Calorie Reduction Research Articles

Evaluation of Calorie Content of an All-natural Cane Sugar and Botanical Extract Sweetener: Studies in Wistar Rats

The purpose of the study was to evaluate the caloric content and biochemical effects of an all-natural cane sugar/botanical extract sweetener in comparison to reference glucose in Wistar rats. A total of 24 male Wistar rats aged 6-7 weeks, weighing 148-188 grams, free from disease, and possessing a functional health status were chosen for the study. The animals were divided into four sets and allocated to different treatment groups using a randomized block design. For the study, the test and reference substances were administered orally at approximately one-hour intervals from Day 8 until the end of the treatment period. A greater than 50% reduction (58.7%) of liver adenosine triphosphate (ATP) levels (a proxy for caloric content) was observed for the test item (TI) treatment group compared to the reference glucose group. In the preliminary oral glucose tolerance test (OGTT), treatment with TI at a dose of 5.8 g/kg bodyweight considerably decreased the normal post-prandial rise in serum glucose levels. Other biochemical parameters such as cholesterol, triglycerides, LDL, and VLDL also decreased in the test item high dose group as compared to the normal control (NC). The current study confirms a significant reduction in calories (>50%) and blood glucose levels in Wistar rats when cane sugar is combined with a formulation of botanical extracts. Based on these results, we feel that all-natural TI has potential as a reduced-calorie, low glycemic index (GI) alternative to standard sucrose and can be a valuable dietary aid in the fight against the global obesity epidemic and its associated metabolic disorders.

Will college students take a stand? Effects of health orientations on purchase decision factors for standing desks

PurposeThis study aims to examine the impact of college students’ health and wellness orientations on the perceived importance of health benefits for an innovative new brand of standing desk, which is hypothesized to positively affect students’ attitudes and intentions. Research in this domain for the college student market is sparse.Design/methodology/approachAn online survey was conducted among business students at a large Midwestern US University, with class credit offered for completion. Of the 325 students given the opportunity to participate, 210 completed the survey.FindingsHealth motivation is positively related to calorie reduction importance, whereas wellness orientation is positively related to back health and cognitive enhancement. Calorie reduction and potential cognitive benefits significantly affect attitudes toward standing desks, which positively impact intentions to use, pay a school usage fee and buy the product.Research limitations/implicationsDifferent health orientation factors are associated with specific health benefits, providing greater insight into consumer attitudinal motivations for health-related products. Future research can further evaluate the generalizability of the results.Practical implicationsMarketers can tailor more effective communications based on underlying consumer motivations for health-related product benefits, resulting in better marketing outcomes.Social implicationsObesity is a growing societal issue, which could be ameliorated by improved daily behaviors, including the use of standing desks to assist in countering sedentarism.Originality/valueTo the best of the authors’ knowledge, neither academic research has yet examined standing desk purchase decision factors for the college student market, nor the effects of different health orientations on perceived health benefits.

Predictingobesity reduction after implementing warning labels in Mexico: Amodeling study.

In October 2019, Mexico approved a law to establish that nonalcoholic beverages and packaged foods that exceed a threshold for added calories, sugars, fats, trans fat, or sodium should have an "excess of" warning label. We aimed to estimate the expected reduction in the obesity prevalence and obesity costs in Mexico by introducing warning labels, over 5 years, among adults under 60 years of age. Baseline intakes of beverages and snacks were obtained from the 2016 Mexican National Health and Nutrition Survey. The expected impact of labels on caloric intake was obtained from an experimental study, with a 10.5% caloric reduction for beverages and 3.0% caloric reduction for snacks. The caloric reduction was introduced into a dynamic model to estimate weight change. The model output was then used to estimate the expected changes in the prevalence of obesity and overweight. To predict obesity costs, we used the Health Ministry report of the impact of overweight and obesity in Mexico 1999-2023. We estimated a mean caloric reduction of 36.8 kcal/day/person (23.2 kcal/day from beverages and 13.6 kcal/day from snacks). Five years after implementation, this caloric reduction could reduce 1.68 kg and 4.98 percentage points (pp) in obesity (14.7%, with respect to baseline), which translates into a reduction of 1.3 million cases of obesity and a reduction of US$1.8 billion in direct and indirect costs. Our estimate is based on experimental evidence derived from warning labels as proposed in Canada, which include a single label and less restrictive limits to sugar, sodium, and saturated fats. Our estimates depend on various assumptions, such as the transportability of effect estimates from the experimental study to the Mexican population and that other factors that could influence weight and food and beverage consumption remain unchanged. Our results will need to be corroborated by future observational studies through the analysis of changes in sales, consumption, and body weight. In this study, we estimated that warning labels may effectively reduce obesity and obesity-related costs. Mexico is following Chile, Peru, and Uruguay in implementing warning labels to processed foods, but other countries could benefit from this intervention.

Acceptability and Usability of the Mobile Digital Health App NoObesity for Families and Health Care Professionals: Protocol for a Feasibility Study.

BackgroundAlmost a quarter or more than a fifth of children in the United Kingdom are overweight or obese by the time they start school. The UK Department of Health and Social Care’s national policy for combating childhood obesity has critical outcomes centered on sugar and caloric consumption reduction. Health Education England has developed two digital apps for families with children up to 15 years and for their associated health care professionals to provide a digital learning resource and tool aimed at encouraging healthy lifestyles to prevent obesity.ObjectiveThis feasibility study assesses the usability and acceptability of Health Education England’s NoObesity app for undertaking activities to improve families’ diet and physical activity. The purpose of the study is to evaluate the app’s influence on self-efficacy and goal setting and to determine what can be learnt to improve its design for future studies, if there is evidence of adoption and sustainability.MethodsThe study population will include 20 to 40 families and their linked health care professionals. Considering issues related to digital access associated with socioeconomic status and the impact on information technology use, study recruitment will be regionally focused in a low socioeconomic status area. The study will last for 9 months (3-month intervention period and 6-month follow-up). The evaluations of feasibility, acceptability, and usability will be conducted using the following scales and theoretical frameworks: (1) system usability scale; (2) Reach Effectiveness Adoption Implementation Maintenance framework; (3) Bandura model of health promotion; and (4) Nonadoption, Abandonment, and Challenges to the Scale-up, Spread, and Suitability framework. App use will be captured and quantitatively analyzed for net use patterns (eg, number of screens viewed, number of logins, cumulative minutes using the app, number of plans made, and number of times goals met) and to triangulate qualitative feedback from study participants.ResultsThis study was funded in March 2019 by Health Education England and received University of Oxford Medical Sciences Interdivisional Research Ethics Committee approval on January 31, 2020 (R62092/RE001). At manuscript submission, study recruitment is pending, and expected results will be published in 2021.ConclusionsThis study will provide evidence on the NoObesity app’s influence on self-efficacy and goal-setting and determine what can be learnt to improve its design for future studies, if there is evidence of adoption and sustainability.International Registered Report Identifier (IRRID)PRR1-10.2196/18068

BDNF and orexin-A response to aerobic exercise are moderated by the meal consumption before exercise in overweight men: Effect of high-carbohydrate, high-protein and high-fat meals

Summary Purpose The response of orexin-A and brain-derived neurotrophic factor (BDNF) to exercise and diet are not fully understood. We examined the effect of acute aerobic exercise 2 h after the consumption of four meals on serum levels of orexin-A and BDNF in overweight men. Methods We used a quasi-experimental and single-blinded crossover study in 16 overweight men (age 23 ± 6.1 y) who voluntarily participated in four sessions separated by 7d, consisting of 30-min of treadmill running (60–70% of maximum heart rate) after consuming one of four selected meals: Normal (Normal), High carbohydrate (HCHO), High protein (HP) and High-fat (HF) meals. Blood samples were taken after fasting, two hours after meal consumption (before exercise), and after exercise test. Results The results indicated that orexin-A and BDNF levels significantly increased after acute exercise test following HCHO (18.24 ± 25.06% and 13.38 ± 4.93%, respectively, P 0.05), and HF meals (−0.43 ± 8.97% and −0.06 ± 4.01%, respectively, P > 0.05). When the four conditions were compared, between group comparisons demonstrated that orexin-A was significantly higher in HCHO (P ≤ 0.019) and HP meal (P ≤ 0.033) vs. HF meal after exercise. Further, BDNF was significantly higher after exercise in HCHO (P ≤ 0.001) and HP (P ≤ 0.001), and Normal (P ≤ 0.039) meals vs. HF meal. Conclusions It appears that the exercise-induced increase in orexin-A and BDNF following caloric reduction is attenuated by HF meals in overweight men.

Preparation and physicochemical properties of fiber-rich fraction from pineapple peels as a potential ingredient

Pineapple (Ananas comosus L. Merr.) peels as agricultural wastes represent around 35% of the whole fruit mass. By different preparation methods, the pineapple peel fiber was analyzed and evaluated for its composition and functional properties, which would provide a clue to its physiological function. The pineapple peel contained an appreciable amount of insoluble fiber-rich fraction (FRF) (41.8-48.0 g/100 g) including insoluble dietary fiber (IDF), alcohol-insoluble solids (AIS), and water-insoluble solids (WIS), which primarily consisted of cellulose, pectic substances and hemicellulose. These fractions also contained notable proportions of lignin (60.7-65.8 g/100 g). Compared with cellulose, these FRFs exhibited the greater water- and oil-holding capacities (7.94-12.3 mL/g and 5.84-8.64 g/g, respectively), swelling properties (10.6-18.4 mL/g), and cation-exchange capacities (102-120 mequiv/kg). The results indicate that the physicochemical properties of various fibers are dependent on the preparation method and composition. Every insoluble FRF studied possesses interesting characteristics, suggesting possible uses in the development of functional food ingredients for reduction of calories or dietary fiber enrichment.

A Call for a New Paradigm for Diabetes Care in the Era of Sodium–Glucose Cotransporter 2 Inhibitors (SGLT2i)

In 2013, canagliflozin was the first sodium–glucose cotransporter 2 inhibitor (SGLT2i) approved by the US Food and Drug Administration for the treatment of type 2 diabetes (T2DM). Today, there are four SGLT2i approved for T2DM, and some SGLT2i have been approved for indications beyond glucose control. For example, SGLT2i reduce major adverse clinical events (MACE) including nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death (canagliflozin); cardiovascular death (empagliflozin, dapagliflozin); diabetic kidney disease progression (canagliflozin); and heart failure hospitalization (canagliflozin, dapagliflozin). However, despite the potential benefits of SGLT2i in reducing adverse clinical events, providers underprescribe SGLT2i for eligible patients. Thus, we propose the CKD-PCP framework which allows multiple providers to utilize the benefits of SGLT2i. CKD-PCP has dual meaning: it applies to providers who most often care for patients with T2DM (Cardiologists, Kidney specialists, Diabetologists, and Primary Care Physicians) and it refers to the benefits of SGLT2i (treatment of Cardiovascular disease, Kidney disease, Diabetes, and reduction of blood Pressure, Calories, and Plasma volume). This article is based on previously conducted studies and the authors disclose their roles in relevant trials in the Acknowledgements.

Prompting consumers to make healthier food choices in hospitals: a cluster randomised controlled trial

BackgroundHospitals in the UK offer snacks for sale to patients, staff and visitors. Despite the NHS’s health promoting role, and tightening of regulations around which foods can be sold in hospitals, many snacks purchased in this setting are unhealthy. The present project tests the effectiveness of theory-based point of purchase prompts (PPPs; a form of cognitive nudge) designed to make it cognitively easier for consumers to compare available products and choose healthier options.MethodsHospital shops in Scotland (n = 30) were recruited into a cluster randomised controlled trial to test whether a PPP could reduce the average calorie, fat and/or sugar content of purchased snacks. Inclusion criteria stated that eligible sites; sold food; were located in a hospital; and were accessible to staff, patients and visitors. The PPP intervention was a theory-based sign (tailored to the available range in each location) designed to cognitively simplify healthier snack choices by facilitating cross-product comparison. Shops were randomised to display PPPs (intervention; n = 15) or not (control; n = 15) using block randomisation controlling for shop size. Data on all snacks purchased from participating shops were obtained from retailers for a 12-week baseline and 12-week follow-up period. Primary outcomes were the average calorie (kcals), fat(g) and sugar(g) content of snacks purchased each day. Secondary outcomes were the average customer spend per item purchased (£,p) and the total number of snacks purchased daily. Shop staff were not blinded to group assignment but data providers were. Data were analysed using mixed effects multi-level regression models.ResultsData from > 1 million snack purchases were analysed. Snacks purchased from intervention sites were on average significantly lower in calorie (γ = − 1.84, p < .001) and sugar (γ = − 0.18, p = .030) at follow up relative to baseline but only the reduction in calories was significantly different to control. Average spend per item also reduced significantly in intervention (but not control) sites (γ = − 0.89, p < .001). The intervention had no effect on the fat content of snacks or the number of snacks sold.ConclusionsSimple, theory-based point of purchase prompts can produce small but statistically significant reductions in the energy content of snack purchases from hospital shops.Trial registrationRetrospectively registered (8/Oct/2018) with ISRCTN (ID: ISRCTN90365793).

MRNA expression of ageing-associated genes in calorie reduction is subject to donor variability and can be induced by calorie restriction mimetics.

Finding ways to a healthier ageing are increasingly becoming the focus of geriatric research. One way to accomplish this could be calorie restriction, as this is known to positively influence the ageing of model organisms. The aim of this study was to investigate the influence of calorie reduction (F. X. Mayr therapy) and of the calorie restriction mimetics resveratrol and spermidine on the expression of ageing-associated genes. mRNA expression in peripheral blood mononuclear cells (PBMCs) of 18 participants taking part in an F. X. Mayr therapy was analysed. The PBMCs of one additional participant were treated ex vivo with spermidine or resveratrol. mRNA expression of SIRT1, SIRT3, FOXO3 and SOD2 was determined for these two calorie restriction mimetics. For the F. X. Mayr therapy samples, mRNA of XPA was analysed additionally. mRNA expression of the ageing-associated genes showed a distinct donor variation during F. X. Mayr therapy, with a significant increase in mRNA expression of SIRT1. Expression of XPA was similar to SIRT1, with a significant correlation at the last time point tested. Spermidine treatment of PBMCs resulted in a significantly increased expression of all genes tested, whereas resveratrol treatment caused a significant increase of SIRT3, FOXO3 and SOD2 mRNA expression. By increasing SIRT1 and XPA mRNA expression, calorie reduction in the form of F. X. Mayr therapy could contribute to a healthier ageing; however, the donor variability observed showed that not everyone benefited from this. Calorie restriction mimetics may be an option for promote healthier ageing for those who do not benefit from calorie reduction.

Potential prevention of diabetes and obesity by achieving macronutrient balance: a guide for diet and fast food

Protein is the most satiating macronutrient. Animal studies have indicated that there may be a discrete amount of protein that an individual seeks to consume each day. Given this to be true, a person will continue to eat until this amount of protein has been consumed. Once the target is met, hunger signals are switched off. By altering the proportion of protein in a diet, you can affect how many calories are required to meet this target. A diet with a protein content &gt;15% drives weight loss through the reduction of calories consumed to meet protein needs. We hypothesise that changing the proportion of calories from protein in a person’s diet from 12% to 20% could alter their total intake by 1000 kcal each day. This equates to a weight change of 0.9 kg each week. Maintaining a healthy weight is not as simple as changing a single variable. Eating habits in the UK are governed by a range of complex interdependent factors including hunger, emotions, cost, accessibility, education and culture. However, we suggest that by addressing satiety, and thereby hunger, we may remove a significant barrier for those trying to alter their diet for weight loss.

Health and Economic Impacts of the National Menu Calorie Labeling Law in the United States: A Microsimulation Study.

Excess caloric intake is linked to weight gain, obesity, and related diseases, including type 2 diabetes mellitus and cardiovascular disease (CVD). Obesity incidence is rising, with nearly 3 in 4 US adults being overweight or obese. In 2018, the US federal government finalized the implementation of mandatory labeling of calorie content on all menu items across major chain restaurants nationally as a strategy to support informed consumer choice, reduce caloric intake, and potentially encourage restaurant reformulations. Yet, the potential health and economic impacts of this policy remain unclear. We used a validated microsimulation model (CVD-PREDICT) to estimate reductions in CVD events, diabetes mellitus cases, gains in quality-adjusted life years, costs, and cost-effectiveness of the menu calorie labeling intervention, based on consumer responses alone, and further accounting for potential industry reformulation. The model incorporated nationally representative demographic and dietary data from National Health and Nutrition Examination Surveys 2009 to 2016; policy effects on consumer diets and body mass index-disease effects from published meta-analyses; and policy effects on industry reformulation, policy costs (policy administration, industry compliance, and reformulation), and health-related costs (formal and informal healthcare costs, productivity costs) from established sources or reasonable assumptions. We modeled change in calories to change in weight using an established dynamic weight-change model, assuming 50% of expected calorie reductions would translate to long-term reductions. Findings were evaluated over 5 years and a lifetime from healthcare and societal perspectives, with uncertainty incorporated in both 1-way and probabilistic sensitivity analyses. Between 2018 and 2023, implementation of the restaurant menu calorie labeling law was estimated, based on consumer response alone, to prevent 14 698 new CVD cases (including 1575 CVD deaths) and 21 522 new type 2 diabetes mellitus cases, gaining 8749 quality-adjusted life years. Over a lifetime, corresponding values were 135 781 new CVD cases (including 27 646 CVD deaths), 99 736 type 2 diabetes mellitus cases, and 367 450 quality-adjusted life years. Assuming modest restaurant item reformulation, both health and economic benefits were estimated to be about 2-fold larger than based on consumer response alone. The consumer response alone was estimated to be cost-saving by 2023, with net lifetime savings of $10.42B from a healthcare perspective and $12.71B from a societal perspective. Findings were robust in a range of sensitivity analyses. Our national model suggests that the full implementation of the US calorie menu labeling law will generate significant health gains and healthcare and societal cost-savings. Industry responses to modestly reformulate menu items would provide even larger additional benefits.

726-P: Mediterranean Diet Adherence and Association with Cardiometabolic Risk after Behavioral Weight Intervention in Older Adults

Adherence to a Mediterranean (Med) diet pattern, characterized by increased intake of fruits, nuts/seeds, vegetables, legumes, whole grains, seafood, yogurt and vegetables, and decreased intake of red/processed meats, refined grains, starches and added sugars, is associated with reduced cardiometabolic risk independent of total calorie intake or single nutrients. We examined whether adherence to Med diet was associated with risk factor change in the context of a behavioral weight management trial for U.S. community-dwelling older adults at elevated diabetes and cardiovascular risk. The Pitt Retiree Study (n=322) examined the impact of 12 weekly group lifestyle sessions on weight and cardiometabolic risk (BMI, waist, glucose, lipids, and blood pressure) in older adults (age 65-80 yrs). Dietary goals included calorie reduction, &amp;lt;30% of total calories from fat, lean protein at most meals, and following USDA MyPlate guidelines but not a Med diet. Adherence to a Med diet pattern (0-14 score) was assessed at baseline, 4, 12, and 24 months and categorized as low (0-5), moderate (6-9), or high (≥10). The baseline median Med diet score was 6 (range 0-13), with 45% categorized as low, 50% moderate, 5% high. Women were more adherent than men (p&amp;lt;0.01). Adjusting for sex, higher scores were correlated with older age (p=0.02), lower baseline BMI (p=0.01) and smaller waist (p=0.01). Median [IQR] scores improved at 4 months (+1 [0, +2] p&amp;lt;.001) with 27% low, 63% moderate, 10% high. Each 1-unit Med diet increase was associated with -0.1 kg/m2 BMI (SE=0.04, p=.006) and -1.0 mmHg Systolic BP (SE=0.47, p=0.03) at 4 months. Med diet improvement was maintained at 12 (+1, [0, +2] p&amp;lt;.001) and 24 months (n=299, +1 [0, +2] p&amp;lt;.001). Adherence to a food pattern consistent with a Med diet improves after lifestyle intervention, even when not specifically prescribed, and is associated with weight and blood pressure benefits. Importantly, older adults sustain change in dietary quality over 2 years. Disclosure R.G. Miller: None. E.M. Venditti: None. M.D. Marcus: None. L.J. Germeroth: None. R.P.K. Conlon: None. M.D. Levine: None. T. Costacou: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R18DK096404)

Cost-Effectiveness of the FDA Menu Labeling to Reduce Obesity-Associated Cancer Burden in the United States

Abstract Objectives The FDA menu labeling policy requires chain restaurants with ≥20 outlets to list total calories on menus or menu boards. While obesity is a known risk factor for 13 cancers, the potential impact of this policy on cancer burdens and healthcare costs in the US is unknown. Methods Using a probabilistic cohort state-transition model, we estimated the health impacts, costs, and cost-effectiveness of the FDA menu labeling policy on reducing calorie intake, subsequent weight change, and obesity-related cancer cases among US adults over a lifetime. Baseline demographics and calorie intake from restaurants were estimated using NHANES 2013–2016. Based on published meta-analyses, we assumed that labeling would reduce calorie intake per meal by 7.3%, evaluated with and without an additional 5% reduction through industry reformulations; and assumed only half of these calorie reductions would be sustained by individuals throughout their day (i.e., to account for potential calorie compensation outside restaurants). Changes in BMI were derived from published energy models (0.45 kg lower long-term weight per 55 kcal/d calorie reduction). National cancer rates and healthcare costs were obtained from published sources. Uncertainties of inputs were incorporated in probabilistic sensitivity analyses using 1000 simulations. Results The FDA menu labeling policy was estimated to prevent 31,300 (95% UI: 27,600–35,500) new cancer cases and 18,700 (16,400–21,300) cancer deaths, gaining 134,000 (117,000–153,000) quality-adjusted life years (QALYs) among US adults over a lifetime. Top three cancers prevented were endometrial, post-menopausal breast, and kidney. Accounting for policy implementation and healthcare costs, the policy was net cost saving at $1.74B ($1.55–$1.95B) and $1.76B ($1.46–$2.09B) from healthcare and societal perspectives, respectively. A modest industry response (5% calorie reduction) would prevent a total of 51,800 new cancer cases (47,900–56,400) and 30,900 cancer deaths (28,600–34,000) and increase net savings to $2.87B ($2.68–$3.12B) and $3.19B ($2.86–$3.54B), respectively. Conclusions Our model suggests implementation of the FDA menu calorie labeling policy would substantially reduce incident cancers and deaths and be cost-saving, with even larger effects if accompanied by modest industry reformulation. Funding Sources NIH/NIMHD.

Quality of Diet and Cardio-Metabolic Outcomes in Native American Adolescents Participating in the Together on Diabetes Home-Visiting Program

Abstract Objectives 1) Examine the impact of the Together on Diabetes (TOD) program on diet quality using the Alternative Healthy Eating Index (AHEI); 2) Determine the association of diet quality with outcomes of cardio-metabolic health (systolic and diastolic blood pressure, hemoglobin A1c, and zBMI). Methods TOD was a 12-month home-visiting diabetes prevention/management program, evaluated using a pre/post study design, conducted in four rural, reservation-based Native American communities in the southwestern United States. Participants were 10 to 19 years of age and were identified as pre-diabetic, T2DM or “at risk” based on body mass index (zBMI) and a qualifying laboratory test. Diet information was collected via an adapted Block food-frequency questionnaire (FFQ). Diet quality was calculated using the AHEI, broken into quartiles based on distribution of the sample. Changes in AHEI-score and associations with cardio-metabolic measures were tested, over time, using adjusted linear mixed effects models. Results The majority of the sample (n = 240) completed the FFQ at baseline and reported an average energy intake of 2016.18 Kcal/day (±1260.45) and AHEI-score (Range: 0–110, higher = better diet quality) of 47.37 (±7.36), indicating low diet quality. At 12 months follow-up, there was a reduction in calories (m = –345.75 Kcal/day (P &amp;lt; 0.001)), sugar-sweetened beverages (SSB) (m = –2 fluid ounces/day (P = 0.032)), red-processed meat (m = –1.5 ounces/day (P = 0.008)), and sodium (m = –650.37 mg/day (P &amp;lt; 0.001)) but no change in overall AHEI-score (p-value = 0.600). At baseline, the HbA1c of diabetic participants with the highest quartile AHEI-score was significantly lower (m = –1.43% (p-value = 0.048)) than those with the lowest quartile score. At 12-months the systolic blood pressure of participants with the highest quartile AHEI-score was significantly lower (m = –5.71 mm Hg (p-value = 0.038)) than those with the lowest quartile score. Conclusions Despite stable AHEI-scores during follow-up, there were improvements in diet quality domains most likely to be associated with poor cardio-metabolic health (e.g., overall calories, SSB consumption, and sodium intake). Home-visiting programs, like TOD, are promising interventions for decreasing dietary intake of poor quality foods. Funding Sources The Bristol Meyers Squibb Foundation funded the TOD Program.

Effects of Varying Avocado Intake on Energy and Nutrient Intake of Hispanic Families: A Cluster Randomized Trial

Abstract Objectives Avocados are nutrient-dense and could be a favorable component of a healthy dietary pattern, yet there are limited data on the effects of avocado intake on nutritional status. To test if avocados impact energy intake, we examined the effects of two levels of avocado intake, plus a standard nutrition education intervention, on energy and nutrient intake in families of Hispanic Heritage. Methods Between April 2017 and June 2018, we conducted a cluster randomized controlled trial in families consisting of at least 3 members residing in the same home, at least 5 years of age, free of severe chronic disease, not on specific diets, and self-identified of Hispanic heritage. Seventy-two (n = 72) families were randomized to one of two groups: nutrition education with low avocado allotment (3 avocados/family/week) or nutrition education with high avocado allotment (14 avocados/family/week). Community health workers (i.e., Promotoras) led 12 bi-weekly in-home nutrition education sessions per family and delivered weekly avocado allotments. Dietary patterning, energy and nutrient intake were measured at baseline, and after 3- and 6-months. The primary outcome was change in a family's total energy intake after 6 months. Secondary outcome measures included differences in macro- and micronutrients between groups. Results Over the 6-month follow-up period, the mean difference in energy intake for the high versus low avocado intervention group was −1884 kcals/family/day (95% CI −3205 to −563 kcals, P &amp;lt; 0.01). The high avocado intake group also had significant reductions in carbohydrate, animal and vegetable protein saturated and polyunsaturated fat calcium, magnesium, sodium, potassium, iron, and vitamin D intakes (P &amp;lt; 0.05 for all). There were no significant changes in MUFA or dietary fiber intakes. Conclusions In families of Hispanic heritage, an intervention including nutrition education combined with 14 avocados/week, compared to 3 avocados per week, resulted in a significant reduction in calories and select macro- and micronutrients. This trial suggests interventions with specific plant foods, but without specific counseling on energy restriction, may lead to reductions in total energy intake. Future studies should investigate the effects of avocado intake in other populations. Funding Sources Hass Avocado Board.

A Nutrient-Dense Supplement Shake Improves Weight Loss and Metabolic Markers in Overweight Individuals: A Multicenter, Randomized, Double Blind, Placebo-Controlled Trial

Abstract Objectives To determine if greater weight loss and improvement in metabolic outcomes could be achieved with twice daily consumption of a proprietary supplement shake containing high protein and fiber (HPF) as compared to an isocaloric low protein, lower fiber placebo (P). Methods In an independently conducted randomized, double-blind, placebo-controlled, multi-center clinical trial, healthy overweight and obese adults (n = 206, BMI 27–35 kg/m2, 70% Female) were equally assigned to HPF or P. All participants were instructed to follow a 500-calorie deficit diet from estimated daily energy requirements using a dietary exchange program and were asked to consume HPF or P 30 min before breakfast and lunch for 12 weeks. The supplement was a commercially available product composed of protein, fruit, vegetable, and plant powders, as well as vitamins, minerals, pre-, and probiotics. Body weight, body composition, and blood samples were collected at days (D) 0 and 84. Statistics were conducted by ANCOVA or repeated measure ANCOVA modeling using sex and baseline values as covariates, with time and treatment as within- and between-subject variables, respectively. Per protocol analyses were included for the 133 adults who completed the study. Results Weight loss occurred throughout the study in both groups. HPF had greater weight loss at D 84 vs P (–4.0% vs −2.2% body weight, respectively; P &amp;lt; 0.05). Total cholesterol, LDL, and oxidized LDL decreased to a greater extent following HPF at D 84 (P &amp;lt; 0.05 vs D 0 and vs P), with no change in HDL cholesterol. The increase in serum adiponectin from D 0 to D 84 was greater in HPF vs P (P &amp;lt; 0.05) with no change in leptin. Percent body fat tended to decrease throughout the study in both groups (HPF: −1.44%, P: −1.27%; P = 0.056) with no differences between groups. There were no clinically relevant changes in assessed safety outcomes in either group. Conclusions A HPF supplement taken as a preload before breakfast and lunch improved weight loss and metabolic outcomes such as total, LDL and oxidized LDL cholesterol compared to a calorie-matched placebo. This study suggests nutrient factors other than calorie reduction alone influence the success of a weight loss regimen, potentially including nutrient density, protein and fiber content. This trial was registered at clinicaltrials.gov as NCT03057873. Funding Sources This study was funded by Beachbody, LLC.

Ultra-Processed Food Consumption and Obesity Among US Children

Abstract Objectives With the rise in production and consumption of ultra-processed foods (UPF), children in the US consume a significant amount of total daily calories from UPF. High UPF consumption can contribute to obesity among US children through excessive calorie intake from UPF.1 We aimed to estimate the potential impact of reducing UPF consumption on childhood obesity in the US. Methods We modelled a nationally representative cohort of 5804 US children ages 7–18 years with weight, height, body mass index (BMI) percentile, and UPF consumption estimated from the National Health and Nutrition Examination Survey (NHANES) 2013–2016. From the reported difference in ad libitum calorie intake between individuals consuming a UPF vs. non-UPF diet in a randomized controlled trial, we estimated that children reduce their proportion of calories from UPF by 17% when switching to a non-UPF diet. Under this assumption, we projected weight loss based on estimated weight reduction due to calorie reduction in children accounting for potential changes in energy expenditure and appetite.2 We compared the current and modelled BMI distribution and prevalence of overweight and obesity by age (7–11 and 12–18 years) and sex (boys and girls). NHANES survey weights were used to estimate the mean BMI and prevalence of overweight and obesity among US children. Uncertainty of model inputs were incorporated using probabilistic sensitivity analysis with 1000 simulations. Results Under this scenario, the median (95% UI) of weight-adjusted BMI among US children ages 7–18 years old was 20.2 kg/m2 (19.7, 20.8), corresponding to a −1.74 kg/m2 (–2.67, −0.67) reduction in BMI. The median (95% UI) prevalence of overweight (BMI percentile ≥85th) and obesity (BMI percentile ≥95th percentile) was reduced from 37.2% (36.1%, 38.3%) to 23.3% (17.8%, 31.4%) and from 20.2% (19.3%, 21.1%) to 12.3% (9.3%,16.9%), respectively. Adolescent boys (–1.87 kg/m2: −2.42, −1.32) experienced the largest reduction in BMI, followed by adolescent girls (–1.73 kg/m2: −2.24, −1.22), boys ages 7–11 years (–1.66 kg/m2: −2.15, −1.17), and girls ages 7–11 years (–1.62 kg/m2: −2.10, - 1.15). Conclusions Reducing current levels of UPF consumption among US children has the potential to reduce the childhood obesity rate in the US to a great extent, especially among adolescents. Funding Sources NIH/NIMHD.

Efficacy of a Short-Term Low-Calorie Diet in Overweight and Obese Patients with Chronic Sciatica: A Randomized Controlled Trial

Objectives: Chronic sciatica is a common condition. According to Traditional Persian Medicine and recent studies, calorie reduction is thought to be helpful for this condition. The purpose of this work is to evaluate a short-term low-calorie diet (LCD) for ameliorating chronic sciatica in the context of pain relief and reduced disability for patients. Design: In this randomized controlled trial, 96 candidates for the nonsurgical treatment of chronic sciatica were randomly assigned to two groups to receive a 1-month LCD (intervention) or ordinary diet (control), both in combination with nonsteroidal anti-inflammatory drugs (NSAIDs). Afterward, patients were visited at baseline and on days 15, 30, and 60 after treatment. Pain and disability were evaluated using the short-form McGill pain questionnaire (SFMPQ) and the Roland-Morris disability questionnaire (RMDQ), respectively. Results: Both mean RMDQ scores and SFMPQ scores decreased significantly in the LCD group compared to the control group. SFMPQ descriptor scale scores at baseline and on days 15, 30, and 60 in the LCD group were 7.71 ± 1.69, 6.63 ± 1.61, 5.54 ± 1.87, and 4.96 ± 2.02, respectively, and in the control group were 6.63 ± 1.44, 6.69 ± 1.32, 6.64 ± 1.98, and 6.62 ± 2.53, respectively (p = 0.001). RMDQ scores at baseline and on days 15, 30, and 60 in LCD group were 11.17 ± 3.90, 8.60 ± 1.97, 7.50 ± 2.71, and 6.77 ± 3.06, respectively, and in the control group, 10.00 ± 2.20, 9.98 ± 2.29, 9.94 ± 2.94, and 9.85 ± 3.32, respectively (p < 0.001). Conclusion: A short-term (1-month) LCD is effective in decreasing pain and disability in candidates for nonsurgical treatment of chronic sciatica.

MON-LB106 The Effect of the Ketogenic Diet on Aldosterone Over 6 Weeks

Introduction: A ketogenic diet improves type 2 diabetes, metabolic syndrome, and cardiovascular disease. Weight loss studies using caloric reduction have demonstrated a decrease in aldosterone, but there is limited data on the effect of a ketogenic diet on aldosterone. Thus, we evaluated the impact of a ketogenic diet on aldosterone in overweight or obese individuals over 6 weeks. Methods: This 3-arm prospective controlled feeding study evaluated aldosterone and renin concentrations over 6 weeks on a hypocaloric (25% energy restricted) ketogenic diet + placebo (KD+PL), ketogenic diet + ketone salt supplement (KD+KS), and a low-fat diet (LFD). Sodium intake consisted of 6100 mg, 2300 mg, and 2000 mg for the KD+KS, KD+PL, and LFD groups, respectively. Both ketogenic diets provided 40 grams(g) day of carbohydrates, 1.5 g/kg reference weight of protein and remaining calories provided as fat. The LFD provided 25% total fat, 1.5 g/kg reference weight of protein, and 100g of carbohydrates. Serum aldosterone was drawn fasting in upright position at 0, 2, 4, and 6 weeks. Scatter plots were used to explore the residual and predicted associations between aldosterone with other measures after accounting for time and group effect.Results: Twenty-four participants in the ketogenic diet groups were matched for age and body mass index, then randomized to either the KD+PL or KD+KS group. A separate group of 12 matched participants were specifically recruited for the LFD group. The median age was 33 years. Weight decreased 6, 8, and 7 kg on average in the KD+KS, KD+PL, and LFD groups, respectively, over 6 weeks (p<0.05 for all). Systolic blood pressure (SBP) improved from 117 and 115 mmHg in the KD+KS and KD+PL groups to 110 mmHg over 6 weeks while the baseline mean SBP 118 in the LF group did not change. Baseline mean aldosterone of 13.6 and 13.6 ng/dL in the KD+KS and KD+PL groups increased to 33.3 and 27.3 ng/dL over 6 weeks (p<0.001). Baseline mean aldosterone of 8 ng/dL in the LF group non-significantly changed to 11.5 ng/dL over 6 weeks (p>0.05). Using predicted value associations, increases in ketones were positively associated with higher aldosterone (R2=0.86; p<0.001). Conclusion: Participants on a ketogenic diet had significantly elevated aldosterone levels throughout the study while participants on low fat diet had little change. Unexpectedly, aldosterone was significantly higher in the high sodium vs. low sodium ketogenic diet. There was a significant association between ketones and aldosterone suggesting that ketones may play a stimulatory role on aldosterone synthesis or secretion.

The Impact of Information Disclosure on Consumer Behavior: Evidence from a Randomized Field Experiment of Calorie Labels on Restaurant Menus

AbstractIn 2018, the U.S. adopted a nationwide law requiring that chain restaurants post calorie counts on their menus and menu boards. This has led to considerable interest in the extent to which providing calorie information leads consumers to choose healthier diets.To estimate the impact of calorie labeling, we conducted a randomized controlled field experiment in two full‐service restaurants, in which the control group received menus without calorie counts and the treatment group received the same menus but with calorie counts. We estimate that the calorie labels resulted in a 3.0 percent reduction in calories ordered, with the reduction occurring in appetizers and entrées but not drinks or desserts. Exposure to the information also increased consumers’ support for requiring calorie labels by 9.6 percent. These results are informative about the impact of the new nationwide menu label requirement, and more generally contribute to the literature on the impact of information disclosure on consumer behavior.