' perception. This tendency may prove in close relationship with the negative cultural views on obesity.
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Affiliation(s)
- Elisabeth Leehr
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- *Katrin Elisabeth Giel, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstraße 5, 72076 Tübingen, Germany,
| | - Norbert Schaeffeler
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Ansgar Thiel
- Institute of Sports Science, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Guido Zurstiege
- Institute of Media Science, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
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Mack I, Ölschläger S, Sauer H, von Feilitzsch M, Weimer K, Junne F, Peeraully R, Enck P, Zipfel S, Teufel M. Does Laparoscopic Sleeve Gastrectomy Improve Depression, Stress and Eating Behaviour? A 4-Year Follow-up Study. Obes Surg 2017; 26:2967-2973. [PMID: 27178406 DOI: 10.1007/s11695-016-2219-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is a restrictive bariatric surgery procedure and currently the second most performed technique worldwide. Follow-up data on depression, stress and eating behaviour are scarce. The aim of this longitudinal study was to investigate the medium-term effects of LSG on mental health and eating behaviour and their influence on weight loss by using a comprehensive interview-based assessment. METHODS Seventy-five individuals, who had undergone LSG at a university hospital, were included in the study. Symptoms of disordered eating were assessed using a structured clinical interview (eating disorder examination) and the Three-Factor Eating Questionnaire with depressive symptoms and stress assessed via the Patient Health Questionnaire. RESULTS Mean interval from LSG to follow-up (FU) examination was 48 ± 13.3 months. The total body weight loss was 24.2 ± 12.0 %. Depressive symptom scores improved from pre-operative to FU (9 [IQR 5-14] vs. 6 [IQR 2-10], p = 0.002) as did stress scores (8.7 ± 4.6 vs. 6.3 ± 4.7, p = 0.001). At FU, 11 % of patients reported loss-of-control eating and 39 % grazing, paralleled by increased body mass index, stress and depressive symptoms. Prior to LSG, nine patients fulfilled the diagnostic criteria of binge eating disorder but only one at FU. CONCLUSIONS Post-surgical mental health appears to be highly relevant in terms of weight loss maintenance. It is likely that the surgical outcome could be positively influenced if patients at risk of developing mental health issues or eating disorders were identified and monitored in order to offer targeted interventions.
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Affiliation(s)
- Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.
| | - Sabrina Ölschläger
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Helene Sauer
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Maximilian von Feilitzsch
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Katja Weimer
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Riyad Peeraully
- Department of Paediatric Surgery, Queen's Medical Centre, Nottingham, UK
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
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Mack I, Bayer C, Schäffeler N, Reiband N, Brölz E, Zurstiege G, Fernandez-Aranda F, Gawrilow C, Zipfel S. Chances and Limitations of Video Games in the Fight against Childhood Obesity-A Systematic Review. Eur Eat Disord Rev 2017; 25:237-267. [PMID: 28467004 DOI: 10.1002/erv.2514] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 12/18/2016] [Accepted: 02/27/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE AND METHOD A systematic literature search was conducted to assess the chances and limitations of video games to combat and prevent childhood obesity. This search included studies with video or computer games targeting nutrition, physical activity and obesity for children between 7 and 15 years of age. RESULTS The study distinguished between games that aimed to (i) improve knowledge about nutrition, eating habits and exercise; (ii) increase physical activity; or (iii) combine both approaches. Overall, the games were well accepted. On a qualitative level, most studies reported positive effects on obesity-related outcomes (improvement of weight-related parameters, physical activity or dietary behaviour/knowledge). However, the observed effects were small. The games did not address psychosocial aspects. CONCLUSIONS Using video games for weight management exclusively does not deliver satisfying results. Video games as an additional guided component of prevention and treatment programs have the potential to increase compliance and thus enhance treatment outcome. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Carolin Bayer
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Norbert Schäffeler
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Nadine Reiband
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Department of School Psychology, University of Tübingen, Tübingen, Germany
| | - Ellen Brölz
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Department of Sports Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Guido Zurstiege
- Department of Media Studies, University of Tübingen, Tübingen, Germany
| | - Fernando Fernandez-Aranda
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN, ISCIII), Barcelona, Spain
| | - Caterina Gawrilow
- Department of School Psychology, University of Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
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Tajik N, Tajik M, Mack I, Enck P. The potential effects of chlorogenic acid, the main phenolic components in coffee, on health: a comprehensive review of the literature. Eur J Nutr 2017; 56:2215-2244. [PMID: 28391515 DOI: 10.1007/s00394-017-1379-1] [Citation(s) in RCA: 368] [Impact Index Per Article: 52.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 01/10/2017] [Indexed: 02/08/2023]
Abstract
Chlorogenic acid (CGA), an important biologically active dietary polyphenol, is produced by certain plant species and is a major component of coffee. Reduction in the risk of a variety of diseases following CGA consumption has been mentioned in recent basic and clinical research studies. This systematic review discusses in vivo animal and human studies of the physiological and biochemical effects of chlorogenic acids (CGAs) on biomarkers of chronic disease. We searched PubMed, Embase, Amed and Scopus using the following search terms: ("chlorogenic acid" OR "green coffee bean extract") AND (human OR animal) (last performed on April 1st, 2015) for relevant literature on the in vivo effects of CGAs in animal and human models, including clinical trials on cardiovascular, metabolic, cancerogenic, neurological and other functions. After exclusion of editorials and letters, uncontrolled observations, duplicate and not relevant publications the remaining 94 studies have been reviewed. The biological properties of CGA in addition to its antioxidant and anti-inflammatory effects have recently been reported. It is postulated that CGA is able to exert pivotal roles on glucose and lipid metabolism regulation and on the related disorders, e.g. diabetes, cardiovascular disease (CVD), obesity, cancer, and hepatic steatosis. The wide range of potential health benefits of CGA, including its anti-diabetic, anti-carcinogenic, anti-inflammatory and anti-obesity impacts, may provide a non-pharmacological and non-invasive approach for treatment or prevention of some chronic diseases. In this study, the effects of CGAs on different aspects of health by reviewing the related literatures have been discussed.
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Affiliation(s)
- Narges Tajik
- Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Frondsbergstr 23, 72076, Tuebingen, Germany
| | - Mahboubeh Tajik
- Faculty of Physical Education and Sport Sciences, International Branch of Ferdowsi University of Mashhad, Mashhad, Iran
| | - Isabelle Mack
- Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Frondsbergstr 23, 72076, Tuebingen, Germany
| | - Paul Enck
- Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Frondsbergstr 23, 72076, Tuebingen, Germany.
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Sauer H, Ohla K, Dammann D, Teufel M, Zipfel S, Enck P, Mack I. Changes in Gustatory Function and Taste Preference Following Weight Loss. J Pediatr 2017; 182:120-126. [PMID: 27989411 DOI: 10.1016/j.jpeds.2016.11.055] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 10/05/2016] [Accepted: 11/16/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To investigate taste changes of obese children during an inpatient weight reduction treatment in comparison with normal weight children. STUDY DESIGN Obese (n = 60) and normal weight (n = 27) children aged 9-17 years were assessed for gustatory functions using taste strips (taste identification test for the taste qualities sour, salty, sweet, and bitter), taste preferences, and experienced taste sensitivity. Obese children were examined upon admission (T1) and before discharge (T2). Normal weight children served as the control group. RESULTS Irrespective of taste quality, obese children exhibited a lower ability to identify taste (total taste score) than normal weight children (P < .01); this overall score remained stable during inpatient treatment in obese children. Group and treatment effects were seen when evaluating individual taste qualities. In comparison with normal weight children, obese children exhibited poorer sour taste identification performance (P < .01). Obese children showed improvement in sour taste identification (P < .001) and deterioration in sweet taste identification (P < .001) following treatment. Subjective reports revealed a lower preference for sour taste in obese children compared with normal weight children (P < .05). The sweet and bitter taste ability at T1 predicted the body mass index z score at T2 (R2 = .23, P < .01). CONCLUSIONS We identified differences in the ability to discriminate tastes and in subjective taste perception between groups. Our findings of increased sour and reduced sweet taste discrimination after the intervention in obese children are indicative of an exposure-related effect on taste performance, possibly mediated by increased acid and reduced sugar consumption during the intervention. Because the sweet and bitter taste ability at T1 predicted weight loss, addressing gustatory function could be relevant in individualized obesity treatment approaches. TRIAL REGISTRATION Germanctr.de: DRKS00005122.
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Affiliation(s)
- Helene Sauer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tübingen, Germany
| | - Kathrin Ohla
- Psychophysiology of Food Perception, German Institute of Human Nutrition Potsdam-Rehbrücke, Potsdam-Rehbrücke, Germany
| | - Dirk Dammann
- Children Rehabilitation Hospital for Respiratory Diseases, Allergies and Psychosomatics, Wangen i.A., Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tübingen, Germany
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tübingen, Germany
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tübingen, Germany.
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Junne F, Ziser K, Giel KE, Schag K, Skoda E, Mack I, Niess A, Zipfel S, Teufel M. Determinants of Perceived Stress in Individuals with Obesity: Exploring the Relationship of Potentially Obesity-Related Factors and Perceived Stress. Obes Facts 2017; 10:127-138. [PMID: 28433993 PMCID: PMC5644933 DOI: 10.1159/000454833] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 11/23/2016] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Associations of specific types of stress with increased food intake and subsequent weight gain have been demonstrated in animal models as well as in experimental and epidemiological studies on humans. This study explores the research question of to what extent potentially obesity-related factors determine perceived stress in individuals with obesity. METHODS N = 547 individuals with obesity participated in a cross-sectional study assessing perceived stress as the outcome variable and potential determinants of stress related to obesity. Based on the available evidence, a five factorial model of 'obesity-related obesogenic stressors' was hypothesized, including the dimensions, 'drive for thinness', 'impulse regulation', 'ineffectiveness', 'social insecurity', and 'body dissatisfaction'. The model was tested using multiple linear regression analyses. RESULTS The five factorial model of 'potentially obesity-related stressors' resulted in a total variance explanation of adjusted R² = 0.616 for males and adjusted R² = 0.595 for females for perceived stress. The relative variance contribution of the five included factors differed substantially for the two sexes. CONCLUSION The findings of this cross-sectional study support the hypothesized, potentially obesity-related factors: 'drive for thinness', 'impulse regulation', 'ineffectiveness', 'social insecurity', and 'body dissatisfaction' as relevant determinants of perceived stress in individuals with obesity.
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Affiliation(s)
- Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
- *Dr. med. Florian Junne, Abteilung für Psychosomatische Medizin und Psychotherapie, Medizinische Universitätsklinik Tübingen, Osianderstraße 5, 72076 Tübingen, Germany,
| | - Katrin Ziser
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
| | - Kathrin Schag
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
| | - Eva Skoda
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
| | - Andreas Niess
- Department of Sports Medicine, Medical University Hospital Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University Duisburg-Essen, Essen, Germany
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Mölbert SC, Sauer H, Dammann D, Zipfel S, Teufel M, Junne F, Enck P, Giel KE, Mack I. Multimodal Body Representation of Obese Children and Adolescents before and after Weight-Loss Treatment in Comparison to Normal-Weight Children. PLoS One 2016; 11:e0166826. [PMID: 27875563 PMCID: PMC5119783 DOI: 10.1371/journal.pone.0166826] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 11/05/2016] [Indexed: 12/29/2022] Open
Abstract
Objective The aim of the study was to investigate whether obese children and adolescents have a disturbed body representation as compared to normal-weight participants matched for age and gender and whether their body representation changes in the course of an inpatient weight-reduction program. Methods Sixty obese (OBE) and 27 normal-weight (NW) children and adolescents (age: 9–17) were assessed for body representation using a multi-method approach. Therefore, we assessed body size estimation, tactile size estimation, heartbeat detection accuracy, and attitudes towards one’s own body. OBE were examined upon admission and before discharge of an inpatient weight-reduction program. NW served as cross-sectional control group. Results Body size estimation and heartbeat detection accuracy were similar in OBE and NW. OBE overestimated sizes in tactile size estimation and were more dissatisfied with their body as compared to NW. In OBE but not in NW, several measures of body size estimation correlated with negative body evaluation. After weight-loss treatment, OBE had improved in heartbeat detection accuracy and were less dissatisfied with their body. None of the assessed variables predicted weight-loss success. Conclusions Although OBE children and adolescents generally perceived their body size and internal status of the body accurately, weight reduction improved their heartbeat detection accuracy and body dissatisfaction.
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Affiliation(s)
- Simone Claire Mölbert
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
- Max Planck Institute for Biological Cybernetics, Tübingen, Germany
- Graduate Training Centre of Neuroscience, International Max Planck Research School, University Tübingen, Tübingen, Germany
| | - Helene Sauer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Dirk Dammann
- Fachkliniken Wangen i.A., Children Rehabilitation Hospital for Respiratory Diseases, Allergies and Psychosomatics, Wangen i.A., Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
- * E-mail:
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Schag K, Mack I, Giel KE, Ölschläger S, Skoda EM, von Feilitzsch M, Zipfel S, Teufel M. The Impact of Impulsivity on Weight Loss Four Years after Bariatric Surgery. Nutrients 2016; 8:nu8110721. [PMID: 27854246 PMCID: PMC5133107 DOI: 10.3390/nu8110721] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/03/2016] [Accepted: 11/09/2016] [Indexed: 01/01/2023] Open
Abstract
Bariatric surgery has serious implications on metabolic health. The reasons for a failure of bariatric surgery, i.e., limited weight loss, are multifactorial and include psychological factors. We established a theoretical model of how impulsivity is related to weight loss outcome. We propose that depressive symptoms act as a mediator between impulsivity and pathological eating behavior, and that pathological eating behavior has a direct impact on weight loss outcome. We calculated excessive weight loss (%EWL) and assessed self-reported impulsivity (using the Baratt Impulsiveness Scale (BIS-15) total score), depressive symptoms (the Patient Health Questionnaire (PHQ-9) score), and pathological eating behavior (the Eating Disorder Inventory 2 (EDI-2) total score) in 65 patients four years after laparoscopic sleeve gastrectomy. Regression and mediation analyses were computed to validate the theoretical model. The BIS-15, PHQ-9, and EDI-2 have medium to high correlations between each other, and EDI-2 correlated with %EWL. The mediation analysis yielded that the PHQ-9 represents a significant mediator between BIS-15 and EDI-2. The regression model between EDI-2 and %EWL was also significant. These results support our theoretical model, i.e., suggest that impulsivity has an indirect impact on weight loss outcome after bariatric surgery, mediated by depression and transferred through pathological eating behavior. Thus, the underlying psychological factors should be addressed in post-operative care to optimize weight loss outcome.
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Affiliation(s)
- Kathrin Schag
- Medical Hospital, Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, 72076 Tübingen, Germany.
| | - Isabelle Mack
- Medical Hospital, Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, 72076 Tübingen, Germany.
| | - Katrin E Giel
- Medical Hospital, Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, 72076 Tübingen, Germany.
| | - Sabrina Ölschläger
- Medical Hospital, Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, 72076 Tübingen, Germany.
| | - Eva-Maria Skoda
- Medical Hospital, Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, 72076 Tübingen, Germany.
| | - Maximilian von Feilitzsch
- Department of General, Visceral and Transplant Surgery, University of Tübingen, 72076 Tübingen, Germany.
| | - Stephan Zipfel
- Medical Hospital, Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, 72076 Tübingen, Germany.
| | - Martin Teufel
- Medical Hospital, Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, 72076 Tübingen, Germany.
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Ritze Y, Schollenberger A, Hamze Sinno M, Bühler N, Böhle M, Bárdos G, Sauer H, Mack I, Enck P, Zipfel S, Meile T, Königsrainer A, Kramer M, Bischoff SC. Gastric ghrelin, GOAT, leptin, and leptinR expression as well as peripheral serotonin are dysregulated in humans with obesity. Neurogastroenterol Motil 2016; 28:806-15. [PMID: 26787056 DOI: 10.1111/nmo.12773] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 12/19/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND Gastrointestinal hormone release and the regulation of appetite and body weight are thought to be dysbalanced in obesity. However, human data investigating the expression of gastrointestinal hormones in the obese are rare. We studied the expression of ghrelin, leptin, and the serotonergic system in stomach tissue and serum of obese and non-obese individuals. METHODS Gastric tissue and serum were collected from 29 adult obese (BMI 48.7 ± 10.6 kg/m(2) ; mean ± SD) who underwent laparoscopic sleeve gastrectomy. Gastric biopsies, surgery specimen or serum was obtained from 35 adult non-obese humans (BMI 22.7 ± 1.9 kg/m(2) ). Ghrelin, ghrelin O-acyl transferase (GOAT), leptin, leptin receptor, and tryptophan hydroxylase 1 (TPH1) mRNA expression were measured by qRT-PCR. Serotonin (5HT) and leptin protein concentration were quantified in tissue extracts and serum; GOAT and ghrelin-positive cells were immunohistologically quantified in tissue. Additionally, 21 blood immune markers were analyzed. KEY RESULTS In gastric tissue, GOAT-positive cells were reduced (p < 0.01), but ghrelin-positive cells and mRNA were increased (both p < 0.05) in obese compared with non-obese individuals. Gastric leptin (p < 0.001) and leptin receptor (p < 0.001) mRNA expression, as well as leptin concentrations in serum (p < 0.001), were increased in obese compared with non-obese individuals. Serum 5HT was reduced (p < 0.05), while tissue 5HT and TPH1 mRNA were reduced only by trend. Interleukin 1 receptor a (IL1Ra), IL-8, IL-12, and monocyte chemoattractant protein 1 (IL1Ra) were increased and IL1Ra correlated negatively with serum leptin. CONCLUSIONS & INFERENCES Our data indicate that obesity causes a dysregulation of gastrointestinal hormones at the tissue level and serum, including a negative correlation with an increased marker of subclinical inflammation.
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Affiliation(s)
- Y Ritze
- Department of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany.,Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - A Schollenberger
- Department of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany
| | - M Hamze Sinno
- Department of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany
| | - N Bühler
- Department of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany
| | - M Böhle
- Department of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany
| | - G Bárdos
- Department of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany
| | - H Sauer
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - I Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - P Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - S Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - T Meile
- Department of General and Transplant Surgery and Comprehensive Cancer Center, University of Tübingen, Tübingen, Germany
| | - A Königsrainer
- Department of General and Transplant Surgery and Comprehensive Cancer Center, University of Tübingen, Tübingen, Germany
| | - M Kramer
- Arabella Clinic, München, Germany
| | - S C Bischoff
- Department of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany
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Mack I, Cuntz U, Grämer C, Niedermaier S, Pohl C, Schwiertz A, Zimmermann K, Zipfel S, Enck P, Penders J. Weight gain in anorexia nervosa does not ameliorate the faecal microbiota, branched chain fatty acid profiles, and gastrointestinal complaints. Sci Rep 2016; 6:26752. [PMID: 27229737 PMCID: PMC4882621 DOI: 10.1038/srep26752] [Citation(s) in RCA: 192] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 05/09/2016] [Indexed: 02/07/2023] Open
Abstract
The gut microbiota not only influences host metabolism but can also affect brain function and behaviour through the microbiota-gut-brain axis. To explore the potential role of the intestinal microbiota in anorexia nervosa (AN), we comprehensively investigated the faecal microbiota and short-chain fatty acids in these patients before (n = 55) and after weight gain (n = 44) in comparison to normal-weight participants (NW, n = 55) along with dietary intake and gastrointestinal complaints. We show profound microbial perturbations in AN patients as compared to NW participants, with higher levels of mucin-degraders and members of Clostridium clusters I, XI and XVIII and reduced levels of the butyrate-producing Roseburia spp. Branched-chain fatty acid concentrations, being markers for protein fermentation, were elevated. Distinct perturbations in microbial community compositions were observed for individual restrictive and binge/purging AN-subtypes. Upon weight gain, microbial richness increased, however perturbations in intestinal microbiota and short chain fatty acid profiles in addition to several gastrointestinal symptoms did not recover. These insights provide new leads to modulate the intestinal microbiota in order to improve the outcomes of the standard therapy.
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Affiliation(s)
- Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Ulrich Cuntz
- Klinik Roseneck, Center for Behavioral Medicine, Prien, Germany
| | - Claudia Grämer
- Klinik Roseneck, Center for Behavioral Medicine, Prien, Germany
| | | | - Charlotte Pohl
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | | | | | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - John Penders
- Maastricht University Medical Center, NUTRIM School for Nutrition and Translational Research in Metabolism, Department of Medical Microbiology, Maastricht, The Netherlands
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Mazurak N, Sauer H, Weimer K, Dammann D, Zipfel S, Horing B, Muth ER, Teufel M, Enck P, Mack I. Effect of a weight reduction program on baseline and stress-induced heart rate variability in children with obesity. Obesity (Silver Spring) 2016; 24:439-45. [PMID: 26704529 DOI: 10.1002/oby.21355] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 08/31/2015] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Autonomic dysregulation is a well-established feature in adults with obesity but not in children. Since this dysregulation could contribute to weight dynamics, this study aimed to compare autonomic regulation in children with obesity and normal-weight peers and to track autonomic status during weight reduction. METHODS Sixty children with obesity and 27 age- and sex-matched normal-weight healthy participants were included. Heart rate variability (HRV) was assessed at baseline and during a mental stress test and a subsequent recovery period. Children with obesity were investigated both upon admission and discharge. RESULTS Upon admission, no significant differences in HRV parameters were found for normal-weight participants and those with obesity. Inpatient treatment led to significant changes in HRV with increase in general variability (standard deviation of the normal-to-normal interval (SDNN), P < 0.001) as well as of parasympathetic regulation (root mean square successive difference (RMSSD) and high frequency power (logHF), P < 0.01). Children with obesity had sympathetic activation similar to normal-weight controls during mental stress with subsequent return to baseline values, and weight loss did not affect this profile. CONCLUSIONS A weight reduction program induced a change in autonomic activity in children with obesity toward parasympathetic dominance but had no influence on autonomic nervous system reactivity during stress conditions.
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Affiliation(s)
- Nazar Mazurak
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
- SymbioGruppe GmbH, Herborn, Germany
| | - Helene Sauer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Katja Weimer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Dirk Dammann
- Fachkliniken Wangen I.A., Children Rehabilitation Hospital for Respiratory Diseases, Allergies and Psychosomatics, Wangen I.A., Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Björn Horing
- Department of Psychology, Clemson University, Clemson, South Carolina, USA
| | - Eric R Muth
- Department of Psychology, Clemson University, Clemson, South Carolina, USA
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
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Rapps N, Mack I, Herrmann-Werner A, Zipfel S, Teufel M. Die Angst vor der Aminosäure: Atypische Essstörung bei angeborenem Enzymdefekt – Fall 2 / 2015. Dtsch Med Wochenschr 2015; 140:1077. [DOI: 10.1055/s-0041-103315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Nora Rapps
- Abteilung für Psychosomatische Medizin und Psychotherapie, Medizinische Universitätsklinik Tübingen
| | - Isabelle Mack
- Abteilung für Psychosomatische Medizin und Psychotherapie, Medizinische Universitätsklinik Tübingen
| | - Anne Herrmann-Werner
- Abteilung für Psychosomatische Medizin und Psychotherapie, Medizinische Universitätsklinik Tübingen
| | - Stephan Zipfel
- Abteilung für Psychosomatische Medizin und Psychotherapie, Medizinische Universitätsklinik Tübingen
| | - Martin Teufel
- Abteilung für Psychosomatische Medizin und Psychotherapie, Medizinische Universitätsklinik Tübingen
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Wild B, Hünnemeyer K, Sauer H, Hain B, Mack I, Schellberg D, Müller-Stich BP, Weiner R, Meile T, Rudofsky G, Königsrainer A, Zipfel S, Herzog W, Teufel M. A 1-year videoconferencing-based psychoeducational group intervention following bariatric surgery: results of a randomized controlled study. Surg Obes Relat Dis 2015; 11:1349-60. [PMID: 26421929 DOI: 10.1016/j.soard.2015.05.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 04/30/2015] [Accepted: 05/28/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND For severely obese patients, bariatric surgery has been recommended as an effective therapy. OBJECTIVES The Bariataric Surgery and Education (BaSE) study aimed to assess the efficacy of a videoconferencing-based psychoeducational group intervention in patients after bariatric surgery. SETTING The BaSE study is a randomized, controlled multicenter clinical trial involving 117 patients undergoing bariatric surgery (mean preoperative body mass index [BMI] 49.9 kg/m(2), SD 6.4). Patients were enrolled between May 2009 and November 2012 and were randomly assigned to receive either conventional postsurgical visits or, in addition, a videoconferencing-based 1-year group program. METHODS Primary outcome measures were weight in kilograms, health-related quality of life (HRQOL), and general self-efficacy (GSE). Secondary outcome measures were depression symptoms and eating behavior. RESULTS 94% of the patients completed the study. Mean weight loss for all patients was 45.9 kg (SD 16.4) 1 year after surgery (mean excess weight loss [EWL] 63%). Intention-to-treat analyses revealed no differences in weight loss, EWL, HRQOL, or self-efficacy between study groups at 1 year after surgery. However, patients with clinically significant depression symptoms (CSD) at baseline assigned to the intervention group (n = 29) had a significantly better HRQOL (P = .03), lower depression scores (P = .02), and a trend for a better EWL (.06) 1 year after surgery compared with the control group (n = 20). CONCLUSION We could not prove the efficacy of the group program for the whole study sample. However, results indicate that the intervention is effective for the important subgroup of patients with CSD.
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Affiliation(s)
- Beate Wild
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany.
| | - Katharina Hünnemeyer
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Helene Sauer
- Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Bernhard Hain
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Dieter Schellberg
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Beat Peter Müller-Stich
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Rudolf Weiner
- Department of Surgery, Hospital Sachsenhausen, Heidelberg, Frankfurt
| | - Tobias Meile
- Department of General, Visceral and Transplant Surgery, University of Tübingen, Tübingen, Germany
| | - Gottfried Rudofsky
- Department of Medicine I and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany
| | - Alfred Königsrainer
- Department of General, Visceral and Transplant Surgery, University of Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, Tübingen, Germany
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Mack I, Sauer H, Weimer K, Dammann D, Zipfel S, Enck P, Teufel M. Obese children and adolescents need increased gastric volumes in order to perceive satiety. Obesity (Silver Spring) 2014; 22:2123-5. [PMID: 25070787 DOI: 10.1002/oby.20850] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 06/15/2014] [Accepted: 07/11/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVE In order to develop effective weight management strategies, it is important to identify factors that influence energy intake. Portion size has been discussed as one such factor. To date, most studies focusing on the relationship between portion size, energy intake, and weight have analyzed questionnaire data and 24-h records. In this study, we assessed the onset of satiety using the water-load test in normal-weight and obese children and adolescents. METHODS 60 obese and 27 normal-weight children and adolescents aged between 9 and 17 years participated in the water load test which involved drinking water for 3 min or until feeling full. The amount of water consumed was recorded. RESULTS Obese children and adolescents drank 20% more water until the onset of satiety when compared with normal-weight participants (478 ± 222 ml vs. 385 ± 115 ml, P < 0.05). CONCLUSIONS Obese children and adolescents need to ingest greater volumes to feel full which may predispose toward the consumption of larger portion sizes. This may easily lead to overeating if predominantly energy-dense foods are consumed. A reduction in energy-dense foods in the diet of obese children and adolescents appears to be a necessary strategy for managing body weight.
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Affiliation(s)
- Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
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Enck P, Rieber N, Sauer H, Klosterhalfen S, Mack I, Zipfel S, Teufel M. Almost Nothing - Not Even Bariatric Surgery for Obesity - Changes Olfactory Sensitivity. ACTA ACUST UNITED AC 2014. [DOI: 10.5171/2014.491890] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Sauer H, Krumm A, Weimer K, Horing B, Mazurak N, Gulewitsch MD, Hellmond F, Dammann D, Binder W, Linse P, Zipfel S, Ehehalt S, Binder G, Demircioglu A, Muth ER, Enck P, Mack I. PreDictor Research in Obesity during Medical care - weight Loss in children and adolescents during an INpatient rehabilitation: rationale and design of the DROMLIN study. J Eat Disord 2014; 2:7. [PMID: 24764531 PMCID: PMC3984741 DOI: 10.1186/2050-2974-2-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 02/25/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Obesity in adults and children is increasing worldwide at alarming rates. Obese children and adolescents are likely to become obese adults with increased risk of a number of comorbidities. In addition to preventing the development of obesity at young age, it is necessary to individualize the therapy of already obese children and adolescents in order to increase the likelihood of weight loss and maintenance. Therefore, the aim of this study is to identify predictors which play a significant role in successful weight loss and weight loss maintenance in children and adolescents. METHODS/DESIGN Over a one year period, 60 obese children and adolescents between 9 to 17 years of age shall be recruited at an inpatient children rehabilitation facility in Germany. They will be investigated twice within a few days following admission and prior to discharge. The study will be an integrated component of an established inpatient weight-loss and in part psychosomatic therapy. The collected data can be grouped into four clusters: 1) demographic, sociometric and psychometric data, 2) objective and subjective parameters of body condition, 3) autonomic nervous system regulated functions and 4) objective and subjective parameters for eating behavior. Primary outcome is the change of the body mass index standard deviation score (BMI-SDS). In order to evaluate the data appropriately, all examinations will be also conducted in a normal-weight reference group, matched for age and gender. DISCUSSION For some of the collected parameters the time span between measures may be too short. Therefore, a 6 months, 1 year and 2 year follow-up will be performed for evaluating the different predictors and their influence in regard to a successful intervention. Further middle- and long-term follow-up studies are planned. TRIAL REGISTRATION The study protocol was approved by the Ethics Committee of the University Hospital Tübingen, Germany. This study is registered at the German Clinical Trials Register (DRKS) with the clinical trial number DRKS00005122.
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Affiliation(s)
- Helene Sauer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Anna Krumm
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Katja Weimer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Björn Horing
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Nazar Mazurak
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Marco D Gulewitsch
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Frank Hellmond
- Fachkliniken Wangen i.A., Children Rehabilitation Hospital for Respiratory Diseases, Allergies and Psychosomatics, Wangen i.A., Germany
| | - Dirk Dammann
- Fachkliniken Wangen i.A., Children Rehabilitation Hospital for Respiratory Diseases, Allergies and Psychosomatics, Wangen i.A., Germany
| | - Walter Binder
- Fachkliniken Wangen i.A., Children Rehabilitation Hospital for Respiratory Diseases, Allergies and Psychosomatics, Wangen i.A., Germany
| | - Peter Linse
- Fachkliniken Wangen i.A., Children Rehabilitation Hospital for Respiratory Diseases, Allergies and Psychosomatics, Wangen i.A., Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Stefan Ehehalt
- Public Health Department of Stuttgart, Department of Pediatrics, Dental Health Care, Health Promotion and Social Services, Stuttgart, Germany
| | - Gerhard Binder
- Department of Pediatric Endocrinology and Diabetology, University Children's Hospital, Tübingen, Germany
| | - Aydin Demircioglu
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Eric R Muth
- Department of Psychology, Clemson University, Clemson, South Carolina, USA
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, Medical Hospital, Frondsbergstrasse 23, 72070 Tübingen, Germany
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Zipfel S, Mack I, Baur LA, Hebebrand J, Touyz S, Herzog W, Abraham S, Davies PSW, Russell J. Impact of exercise on energy metabolism in anorexia nervosa. J Eat Disord 2013; 1:37. [PMID: 24499685 PMCID: PMC4081773 DOI: 10.1186/2050-2974-1-37] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 08/27/2013] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Excessive physical activity is one of the most paradoxical features of anorexia nervosa (AN). However, there is individual variation in the degree of physical activity found in AN-patients. As a result, marked differences in energy expenditure may be expected. Furthermore, exercise has a positive impact on a variety of psychological disorders and the psychopathology may be different in AN displaying high exercise levels versus AN displaying low exercise levels. We analyzed the energy metabolism and psychological data in low-level exercise and high-level exercise AN-patients compared with healthy, age matched controls. RESULTS REE was decreased in AN-patients compared with controls but not when adjusted for body surface area or lean body mass. No differences in TDEE between AN- patients and controls were observed. Subgroup analyses showed that the percentage of high-level AN- exercisers was higher compared with controls. This subgroup had increased resting EE, total daily EE and scored higher on depression and the EDI-item "Drive for thinness" compared with low-level AN-exercisers. CONCLUSIONS We identified a significant subgroup of high-level AN-exercisers (66%) with consecutive increased energy requirements. An easy way for clinicians to assess the amount of exercise before and in the course of treatment is a single question in the established Eating Disorder Inventory-SC (EDI-SC).
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Affiliation(s)
- Stephan Zipfel
- Department of Psychosomatic Medicine & Psychotherapy, University Medical Hospital Tuebingen, Osianderstr. 5, 72074 Tuebingen, Germany
- Department of Psychological Medicine, University of Sydney, Sydney, Australia
| | - Isabelle Mack
- Department of Psychosomatic Medicine & Psychotherapy, University Medical Hospital Tuebingen, Osianderstr. 5, 72074 Tuebingen, Germany
| | - Louise A Baur
- Department of Paediatrics & Child Health, University of Sydney, Sydney, Australia
| | - Johannes Hebebrand
- Department of Child & Adolescent Psychiatry, Univ. of Essen, Essen, Germany
| | - Stephen Touyz
- Department of Psychological Medicine, University of Sydney, Sydney, Australia
- School of Psychology and Discipline of Psychiatry, University of Sydney, Sydney, Australia
| | - Wolfgang Herzog
- Department of General Internal and Psychosomatic Medicine, University of Heidelberg, Heidelberg, Germany
| | - Suzanne Abraham
- Department of Obstetrics & Gynaecology, University of Sydney, Sydney, Australia
- Eating Disorders Unit, Northside Clinic, Greenwich NSW 2065, Australia
| | - Peter SW Davies
- Children’s Nutrition Research Centre, School of Medicine, University of Queensland, Brisbane, Australia
| | - Janice Russell
- Department of Psychological Medicine, University of Sydney, Sydney, Australia
- Eating Disorders Unit, Northside Clinic, Greenwich NSW 2065, Australia
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49
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Mack I, BelAiba RS, Djordjevic T, Görlach A, Hauner H, Bader BL. Functional analyses reveal the greater potency of preadipocytes compared with adipocytes as endothelial cell activator under normoxia, hypoxia, and TNFalpha exposure. Am J Physiol Endocrinol Metab 2009; 297:E735-48. [PMID: 19549791 DOI: 10.1152/ajpendo.90851.2008] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Obesity is associated with a state of chronic low-grade inflammation. Immune cells accumulate in white adipose tissue (WAT). The vascular endothelium plays an interactive role in these infiltration and inflammatory processes. Mature and hypertrophic adipocytes are considered as the major adipogenic cell type secreting proinflammatory cytokines in WAT. In contrast, the proinflammatory capacity of preadipocytes and their role in endothelial cell activation have been neglected so far. To gain new insights into this molecular and cellular cross-talk, we examined the proinflammatory expression and secretion of normoxia, hypoxia, and TNFalpha-treated human preadipocytes and adipocytes (SGBS cells) and their impact on human microvascular endothelial cell (HMEC-1) function. In this study, stimulation of HMEC-1 with conditioned media (CM) from preadipocytes increased endothelial ICAM-1 expression and monocyte adhesion but not adipocyte-CM. After hypoxia and TNFalpha stimulation of SGBS cells, adipocyte-CM induced and preadipocyte-CM enhanced the monocyte adhesion. Concordantly, the expression of proinflammatory adipokines was considerably higher in preadipocytes than in adipocytes. SGBS-CM upregulated the phosphorylation of three MAPK pathways, STAT1/3, and c-Jun in HMEC-1, whereas the NF-kappaB pathway was not affected. Inhibitor experiments showed that monocyte/endothelial cell-cell adhesion and endothelial ICAM-1 expression was JNK and JAK-1/STAT1/3 pathway dependent and revealed IL-6 as a major mediator in CM increasing monocyte/endothelial cell-cell adhesion via the STAT1/3 pathway. Our study shows that preadipocytes rather than adipocytes operate as potent activators of endothelial cells. This can be enhanced in preadipocytes and induced in adipocytes by TNFalpha and hypoxia in a manner similar to what may occur in WAT in the etiology of obesity.
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Affiliation(s)
- Isabelle Mack
- Dept. of Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, Technische Universität München, D-85350 Freising Weihenstephan, Germany
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50
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Skurk T, Mack I, Kempf K, Kolb H, Hauner H, Herder C. Expression and secretion of RANTES (CCL5) in human adipocytes in response to immunological stimuli and hypoxia. Horm Metab Res 2009; 41:183-9. [PMID: 18956302 DOI: 10.1055/s-0028-1093345] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Obesity and related disorders represent states of systemic low-grade inflammation. Chemokine secretion by adipocytes may initiate leukocyte infiltration in obese adipose tissue and thus mediate an important step in the establishment of chronic immune activation. The chemokine RANTES (regulated upon activation normal T cell expressed and secreted)/CCL5 is a chemoattractant for various leukocyte subsets. This study was designed to examine whether RANTES is expressed and released by human adipocytes and how its expression is regulated. RANTES expression under basal conditions was studied in mature adipocytes. Cells were therefore challenged with lipopolysaccharide (LPS), interferon (IFN)-gamma, interleukin (IL)-4, monocyte chemoattractant protein (MCP)-1 or exposed to low oxygen pressure. RANTES was expressed and secreted constitutively in most samples of mature adipocytes from the omental and the subcutaneous depot. RANTES release was dependent on adipocyte size and also seemed to be higher from cells of obese donors. Hypoxia (4% O (2)) caused an approximately 36% increase of RANTES release. Human adipocytes express the chemokine RANTES and are thus identified as a novel cellular source of this immune mediator. LPS and IFNgamma do not seem to play a significant role for the expression of RANTES in contrast to moderate hypoxia, which points to a distinct role in the innate immune system.
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Affiliation(s)
- T Skurk
- Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Technische Universität München, Freising, Germany.
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