Caloric Balance Research Articles

Circulating SIRT1 Increases After Intragastric Balloon Fat Loss in Obese Patients.

Sirtuins (SIRTs), ubiquitous deacetylases, are main regulators of energy homeostasis and metabolism. SIRT1 has a positive impact on obesity, diabetes mellitus, liver steatosis, and other metabolic disorders. Lean subjects have higher expression of SIRT1 in the adipose tissue compared to obese. However, it is not known whether weight loss associates with changes in blood SIRT1. We evaluated the effect of weight loss on circulating SIRT1, metabolic parameters, and body composition. Thirty-two obese subjects were studied before and 6months after BioEnterics® Intragastric Balloon (BIB®) [22 patients, BMI 41.82 ± 6.28kg/m(2)] or hypocaloric diet [10 patients, BMI 38.95 ± 6.90kg/m(2)]. Plasma SIRT1, body composition, measures of metabolic syndrome (waist circumference, fasting plasma glucose, blood pressure, HDL cholesterol, triglycerides), and inflammation markers (ESR, CRP, fibrinogen) were recorded. SIRT1 levels showed a significant increase, together with a significant reduction of BMI, excess body weight, and total fat mass either after BIB or diet intervention. The percent excess body weight loss was 33.73 ± 19.06 and 22.08 ± 11.62% after BIB and diet, respectively, a trend toward a metabolic and inflammatory amelioration was observed with both treatments. Negative correlation between SIRT1 and % fat mass (BIB, ρ = -0.537, p = 0.017; diet, ρ = -0.638, p = 0.047) was also seen. The reduction of fat mass associates with increased plasma SIRT1 indicating that, besides tissue levels, circulating SIRT1 is stimulated by a negative caloric balance. The rise of plasma SIRT1 may represent a parameter associating with fat loss rather than weight lowering regardless of the weight reduction system method used.

Energy Balance After Sodium-Glucose Cotransporter 2 Inhibition.

OBJECTIVESodium–glucose cotransporter 2 (SGLT2) inhibitors cause substantially less weight loss than expected from the energy excreted via glycosuria. Our aim was to analyze this phenomenon quantitatively.RESEARCH DESIGN AND METHODSEighty-six patients with type 2 diabetes (HbA1c 7.8 ± 0.8% [62 ± 9 mmol/mol], estimated glomerular filtration rate [eGFR] 89 ± 19 mL ⋅ min−1 ⋅ 1.73 m−2) received empagliflozin (25 mg/day) for 90 weeks with frequent (n = 11) assessments of body weight, eGFR, and fasting plasma glucose (FPG). Time-dependent glucose filtration was calculated as the product of eGFR and FPG; time-dependent glycosuria was estimated from previous direct measurements. The relation of calorie-to-weight changes was estimated using a mathematical model of human energy metabolism that simulates the time course of weight change for a given change in calorie balance and calculates the corresponding energy intake changes.RESULTSAt week 90, weight loss averaged −3.2 ± 4.2 kg (corresponding to a median calorie deficit of 51 kcal/day [interquartile range (IQR) 112]). However, the observed calorie loss through glycosuria (206 kcal/day [IQR 90]) was predicted to result in a weight loss of –11.3 ± 3.1 kg, assuming no compensatory changes in energy intake. Thus, patients lost only 29 ± 41% of the weight loss predicted by their glycosuria; the model indicated that this difference was accounted for by a 13% (IQR 12) increase in calorie intake (269 kcal/day [IQR 258]) coupled with a 2% (IQR 5) increase in daily energy expenditure (due to diet-induced thermogenesis). This increased calorie intake was inversely related to baseline BMI (partial r = −0.34, P < 0.01) and positively to baseline eGFR (partial r = 0.29, P < 0.01).CONCLUSIONSChronic glycosuria elicits an adaptive increase in energy intake. Combining SGLT2 inhibition with caloric restriction is expected to be associated with major weight loss.

Nourrir un patient atteint de troubles neurocognitifs à l’hôpital et à domicile ? Le manger-mains : aspects pratiques

In the elderly, Alzheimer's and related diseases increase the high prevalence of undernutrition, itself accountable of decompensation of geriatric frailty criteria. The finger-food is composed of appetizer served individually, which can be grasped with the hands and eaten in one bite. It is described as a food intake rehabilitation whose main objective is to improve the quality and quantity of calorie balance. The multidisciplinary evaluation will induce the choice of the type of food morsel (classical, smooth mixed or eat-standing) depending on the clinical form of neurocognitive disorders, the existence of swallowing disorders, customs or beliefs, logistical difficulties inherent to the place of living and the availability of carers or caregivers. However, despite positive assessment by the teams having established the finger-food, no tangible evidence of its efficiency has been found in the scientific literature. Thus, the development of its use, including the homes of people with dementia diseases, and education among health professionals promote opportunities to attest the nutritional and cognitive behavioral impacts.

Sentido y aflicción en torno a la desnutrición infantil. Experiencia y narratividad entre los ch’orti’ de Guatemala

In opposition to the biomedical discourse, the Ch’orti’ construction of malnutrition—the indigenous version of illness—has been shaped through representations that highlight «lack of care» and maternal responsibility rather than «lack of food.» This paper explores the ethnography of malnutrition in this region of eastern Guatemala, through an analysis of the relationship between the narratives and experiences of mothers with children who have suffered from malnutrition. Despite energetic attempts at «health and nutrition education,» the narratives tend to place the biomedical discourse of caloric balances in a marginal position. The ethnography proposed here seeks to provide clues to understanding this issue, tackling the density of its meaning and defining malnutrition as a matter of symbolic and political balances.

The Effect of Resistance Training on the Resting Metabolic Rates of Apparently Healthy Adult Women

Recent literature has suggested that resting metabolic rate (RMR) significantly contributes to total daily energy expenditure. Total daily energy expenditure impacts caloric balance. Literature has also suggested that aerobic and anaerobic physical activity can increase RMR, and that RMR is positively correlated to lean muscle mass. PURPOSE: This study examined the effects of six weeks of functional resistance training on the RMR in apparently healthy adult women (n=20), and examined the effects of age and body mass index (BMI) on change in RMR after training. METHODS: Participants in this study were females between 35 and 60 years of age, and had a BMI between 18.5kg/m2 and 39.9kg/m2. All participants had body composition and RMR examined before and after a 6 week resistance training program to determine if any changes had resulted from the training. Changes in absolute and relative RMR were compared by age group (35-50 and 51-60) and BMI category (18.5-24.9 kg/m2, 25-29.9 kg/m2, and 30-39.9 kg/m2). RESULTS: Results are expressed as Mean ±Standard Deviation. Results indicated a significant increase in absolute (236.4 ±242.01 kcal/day, t=4.02, p=.001), and relative (3.4 ±3.7 kcal/kg/day, t=3.79, p=.002) RMR in the sample. No statistically significant differences were found when comparing amount of change across age or BMI category. CONCLUSIONS: Literature suggests that exercise training can increase RMR. This study supports that hypothesis, and suggests that 6 weeks of resistance training is adequate to elicit an increase in RMR in healthy adult women. A possible mechanism explaining this effect is an increase in neuromuscular recruitment or muscular activation with the initiation of resistance exercise from a sedentary state. More research is needed to examine this mechanism; and to determine the effects of age, body composition, and different styles of training on this change.

Chronic hindlimb suspension unloading markedly decreases turnover rates of skeletal and cardiac muscle proteins and adipose tissue triglycerides.

We previously showed that a single bolus of "doubly-labeled" water ((2)H2 (18)O) can be used to simultaneously determine energy expenditure and turnover rates (synthesis and degradation) of tissue-specific lipids and proteins by modeling labeling patterns of protein-bound alanine and triglyceride-bound glycerol (Bederman IR, Dufner DA, Alexander JC, Previs SF. Am J Physiol Endocrinol Metab 290: E1048-E1056, 2006). Using this novel method, we quantified changes in the whole body and tissue-specific energy balance in a rat model of simulated "microgravity" induced by hindlimb suspension unloading (HSU). After chronic HSU (3 wk), rats exhibited marked atrophy of skeletal and cardiac muscles and significant decrease in adipose tissue mass. For example, soleus muscle mass progressively decreased 11, 43, and 52%. We found similar energy expenditure between control (90 ± 3 kcal · kg(-1)· day(-1)) and hindlimb suspended (81 ± 6 kcal/kg day) animals. By comparing food intake (∼ 112 kcal · kg(-1) · day(-1)) and expenditure, we found that animals maintained positive calorie balance proportional to their body weight. From multicompartmental fitting of (2)H-labeling patterns, we found significantly (P < 0.005) decreased rates of synthesis (percent decrease from control: cardiac, 25.5%; soleus, 70.3%; extensor digitorum longus, 44.9%; gastrocnemius, 52.5%; and adipose tissue, 39.5%) and rates of degradation (muscles: cardiac, 9.7%; soleus, 52.0%; extensor digitorum longus, 27.8%; gastrocnemius, 37.4%; and adipose tissue, 50.2%). Overall, HSU affected growth of young rats by decreasing the turnover rates of proteins in skeletal and cardiac muscles and adipose tissue triglycerides. Specifically, we found that synthesis rates of skeletal and cardiac muscle proteins were affected to a much greater degree compared with the decrease in degradation rates, resulting in large negative balance and significant tissue loss. In contrast, we found a small decrease in adipose tissue triglyceride synthesis paired with a large decrease in degradation, resulting in smaller negative energy balance and loss of fat mass. We conclude that HSU in rats differentially affects turnover of muscle proteins vs. adipose tissue triglycerides.

Oxidative stress and metabolic syndrome: Effects of a natural antioxidants enriched diet on insulin resistance

Oxidative stress (OS) could play a role in metabolic syndrome-related manifestations contributing to insulin resistance (IR). The aim of the present study was to gain insight the relationships between OS, IR and other hormones involved in caloric balance, explaining the effects of a natural antioxidant-enriched diet in patients affected by metabolic syndrome. We investigated the effects of dietary antioxidants on IR, studying 53 obese (20 males and 33 females, 18-66 years old, BMI 36.3±5.5kg/m2), with IR evaluated by Homeostasis Model Assessment (HOMA)-index, comparing 4 treatments: hypocaloric dietalone (group A) or plus metformin 1000mg/daily (group B), natural antioxidants-enriched hypocaloric dietalone (group C) or plus metformin (group D). A personalized program, with calculated antioxidant intake of 800-1000mg/daily, from fruit and vegetables, was administered to group C and D. The glycemic and insulinemic response to oral glucose load, and concentrations of total-, LDL- and HDL-cholesterol, triglycerides, uric acid, C reactive protein, fT3, fT4, TSH, insulin-like growth factor 1 were evaluated before and after 3-months. Plasma Total antioxidant capacity was determined by H2O2-metmyoglobin system, which interacting with the chromogen ABTS generates a radical with latency time (LAG) proportional to antioxidant content. Despite a similar BMI decrease, we found a significant decrease of HOMA and insulin peak only in group B and D. Insulin response (AUC) showed the greatest decrease in group D (25.60±8.96%) and was significantly lower in group D vs B. No differences were observed in glucose response, lipid metabolism and TAC (expressed as LAG values). TSH values were significantly suppressed in group D vs B. These data suggest that dietary antioxidants ameliorate insulin-sensitivity in obese subjects with IR by enhancing the effect of insulin-sensitizing drugs albeit with molecular mechanisms which remain yet to be elucidated.

Balancing Calories with Smartphone

Background: People gain weight when assume more calo- ries than their body can consume. Instead, they lose weight when they consume more than what they eat. Comparing the body to a closed system, we can call calorie balance the di erence between the input and output calories. However, keep a balanced diet regime is never a rewarding activity and often people give up. Objectives: The goal is to help subjects with overweight problems: educate these people reduces the number of peo- ple that might migrate in the obese class. We propose an application to encourage healthier lifestyles, whose inno- vative feature is an automatic adaptive monitoring of the daily calorie balance. The system uses a familiar device and motivates the users to reach best result with the diet. Methods: The energy consumption is related to the oxy- gen consumption, obviously also if combined with physical activity. The heart rate is directly related to the supply of oxygen. Using this simple relation, the heartbeats are bound to the calorie consumption. Results: People achieve a greater awareness about food dosage and its calories weight. Moreover the application allows a more careful choice in food selection in order to not vanish the e orts made to change the lifestyles. Conclusions: We have obtained good result with o -the- shelf hardware and user friendly software solutions. The users consider the system like a game where they have to keep higher the burned calories level. A motivational application has been found to be a winning card to promote healthier lifestyles, without intimidating the user.

How calorie-focused thinking about obesity and related diseases may mislead and harm public health. An alternative.

Prevailing thinking about obesity and related diseases holds that quantifying calories should be a principal concern and target for intervention. Part of this thinking is that consumed calories - regardless of their sources - are equivalent; i.e. 'a calorie is a calorie'. The present commentary discusses various problems with the idea that 'a calorie is a calorie' and with a primarily quantitative focus on food calories. Instead, the authors argue for a greater qualitative focus on the sources of calories consumed (i.e. a greater focus on types of foods) and on the metabolic changes that result from consuming foods of different types. In particular, the authors consider how calorie-focused thinking is inherently biased against high-fat foods, many of which may be protective against obesity and related diseases, and supportive of starchy and sugary replacements, which are likely detrimental. Shifting the focus to qualitative food distinctions, a central argument of the paper is that obesity and related diseases are problems due largely to food-induced physiology (e.g. neurohormonal pathways) not addressable through arithmetic dieting (i.e. calorie counting). The paper considers potential harms of public health initiatives framed around calorie balance sheets - targeting 'calories in' and/or 'calories out' - that reinforce messages of overeating and inactivity as underlying causes, rather than intermediate effects, of obesity. Finally, the paper concludes that public health should work primarily to support the consumption of whole foods that help protect against obesity-promoting energy imbalance and metabolic dysfunction and not continue to promote calorie-directed messages that may create and blame victims and possibly exacerbate epidemics of obesity and related diseases.

Changes in body weight after 24 weeks of vildagliptin therapy as a function of fasting glucose levels in patients with type 2 diabetes.

BackgroundIn order to test the hypothesis that the degree of weight change with the dipeptidyl peptidase-4 inhibitor vildagliptin is dependent on the level of glycemic control at baseline, the weight changes from pooled monotherapy studies after 24 weeks of therapy with vildagliptin were assessed versus the fasting plasma glucose (FPG) levels at baseline.MethodsData were pooled from eight clinical monotherapy trials including 2,340 previously drug-naïve patients with type 2 diabetes mellitus who received vildagliptin monotherapy (50 mg once daily [n=359] or 50 mg twice daily [n=1,981]). The trials were all randomized, double-blind, controlled clinical trials with a prespecified week 24 study visit.ResultsLinear regression analysis of weight change after 24 weeks relative to baseline FPG showed an intercept of −2.259 kg (95% confidence interval −2.86, −1.66; P<0.0001) and a positive slope of 0.1552 kg (95% confidence interval 0.10–0.21; P<0.0001). Neutral caloric balance (no weight change) was observed at a FPG of 14.6 mmol/L (263 mg/dL). Baseline FPG values below and above this threshold were associated with weight loss and weight gain, respectively. For instance, from this analysis, a baseline FPG of 8 mmol/L (144 mg/dL) predicts a weight loss of 1 kg.ConclusionThe present analysis showed that treatment with vildagliptin results in a negative caloric balance when glucose levels are below the renal threshold at baseline.

Central obesity as a clinical marker of adiposopathy; increased visceral adiposity as a surrogate marker for global fat dysfunction.

Purpose of reviewSubcutaneous adipose tissue (SAT) is often described as ‘protective’. Visceral adipose tissue (VAT) is often described as ‘pathologic’. However, both SAT and VAT have protective and pathologic potential, with interdependent biologic functions.Recent findingsMost of the body's (excess) energy is stored as fat in SAT. If during positive caloric balance, SAT does not undergo adequate adipogenesis, then excess energy may result in adipocyte hypertrophy, leading to hypoxia, immunopathies, and endocrinopathies. Energy overflow may promote accumulation of pericardial fat, perivascular fat, and myocardial fat, which may directly contribute to atherosclerotic cardiovascular disease (CVD). Lipotoxic free fatty acid delivery to nonadipose body organs (e.g. liver, muscle, and pancreas) may indirectly contribute to CVD by promoting the most common metabolic disorders encountered in clinical practice (e.g. high blood sugars, high blood pressure, and dyslipidaemia), all major CVD risk factors. Finally, SAT energy overflow may increase VAT accumulation, which is also associated with increased risk of metabolic diseases and CVD.SummaryIncreased VAT is a surrogate marker for SAT dysfunction which increases waist circumference, reflecting a shared pathologic process leading to the pathogenic fat accumulation of other fat depots and fatty infiltration of nonadipose body organs. Central obesity is a clinical marker for adiposopathy.

Tofogliflozin, a sodium/glucose cotransporter 2 inhibitor, attenuates body weight gain and fat accumulation in diabetic and obese animal models.

Objective:Tofogliflozin, a highly selective inhibitor of sodium/glucose cotransporter 2 (SGLT2), induces urinary glucose excretion (UGE), improves hyperglycemia and reduces body weight in patients with Type 2 diabetes (T2D). The mechanisms of tofogliflozin on body weight reduction were investigated in detail with obese and diabetic animal models.Methods:Diet-induced obese (DIO) rats and KKAy mice (a mouse model of diabetes with obesity) were fed diets containing tofogliflozin. Body weight, body composition, biochemical parameters and metabolic parameters were evaluated.Results:In DIO rats tofogliflozin was administered for 9 weeks, UGE was induced and body weight gain was attenuated. Body fat mass decreased without significant change in bone mass or lean body mass. Food consumption (FC) increased without change in energy expenditure, and deduced total calorie balance (deduced total calorie balance=FC−UGE−energy expenditure) decreased. Respiratory quotient (RQ) and plasma triglyceride (TG) level decreased, and plasma total ketone body (TKB) level increased. Moreover, plasma leptin level, adipocyte cell size and proportion of CD68-positive cells in mesenteric adipose tissue decreased. In KKAy mice, tofogliflozin was administered for 3 or 5 weeks, plasma glucose level and body weight gain decreased together with a reduction in liver weight and TG content without a reduction in body water content. Combination therapy with tofogliflozin and pioglitazone suppressed pioglitazone-induced body weight gain and reduced glycated hemoglobin level more effectively than monotherapy with either pioglitazone or tofogliflozin alone.Conclusion:Body weight reduction with tofogliflozin is mainly due to calorie loss with increased UGE. In addition, tofogliflozin also induces a metabolic shift from carbohydrate oxidation to fatty acid oxidation, which may lead to prevention of fat accumulation and inflammation in adipose tissue and liver. Tofogliflozin may have the potential to prevent obesity, hepatic steatosis and improve insulin resistance as well as hyperglycemia.

Impact of CPAP on activity patterns and diet in patients with obstructive sleep apnea (OSA).

Patients with severe OSA consume greater amounts of cholesterol, protein, and fat as well as have greater caloric expenditure. However, it is not known whether their activity levels or diet change after treatment with CPAP. To investigate this issue, serial assessments of activity and dietary intake were performed in the Apnea Positive Pressure Long-term Efficacy Study (APPLES); a 6-month randomized controlled study of CPAP vs. sham CPAP on neurocognitive outcomes. Subjects were recruited into APPLES at 5 sites through clinic encounters or public advertisement. After undergoing a diagnostic polysomnogram, subjects were randomized to CPAP or sham if their AHI was ≥ 10. Adherence was assessed using data cards from the devices. At the Tucson and Walla Walla sites, subjects were asked to complete validated activity and food frequency questionnaires at baseline and their 4-month visit. Activity and diet data were available at baseline and after 4 months treatment with CPAP or sham in up to 231 subjects (117 CPAP, 114 Sham). Mean age, AHI, BMI, and Epworth Sleepiness Score (ESS) for this cohort were 55 ± 13 [SD] years, 44 ± 27 /h, 33 ± 7.8 kg/m(2), and 10 ± 4, respectively. The participants lacking activity and diet data were younger, had lower AHI and arousal index, and had better sleep efficiency (p < 0.05). The BMI was higher among women in both CPAP and Sham groups. However, compared to women, men had higher AHI only in the CPAP group (50 vs. 34). Similarly, the arousal index was higher among men in CPAP group. Level of adherence defined as hours of device usage per night at 4 months was significantly higher among men in CPAP group (4.0 ± 2.9 vs. 2.6 ± 2.6). No changes in consumption of total calories, protein, carbohydrate or fat were noted after 4 months. Except for a modest increase in recreational activity in women (268 ± 85 vs. 170 ± 47 calories, p < 0.05), there also were no changes in activity patterns. Except for a modest increase in recreational activity in women, OSA patients treated with CPAP do not substantially change their diet or physical activity habits after treatment. .

Abstract P418: Trans Fats Consumption Linked to Higher BMI

Background: Increasing evidence suggests that factors beyond calorie balance may affect fat deposition (consider environmental obesogens like bisphenol A). Trans fats are prooxidant, proinflammatory, have shown adverse metabolic effects and increased fat deposition in animals. Goal: To assess the relation of dietary trans fatty acid ( dTFA ) consumption to BMI in humans. Method: Subjects were 1018 adult men and women clinical trial screenees (age 20-85, without known diabetes, CVD, with screening LDL 115-190mg/dL). Height and weight were measured at screening and BMI calculated. The Fred Hutchinson Food Frequency Questionnaire provided data on dTFA (gm/d) and calories. Surveys elicited activity, and chocolate consumption (times/week, previously linked favorably in this sample to BMI). Mood (adversely linked to dTFA in this sample and in literature) was assessed by the CES-D (depression scale). Regression assessed the relation of BMI (outcome) to dTFA, unadjusted and in models adjusted for age and sex, calories and activity, chocolate consumption, and mood. Results: Higher dTFA was linked with higher BMI across adjustment models, with strong statistical significance. The coefficient was strengthened, not attenuated, when calories and activity were considered. Each additional gram/day of dTFAs was associated with around 0.4 points greater BMI. Discussion: These findings extend adverse metabolic associations of dTFA, and comport with evidence suggesting that composition of calories, as well as their number, has relevance to BMI.

Adiposopathy, "sick fat," Ockham's razor, and resolution of the obesity paradox.

Among lean populations, cardiovascular disease (CVD) is rare. Among those with increased adiposity, CVD is the commonest cause of worldwide death. The “obesity paradox” describes seemingly contrary relationships between body fat and health/ill-health. Multiple obesity paradoxes exist, and include the anatomic obesity paradox, physiologic obesity paradox, demographic obesity paradox, therapeutic obesity paradox, cardiovascular event/procedure obesity paradox, and obesity treatment paradox. Adiposopathy (“sick fat”) is defined as adipocyte/adipose tissue dysfunction caused by positive caloric balance and sedentary lifestyle in genetically and environmentally susceptible individuals. Adiposopathy contributes to the commonest metabolic disorders encountered in clinical practice (high glucose levels, high blood pressure, dyslipidemia, etc.), all major CVD risk factors. Ockham's razor is a principle of parsimony which postulates that among competing theories, the hypothesis with the fewest assumptions is the one best selected. Ockham’s razor supports adiposopathy as the primary cause of most cases of adiposity-related metabolic diseases, which in turn helps resolve the obesity paradox.

SGLT-2 inhibitors and their potential in the treatment of diabetes.

Diabetes remains a burgeoning global problem, necessitating ongoing efforts on the part of pharmaceutical and device manufacturers, patients, and society to curb the frightening trends in morbidity and mortality attributable to the malady. Since 1835 when phlorizin was discovered, sodium glucose co-transporter 2 (SGLT-2) inhibitors have rested tantalizingly on the horizon, promising a more physiological approach to glucose control. These agents lower glucose by enhancing its excretion by blocking reabsorption in the renal tubules, thus eliminating glucose from the body along with the molecules’ attendant effects on caloric balance, plasma osmolality, and lipids. Consequently, SGLT-2 inhibitors improve glucose control to an extent comparable to other hypoglycemic agents while simultaneously reducing body weight, blood pressure, and cholesterol – an admirable portfolio. One agent, canagliflozin, has recently been approved by the US Food and Drug Administration (FDA) and two other agents have progressed through Phase III trials, including dapagliflozin and empagliflozin. Collectively, when used as monotherapy, these agents have demonstrated reductions in hemoglobin A1c (HbA1c), body weight, and blood pressure of −0.34% to −1.03%, −2.0 to −3.4 kg, and −1.7 to −6.4 mmHg/−0.3 to −2.6 mmHg (systolic blood pressure/diastolic blood pressure), respectively. SGLT-2 inhibitors have been well tolerated, with hypoglycemia (0.9% to 4.3%) occurring infrequently in clinical trials. Safety signals related to breast and bladder cancer have arisen with dapagliflozin, though these are unsubstantiated and likely ascribed to the presence of preexisting cancer. As these agents emerge, clinicians should embrace the addition to the formulary for treating type 2 diabetes, but must also weight the risk–benefit of this new class in deciding which patient types are most likely to benefit from their novel mechanism of action.

Increased Protein Intake in Military Special Operations

Special operations are so designated for the specialized military missions they address. As a result, special operations present some unique metabolic challenges. In particular, soldiers often operate in a negative energy balance in stressful and demanding conditions with little opportunity for rest or recovery. In this framework, findings inferred from the performance literature suggest that increased protein intake may be beneficial. In particular, increased protein intake during negative caloric balance maintains lean body mass and blood glucose production. The addition of protein to mixed macronutrient supplements is beneficial for muscle endurance and power endpoints, and the use of amino acids improves gross and fine motor skills. Increasing protein intake during periods of intense training and/or metabolic demand improves subsequent performance, improves muscular recovery, and reduces symptoms of psychological stress. Consumption of protein before sleep confers the anabolic responses required for the maintenance of lean mass and muscle recovery. A maximal response in muscle protein synthesis is achieved with the consumption of 20–25 g of protein alone. However, higher protein intakes in the context of mixed-nutrient ingestion also confer anabolic benefits by reducing protein breakdown. Restricted rations issued to special operators provide less than the RDA for protein ( ∼ 0.6 g/kg), and these soldiers often rely on commercial products to augment their rations. The provision of reasonable alternatives and/or certification of approved supplements by the U.S. Department of Defense would be prudent.

Confusion on All Sides of the Calorie Equation

ThehighprevalenceofoverweightandobesityintheUnited States has increased attention to the importance of balancing calories in and out to achieve and maintain a healthy weight. Numerous policy and educational efforts are aimed at helping consumers achieve calorie balance. Still, a calorie disconnect exists as consumers remain largely unaware of personal calorie needs or the relationship between calories and weight management. A key first step in addressing consumers’ calorie confusion may be to familiarizethemwiththeir‘‘dailycalorienumber,’’ortheamount of calories that are needed to maintain weight, and how thatdailycalorienumberisimpactedbyphysicalactivity. The need to individualize calorie balance communications is essential, as each person has a unique weight management profile that will be impacted by many factors, including age, physical activity, and desired weight outcome. Whereas some Americans would like to maintain weight and prevent further weight gain, many others would likely benefit from tipping the calorie balance equation to achieve successful weight loss. To effectively communicate calorie balance, it is imperative to examine consumer response to calorie balance communications. Somemessagesorterminology, although widely accepted by nutrition and health professionals, may not be understood by consumers. The social-ecological model is a useful framework to further examine factors that impact behavior changerelated to foodandphysicalactivitydecisions, providing opportunities for futureresearch andinitiatives aimed at helping consumers achieve calorie balance. Nutr Today. 2013;48(5):195Y202

Perioperative nutriture in esophageal cancer patients undergoing esophagectomy.

Postoperative complications after thoracic esophagectomy are common and sometimes life-threatening. Optimized perioperative nutrition is essential for patient well-being and recovery. In this paper, we assessed the effects of perioperative parenteral nutrition on the nutritional status of thoracic esophagectomy patients. The nutritional status of 25 patients, undergoing either 2- or 3-field lymph node dissection, was evaluated from one day before surgery until 14 days after. Respiratory quotient and energy expenditure were measured by indirect calorimetry. Nitrogen balance was measured as the difference between urophanic and intake nitrogen. We also measured nitrogen loss, total cholesterol, cholinesterase, total protein, rapid turnover protein, and biomarkers that included prealbumin, transferrin, and retinol-binding protein. We observed significant and negative differences between pre- and postoperative calorie intake, caloric balance, respiratory quotient, nitrogen loss, nitrogen balance, total cholesterol, cholinesterase, total protein, and retinol-binding protein. On postoperative days 1-3, calorie intake was insufficient and caloric balance became negative and significantly lower than that before surgery. Parenteral nutrition provides insufficient nutrients to thoracic esophagectomy patients. Preoperative nutrition and early postoperative enteral nutrition in combination with parenteral nutrition may improve nutritional status, particularly in the early stages after surgery.

Weighing in on Residents' Body Mass Index: A Teachable Moment for Physicians and Patients Alike?

Weighing in on Residents' Body Mass Index: A Teachable Moment for Physicians and Patients Alike?