Gut microbiota in obesity and related complications: Unveiling the complex interplay

In recent years, the obesity epidemic has escalated into a serious public health catastrophe that is only getting worse. However, research into the pathophysiological pathways behind the obesity development and the illnesses that it is associated with is ongoing. In the last decades, it is now clear that the gut microbiota plays a significant role in the genesis and progression of obesity and obesity-related illnesses, particularly changes in its metabolites and composition as obesity progresses. Here, we provide a summary of the processes by which variations in gut metabolite levels and the composition of gut microbiota affect obesity and associated disorders. The bacteria residing in the gut release several chemicals that influence the appetite control, metabolism, and other systems. Since it can either encourage or restrict the deposition of fat in several different ways, the gut microbiota's role in obesity is debatable. Additionally, we go over potential therapeutic approaches that could be utilized to alter gut microbiota composition and focus on the important metabolic pathways associated with obesity and metabolic disorders linked to obesity.

No effect of prefrontal transcranial direct current stimulation (tDCS) on food craving, food reward and subjective appetite in females displaying mild-to-moderate binge-type behaviour

Previous work suggests there may be an effect of transcranial direct current stimulation (tDCS) on appetite control in people at risk of overconsumption, however findings are inconsistent. This study aimed to further understand the potential eating behaviour trait-dependent effect of tDCS, specifically in those with binge-type behaviour. Seventeen females (23 ± 7 years, 25.4 ± 3.8 kg m-2) with mild-to-moderate binge eating behaviour completed two sessions of double-blind, randomised and counterbalanced anodal and sham tDCS applied over the right dorsolateral prefrontal cortex at 2.0 mA for 20 min. Subjective appetite visual analogue scales (VAS), the Food Craving Questionnaire-State (FCQ-S), and Leeds Food Preference Questionnaire (LFPQ) were completed pre- and post-tDCS. Participants then consumed a fixed-energy meal, followed by the VAS, FCQ-S and LFPQ. No difference between pre- and post-tDCS scores were found across fullness (p = 0.275, BF10 = 0.040), prospective consumption (p = 0.127, BF10 = 0.063), desire to eat (p = 0.247, BF10 = 0.054) or FCQ-S measures (p = 0.918, BF10 = 0.040) when comparing active and sham protocols. Only explicit liking and wanting for high-fat sweet foods were significantly different between conditions, with increased scores following active tDCS. When controlling for baseline hunger, the significant differences were removed (p = 0.138 to 0.161, BF10 = 0.810 to 1.074). The present data does not support the eating behaviour trait dependency of tDCS in a specific cohort of female participants with mild-to-moderate binge eating scores, and results align with those from individuals with healthy trait scores. This suggests participants with sub-clinical binge eating behaviour do not respond to tDCS. Future work should further explore effects in clinical and sub-clinical populations displaying susceptibility to overconsumption and weight gain.

Impact of one-day fasting, ketogenic diet or exogenous ketones on control of energy balance in healthy participants

BACKGROUND & AIMS

Oral ketone supplements may mimic the beneficial effects of endogenous ketones on energy metabolism as β-hydroxybutyrate has been proposed to increase energy expenditure and improve body weight regulation. Therefore, our objective was to compare the effects of a one-day isocaloric ketogenic diet, fasting and supplementation with ketone salts on energy expenditure and appetite perception.

METHODS

Eight healthy young adults (4 women, 4 men, age 24 ± 3 years, BMI 24.3 ± 3.1 kg/m²) participated in a randomized cross-over trial with four 24 h-interventions in a whole room indirect calorimeter at a physical activity level of 1.65: (i) total fasting (FAST), (ii) isocaloric ketogenic diet (3.1% energy from carbohydrates (CHO), KETO), (iii) isocaloric control diet (47.4% energy from CHO, ISO), and (iv) ISO supplemented with 38.7 g/d ketone salts (exogenous ketones, EXO). Effects on serum ketone levels (15 h-iAUC), energy metabolism (total energy expenditure, TEE; sleeping energy expenditure, SEE; macronutrient oxidation) and subjective appetite were measured.

RESULTS

Compared to ISO, ketone levels were considerably higher with FAST and KETO and little higher with EXO (all p > 0.05). Total and sleeping energy expenditure did not differ between ISO, FAST and EXO whereas KETO increased TEE (+110 ± 54 kcal/d vs. ISO, p < 0.05) and SEE (+201 ± 90 kcal/d vs. ISO, p < 0.05). CHO oxidation was slightly decreased with EXO compared to ISO (-48 ± 27 g/d, p < 0.05) resulting in a positive CHO balance (p < 0.05). No differences between the interventions were found for subjective appetite ratings (all p > 0.05).

CONCLUSION

A 24 h-ketogenic diet may contribute to maintain a neutral energy balance by increasing energy expenditure. Exogenous ketones in addition to an isocaloric diet did not improve regulation of energy balance.

CLINICAL TRIAL REGISTRATION

NCT04490226 https://clinicaltrials.gov/.

The complex pattern of the effects of prolonged frequent exercise on appetite control, and implications for obesity

From a public health perspective, much of the interest in the relationship between exercise and appetite rests on the implications for energy balance and obesity. Energy balance reflects a dynamic 2-way interaction between energy expenditure (EE) and energy intake (EI). Physical activity and exercise, and appetite are the behavioural components of EE and EI, respectively. Beyond EE, exercise is a powerful and complex physiological stimulus acting on several bodily systems. There are multiple effects of frequent and prolonged exercise on appetite which include inter alia an increase in fasting hunger, an enhancement of post-prandial satiety, a modulation of the hedonic responses to food and improvements in eating behaviour traits. These lead to variable adjustments in EI and in a reduction in the susceptibility to overconsumption. Frequent and prolonged physical activity and exercise behaviour can strengthen and sensitise the appetite control system, whilst physical inactivity and sedentariness (low level of EE) fails to downregulate EI and can permit overconsumption. Not all of the effects of exercise operate uniformly to drive appetite in the same direction. The complexity of the interaction between EE and EI means that the effects of prolonged exercise are characterised by substantial individual heterogeneity. This leads to variable effects on energy balance and body mass.

Emotional Appetite Questionnaire: psychometric properties in Brazilian adult samples before and after the COVID-19 pandemic onset

Background

Appetite represents a desire of a person to eat specific food in order to reach satisfaction and pleasure states. This desire may be associated with the experience of negative or positive emotions (emotional appetite). Emotional appetite can influence eating behavior, and its investigation is relevant to avoid possible damage to health resulting from a disordered eating.

Objectives

To adapt the Emotional Appetite Questionnaire (EMAQ) to the Portuguese language; to assess the validity and reliability of the data; and to assess emotional appetite in three samples of adults collected before and after the outbreak of the COVID-19 pandemic.

Methods

This is a cross-sectional study with non-probabilistic convenience sampling. The Portuguese version of the EMAQ was presented after translation, back-translation, and content analysis. Two studies were conducted, the first before and the second after the pandemic onset. Three samples were formed (2019: Sample 1 (age = 19.7 ± 1.5 years) n = 323; 2020: Sample 2 (age = 21.3 ± 1.8 years) n = 1,011; and Sample 3 (age = 28.9 ± 3.1 years) n = 909). An exploratory strategy with parallel analysis was performed. The analyses were conducted in FACTOR and R (lavaan and semTools packages) software. After determining the best-fit model for the data, emotional appetite was examined considering decrease, non-alteration, and increase in appetite in the face of positive and negative emotions/situations. The profile of emotional appetite was determined using a circumplex model.

Results

The two-factor model described by the valence of emotions/situations fitted the samples (Comparative Fit Index_{minimum-maximum} = 0.95-0.98; Tucker-Lewis Index = 0.94-0.98; Root Mean Square Error of Approximation = 0.03-0.08; α_ord = 0.78-0.88). Increases in appetite were more frequent for positive emotions/situations (52.0-57.5%), and both decreases (35.4-44.5%) and increases (50.0-56.2%) in appetite were observed for negative emotions/situations. Emotions with negative valence and activation were more relevant to appetite reduction, while a significant increase in appetite was observed with anxiety (negative valence and positive activation).

Conclusion

Different emotions and situations may influence appetite in people, and such an investigation may be useful in preparing eating protocols.

Impact of exercise timing on perceived appetite and food reward in early and late chronotypes: An exploratory study in a male Saudi sample

There is very limited evidence on the influence of diurnal exercise timing on appetite control, and none on food reward or how an individual's chronotype could moderate such effects. We examined the impact of acute exercise timing on perceived appetite and food reward in young Saudi adults with early or late chronotypes. Forty-five young adults (23 ± 4 years; BMI = 25.1 ± 4.0 kg/m²) completed the Morningness-Eveningness Questionnaire (MEQ) and were divided into early (score = 59 ± 5) or late (score = 41 ± 6) chronotypes. Participants attended the laboratory after ≥4 h fast on two occasions for an AM (8:00-10:00) and PM (17:00-19:00) 30-min moderate-intensity cycling bout in a randomized counterbalanced order. Appetite ratings and food reward (Arab Leeds Food Preference Questionnaire) were measured before and after exercise. An acute exercise-induced decrease in hunger was found, which appeared to be dependent upon diurnal timing and chronotype, with hunger being more suppressed after AM exercise in the early chronotypes and after PM exercise in the late chronotypes. There was greater wanting for low-fat sweet foods after AM exercise relative to PM exercise, whereas there was greater wanting for high-fat sweet food and sweet relative to savoury food after PM exercise compared to AM exercise. These preliminary findings suggest that diurnal timing of exercise impacts food preferences, and that chronotype may influence the appetite response to an exercise bout at different times of day.

The Data Behind Popular Diets for Weight Loss

Both scientific evidence and popular diet trends have sought to identify the ideal diet for weight loss with strategies focused on either restricting carbohydrates or fat. While there is a strong physiologic rationale for either carbohydrate restriction or fat restriction to achieve a calorie deficit needed for weight loss, evidence from randomized controlled trials suggest either type of diet is effective for weight loss. The level of adherence, rather than macronutrient content, is the driver of successful weight loss.

Effects of Movement Behaviors on Overall Health and Appetite Control: Current Evidence and Perspectives in Children and Adolescents

PURPOSE OF REVIEW

To present the definitions and recommendations for movement behaviors in children and adolescents, including physical activity (PA), sedentary behaviors (SB), and sleep, and to provide an overview regarding their impact on health and obesity outcomes from childhood to adulthood, as well as interactions with appetite control.

RECENT FINDINGS

PA represents a variable proportion of daily energy expenditure and one can be active with high SB or vice versa. Studies have described movements across the whole day on a continuum from sleep to SB to varying intensities of PA. More PA, less SB (e.g., less screen time) and longer sleep are positively associated with indicators of physical health (e.g., lower BMI, adiposity, cardiometabolic risk) and cognitive development (e.g., motor skills, academic achievement). However, less than 10% of children currently meet recommendations for all three movement behaviors. Movement behaviors, adiposity, and related cardiometabolic diseases in childhood track into adolescence and adulthood. Furthermore, low PA/high SB profiles are associated with increased energy intake. Recent studies investigating energy balance regulation showed that desirable movement behavior profiles are associated with better appetite control and improved eating habits. Early identification of behavioral phenotypes and a comprehensive approach addressing all key behaviors that directly affect energy balance will allow for individual strategies to prevent or treat obesity and its comorbidities. Investigating exercise as a potential "corrector" of impaired appetite control offers a promising weight management approach.

Lipopolysaccharide inhibits hypothalamic Agouti-related protein gene expression via activating mechanistic target of rapamycin signaling in chicks

Lipopolysaccharide (LPS) induces profound anorexia in birds. However, the neuronal regulatory network underlying LPS-provoked anorexia is unclear. To determine whether any cross talk occurs among hypothalamic mechanistic target of rapamycin (mTOR) and LPS in the regulation of appetite, we performed an intracerebroventricular injection of rapamycin (an mTOR inhibitor) on LPS-treated chicks. The results indicate that peripheral administrations of LPS decreased the agouti-related protein (AgRP) mRNA level, but increased the phosphorylated mTOR and nuclear factor-кB (NF-кB) protein level. Blocking mTOR significantly attenuated LPS-induced anorexia, AgRP suppression, and p-NF-кB increase. Thus, the results suggest that LPS causes anorexia via the mTOR-AgRP signaling pathway, and mTOR signaling is also associated with the regulation of LPS in p-NF-кB.

The efficacy and safety of setmelanotide in individuals with Bardet-Biedl syndrome or Alström syndrome: Phase 3 trial design

Background

A phase 2 trial has suggested that treatment with the melanocortin-4 receptor (MC4R) agonist setmelanotide is associated with a decrease in hunger and weight-related outcomes in participants with Bardet-Biedl syndrome (BBS) and Alström syndrome. Here, we present the study design of an ongoing, randomized, double-blind, placebo-controlled, phase 3 trial to assess the long-term efficacy and safety of setmelanotide for the treatment of obesity and hyperphagia in individuals with BBS or Alström syndrome (ClinicalTrials.gov identifier: NCT03746522).

Methods

It was initially planned that ~30 participants aged ≥6 years with a clinical diagnosis of BBS or Alström syndrome would be enrolled. Participants with obesity as defined by a body mass index ≥30 kg/m² (in those aged ≥16 years) or a weight >97th percentile (in those aged 6–15 years) are included. Participants are initially randomized in a 1:1 ratio to receive setmelanotide or placebo for 14 weeks (period 1). Following period 1, all participants receive 38 weeks of open-label treatment with setmelanotide (period 2). In each treatment period, setmelanotide is administered at 3 mg once a day following completion of dose escalation. The primary endpoint is the proportion of participants aged ≥12 years achieving a clinically meaningful reduction from baseline (≥10%) in body weight after ~52 weeks (eg, following period 2). Safety and tolerability are assessed by frequency of adverse events.

Conclusions

This pivotal trial is designed to evaluate the efficacy and safety of setmelanotide for the treatment of obesity and hyperphagia in individuals with BBS and Alström syndrome.

Submission category

Study Design, Statistical Design, Study Protocols.

11 and 15-month-old infants do not compensate immediately for energy variation, and no further adjustment occurs 12 or 24 hours later

Previously, we demonstrated that, in the short term, infants undercompensated for the energy from a preload given 25 min before an ad libitum meal. However, although not consistent, there is evidence in young children that caloric adjustment may occur over longer periods. We investigated the extent to which further energy adjustment occurs up to 24 h after a single meal preceded by preloads of varying energy density (ED) in infants that are 11 and 15 months old. Short-term caloric adjustment was measured in 11- and 15-month-old infants through a preload paradigm meal in the laboratory. To assess their caloric adjustment over longer periods (12 and 24 h), we used 24 h dietary records to evaluate the energy intake (EI) after each visit to the laboratory. Three COMPX scores were calculated according to three different time periods after preload consumption (0 h [i.e., short-term], 12 h or 24 h). Our main result was that, on average, regardless of the time period considered, the infants undercompensated their EI after preload consumption: at 11 and 15 months, caloric adjustment was partial and similar overtime. Considering that a slight repeated imbalance of the energy balance may promote rapid weight gain over the first months, this study calls for further research focusing on facilitators and barriers of efficient appetite control abilities in infancy.

The effect of transcranial direct current stimulation (tDCS) on food craving, reward and appetite in a healthy population

The ability to control hedonic appetite is associated with executive functioning, originating in the prefrontal cortex (PFC). These rewarding components of food can override homeostatic mechanisms, potentiating obesogenic behaviours. Indeed, those susceptible to overconsumption appear to have PFC hypo-activation. Transcranial direct current stimulation (tDCS) over the dorsolateral PFC (DLPFC) has been shown to reduce food craving and consumption, potentially via attenuating this reward response. We examined the effects of stimulation on food reward and craving using a healthy-weight cohort. This study is amongst the first to explore the effects of tDCS on explicit and implicit components of reward for different food categories. Twenty-one healthy-weight participants (24 ± 7 years, 22.8 ± 2.3 kg m^-2) completed two sessions involving double-blind, randomised and counterbalanced anodal or sham tDCS over the right DLPFC, at 2 mA for 20 min. Food craving (Food Craving Questionnaire-State), reward (Leeds Food Preference Questionnaire), and subjective appetite (100 mm visual analogue scales) were measured pre- and post-tDCS. Eating behaviour trait susceptibility was assessed using the Three Factor Eating Questionnaire-Short Form, Control of Eating Questionnaire, and Food Craving Questionnaire-Trait-reduced. Stimulation did not alter food craving, reward or appetite in healthy-weight participants who displayed low susceptibility to overconsumption, with low trait craving, good craving control, and low uncontrolled eating and emotional eating behaviour. Implicit and explicit reward were reliable measures of hedonic appetite, suggesting these are robust targets for future tDCS research. These findings suggest that applying tDCS over the DLPFC does not change food reward response in individuals not at risk for overconsumption, and future work should focus on those at risk of overconsumption who may be more responsive to the effects of tDCS on hedonic appetite.

Understanding the interplay between food structure, intestinal bacterial fermentation and appetite control

Epidemiological and clinical evidence highlight the benefit of dietary fibre consumption on body weight. This benefit is partly attributed to the interaction of dietary fibre with the gut microbiota. Dietary fibre possesses a complex food structure which resists digestion in the upper gut and therefore reaches the distal gut where it becomes available for bacterial fermentation. This process yields SCFA which stimulate the release of appetite-suppressing hormones glucagon-like peptide-1 and peptide YY. Food structures can further enhance the delivery of fermentable substrates to the distal gut by protecting the intracellular nutrients during upper gastrointestinal digestion. Domestic and industrial processing can disturb these food structures that act like barriers towards digestive enzymes. This leads to more digestible products that are better absorbed in the upper gut. As a result, less resistant material (fibre) and intracellular nutrients may reach the distal gut, thus reducing substrates for bacterial fermentation and its subsequent benefits on the host metabolism including appetite suppression. Understanding this link is essential for the design of diets and food products that can promote appetite suppression and act as a successful strategy towards obesity management. This article reviews the current evidence in the interplay between food structure, bacterial fermentation and appetite control.

Appetite control and exercise: Does the timing of exercise play a role?

The prevention and management of chronic diseases, particularly overweight and obesity, relies on multidisciplinary strategies mainly combining dietary approaches with physical activity. Recently, the timing of exercise (time of the day as well as delay/position relative to a meal) has been suggested as an important parameter to consider when prescribing physical activity. Some studies have for instance shown the interest of the timing of exercise on the glycemia, sleep and body composition regulation. However, the impact of exercise-timing on appetite control and energy intake remains unclear. This is why, the present paper questions whether physical exercise, depending on its timing during the day and related to a meal, can affect energy intake, appetite sensations and food reward. Although evidences remain actually limited, exercising during the morning; and particularly close to lunch, might have a better impact on overall energy balance through reduced subsequent energy intake, without leading to compensatory intakes at the following meals. Importantly, dealing with the timing of exercise to optimize energy balance (and affect energy intake and appetite) does not only require to consider its time during the day (morning vs. afternoon or evening), but also and maybe mainly its order/position (pre vs. post) and delay regarding meals. While the actual literature remains limited in this area, the present paper tends to highlight the importance of considering the timing of exercise to optimize our impact on the overall energy balance, and to encourage the elaboration of further studies to better understand and determine the potential effect of this timing of exercise, in order to find the best combination between the different exercise characteristics, intensity, duration, modality, to empower these effects.

Issues in Measuring and Interpreting Human Appetite (Satiety/Satiation) and Its Contribution to Obesity

PURPOSE OF REVIEW

The goals of this paper are to report current research practices in investigations of human appetite control and to assess their relationships with emerging theoretical principles. Appetite is often distinguished by the separation of homeostatic and hedonic processes.

RECENT FINDINGS

This report assesses the validity of a homeostatic toolkit to measure subjectively perceived hunger and its relationship to the developing processes of satiation (control of meal size) and satiety (control of the post-eating period). The capacity of a procedure to measure the influence of hedonic processes on food intake is also evaluated. A major issue is the relationship between the pattern of eating behaviour (influenced by the underlying drive to eat and the inhibition induced by the act of eating itself) and the parallel underlying profile of hormonal and other metabolic biomarkers. Increasing recognition is being given to individual variability in the expression of appetite, and the fact that the use of the average (mean) response conceals important information about the nature of appetite control. There is a growing interest in the identification of satiety phenotypes that operate in parallel to metabolic phenotypes. Interestingly, energy expenditure (metabolic and behavioural) contributes to an energy balance framework for understanding energy intake (appetite).

Milk protein enriched beverage reduces post-exercise energy intakes in women with higher levels of cognitive dietary restraint

OBJECTIVE

The aim of this study was to assess the satiating efficacy of milk proteins compared to carbohydrates in twenty women during post-exercise period.

METHODS

A milk protein-enriched beverage (MPB), and an isocaloric carbohydrate-enriched beverage (CB) containing respectively 9.3g and 0.3g of milk proteins per 100mL beverage, were developed and tested in a satiety study with 20 free-living healthy and normal weight women. The participants drank 250mL of the two beverages after an aerobic exercise session, filled daily food diaries and rated their appetite on visual analogue scale (VAS), in two days over three consecutive weeks. A psychometric evaluation of eating behaviour was obtained by three-factor eating questionnaire (TFEQ).

RESULTS

No differences in appetite feelings and energy intakes between MPB and CB were found in the study population. However, 9 participants were significantly less hungry (-9% vs+15%, p 0.03) and ate later (208min vs 127min, p 0.03) and less (-10% vs+8% daily energy intake, p 0.01) when they had MPB than CB. These women had a slightly higher BMI and were more restrained than the others.

CONCLUSIONS

Data showed that MPB compared to CB could modify daily eating habits by enhancing satiety in women with a stronger cognitive control of eating behaviour.

Brain functional imaging in obese and diabetic patients

Obesity and type 2 diabetes are associated with greater risk of brain damage. Over the last decade, functional imaging techniques (functional magnetic resonance imaging, fMRI, positron emission tomography, PET, electroencephalography, magnetoencephalography, near infrared spectroscopy) have been exploited to better characterize behavioral and cognitive processes, by addressing cerebral reactions to a variety of stimuli or tasks, including hormones and substrates (e.g., glucose, insulin, gut peptides), environmental cues (e.g., presentation of sensory stimuli), and cognitive tasks. Among these techniques, fMRI and PET are most commonly used, and this review focuses on results obtained with these techniques in relation to brain substrate metabolism, appetite control and food intake, and cognitive decline in obesity and type 2 diabetes. The available knowledge indicates that there are a series of cerebral abnormalities associating with, or preceding obesity and type 2 diabetes, including impaired substrate handling, insulin resistance, disruption of inter-organ cross-talk and of resting state networking. Some of these abnormalities are reversed by metabolic interventions, suggesting that they are partly a consequence rather than cause of disease. Therefore, causal implications and mechanisms remain to be determined.

Portion size influences intake in Samburu Kenyan people not exposed to the Western obesogenic environment

For people in the modernized food environment, external factors like food variety, palatability, and ubiquitous learned cues for food availability can overcome internal, homeostatic signals to promote excess intake. Portion size is one such external cue; people typically consume more when served more, often without awareness. Though susceptibility to external cues may be attributed to the modernized, cue-saturated environment, there is little research on people living outside that context, or with distinctly different food norms. We studied a sample of Samburu people in rural Kenya who maintain a traditional, semi-nomadic pastoralist lifestyle, eat a very limited diet, and face chronic food insecurity. Participants (12 male, 12 female, aged 20-74, mean BMI = 18.4) attended the study on two days and were provided in counterbalanced order an individual serving bowl containing 1.4 or 2.3 kg of a familiar bean and maize stew. Amount consumed was recorded along with post-meal questions in their dialect about their awareness of intake amount. Data were omitted from two participants who consumed the entire portion in a session. Even though the 'smaller' serving was a very large meal, participants consumed 40% more when given the larger serving, despite being unable to reliably identify which day they consumed more food. This result in the Samburu demonstrates the portion size effect is not a by-product of the modern food environment and may represent a more fundamental feature of human dietary psychology.

Structured, aerobic exercise reduces fat mass and is partially compensated through energy intake but not energy expenditure in women

BACKGROUND

Exercise-induced weight loss is often less than expected and highly variable in men and women. Behavioural compensation for the exercise-induced energy deficit could be through energy intake (EI), non-exercise physical activity (NEPA) or sedentary behaviour (SB). We investigated this issue in women.

METHODS

Twenty-four overweight [body mass index (BMI) M = 27.9 kg/m², SD = 2.7] women [age M = 33.1 years, SD = 11.7] completed 12-weeks of supervised exercise (5×500kcal per week) in a non-randomised, pre-post intervention study. Body mass (BM), waist circumference (WC), body composition, resting metabolic rate (RMR), total daily EI, individual meals, appetite sensations and appetite-related peptides were measured at baseline (week 0) and post-intervention (week 12). Free-living physical activity (PA) and SB were measured (SenseWear) at baseline, week 1 and 10 of the exercise intervention, and at post-intervention (week 13).

RESULTS

Following the 12-week exercise intervention BM [p = .04], BMI [p = .035], WC [p < .001] and fat mass (FM) [p = .003] were significantly reduced, and fat-free mass (FFM) significantly increased [p = .003]. Total [p = .028], ad libitum [p = .03] and snack box EI [p = .048] were significantly increased and this was accompanied by an increase in hunger [p = .01] and a decrease in fullness [p = .03] before meals. The peptides did not explain changes in appetite [p > .05]. There was no compensatory reduction in NEPA [p > .05] and no increase in SB, rather there was a decrease in SB during the exercise intervention [p = .03].

CONCLUSIONS

Twelve-weeks of supervised aerobic exercise resulted in a significant reduction in FM and an increase in FFM. Exercise increased hunger and EI which only partially compensated for the increase in energy expenditure. There was no evidence for a compensatory reduction in NEPA or an increase in SB. Dietary intervention, as an adjunct to exercise, may offset the compensatory increase in EI and result in a greater reduction in BM.

TRIAL REGISTRATION

Our trial was retrospectively registered on the International Standard Randomised Controlled Trials Registry (ISRCTN78021668, 27th September 2016) and can be found here: https://doi.org/10.1186/ISRCTN78021668.

The influence of claims of appetite control benefits in those trying to lose or maintain weight: The role of claim believability and attitudes to functional foods

Functional foods which enhance satiety and hence offer appetite control can support weight loss efforts, but consumers' perceptions of such products are not fully understood. Urban-dwelling Australian consumers (n = 1629) trying to lose or to maintain weight rated written product concepts offering appetite control benefits for purchase intent and believability. In general, all product concepts were rated moderately for purchase intent, although products that were more likely to be commonly consumed, and that were a solid format received significantly higher ratings. Believability of product concept statements was found to vary significantly depending on product category. Compared to consumers trying to maintain their weight, consumers actively trying to lose weight tended to rate product concepts higher for purchase intent, despite similar scores for believability of concept. Age, gender and a sceptical attitude towards functional foods did not tend to strongly influence purchase intent and believability of product concepts offering appetite control. Actively trying to lose or maintain weight also had little influence over the degree to which consumers believed the product concept would deliver the benefits it was claiming. The association between a positive attitude towards functional foods and both purchase intent and believability was significant across all product concept categories, although the impact on purchase intent was largely mediated through believability. In assessing information provided about the active ingredients and functionality of the products, consumers rated as the two most important attributes that the products were clinically tested and that the active ingredient was derived from fruits and vegetables. In a broader perspective, careful communication of the clinical efficacy and effective consumption of appetite control products to assist with weight loss seems warranted.

mRNA expression and metabolic regulation of npy and agrp1/2 in the zebrafish brain

Neuropeptide Y (NPY) is an evolutionarily conserved neuropeptide implicated in feeding regulation in vertebrates. In mammals, NPY neurons coexpress Agouti-related protein (AgRP) in the arcuate nucleus of the hypothalamus, and NPY/AgRP neurons activate orexigenic signaling to increase food intake. Zebrafish express npy and two agrp genes, agrp1 and agrp2, in the brain. Similar to mammals, NPY and AgRP1 act as orexigenic factors in zebrafish, but the exact distribution of NPY and AgRP neurons in the zebrafish brain and the regulation of these genes by metabolic states remain unclear. In this study, we analyzed the tissue distribution of npy, agrp1, and agrp2 mRNA in the brain of larval and adult zebrafish. We detected the expression of agrp1, but not npy, in the hypothalamus of larval zebrafish. In the adult zebrafish brain, npy mRNA expression was detected in the dorsal area of the periventricular and lateral hypothalamus, but fasting induced upregulation of npy only in the lateral hypothalamus, indicating that NPY neurons in this area are implicated in feeding regulation. However, consistent with the findings in larval zebrafish, NPY neurons in the hypothalamus did not coexpress AgRP1. In contrast, fasting resulted in a dramatic increase in AgRP1 neurons in the ventral periventricular hypothalamus, which do not coexpress NPY. In addition, we found for the first time that npy- and agrp1-expressing neurons function as GABAergic inhibitory neurons in zebrafish, as they do in mammals. Taken together, our results show that the zebrafish NPY/AgRP system is involved in appetite regulation. In addition, our data suggest that although npy and agrp1 were initially expressed in distinct neurons, evolution has resulted in their coexpression in mammalian hypothalamic neurons.

The role of low-calorie sweeteners in the prevention and management of overweight and obesity: evidence v. conjecture

By virtue of reducing dietary energy density, low-calorie sweeteners (LCS) can be expected to decrease overall energy intake and thereby decrease body weight. Such effects will be limited by the amount of sugar replaced by LCS, and the dynamics of appetite and weight control (e.g., acute compensatory eating, and an increase in appetite and decrease in energy expenditure accompanying weight loss). Consistent with these predictions, short-term intervention studies show incomplete compensation for the consumption of LCS v. sugar, and longer-term intervention studies (from 4 weeks to 40 months duration) show small decreases in energy intake and body weight with LCS v. sugar. Despite this evidence, there are claims that LCS undermine weight management. Three claims are that: (1) LCS disrupt the learned control of energy intake (sweet taste confusion hypothesis); (2) exposure to sweetness increases desire for sweetness (sweet tooth hypothesis); (3) consumers might consciously overcompensate for 'calories saved' when they know they are consuming LCS (conscious overcompensation hypothesis). None of these claims stands up to close examination. In any case, the results of the intervention studies comparing LCS v. sugar indicate that the effect of energy dilution outweighs any tendency LCS might conceivably have to increase energy intake.

Baby-Led Weaning: The Evidence to Date

PURPOSE OF REVIEW

Infants are traditionally introduced to solid foods using spoon-feeding of specially prepared infant foods.

RECENT FINDINGS

However, over the last 10-15 years, an alternative approach termed 'baby-led weaning' has grown in popularity. This approach involves allowing infants to self-feed family foods, encouraging the infant to set the pace and intake of the meal. Proponents of the approach believe it promotes healthy eating behaviour and weight gain trajectories, and evidence is starting to build surrounding the method. This review brings together all empirical evidence to date examining behaviours associated with the approach, its outcomes and confounding factors.

SUMMARY

Overall, although there is limited evidence suggesting that a baby-led approach may encourage positive outcomes, limitations of the data leave these conclusions weak. Further research is needed, particularly to explore pathways to impact and understand the approach in different contexts and populations.

Appetite control by the tongue-gut axis and evaluation of the role of CD36/SR-B2

Understanding the mechanisms governing food intake is a public health issue given the dramatic rise of obesity over the world. The overconsumption of tasty energy-dense foods rich in lipids is considered to be one of the nutritional causes of this epidemic. Over the last decade, the identification of fatty acid receptors in strategic places in the body (i.e. oro-intestinal tract and brain) has provided a major progress in the deciphering of regulatory networks involved in the control of dietary intake. Among these lipid sensors, CD36/SR-B2 appears to play a significant role since this membrane protein, known to bind long-chain fatty acid with a high affinity, was specifically found both in enterocytes and in a subset of taste bud cells and entero-endocrine cells. After a short overview on CD36/SR-B2 structure, function and regulation, this mini-review proposes to analyze the key findings about the role of CD36/SR-B2 along of the tongue-gut axis in relation to appetite control. In addition, we discuss whether obesogenic diets might impair lipid sensing mediated by CD36/SR-B2 along this axis.

Impact of physical activity level and dietary fat content on passive overconsumption of energy in non-obese adults

Background

Passive overconsumption is the increase in energy intake driven by the high-fat energy-dense food environment. This can be explained in part because dietary fat has a weaker effect on satiation (i.e. process that terminates feeding). Habitually active individuals show improved satiety (i.e. process involved in post-meal suppression of hunger) but any improvement in satiation is unknown. Here we examined whether habitual physical activity mitigates passive overconsumption through enhanced satiation in response to a high-fat meal.

Methods

Twenty-one non-obese individuals with high levels of physical activity (HiPA) and 19 individuals with low levels of physical activity (LoPA) matched for body mass index (mean = 22.8 kg/m²) were recruited. Passive overconsumption was assessed by comparing ad libitum energy intake from covertly manipulated high-fat (HFAT; 50% fat) or high-carbohydrate (HCHO; 70% carbohydrate) meals in a randomized crossover design. Habitual physical activity was assessed using SenseWear accelerometers (SWA). Body composition, resting metabolic rate, eating behaviour traits, fasting appetite-related peptides and hedonic food reward were also measured.

Results

In the whole sample, passive overconsumption was observed with greater energy intake at HFAT compared to HCHO (p < 0.01), without any differences between activity groups (p > 0.05). SWA confirmed that HiPA were more active than LoPA (p < 0.01). HiPA had lower body fat and greater fat-free mass than LoPA (p < 0.05 for both) but did not differ in resting metabolic rate, eating behaviour traits, appetite-related peptides or food reward (p > 0.05 for all).

Conclusions

Non-obese individuals with high or low physical activity levels but matched for BMI showed similar susceptibility to passive overconsumption when consuming an ad libitum high-fat compared to a high-carbohydrate meal. This occurred despite increased total daily energy expenditure and improved body composition in HiPA. Greater differences in body composition and/or physical activity levels may be required to impact on satiation.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-017-0473-3) contains supplementary material, which is available to authorized users.

The link between hypothalamic epigenetic modifications and long-term feeding control

The incidence of obesity, one of the main risks for type 2 diabetes and cardiovascular disease, has been rising, and changes in eating behavior are associated with this increasing rate. Body weight is maintained via a complex integration of endocrine and neuronal inputs that regulate the control of orexigenic and anorexigenic neuropeptides in the arcuate nucleus of the hypothalamus. Overfeeding may disrupt the mechanisms of feeding control, increasing orexigenic peptides such as neuropeptide Y (NPY), and/or decreasing the anorexigenic peptide proopiomelanocortin (POMC) leading to a change in energy balance and body-weight index. Despite of the great interest in this field, the mechanism by which expression of POMC and NPY is modified is not entirely clear. Over the past decades, studies have demonstrated that epigenetic modifications such as DNA methylation, histone modification and changes in miRNA dynamics, could be modulated by external stimuli and these could affect protein expression in different cells. Therefore, this review discusses the recent reports that link epigenetic modifications in the hypothalamus to changes on long-term feeding control and its role in the onset of obesity.

Potential anti-obesity effects of a long-acting cocaine hydrolase

A long-acting cocaine hydrolase, known as CocH3-Fc(M3), engineered from human butyrylcholinesterase (BChE) was tested, in this study, for its potential anti-obesity effects. Mice on a high-fat diet gained significantly less body weight when treated weekly with 1 mg/kg CocH3-Fc(M3) compared to control mice, though their food intake was similar. There is no correlation between the average body weight and the average food intake, which is consistent with the previously reported observation in BChE knockout mice. In addition, molecular modeling was carried out to understand how ghrelin binds with CocH3, showing that ghrelin binds with CocH3 in a similar mode as ghrelin binding with wild-type human BChE. The similar binding structures explains why CocH3 and BChE have similar catalytic activity against ghrelin.

Food intake and appetite control in a GH-transgenic zebrafish

The biological actions of growth hormone (GH) are pleiotropic, including growth promotion, energy mobilization, gonadal development, appetite, and social behavior. The regulatory network for GH is complex and includes many central and peripheral endocrine factors as well as that from the environment. It is known that GH transgenesis results in increased growth, food intake, and consequent metabolic rates in fishes. However, the manner in which GH transgenesis alters the energetic metabolism in fishes has not been well explored. In order to elucidate these consequences, we examined the effect of GH overexpression on appetite control mechanisms in a transgenic zebrafish (Danio rerio) model. To this, we analyzed feeding behavior and the expression of the main appetite-related genes in two different feeding periods (fed and fasting) in non-transgenic (NT) and transgenic (T) zebrafish as well as glycaemic parameters of them. Our initial results have shown that NT males and females present the same feeding behavior and expression of main appetite-controlling genes; therefore, the data of both sexes were properly grouped. Following grouped data analyses, we compared the same parameters in NT and T animals. Feeding behavior results have shown that T animals eat significantly more and faster than NT siblings. Gene expression results pointed out that gastrointestinal (GT) cholecystokinin has a substantial contribution to the communication between peripheral and central control of food intake. Brain genes expression analyses revealed that T animals have a down-regulation of two strong and opposite peptides related to food intake: the anorexigenic proopiomelanocortin (pomc) and the orexigenic neuropeptide Y (npy). The down-regulation of pomc in T when compared with NT is an expected result, since the decrease in an anorexigenic factor might keep the transgenic fish hungry. The down-regulation of npy seemed to be contradictory at first, but if we consider the GH's capacity to elevate blood glucose, and that NPY is able to respond to humoral factors like glucose, this down-regulation makes sense. In fact, our last experiment showed that transgenics presented elevated blood glucose levels, confirming that npy might responded to this humoral factor. In conclusion, we have shown that GT responds to feeding status without interference of transgenesis, whereas brain responds to GH transgenesis without any effect of treatment. It is clear that transgenic zebrafish eat more and faster, and it seems that it occurs due to pomc down-regulation, since npy might be under regulation of the humoral factor glucose.

A Mediterranean-like breakfast affects energy intake and appetite-related feelings

Energy intake and appetite feelings after the consumption of two different types of breakfast, a high-fiber, traditional, Mediterranean-type breakfast and a low-fiber, Western-type breakfast were compared. Sixteen non-obese young men received the two treatments on separate days: the Mediterranean- and the Western-type breakfasts were isocaloric, similar in volume and macronutrient content, but different in fiber content. Following a 4-hour fast, subjects offered an ad libitum lunch. Food consumed and subjective feelings of hunger, fullness, and desire to eat were evaluated. Energy intake in the ad libitum lunch was significantly lower after the Mediterranean-type, compared to the Western-type breakfast, adjusting for previous day's energy intake (1488 ± 468 versus 1674 ± 416 kcal, respectively), whereas no energy compensation was made throughout the day. Furthermore, those who had the Mediterranean-type breakfast reported lower values in the desire to eat during study's course. These findings propose a fulfilling effect of a traditional, Mediterranean, high in fiber breakfast.

New centrally acting agents for appetite control: from biological mechanisms to clinical efficacy

BACKGROUND

Obesity is one of the major problems of health policy in different countries. Pharmacological attempts have been made to help affected people without a definitive solution. Some agents--either with peripheral or central effect--are available in the market. On July 2012, the FDA approved two novel preparations for obese patients: (1) topiramate-phentermine--the first one an anticonvulsant and the second one a sympathomimetic amine--and (2) lorcaserin, a 5-HT2CR agonist. Both preparations emerged as new options for weight management.

SCOPE

Based on the complex biology of eating behavior, in this review we discuss the features, mechanisms of action, pharmacokinetics, advantages and possible disadvantages of these new agents.

CONCLUSION

With differences in efficacy (higher for the topiramate-phentermine combination), both preparations are active in reducing appetite and body weight, as well as in improving comorbidities. Additional information will be collected from Phase IV surveillance. Focus on cardiovascular, neuropsychiatric (for both introductions) and embrio-fetal safety (especially for topiramate) is expected.