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Stanford D, Dinh MM, Eastwood JG, Korczak V, Seimon RV, Moore C, Liu H, Bein KJ. Clinical and longitudinal patterns of frequent presenters to emergency departments: A multi-centre data linkage analysis. Emerg Med Australas 2024; 36:277-282. [PMID: 38172087 DOI: 10.1111/1742-6723.14349] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/21/2023] [Accepted: 11/04/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE To describe clinical characteristics and longitudinal patterns of representation in a cohort of patients who frequently present to EDs for care. METHODS A retrospective data analysis linking routinely collected ED data across three hospitals. The study population consisted of patients who presented to any ED on 10 or more occasions in any continuous 365-day period from 1 July 2015 to 30 June 2021. Presenting complaints were divided into those with any mental health, drug and alcohol, or social presentations (MHDAS group) and those without (non-MHDAS group). Outcomes of interest were number of presentations as well as temporal and facility clustering of presentations. A per patient regression analysis was performed to identify independent risk factors for increased presentations. RESULTS Presentations by 1640 frequent ED presenters in the study constituted 4.6% of total ED presentations. MHDAS study group were younger, predominantly English speaking, twice as likely to be married, had lower hospital admission rates and almost three times as many of them did not wait for treatment. Statistically significant differences were also found between these groups regarding presentation clustering, facility entropy, each of the four categories of the number of ED presentations, and Index of Relative Socio-Economic Advantage and Disadvantage. CONCLUSION Representations associated with MHDAS have a different trajectory of representation episodes compared to non-MHDAS group. Escalating number of presentations and clustering are important predictors of future representation numbers. Those 'did not waits' who appear to be representing would be the highest risk of ongoing and persistent representations in the future and should be the target of early interventions to ensure they are accessing appropriate care before this happens.
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Affiliation(s)
- Dorota Stanford
- Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Michael M Dinh
- Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
- RPA Green Light Institute for Emergency Care, Sydney Local Health District, Sydney, New South Wales, Australia
| | - John G Eastwood
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, Australia
| | - Viola Korczak
- Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Radhika V Seimon
- RPA Green Light Institute for Emergency Care, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Corey Moore
- Public Health Unit, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Hueiming Liu
- Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Kendall J Bein
- Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
- RPA Green Light Institute for Emergency Care, Sydney Local Health District, Sydney, New South Wales, Australia
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Berendsen Russell S, Seimon RV, Dixon E, Murphy M, Vukasovic M, Bohlken N, Taylor S, Cooper Z, Scruton J, Jain N, Dinh MM. Applying Sydney Triage to Admission Risk Tool (START) to improve patient flow in emergency departments: a multicentre randomised, implementation study. BMC Emerg Med 2024; 24:39. [PMID: 38454324 PMCID: PMC10921805 DOI: 10.1186/s12873-024-00956-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/26/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND To determine the effectiveness of applying the Sydney Triage to Admission Risk Tool (START) in conjunction with senior early assessment in different Emergency Departments (EDs). METHODS This multicentre implementation study, conducted in two metropolitan EDs, used a convenience sample of ED patients. Patients who were admitted, after presenting to both EDs, and were assessed using the existing senior ED clinician assessment, were included in the study. Patients in the intervention group were assessed with the assistance of START, while patients in the control group were assessed without the assistance of START. Outcomes measured were ED length of stay and proportion of patients correctly identified as an in-patient admission by START. RESULTS A total of 773 patients were evaluated using the START tool at triage across both sites (Intervention group n = 355 and control group n = 418 patients). The proportion of patients meeting the 4-hour length of stay thresholds was similar between the intervention and control groups (30.1% vs. 28.2%; p = 0.62). The intervention group was associated with a reduced ED length of stay when compared to the control group (351 min, interquartile range (IQR) 221.0-565.0 min versus 383 min, IQR 229.25-580.0 min; p = 0.85). When stratified into admitted and discharged patients, similar results were seen. CONCLUSION In this extension of the START model of care implementation study in two metropolitan EDs, START, when used in conjunction with senior early assessment was associated with some reduced ED length of stay.
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Affiliation(s)
- Saartje Berendsen Russell
- Emergency Department, RPA Green Light Institute, Royal Prince Alfred Hospital, Missenden Road, 2050, Camperdown, NSW, Australia.
| | - Radhika V Seimon
- Emergency Department, RPA Green Light Institute, Royal Prince Alfred Hospital, Missenden Road, 2050, Camperdown, NSW, Australia
| | - Emma Dixon
- Emergency Department, Westmead Hospital, Westmead, NSW, Australia
| | - Margaret Murphy
- Emergency Department, Westmead Hospital, Westmead, NSW, Australia
| | | | - Nicole Bohlken
- Emergency Department, Westmead Hospital, Westmead, NSW, Australia
| | - Sharon Taylor
- Emergency Department, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Zoe Cooper
- Emergency Department, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Jennifer Scruton
- Emergency Department, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Nitin Jain
- Emergency Department, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Michael M Dinh
- Emergency Department, RPA Green Light Institute, Royal Prince Alfred Hospital, Missenden Road, 2050, Camperdown, NSW, Australia
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Curtis K, Dinh MM, Shetty A, Kourouche S, Fry M, Considine J, Li L, Lung T, Shaw T, Lam MK, Murphy M, Alkhouri H, Aggar C, Russell SB, Seimon RV, Hughes JA, Varndell W, Shaban RZ. The Emergency nurse Protocols Initiating Care-Sydney Triage to Admission Risk Tool (EPIC-START) trial: protocol for a stepped wedge implementation trial. Implement Sci Commun 2023; 4:70. [PMID: 37340486 DOI: 10.1186/s43058-023-00452-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 06/04/2023] [Indexed: 06/22/2023] Open
Abstract
INTRODUCTION Emergency department (ED) overcrowding is a global problem and a threat to the quality and safety of emergency care. Providing timely and safe emergency care therein is challenging. To address this in New South Wales (NSW), Australia, the Emergency nurse Protocol Initiating Care-Sydney Triage to Admission Risk Tool (EPIC-START) was developed. EPIC-START is a model of care incorporating EPIC protocols, the START patient admission prediction tool, and a clinical deterioration tool to support ED flow, timely care, and patient safety. The aim of this study is to evaluate the impact of EPIC-START implementation across 30 EDs on patient, implementation, and health service outcomes. METHODS AND ANALYSIS This study protocol adopts an effectiveness-implementation hybrid design (Med Care 50: 217-226, 2012) and uses a stepped-wedge cluster randomised control trial of EPIC-START, including uptake and sustainability, within 30 EDs across four NSW local health districts spanning rural, regional, and metropolitan settings. Each cluster will be randomised independently of the research team to 1 of 4 dates until all EDs have been exposed to the intervention. Quantitative and qualitative evaluations will be conducted on data from medical records and routinely collected data, and patient, nursing, and medical staff pre- and post-surveys. ETHICS AND DISSEMINATION Ethical approval for the research was received from the Sydney Local Health District Research Ethics Committee (Reference Number 2022/ETH01940) on 14 December 2022. TRIAL REGISTRATION Australian and New Zealand Clinical trial, ACTRN12622001480774p. Registered on 27 October 2022.
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Affiliation(s)
- Kate Curtis
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, NSW, Australia.
- Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Crown St, Wollongong, NSW, Australia.
| | - Michael M Dinh
- New South Wales Institute of Trauma and Injury Management, Chatswood, Australia
- Sydney Medical School, The University of Sydney, Camperdown, Australia
- RPA Green Light Institute for Emergency Care, Sydney Local Health District, Camperdown, Australia
| | - Amith Shetty
- System Sustainability and Performance, NSW Ministry of Health, St Leonards, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Sarah Kourouche
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, NSW, Australia
| | - Margaret Fry
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, NSW, Australia
- Sydney Faculty of Health, University of Technology, Ultimo, NSW, Australia
- Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Julie Considine
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Experience in the Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, VIC, Australia
| | - Ling Li
- Macquarie University, Sydney, Australia
| | - Thomas Lung
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Timothy Shaw
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Mary K Lam
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Margaret Murphy
- Western Sydney Local Health District, North Parramatta, NSW, 2145, Australia
| | - Hatem Alkhouri
- Agency for Clinical Innovation, NSW Emergency Care Institute, St Leonards, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Christina Aggar
- Nothern NSW Local Health District, Southern Cross University, Lismore, Australia
| | | | - Radhika V Seimon
- RPA Green Light Institute for Emergency Care, Sydney Local Health District, Camperdown, Australia
| | - James A Hughes
- School of Nursing, Centre for Healthcare Transformation, Brisbane, QUT, Australia
| | - Wayne Varndell
- Prince of Wales Hospital Emergency Department, Randwick, Australia
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
- College of Emergency Nursing Australasia (CENA), Hobart, Australia
| | - Ramon Z Shaban
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, NSW, Australia
- Faculty of Medicine and Health, Sydney Institute for Infectious Diseases, The University of Sydney, Camperdown, NSW, 2006, Australia
- Communicable Diseases Branch, Public Health Unit, Centre for Population Health, Western Sydney Local Health District, North Parramatta, NSW, 2141, Australia
- New South Wales Biocontainment Centre, Western Sydney Local Health District and New South Wales Health, Westmead, NSW, 2145, Australia
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Dinh MM, Bein KJ, Alkhouri H, Ní Bhraonáin S, Seimon RV. 24 hours - Life in the E.R.: A state-wide data linkage analysis of in-patients with prolonged emergency department length of stay in New South Wales, Australia. Emerg Med Australas 2023. [PMID: 36854419 DOI: 10.1111/1742-6723.14183] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/22/2022] [Accepted: 01/29/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVE Describe the characteristics and predictors of mortality for patients who spend more than 24 h in the ED waiting for an in-patient bed and compare baseline clinical and demographic characteristics between tertiary and non-tertiary hospitals. METHODS This was a state-wide analysis data linkage analysis of adult (age >16 years) ED presentations across New South Wales from 2019 to 2020. Cases were included if their mode of separation from ED indicated admission to an in-patient unit including critical care ward and their ED length of stay was greater than or equal to 24 h. Cases were categorised by service-related groups based on principle diagnosis. RESULTS A total of 26 854 eligible cases were identified. The most common diagnosis groups were psychiatry, cardiology and respiratory. The odds ratio (OR) for 30-day all-cause mortality in admitted patients with an ED length of stay greater than 24 h were highest in those aged >75 years (OR 15.18, 95% confidence interval [CI] 9.99-23.07, P < 0.001), oncology (OR 10.45, 95% CI 7.93-13.77, P < 0.001) and haematology patients (OR 2.95, 95% CI 2.01-4.33, P < 0.001). CONCLUSION Interventions and models of care to address ED access block need to focus on mental health patients, older patients particularly those with cardiorespiratory illness and oncology and haematology patients for whom risk of mortality is disproportionately higher.
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Affiliation(s)
- Michael M Dinh
- Sydney Local Health District, RPA Green Light Institute for Emergency Care, Sydney, New South Wales, Australia
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Kendall J Bein
- Sydney Local Health District, RPA Green Light Institute for Emergency Care, Sydney, New South Wales, Australia
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Hatem Alkhouri
- Emergency Care Institute, Agency for Clinical Innovation, Sydney, New South Wales, Australia
- Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Sinéad Ní Bhraonáin
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Radhika V Seimon
- Sydney Local Health District, RPA Green Light Institute for Emergency Care, Sydney, New South Wales, Australia
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Harris RA, Fernando HA, Seimon RV, da Luz FQ, Gibson AA, Touyz SW, Sainsbury A. Effects of total diet replacement programs on mental well-being: A systematic review with meta-analyses. Obes Rev 2022; 23:e13465. [PMID: 35997170 PMCID: PMC9786773 DOI: 10.1111/obr.13465] [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: 12/26/2021] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 12/30/2022]
Abstract
This systematic review with meta-analyses assessed the effects of total diet replacement (TDR) programs on mental well-being in clinical trial participants with a body mass index greater than or equal to 25 kg/m2 . TDR programs involve replacing all dietary requirements with nutritionally replete formula foods and are generally administered to induce rapid weight loss. To date, it is largely unclear what effects TDR programs may have on mental well-being, particularly in the long-term. To address this, we screened 25,976 references across six databases and extracted 35 publications. These 35 publications provided sufficient data to evaluate the effects of TDR programs on depression, anxiety, stress, positive affect, negative affect, vitality, role-emotional, social functioning, mental health, mental composite summary score, self-esteem, and general psychological health in 24 meta-analyses. Due to the lack of research comparing TDR programs to comparator groups, 22 of our 24 meta-analyses explored change in these mental well-being sub-domains over time in TDR programs without comparators. Specifically, we assessed the change from pre-diet (before the TDR program) to either post-diet (up to and including two months after the TDR program); and/or follow-up (more than two months after the TDR program). For depression and anxiety, we were also able to assess the change from pre-diet to mid-diet (which fell within two weeks of the diet half-way point). The remaining two meta-analyses assessed the difference in depression scores between a TDR group and a food-based comparator group from pre-diet to post-diet and from pre-diet to follow-up. Across all meta-analyses, our results found no marked adverse effects of TDR programs on any mental well-being sub-domain. In fact, clear improvements were observed for depression, anxiety, stress, vitality, role-emotional, and social functioning at post-diet. Interestingly, the improvements for depression, vitality and role-emotional were maintained at follow-up. All improvements were observed in meta-analyses without comparators. While the two comparator-based meta-analyses showed no difference between TDR programs and food-based diets in depression symptoms, there was low statistical power. For all meta-analyses containing three or more independent samples, we constructed prediction intervals to determine the range within which the mean of the true effects may fall for future populations. While these prediction intervals varied between sub-domains, we found that mean depression scores are only likely to increase (i.e., depression will worsen) in less than 3% of future TDR interventions which meet our inclusion/exclusion criteria. Taken together, we concluded that for adults with a body mass index greater than or equal to 25 kg/m2 , TDR programs are unlikely to lead to marked adverse effects on mental well-being. These findings do not support the exclusion of participants from trials or interventions involving TDR programs based on concerns that these programs may adversely affect mental well-being. In fact, by excluding these participants, they may be prevented from improving their metabolic health and mental well-being.
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Affiliation(s)
- Rebecca A Harris
- Faculty of Medicine and Health, Charles Perkins Centre, Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Camperdown, New South Wales, Australia.,School of Human Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Hamish A Fernando
- Faculty of Medicine and Health, Charles Perkins Centre, Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Camperdown, New South Wales, Australia.,School of Biomedical Engineering, Faculty of Engineering, The University of Sydney, Darlington, New South Wales, Australia
| | - Radhika V Seimon
- Faculty of Medicine and Health, Charles Perkins Centre, Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Camperdown, New South Wales, Australia
| | - Felipe Q da Luz
- Faculty of Medicine and Health, Charles Perkins Centre, Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Camperdown, New South Wales, Australia.,Faculty of Medicine, Institute of Psychiatry, Eating Disorders Program (AMBULIM), University of São Paulo, São Paulo, Brazil
| | - Alice A Gibson
- Faculty of Medicine and Health, Charles Perkins Centre, Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Camperdown, New South Wales, Australia.,Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Stephen W Touyz
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, New South Wales, Australia
| | - Amanda Sainsbury
- School of Human Sciences, The University of Western Australia, Crawley, Western Australia, Australia
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Seimon RV, Natasha N, Schneuer FJ, Pereira G, Mackie A, Ross GP, Sweeting AN, Seeho SKM, Hocking SL. Maternal and neonatal outcomes of women with gestational diabetes and without specific medical conditions: an Australian population‐based study comparing induction of labor with expectant management. Aust N Z J Obstet Gynaecol 2022; 62:525-535. [PMID: 35347699 PMCID: PMC9545300 DOI: 10.1111/ajo.13505] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Radhika V. Seimon
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders Faculty of Medicine and Health Charles Perkins Centre The University of Sydney Sydney New South WalesAustralia
| | - Nassar Natasha
- The Boden Initiative, Charles Perkins Centre The University of Sydney Sydney New South WalesAustralia
| | - Francisco J. Schneuer
- The Boden Initiative, Charles Perkins Centre The University of Sydney Sydney New South WalesAustralia
| | - Gavin Pereira
- School of Public Health Curtin University Perth Western AustraliaAustralia
- Telethon Kids Institute Perth Western AustraliaAustralia
- Centre for Fertility and Health (CeFH) Norwegian Institute of Public Health Oslo Norway
| | - Adam Mackie
- Women and Babies Royal Prince Alfred Hospital Sydney New South Wales Australia
- Discipline of Obstetrics, Gynaecology and Neonatology Central Clinical School The University of Sydney Sydney New South Wales Australia
| | - Glynis P. Ross
- Discipline of Obstetrics, Gynaecology and Neonatology Central Clinical School The University of Sydney Sydney New South Wales Australia
- Discipline of Medicine Central Clinical School The University of Sydney Sydney New South Wales Australia
- Department of Endocrinology Royal Prince Alfred Hospital Sydney New South Wales Australia
| | - Arianne N. Sweeting
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders Faculty of Medicine and Health Charles Perkins Centre The University of Sydney Sydney New South WalesAustralia
- Discipline of Medicine Central Clinical School The University of Sydney Sydney New South Wales Australia
- Department of Endocrinology Royal Prince Alfred Hospital Sydney New South Wales Australia
- Central Clinical School Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
| | - Sean K. M. Seeho
- Northern Clinical School Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
- Women and Babies Research Kolling InstituteRoyal North Shore HospitalThe University of Sydney Sydney New South Wales Australia
- Specialty of Obstetrics, Gynaecology and Neonatology Northern Clinical School Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
| | - Samantha L. Hocking
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders Faculty of Medicine and Health Charles Perkins Centre The University of Sydney Sydney New South WalesAustralia
- Department of Endocrinology Royal Prince Alfred Hospital Sydney New South Wales Australia
- Central Clinical School Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
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Jin X, Gibson AA, Salis Z, Seimon RV, Harper C, Markovic TP, Byrne NM, Keating SE, Stamatakis E, Inan-Eroglu E, da Luz FQ, Ayre J, Sainsbury A. Effect of severe compared with moderate energy restriction on physical activity among postmenopausal female adults with obesity: a prespecified secondary analysis of the Type of Energy Manipulation for Promoting optimum metabolic health and body composition in Obesity (TEMPO) Diet randomized controlled Trial. Am J Clin Nutr 2022; 115:1393-1403. [PMID: 35102380 PMCID: PMC9071468 DOI: 10.1093/ajcn/nqac024] [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: 12/09/2020] [Accepted: 01/24/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND An under-explored strategy for increasing physical activity is the dietary treatment of obesity, but empirical evidence is lacking. OBJECTIVES We aimed to compare the effects of weight loss via severe as opposed to moderate energy restriction on physical activity over 36 mo. METHODS A total of 101 postmenopausal female adults (45-65 y, BMI 30-40 kg/m2, <180 min/wk of structured exercise) were randomly assigned to either 12 mo of moderate energy restriction (25%-35% of energy requirement) with a food-based diet, or a severe intervention involving 4 mo of severe energy restriction (65%-75% of energy requirement) with a total meal replacement diet, followed by 8 mo of moderate energy restriction. Physical activity was encouraged, but no tailored or supervised exercise prescription was provided. Physical activity was assessed with an accelerometer worn for 7 d before baseline (0 mo) and 0.25, 1, 4, 6, 12, 24, and 36 mo after intervention commencement. RESULTS Compared with the moderate group, the severe group exhibited greater mean: total volume of physical activity; duration of moderate-to-vigorous-intensity physical activity (MVPA); duration of light-intensity physical activity; step counts, as well as lower mean duration of sedentary time. All these differences (except step counts) were apparent at 6 mo [e.g., 1006 metabolic equivalent of task (MET)-min/wk; 95% CI: 564, 1449 MET-min/wk for total volume of physical activity], and some were also apparent at 4 and/or 12 mo. There were no differences between groups in the 2 other outcomes investigated (self-efficacy to regulate exercise; and proportion of participants meeting the WHO's 2020 Physical Activity Guidelines for MVPA). When the analyses were adjusted for weight at each time point, the differences between groups were either attenuated or abolished. CONCLUSIONS Among female adults with obesity, including a dietary component to reduce excess body weight-notably one involving severe energy restriction-could potentially enhance the effectiveness of physical activity interventions.This trial was registered at www.anzctr.org.au as ACTRN12612000651886.
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Affiliation(s)
- Xingzhong Jin
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia,The Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia,Sydney Musculoskeletal Health, Kolling Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Alice A Gibson
- The Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia,Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Zubeyir Salis
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Radhika V Seimon
- The Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Claudia Harper
- The Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Tania P Markovic
- The Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia,Metabolism & Obesity Service, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Nuala M Byrne
- School of Health Sciences, University of Tasmania, Hobart, Tasmania, Australia
| | - Shelley E Keating
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Emmanuel Stamatakis
- Charles Perkins Centre, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Elif Inan-Eroglu
- The Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia,Charles Perkins Centre, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Felipe Q da Luz
- The Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia,Eating Disorders Program (AMBULIM), Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Julie Ayre
- Charles Perkins Centre, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Pattinson AL, Seimon RV, Harper C, Nassar N, Grech A, Santoso EA, Franklin J, Inan-Eroglu E, Gibson AA, Sainsbury A. Diet Quality following Total Meal Replacement Compared with Food-Based Weight-Loss Diets in Postmenopausal Women with Obesity: A Secondary Analysis of the TEMPO Diet Trial. J Nutr 2021; 151:3299-3312. [PMID: 34515308 DOI: 10.1093/jn/nxab311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/07/2021] [Revised: 08/12/2021] [Accepted: 08/16/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Severely energy-restricted diets that utilize meal-replacement products are the most effective dietary treatment for obesity. However, there are concerns they may fail to educate individuals on how to adopt a healthy food-based diet after weight loss. OBJECTIVES The aim of this research was to compare changes in diet quality following total meal replacement compared with food-based weight-loss diets. METHODS In this secondary analysis of a randomized controlled trial, 79 postmenopausal women aged 45-65 y, with a BMI (in kg/m2) of 30-40, were randomly assigned to either a total meal-replacement diet (energy intake restricted by 65-75% relative to requirements) for 16 wks, followed by a food-based diet (energy intake restricted by 25-35% relative to requirements) until 52 wks, or the food-based diet for the entire 52-wk period. Diet quality was scored at baseline and 52 wks using the Healthy Eating Index for Australian Adults, with score changes compared between groups using an independent t test. RESULTS Diet quality improved from baseline in both groups, but less so in the total meal-replacement group, with a mean (SD) increase of 3.6 (10.8) points compared with 11.8 (13.9) points in the food-based group, resulting in a mean between-group difference of -8.2 (P = 0.004; 95% CI: -13.8, -2.7) points. This improvement in diet quality within both groups was mostly driven by a reduction in the intake of discretionary foods. Intake remained below the recommendations at 52 wks for 4 of the 5 food groups in both dietary interventions. CONCLUSIONS In postmenopausal women with obesity, weight-loss interventions that involve either a total meal-replacement diet or a food-based diet both improve diet quality, however, not sufficiently to meet recommendations. This highlights the importance of addressing diet quality as a part of all dietary weight-loss interventions. This trial is registered with the Australia and New Zealand Clinical Trials Registry as 12612000651886.
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Affiliation(s)
- Andrea L Pattinson
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Radhika V Seimon
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Claudia Harper
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Natasha Nassar
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Amanda Grech
- School of Life and Environmental Sciences, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Eunike A Santoso
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Janet Franklin
- Metabolism & Obesity Service, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Elif Inan-Eroglu
- Charles Perkins Centre, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Alice A Gibson
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Amanda Sainsbury
- School of Human Sciences, Faculty of Science, The University of Western Australia, Perth, Western Australia, Australia
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9
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Zhu R, Fogelholm M, Larsen TM, Poppitt SD, Silvestre MP, Vestentoft PS, Jalo E, Navas-Carretero S, Huttunen-Lenz M, Taylor MA, Stratton G, Swindell N, Kaartinen NE, Lam T, Handjieva-Darlenska T, Handjiev S, Schlicht W, Martinez JA, Seimon RV, Sainsbury A, Macdonald IA, Westerterp-Plantenga MS, Brand-Miller J, Raben A. Corrigendum: A High-Protein, Low Glycemic Index Diet Suppresses Hunger but Not Weight Regain After Weight Loss: Results From a Large, 3-Years Randomized Trial (PREVIEW). Front Nutr 2021; 8:736531. [PMID: 34368215 PMCID: PMC8344043 DOI: 10.3389/fnut.2021.736531] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ruixin Zhu
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Mikael Fogelholm
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Thomas M Larsen
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Sally D Poppitt
- Human Nutrition Unit, School of Biological Sciences, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Marta P Silvestre
- Human Nutrition Unit, School of Biological Sciences, Department of Medicine, University of Auckland, Auckland, New Zealand.,Center for Health Technology Services Research, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Pia S Vestentoft
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Elli Jalo
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Santiago Navas-Carretero
- Centre for Nutrition Research, University of Navarra, Pamplona, Spain.,Centro de Investigacion Biomedica en Red Area de Fisiologia de la Obesidad y la Nutricion (CIBEROBN), Madrid, Spain.,IdisNA Instituto for Health Research, Pamplona, Spain
| | - Maija Huttunen-Lenz
- Institute for Nursing Science, University of Education Schwäbisch Gmünd, Schwäbisch Gmünd, Germany
| | - Moira A Taylor
- Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, Queen's Medical Centre, Nottingham, United Kingdom.,National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Gareth Stratton
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, Swansea, United Kingdom
| | - Nils Swindell
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, Swansea, United Kingdom
| | - Niina E Kaartinen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tony Lam
- NetUnion sarl, Lausanne, Switzerland
| | | | - Svetoslav Handjiev
- Department of Pharmacology and Toxicology, Medical University of Sofia, Sofia, Bulgaria
| | - Wolfgang Schlicht
- Exercise and Health Sciences, University of Stuttgart, Stuttgart, Germany
| | - J Alfredo Martinez
- Centro de Investigacion Biomedica en Red Area de Fisiologia de la Obesidad y la Nutricion (CIBEROBN), Madrid, Spain.,IdisNA Instituto for Health Research, Pamplona, Spain.,Department of Nutrition and Physiology, University of Navarra, Pamplona, Spain.,Precision Nutrition and Cardiometabolic Health Program, IMDEA (Madrid Institute for Advanced Studies)-Food Institute, CEI UAM + CSIC (Campus de Excelencia Internacional, Universidad Autónoma de Madrid + Consejo Superior de Investigaciones Científicas), Madrid, Spain
| | - Radhika V Seimon
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Amanda Sainsbury
- School of Human Sciences (Exercise and Sports Science), Faculty of Science, The University of Western Australia, Crawley, WA, Australia
| | - Ian A Macdonald
- Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, Queen's Medical Centre, MRC/ARUK Centre for Musculoskeletal Ageing Research, ARUK Centre for Sport, Exercise and Osteoarthritis, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Margriet S Westerterp-Plantenga
- Department of Nutrition and Movement Sciences, NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Jennie Brand-Miller
- School of Life and Environmental Sciences and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Anne Raben
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.,Steno Diabetes Center Copenhagen, Gentofte, Denmark
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10
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Zhu R, Fogelholm M, Larsen TM, Poppitt SD, Silvestre MP, Vestentoft PS, Jalo E, Navas-Carretero S, Huttunen-Lenz M, Taylor MA, Stratton G, Swindell N, Kaartinen NE, Lam T, Handjieva-Darlenska T, Handjiev S, Schlicht W, Martinez JA, Seimon RV, Sainsbury A, Macdonald IA, Westerterp-Plantenga MS, Brand-Miller J, Raben A. A High-Protein, Low Glycemic Index Diet Suppresses Hunger but Not Weight Regain After Weight Loss: Results From a Large, 3-Years Randomized Trial (PREVIEW). Front Nutr 2021; 8:685648. [PMID: 34141717 PMCID: PMC8203925 DOI: 10.3389/fnut.2021.685648] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Previous studies have shown an increase in hunger during weight-loss maintenance (WLM) after diet-induced weight loss. Whether a combination of a higher protein, lower glycemic index (GI) diet and physical activity (PA) can counteract this change remains unclear. Aim: To compare the long-term effects of two diets [high protein (HP)-low GI vs. moderate protein (MP)-moderate GI] and two PA programs [high intensity (HI) vs. moderate intensity (MI)] on subjective appetite sensations during WLM after ≥8% weight loss (WL). Methods: Data derived from the 3-years PREVIEW randomized intervention study. An 8-weeks WL phase using a low-energy diet was followed by a 148-weeks randomized WLM phase. For the WLM phase, participants were assigned to one of the four groups: HP-MI, HP-HI, MP-MI, and MP-HI. Available data from 2,223 participants with overweight or obesity (68% women; BMI ≥ 25 kg/m2). Appetite sensations including satiety, hunger, desire to eat, and desire to eat something sweet during the two phases (at 0, 8 weeks and 26, 52, 104, and 156 weeks) were assessed based on the recall of feelings during the previous week using visual analogue scales. Differences in changes in appetite sensations from baseline between the groups were determined using linear mixed models with repeated measures. Results: There was no significant diet × PA interaction. From 52 weeks onwards, decreases in hunger were significantly greater in HP-low GI than MP-moderate GI (P time × diet = 0.018, P dietgroup = 0.021). Although there was no difference in weight regain between the diet groups (P time × diet = 0.630), hunger and satiety ratings correlated with changes in body weight at most timepoints. There were no significant differences in appetite sensations between the two PA groups. Decreases in hunger ratings were greater at 52 and 104 weeks in HP-HI vs. MP-HI, and greater at 104 and 156 weeks in HP-HI vs. MP-MI. Conclusions: This is the first long-term, large-scale randomized intervention to report that a HP-low GI diet was superior in preventing an increase in hunger, but not weight regain, during 3-years WLM compared with a MP-moderate GI diet. Similarly, HP-HI outperformed MP-HI in suppressing hunger. The role of exercise intensity requires further investigation. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT01777893.
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Affiliation(s)
- Ruixin Zhu
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Mikael Fogelholm
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Thomas M Larsen
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Sally D Poppitt
- Human Nutrition Unit, School of Biological Sciences, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Marta P Silvestre
- Human Nutrition Unit, School of Biological Sciences, Department of Medicine, University of Auckland, Auckland, New Zealand.,Center for Health Technology Services Research, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Pia S Vestentoft
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Elli Jalo
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Santiago Navas-Carretero
- Department of Nutrition, University of Navarra, Pamplona, Spain.,CIBERobn, Instituto de Salud Carlos III, Madrid, Spain.,Precision Nutrition Program, IMDEA Food, Campus de Excelencia Internacional, Universidad Autónoma de Madrid + Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Maija Huttunen-Lenz
- Institute for Nursing Science, University of Education Schwäbisch Gmünd, Schwäbisch Gmünd, Germany
| | - Moira A Taylor
- Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, Queen's Medical Centre, Nottingham, United Kingdom.,National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Gareth Stratton
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, Swansea, United Kingdom
| | - Nils Swindell
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, Swansea, United Kingdom
| | - Niina E Kaartinen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tony Lam
- NetUnion sarl, Lausanne, Switzerland
| | | | - Svetoslav Handjiev
- Department of Pharmacology and Toxicology, Medical University of Sofia, Sofia, Bulgaria
| | - Wolfgang Schlicht
- Exercise and Health Sciences, University of Stuttgart, Stuttgart, Germany
| | - J Alfredo Martinez
- Department of Nutrition, University of Navarra, Pamplona, Spain.,CIBERobn, Instituto de Salud Carlos III, Madrid, Spain.,Precision Nutrition Program, IMDEA Food, Campus de Excelencia Internacional, Universidad Autónoma de Madrid + Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Radhika V Seimon
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Amanda Sainsbury
- School of Human Sciences (Exercise and Sports Science), Faculty of Science, The University of Western Australia, Crawley, WA, Australia
| | - Ian A Macdonald
- Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, Queen's Medical Centre, MRC/ARUK Centre for Musculoskeletal Ageing Research, ARUK Centre for Sport, Exercise and Osteoarthritis, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Margriet S Westerterp-Plantenga
- Department of Nutrition and Movement Sciences, NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Jennie Brand-Miller
- School of Life and Environmental Sciences and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Anne Raben
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.,Steno Diabetes Center Copenhagen, Gentofte, Denmark
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11
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Buso MEC, Seimon RV, McClintock S, Muirhead R, Atkinson FS, Brodie S, Dodds J, Zibellini J, Das A, Wild-Taylor AL, Burk J, Fogelholm M, Raben A, Brand-Miller JC, Sainsbury A. Can a Higher Protein/Low Glycemic Index vs. a Conventional Diet Attenuate Changes in Appetite and Gut Hormones Following Weight Loss? A 3-Year PREVIEW Sub-study. Front Nutr 2021; 8:640538. [PMID: 33829034 PMCID: PMC8019730 DOI: 10.3389/fnut.2021.640538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/12/2021] [Indexed: 01/06/2023] Open
Abstract
Background: Previous research showed that weight-reducing diets increase appetite sensations and/or circulating ghrelin concentrations for up to 36 months, with transient or enduring perturbations in circulating concentrations of the satiety hormone peptide YY. Objective: This study assessed whether a diet that is higher in protein and low in glycemic index (GI) may attenuate these changes. Methods: 136 adults with pre-diabetes and a body mass index of ≥25 kg/m2 underwent a 2-month weight-reducing total meal replacement diet. Participants who lost ≥8% body weight were randomized to one of two 34-month weight-maintenance diets: a higher-protein and moderate-carbohydrate (CHO) diet with low GI, or a moderate-protein and higher-CHO diet with moderate GI. Both arms involved recommendations to increase physical activity. Fasting plasma concentrations of total ghrelin and total peptide YY, and appetite sensations, were measured at 0 months (pre-weight loss), at 2 months (immediately post-weight loss), and at 6, 12, 24, and 36 months. Results: There was a decrease in plasma peptide YY concentrations and an increase in ghrelin after the 2-month weight-reducing diet, and these values approached pre-weight-loss values by 6 and 24 months, respectively (P = 0.32 and P = 0.08, respectively, vs. 0 months). However, there were no differences between the two weight-maintenance diets. Subjective appetite sensations were not affected by the weight-reducing diet nor the weight-maintenance diets. While participants regained an average of ~50% of the weight they had lost by 36 months, the changes in ghrelin and peptide YY during the weight-reducing phase did not correlate with weight regain. Conclusion: A higher-protein, low-GI diet for weight maintenance does not attenuate changes in ghrelin or peptide YY compared with a moderate-protein, moderate-GI diet. Clinical Trial Registry:ClinicalTrials.gov registry ID NCT01777893 (PREVIEW) and ID NCT02030249 (Sub-study).
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Affiliation(s)
- Marion E C Buso
- Division of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands.,The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Radhika V Seimon
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Sally McClintock
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Roslyn Muirhead
- School of Life and Environmental Sciences and Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Fiona S Atkinson
- School of Life and Environmental Sciences and Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Shannon Brodie
- School of Life and Environmental Sciences and Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Jarron Dodds
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Jessica Zibellini
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Arpita Das
- School of Life and Environmental Sciences and Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Anthony L Wild-Taylor
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Jessica Burk
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Mikael Fogelholm
- Department of Food and Environmental Sciences, University of Helsinki, Helsinki, Finland
| | - Anne Raben
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark.,Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Jennie C Brand-Miller
- School of Life and Environmental Sciences and Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Amanda Sainsbury
- School of Human Sciences, Faculty of Science, The University of Western Australia, Crawley, WA, Australia
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12
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Bein KJ, Berendsen Russell S, Ní Bhraonáin S, Seimon RV, Dinh MM. Does volume or occupancy influence emergency access block? A multivariate time series analysis from a single emergency department in Sydney, Australia during the COVID-19 pandemic. Emerg Med Australas 2021; 33:343-348. [PMID: 33387421 DOI: 10.1111/1742-6723.13717] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/09/2020] [Accepted: 12/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study aims to determine whether ED presentation volume or hospital occupancy had a greater impact on ED performance before and during the COVID-19 health response at a tertiary referral hospital in Sydney, Australia. METHODS Single centre time series analysis using routinely collected hospital and ED data from January 2019 to September 2020. The primary outcome was ED access block measured by emergency treatment performance (ETP; i.e. percentage of patients who were discharged or transferred to a ward from ED within 4 h of ED arrival time). Secondary outcomes were hospital occupancy, elective theatre cases and ambulance ramping. Multivariate time series analysis was performed using vector autoregression, to model effects of changes in various endogenous and correlated variables on ETP. RESULTS There was an increase in ETP, drop in ED presentations and decrease in hospital occupancy between April and June 2020. Elective surgery and hospital occupancy had significant effects up to 2 days prior on ETP, while there were no significant effects of either ED or ambulance presentations on ETP. Hospital occupancy itself increased with ED presentations after 2-4 days and decreased with elective surgery after 1 day. Shocks (a one standard deviation increase) in hospital occupancy had a peak impact nearly two times greater compared to ED presentations (-1.43, 95% confidence interval -1.92, -0.93 vs -0.73, 95% confidence interval -1.21, -0.25). CONCLUSION The main determinants of the reduction of ED overcrowding and access block during the pandemic were associated with reductions in hospital occupancy and elective surgery levels, and more research is required to assess more complex associations beyond the scope of this manuscript.
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Affiliation(s)
- Kendall J Bein
- RPA Green Light Institute for Emergency Care, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Saartje Berendsen Russell
- RPA Green Light Institute for Emergency Care, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Sinéad Ní Bhraonáin
- RPA Green Light Institute for Emergency Care, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Radhika V Seimon
- RPA Green Light Institute for Emergency Care, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Michael M Dinh
- RPA Green Light Institute for Emergency Care, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
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13
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Gibson AA, Eroglu EI, Rooney K, Harper C, McClintock S, Franklin J, Markovic TP, Seimon RV, Sainsbury A. Urine dipsticks are not accurate for detecting mild ketosis during a severely energy restricted diet. Obes Sci Pract 2020; 6:544-551. [PMID: 33082996 PMCID: PMC7556427 DOI: 10.1002/osp4.432] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 11/18/2022] Open
Abstract
Background Detection of the mild ketosis induced by severely energy‐restricted diets may be a clinically useful way to monitor and promote dietary adherence. Mild ketosis is often assessed using urine dipsticks, but accuracy for this purpose has not been tested. Objective To determine the accuracy of urine dipsticks to detect mild ketosis during adherence to a severely energy‐restricted diet. Methods Two hundred and sixty three (263) fasting urine and 263 fasting blood samples were taken from 50 women (mean [standard deviation, SD] age 58.0 [4.3] years and body mass index 34.3 [2.4] kg/m2) before and at six time points during or for up to 10 weeks after 16 weeks of severe energy restriction, achieved with a total meal replacement diet. The amount of ketones (acetoacetate) in the urine was classified as ‘0 (Negative)’, ‘+/− (Trace)’, ‘+ (Weak)’ or ‘++ (Medium)’ by urine dipsticks (Ketostix, Bayer). The concentration of ketones (β‐hydroxybutyrate) in the blood was measured with our reference method, a portable ketone monitor (FreeStyle Optium, Abbott). The diagnostic accuracy of the urine dipsticks was assessed from the percent of instances when a person was actually ‘in ketosis’ (as defined by a blood β‐hydroxybutyrate concentration at or above three different thresholds) that were also identified by the urine dipsticks as being from a person in ketosis (the percent ‘true positives’ or sensitivity), as well as the percent of instances when a person was not in ketosis (as defined by the blood monitor result) was correctly identified as such with the urine dipstick (the percent ‘true negatives’ or specificity). Thresholds of ≥0.3mM, ≥0.5mM or ≥1.0mM were selected, because mean blood concentrations of β‐hydroxybutyrate during ketogenic diets are approximately 0.5mM. Sensitivity and specificity were then used to generate receiver operating characteristic curves, with the area under these curves indicating the ability of the dipsticks to correctly identify people in ketosis (1 = perfect results, 0.5 = random results). Results At threshold blood β‐hydroxybutyrate concentrations of ≥0.3mM, ≥0.5mM and ≥1.0mM, the sensitivity of the urine dipsticks was 35%, 52% and 76%; the specificity was 100%, 97% and 78%; and the area under the receiver operating characteristic curves was 0.67, 0.74 and 0.77, respectively. These low levels of sensitivity mean that 65%, 48% or 24% of the instances when a person was in ketosis were not detected by the urine dipsticks. Conclusion Urine dipsticks are not an accurate or clinically useful means of detecting mild ketosis in people undergoing a severely energy‐restricted diet and should thus not be recommended in clinical treatment protocols. If monitoring of mild ketosis is indicated (eg, to monitor or help promote adherence to a severely energy‐restricted diet), then blood monitors should be used instead.
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Affiliation(s)
- Alice A Gibson
- Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, Faculty of Medicine and Health The University of Sydney Camperdown New South Wales Australia.,The Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health The University of Sydney Camperdown New South Wales Australia
| | - Elif I Eroglu
- Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, Faculty of Medicine and Health The University of Sydney Camperdown New South Wales Australia
| | - Kieron Rooney
- Discipline of Exercise and Sport Science, Faculty of Medicine and Health, Charles Perkins Centre University of Sydney Sydney New South Wales Australia
| | - Claudia Harper
- Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, Faculty of Medicine and Health The University of Sydney Camperdown New South Wales Australia
| | - Sally McClintock
- Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, Faculty of Medicine and Health The University of Sydney Camperdown New South Wales Australia
| | - Janet Franklin
- Metabolism & Obesity Services Royal Prince Alfred Hospital Camperdown New South Wales Australia
| | - Tania P Markovic
- Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, Faculty of Medicine and Health The University of Sydney Camperdown New South Wales Australia.,Metabolism & Obesity Services Royal Prince Alfred Hospital Camperdown New South Wales Australia
| | - Radhika V Seimon
- Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, Faculty of Medicine and Health The University of Sydney Camperdown New South Wales Australia
| | - Amanda Sainsbury
- School of Human Sciences, Faculty of Science The University of Western Australia Crawley Western Australia Australia
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14
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Seimon RV, Wild-Taylor AL, McClintock S, Harper C, Gibson AA, Johnson NA, Fernando HA, Markovic TP, Center JR, Franklin J, Liu PY, Grieve SM, Lagopoulos J, Caterson ID, Byrne NM, Sainsbury A. 3-Year effect of weight loss via severe versus moderate energy restriction on body composition among postmenopausal women with obesity - the TEMPO Diet Trial. Heliyon 2020; 6:e04007. [PMID: 32613096 PMCID: PMC7322133 DOI: 10.1016/j.heliyon.2020.e04007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/06/2020] [Accepted: 05/13/2020] [Indexed: 12/15/2022] Open
Abstract
We have previously shown that a severely energy-restricted diet leads to greater loss of weight, fat, lean mass and bone mineral density (BMD) at 12 months in postmenopausal women with obesity than a moderately energy-restricted diet. We now aim to evaluate whether these effects are sustained longer term (ie, at 36 months). 101 postmenopausal women were randomized to either 12 months of moderate (25 to 35%) energy restriction with a food-based diet (moderate intervention), or 4 months of severe (65 to 75%) energy restriction with a total meal replacement diet followed by moderate energy restriction for 8 months (severe intervention). Body weight and composition were measured at 0, 24 and 36 months. Participants in the severe intervention lost ~1.5 to 1.7 times as much weight, waist circumference, whole-body fat mass and visceral adipose tissue compared to those in the moderate intervention, and were 2.6 times more likely (42% versus 16%) to have lost 10% or more of their initial body weight at 36 months (P < 0.01 for all). However, those in the severe versus moderate intervention lost ~1.4 times as much whole-body lean mass (P < 0.01), albeit this was proportional to total weight lost and there was no greater loss of handgrip strength, and they also lost ~2 times as much total hip BMD between 0 and 36 months (P < 0.05), with this bone loss occurring in the first 12 months. Thus, severe energy restriction is more effective than moderate energy restriction for reducing weight and adiposity in postmenopausal women in the long term (3 years), but attention to BMD loss in the first year is required. Trial registration Australian New Zealand Clinical Trials Registry Reference Number: 12612000651886, anzctr.org.au.
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Affiliation(s)
- Radhika V. Seimon
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Corresponding author.
| | - Anthony L. Wild-Taylor
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sally McClintock
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Claudia Harper
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Alice A. Gibson
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Nathan A. Johnson
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
| | - Hamish A. Fernando
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Tania P. Markovic
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Jacqueline R. Center
- Bone Biology Program, Garvan Institute of Medical Research, St Vincent's Hospital Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Janet Franklin
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Peter Y. Liu
- Division of Endocrinology, Department of Medicine, Harbor-University of California Los Angeles Medical Center and Los Angeles BioMedical Research Institute, Los Angeles
| | - Stuart M. Grieve
- Imaging and Phenotyping Laboratory, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Jim Lagopoulos
- Sunshine Coast Mind and Neuroscience–Thompson Institute, University of the Sunshine Coast, Queensland, Australia
| | - Ian D. Caterson
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Nuala M. Byrne
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Amanda Sainsbury
- School of Human Sciences, Faculty of Science, The University of Western Australia, Crawley, Western Australia, Australia
- Corresponding author.
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Seimon RV, Wild-Taylor AL, Keating SE, McClintock S, Harper C, Gibson AA, Johnson NA, Fernando HA, Markovic TP, Center JR, Franklin J, Liu PY, Grieve SM, Lagopoulos J, Caterson ID, Byrne NM, Sainsbury A. Effect of Weight Loss via Severe vs Moderate Energy Restriction on Lean Mass and Body Composition Among Postmenopausal Women With Obesity: The TEMPO Diet Randomized Clinical Trial. JAMA Netw Open 2019; 2:e1913733. [PMID: 31664441 PMCID: PMC6824325 DOI: 10.1001/jamanetworkopen.2019.13733] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Severely energy-restricted diets are the most effective dietary obesity treatment. However, there are concerns regarding potential adverse effects on body composition. OBJECTIVE To compare the long-term effects of weight loss via severe vs moderate energy restriction on lean mass and other aspects of body composition. DESIGN, SETTING, AND PARTICIPANTS The Type of Energy Manipulation for Promoting Optimum Metabolic Health and Body Composition in Obesity (TEMPO) Diet Trial was a 12-month, single-center, randomized clinical trial. A total of 101 postmenopausal women, aged 45 to 65 years with body mass index (calculated as weight in kilograms divided by height in meters squared) from 30 to 40, who were at least 5 years after menopause, had fewer than 3 hours of structured physical activity per week, and lived in the Sydney metropolitan area of New South Wales, Australia, were recruited between March 2013 and July 2016. Data analysis was conducted between October 2018 and August 2019. INTERVENTION Participants were randomized to either 12 months of moderate (25%-35%) energy restriction with a food-based diet (moderate intervention) or 4 months of severe (65%-75%) energy restriction with a total meal replacement diet followed by moderate energy restriction for an additional 8 months (severe intervention). Both interventions had a prescribed protein intake of 1.0 g/kg of actual body weight per day, and physical activity was encouraged but not supervised. MAIN OUTCOMES AND MEASURES The primary outcome was whole-body lean mass at 12 months after commencement of intervention. Secondary outcomes were body weight, thigh muscle area and muscle function (strength), bone mineral density, and fat mass and distribution, measured at 0, 4, 6, and 12 months. RESULTS A total of 101 postmenopausal women were recruited (mean [SD] age, 58.0 [4.2] years; mean [SD] weight, 90.8 [9.1] kg; mean [SD] body mass index, 34.4 [2.5]). Compared with the moderate group at 12 months, the severe group lost more weight (effect size, -6.6 kg; 95% CI, -8.2 to -5.1 kg), lost more whole-body lean mass (effect size, -1.2 kg; 95% CI, -2.0 to -0.4 kg), and lost more thigh muscle area (effect size, -4.2 cm2; 95% CI, -6.5 to -1.9 cm2). However, decreases in whole-body lean mass and thigh muscle area were proportional to total weight loss, and there was no difference in muscle (handgrip) strength between groups. Total hip bone mineral density (effect size, -0.017 g/cm2; 95% CI, -0.029 to -0.005 g/cm2), whole-body fat mass (effect size, -5.5 kg; 95% CI, -7.1 to -3.9 kg), abdominal subcutaneous adipose tissue (effect size, -1890 cm3; 95% CI, -2560 to -1219 cm3), and visceral adipose tissue (effect size, -1389 cm3; 95% CI, -1748 to -1030 cm3) loss were also greater for the severe group than for the moderate group at 12 months. CONCLUSIONS AND RELEVANCE Severe energy restriction had no greater adverse effect on relative whole-body lean mass or handgrip strength compared with moderate energy restriction and was associated with 2-fold greater weight and fat loss over 12 months. However, there was significantly greater loss of total hip bone mineral density with severe vs moderate energy restriction. Therefore, caution is necessary when implementing severe energy restriction in postmenopausal women, particularly those with osteopenia or osteoporosis. TRIAL REGISTRATION anzctr.org.au Identifier: 12612000651886.
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Affiliation(s)
- Radhika V. Seimon
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Anthony L. Wild-Taylor
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Shelley E. Keating
- School of Human Movement and Nutrition Sciences, Centre for Research on Exercise, Physical Activity and Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Sally McClintock
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Claudia Harper
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Alice A. Gibson
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Nathan A. Johnson
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
| | - Hamish A. Fernando
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Tania P. Markovic
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Metabolism and Obesity Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Jacqueline R. Center
- Bone Biology Program, Garvan Institute of Medical Research, St Vincent’s Hospital Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Janet Franklin
- Metabolism and Obesity Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Peter Y. Liu
- Division of Endocrinology, Department of Medicine, Harbor-University of California Los Angeles Medical Center and Los Angeles BioMedical Research Institute, Los Angeles
| | - Stuart M. Grieve
- Sydney Translational Imaging Laboratory, Heart Research Institute, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Jim Lagopoulos
- Sunshine Coast Mind and Neuroscience–Thompson Institute, University of the Sunshine Coast, Queensland, Australia
| | - Ian D. Caterson
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Metabolism and Obesity Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Nuala M. Byrne
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Amanda Sainsbury
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
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Smith VM, Seimon RV, Harris RA, Sainsbury A, da Luz FQ. Less Binge Eating and Loss of Control over Eating Are Associated with Greater Levels of Mindfulness: Identifying Patterns in Postmenopausal Women with Obesity. Behav Sci (Basel) 2019; 9:E36. [PMID: 30965602 PMCID: PMC6523377 DOI: 10.3390/bs9040036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/02/2019] [Accepted: 04/03/2019] [Indexed: 11/16/2022] Open
Abstract
Obesity is a public health concern resulting in widespread personal, social, and economic burden. Many individuals with obesity report feeling unable to stop eating or to control their food intake (i.e., a loss of control over eating) despite their best efforts. Experiencing loss of control over eating predicts further eating pathology and is a key feature of binge eating. Mindfulness (i.e., awareness and acceptance of current thoughts, feelings, sensations, and surrounding events) has emerged as a potential strategy to treat such eating disorder behaviors, but it is not known whether there is merit in investigating this strategy to address binge eating in postmenopausal women with obesity. Thus, this study aimed to examine the relationships between binge eating and mindfulness in postmenopausal women with obesity seeking weight loss treatment. Participants (n = 101) were assessed with the Eating Disorder Examination Questionnaire, the Loss of Control over Eating Scale, the Five-Facet Mindfulness Questionnaire, and the Langer Mindfulness Scale. Participants´ overall scores on both mindfulness scales were significantly and negatively correlated with binge eating frequency or the severity of loss of control over eating. Moreover, participants who reported fewer binge eating episodes were significantly more mindful than those who reported greater frequencies of binge eating episodes within the past 28 days. These findings suggest a merit in investigating the use of mindfulness-based therapies to treat binge eating in postmenopausal women with obesity.
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Affiliation(s)
- Veronica M Smith
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2050, Australia.
| | - Radhika V Seimon
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2050, Australia.
| | - Rebecca A Harris
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2050, Australia.
| | - Amanda Sainsbury
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2050, Australia.
| | - Felipe Q da Luz
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2050, Australia.
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Keating SE, Alzahrani A, Kirchner J, Caterson ID, King NA, Johnson NA, Seimon RV, Sainsbury A. Effects of exercise on appetite and gut hormones: Implications for weight management. Obes Res Clin Pract 2019. [DOI: 10.1016/j.orcp.2016.10.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sainsbury A, Wood RE, Seimon RV, Hills AP, King NA, Gibson AA, Byrne NM. Rationale for novel intermittent dieting strategies to attenuate adaptive responses to energy restriction. Obes Rev 2018; 19 Suppl 1:47-60. [PMID: 30511512 DOI: 10.1111/obr.12787] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 09/07/2018] [Accepted: 09/11/2018] [Indexed: 12/16/2022]
Abstract
Eating patterns involving intermittent energy restriction (IER) include 'intermittent fasting' where energy intake is severely restricted for several 'fasting' days per week, with 'refeeding' days (involving greater energy intake than during fasting days) at other times. Intermittent fasting does not improve weight loss compared to continuous energy restriction (CER), where energy intake is restricted every day. We hypothesize that weight loss from IER could be improved if refeeding phases involved restoration of energy balance (i.e. not ongoing energy restriction, as during intermittent fasting). There is some evidence in adults with overweight or obesity showing that maintenance of a lower weight may attenuate (completely or partially) some of the adaptive responses to energy restriction that oppose ongoing weight loss. Other studies show some adaptive responses persist unabated for years after weight loss. Only five randomized controlled trials in adults with overweight or obesity have compared CER with IER interventions that achieved energy balance (or absence of energy restriction) during refeeding phases. Two reported greater weight loss than CER, whereas three reported similar weight loss between interventions. While inconclusive, it is possible that achieving energy balance (i.e. avoiding energy restriction or energy excess) during refeeding phases may be important in realizing the potential of IER.
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Affiliation(s)
- A Sainsbury
- Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, NSW, Australia
| | - R E Wood
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
| | - R V Seimon
- Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, NSW, Australia
| | - A P Hills
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
| | - N A King
- School of Exercise and Nutrition Sciences and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - A A Gibson
- Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, NSW, Australia
| | - N M Byrne
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
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Harper C, Maher J, Grunseit A, Seimon RV, Sainsbury A. Experiences of using very low energy diets for weight loss by people with overweight or obesity: a review of qualitative research. Obes Rev 2018; 19:1412-1423. [PMID: 30144269 DOI: 10.1111/obr.12715] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 03/09/2018] [Revised: 04/18/2018] [Accepted: 04/30/2018] [Indexed: 12/13/2022]
Abstract
Although very low energy diets (VLEDs) are the most successful non-surgical, non-pharmacological treatment for obesity, they are underutilized, and little is known about experiences of people using VLEDs for weight loss. This systematic review synthesizes qualitative studies investigating participants' experiences of undertaking a VLED composed of total meal replacement products to lose weight. Of the 4,911 articles screened, three studies met criteria for inclusion. Thematic synthesis was used to analyse the study findings. Health and appearance were the main motivators to use a VLED for weight loss. Adherence was facilitated by group support meetings, rapid weight loss and ease of use of the diet. Being part of a clinical trial gave a sense of accountability and further reason to adhere to a VLED, and the VLED itself was well accepted by users. Barriers to adherence, such as temptations and social occasions, were overcome by avoidance and distraction strategies. In conclusion, this qualitative synthesis of users' experiences of VLEDs shows that VLEDs are well accepted and positively viewed by users. More in-depth research could facilitate understanding of how this weight loss strategy influences the weight maintenance period, in order to facilitate better long-term results.
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Affiliation(s)
- C Harper
- Faculty of Medicine and Health, The Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Sydney Medical School, The University of Sydney, Charles Perkins Centre, Sydney, NSW, Australia
| | - J Maher
- Faculty of Science, Health, Education and Engineering, School of Health and Sport Sciences, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - A Grunseit
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Charles Perkins Centre, Sydney, NSW, Australia
| | - R V Seimon
- Faculty of Medicine and Health, The Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Sydney Medical School, The University of Sydney, Charles Perkins Centre, Sydney, NSW, Australia
| | - A Sainsbury
- Faculty of Medicine and Health, The Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Sydney Medical School, The University of Sydney, Charles Perkins Centre, Sydney, NSW, Australia
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Hsu MSH, Harper C, Gibson AA, Sweeting AN, McBride J, Markovic TP, Caterson ID, Byrne NM, Sainsbury A, Seimon RV. Recruitment Strategies for a Randomised Controlled Trial Comparing Fast Versus Slow Weight Loss in Postmenopausal Women with Obesity-The TEMPO Diet Trial. Healthcare (Basel) 2018; 6:healthcare6030076. [PMID: 29986398 PMCID: PMC6163885 DOI: 10.3390/healthcare6030076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 06/12/2018] [Revised: 07/02/2018] [Accepted: 07/03/2018] [Indexed: 12/12/2022] Open
Abstract
Current research around effective recruitment strategies for clinical trials of dietary obesity treatments have largely focused on younger adults, and thus may not be applicable to older populations. The TEMPO Diet Trial (Type of Energy Manipulation for Promoting optimal metabolic health and body composition in Obesity) is a randomised controlled trial comparing the long-term effects of fast versus slow weight loss on body composition and cardio-metabolic health in postmenopausal women with obesity. This paper addresses the recruitment strategies used to enrol participants into this trial and evaluates their relative effectiveness. 101 post-menopausal women aged 45–65 years, with a body mass index of 30–40 kg/m2 were recruited and randomised to either fast or slow weight loss. Multiple strategies were used to recruit participants. The total time cost (labour) and monetary cost per randomised participant from each recruitment strategy was estimated, with lower values indicating greater cost-effectiveness and higher values indicating poorer cost-effectiveness. The most cost-effective recruitment strategy was word of mouth, followed (at equal second place) by free publicity on TV and radio, and printed advertorials, albeit these avenues only yielded 26/101 participants. Intermediate cost-effective recruitment strategies were flyer distribution at community events, hospitals and a local tertiary education campus, internet-based strategies, and clinical trial databases and intranets, which recruited a further 40/101 participants. The least cost-effective recruitment strategy was flyer distribution to local health service centres and residential mailboxes, and referrals from healthcare professionals were not effective. Recruiting for clinical trials involving postmenopausal women could benefit from a combination of recruitment strategies, with an emphasis on word of mouth and free publicity via radio, TV, and print media, as well as strategic placement of flyers, supplemented with internet-based strategies, databases and intranets if a greater yield of participants is needed.
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Affiliation(s)
- Michelle S H Hsu
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia.
| | - Claudia Harper
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia.
| | - Alice A Gibson
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia.
| | - Arianne N Sweeting
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia.
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia.
| | - John McBride
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia.
| | - Tania P Markovic
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia.
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia.
| | - Ian D Caterson
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia.
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia.
| | - Nuala M Byrne
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS 7250, Australia.
| | - Amanda Sainsbury
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia.
| | - Radhika V Seimon
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia.
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Seimon RV, Wild-Taylor AL, Gibson AA, Harper C, McClintock S, Fernando HA, Hsu MSH, da Luz FQ, Keating SE, Johnson NA, Grieve SM, Markovic TP, Caterson ID, Byrne NM, Sainsbury A. Less Waste on Waist Measurements: Determination of Optimal Waist Circumference Measurement Site to Predict Visceral Adipose Tissue in Postmenopausal Women with Obesity. Nutrients 2018; 10:nu10020239. [PMID: 29461494 PMCID: PMC5852815 DOI: 10.3390/nu10020239] [Citation(s) in RCA: 12] [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: 12/19/2017] [Revised: 02/01/2018] [Accepted: 02/14/2018] [Indexed: 11/16/2022] Open
Abstract
With obesity being a leading cause of preventable death, it is vital to understand how best to identify individuals with greater risk of metabolic disease, especially those with high visceral adipose tissue (VAT). This study aimed to determine whether three commonly used waist circumference (WC) measurement sites could provide accurate estimations of VAT, as determined by magnetic resonance imaging (MRI), which is a gold standard for measuring VAT, in postmenopausal women with obesity. VAT volume was measured by MRI of the total abdomen in 97 women aged 57.7 ± 0.4 years (mean ± SEM), mean body mass index 34.5 ± 0.2 kg/m2. WC was measured at the midpoint between the lowest rib and the iliac crest (WCmid), the narrowest point of the torso (WCnarrow), and at the level of the umbilicus (WCumbilicus). WC differed significantly according to measurement site, with WCnarrow (102.1 ± 0.7 cm) < WCmid (108.3 ± 0.7 cm) < WCumbilicus (115.7 ± 0.8 cm) (p < 0.001). WCmid, WCnarrow and WCumbilicus were all significantly correlated with VAT, as measured by MRI (r = 0.581, 0.563 and 0.390, respectively; p < 0.001 for all), but the relationships between WCmid or WCnarrow and VAT determined by MRI were stronger than for WCumbilicus. Measurement of either WCmid or WCnarrow provides valid estimates of VAT in postmenopausal women with obesity, with WCnarrow being favoured in light of its greater ease and speed of measurement in this population.
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Affiliation(s)
- Radhika V. Seimon
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2050, Australia; (A.L.W.-T.); (A.A.G.); (C.H.); (S.M.); (H.A.F.); (M.S.H.H.); (F.Q.d.L.); (N.A.J.); (T.P.M.); (I.D.C.); (A.S.)
- Correspondence: ; Tel.: +61-2-8627-1918; Fax: +61-2-8627-0141
| | - Anthony L. Wild-Taylor
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2050, Australia; (A.L.W.-T.); (A.A.G.); (C.H.); (S.M.); (H.A.F.); (M.S.H.H.); (F.Q.d.L.); (N.A.J.); (T.P.M.); (I.D.C.); (A.S.)
| | - Alice A. Gibson
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2050, Australia; (A.L.W.-T.); (A.A.G.); (C.H.); (S.M.); (H.A.F.); (M.S.H.H.); (F.Q.d.L.); (N.A.J.); (T.P.M.); (I.D.C.); (A.S.)
| | - Claudia Harper
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2050, Australia; (A.L.W.-T.); (A.A.G.); (C.H.); (S.M.); (H.A.F.); (M.S.H.H.); (F.Q.d.L.); (N.A.J.); (T.P.M.); (I.D.C.); (A.S.)
| | - Sally McClintock
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2050, Australia; (A.L.W.-T.); (A.A.G.); (C.H.); (S.M.); (H.A.F.); (M.S.H.H.); (F.Q.d.L.); (N.A.J.); (T.P.M.); (I.D.C.); (A.S.)
| | - Hamish A. Fernando
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2050, Australia; (A.L.W.-T.); (A.A.G.); (C.H.); (S.M.); (H.A.F.); (M.S.H.H.); (F.Q.d.L.); (N.A.J.); (T.P.M.); (I.D.C.); (A.S.)
| | - Michelle S. H. Hsu
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2050, Australia; (A.L.W.-T.); (A.A.G.); (C.H.); (S.M.); (H.A.F.); (M.S.H.H.); (F.Q.d.L.); (N.A.J.); (T.P.M.); (I.D.C.); (A.S.)
| | - Felipe Q. da Luz
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2050, Australia; (A.L.W.-T.); (A.A.G.); (C.H.); (S.M.); (H.A.F.); (M.S.H.H.); (F.Q.d.L.); (N.A.J.); (T.P.M.); (I.D.C.); (A.S.)
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, NSW 2050, Australia
| | - Shelley E. Keating
- School of Human Movement and Nutrition Sciences, Centre for Research on Exercise, Physical Activity and Health, The University of Queensland, Brisbane, QLD 4072, Australia;
| | - Nathan A. Johnson
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2050, Australia; (A.L.W.-T.); (A.A.G.); (C.H.); (S.M.); (H.A.F.); (M.S.H.H.); (F.Q.d.L.); (N.A.J.); (T.P.M.); (I.D.C.); (A.S.)
- Faculty of Health Sciences, The University of Sydney, Sydney, NSW 2050, Australia
| | - Stuart M. Grieve
- Sydney Translational Imaging Laboratory, Heart Research Institute, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2050, Australia;
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
| | - Tania P. Markovic
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2050, Australia; (A.L.W.-T.); (A.A.G.); (C.H.); (S.M.); (H.A.F.); (M.S.H.H.); (F.Q.d.L.); (N.A.J.); (T.P.M.); (I.D.C.); (A.S.)
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
| | - Ian D. Caterson
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2050, Australia; (A.L.W.-T.); (A.A.G.); (C.H.); (S.M.); (H.A.F.); (M.S.H.H.); (F.Q.d.L.); (N.A.J.); (T.P.M.); (I.D.C.); (A.S.)
| | - Nuala M. Byrne
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS 7250, Australia;
| | - Amanda Sainsbury
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2050, Australia; (A.L.W.-T.); (A.A.G.); (C.H.); (S.M.); (H.A.F.); (M.S.H.H.); (F.Q.d.L.); (N.A.J.); (T.P.M.); (I.D.C.); (A.S.)
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, NSW 2050, Australia
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Harper C, Pattinson AL, Fernando HA, Zibellini J, Seimon RV, Sainsbury A. Effects of obesity treatments on bone mineral density, bone turnover and fracture risk in adults with overweight or obesity. Horm Mol Biol Clin Investig 2017; 28:133-149. [PMID: 27665425 DOI: 10.1515/hmbci-2016-0025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 08/04/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND New evidence suggests that obesity is deleterious for bone health, and obesity treatments could potentially exacerbate this. MATERIALS AND METHODS This narrative review, largely based on recent systematic reviews and meta-analyses, synthesizes the effects on bone of bariatric surgery, weight loss pharmaceuticals and dietary restriction. RESULTS AND CONCLUSIONS All three obesity treatments result in statistically significant reductions in hip bone mineral density (BMD) and increases in bone turnover relative to pre-treatment values, with the reductions in hip BMD being strongest for bariatric surgery, notably Roux-en Y gastric bypass (RYGB, 8%-11% of pre-surgical values) and weakest for dietary restriction (1%-1.5% of pre-treatment values). Weight loss pharmaceuticals (orlistat or the glucagon-like peptide-1 receptor agonist, liraglutide) induced no greater changes from pre-treatment values than control, despite greater weight loss. There is suggestive evidence that liraglutide may increase bone mineral content (BMC) - but not BMD - and reduce fracture risk, but more research is required to clarify this. All three obesity treatments have variable effects on spine BMD, probably due to greater measurement error at this site in obesity, suggesting that future research in this field could focus on hip rather than spine BMD. Various mechanisms have been proposed for BMD loss with obesity treatments, notably reduced nutritional intake/absorption and insufficient exercise, and these are potential avenues for protection against bone loss. However, a pressing outstanding question is whether this BMD reduction contributes to increased fracture risk, as has been observed after RYGB, and whether any such increase in fracture risk outweighs the risks of staying obese (unlikely).
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Maggioni AP, Caterson ID, Urso R, Coutinho W, Finer N, Van Gaal L, Legler UF, Sharma AM, Seimon RV, Sweeting A, Torp-Pedersen C, James WPT. Relation between weight loss and causes of death in patients with cardiovascular disease. J Cardiovasc Med (Hagerstown) 2017; 18:144-151. [DOI: 10.2459/jcm.0000000000000492] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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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Schober G, Lange K, Steinert RE, Hutchison AT, Luscombe-Marsh ND, Landrock MF, Horowitz M, Seimon RV, Feinle-Bisset C. Contributions of upper gut hormones and motility to the energy intake-suppressant effects of intraduodenal nutrients in healthy, lean men - a pooled-data analysis. Physiol Rep 2016; 4:4/17/e12943. [PMID: 27613824 PMCID: PMC5027351 DOI: 10.14814/phy2.12943] [Citation(s) in RCA: 8] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 08/08/2016] [Indexed: 02/07/2023] Open
Abstract
We have previously identified pyloric pressures and plasma cholecystokinin (CCK) concentrations as independent determinants of energy intake following administration of intraduodenal lipid and intravenous CCK. We evaluated in healthy men whether these parameters also determine energy intake in response to intraduodenal protein, and whether, across the nutrients, any predominant gastrointestinal (GI) factors exist, or many factors make small contributions. Data from nine published studies, in which antropyloroduodenal pressures, GI hormones, and GI /appetite perceptions were measured during intraduodenal lipid or protein infusions, were pooled. In all studies energy intake was quantified immediately after the infusions. Specific variables for inclusion in a mixed-effects multivariable model for determination of independent predictors of energy intake were chosen following assessment for collinearity, and within-subject correlations between energy intake and these variables were determined using bivariate analyses adjusted for repeated measures. In models based on all studies, or lipid studies, there were significant effects for amplitude of antral pressure waves, premeal glucagon-like peptide-1 (GLP-1) and time-to-peak GLP-1 concentrations, GLP-1 AUC and bloating scores (P < 0.05), and trends for basal pyloric pressure (BPP), amplitude of duodenal pressure waves, peak CCK concentrations, and hunger and nausea scores (0.05 < P ≤ 0.094), to be independent determinants of subsequent energy intake. In the model including the protein studies, only BPP was identified as an independent determinant of energy intake (P < 0.05). No single parameter was identified across all models, and effects of the variables identified were relatively small. Taken together, while GI mechanisms contribute to the regulation of acute energy intake by lipid and protein, their contribution to the latter is much less. Moreover, the effects are likely to reflect small, cumulative contributions from a range of interrelated factors.
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Affiliation(s)
- Gudrun Schober
- University of Adelaide Discipline of Medicine, Adelaide, Australia
| | - Kylie Lange
- University of Adelaide Discipline of Medicine, Adelaide, Australia NHMRC Centre of Excellence in Translating Nutritional Science to Good Health University of Adelaide, Adelaide, Australia
| | - Robert E Steinert
- University of Adelaide Discipline of Medicine, Adelaide, Australia NHMRC Centre of Excellence in Translating Nutritional Science to Good Health University of Adelaide, Adelaide, Australia
| | - Amy T Hutchison
- University of Adelaide Discipline of Medicine, Adelaide, Australia NHMRC Centre of Excellence in Translating Nutritional Science to Good Health University of Adelaide, Adelaide, Australia South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Natalie D Luscombe-Marsh
- NHMRC Centre of Excellence in Translating Nutritional Science to Good Health University of Adelaide, Adelaide, Australia CSIRO Animal, Food and Health Sciences, Adelaide, Australia
| | - Maria F Landrock
- University of Adelaide Discipline of Medicine, Adelaide, Australia
| | - Michael Horowitz
- University of Adelaide Discipline of Medicine, Adelaide, Australia NHMRC Centre of Excellence in Translating Nutritional Science to Good Health University of Adelaide, Adelaide, Australia
| | - Radhika V Seimon
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, Australia
| | - Christine Feinle-Bisset
- University of Adelaide Discipline of Medicine, Adelaide, Australia NHMRC Centre of Excellence in Translating Nutritional Science to Good Health University of Adelaide, Adelaide, Australia
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Zibellini J, Seimon RV, Lee CMY, Gibson AA, Hsu MSH, Sainsbury A. Effect of diet-induced weight loss on muscle strength in adults with overweight or obesity - a systematic review and meta-analysis of clinical trials. Obes Rev 2016; 17:647-63. [PMID: 27126087 DOI: 10.1111/obr.12422] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 02/26/2016] [Accepted: 04/04/2016] [Indexed: 12/20/2022]
Abstract
We conducted a systematic review and meta-analysis to identify how diet-induced weight loss in adults with overweight or obesity impacts on muscle strength. Twenty-seven publications, including 33 interventions, most of which were 8-24 weeks in duration, were included. Meta-analysis of seven interventions measuring knee extensor strength by isokinetic dynamometry in 108 participants found a significant decrease following diet-induced weight loss (-9.0 [95% confidence interval: -13.8, -4.1] N/m, P < 0.001), representing a 7.5% decrease from baseline values. Meta-analysis of handgrip strength from 10 interventions in 231 participants showed a non-significant decrease (-1.7 [-3.6, 0.1] kg, P = 0.070), with significant heterogeneity (I(2) = 83.9%, P < 0.001). This heterogeneity may have been due to diet type, because there was a significant decrease in handgrip strength in seven interventions in 169 participants involving moderate energy restriction (-2.4 [-4.8, -0.0] kg, P = 0.046), representing a 4.6% decrease from baseline values, but not in three interventions in 62 participants involving very-low-energy diet (-0.4 [-2.0, 1.2] kg, P = 0.610). Because of variability in methodology and muscles tested, no other data could be meta-analyzed, and qualitative assessment of the remaining interventions revealed mixed results. Despite varying methodologies, diets and small sample sizes, these findings suggest a potential adverse effect of diet-induced weight loss on muscle strength. While these findings should not act as a deterrent against weight loss, due to the known health benefits of losing excess weight, they call for strategies to combat strength loss - such as weight training and other exercises - during diet-induced weight loss. © 2016 World Obesity.
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Affiliation(s)
- J Zibellini
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - R V Seimon
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - C M Y Lee
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - A A Gibson
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - M S H Hsu
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - A Sainsbury
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Sydney, Australia
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Gibson AA, Seimon RV, Franklin J, Markovic TP, Byrne NM, Manson E, Caterson ID, Sainsbury A. Fast versus slow weight loss: development process and rationale behind the dietary interventions for the TEMPO Diet Trial. Obes Sci Pract 2016; 2:162-173. [PMID: 27840689 PMCID: PMC5089659 DOI: 10.1002/osp4.48] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/19/2016] [Accepted: 05/02/2016] [Indexed: 11/24/2022] Open
Abstract
Objective and methods Finding effective solutions to curb the obesity epidemic is a great global public health challenge. The need for long‐term follow‐up necessitates weight loss trials conducted in real‐world settings, outside the confines of tightly controlled laboratory or clinic conditions. Given the complexity of eating behaviour and the food supply, this makes the process of designing a practical dietary intervention that stands up to scientific rigor difficult. Detailed information about the dietary intervention itself, as well as the process of developing the final intervention and its underlying rationale, is rarely reported in scientific weight management publications but is valuable and essential for translating research into practice. Thus, this paper describes the design process and underlying rationale behind the dietary interventions in an exemplar weight loss trial – the TEMPO Diet Trial (Type of Energy Manipulation for Promoting optimal metabolic health and body composition in Obesity). This trial assesses the long‐term effects of fast versus slow weight loss on adiposity, fat free mass, muscle strength and bone density in women with obesity (body mass index 30–40 kg m−2) that are 45–65 years of age, postmenopausal and sedentary. Results and conclusions This paper is intended as a resource for researchers and/or clinicians to illustrate how theoretical values based on a hypothesis can be translated into a dietary weight loss intervention to be used in free‐living women of varying sizes.
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Affiliation(s)
- A A Gibson
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre University of Sydney Sydney NSW Australia
| | - R V Seimon
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre University of Sydney Sydney NSW Australia
| | - J Franklin
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre University of Sydney Sydney NSW Australia
| | - T P Markovic
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre University of Sydney Sydney NSW Australia; Metabolism & Obesity Services Royal Prince Alfred Hospital Camperdown NSW Australia
| | - N M Byrne
- Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine Bond University Gold Coast Australia
| | - E Manson
- Metabolism & Obesity Services Royal Prince Alfred Hospital Camperdown NSW Australia
| | - I D Caterson
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre University of Sydney Sydney NSW Australia; Metabolism & Obesity Services Royal Prince Alfred Hospital Camperdown NSW Australia
| | - A Sainsbury
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre University of Sydney Sydney NSW Australia
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Seimon RV, Roekenes JA, Zibellini J, Zhu B, Gibson AA, Hills AP, Wood RE, King NA, Byrne NM, Sainsbury A. Do intermittent diets provide physiological benefits over continuous diets for weight loss? A systematic review of clinical trials. Mol Cell Endocrinol 2015; 418 Pt 2:153-72. [PMID: 26384657 DOI: 10.1016/j.mce.2015.09.014] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [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: 04/21/2015] [Revised: 09/14/2015] [Accepted: 09/15/2015] [Indexed: 01/14/2023]
Abstract
Energy restriction induces physiological effects that hinder further weight loss. Thus, deliberate periods of energy balance during weight loss interventions may attenuate these adaptive responses to energy restriction and thereby increase the efficiency of weight loss (i.e. the amount of weight or fat lost per unit of energy deficit). To address this possibility, we systematically searched MEDLINE, PreMEDLINE, PubMed and Cinahl and reviewed adaptive responses to energy restriction in 40 publications involving humans of any age or body mass index that had undergone a diet involving intermittent energy restriction, 12 with direct comparison to continuous energy restriction. Included publications needed to measure one or more of body weight, body mass index, or body composition before and at the end of energy restriction. 31 of the 40 publications involved 'intermittent fasting' of 1-7-day periods of severe energy restriction. While intermittent fasting appears to produce similar effects to continuous energy restriction to reduce body weight, fat mass, fat-free mass and improve glucose homeostasis, and may reduce appetite, it does not appear to attenuate other adaptive responses to energy restriction or improve weight loss efficiency, albeit most of the reviewed publications were not powered to assess these outcomes. Intermittent fasting thus represents a valid--albeit apparently not superior--option to continuous energy restriction for weight loss.
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Affiliation(s)
- Radhika V Seimon
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Camperdown NSW 2006, Australia
| | - Jessica A Roekenes
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Camperdown NSW 2006, Australia
| | - Jessica Zibellini
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Camperdown NSW 2006, Australia
| | - Benjamin Zhu
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Camperdown NSW 2006, Australia
| | - Alice A Gibson
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Camperdown NSW 2006, Australia
| | - Andrew P Hills
- Centre for Nutrition and Exercise, Mater Research Institute, The University of Queensland, South Brisbane QLD, 4101, Australia
| | - Rachel E Wood
- Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Neil A King
- Queensland University of Technology (QUT), Institute of Health and Biomedical Innovation and School of Exercise and Nutrition Sciences, Brisbane, QLD 4059, Australia
| | - Nuala M Byrne
- Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Amanda Sainsbury
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Camperdown NSW 2006, Australia.
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Zibellini J, Seimon RV, Lee CMY, Gibson AA, Hsu MSH, Shapses SA, Nguyen TV, Sainsbury A. Does Diet-Induced Weight Loss Lead to Bone Loss in Overweight or Obese Adults? A Systematic Review and Meta-Analysis of Clinical Trials. J Bone Miner Res 2015; 30:2168-78. [PMID: 26012544 DOI: 10.1002/jbmr.2564] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [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: 12/29/2014] [Revised: 03/03/2015] [Accepted: 05/02/2015] [Indexed: 12/26/2022]
Abstract
Diet-induced weight loss has been suggested to be harmful to bone health. We conducted a systematic review and meta-analysis (using a random-effects model) to quantify the effect of diet-induced weight loss on bone. We included 41 publications involving overweight or obese but otherwise healthy adults who followed a dietary weight-loss intervention. The primary outcomes examined were changes from baseline in total hip, lumbar spine, and total body bone mineral density (BMD), as assessed by dual-energy X-ray absorptiometry (DXA). Secondary outcomes were markers of bone turnover. Diet-induced weight loss was associated with significant decreases of 0.010 to 0.015 g/cm(2) in total hip BMD for interventions of 6, 12, or 24 (but not 3) months' duration (95% confidence intervals [CIs], -0.014 to -0.005, -0.021 to -0.008, and -0.024 to -0.000 g/cm(2), at 6, 12, and 24 months, respectively). There was, however, no statistically significant effect of diet-induced weight loss on lumbar spine or whole-body BMD for interventions of 3 to 24 months' duration, except for a significant decrease in total body BMD (-0.011 g/cm(2); 95% CI, -0.018 to -0.003 g/cm(2)) after 6 months. Although no statistically significant changes occurred in serum concentrations of N-terminal propeptide of type I procollagen (P1NP), interventions of 2 or 3 months in duration (but not of 6, 12, or 24 months' duration) induced significant increases in serum concentrations of osteocalcin (0.26 nmol/L; 95% CI, 0.13 to 0.39 nmol/L), C-terminal telopeptide of type I collagen (CTX) (4.72 nmol/L; 95% CI, 2.12 to 7.30 nmol/L) or N-terminal telopeptide of type I collagen (NTX) (3.70 nmol/L; 95% CI, 0.90 to 6.50 nmol/L bone collagen equivalents [BCEs]), indicating an early effect of diet-induced weight loss to promote bone breakdown. These data show that in overweight and obese individuals, a single diet-induced weight-loss intervention induces a small decrease in total hip BMD, but not lumbar spine BMD. This decrease is small in comparison to known metabolic benefits of losing excess weight.
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Affiliation(s)
- Jessica Zibellini
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - Radhika V Seimon
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - Crystal M Y Lee
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - Alice A Gibson
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - Michelle S H Hsu
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - Sue A Shapses
- Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ, USA
| | - Tuan V Nguyen
- Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia.,Centre for Health Technologies, University of Technology, Sydney, Ultimo, NSW, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Amanda Sainsbury
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
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Seimon RV, Hostland N, Silveira SL, Gibson AA, Sainsbury A. Effects of energy restriction on activity of the hypothalamo-pituitary-adrenal axis in obese humans and rodents: implications for diet-induced changes in body composition. Horm Mol Biol Clin Investig 2015; 15:71-80. [PMID: 25436734 DOI: 10.1515/hmbci-2013-0038] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 07/23/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND Obesity treatments aim to maximize fat loss, particularly abdominal or visceral fat, without compromising lean or bone mass. However, the literature contains numerous examples of obesity treatments that - in addition to fat loss - result in loss of lean mass and/or bone mass. MATERIALS AND METHODS Because of the known effects of energy restriction to increase activity of the hypothalamo-pitutiary adrenal (HPA) axis in lean humans and animals, and because increases in circulating glucocorticoid levels could potentially contribute to adverse body compositional changes with obesity treatments, we conducted a systematic PubMed search to determine whether HPA axis activation also occurs in response to energy restriction in obese humans and animals. RESULTS AND CONCLUSIONS In most studies in obese humans, short-term severe energy restriction increased circulating cortisol levels, and this response was also seen in two longer-term human studies involving severe or moderate energy restriction. These findings parallel studies on short- or long-term energy restriction in obese rodents, with most studies showing increases in circulating corticosterone concentrations, and no change or actual increases in hypothalamic expression of corticotropin-releasing hormone, urocortin 3 or their receptors. However, a significant proportion of studies involving longer-term severe or moderate energy restriction in obese humans showed no change or decreases in HPA axis function. There was variability among human studies in the duration of energy restriction and timing of the HPA axis investigations (i.e., during energy restriction, or after a period of post-restriction weight maintenance). In order to unambiguously determine changes in HPA axis function with energy restriction in obese humans, it will be important to assess HPA axis function at multiple time points during energy restriction, given that obese individuals may spend many weeks or months in severe or moderate energy restriction in order to reduce excess weight, and given that increases in glucocorticoid function can have significant effects on body composition within weeks to months.
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Affiliation(s)
- Radhika V Seimon
- The Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia
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Sainsbury A, Evans IR, Wood RE, Seimon RV, King NA, Hills AP, Byrne NM. Effect of a 4-week weight maintenance diet on circulating hormone levels: implications for clinical weight loss trials. Clin Obes 2015; 5:79-86. [PMID: 25645138 DOI: 10.1111/cob.12086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 07/27/2014] [Revised: 11/11/2014] [Accepted: 12/10/2014] [Indexed: 11/28/2022]
Abstract
The majority of weight loss studies fail to standardize conditions such as diet and exercise via a weight maintenance period prior to commencement of the trial. This study aimed to determine whether a weight stabilization period is necessary to establish stable baseline hormone concentrations. Fifty-one obese male participants with a body mass index of 30-40 kg m(-2) and aged 25-54 years underwent 4 weeks on an energy balance diet that was designed to achieve weight stability. Blood samples were collected in the fasting state at commencement and completion of the 4-week period, and circulating concentrations of 18 commonly measured hormones were determined. During the 4-week weight maintenance period, participants achieved weight stability within -1.5 ± 0.2 kg (-1.4 ± 0.2%) of their initial body weight. Significant reductions in serum insulin (by 18 ± 6.5%) and leptin (by 21 ± 6.0%) levels occurred, but no significant changes were observed for gut-derived appetite-regulating hormones (ghrelin and peptide YY), nor thyroid, adrenal, gonadal or somatotropic hormones. There were no significant correlations between the change in body weight and the change in circulating concentrations of insulin or leptin over the 4-week period, indicating that the observed changes were not due to weight loss, albeit significant negative correlations were observed between the changes in body weight and plasma ghrelin and peptide YY levels. This study demonstrates the need for baseline weight maintenance periods to stabilize serum levels of insulin and leptin in studies specifically investigating effects on these parameters in the obese. However, this does not apply to circulating levels of gut-derived appetite-regulating hormones (ghrelin and peptide YY), nor thyroid, adrenal, gonadal or somatotropic hormones.
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Affiliation(s)
- A Sainsbury
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Camperdown, Australia; Neuroscience Research Program, Garvan Institute of Medical Research, Darlinghurst, Australia
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Fernando HA, Zibellini J, Hsu MS, Seimon RV, Nguyen AD, Sainsbury A. The neuropeptide Y-ergic system: potential therapeutic target against bone loss with obesity treatments. Expert Rev Endocrinol Metab 2015; 10:177-191. [PMID: 30293515 DOI: 10.1586/17446651.2015.1001741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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] [Indexed: 01/11/2023]
Abstract
Obesity is no longer considered to provide protection against osteoporosis. Moreover, treatments for obesity are now suspected of reducing bone mass. With the escalating incidence of obesity, combined with increases in the frequency, duration and intensity of interventions used to combat it, we face a potential increase in health burden due to osteoporotic fractures. The neuropeptide Y-ergic system offers a potential target for the prevention and anabolic treatment of bone loss in obesity, due to its dual role in the regulation of energy homeostasis and bone mass. Although the strongest stimulation of bone mass by this system appears to occur via indirect hypothalamic pathways involving Y2 receptors (one of the five types of receptors for neuropeptide Y), Y1 receptors on osteoblasts (bone-forming cells) induce direct effects to enhance bone mass. This latter pathway may offer a suitable target for anti-osteoporotic treatment while also minimizing the risk of adverse side effects.
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Affiliation(s)
- Hamish A Fernando
- a 1 The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Camperdown NSW 2006, Australia
| | - Jessica Zibellini
- a 1 The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Camperdown NSW 2006, Australia
| | - Michelle Sh Hsu
- a 1 The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Camperdown NSW 2006, Australia
| | - Radhika V Seimon
- a 1 The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Camperdown NSW 2006, Australia
| | - Amy D Nguyen
- b 2 Neuroscience Program, Garvan Institute of Medical Research, University of New South Wales, Darlinghurst, Australia
| | - Amanda Sainsbury
- a 1 The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Camperdown NSW 2006, Australia
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Gibson AA, Seimon RV, Lee CMY, Ayre J, Franklin J, Markovic TP, Caterson ID, Sainsbury A. Do ketogenic diets really suppress appetite? A systematic review and meta-analysis. Obes Rev 2015; 16:64-76. [PMID: 25402637 DOI: 10.1111/obr.12230] [Citation(s) in RCA: 217] [Impact Index Per Article: 24.1] [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: 08/01/2014] [Revised: 09/05/2014] [Accepted: 09/12/2014] [Indexed: 01/22/2023]
Abstract
Very-low-energy diets (VLEDs) and ketogenic low-carbohydrate diets (KLCDs) are two dietary strategies that have been associated with a suppression of appetite. However, the results of clinical trials investigating the effect of ketogenic diets on appetite are inconsistent. To evaluate quantitatively the effect of ketogenic diets on subjective appetite ratings, we conducted a systematic literature search and meta-analysis of studies that assessed appetite with visual analogue scales before (in energy balance) and during (while in ketosis) adherence to VLED or KLCD. Individuals were less hungry and exhibited greater fullness/satiety while adhering to VLED, and individuals adhering to KLCD were less hungry and had a reduced desire to eat. Although these absolute changes in appetite were small, they occurred within the context of energy restriction, which is known to increase appetite in obese people. Thus, the clinical benefit of a ketogenic diet is in preventing an increase in appetite, despite weight loss, although individuals may indeed feel slightly less hungry (or more full or satisfied). Ketosis appears to provide a plausible explanation for this suppression of appetite. Future studies should investigate the minimum level of ketosis required to achieve appetite suppression during ketogenic weight loss diets, as this could enable inclusion of a greater variety of healthy carbohydrate-containing foods into the diet.
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Affiliation(s)
- A A Gibson
- The Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
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Seimon RV, Espinoza D, Finer N, James PT, Legler UF, Coutinho W, Sharma AM, Van Gaal L, Maggioni AP, Sweeting A, Torp-Pedersen C, Gebski V, Caterson ID. Changes in Body Weight and Pulse: Outcome Events in Overweight and Obese Subjects with Cardiovascular Disease. Obes Res Clin Pract 2014. [DOI: 10.1016/j.orcp.2014.10.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gibson AA, Seimon RV, Lee CM, Ayre J, Franklin J, Markovic T, Caterson I, Sainsbury A. Do ketogenic diets really suppress appetite? A systematic review and meta-analysis. Obes Res Clin Pract 2014. [DOI: 10.1016/j.orcp.2014.10.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Seimon RV, Taylor P, Little TJ, Noakes M, Standfield S, Clifton PM, Horowitz M, Feinle-Bisset C. Effects of acute and longer-term dietary restriction on upper gut motility, hormone, appetite, and energy-intake responses to duodenal lipid in lean and obese men. Am J Clin Nutr 2014; 99:24-34. [PMID: 24196400 DOI: 10.3945/ajcn.113.067090] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND A 4-d 70% energy restriction enhances gastrointestinal sensitivity to nutrients associated with enhanced energy-intake suppression by lipid. To our knowledge, it is unknown whether these changes occur with 30% energy restriction and are sustained in the longer term. OBJECTIVES We hypothesized that 1) a 4-d 30% energy restriction would enhance effects of intraduodenal lipid on gastrointestinal motility, gut hormones, appetite, and energy intake in lean and obese men and 2) a 12-wk energy restriction associated with weight loss would diminish effects of acute energy restriction on responses to lipid in in obese men. DESIGN Twelve obese males were studied before (day 0) and after 4 d (day 5), 4 wk (week 4), and 12 wk (week 12), and 12 lean males were studied before and after 4 d of consumption of a 30% energy-restricted diet. On each study day, antropyloroduodenal pressures, gut hormones, and appetite during a 120-min (2.86-kcal/min) intraduodenal lipid infusion and energy intake at a buffet lunch were measured. RESULTS On day 5, fasting cholecystokinin was less, and ghrelin was higher, in lean (P < 0.05) but not obese men, and lipid-stimulated cholecystokinin and peptide YY and the desire to eat were greater in both groups (P < 0.05), with no differences in energy intakes compared with on day 0. In obese men, a 12-wk energy restriction led to weight loss (9.7 ± 0.7 kg). Lipid-induced basal pyloric pressures (BPPs), peptide YY, and the desire to eat were greater (P < 0.05), whereas the amount eaten was less (P < 0.05), at weeks 4 and 12 compared with day 0. CONCLUSIONS A 4-d 30% energy restriction modestly affects responses to intraduodenal lipid in health and obesity but not energy intake, whereas a 12-wk energy restriction, associated with weight-loss, enhances lipid-induced BPP and peptide YY and reduces food intake, suggesting that energy restriction increases gastrointestinal sensitivity to lipid. This trial was registered at the Australian New Zealand Clinical Trials Registry (www.anzctr.org.au) as 12609000943246.
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Affiliation(s)
- Radhika V Seimon
- University of Adelaide Discipline of Medicine, Royal Adelaide Hospital, Adelaide, Australia (RVS, TJL, SS, MH, and CF-B); the National Health and Medical Research Council of Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide, Australia (RVS, TJL, MN, SS, PMC, MH, and CF-B); the Commomwealth Science and Industry Research Organisation Animal, Food and Health Science, Adelaide, Australia (PT and MN); and the University of South Australia, Adelaide, Australia (PMC)
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Seimon RV, Slack K, Shi Y, Zhang L, Lin S, Enriquez RF, Herzog H, Salis A(S. Intermittent energy restriction improves fat loss efficiency in diet-induced obese mice. Obes Res Clin Pract 2013. [DOI: 10.1016/j.orcp.2013.12.550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Seimon RV, Taylor P, Little TJ, Noakes M, Standfield S, Clifton PM, Horowitz M, Feinle-Bisset C. Effects of acute and longer-term moderate dietary restriction on gut motility, hormone, appetite and energy intake responses to duodenal lipid in lean and obese males. Obes Res Clin Pract 2013. [DOI: 10.1016/j.orcp.2013.12.583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Gibson AA, Seimon RV, Byrne NM, Markovic T, Franklin J, Manson E, Denyer GS, King N, Caterson I, Sainsbury A. Comparing the compensatory responses to moderate and severe energy restrictions during the first 6 months of weight loss: The TEMPO Diet Trial. Obes Res Clin Pract 2013. [DOI: 10.1016/j.orcp.2013.12.635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Seimon RV, Brennan IM, Russo A, Little TJ, Jones KL, Standfield S, Wishart JM, Horowitz M, Feinle-Bisset C. Gastric emptying, mouth-to-cecum transit, and glycemic, insulin, incretin, and energy intake responses to a mixed-nutrient liquid in lean, overweight, and obese males. Am J Physiol Endocrinol Metab 2013; 304:E294-300. [PMID: 23211514 DOI: 10.1152/ajpendo.00533.2012] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [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: 02/07/2023]
Abstract
Observations relating to the impact of obesity on gastric emptying (GE) and the secretion of gut hormones are inconsistent, probably because of a lack of studies in which GE, gastrointestinal hormone release, and energy intake (EI) have been evaluated concurrently with previous patterns of nutrient intake. GE is known to be a major determinant of postprandial glycemia and incretin secretion in health and type 2 diabetes. The aims of this study were to determine the effects of a mixed-nutrient drink on GE, oro-cecal transit, blood glucose, insulin and incretin concentrations and EI, and the relationship between the glycemic response to the drink with GE in lean, overweight, and obese subjects. Twenty lean, 20 overweight, and 20 obese males had measurements of GE, oro-cecal transit, and blood glucose, insulin, GLP-1, and GIP concentrations for 5 h after ingestion of a mixed-nutrient drink (500 ml, 532 kcal); EI at a subsequent buffet lunch was determined. Habitual EI was also quantified. Glycemic and insulinemic responses to the drink were greater in the obese (both P < 0.05) when compared with both lean and overweight, with no significant differences in GE, intragastric distribution, oro-cecal transit, incretins, or EI (buffet lunch or habitual) between groups. The magnitude of the rise in blood glucose after the drink was greater when GE was relatively more rapid (r = -0.55, P < 0.05). In conclusion, in the absence of differences in habitual EI, both GE and incretin hormones are unaffected in the obese despite greater glucose and insulin responses, and GE is a determinant of postprandial glycemia.
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Affiliation(s)
- Radhika V Seimon
- University of Adelaide Discipline of Medicine and National Health and Medical Research Council Centre of Australia Clinical Research Excellence in Nutritional Physiology, Interactions and Outcomes, Adelaide, South Australia, Australia
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Luscombe-Marsh ND, Seimon RV, Bollmeyer E, Wishart JM, Wittert GA, Horowitz M, Bellon M, Feinle-Bisset C. Acute effects of oral preloads with increasing energy density on gastric emptying, gut hormone release, thermogenesis and energy intake, in overweight and obese men. Asia Pac J Clin Nutr 2013; 22:380-90. [PMID: 23945408 DOI: 10.6133/apjcn.2013.22.3.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This study investigated the effect of high- and low-energy density preloads on gastrointestinal and metabolic factors, which act to regulate acute energy intake. Sixteen overweight and obese men (BMI range: 27.2-36.5 kg/m2) each received 3 oral preloads in randomised order: i) high-energy-density, high-fat (1.5 kcal/g), ii) low-energy density, high-fat (1.1 kcal/g), and iii) low-energy-density, high-protein (1.1 kcal/g). Over 180 min, gastric emptying, plasma glucagon-like peptide-1 concentrations, and diet-induced thermogenesis were assessed, and subsequent energy intake was determined. Total energy intake did not differ between preloads (high-energy-density, high-fat, 2059±72 kilocalories (kcal); low-energy-density, high-fat, 1876±91 kcal; and low-energy-density, high protein, 1867±63 kcal). Gastric emptying was slower following the high-energy-density, high-fat preload (158±8 min) compared with the low-energy-density, high-protein preload (130±9 min) (p=0.05), but did not differ between the high-energy-density, high-fat and low-energy-density, high-fat (147±8 min) preloads. Plasma glucagon- like peptide-1 did not differ substantially between preloads. Diet-induced thermogenesis was lower following high-energy-density, high-fat (10.4±0.7 %) than low-energy-density, high-fat (14.9±1.2 %) and low-energy density, high-protein (18.1±1.1 %) preloads (p<0.01 for both). We conclude that an increased energy density slows gastric emptying and reduces thermogenesis, but that a high fat content overrides the effect of energy density on gastric emptying. The counter-regulatory modulation of these gastric and metabolic factors may explain, at least in part, the lack of differences in subsequent energy intake in response to oral preloads with increasing energy density.
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Brennan IM, Luscombe-Marsh ND, Seimon RV, Otto B, Horowitz M, Wishart JM, Feinle-Bisset C. Effects of fat, protein, and carbohydrate and protein load on appetite, plasma cholecystokinin, peptide YY, and ghrelin, and energy intake in lean and obese men. Am J Physiol Gastrointest Liver Physiol 2012; 303:G129-40. [PMID: 22556143 DOI: 10.1152/ajpgi.00478.2011] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [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: 02/07/2023]
Abstract
While protein is regarded as the most satiating macronutrient, many studies have employed test meals that had very high and unsustainable protein contents. Furthermore, the comparative responses between lean and obese subjects and the relationships between energy intake suppression and gut hormone release remain unclear. We evaluated the acute effects of meals with modest variations in 1) fat, protein, and carbohydrate content and 2) protein load on gastrointestinal hormones, appetite, and subsequent energy intake in lean and obese subjects. Sixteen lean and sixteen obese men were studied on four occasions. Following a standardized breakfast, they received for lunch: 1) high-fat (HF), 2) high-protein (HP), 3) high-carbohydrate/low-protein (HC/LP), or 4) adequate-protein (AP) isocaloric test meals. Hunger, fullness, and gut hormones were measured throughout, and at t = 180 min energy intake at a buffet meal was quantified. In lean subjects, hunger was less and fullness greater following HF, HP, and AP compared with HC/LP meals, and energy intake was less following HF and HP compared with HC meals (P < 0.05). In the obese subjects, hunger was less following HP compared with HF, HC/LP, and AP meals, and energy intake was less following HP and AP compared with HF and HC meals (P < 0.05). There were no major differences in hormone responses to the meals among subject groups, but the CCK and ghrelin responses to HP and AP were sustained in both groups. In conclusion, HP meals suppress energy intake in lean and obese subjects, an effect potentially mediated by CCK and ghrelin, while obese individuals appear to be less sensitive to the satiating effects of fat.
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Affiliation(s)
- Ixchel M Brennan
- University. of Adelaide Discipline of Medicine, Royal Adelaide Hospital, North Terrace, Adelaide SA 5000, Australia
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Stewart JE, Seimon RV, Otto B, Keast RSJ, Clifton PM, Feinle-Bisset C. Marked differences in gustatory and gastrointestinal sensitivity to oleic acid between lean and obese men. Am J Clin Nutr 2011; 93:703-11. [PMID: 21310831 DOI: 10.3945/ajcn.110.007583] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Both orosensory stimulation and feedback from the gastrointestinal tract contribute to energy intake regulation. OBJECTIVE We evaluated the hypothesis that overweight or obese subjects would be less sensitive to both oral and intraduodenal oleic acid exposure than would lean subjects. DESIGN Eleven overweight or obese and 8 lean men were studied on 2 occasions, during which antropyloroduodenal pressures, plasma cholecystokinin and peptide YY, and appetite were measured during 90-min intraduodenal infusions of saline or oleic acid (18:1 load: 0.78 kcal/min); energy intake (buffet lunch) was determined immediately afterward. Oral detection thresholds for 18:1 and recent dietary intake (2-d recall) were also quantified. RESULTS In lean subjects, the number of isolated pyloric pressure waves (IPPWs) was greater during 18:1 infusion than during saline infusion (P < 0.05); no significant differences were observed between the 18:1 and saline infusions in the overweight or obese subjects. In both groups, 18:1 stimulated plasma cholecystokinin and peptide YY and suppressed energy intake compared with saline (P < 0.05), with trends for reduced cholecystokinin and energy intake responses in the overweight or obese subjects. Detection thresholds for 18:1 were greater in overweight or obese (7.9 ± 0.1 mmol/L) than in lean (4.1 ± 0.4 mmol/L) subjects (P < 0.05). Overweight or obese subjects had greater recent energy (P < 0.05) and fat (P = 0.07) intakes than did lean subjects. There was a direct relation (r = 0.669) of body mass index with 18:1 detection thresholds and inverse relations (r < -0.51) of IPPWs with body mass index and 18:1 detection thresholds (P < 0.05). CONCLUSIONS The ability to detect oleic acid both orally and within the gastrointestinal tract is compromised in obese men, and oral and gastrointestinal responses to oleic acid are related. This trial was registered at www.actr.org.au (Australian New Zealand Clinical Trials Registry) as 12609000557235.
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Affiliation(s)
- Jessica E Stewart
- University of Adelaide Discipline of Medicine, Royal Adelaide Hospital, Adelaide, Australia
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Brennan IM, Seimon RV, Luscombe-Marsh ND, Otto B, Horowitz M, Feinle-Bisset C. Effects of acute dietary restriction on gut motor, hormone and energy intake responses to duodenal fat in obese men. Int J Obes (Lond) 2011; 35:448-56. [PMID: 20680017 DOI: 10.1038/ijo.2010.153] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [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: 02/07/2023]
Abstract
BACKGROUND Previous patterns of energy intake influence gastrointestinal function and appetite, probably reflecting changes in small-intestinal nutrient-mediated feedback. Obese individuals consume more fat and may be less sensitive to its gastrointestinal and appetite-suppressant effects than lean individuals. OBJECTIVE To evaluate the hypothesis that, in obese individuals, the effects of duodenal fat on gastrointestinal motor and hormone function, and appetite would be enhanced by a short period on a very-low-calorie diet (VLCD). METHODS Eight obese men (body mass index 34±0.6 kg m(-2)) were studied on two occasions, before (V1), and immediately after (V2), a 4-day VLCD. On both occasions, antropyloroduodenal motility, plasma cholecystokinin (CCK), peptide-YY (PYY) and ghrelin concentrations, and appetite perceptions were measured during a 120-min intraduodenal fat infusion (2.86 kcal min(-1)). Immediately afterwards, energy intake was quantified. RESULTS During V2, basal pyloric pressure and the number and amplitude of isolated pyloric pressure waves (PWs) were greater, whereas the number of antral and duodenal PWs was less, compared with V1 (all P<0.05). Moreover, during V2, baseline ghrelin concentration was higher; the stimulation of PYY and suppression of ghrelin by lipid were greater, with no difference in CCK concentration; and hunger and energy intake (kJ; V1: 4378±691, V2: 3634±700) were less (all P<0.05), compared with V1. CONCLUSIONS In obese males, the effects of small-intestinal lipid on gastrointestinal motility and some hormone responses and appetite are enhanced after a 4-day VLCD.
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Affiliation(s)
- I M Brennan
- University of Adelaide Discipline of Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Seimon RV, Lange K, Little TJ, Brennan IM, Pilichiewicz AN, Feltrin KL, Smeets AJ, Horowitz M, Feinle-Bisset C. Pooled-data analysis identifies pyloric pressures and plasma cholecystokinin concentrations as major determinants of acute energy intake in healthy, lean men. Am J Clin Nutr 2010; 92:61-8. [PMID: 20484444 DOI: 10.3945/ajcn.2009.29015] [Citation(s) in RCA: 43] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The interaction of nutrients with the small intestine modulates gastropyloroduodenal motility, stimulates the release of gut hormones, and suppresses appetite and energy intake. OBJECTIVE We evaluated which, if any, of these variables are independent determinants of acute energy intake in healthy, lean men. DESIGN We pooled data from 8 published studies that involved a total of 67 healthy, lean men in whom antropyloroduodenal pressures, gastrointestinal hormones, and perceptions were measured during intraduodenal nutrient or intravenous hormone infusions. In all of the studies, the energy intake at a buffet lunch was quantified immediately after the infusions. To select specific motor, hormone, or perception variables for inclusion in a multivariable mixed-effects model for determination of independent predictors of energy intake, we assessed all variables for collinearity and determined within-subject correlations between energy intake and these variables by using bivariate analyses adjusted for repeated measures. RESULTS Although correlations were shown between energy intake and antropyloroduodenal pressures, plasma hormone concentrations, and gastrointestinal perceptions, only the peak number of isolated pyloric-pressure waves, peak plasma cholecystokinin concentration, and area under the curve of nausea were identified as independent predictors of energy intake (all P < 0.05), so that increases of 1 pressure wave, 1 pmol/L, and 1 mm . min were associated with reductions in energy intake of approximately 36, approximately 88, and approximately 0.4, respectively. CONCLUSION We identified specific changes in gastrointestinal motor and hormone functions (ie, stimulation of pyloric pressures and plasma cholecystokinin) and nausea that are associated with the suppression of acute energy intake.
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Affiliation(s)
- Radhika V Seimon
- University of Adelaide, Discipline of Medicine, Adelaide, South Australia Australia
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Seimon RV, Wooster T, Otto B, Golding M, Day L, Little TJ, Horowitz M, Clifton PM, Feinle-Bisset C. The droplet size of intraduodenal fat emulsions influences antropyloroduodenal motility, hormone release, and appetite in healthy males. Am J Clin Nutr 2009; 89:1729-36. [PMID: 19369371 DOI: 10.3945/ajcn.2009.27518] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The presence of fat in the small intestine modulates gastrointestinal motility, stimulates plasma cholecystokinin and peptide YY release, and suppresses appetite and energy intake. These effects are dependent on the lipolysis of fat. OBJECTIVE Our aim was to evaluate the hypothesis that increasing the droplet size of a fat emulsion would attenuate these effects. DESIGN Ten healthy, lean males were studied on 4 separate occasions in single-blind randomized order. Antropyloroduodenal pressures, plasma triglycerides, cholecystokinin, peptide YY, and appetite were measured during 120-min intraduodenal infusions of fat emulsions comprising 3 different droplet sizes: 1) 0.26 microm (LE-0.26), 2) 30 microm (LE-30), and 3) 170 microm (LE-170) in addition to saline (control). Energy intake at a buffet lunch was quantified immediately after the infusions. RESULTS Increasing the droplet size of the lipid emulsion was associated with diminished suppression of antral (r = 0.75, P < 0.01) and duodenal (r = 0.80, P < 0.01) pressure waves and with stimulation of isolated (r = -0.72, P < 0.01) and basal (r = -0.83, P < 0.01) pyloric pressures. Increasing the droplet size was also associated with attenuation of the stimulation of plasma triglycerides (r = -0.73, P < 0.001), cholecystokinin (r = -0.73, P < 0.001), and peptide YY (r = -0.83, P < 0.001) as well as with reductions in the suppression of hunger (r = 0.75, P < 0.01) and energy intake (r = 0.66, P < 0.001). CONCLUSIONS The acute effects of intraduodenal fat emulsions on gastrointestinal function and appetite are dependent on fat droplet size. These observations have implications for the design of functional foods to maximize effects on those gut functions that are involved in the suppression of appetite.
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Affiliation(s)
- Radhika V Seimon
- University of Adelaide Discipline of Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia
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Seimon RV, Feltrin KL, Meyer JH, Brennan IM, Wishart JM, Horowitz M, Feinle-Bisset C. Effects of varying combinations of intraduodenal lipid and carbohydrate on antropyloroduodenal motility, hormone release, and appetite in healthy males. Am J Physiol Regul Integr Comp Physiol 2009; 296:R912-20. [PMID: 19211720 DOI: 10.1152/ajpregu.90934.2008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Intraduodenal infusions of both lipid and glucose modulate antropyloroduodenal motility and stimulate plasma CCK, with lipid being more potent than glucose. Both stimulate glucagon-like peptide-1, but only lipid stimulates peptide YY (PYY), while only glucose raises blood glucose and stimulates insulin. When administered in combination, lipid and carbohydrate may, thus, have additive effects on energy intake. However, elevated blood glucose levels do not suppress energy intake, and the effect of insulin is controversial. We hypothesized that increasing the ratio of maltodextrin, a complex carbohydrate, relative to lipid would be associated with a reduction in effects on antropyloroduodenal pressures, gut hormones, appetite, and energy intake, when compared with lipid alone. Ten healthy males were studied on three occasions in double-blind, randomized order. Antropyloroduodenal pressures, plasma CCK, PYY and insulin, blood glucose, and appetite were measured during 90-min intraduodenal infusions of 1) 3 kcal/min lipid (L3), 2) 2 kcal/min lipid and 1 kcal/min maltodextrin (L2/CHO1), or 3) 1 kcal/min lipid and 2 kcal/min maltodextrin (L1/CHO2). Energy intake at a buffet lunch consumed immediately after the infusion was quantified. Reducing the lipid (thus, increasing the carbohydrate) content of the infusion was associated with reduced stimulation of basal pyloric pressures (r = 0.76, P < 0.01), plasma CCK (r = 0.66, P < 0.01), and PYY (r = 0.98, P < 0.001), and reduced suppression of antral (r = -0.64, P < 0.05) and duodenal (r = -0.69, P < 0.05) pressure waves, desire-to-eat (r = -0.8, P < 0.001), and energy intake (r = 0.74, P < 0.01), with no differences in phasic (isolated) pyloric pressures. In conclusion, in healthy males, intraduodenal lipid is a more potent modulator of gut function, associated with greater suppression of energy intake, when compared with isocaloric combinations of lipid and maltodextrin.
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Affiliation(s)
- Radhika V Seimon
- University of Adelaide Discipline of Medicine, Royal Adelaide Hospital, Adelaide SA 5000, Australia
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