Caloric Intake Research Articles

Dietary recommendations for bariatric patients

Over the past few decades, obesity has become a growing public health problem worldwide. The goal of fighting obesity is to improve health. Sustained weight loss of more than 10% of the total body weight improves the course of many obesity-related diseases, as well as the quality of life. The high effectiveness of bariatric surgery in the treatment of obesity in achieving significant and sustained weight loss has been demonstrated in several studies. In most centers where bariatric surgery is performed, the recommendation for preoperative weight loss is followed. The enlarged left lobe of the liver makes it difficult to access the stomach and, accordingly, prevents technically correct operation. Weight loss before bariatric surgery reduces the risk of complications in the postoperative period, and therefore preoperative preparation in the form of hypocaloric nutrition and regular physical activity is recommended for patients, considering concomitant pathology. One of the problems in the postoperative period is the need to change the usual lifestyle and diet due to the need to follow the recommendations of the attending physician. This can lead to a decrease in the quality of life after surgery due to psychoemotional overstrain. The nutrition of bariatric patients implies significant changes associated with a decrease in the amount of food consumed, difficulty in assimilation of nutrients, and the poverty of flavors offered up to this day in the specialized nutrition market. With the help of food products within the framework of low-calorie diets, it becomes almost impossible to feed such a patient without reducing their nutritional value. In 2024, balanced low-calorie nutrition OPTIFAST® (OPTIFAST) appeared on the Russian market, which has proven itself worldwide for more than 50 years and has shown its effectiveness and safety in more than 80 international clinical trials with a high level of evidence. OPTIFAST provides the patient with all the necessary nutrients and allows you to manage the daily calorie intake, gives the patient a feeling of satiety necessary for high adherence to a low-calorie diet, which is indicated for patients with obesity and overweight.

Potential of GLP-1 Analogs in Managing Hyperphagia and Obesity in Prader-Willi Syndrome: A Review of Efficacy and Safety

Introduction: Prader-Willi Syndrome (PWS) is a genetic disorder marked by hyperphagia, obesity, developmental delays, and behavioral challenges. Traditional treatments like dietary control and growth hormone therapy often fail to effectively manage these symptoms. Recently, glucagon-like peptide-1 (GLP-1) analogs have shown potential in treating PWS. This review assesses the efficacy, safety and mechanisms of GLP-1 analogs in PWS treatment. They improve glycemic control, cardiovascular health, and appetite regulation, contributing to better weight management and overall health in PWS patients. These analogs enhance insulin secretion, inhibit glucagon release, and slow gastric emptying, helping to reduce postprandial glucose spikes and caloric intake. Results: Several small-scale studies and case reports have shown mixed results regarding the effectiveness of GLP-1 analogs in reducing BMI and hyperphagia in PWS patients. Although the studies demonstrated varied outcomes in terms of BMI reduction, all of them reported improvement in satiety or appetite levels.Conclusions: Overall, GLP-1 analogs hold promise for addressing hyperphagia, obesity, and glycemic control in PWS patients, improving their overall health and quality of life. Continued research and long-term studies are essential to establish these benefits and optimize treatment strategies.

Association of Nutritional Intake with Physical Activity and Handgrip Strength in Individuals with Airflow Limitation.

We investigated whether nutritional intake is associated with physical activity (PA) and handgrip strength (HGS) in individuals with airflow limitation. This study analyzed data from the 2014 to 2016 Korean National Health and Nutrition Examination Survey. We assessed total protein intake (g/day), caloric intake (kcal/day), and other nutritional intakes using a 24-hour dietary recall questionnaire. HGS was measured three times for each hand using a digital grip strength dynamometer, and PA was assessed as health-enhancing PA. Airflow limitation was defined as a forced expiratory volume/forced vital capacity ratio of 0.7 in individuals over 40 years of age. Participants were categorized into groups based on their PA levels and HGS measurements: active aerobic PA vs. non-active aerobic PA, and normal HGS vs. low HGS. Among the 622 individuals with airflow limitation, those involved in active aerobic PA and those with higher HGS had notably higher total food, calorie, water, protein, and lipid intake. The correlations between protein and caloric intake with HGS were strong (correlation coefficients = 0.344 and 0.346, respectively). The forest plots show that higher intakes of food, water, calories, protein, and lipids are positively associated with active aerobic PA, while higher intakes of these nutrients are inversely associated with low HGS. However, in the multivariate logistic regression analysis, no significant associations were observed between nutritional intake and active aerobic PA or HGS. Nutritional intake was not found to be an independent factor associated with PA and HGS. However, the observed correlations suggest potential indirect effects that warrant further investigation.

Spent brewer yeast glucan improves metabolic parameters and inflammatory markers reducing health risky changes imposed by the consumption of hypercaloric diet

β-glucans from yeasts are prebiotic health-promoting food ingredients able to boost immune response. An environmentally friendly source of yeast glucans is the spent brewer's yeast. This study investigated the effects of the administration of carboxymethyl glucan (CMG) (20 mg/kg, 12 weeks, orally), a derivative of the β-glucan from spent brewer's yeast, on food intake, weight gain, dyslipidemia, glucose intolerance, pro-inflammatory state, and hepatic steatosis of rats receiving a hypercaloric diet. The animals were divided into three groups: Normocaloric control (NCT); Hypercaloric diet and saline (HCT); and Hypercaloric diet and CMG (H-CMG). CMG administration could reduce rats' caloric value and food intake, reducing the index of adiposity (HCT:7.2±0.4% vs H-CMG:5.3±0.4% p < 0.05) and weight gain (HCT:111.1±3.8g vs H-CMG: 68.3±4.9g p < 0.05). Furthermore, it improved lipemic and glycemic profiles and lowered hepatic lipid accumulation. CMG decreased Monocyte Chemoattractant Protein (MCP)-1 (H-CT: 89.5±1.8 pg/mL vs H-CMG: 50.7±12.2 pg/mL p < 0.05), Interleukin (IL)-12 (H-CT: 206.0±14.0 pg/mL vs H-CMG:132.4±19.9 pg/mL, p < 0.05), and C-reactive protein (CRP) levels and increased IL-10 levels, decreasing the cardiovascular risk and pro-inflammatory state. Therefore, CMG has beneficial effects in preventing weight gain and, consequently, improves the metabolic profile in rats while consuming a hypercaloric diet. Findings indicate the spent brewer's yeast CMG can be a strategy to attenuate the risky metabolic changes related to the consumption of a hypercaloric diet.

Non/Low-Caloric Artificial Sweeteners and Gut Microbiome: From Perturbed Species to Mechanisms.

Non/low-caloric artificial sweeteners (NAS) are recognized as chemical additives substituting sugars to avoid caloric intake and subsequent sugar-derived diseases such as diabetes and hyperglycemia. Six NAS have been claimed safe and are authorized by the US Food and Drug Administration (FDA) for public use, with acceptable daily intake information available: aspartame, acesulfame-K, saccharin, sucralose, neotame, and advantame. However, the impacts of NAS on the gut microbiome have raised potential concerns, since sporadic research revealed NAS-induced microbial changes in the gastrointestinal tracts and alterations in the microbiome-host interactive metabolism. Given the fact that the gut microbiome influences kaleidoscopic physiological functions in host health, this review aimed to decipher the impacts of NAS on the gut microbiome by implementing a comprehensive two-stage literature analysis based on each NAS. This review documented disturbed microbiomes due to NAS exposure to a maximal resolution of species level using taxonomic clustering analysis, and recorded metabolism alterations involved in gut microbiome-host interactions. The results elucidated that specific NAS exhibited discrepant impacts on the gut microbiome, even though overlapping on the genera and species were identified. Some NAS caused glucose tolerance impairment in the host, but the key metabolites and their underlying mechanisms were different. Furthermore, this review embodied the challenges and future directions of current NAS-gut microbiome research to inspire advanced examination of the NAS exposure-gut microbiome-host metabolism axis.

Is a Meta-Analysis of Clinical Trial Outcomes for Ketogenic Diets Justifiable? A Critical Assessment Based on Systematic Research.

While the macronutrient content of a ketogenic diet specifically utilized for childhood epilepsy is clearly defined in the literature, variations among other ketogenic diets exhibit substantial heterogeneity. Furthermore, studies utilizing ketogenic diets contain several confounders with notable impacts on outcomes, thereby rendering both their findings and those of the meta-analyses less reliable. The objective of this meta-epidemiological assessment was to scrutinize existing clinical trials that investigated the effects of ketogenic diets on patients with obesity and diabetes, thereby determining the feasibility of conducting a meta-analysis. The Ovid Medline, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Embase databases were searched from 1946 to 24 September 2024. Of the studies reviewed, none met the predefined inclusion criteria. However, seven articles met these criteria very closely. In the future, studies investigating the effects of ketogenic diets containing significant confounding factors should adopt a single definition of a ketogenic diet. Additionally, accurate measurement of actual macronutrient and caloric intake, along with regularly monitored nutritional ketosis, will be essential to highlight the true effects of a ketogenic diet.

A whole food, plant-based diet reduces amino acid levels in patients with metastatic breast cancer.

Amino acids are critical to tumor survival. Tumors can acquire amino acids from the surrounding microenvironment, including the serum. Limiting dietary amino acids is suggested to influence their serum levels. Further, a plant-based diet is reported to contain fewer amino acids than an animal-based diet. Here, we investigated the impact of a whole food, plant-based diet on lowering the serum levels of amino acids in patients with cancer. Patients with metastatic breast cancer (n=18) were enrolled in clinical trial NCT03045289 . An ad libitum whole food, plant-based diet was implemented for 8 weeks without calorie or portion restriction. We found that a whole food, plant-based diet resulted in a lower intake of calories, fat, and amino acids and higher levels of fiber. Additionally, body weight, serum insulin, and IGF-1 were reduced in participants. The diet contained lower levels of essential and non-essential amino acids. Importantly, the lowered dietary intake of amino acids translated to reduced serum levels of amino acids in participants (5/9 essential amino acids; 4/11 non-essential amino acids). These findings provide a tractable approach to limiting amino acid levels in cancer patients. This data lays a foundation for studying the relationship between amino acids in patients and tumor progression. Further, a whole-food, plant-based diet has the potential to synergize with cancer therapies that exploit metabolic vulnerabilities.

Types of Intermittent Fasting and Their Effects on Obesity and Type II Diabetes Mellitus

Obesity and type II diabetes mellitus affect millions of people both in Malaysia and worldwide due to sedentary lifestyles and unhealthy diets. Intermittent fasting reduces calorie intake by interweaving eating periods with prolonged fasting periods on a recurring basis. Therefore, it could be a potential solution to induce weight loss, leading to improved blood glucose level as observed in type II diabetes mellitus individuals. However, its feasibility remains unclear. This review aimed to compare the beneficial effects and adverse reactions from different types of intermittent fasting in obese and type II diabetes mellitus studies. The review was carried out by combing through several online databases. Keywords such as “Intermittent fasting”, “Obesity”, “Type II Diabetes Mellitus” were used and relevant articles were selected. The findings of this review showed that intermittent fasting is feasible and effective in reducing body weight and improving blood glucose. The beneficial effects of intermittent fasting appear to outweigh the adverse reactions. Having said that, intermittent fasting is unsuitable for individuals with packed schedules and certain health conditions such as pregnancy. This review will hopefully shed light on intermittent fasting as a potential intervention to combat obesity and type II diabetes mellitus. Further exploration of intermittent fasting could reduce both the morbidity and mortality rates from non-communicable diseases globally.

Evaluation of the Effects of Diet-Induced Obesity in Zebrafish (Danio rerio): A Comparative Study

Objectives: This study aimed to compare diet-induced obesity (DIO) models in zebrafish and investigate the complications and differences between sexes in biochemical and inflammatory parameters. Methods: Adult animals of both sexes were divided into four groups (n = 50) and fed for eight weeks: control group 1: Artemia sp. (15–30 mg/day/fish); control group 2: commercial fish food (3.5% of average weight); obesity group 1: pasteurized egg yolk powder + soybean oil (5% of average weight); obesity group 2: Artemia sp. (60–120 mg/day/fish). Dietary intake, caloric intake and efficiency, body mass index, biochemical, inflammatory, behavioral, histopathological, and stereological parameters, and inflammation-related gene expression were investigated. Results: Obesity group 1 was the most indicated to investigate changes in the anxious behavioral profile (p &lt; 0.05), triglyceride elevation [52.67 (1.2) mg/dL], adipocyte hypertrophy [67.8 (18.1) µm2; p = 0.0004], and intestinal inflammation. Obesity group 2 was interesting to investigate in terms of weight gain [167 mg; p &lt; 0.0001), changes in fasting glucose [48.33 (4.14) mg/dL; p = 0.003), and inflammatory parameters [IL-6: 4.24 (0.18) pg/mL; p = 0.0015]. Conclusions: Furthermore, both DIO models evaluated in the present study were effective in investigating hepatic steatosis. The data also highlighted that sex influences inflammatory changes and fasting blood glucose levels, which were higher in males (p &gt; 0.05). The results show new metabolic routes to be explored in relation to DIO in zebrafish.

Triheptanoin in patients with long-chain fatty acid oxidation disorders: clinical experience in Italy

BackgroundLong-chain fatty acid oxidation disorders (LC-FAOD) are rare and potentially life-threatening diseases that cause deficient energy production and accumulation of toxic metabolites. Despite dietary management, adherence to maximum fasting guidelines, restricted long-chain triglyceride intake and supplementation with medium-chain triglyceride (MCT) oil (current standard of care), most patients experience recurrent decompensation episodes that can require hospitalisation. Herein, we analysed the effectiveness and safety of triheptanoin (a highly purified, synthetic medium odd-chain triglyceride) treatment in a cohort of Italian patients with LC-FAOD.MethodsThis retrospective, nationwide study included nine patients with LC-FAOD who switched from standard therapy with MCT oil to triheptanoin oral liquid. Data were collected between 2018 and 2022. Clinical outcome measures were the number and duration of intercurrent catabolic episodes and number and duration of metabolic decompensation episodes requiring hospitalisation. Creatine kinase (CK) levels and treatment-related adverse effects were also reported.ResultsPatients were provided a mean ± standard deviation (SD) triheptanoin dose of 1.5 ± 0.9 g/kg/day in four divided administrations, which accounted for 23.9 ± 8.9% of patients’ total daily caloric intake. Triheptanoin treatment was started between 2.7 and 16 years of age and was continued for 2.2 ± 0.9 years. The number of intercurrent catabolic episodes during triheptanoin treatment was significantly lower than during MCT therapy (4.3 ± 5.3 vs 22.0 ± 22.2; p = 0.034), as were the number of metabolic decompensations requiring hospitalisation (mean ± SD: 2.0 ± 2.5 vs 18.3 ± 17.7; p = 0.014), and annualised hospitalisation rates and duration. Mean CK levels (outside metabolic decompensation episodes) were lower with triheptanoin treatment versus MCT oil for seven patients. No intensive care unit admissions were required during triheptanoin treatment. Epigastric pain and diarrhoea were recorded as adverse effects during both MCT and triheptanoin treatment.ConclusionsThe significant improvement in clinical outcome measures after the administration of triheptanoin highlights that this treatment approach can be more effective than MCT supplementation in patients with LC-FAOD. Triheptanoin was well tolerated and decreased the number of intercurrent catabolic episodes, metabolic decompensation episodes requiring hospitalisation, and the annualised rate and duration of hospitalisations.

Evaluation of a Workplace Diabetes Prevention Program Delivered via Distance Learning: A Qualitative Study.

Little is known about how distance learning impacts delivery of the National Diabetes Prevention Program (DPP) despite a rapid shift to this platform during the coronavirus disease 2019 (COVID-19) public health emergency. We explored how a workplace DPP, delivered via distance learning, impacted knowledge, motivation, and behavioral skills of participants throughout the program. We conducted repeated qualitative interviews with distance learning participants at baseline, 6 months, and 12 months from September 2020 to July 2022. Three study team members coded interview data using individual responses as the unit of analysis. We used a thematic approach, using the information-motivation-behavioral skills framework, to analyze responses and generate understanding of the program's impact. The 27 individuals who participated in the interviews (89% women, mean age 56 years) reported the distance learning platform was effective in changing their behavior. The program's focus on food logging and setting limits on specific types of caloric intake was perceived as essential. Education on ideal levels of fat and sugar consumption, lessons on how to read food labels, and dissemination of recipes with healthy food substitutions allowed participants to initiate and sustain healthy decision-making. Strategies to increase physical activity, including breaking up exercise throughout the day, made reaching their goals more feasible. Participants reported food logging and weight reporting, as well as group support during sessions, either sustained or increased their motivation to adhere to the program over time. A workplace DPP delivered via distance learning successfully prompted improvements in the knowledge, motivation, and behavioral skills necessary to increase healthy eating and physical activity among participants.

6934 Nutritional Factors and Endothelial Dysfunction in Women with Functional Hypothalamic Amenorrhea

Abstract Disclosure: E.R. Uddenberg: None. N. Safwan: None. G. Cook-Wiens: None. O. Obrutu: None. M. Saadedine: None. M.D. Hurtado: None. S. Faubion: None. M.D. Pisarska: None. S.L. Berga: None. J.E. Manson: None. C.N. Bairey Merz: None. C.L. Shufelt: None. Background: Functional hypothalamic amenorrhea (FHA) occurs in women of reproductive age and is a common form of secondary amenorrhea that results in hypoestrogenemia and hypercortisolemia. The underlying cause of FHA is due to a mismatch between energetic intake and expenditure that often manifests as disordered eating, excessive exercise, and psychosocial stress. Previous research identified that 1 in 3 women with FHA had endothelial dysfunction, a preclinical marker for cardiovascular disease. We sought to evaluate the nutrition content in young women with FHA compared to eumenorrheic controls and further assess the relationship to endothelial dysfunction. Methods: We enrolled 30 women with FHA and 29 eumenorrheic controls, not on hormones. FHA was defined as ≥3 consecutive months of amenorrhea, estradiol &amp;lt;50 pg/mL, FSH&amp;lt;10 mIU/L, and LH&amp;lt;10 mIU/L, and exclusion of polycystic ovary syndrome, hyperprolactinemia, thyroid dysfunction, and pregnancy. Eumenorrheic controls had monthly menses with ovulation (progesterone ≥4 ng/mL). Vascular function was measured using EndoPAT 2000 (Itamar® Medical Ltd) to calculate the reactive hyperemic index (RHI). An RHI ≤1.67 indicates endothelial dysfunction. Nutritional intake was collected using a 3-day food diary and analyzed using ESHA Research Food Processor® Nutrition Analysis. Percent (%) recommendation values for nutrition content comparison were calculated based on height, weight, and age. Statistical analysis included Analysis of Variance and Kruskal Wallis test with nonparametric variables reported as median [IQR]. Results: The mean age and BMI of FHA and controls were 26.4 ± 6.2 yrs and 30.3 ± 3.7 yrs (p=0.008), and 21.6 ± 6.2 and 21.8 ± 2.0 kg/m2 (p=0.16), respectively. The median months of FHA amenorrhea was 12 months [5.0, 34.0]. After adjusting for age, there was no difference in caloric intakes in women with FHA compared to controls (1783.9 [1465, 2011] kcal vs. 1731.9 [1578, 1982] kcal, p=0.73); however FHA has higher intake of grams of protein (84.2 [74, 112] g vs. 74 [59, 92] g, p=0.0036), and higher grams of dietary fiber (30.1 [22, 43] g vs. 17.3 [15, 23] g, p=0.0037), respectively. In women with FHA, endothelial dysfunction was associated with a higher % recommended calories (p=0.0098), calories from fat (p=0.02), grams of saturated fat (p=0.03), and grams of carbohydrates (p=0.049). Conclusions: Our results demonstrate that women with FHA consumed similar daily calories, although more grams of protein and dietary fiber than controls. In women with FHA, higher calories, calories from fat, grams of saturated fat and carbohydrates were associated with endothelial dysfunction. Future studies should aim to identify other factors related to endothelial dysfunction among women with FHA and whether some FHA phenotypes are associated with more endothelial dysfunction than others. Presentation: 6/1/2024

7255 Tirzepatide Helps Achieve Glycemic Control and Lower Triglycerides in Seven Patients with Lipodystrophy

Abstract Disclosure: R. Meral: None. E.D. Frontera: None. M. Celik Guler: None. M.C. Foss de Freitas: None. N. Nachawi: None. D.T. Broome: Consulting Fee; Self; Tayco, Inc.. Research Investigator; Self; Novo Nordisk, Fractyl Laboratories, Rhythm Pharmaceuticals. S.I. Taylor: None. E.A. Oral: Advisory Board Member; Self; Amryt, Regeneron Pharmaceuticals. Consulting Fee; Self; Regeneron Pharmaceuticals, Amryt, Third Rock Ventures. Grant Recipient; Self; Regeneron Pharmaceuticals, Amryt. Research Investigator; Self; Novo Nordisk, Fractyl, Ionis Pharmaceuticals Inc., GI Dynamics, Rhythm Pharmaceuticals. Other; Self; Amryt. Lipodystrophy encompasses a group of rare disorders associated with severe metabolic disease. These disorders are defined by abnormal distribution of fat, with near-total (generalized lipodystrophy, GL) or partial (partial lipodystrophy, PL; i.e. familial partial lipodystrophy, FPLD) absence of adipocyte mass leading to a decreased ability to store triglycerides safely. Excess triglycerides are more likely to be stored in ectopic tissues such as hepatocytes, which leads to the metabolic manifestations of the disease state. Patients with GL have near absent levels of leptin hormone and leptin replacement therapy leads to dramatic improvement, which has mainly been attributed to a reduction in caloric intake. Patients with PL are not as leptin deficient and their response to leptin replacement therapy has been variable. We hypothesized that the clinical use of tirzepatide in patients with lipodystrophy may lead to favorable outcomes through the reduction of caloric intake. We closely observed 7 patients who were prescribed tirzepatide for their diabetes with information presented respectively [Age: 44; 54; 34; 53; 44; 46; 38 years | Sex: F; F; F; F; F; M; F | Subtype: FPLD type 1; FPLD type 2; FPLD type 1; Acquired GL; FPLD type 2; FPLD type 1; FPLD type 3]. At baseline, all patients had poor control of their disease despite aggressive medical therapy (except patient #5). Follow-up durations varied due to the observational nature of the study [follow-up duration (months): 6; 12; 7; 3; 8; 9; 5]. Reductions in A1c, triglycerides, and body mass index (BMI) were observed [A1c (%): 13.4-&amp;gt;7.1; 7.1-&amp;gt;6.6; 7.6-&amp;gt;5.2; 8.7-&amp;gt;6.9; 5.4-&amp;gt;5.1; 8.9-&amp;gt;7.8; 9.7-&amp;gt;7.1 | triglycerides (mg/dL): 539-&amp;gt;339; 164-&amp;gt;109; 367-&amp;gt;NA; 151-&amp;gt;113; 388-&amp;gt;101; 459-&amp;gt;319; 4081-&amp;gt;259 | BMI (Kg/m2): 25.0-&amp;gt;24.5; 30.6-&amp;gt;28.3; 37.7-&amp;gt;33.9; 22.8-&amp;gt;20.9; 27.6-&amp;gt;23.4; 40.1-&amp;gt;37.9; 24.0-&amp;gt;24.9]. Those who were on insulin had decreased daily requirements [total daily insulin requirement (units): 160-&amp;gt;25; 82-&amp;gt;18; not on insulin; 85-&amp;gt;0; not on insulin; 280-&amp;gt;200; 124-&amp;gt;111]. All patients reported a reduction in their daily food intake. Treatment related complications were limited to known gastrointestinal issues which the patients rated as tolerable. Based on our results, a randomized controlled trial to test the efficacy of tirzepatide in patients with lipodystrophy may be warranted. Presentation: 6/3/2024

6934 Nutritional Factors and Endothelial Dysfunction in Women with Functional Hypothalamic Amenorrhea

Abstract Disclosure: E.R. Uddenberg: None. N. Safwan: None. G. Cook-Wiens: None. O. Obrutu: None. M. Saadedine: None. M.D. Hurtado: None. S. Faubion: None. M.D. Pisarska: None. S.L. Berga: None. J.E. Manson: None. C.N. Bairey Merz: None. C.L. Shufelt: None. Background: Functional hypothalamic amenorrhea (FHA) occurs in women of reproductive age and is a common form of secondary amenorrhea that results in hypoestrogenemia and hypercortisolemia. The underlying cause of FHA is due to a mismatch between energetic intake and expenditure that often manifests as disordered eating, excessive exercise, and psychosocial stress. Previous research identified that 1 in 3 women with FHA had endothelial dysfunction, a preclinical marker for cardiovascular disease. We sought to evaluate the nutrition content in young women with FHA compared to eumenorrheic controls and further assess the relationship to endothelial dysfunction. Methods: We enrolled 30 women with FHA and 29 eumenorrheic controls, not on hormones. FHA was defined as ≥3 consecutive months of amenorrhea, estradiol &amp;lt;50 pg/mL, FSH&amp;lt;10 mIU/L, and LH&amp;lt;10 mIU/L, and exclusion of polycystic ovary syndrome, hyperprolactinemia, thyroid dysfunction, and pregnancy. Eumenorrheic controls had monthly menses with ovulation (progesterone ≥4 ng/mL). Vascular function was measured using EndoPAT 2000 (Itamar® Medical Ltd) to calculate the reactive hyperemic index (RHI). An RHI ≤1.67 indicates endothelial dysfunction. Nutritional intake was collected using a 3-day food diary and analyzed using ESHA Research Food Processor® Nutrition Analysis. Percent (%) recommendation values for nutrition content comparison were calculated based on height, weight, and age. Statistical analysis included Analysis of Variance and Kruskal Wallis test with nonparametric variables reported as median [IQR]. Results: The mean age and BMI of FHA and controls were 26.4 ± 6.2 yrs and 30.3 ± 3.7 yrs (p=0.008), and 21.6 ± 6.2 and 21.8 ± 2.0 kg/m2 (p=0.16), respectively. The median months of FHA amenorrhea was 12 months [5.0, 34.0]. After adjusting for age, there was no difference in caloric intakes in women with FHA compared to controls (1783.9 [1465, 2011] kcal vs. 1731.9 [1578, 1982] kcal, p=0.73); however FHA has higher intake of grams of protein (84.2 [74, 112] g vs. 74 [59, 92] g, p=0.0036), and higher grams of dietary fiber (30.1 [22, 43] g vs. 17.3 [15, 23] g, p=0.0037), respectively. In women with FHA, endothelial dysfunction was associated with a higher % recommended calories (p=0.0098), calories from fat (p=0.02), grams of saturated fat (p=0.03), and grams of carbohydrates (p=0.049). Conclusions: Our results demonstrate that women with FHA consumed similar daily calories, although more grams of protein and dietary fiber than controls. In women with FHA, higher calories, calories from fat, grams of saturated fat and carbohydrates were associated with endothelial dysfunction. Future studies should aim to identify other factors related to endothelial dysfunction among women with FHA and whether some FHA phenotypes are associated with more endothelial dysfunction than others. Presentation: 6/1/2024

8684 Lifetime Duration of Amenorrhea Is Associated With Monetary Decision-Making and Hedonic Eating In Females With a Low-Weight Eating Disorder

Abstract Disclosure: F. Plessow: None. M. Wronski: None. M. Rogers: None. M.G. Turley: None. E.R. Golden: None. M. Slattery: None. J.J. Thomas: None. E.A. Lawson: None. M. Misra: None. K.T. Eddy: None. Background: Low estrogen levels and oligomenorrhea are common characteristics in females with a low-weight eating disorder (LWED). In animal models, estrogen status is associated with neural activity in dopaminergic reward pathways affecting reward processing and decision-making. Whether a similar link exists in humans is unknown but important to understand, as reduced reward-driven behavior and an increased delay of gratification driving decision-making hinder recovery from a LWED. To fill this knowledge gap, we studied the relationship between lifetime duration of amenorrhea and hedonic eating and monetary decision-making in a group of females with a LWED. We hypothesized that longer lifetime duration of amenorrhea is associated with reduced hedonic food intake and a smaller delay discounting rate (indicating an increased delay of gratification) in females with a LWED (independent of age and illness severity). Methods: Fifty-six females with a LWED (mean age±SD: 19.84±2.98 years, range: 13.6-23.5 years) and 34 female healthy controls (HC; 19.08±2.41 years, 13.4-22.2 years) underwent a menstrual history to determine the number of missed menses since menarche, Eating Disorder Examination (EDE) to assess ED psychopathology, anthropometric measurements to calculate body mass index (BMI), Cookie Taste Test as a laboratory-based assessment of reward-related eating beyond satiety, and a monetary Delay Discounting Task to determine their delay discounting rate. Between-group differences were tested using Mann-Whitney U-tests, and associations between duration of amenorrhea and caloric intake at the Cookie Taste Test and delay discounting rate in the LWED group were examined using partial Spearman correlations adjusted for age and BMI as a marker for illness severity. Results: By study design, females with a LWED had a lower BMI (17.97±2.16 vs. 21.71±2.57 kg/m2, U=1,802.50, p&amp;lt;0.001, r=0.75) and more pronounced ED psychopathology (EDE Global Score: 2.38±2.50 vs. 0.00±0.00, U=22.50, p&amp;lt;0.001, r=0.83) than HC. They had missed 16.50±22.64 menses since menarche. When controlling for age and BMI, longer lifetime duration of amenorrhea was correlated with lower caloric intake in the Cookie Taste Test (rs=-0.34, p=0.011) and a smaller delay discounting rate indicating an increased delay of gratification (rs=-0.40, p=0.004). Conclusions: This is the first demonstration that lifetime duration of amenorrhea is associated with hedonic food intake and monetary decision-making in females with a LWED, pointing towards a potential role of cumulative estrogen status in reward processing and decision-making in this population. Future research avenues include investigating whether estrogen replacement can increase reward responsiveness and reduce delay of gratification to promote a faster recovery from a LWED. Presentation: 6/1/2024

8684 Lifetime Duration of Amenorrhea Is Associated With Monetary Decision-Making and Hedonic Eating In Females With a Low-Weight Eating Disorder

Abstract Disclosure: F. Plessow: None. M. Wronski: None. M. Rogers: None. M.G. Turley: None. E.R. Golden: None. M. Slattery: None. J.J. Thomas: None. E.A. Lawson: None. M. Misra: None. K.T. Eddy: None. Background: Low estrogen levels and oligomenorrhea are common characteristics in females with a low-weight eating disorder (LWED). In animal models, estrogen status is associated with neural activity in dopaminergic reward pathways affecting reward processing and decision-making. Whether a similar link exists in humans is unknown but important to understand, as reduced reward-driven behavior and an increased delay of gratification driving decision-making hinder recovery from a LWED. To fill this knowledge gap, we studied the relationship between lifetime duration of amenorrhea and hedonic eating and monetary decision-making in a group of females with a LWED. We hypothesized that longer lifetime duration of amenorrhea is associated with reduced hedonic food intake and a smaller delay discounting rate (indicating an increased delay of gratification) in females with a LWED (independent of age and illness severity). Methods: Fifty-six females with a LWED (mean age±SD: 19.84±2.98 years, range: 13.6-23.5 years) and 34 female healthy controls (HC; 19.08±2.41 years, 13.4-22.2 years) underwent a menstrual history to determine the number of missed menses since menarche, Eating Disorder Examination (EDE) to assess ED psychopathology, anthropometric measurements to calculate body mass index (BMI), Cookie Taste Test as a laboratory-based assessment of reward-related eating beyond satiety, and a monetary Delay Discounting Task to determine their delay discounting rate. Between-group differences were tested using Mann-Whitney U-tests, and associations between duration of amenorrhea and caloric intake at the Cookie Taste Test and delay discounting rate in the LWED group were examined using partial Spearman correlations adjusted for age and BMI as a marker for illness severity. Results: By study design, females with a LWED had a lower BMI (17.97±2.16 vs. 21.71±2.57 kg/m2, U=1,802.50, p&amp;lt;0.001, r=0.75) and more pronounced ED psychopathology (EDE Global Score: 2.38±2.50 vs. 0.00±0.00, U=22.50, p&amp;lt;0.001, r=0.83) than HC. They had missed 16.50±22.64 menses since menarche. When controlling for age and BMI, longer lifetime duration of amenorrhea was correlated with lower caloric intake in the Cookie Taste Test (rs=-0.34, p=0.011) and a smaller delay discounting rate indicating an increased delay of gratification (rs=-0.40, p=0.004). Conclusions: This is the first demonstration that lifetime duration of amenorrhea is associated with hedonic food intake and monetary decision-making in females with a LWED, pointing towards a potential role of cumulative estrogen status in reward processing and decision-making in this population. Future research avenues include investigating whether estrogen replacement can increase reward responsiveness and reduce delay of gratification to promote a faster recovery from a LWED. Presentation: 6/1/2024

Stress-induced eating in rural adolescents: Unique variability among boys and adolescents with obesity

Stress may contribute to the development of obesity through its effects on dysregulated eating, although this has not yet been examined among low-income, rural adolescents. We examined adolescents’ stress-induced changes in eating an ad libitum meal, and after, in the absence of hunger (EAH), and the extent to which these varied by sex, race, and weight status. Participants included 260 adolescents, drawn from a sample of rural households experiencing poverty. Adolescents completed two home visits while salivary cortisol was measured; during the control (low stress) visit, they completed questionnaires and procedures thought to elicit low levels of stress and had BMI assessed. During the stress visit, adolescents completed a 20-min set of psychosocial stress challenges before eating. At each visit, adolescents consumed an ad-libitum meal after which they were additionally given large portions of snacks (EAH task). Results revealed that indeed cortisol was higher during the stress visit, across the sample. Boys showed stress-induced increases during ad-libitum meal intake (for calories, fat, and carbohydrates) whereas girls exhibited decreased intake. Further, adolescents with obesity showed stress-induced increases in fat intake, but only when hunger was satiated (EAH). There were no differences by race. These findings provide the first evidence of stress-induced alterations in food intake in a rural, low-income sample of adolescents and point to a strong vulnerability for stress-induced increases in eating in rural boys as well as stress-induced increases in fat intake when satiated as a possible contributor to obesity in youth.

8075 Euglycemic Diabetic Ketoacidosis Associated With Cocaine Use

Abstract Disclosure: N.N. Solanki: None. A.N. Kiani: None. M. Feldman: None. Euglycemic diabetic ketoacidosis (EDKA) is characterized by increased anion gap metabolic acidosis, ketonemia or ketonuria, and normal blood glucose levels (&amp;lt;200 mg/dL). Due to the absence of hyperglycemia, it commonly presents as a diagnostic and therapeutic dilemma. EDKA is commonly associated with decreased caloric intake, sodium-glucose cotransporter-2 (SGLT-2) inhibitors, recent use of insulin, heavy alcohol consumption, chronic liver disease, glycogen storage disorders, and drug-induced intoxication. Cocaine use is a lesser-known etiology for EDKA. We present a case of a 64-year-old female with a history of type 2 diabetes mellitus who presented with complaints of decreased oral intake for two days secondary to nausea and vomiting and productive cough for one week, along with cocaine use. Despite an extensive history of diabetes and no recent SGLT-2 inhibitor use, her labs were consistent with euglycemic DKA. Her imaging and further investigations revealed respiratory syncytial virus pneumonia. The patient was initially managed for starvation ketoacidosis with fluid resuscitation with no improvement in acidosis and later treated with DKA protocol with rapid correction of her anion gap metabolic acidosis. This case highlights the challenges associated with diagnosing and treating EDKA. Early initiation of DKA protocol should be considered in diabetic patients presenting with euglycemia with high anion gap metabolic acidosis with a clinical picture of starvation and cocaine use. Presentation: 6/3/2024

9179 Type 2 Diabetes Alters Metabolic Fuel Selection During Intermittent Fasting

Abstract Disclosure: M.O. Conn: None. D.M. Marko: None. J.D. Schertzer: None. Type 2 Diabetes Alters Metabolic Fuel Selection During Intermittent Fasting Diabetes is characterized by elevated blood glucose resulting from defective insulin secretion and/or insulin resistance. Intermittent fasting, a popular weight loss strategy involving periodic reduction of caloric intake, can improve glycemia. Fasting shifts metabolism from carbohydrates to free fatty acids and ketones. However, high blood insulin can inhibit lipolysis and alter metabolic substrate selection in prediabetes, resulting in muscle catabolism to maintain energy homeostasis. Clinical studies have observed a significant decrease in muscle mass in subjects with obesity and diabetes. Our research aims to characterize lean mass versus fat loss after intermittent fasting in a mouse model of obesity and type 2 diabetes (T2D) and investigate the role of muscle alanine catabolism. We hypothesized that intermittent fasting would promote less lipolysis and more muscle alanine catabolism, causing more muscle loss in diabetic mice than controls. We compared male db/db mice manifesting obesity, hyperglycemia, and hyperinsulinemia to age-matched db/+ (control) mice. Our lab established a 5:2 repeated fasting protocol of ad-libitum access to food for 5 days a week and 2 days of fasting on non-consecutive days. Blood glucose was monitored weekly in fed and fasted states to assess glycemic control. While intermittent fasting lowered fasted blood glucose in both groups, no significant body weight or metabolic tissue mass changes were observed. Metabolic cage data demonstrated increased reliance on fat-based substrates for energy in control mice that underwent intermittent fasting during feeding and fasting periods. Diabetic mice did not show significant changes in the fasted state, but intermittent fasting led to increased reliance on carbohydrate oxidation during re-feeding periods, indicating impaired metabolic flexibility. After 10 weeks, the mice were sacrificed, and metabolic tissue histology (adipose, liver, skeletal muscle) will be performed. We will also analyze serum markers (alanine, fatty acids, glycerol, glucose, insulin) and the activity of the metabolic enzyme alanine transaminase (ALT) in the muscle and liver. This experiment will improve our understanding of how lipolysis and protein breakdown in muscle regulate lean mass versus fat mass loss in obesity and T2D, leading to more effective tailoring of fasting to specific populations. Presentation: 6/3/2024

Physical Activity before and After Bariatric Surgery.

Lifestyle changes including reduced calorie intake and increased physical activity (PA) improve the prognosis associated with bariatric surgery (BS) and metabolic indices. Early implementation of exercise leads to improved physical performance, better glycemic control and lipid profile, reduces the risks associated with anesthesia, and accelerates recovery from surgery. Undertaking systematic exercise after BS is associated with a better quality of life, improves insulin sensitivity, results in additional weight loss, reduces adverse effects on bone mass, and results in better body composition. The aim of this review was to summarize recommendations for physical activity in patients undergoing BS and to highlight the key role of physical activity in this patient group.